How to Get Into: Adult and Old Age Psychiatry ST4

Courses & Conferences to Attend

It is not essential to attend any courses or conferences to improve your chances of success, and you should be wary of any that are advertised on this basis. Selection for Core Psychiatry Training is based solely on your MSRA score, and attending conferences won’t score you points in your higher training application unless you’re also presenting something.

That said, don’t be put off attending courses that you’re interested in; it’s not all about points, and you might be surprised by the serendipitous opportunities that arise from these events. I attended the IoPPN Summer School largely to demonstrate my commitment to the specialty (back when this still mattered), but I found it an enjoyable, stimulating, and varied course. After a talk, I approached a Professor who later introduced me to several research projects. I’d highly recommend it.

How to Maximise Your Portfolio

It’s a real shame, in my opinion, that your portfolio does not count at all for a Core Psychiatry application. It also has relatively little influence on your ST4 application, accounting for less of your score (17.5%) than a 12-minute online interview (32.5%) or the results of your CASC, a membership examination (50%).

Despite the relatively small weighting of your portfolio score in higher training applications, you should not neglect it entirely; most applicants will have very similar scores in a narrow bell curve, and especially as Psychiatry gets more competitive, tiny margins might still be decisive. The domains for your portfolio include undergraduate and postgraduate degrees and prizes; additional qualifications; experience in another specialty; clinical governance, audit, and QI; research; teaching; academic publications; and presentations. Scoring is essentially based on the most impressive thing you have done in each domain; quantity counts for naught! My advice would be to keep these categories in mind and to try to do at least something for each of them, logging and retaining evidence as you go. Bear in mind that you cannot use the same achievement to score in two domains (e.g, a prize won for a poster presentation).

Making the Most of Your Day Job

Being a junior doctor is hard; you should first focus on learning your core job, completing your basic portfolio requirements, and maintaining your well-being. This might sound trite, but I have found it comforting at times to remember that being a “good enough” doctor is good enough.

If you are ready to stretch yourself, then look out for supportive seniors and ask them if there’s anything you can get involved with. Having a mentor, or several, can be extremely valuable in your early career. Follow your interests and avoid just ticking boxes; you will be surprised at what you can achieve. Conversely, even a simple project can make you miserable if you’re just not interested.

Unless you’re exceptionally motivated, I think that it’s difficult to conceive and complete your own audit or Quality Improvement project in a 4-to-6-month job. I couldn’t manage it, anyway. It is far more feasible to work together with other trainees, to do a re-audit, or join something in process. I’d recommend that you ask your Consultant for advice. They have the benefit of having worked in the same service for a while and will likely have ideas.

Making the Most of Adult and Old Age Psychiatry ST4 Placements

Even if you’re already interested in Psychiatry, don’t be disheartened if you don’t love it. It is an unfortunate quirk of our system that foundation and CT1 doctors usually get chucked into some of the most high-pressure jobs, like general adult inpatient units. There are a different set of challenges to general medical wards, which can make the experience jarring. For one thing, it is harder to do medicine (or even do a simple blood test) without the surrounding infrastructure of a hospital. They can be stressful environments with some of the most unwell patients. And you can spend so much time on administrative tasks, as well as attending to the physical health of patients, that there isn’t much time for Psychiatry.

For a sense of what the real job is like, take the opportunity to talk to your seniors – find a variety of them if possible. Could you see yourself in their shoes?

What About Non-Adult and Old Age Psychiatry ST4 Placements?

Throw yourself into whatever you are working on. This might be the last time you get experience in other specialties, and you will be surprised at how much you draw on it years down the line!

Top 3 Tips for Getting Into Adult and Old Age Psychiatry ST4

Managing Emotional Demands and Burnout in Psychiatry
Psychiatry is a specialty that can be quiet until it’s not, and we can find ourselves ‘under fire’ emotionally. If you are the sort of person that can be deeply affected by the emotions of your patients, you might be a great Psychiatrist, but also at risk of burnout. We are lucky in Psychiatry to have dedicated reflective spaces like supervision and Balint groups. Use them.
Learn Psychiatry From Life, Not Just Textbooks
A fantastic thing about Psychiatry is that you can draw on pretty much anything that you have learned about what it is to be human, whether or not you learned it in medical school. So read widely; watch films; read books; go to galleries; talk to friends! It all helps.
Being ‘Good Enough’ Really Is Enough
Remember: being “good enough” is good enough. (And if you’re interested in Psychiatry, consider reading more about Donald Winnicott, who first popularised this concept.)