Risk assessment has become a large and anxiety-provoking part of the work of many psychiatrists. This article unpicks the different meanings of the word ‘risk’ to seek out the source of that anxiety, looking at both statistical and sociological ideas about risk. A risk assessment is often a subjective, plastic and context-dependent statement about a patient that carries strong moral overtones. Risk management is also highly anxiogenic for those charged with carrying it out, because uncertainty about the future is impossible to eliminate and the consequences of an adverse outcome in the patient may also carry hazards to the doctor making the risk assessment. This leads to behaviour change in people carrying out risk assessments as they attempt to minimise their anxiety in a rationally selfish way, often with unintended negative consequences for patients, doctors and health service providers generally. Some possible strategies for minimising this effect are considered.

SummaryConsultant psychiatrists are often called to work in teams that are functioning suboptimally. This is a major challenge, both professionally and personally. This article gives advice and strategies for working with struggling teams. It recommends combining objective-, data- and procedure-driven approaches to technical challenges with ‘softer’ person-centred and relational strategies matched to the learning needs of the team.

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This paper describes a model of training in leadership and project management skills for advanced trainees, using educational projects within the Severn School of Psychiatry. Fellowships lasting 1 year have been developed to enable trainees, working with a senior consultant trainer associated with the School of Psychiatry, to support important new educational initiatives. Linkage with the local university training and learning for health professionals research module has provided academic support for the trainees and the projects. Four examples for the first year of the programme are described and feedback from structured interviews with participants is presented. The development of the fellowships appears to have had wider benefits, in developing educational faculty in the School of Psychiatry and the trainees involved have had opportunities to extend their project management and leadership skills. The fellowship programme is continuing to develop, based on feedback from its first successful year.