COVID-19 and Postgraduate Training
COVID-19: Updates to Postgraduate Training
Updated advice for trainees in the context of COVID-19 – October 2021
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.
Review of contingencies during COVID 19 pandemic for portfolio requirements and ARP – October 2021
We last updated our guidance for postgraduate training during the Covid 19 pandemic in November 2020. Now we find ourselves 18 months into this global pandemic. It is heartening to see our schools, colleges and wider society reopening and to witness the national response to the vaccination programme.
Throughout this time, you have all adapted your clinical practices, learned many new skills, continued to provide care for your patients and maintained your training requirements. We commend you for this and for the resilience that you have demonstrated during these times. We would also like to acknowledge the many educational supervisors, tutors, vice deans and HST mentors and all consultants who have supported trainees to maintain their training requirements. We also highlight the work of the College staff in PGT who rapidly adapted work practices to maintain the many activities of each training year.
- Portfolio: During the pandemic we advised that workplace-based assessments would be accepted where they had been completed virtually provided that otherwise the same requirements for a WPBA were met. While most services are now working face to face, some clinical work will continue virtually, and we will continue to accept these WPBAs to your portfolio.Reflective practice groups, journal clubs, case conferences and other nonclinical/ academic activities may be continuing to be held virtually. These can also be logged in the usual manner to your portfolio.Specific to HSTs, the Coroners Court has reopened, and the court sessions are being held virtually.
Mandatory weekly supervision can be conducted either face to face or virtually.
- ECT: We are aware of the difficulties that trainees, in particular HST trainees have been experiencing in accessing ECT experience to attain the relevant competencies, particularly if they are not working in a clinical site that provides ECT. Limited capacity and limited access to crossing clinical sites, remain as barriers. We have been discussing alternative methods of attaining this essential competency into the future. For the duration of these contingencies, attainment of the relevant HST learning outcome ‘Administration of ECT’ can be submitted to your portfolio if it has been completed during either BST or HST training. There must be evidence provided to your portfolio, and available to the ARP panel, that certifies that you have (i) Attended training in ECT with details of what this entailed, what the duration of the training and who provided the training (ii) Experience in the supervised administration of ECTat BST or HST and (iii) documentation of who provided supervision and (iv) Supporting documentation as a record of attendance at training and certification of the experience in adminstration of ECT.
- SAPE: The requirements for your SAPE (Structured Assessment of Psychotherapy experience) remain unchanged but can be completed virtually or by blended platforms. We are aware of feedback from HSTs primarily regarding the impact of the pandemic on completion on the required number of sessions for attainment of the SAPE. Where there are a small number of missed sessions due to the impact of the pandemic, these sessions can be logged on your SAPE. There should be an accompanying reference to the discussions of the reasons for the missed sessions with your supervisor as relevant to the psychotherapy experience. We would suggest this should also be accompanied by a reflective note which has been discussed with your SAPE supervisor and which should focus on the meaning of any missed sessions or the termination of therapy in this case, in psychological terms. This documentation should be available to the ARP panel which will form part of their review of the evidence and progress decisions.
- HST Reflective Practice: Further HST Balint sessions have been offered to HSTs by the psychotherapy faculty. Reflective practice requirements for HSTs are unchanged but can be attained by attendance at either BST or HST reflective practice groups.
- NANE: Where there have been periods of leave due to advised self isolation as a close contact, this is not recorded as sick leave for the purposes of your NANE and for the calculation of duration of training. In line with HSE advice you are available to work remotely as required by your service/ supervisor. Training activities that are provided online, including weekly supervision, continue during this time. Appropriate medical/ HSE advice to self isolate should be submitted to the PGT department.
- ARPs: The timeline for the ARPs will continue as per the regulations and the deadlines for submissions are unchanged. These are available on Moodle, PGT communication, and in your e-portfolio. ARP documentation review meetings were moved online throughout the pandemic. These, based on feedback, have worked very well and have if anything helped to streamline the process. We intend to continue ARP documentation review meetings via video platforms. Trainee meetings have also continued via video platforms. We are reviewing this but for the purpose of these updates, trainee meetings willl continue virtually at present. The grounds for appeals remain unchanged.
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.
BST Clinical Examinations in 2021
The Winter 2021 exam sitting is scheduled to take place online on 12th, 18th and 19th November 2021. Applications will be invited in July. Exact dates will be available soon. Exams will continue to operate online until such time as it is deemed safe to resume exams in a face-to-face format. Please refer to the BST Clinical Examinations webpage for further exam information and updates.
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.
We are aware that, for a variety of reasons, delays have arisen in research stages during the pandemic. Some contingencies will be applied to the new regulations in context of the expected research outcomes for HSTs at CSCST stage for ARP in April 2022. The research outcomes expected are as outlined in the regulations (pg 27) but it will not be mandatory that publication has been completed by the ARP deadline. The research must be of the standard required, similar to that expected of a postgraduate university student, and must be suitable for publication. The ARP panels will be advised accordingly. Trainees who have initiated the process of submitting research for publication before their ARP should provide evidence of this by the ARP submission deadline.
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 firstname.lastname@example.org
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.