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The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists (consultants and staff grade, associate specialist and specialty doctors) in a UK health and well-being Trust.

This was completed through an online survey, developed by the authors, of all career grade and trainee psychiatrists within the Trust.

Only 9 per cent of respondents reported that they felt they had adequate training to feel competent as an expert witness. Despite low levels of training and confidence, 73 per cent of respondents had written an expert report. As well as shortage of training opportunities for psychiatrics acting as expert witnesses, the findings indicated increasing fear of litigation and lack of direct experience of court proceedings during training.

Doctors need to be offered formal training opportunities including simulated training, ideally organised within Trust, Continuing Professional Development (CPD) committees or Education committees. Implementation of the RCPsych report guidance into speciality curricula and CPD opportunities for doctors would ensure a robust curriculum-based delivery of these essential skills.

A wealth of guidance is available for expert witnesses, but no previous study had identified the specific training issues and overall confidence in competency to act as an expert witness amongst psychiatrists. It will be valuable to all psychiatrists involved in court work and organisations involved in training psychiatrists, especially in light of recent relevant court cases and removal of expert witness immunity.

The purpose of this paper is to investigate perceptions towards a career in psychiatry among medical students and psychiatrists and identify how recruitment into the specialty may be improved.

This study locally compares medical student and psychiatric doctor responses to a structured online survey and structured interviews with key managerial figures in the Humber NHS Foundation Trust.

Comparison across two main areas (pre-decision exposure to psychiatry and reasons for considering a psychiatric career) found that both students and doctors were influenced to make a choice about a career in psychiatry during medical school. Medical students found compatibility with family life to be more important when considering psychiatry, whereas doctors cited content-based reasons as significant pull factors. Stigma and fear of being harmed deterred some students from choosing a career in psychiatry. Structured interview responses reiterated the importance of pre-medical school and undergraduate mentorship in bolstering future recruitment to psychiatry.

Medical students perceive certain career issues differently to their postgraduate counterparts. Widening the content-based appeal of psychiatry and optimising the medical school experience of the specialty via varied and high-quality placements may be a key step towards tackling the national shortfall in qualified psychiatrists.

This is the first published study comparing medical student and psychiatric doctor perceptions of a career in psychiatry.

Psychiatric recruitment and retention are at an unprecedented low within the UK. The reasons for this shortfall may include public and professional stigma, recent NHS service developments and changes in undergraduate training. The purpose of this study is to explore medical student’s perceptions of the nature and magnitude of these factors on influencing whether or not they would choose a career in psychiatry.

This qualitative study was conducted with year four medical students at a single UK University with low levels of recruitment into psychiatry. Two focus groups were asked about their undergraduate experience within the speciality. Thematic analysis of the resulting transcripts enabled the identification of codes and over-arching themes, which formed the focus of this study.

Four key themes were identified during analysis and these included: the core subject matter (of psychiatry) viewed as being different; curriculum or course variables; interpersonal factors and; career factors. Placement enjoyment, positive role-modelling and enthusiasm were all important when considering psychiatry as a career. Therapeutic success, career flexibility and pay-banding were also powerful determinants.

These findings led to the initiation of an apprentice programme for undergraduates on psychiatric placement, designed to enhance the student experience of psychiatry and the perception of the speciality as a career.

While there are a number of possible solutions to current adverse national trends in psychiatric recruitment, increasing efforts to increase both the variety and quality of undergraduate placements and establishing a clearer sense of team identity is of vital importance if these patterns are to be reversed.

As a site of contestation among job seekers, workers, and managers, the bureaucratic workplace both reproduces and erodes occupational race segregation and racial status hierarchies. Much sociological research has examined the reproduction of racial inequality at work; however, little research has examined how desegregationist forces, including civil rights movement values, enter and permeate bureaucratic workplaces into the broader polity. Our purpose in this chapter is to introduce and typologize what we refer to as “occupational activism,” defined as socially transformative individual and collective action that is conducted and realized through an occupational role or occupational community. We empirically induce and present a typology from our study of the half-century-long, post-mobilization occupational careers of over 60 veterans of the nonviolent Nashville civil rights movement of the early 1960s. The fourfold typology of occupational activism is framed in the “new” sociology of work, which emphasizes the role of worker agency and activism in determining worker life chances, and in the “varieties of activism” perspective, which treats the typology as a coherent regime of activist roles in the dialogical diffusion of civil rights movement values into, within, and out of workplaces. We conclude with a research agenda on how bureaucratic workplaces nurture and stymie occupational activism as a racially desegregationist force at work and in the broader polity.

People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID.

An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed.

Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone.

The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias.

UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group.

This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID.

To determine the extent to which psychiatrists of different grades complied with published recommendations regarding referral for psychological treatment of patients suffering from depression.

Clinic letters regarding patients with depression were audited to see whether patients were referred for psychological treatment and, if not, whether a reason was recorded. The results were presented and the audit repeated.

There was little difference in the results of the two audits. Overall, 51 per cent of depressed patients were referred for psychological treatment and 26 per cent were not referred without a reason being given. SHOs were significantly (p=0.008) more likely than other grades not to refer without giving a reason.

SHOs should be encouraged to consider psychological treatment for depression and to record their reasons when not making a referral for this.

This audit has identified a probable reluctance of SHOs to consider referral for psychological treatment and hence suggests that this issue should be specifically addressed as a supervision and training issue.

Whilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change.

This evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions.

Four themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed.

This paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously.