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Taking on the management: training specialist registrars in child and adolescent psychiatry

Taking on the management: training specialist registrars in child and adolescent psychiatry Hewson et al Training specialist registrars in child and adolescent psychiatry education & training Psychiatric Bulletin (2006), 30,71^74 LESL EY HEW S ON, S USIE HO OPER AND ANNE WORR ALL - DAVIE S Taking on the management: training specialist registrars in child and adolescent psychiatry The proposal that management training should be integral Need for leadership to the training of all doctors, including psychiatrists, is not The NHS Plan (Department of Health, 2000) stresses the new (Gadd, 1990). The Child and Adolescent Psychiatry need to develop leadership within all professions if Specialist Advisory Sub-Committee (CAPSAC) training modernisation and the redesign of services are to be guidelines (1999) recognise that future consultants will achieved. Clinical governance (Department of Health, need sufficient management skills to be leaders in service 1998) and the drive to improve the quality of health development as well as effective clinicians, and outline services are dependent on effective working between the knowledge and experience to be gained during higher clinicians and managers. professional training (Box 1). This paper describes the Although management as a component of training Yorkshire scheme’s approach to supporting trainees to for specialist registrars is well recognised, new consul- achieve these objectives and highlights the need to engage tants consistently report that this is the area of their trainees, trainers and managers in taking forward this work for which they feel most unprepared (Houghton important agenda. et al, 2002). Where new consultants have gained management experience during their training, this was seen as helpful, but generally a result of the actions of individual consultants rather than a planned component of training. A survey of the training experiences and attitudes of Box 1. Learning objectives in management, audit and information technology proposed by the higher specialist trainees in child and adolescent Child and Adolescent Psychiatry Specialist Advisory psychiatry (Smart & Cottrell, 2000) found that 17% were Sub-Committee unlikely to have the opportunity to shadow a manager during their training and 13% would not be involved in the . Understanding of relevant organisational structures and processes relevant to delivery ofa CAMHS (e.g. within the planning of services. The majority of trainees, however, NHS, other agencies, delivery of postgraduate and under- recognised management training as essential. graduate training, GMC, Royal College of Psychiatrists) The Yorkshire Child and Adolescent Psychiatry Higher . Understanding of service planning, effective use of Training Scheme has worked over the last 7 years with all resources, ability to generate short- and long-term specialist registrars and scheme trainers to ensure that strategy and relate to day-to-day activities management knowledge and experience becomes an . Use of information to inform service development and audit integral and routine aspect of training. . Understand principles of clinical governance, risk management and accountability . Familiarity with recruitment, equal opportunities and Starting point appraisal and the need for continuing professional development for all professionals in the multidisciplinary In 1998 the training committee sent out a questionnaire team to the 17 trainers and 14 trainees on the Yorkshire Child . Development of team leadership skills and effective and Adolescent Psychiatry Scheme. This aimed to identify working with other professionals attitudes towards management training, the availability of . An ability to maintain appropriate clinical records and communicate effectively with other professionals management experiences on the scheme and to identify . Effective self-management: time management, development needs. The questionnaire was completed self-presentation, ethical awareness and use of initiative and returned by all trainers and trainees. CAMHS, Child and adolescent mental health service; Trainees appeared keen to gain understanding of the GMC, General Medical Council relevance of management to their future clinical practice and for management to become more meaningful and 71 Hewson et al Training specialist registrars in child and adolescent psychiatry included in their training. They were asking for improved Box 3. Key components of generic management understanding of the day-to-day running of children’s courses education & mental health services, including structures, business . Management and leadership training planning, finance and how and where decisions are made. . Mentoring, appraisal, interview skills Future survival as a consultant on a day-to-day basis was . Effective team-working a major concern. . Managing change The consultant trainers unanimously endorsed the . Time management . Preventing and managing stress proposal that management should be included in trainees’ . Negotiating skills training plans but appeared unsure of their own contri- . Managing meetings. bution. Many thought that they would have little to offer a trainee, not viewing themselves as undertaking management tasks or having expertise to share. Even However, the survey and workshop identified key those trainers with formal management roles were not areas likely to require a more systematic approach to used to routinely engaging trainees in this aspect of their management training for trainees in child and adolescent work. psychiatry than that provided either by generic manage- As a result of the questionnaire, a number of ment courses or experience in clinical placements. These suggestions were made to improve training. These find- included understanding the relevance of inter-agency ings continue to underpin the scheme’s overall approach planning to child and adolescent psychiatry, the forces to management training. shaping demand for child and adolescent mental health services (CAMHS) and government and local policy for children’s services. It was agreed to develop management Moving on seminars that would run two to three times a year and be included in the academic programme. The approach to management training was formalised following a half-day workshop (Hewson & Wright, 2002). Local trainers and trainees came together to develop Management seminars: an evaluation proposals for how the scheme could support all trainees to meet the management learning objectives proposed During 2001, the scheme’s lead trainer for management by CAPSAC and to consider the results of the earlier (L.H.) and a lead trainee (S.H.) planned the content, style survey(Box2). and format of these new seminars (Box 4). These have It was agreed that management training would need now been in place since January 2002. The content has to be promoted across the scheme by including manage- ment experience in the educational objectives for each Box 4. Structure and style of management seminars trainee agreed at the beginning of a new clinical place- ment. Progress would be reviewed mid-year at the annual . 2-3 half-day seminars a year placement visit undertaken by the programme director or . Trainee to work with lead trainer to plan seminars their deputy, and management achievements would be . Include regular update on‘hot issues’ (e.g. new government guidance) included in the annual record of in-training assessment . Focus on CAMHS rather than generic management (RITA). In addition trainees would be expected to attend . Trainees to present accessible papers the local generic management training available to . Trainees share practical management experience from trainees across all the specialties (Box 3). placements . Invite speakers, including CAMHS managers and consultants Box 2. Initial proposals identified in the scheme . Discussion-based learning. survey and/or workshop . Management introduced early in training . Appropriate involvement in clinical teams and service development Box 5. Content of the first four management . Shadowing arrangements in placements facilitated by seminars trainer . Opportunities to discuss management issues in . Historical context of CAMHS supervision . Management experience of a recently appointed . Undertake a small supervised management project consultant . Identified placements providing in-depth management . CAMHS structures and operational management experience . Where is the consultant voice in decision-making? . Generic management courses run by the deanery to . Modernisation in CAMHS and the wider NHS, including become mandatory user views . Include management in the academic programme . CAMHS in a multi-agency context . Combine theory and practice to make management . Multi-agency working in practice: the rhetoric and the meaningful reality . Directed reading, skill sessions, role-play. . Management responsibilities of the consultant. 72 Hewson et al Training specialist registrars in child and adolescent psychiatry showed that the seminars appear highly valued by the Box 6. Characteristics of trainees eligible to attend trainees (Box 7). management seminars from January to July 2003 (n=15) education & Trainees were given an opportunity to advise on training how to improve the seminars. The most consistent Age range 32-41years request was for more trainers to attend the sessions and Median age 35 years outside speakers to be invited so as to ensure a broad Sex Female:14 perspective. Trainees suggested that final-year trainees Male:1 Training pattern Flexible trainees: 7 should take a specific lead in the planning and delivery of Full-time: 8 seminars. These recommendations are being addressed. A Time in training 0-12 months:1 commissioner and service manager have been included in 13-34 months:1 seminars and there are now plans to include a CAMHS 25-36 months: 5 regional development worker. Engaging trainees early 436 months: 8 continues to be considered important so as to develop Trainee still on scheme 9 remained in training, at evaluation 6 had left the scheme understanding throughout training rather than manage- ment training simply being an exercise prior to a consultant interview. focused on topics considered to be relevant to CAMHS and the future role of child and adolescent psychiatrists Discussion (Box 5). An evaluation was carried out following the first four Child and adolescent mental health services are under- seminars to ensure that these were on the right track and going significant change and development which is likely to continue for the foreseeable future. The Children’s to ensure ownership by the group. A questionnaire was National Service Framework presents a challenging multi- sent to all specialist registrars who had been eligible to agency vision for children’s services (Department of attend any of the seminars (n=15). The characteristics of Education and Skills, 2004) requiring whole-system this trainee group are summarised according to age, change to achieve better outcomes for children and gender and time in training (Box 6). young people. The new standards for CAMHS will be Fourteen trainees (93%) returned the feedback delivered over the next 10 years. Trainees today will start form. The median number of seminars attended was two their consultant careers in services which are taking on (50%). Although full attendance is expected, all absences these development challenges. were understandable, being the result of sick leave, It is well recognised that tensions can exist between annual leave, maternity leave or undertaking a locum doctors and managers (Davies et al, 2003). Getting post. Trainees were asked to rate the style, relevance and Better? - A Report on the NHS (Commission for Health trainee involvement in the seminars. The evaluation Improvement, 2003) identifies the difficulty of securing Box 7. Feedback on management seminars by trainees (November 2003) Box 8. Types of management experience undertaken in placements Median score . How relevant have you found the topics 5 . Shadow a senior manager in the trust (e.g. trust board or covered in the seminar? executive to gain understanding of decision-making . How appropriate have the papers and 5 structures and processes) written material been? . Meet with the financial lead for the service to gain under- . How beneficial has it been for trainees to 5 standing of the financial constraints and opportunities of summarise and present papers? the service . How useful has it been to discuss examples 4 . Attend service or directorate clinical governance meetings of local services? and lead a small project supervised by trainer or service . How valuable have you found opportunities 5 clinical lead for free discussion? . Follow through a service reprovision or restructure . How adequate has trainee involvement in 4 . Lead the development of a service clinical protocol planning and organisation of seminars been? . Take part in the development of a bid for local or national . Do you feel trainee participation in the 4 resources sessions has been sufficiently valued? . Take part in a review of service (e.g. compared with NICE . How helpful have the seminars been in 4 guidelines) enhancing your understanding of the wider . Shadow multi-agency partnership meetings organisational context of CAMHS? . Follow through the development of a multi-agency . How useful have the seminars been in 4 initiative (e.g. CAMHS input to looked after children or the developing your understanding of the possible youth offending team) management roles of a consultant in child and . Attend meetings with commissioners to gain under- adolescent psychiatry? standing of the agreed approach to managing a service- level agreement. 1. A 5-point Likert scale was used where 1=not at all and 5=extremely. NICE, National Institute for Clinical Excellence. 73 Hewson et al Training specialist registrars in child and adolescent psychiatry management common to all specialties in medicine rather Box 9. Key components of management training on than more specific areas of interest to future child and theYorkshire scheme education & adolescent psychiatrists. . Systematic approach for all trainees training The Yorkshire scheme has introduced a systematic . Training across the 3 years of training approach (Box 9) to management training. This is now . Identified management objectives in each placement recognised as an integral part of training for all higher . Generic management courses as mandatory trainees in child and adolescent psychiatry in Yorkshire. . Service development issues included during supervision Specialist registrar training schemes in other areas may . Service development seminars included in the academic programme benefit from similar developments. . Identified lead trainer for management training . Involvement of the trainees and trainers in ongoing development and evaluation Declaration of interest None. doctors’ interest in management, particularly those working in mental health, but reports that services do better when doctors get involved in management. Poor relations between doctors and managers can damage References services to patients and impede improvements. This has led to a recommendation that developing doctors’ CHILD AND ADOLESCENT PSYCHIATRY GADD, E. M. (1990) Extending SPECIALIST ADVISORY SUB- management training for senior understanding of the organisation of healthcare and COMMITTEE (1999) A Higher Specialist registrars. Psychiatric Bulletin, 14, the role of management is essential at the earliest Training Committee Advisory Paper. 482-484. opportunity (NHS Confederation, 2003). London: Royal College of Psychiatrists. HEWSON, L. & WRIGHT, B. (2002) Joint Future consultants in child and adolescent psychi- http://www.rcpsych.ac.uk/traindev/ trainers and trainees forum - a sac/pdfFiles/advisorypapernov99.pdf atry will need to work within increasingly complex collaborative approach to higher management and accountability frameworks (Reder, COMMISSION FOR HEALTH specialist training. Psychiatric Bulletin, IMPROVEMENT (2003) Getting 26,33-35. 2003). They will need to contribute to service develop- Better? - A Report on the NHS. ment through job planning and clinical governance with HOUGHTON, A., PETERS,T. & BOLTON, J. London: Stationery Office. (2002) What do new consultants have an understanding that service priorities are increasingly DAVIES, H.T. O., HODGES, C. & to say? BMJ, 325,S145. set by national policy, multi-agency joint commissioning RUNDALL,T. G. (2003) Views of doctors NHS CONFEDERATION (2003) Medicine and the expectations of users and the general public. and managers on the doctor-manager and Management: Improving Relations relationship in the NHS. BMJ, 326, Higher training programmes should ensure that future between Doctors and Managers. 626-668. consultants are prepared for this. London: NHS Confederation. DEPARTMENT FOR EDUCATION AND The scheme’s annual audit of training has confirmed REDER, P. (2003) Consultant SKILLS (2004) Every Child Matters. that all trainees now have management objectives. Many responsibilities in child and adolescent London: Stationery Office. http:// mental health services teams: a system of these include shadowing managers or the consultant www.everychildmatters.gov.uk/___files/ dilemma. Psychiatric Bulletin, 27, trainer and discussing service development during super- EBE7EEAC90382663EOD5BBF24C99 68-70. A7AC.pdf vision (Box 8). The undertaking of a management project SMART, S. & COTTRELL, D. (2000) A DEPARTMENT OF HEALTH (1998) A First has been less consistent. Organisational change and the survey of training experiences and Class Service. Quality in the New NHS. move away from business planning to multi-agency attitudes of higher specialist trainees in London: Department of Health. child and adolescent psychiatry. commissioning appears to have made the direct involve- DEPARTMENT OF HEALTH (2000) The Psychiatric Bulletin, 24,302-304. ment of trainees in management projects more difficult. As NHS Plan. A Plan for Investment and clinical governance, access and choice increasingly drive Reform. London: Stationery Office. service improvement, specialist registrars and their trai- ners should consider engaging with managers through this agenda. *Lesley Hewson Consultant in Child and Adolescent Psychiatry, Director Child and Adolescent Mental Health Service, Bradford District CareTrust, 2-8StMartin’s Avenue, Lister Hills, Bradford BD71LG, e-mail: lesley.hewson bdct.nhs.uk, Conclusion Susie Hooper Consultant in Child and Adolescent Psychiatry, Bradford District CareTrust, Anne Worrall-Davies Senior Lecturer in Child and Adolescent Generic management courses for doctors provide valuable Psychiatry, Academic Unit of Psychiatry and Behavioural Sciences, School of training but tend to focus on general aspects of Medicine, University of Leeds http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Psychiatric Bulletin Unpaywall

Taking on the management: training specialist registrars in child and adolescent psychiatry

Psychiatric BulletinFeb 1, 2006

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Hewson et al Training specialist registrars in child and adolescent psychiatry education & training Psychiatric Bulletin (2006), 30,71^74 LESL EY HEW S ON, S USIE HO OPER AND ANNE WORR ALL - DAVIE S Taking on the management: training specialist registrars in child and adolescent psychiatry The proposal that management training should be integral Need for leadership to the training of all doctors, including psychiatrists, is not The NHS Plan (Department of Health, 2000) stresses the new (Gadd, 1990). The Child and Adolescent Psychiatry need to develop leadership within all professions if Specialist Advisory Sub-Committee (CAPSAC) training modernisation and the redesign of services are to be guidelines (1999) recognise that future consultants will achieved. Clinical governance (Department of Health, need sufficient management skills to be leaders in service 1998) and the drive to improve the quality of health development as well as effective clinicians, and outline services are dependent on effective working between the knowledge and experience to be gained during higher clinicians and managers. professional training (Box 1). This paper describes the Although management as a component of training Yorkshire scheme’s approach to supporting trainees to for specialist registrars is well recognised, new consul- achieve these objectives and highlights the need to engage tants consistently report that this is the area of their trainees, trainers and managers in taking forward this work for which they feel most unprepared (Houghton important agenda. et al, 2002). Where new consultants have gained management experience during their training, this was seen as helpful, but generally a result of the actions of individual consultants rather than a planned component of training. A survey of the training experiences and attitudes of Box 1. Learning objectives in management, audit and information technology proposed by the higher specialist trainees in child and adolescent Child and Adolescent Psychiatry Specialist Advisory psychiatry (Smart & Cottrell, 2000) found that 17% were Sub-Committee unlikely to have the opportunity to shadow a manager during their training and 13% would not be involved in the . Understanding of relevant organisational structures and processes relevant to delivery ofa CAMHS (e.g. within the planning of services. The majority of trainees, however, NHS, other agencies, delivery of postgraduate and under- recognised management training as essential. graduate training, GMC, Royal College of Psychiatrists) The Yorkshire Child and Adolescent Psychiatry Higher . Understanding of service planning, effective use of Training Scheme has worked over the last 7 years with all resources, ability to generate short- and long-term specialist registrars and scheme trainers to ensure that strategy and relate to day-to-day activities management knowledge and experience becomes an . Use of information to inform service development and audit integral and routine aspect of training. . Understand principles of clinical governance, risk management and accountability . Familiarity with recruitment, equal opportunities and Starting point appraisal and the need for continuing professional development for all professionals in the multidisciplinary In 1998 the training committee sent out a questionnaire team to the 17 trainers and 14 trainees on the Yorkshire Child . Development of team leadership skills and effective and Adolescent Psychiatry Scheme. This aimed to identify working with other professionals attitudes towards management training, the availability of . An ability to maintain appropriate clinical records and communicate effectively with other professionals management experiences on the scheme and to identify . Effective self-management: time management, development needs. The questionnaire was completed self-presentation, ethical awareness and use of initiative and returned by all trainers and trainees. CAMHS, Child and adolescent mental health service; Trainees appeared keen to gain understanding of the GMC, General Medical Council relevance of management to their future clinical practice and for management to become more meaningful and 71 Hewson et al Training specialist registrars in child and adolescent psychiatry included in their training. They were asking for improved Box 3. Key components of generic management understanding of the day-to-day running of children’s courses education & mental health services, including structures, business . Management and leadership training planning, finance and how and where decisions are made. . Mentoring, appraisal, interview skills Future survival as a consultant on a day-to-day basis was . Effective team-working a major concern. . Managing change The consultant trainers unanimously endorsed the . Time management . Preventing and managing stress proposal that management should be included in trainees’ . Negotiating skills training plans but appeared unsure of their own contri- . Managing meetings. bution. Many thought that they would have little to offer a trainee, not viewing themselves as undertaking management tasks or having expertise to share. Even However, the survey and workshop identified key those trainers with formal management roles were not areas likely to require a more systematic approach to used to routinely engaging trainees in this aspect of their management training for trainees in child and adolescent work. psychiatry than that provided either by generic manage- As a result of the questionnaire, a number of ment courses or experience in clinical placements. These suggestions were made to improve training. These find- included understanding the relevance of inter-agency ings continue to underpin the scheme’s overall approach planning to child and adolescent psychiatry, the forces to management training. shaping demand for child and adolescent mental health services (CAMHS) and government and local policy for children’s services. It was agreed to develop management Moving on seminars that would run two to three times a year and be included in the academic programme. The approach to management training was formalised following a half-day workshop (Hewson & Wright, 2002). Local trainers and trainees came together to develop Management seminars: an evaluation proposals for how the scheme could support all trainees to meet the management learning objectives proposed During 2001, the scheme’s lead trainer for management by CAPSAC and to consider the results of the earlier (L.H.) and a lead trainee (S.H.) planned the content, style survey(Box2). and format of these new seminars (Box 4). These have It was agreed that management training would need now been in place since January 2002. The content has to be promoted across the scheme by including manage- ment experience in the educational objectives for each Box 4. Structure and style of management seminars trainee agreed at the beginning of a new clinical place- ment. Progress would be reviewed mid-year at the annual . 2-3 half-day seminars a year placement visit undertaken by the programme director or . Trainee to work with lead trainer to plan seminars their deputy, and management achievements would be . Include regular update on‘hot issues’ (e.g. new government guidance) included in the annual record of in-training assessment . Focus on CAMHS rather than generic management (RITA). In addition trainees would be expected to attend . Trainees to present accessible papers the local generic management training available to . Trainees share practical management experience from trainees across all the specialties (Box 3). placements . Invite speakers, including CAMHS managers and consultants Box 2. Initial proposals identified in the scheme . Discussion-based learning. survey and/or workshop . Management introduced early in training . Appropriate involvement in clinical teams and service development Box 5. Content of the first four management . Shadowing arrangements in placements facilitated by seminars trainer . Opportunities to discuss management issues in . Historical context of CAMHS supervision . Management experience of a recently appointed . Undertake a small supervised management project consultant . Identified placements providing in-depth management . CAMHS structures and operational management experience . Where is the consultant voice in decision-making? . Generic management courses run by the deanery to . Modernisation in CAMHS and the wider NHS, including become mandatory user views . Include management in the academic programme . CAMHS in a multi-agency context . Combine theory and practice to make management . Multi-agency working in practice: the rhetoric and the meaningful reality . Directed reading, skill sessions, role-play. . Management responsibilities of the consultant. 72 Hewson et al Training specialist registrars in child and adolescent psychiatry showed that the seminars appear highly valued by the Box 6. Characteristics of trainees eligible to attend trainees (Box 7). management seminars from January to July 2003 (n=15) education & Trainees were given an opportunity to advise on training how to improve the seminars. The most consistent Age range 32-41years request was for more trainers to attend the sessions and Median age 35 years outside speakers to be invited so as to ensure a broad Sex Female:14 perspective. Trainees suggested that final-year trainees Male:1 Training pattern Flexible trainees: 7 should take a specific lead in the planning and delivery of Full-time: 8 seminars. These recommendations are being addressed. A Time in training 0-12 months:1 commissioner and service manager have been included in 13-34 months:1 seminars and there are now plans to include a CAMHS 25-36 months: 5 regional development worker. Engaging trainees early 436 months: 8 continues to be considered important so as to develop Trainee still on scheme 9 remained in training, at evaluation 6 had left the scheme understanding throughout training rather than manage- ment training simply being an exercise prior to a consultant interview. focused on topics considered to be relevant to CAMHS and the future role of child and adolescent psychiatrists Discussion (Box 5). An evaluation was carried out following the first four Child and adolescent mental health services are under- seminars to ensure that these were on the right track and going significant change and development which is likely to continue for the foreseeable future. The Children’s to ensure ownership by the group. A questionnaire was National Service Framework presents a challenging multi- sent to all specialist registrars who had been eligible to agency vision for children’s services (Department of attend any of the seminars (n=15). The characteristics of Education and Skills, 2004) requiring whole-system this trainee group are summarised according to age, change to achieve better outcomes for children and gender and time in training (Box 6). young people. The new standards for CAMHS will be Fourteen trainees (93%) returned the feedback delivered over the next 10 years. Trainees today will start form. The median number of seminars attended was two their consultant careers in services which are taking on (50%). Although full attendance is expected, all absences these development challenges. were understandable, being the result of sick leave, It is well recognised that tensions can exist between annual leave, maternity leave or undertaking a locum doctors and managers (Davies et al, 2003). Getting post. Trainees were asked to rate the style, relevance and Better? - A Report on the NHS (Commission for Health trainee involvement in the seminars. The evaluation Improvement, 2003) identifies the difficulty of securing Box 7. Feedback on management seminars by trainees (November 2003) Box 8. Types of management experience undertaken in placements Median score . How relevant have you found the topics 5 . Shadow a senior manager in the trust (e.g. trust board or covered in the seminar? executive to gain understanding of decision-making . How appropriate have the papers and 5 structures and processes) written material been? . Meet with the financial lead for the service to gain under- . How beneficial has it been for trainees to 5 standing of the financial constraints and opportunities of summarise and present papers? the service . How useful has it been to discuss examples 4 . Attend service or directorate clinical governance meetings of local services? and lead a small project supervised by trainer or service . How valuable have you found opportunities 5 clinical lead for free discussion? . Follow through a service reprovision or restructure . How adequate has trainee involvement in 4 . Lead the development of a service clinical protocol planning and organisation of seminars been? . Take part in the development of a bid for local or national . Do you feel trainee participation in the 4 resources sessions has been sufficiently valued? . Take part in a review of service (e.g. compared with NICE . How helpful have the seminars been in 4 guidelines) enhancing your understanding of the wider . Shadow multi-agency partnership meetings organisational context of CAMHS? . Follow through the development of a multi-agency . How useful have the seminars been in 4 initiative (e.g. CAMHS input to looked after children or the developing your understanding of the possible youth offending team) management roles of a consultant in child and . Attend meetings with commissioners to gain under- adolescent psychiatry? standing of the agreed approach to managing a service- level agreement. 1. A 5-point Likert scale was used where 1=not at all and 5=extremely. NICE, National Institute for Clinical Excellence. 73 Hewson et al Training specialist registrars in child and adolescent psychiatry management common to all specialties in medicine rather Box 9. Key components of management training on than more specific areas of interest to future child and theYorkshire scheme education & adolescent psychiatrists. . Systematic approach for all trainees training The Yorkshire scheme has introduced a systematic . Training across the 3 years of training approach (Box 9) to management training. This is now . Identified management objectives in each placement recognised as an integral part of training for all higher . Generic management courses as mandatory trainees in child and adolescent psychiatry in Yorkshire. . Service development issues included during supervision Specialist registrar training schemes in other areas may . Service development seminars included in the academic programme benefit from similar developments. . Identified lead trainer for management training . Involvement of the trainees and trainers in ongoing development and evaluation Declaration of interest None. doctors’ interest in management, particularly those working in mental health, but reports that services do better when doctors get involved in management. Poor relations between doctors and managers can damage References services to patients and impede improvements. This has led to a recommendation that developing doctors’ CHILD AND ADOLESCENT PSYCHIATRY GADD, E. M. (1990) Extending SPECIALIST ADVISORY SUB- management training for senior understanding of the organisation of healthcare and COMMITTEE (1999) A Higher Specialist registrars. Psychiatric Bulletin, 14, the role of management is essential at the earliest Training Committee Advisory Paper. 482-484. opportunity (NHS Confederation, 2003). London: Royal College of Psychiatrists. HEWSON, L. & WRIGHT, B. (2002) Joint Future consultants in child and adolescent psychi- http://www.rcpsych.ac.uk/traindev/ trainers and trainees forum - a sac/pdfFiles/advisorypapernov99.pdf atry will need to work within increasingly complex collaborative approach to higher management and accountability frameworks (Reder, COMMISSION FOR HEALTH specialist training. Psychiatric Bulletin, IMPROVEMENT (2003) Getting 26,33-35. 2003). They will need to contribute to service develop- Better? - A Report on the NHS. ment through job planning and clinical governance with HOUGHTON, A., PETERS,T. & BOLTON, J. London: Stationery Office. (2002) What do new consultants have an understanding that service priorities are increasingly DAVIES, H.T. O., HODGES, C. & to say? BMJ, 325,S145. set by national policy, multi-agency joint commissioning RUNDALL,T. G. (2003) Views of doctors NHS CONFEDERATION (2003) Medicine and the expectations of users and the general public. and managers on the doctor-manager and Management: Improving Relations relationship in the NHS. BMJ, 326, Higher training programmes should ensure that future between Doctors and Managers. 626-668. consultants are prepared for this. London: NHS Confederation. DEPARTMENT FOR EDUCATION AND The scheme’s annual audit of training has confirmed REDER, P. (2003) Consultant SKILLS (2004) Every Child Matters. that all trainees now have management objectives. Many responsibilities in child and adolescent London: Stationery Office. http:// mental health services teams: a system of these include shadowing managers or the consultant www.everychildmatters.gov.uk/___files/ dilemma. Psychiatric Bulletin, 27, trainer and discussing service development during super- EBE7EEAC90382663EOD5BBF24C99 68-70. A7AC.pdf vision (Box 8). The undertaking of a management project SMART, S. & COTTRELL, D. (2000) A DEPARTMENT OF HEALTH (1998) A First has been less consistent. Organisational change and the survey of training experiences and Class Service. Quality in the New NHS. move away from business planning to multi-agency attitudes of higher specialist trainees in London: Department of Health. child and adolescent psychiatry. commissioning appears to have made the direct involve- DEPARTMENT OF HEALTH (2000) The Psychiatric Bulletin, 24,302-304. ment of trainees in management projects more difficult. As NHS Plan. A Plan for Investment and clinical governance, access and choice increasingly drive Reform. London: Stationery Office. service improvement, specialist registrars and their trai- ners should consider engaging with managers through this agenda. *Lesley Hewson Consultant in Child and Adolescent Psychiatry, Director Child and Adolescent Mental Health Service, Bradford District CareTrust, 2-8StMartin’s Avenue, Lister Hills, Bradford BD71LG, e-mail: lesley.hewson bdct.nhs.uk, Conclusion Susie Hooper Consultant in Child and Adolescent Psychiatry, Bradford District CareTrust, Anne Worrall-Davies Senior Lecturer in Child and Adolescent Generic management courses for doctors provide valuable Psychiatry, Academic Unit of Psychiatry and Behavioural Sciences, School of training but tend to focus on general aspects of Medicine, University of Leeds

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Psychiatric BulletinUnpaywall

Published: Feb 1, 2006

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