To be 'within and without' - A trainee's perspective of an intellectual and developmental disability consultation...

BackgroundThe first author is a third-year trainee with Queensland Centre of Excellence for Intellectual Disability and Autism Health (QCEIDAH). This perspective stemmed from the experience of working at QCEIDAH and reflecting during supervision on the complexity and confusion that arose being 'within and without' - quote from F. Scott Fitzgerald's 1925 novel, 'The Great Gatsby', depicting the narrator's coming of age.ObjectiveTo explore and outline the perspective of a registrar working in a state-wide intellectual and developmental disability consultation service.MethodThe utility of various psychiatric frameworks within a complex consultation service is discussed, including biopsychosocial model, psychodynamic model, and systems framework.ConclusionTo be 'within and without' not only describes the physical state of being inside a room with the patient in a time-limited consultation service but also mirrors the complexity of stepping into the various system of the patient including their families, support workers, NDIS coordinator, and other health providers in a variety of physical, metaphorical, and metatheatrical sense. This presentation highlights the challenge of a trainee working in a space with high expectations from a variety of systems in a field which lacks the clarity and framework to easily achieve this.