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Everything posted by DrDave

  1. CESR Timeline Howells 2019.pdfhi all, I have been asked a numerous times recently about CESR and any advice I have for applying. I would say planning ahead is key, with prospective evidence being easier to tailor for the application, knowing as much as possible about the requirements and your strategy would be vital. After that it is one foot after the other for years on end Worth checking out the work going on in Emergency Medicine, notably in Derby, Lancashire with Dr Dan Boden but also elsewhere in the country where CESR rotation schemes have been set up. Dr William Niven has also produced a CESR Guide, again in Emergency Medicine, link below; https://www.rcemlearning.co.uk/foamed/cesr-or-cct-some-reflections-on-my-journey/ Talk to your colleagues to share advice as there will be people in your area who have gone down this route who can give you top tips and hopefully provide some work-place based assessments! I have gathered some ideas from various places about how to support SASGs better and will post below but if anyone has any other thoughts about supporting the needs of SASGs, please comment! I will also add a copy of my 'CESR Timeline' to give an idea of the process (or my attempt at it in any case). Best Wishes and Good Luck! (if you are not put off) Dr Dave The key points for a CESR Support Scheme include; · SASGs provide an essential role in many areas of health service provision within the UHB. · There are clinical areas within the UHB that rely on Locum SASG and/or Locum Consultant appointments to maintain patient safety at significant cost. · SASGs require access to training and development to meet the requirements of revalidation, drive independent practice and follow specialist interests.. · Supporting SASGs in their development goals will aid recruitment and retention of SASGs and have beneficial effects for the department as a whole. · Some SASGs have a desire to join the Specialist Register in their respective fields, either through (re)joining a training scheme or through the CESR route. · There is an appetite from CAVUHB SASGs to engage in a system that supports them through the CESR process. · There is an appetite from Health Education and Innovation Wales to support the development of SASGs. · Many areas (in England) already have well-advertised CESR development schemes/posts. · It would be in the interests of certain clinical directorates to establish formal and recognised CESR development posts for SASGs. · Even where formal SASG CESR development posts are not implemented, the principles of CESR development schemes match the goals outlined in the Wales SAS Charter. Increased support for SASGs following the CESR route to specialist registration with the GMC would benefit the UHB by; · Recruitment and retention of high quality SASGs from the UK and abroad. · Improving medical engagement amongst SASGs. · Developing the skills of SASGs within the UHB. · Providing a supply of locally trained consultants in key areas of the UHB. SASG CESR development schemes typically include the following components; Infrastructure · Executive Board support. · Involvement of the SAS Tutor · Business planning for a SASG CESR workforce development scheme. · Identification of a clinical area that would most benefit from SASG development. · Senior Clinical Board engagement in SASG development. · An identified consultant leader as a point of contact for the scheme. · Recognition of SPA time for supervisors. · Engagement with the relevant Royal College(s) on requirements/ evidence gathering for CESR Applicants. · Advice from doctors that have attained or attempted specialist registration via the CESR route. Organisation · Awareness raising of a SASG CESR Support Scheme. · Advertising for SASG applicants internal/external to the UHB. · Identification of highly motivated SASGs, aware of the demands of CESR application. · A fair and transparent candidate selection process. · Organisation of a rotation that would meet the necessary clinical and educational needs in a flexible ‘SASG-friendly’ manner. · A SASG CESR support group to access and cascade advice and share experiences. Individual Support · Objective setting and accountability through Professional Development Planning. · Job Planning to provide a realistic balance of DCC/SPA commitments. · Protected time to complete CESR-related work. · Annual appraisal. · Annual assessment of competencies as separate from appraisal. · A Named Educational Supervisor. · Regular clinical and managerial supervision. · A designated CESR mentor. · Early identification of potential referees (typically 6 consultants, including the clinical director are required) to facilitate reference writing (references are extensive and require the consultants to be familiar with the candidate’s clinical, professional and academic work and request examples of direct experience of such work). Addressing Development Needs · Access to training opportunities and clinical work equivalent to those offered to Higher Trainees. · Support for Royal College Examinations, if required. · Regular assessment through workplace-based assessments. · A commitment to support study leave applications and funding for identified learning needs. · Secondments to gain the necessary experience to meet the requirements of the relevant specialist curriculum, preferably as part of a planned and predictable rotation. · Provision of regular/rota’d on-call experience where this is not a regular part of the SASGs’ role. · Clinical activities coded under the individual SASG’s name. · Support for taking on management/leadership roles. · SASG representation on committees, directorate meetings, interview panels and/or delivery of educational programmes. · Appointment to locum consultant posts where appropriate.
  2. Hello PsychClub members! I joined this forum over 4 years (Nov 2014) ago, thinking seriously about moving from a SASG post to consultant. This was primarily to ensure job security but to develop within the role. It has been a long process and not to be underestimated but suited my circumstances. I would not advise anyone to follow if they would be better suited to re-enter training. I completed MRCPsych with help from the PsychClub forum and submitted my portfolio in March 2017. After what seemed like an eternity (Sept 2017) I was refused by the GMC. I submitted a review application in July 2018 with additional evidence. A few days ago I was approved for entry onto the Specialist Register! Many thanks to the support given by PsychClub members. Some things have changed in that time to make the process slightly easier and some areas are offering CESR directed SASG posts but it still needs a massive change to make the process clearer and to give more support to SASGs. I hope going forward I can help others follow this route if it suits their needs. Best wishes to all for the New Year! DrDave
  3. Hi Fludoc, thanks for your words. Specialty dr posts are around and difficult to recruit to so likely a good way to get experience and local contacts. only a few associate specialist posts around coz the grade was closed approx 2008. ST post you would have to apply and hope- again maybe easier with local experience. good luck, dave
  4. After about 3 years of slog, including MRCPsych, dozens of WPBAs, and documents from allover the place, it has finally been submitted! Well over the suggested 1000 pages, and I struggled to see how to cut it down further. I love my job and had great support from colleagues. Without the above, I would suggest SpR route would be less of a headache! Now time to wait...
  5. Hi, I am putting a CESR portfolio together and a colleague mentioned that it might be possible to apply for more than one specialty e.g. Adult/old age/liaison. I have not found any information about this anywhere and it seems to me that it would be unlikely without submitting slightly different portfolios and paying again in any case. if anyone has heard of this, let me know ta DrDave
  6. Doctor03, I would echo Laura's sentiments, that was a tough exam with lots that I had not even thought to revise. Small consolation but this will prepare you well for the resit. Over the past few months I have been looking at learning methods to try and maximise the revision time for my resit (I am greatly relieved to have passed!). The following link gives a systematic review of techniques well worth reading! http://www.indiana.edu/~pcl/rgoldsto/courses/dunloskyimprovinglearning.pdf I have also learnt how to memorise a pack of cards through my exploration of the subject - some good fun, psychodynamic ally fascinating and liable to get you run out of Vegas! Good luck on the resit! DrDave
  7. Agreed, Paper Ai was seriously hard! Loads in there that was not in SPMM or PsychMentor. If I fail, not sure how to revise for the resit even! D
  8. Carrot - shaped objects in Alzheimer's - ? Hirano which is more common in Famillial Alz - presenilin 1 or APP? something about a CJD protein with a 5 digit number(plus letter) asking what it is used for e.g. Monitoring progress; 60% sensitivity or less reliable than EEG asked what CT is better than MRI for ? Oedema lateral hemianopia lesion what illness most UNLIKELY in 3rd trimester of pregnancy - major depression, psychosis, adjustment disorder, anxiety drug with half life of 72 hours ?fluox, aripopraze, carbamazepine supra optic nuclei function supra chiasmatic nucleus function apperceptive visual agnosia- which function spared lots on age of child at certain milestones (including Piaget moral development that I completely missed on revision!) Nb first word age and words galore after that! a few questions on attachment, including one on a 'needy' patient over reliant of services adjunctive antipsychotic to reduce hyperprolactinaemia opioid mu receptor questions - methadone and buprenorphine Cross over time. from MAOI to SSRI
  9. Ai kicked off with DSM V and Autism Spectrum disorders classification (nearly fell off my seat - never even looked at DSM V!) Essential criteria for antisocial PD, with a load of additional criteria to confuse - also with essential criteria for harmful use of alcohol bipolar hormone changes/ structural brain changes antidepressants that inhibit antipsychotics AIMS and Simpson Angus came up in separate questions questions on antipsychotics and hypotension, hyperprolacinia Fat man on olanzapine and erectile dysfunction - what's the cause? Diabetes or huperprolactinamia
  10. ECGs came up a lot - a full EMQ LOTS OF FTDm - progranilin/MAPT Lol - a Q on female homozygous ratio in population if male has 1/100 recessive (?eh... Choices 1/1000, 1/4000, 1/10000, etc) Limbic cortex- amygdala or orbital cortex (put orbital but both possible)
  11. It was LESST likely to prescribe. Put TCA (not sur if right) as recall one of them inhibits it
  12. Darn, put Mirtazapine : coz I like it!
  13. Just sat down to start Paper A revision for December and hoped to use SPMM as this worked well for me for Paper B. Seems like you can only buy a 6 month course at £250, rather than a 3 month at £150 as you previously could. so have signed up for Psych Mentor - will let you know how it compares! Dr Dave
  14. I was under he impression of gabapentin (as with pregabalin) had its action through alpha-2-delta subunits of the voltage gated calcium channels (and were NOT involved in acting on the GABA receptor but received the name through it being an analogue of gamma amino-butyric acid). I have seen this written, seemingly in error in a course material. Dr Dave
  15. I had also spent time with SPMM doing a small quantitative survey and Andy Fields book on stats was a great help with this if you need a practical guide. A lot easier to remember stats if you have needed them to work out a practical problem! d
  16. Emily34, apologies, the PassTest book! By Gosall. I read the Lawrie Critical Appraisal one also and while more comprehensive, was a harder read, sufficient info in the other if time-strapped. Regards Dave
  17. I have just passed paper B (yay!) and am now going to sit paper A in December. For paper B, I did 3 months intensive SPMM online course and a couple of stats books. The PassMark book is the best IMHO and most readable but SPMM is also good for the PDF resources. I would write down the main half dozen or so statistical equations and main facts on an A4 sheet and learn them backwards. Then when you get in the hall, the first thing to do is to write them all on the front cover of the exam paper. This helped loads as by the time the stats questions came up my head was a bit fuzzy! Overall the stats were fairly basic but there were a few hard questions that needed you to know the equation 'route' as it did not lead you in step by step as the SPMM MCQs often do. SPMM was amazingly useful with loads (>50% I would say - Some on the psychclub website disagree with this) of questions that came up again (perhaps with a small tweak). Some were carbon-copies of the questions on SPMM. The SPMM MCQs were the most useful part and I went through them 3 times and read through the PDFs 2 times. I would say the MCQs were the best learning aid and would focus on these more (even with significant retest improvement accounted for). It gives a different perspective on the learning process. A lot of the info I copied onto my phone and use day to day now also to check and refresh myself and was a good learning aid of you are thinking of a question and can't remember the answer. Hope this is of some help Regards Dave
  18. I'd start with revising basic psychological defence mechanisms
  19. Methedrone -fishy smell Older man with Parkinson's symptoms and Risperidone And citalopram 40mg - stop citalopram as now CI >20mg in older adults. Alternative was reduce Risperidone (had it stated stop Risperidone, I would have agreed) I struggled with the £50,000 QALY – % improvement was 10 or 20 % and the value looked like 15%! Put 10% as the probability as it's good to be conservative where money is concerned! Question on Positive predictive value for 0.23 and the PEER question chose the mini-cog as best test (or other way round) Depressive projection - put externalisation Neurotic defence - reaction formation
  20. Hi Vishel and responders, Hope the December exam went well. I have decided to start the ball rolling with Paper B in April 2015 Which of the methods did you use and did you find a preference if more than one? Ta Dave
  21. Hi, a question for those who have completed MRCPsych and those nearing the end; Is this knowledge you have gained across the broad spectrum of use in your chosen specialty? I have worked 7 years as a specialty doctor and am thinking about sitting the exams but questioning if my time would be best spent actually learning more about the specialty I am in rather than on conditions I will never see. Ta Dave
  22. Thanks BobAukland! I suspected that might be the case! Lol! Admittedly, cognitive dissonance might suggest that it would be upsetting to hold an opposing view after months/years of hard work. Well, here's throwing my hat into the ring... Happy New Year! DrDave
  23. Hi, I am not bashing the RCPsych; it has a very valuable role to play, however not unlike herd immunity, the benefits extend to me without me having to expose myself to the jab (£££)! I am a Specialty Dr of several years and want the extra job security and potential options that CESR would give. I do not have MRCPsych exams and have had little in the way of WPBAs (I was in training pre MMC). My query is whether anyone knows if it is possible to get CESR without doing the formal WPBAs. The RCPsych does not have them freely downloadable anymore and they appear to be 'copyrighted' anyway which may restrict their use (some ST1 ACE forms etc are left carelessly around the web). If you have done alternative WPBAs or have provided alternative equivalent evidence this would be good to know. It is not clear that joining RCPsych as an 'affiliate' would get you the forms anyway, just the 'CPD Online' resources (which may be good to fill in gaps but is not the same as WPBAs). The CESR guidance from GMC does recommend being a member of RCPsych but does not insist on it - has anyone joined the specialist register without? Thanks in advance, Dave
  24. The CESR application must fit in a foolscap box file: 24 x 34 x 7cm. The advice is approx. 950 pages (I will use 1000 pages for illustration), split between the 4 GMC domains; Domain 1: Knowledge, Skills and Performance - 75% or ~750 pages Domain 2: Safety and Quality - 20% or ~ 200 pages Domain 3: Communication and Teamwork & Domain 4: Maintaining Trust - 5% or ~ 50 pages Domain 1. is to include the 'Specialist Qualification' subsection, which either includes the MRCPsych certificate or the equivalent (as cross-referenced with the syllabus - the 2015 syllabus has 208 items!). As the CESR application is for both MRCPsych and non-MRCPsych holders, the question is, should the CESR application; A) stick to the 950 page advised limit but risk not having enough evidence in other areas, certainly when compared to those with MRCPsych. have the MRCPsych equivalence as a subsection, in addition to the 950 pages advised, risking being unable to fit it inside the box and going way over the advised size. C) a fudge between A and B Ta Dave