StR/ SpR POST DETAILS 2009-2010

DETAILS/DESCRIPTION OF PLACEMENT:

This is a general adult psychiatry post and is based at Cromwell House. This is a modern purpose built Community Mental Health Centre that houses all members of the Community Mental Health Team (CMHT) including medical staff, community psychiatric nurses, social workers, support workers, secretaries and the team administrator, team occupational therapist and the team Psychologist. The job is predominantly out-patient based. The ST4-6 trainee will conduct two follow-up outpatients clinics per week and see one new-patient per week. There are also two sessions allocated to inpatient work; one will be attending a ward round, the duties of the second session are negotiable and may include reviewing a complex patient, liaising with other professional about an in-patient or attending a Mental Health Review Tribunal for a specific inpatient. The trainer (Dr Haddad) is RMO for outpatients at the Cromwell House Community Mental Health Team (CMHT) and works closely with Dr Ali who is the dedicated inpatient consultant for the sector. Dr Haddad is educational supervisor for all the work that the Trainee does whether it be inpatient or out-patient though clinical supervision for the 2 sessions of inpatient work will be from Dr Ali, the inpatient consultant.

The CMHT is very enthusiastic and great importance is placed on effective team working. With the exception of one satellite clinic, held in Irlam, all outpatients are seen at Cromwell House. There are opportunities for joint community assessments with other members of the CMHT. All major psychiatric disorders relevant to adult community psychiatry will be encountered in this post.

Facilities at Cromwell House include:

1. Secure car park with CCTV surveillance.
2. Own office with phone, computer, filing cabinet.
3. Secretarial support.
4. Reception and administrative support on site for ALL clinic including satellite clinic in Irlam.
5. Library at Meadowbrook.

EXPERIENCE GAINED AND DUTIES OF TRAINEES:

Dr Haddad has a major clinical and research interest in pharmacological treatment of major mental illnesses (depression, bipolar disorder, schizophrenia) including adherence. He is also interested in improving the physical health of those with serious mental illness. Trainees will gain particular experience in these areas. The main duties of the post are:

1. Two follow-up out patients clinics per week.
2. To conduct one new patient assessment per week.
3. To attend weekly meeting of community mental health team (1 hour).
4. To attend weekly ward round.
5. To spend one additional session in clinical work relevant to inpatients.
6. Involvement in community CPA meetings.
7. To share management of psychiatric emergencies between 9am and 5pm in the team sector with the consultant and staff grade doctor.
8. Occasional assessment of liaison cases at Hope hospital.

There is an ST1-3 or Foundation Doctor attached to the team.

ON CALL COMMITMENT:

1. About 1 in 14 (20% banding).
2. Immediate advice is available from the on call consultant that night.
3. Additional supervision is available from the Dr Haddad in the weekly supervision session.

TEACHING / ACADEMIC EXPERIENCE:

1. Medical students are regularly attached to Cromwell House and the Trainee will be involved in their teaching.
2. Weekly journal club/ case conference at in-pt site (Wednesday 1-2pm).
4. Trainee encouraged to attend other education events inside and outside the Trust.
5. Other options are available for trainees with a particular commitment to teaching and Dr Haddad will provide guidance and supervision of these. Such optional activities include:

- Giving an occasional lecture on an appropriate post-graduate course arranged at Manchester University (e.g. Diploma in Social Work course).
- Involvement in exam practice courses for trainees.
- Involvement in problem based leaning for medical students.

RESEARCH OPPORTUNITIES:

Dr Haddad’s clinical and research interests centre on the pharmacological treatment of affective disorders and schizophrenia and the safety and tolerability of psychotropic medication. Most senior trainees have conducted and published a review or small research project during their placement at Cromwell House under supervision. Examples of recent trainees’ work includes the following (NB Trainees’ names have been put in bold):

1. A review of valproate in psychiatric practice. Haddad PM, Das A, Ashfaq M, Wieck A. Expert Opin Drug Metab Toxicol. 2009 May;5(5):539-51.
2. Aripiprazole in the treatment of primary delusional parasitosis. Narayan V, Ashfaq M, Haddad PM. Br J Psychiatry. 2008 Sep;193(3):258.
3. The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study. Tint A, Haddad PM, Anderson IM. J Psychopharmacol. 2008 May;22(3):330-2.
4. Adverse effects of antipsychotics as outcome measures. Hamer S, Haddad PM. Br J Psychiatry Suppl. 2007 Aug;50:s64-70.
5. Adverse effects of atypical antipsychotics: differential risk and clinical implications. Haddad PM, Sharma SG. CNS Drugs. 2007;21(11): 911-36.

MANAGEMENT TRAINING:

There are excellent opportunities to become involved in management at Cromwell House and in the inpatient part of the post. This includes chairing the CMHT team meeting and the ward round and supervising members of the CMHT as appropriate. Some trainees have joined Trust Committees while in the post. Examples of specific management projects that previous trainees have worked on during their time at Cromwell House include strategies to improve physical health and using information technology to improve patients’ access to information. Dr Haddad’s management work includes being a member of the Trust Medicines Management Group and working with various national bodies to devise treatment guidelines. Advice on working with professional bodies and guidelines can be provided as part of training.

ADDITIONAL EXPERIENCE AVAILABLE:

1. Dr Haddad provides input to a psychiatric bail hostel and if trainees wish they can be involved in this, though this is entirely optional.
2. Dr Haddad has a long-standing commitment to clinical audit, including working with POMH. Trainees will be encouraged work with Dr Haddad and the Trust audit department to design and complete an audit project during the placement. The standard of audits conducted by previous trainees has been very high.

PROBABLE TRAINEE TIMETABLE:

IMPORTANT ADDITIONAL DETAILS:

This is a core training post in general adult psychiatry that provides both inpatient and outpatient experience. The feedback from trainees who have worked in this post is that they have enjoyed it, gained greatly in clinical experience and confidence and that it has equipped them very well to become consultants.