COVID-19 and Postgraduate Training

COVID-19: Updates to Postgraduate Training

As the COVID-19 pandemic progresses and further information becomes available, the College will be constantly providing new information to ensure the health and safety of our members and staff while promoting best practice at this trying time for the medical community. Click here for an evolving list of information by the College for all members and staff.

Updated advice for trainees in the context of COVID-19 – June 2020

As we progress through the weeks since the Covid 19 pandemic began, we have all encountered challenges that we could probably never have envisaged. We have heard from many of you about the ways in which you have adapted your clinical practice, dealt with the absence of colleagues, and in some cases worked in situations that are different to your usual working environment. Some of you may have had to deal with contracting Covid 19 or had to self-isolate. This is all occurring in the context of managing our own personal fears for ourselves and for our loved ones. We would like to pay tribute to the work that you are doing despite the challenges presented.

We are now all coming to the clear realisation that we will need to adapt our clinical practices, perhaps for many months, while restrictions imposed by the pandemic continue. However, it is becoming apparent that within this there are also opportunities. These may be in developing new knowledge and clinical skills, developing leadership skills, reviewing evidence and auditing practice, as well as relationship building both within teams and with other specialties. We may also recognize areas of personal development and reflect on our own responses to new experiences and stress.

Alongside this, many of you may have experienced some difficulty in maintaining your training requirements. We are aware that some clinical and non clinical activities will have been reduced or postponed. As you know, for the current ARP we are providing guidance around contingencies to deal with this and to ensure, as far as possible, that trainees are not disadvantaged by the impact of the pandemic during the last 3months.

As we move forward, we will need to continue our engagement with training requirements albeit with some rethinking how we access these.

Some contingencies or alternatives are suggested below. These contingencies apply to the first 3 months of the next placement, at which time we will review the situation.

  • We continue to ask trainees to keep us informed of any training changes which occur as a result of the Covid 19 pandemic and which are relevant to your portfolio.
  • Completing an ACE in each placement remains part of the mandatory training requirements. For the duration of the current placement only (finishing July 2020) if it has not been possible to complete an ACE, Mini-ACEs may be used as an alternative to an ACE. Additional numbers of Mini ACEs will be required to attain the outcomes usually attained by an ACE. These can be attained using telephone or video technology provided your supervisor observes them, in the usual manner.
  • CBDs may be carried out using audio or video platforms.
  • In many instances, educational activities like journal clubs and reflective practice groups will have recommenced using audio or video platforms or social distancing. We encourage trainees to discuss this with local organisers/ Tutors in order to continue access to these training requirements.
  • The home visit learning outcome (BST) may be difficult to attain and this will be taken note of by ARP panels for the duration of these contingencies.
  • It is likely that attainment of psychotherapy outcomes has been interrupted or suspended. We would, at this point, encourage trainees to discuss with their supervisor how psychotherapy provision can be recommenced/ planned. It is likely that, in many cases, this will entail the use of audio or video platforms, and this will be acceptable for portfolio requirements at present. Supervision must be provided as previously.
  • Case Conference and Assessment of Teaching may also be accepted where completed using audio/video platforms.
  • ECT may be possible to observe or administer in some training centers. However, travelling to training centers where ECT is administered may not be possible for other trainees. Trainees should submit documentation describing any disruption caused by the pandemic to their ECT training. Depending on the length of time restrictions are in place for, it may be necessary for CPsychI to develop alternative approaches to ECT training.
  • Supervisors’ reports continue to be mandatory and, in some instances, may be very important where training has been significantly disrupted by the Covid 19 pandemic. We would ask that Educational Supervisors specifically comment on any training deficits which have occurred during this placement.
  • We would encourage taking time to reflect on all of your experiences, new skills/ challenges and to discuss these with your Educational Supervisor. In the context of Covid 19, there are likely to be many suitable subjects, both clinical and non-clinical, for Reflective Notes.
  • Portfolio items may be signed off by other Consultants on the Specialist Register in the absence of your Educational Supervisor.
  • Supervision sessions should continue and may take place by audio or video platforms if physical distancing measures are not possible.
  • We are aware that some trainees’ duties may have changed during this pandemic, both in clinical and non-clinical respects. These new duties may not form part of your usual training requirements but may have provided valuable learning and These activities, clinical and non-clinical, may be described using the attached form. It is important to note that there are no assessment methods for these activities and they cannot replace your training requirements. However they will be available to ARP panels to consider when they are making their progress decisions. (See attached form for logging clinical and non clinical activities)

During the period of restrictions imposed by the Covid 19 pandemic, meetings with trainees will only take place when these are deemed necessary by the ARP panel. These meetings will take place on video or audio conferencing platforms.

Due to the challenges imposed to complete the ARP process during the Covid 19 pandemic temporary changes to the ARP appeal system will be necessary.  Step 1 appeals can only be accepted under particular extenuating circumstances which must be specified by the trainee at the time of making an Appeal to an ARP decision.

These grounds for appeal include:

  • Certified leave where this leave directly impacted on the trainee’s ability to submit material at the time of the deadline.
  • Where there is evidence of administrative irregularity or procedural failure and there are reasonable grounds to believe that, were it not for that irregularity or failure, the ARP outcome would have been different.
  • There were extenuating circumstances affecting the candidate which were not known to the ARP panel at the time it determined the ARP outcome and, had those circumstances been known to the ARP panel, it is likely that the ARP outcome would have been different.

Where there are grounds for appeal as outlined above the appeal request will be accepted by the ARP panel and the Step 1 appeal may proceed.

The appeal must be lodged within 3 days of receiving the ARP report with documentation outlining the circumstances that establish the grounds for the appeal request. There will be a further 3 days allowable to submit further documentation to the ARP panel. The appeal will be scheduled within 7 days of the submission deadline.

Trainees will be aware that the May 2020 sitting of the BST Clinical Examination was postponed. At present, we are working towards holding an extra sitting of the BST Clinical Examination in early October, as well as our usual Winter sitting in late November. We are working on the assumption that provisions for social distancing will need to be incorporated into the arrangements for the examination but will outline the exact provisions as soon as these are confirmed.

BST Clinical Examination Eligibility and Streamlining Status

Some Trainees who are approaching the end of BST may have been particularly disadvantaged by the impact of the COVID-19 pandemic on examinations. Trainees who are approaching 60 months (the maximum period) in BST and who were not  able to attempt the BST Clinical Examination in May 2020, which was postponed as a result of the COVID-19 pandemic, will be accommodated as follows:

BST Vice Deans, where possible, will allocate an additional 6 month training placement to such Trainees from July 2020.  During this additional 6 month BST placement, Trainees will be eligible to make further attempts at the CPsychI Clinical Examination and, if successful, will retain their streamlining status if applying to commence HST in July 2021.

Ordinarily, a Trainee who successfully completes the BST Clinical Examination, having left BST, does not retain streamlining status when applying to HST.  In the current circumstances, if a Trainee has spent their maximum time in BST and opts not to extend formal training past July 2020 but has yet to pass the Clinical Examination, he/she may have one further attempt at the BST Clinical Examination (when it is next held) with the status of a streamlining Trainee.

The above advice with regard to WPBAS is also relevant to HSTS. However Senior Registrars tend to complete a greater proportion of CBDs which may be supervised by telephone/ video platforms if required.

We are aware that some Senior Registrars have not been able to access their special interests or research days since the onset of the pandemic. These trainees are advised to submit a revised training placement plan, which outlines the alternative activities undertaken, and their altered work schedule. This can then be linked to their personal development plan. Other clinical and non-clinical activities may be logged in the form ‘Record of clinical and non-clinical activities. There are no prescribed assessment methods for these activities, but they will be available to the ARP panel, if submitted. In addition, the ‘Research Participation End of Year Report’ and the ‘Special Interest Endpoint Report’ should describe any changes in these activities since the Midpoint Report.

Special interest PET: At the commencement of the next placement in July 2020, HST trainees should discuss suitable special interest sessions with their Educational Supervisor which are workable within the restrictions of Covid 19. If travelling to another clinical site is not possible, there may be suitable options available at your own clinical site with another consultant. Also, non-clinical options should be explored e.g. expanding management experience/leadership opportunities/higher degrees and courses, many of which are available online or by distance.

Research days PET: Some research projects may have been paused since the beginning of the Covid 19 Pandemic. Each trainee should discuss with their research supervisors as to how they can proceed. Important work may still be done on literature reviews, ethics applications or writing introductions even if recruitment is paused. Changes in methodology may be necessary or alterations made in other respects. Some of these changes will require revisions approved by a Research Ethics Committee. Where a trainee is planning to commence a research project the feasibility should now include considerations of the current restrictions. There are many opportunities for useful research during the Covid 19 pandemic and some publications are actively seeking submissions on relevant topics.

Similarly there will be many opportunities to carry out risk management and service development projects. These are relevant to the alterations that we are all making to our clinical practice, for example how we liaise with other specialties and primary care, how we work within our MDTs, deliver care to our patients and utilise new technology in our work.

CSCSTs and completion of training

HSTs are advised that while ARP panels may be flexible about how trainees meet their training requirements and are allowing HSTs until the end of their current rotation to do so, all mandatory items must be completed in order to award a CSCST.

Trainees should inform us if you have been redeployed in whole or in part as a result of arrangements being made for COVID 19. Trainees are reminded of the IMC advice to those being redeployed  https://www.medicalcouncil.ie/covid-19/  . ARP panels will take account of redeployment when considering training portfolios.

Trainees should also inform us of periods of certified leave related to COVID 19. CPsychI will review these instances on a case by case basis in terms of the impact on duration of training.

Documents relating to these issues should be submitted to portfolio@irishpsychiatry.ie

In view of the exceptional circumstances we are in, we will temporarily allow HSTs in their final year of training to ‘act up’ as a Consultant for a maximum of 3 months. This is a longer period than our Regulations usually allow but is still consistent with Medical Council of Ireland guidance. Periods of acting up are subject to the following conditions:

  • During this exceptional period, Senior Registrars may act up either for their own Educational/ Clinical supervisor or for another Consultant in their service aside from their Educational/ Clinical Supervisor, subject to the agreement of the Senior Registrar concerned.
  • Periods spent acting up are agreed in consultation and at the discretion of the Educational Supervisor and granted on an individual case-by-case basis in line with the training needs of the individual Trainee.
  • Senior Registrars must be paid at the appropriate Consultant grade for the duration of the period.
  • When acting up the doctor is working as a Consultant but has access at all times to a named specialist who has undertaken to provide a second opinion and advice at the request of the doctor who is acting up.
  • Each period of acting up must be followed up with a formal supervision session with the Educational Supervisor to report and feedback on the training experience.