EFPT STATEMENTS 2009 

National trainees organisations

(Copenhagen 1995, Gothenburg 2008) 

EFPT believes that organized trainee interest is key to promoting high quality psychiatric training in each country, therefore it is essential to have national trainee organizations which represent psychiatric trainees in each country. It is also essential that, whilst maintaining an independent view point, these organization/s have close working relations with the professional psychiatric organization/s of that country, so that the trainee view point on all aspects of training is represented effectively.  

WFPT/WPA Young Psychiatrists Program

(Berlin 2000, Naples 2001, removed in Gothenburg 2008) 

 

 

 

 

General medicine and neurology in psychiatric training

(Ireland 1994, Gothenburg 2008, Cambridge 2009) 

Psychiatry is an integral part of medicine. Psychiatric trainees require an adequate knowledge of all medical conditions, particularly as they interrelate with psychiatric conditions. Psychiatric trainings bodies must be responsible for educating and maintaining a trainee's knowledge in these areas. It is recognised that as doctors, psychiatrists should have updated skills to handle emergency medical situations. Such knowledge and skills should be refreshed on a regular basis. 

Experience in research

(Ireland 1994; Athens 1997; Naples 2001, Istanbul 2005, Gothenburg 2008) 

Psychiatric trainees should be trained in basic knowledge of research theories and methodologies. They should have basic training in analysing the quality of research. Trainees should also be encouraged to develop a scientific attitudes towards their professional activities and an ability to effectively implement new research evidence into their clinical practice.  

We recognize that research is a vital element for the scientific development of psychiatry. Therefore we recommend that adequate time, resources and research supervision (by a PhD level supervisor) are made available to all trainees to train in and carry out research.  Access to basic research facilities such as a medical library, internet, office facilities and communication with other related professionals (e.g. statisticians) are also recommended to enhance the quality of the training experience. Experience in research can also be a part of exchange programme. 

Training in Child and adolescent Psychiatry

(Lisbon 1996; Sinaia 2002, Istanbul 2005, Gothenburg 2008, Cambridge 2009) 

• CAP trainees are an integral part of EFPT, therefore we acknowledge that in addition to all existing EFPT statements, there are specific areas of needs in CAP training.
• We are mindful of the variance in training systems across Europe and see the following as an aspirational goal.
• We acknowledge that CAP and AP are two separate specialties in the field of psychiatry. Those two specialties are closely linked to each other. Therefore we strongly recommend that trainees in each specialty should have access to basic clinical training in the other specialty.
• In CAP a minimum of 5 years postgraduate training is required. A minimum of 3 years should be pure CAP training.
• Within this period, we recommend that the trainees should gain experience both with a broad range of age groups and within varying settings of care.
• We recommend that for the remaining training period, trainees should have the opportunity  to gain basic clinical experience in related specialties including adult psychiatry / paediatric medicine / (ideally) paediatric neurology.
• All rotation periods should ideally be of a minimum of 3 months duration.

 

Psychotherapy training

(Lisbon 1996, Tampere 1999, Napoli 2001, Sinaia 2002, Paris 2003, Istanbul 2005, Gothenburg 2008, Cambridge 2009) 

A working knowledge of psychotherapy is an integral part of being a psychiatrist and this must be reflected in training in psychiatry.  All trainees should gain the knowledge, skills and attitudes to be competent in psychotherapy.  Competence should be gained in at least one recognised form of psychotherapy (of the trainee’s choice) and basic knowledge should be gained in the other forms of psychotherapy to allow the trainee to evaluate suitability for referral to specialist psychotherapist. 

Training in psychotherapy must include supervision by qualified therapists. A personal psychotherapeutic experience is seen as a valuable component of training. It is crucial that trainees have access to relevant psychotherapy experience to cater to the needs of the appropriate patient group that the trainee is dealing with or is expected to deal with in the future. 

Relevant training authorities should insure that time, resources and funding are available to all trainees to meet the above mentioned psychotherapy training needs.  

Training in Community Based Psychiatry

(Sinaia 2002) 

There should be a training period of at least 6 months in community-based psychiatry, in the training of all psychiatrists, during which: 

1. The trainee is able to see patients outside the hospital and the polyclinics, for example on home-visits and by visiting other institutions caring for mentally ill. The aim is to learn to know and understand the social environment of the patient.
2. The trainee is trained in co-operating with other health professionals and other agencies involved in the treatment of psychiatric patients. The aim is the ability to work in and lead a multidisciplinary team caring for the patient, and interact effectively with other agencies involved in the care of the patient.
3. The aims mentioned above are achieved by structured education, and by personal supervision concentrating on these issues. A minimum amount of personal supervision should be one hour per week.
4.  

Old Age Psychiatry

(Paris 2003, Gothenburg 2008) 

Demographic trends suggest a substantial increase in the elderly population across Europe.  To fulfil the increasing mental health needs of the elderly population all adult psychiatry trainees should have the knowledge, skills and attitudes needed to manage the mental health needs of older people.  

For trainees who have a special interest in old age psychiatry, the training structure in their country should allow and encourage them to acquire the specific competencies in this field. Specialists psychiatrists in older people's mental health should supervise this training experience. 

Consultation Liaison Psychiatry (CLP)

(Istanbul 2005, Gothenburg 2008) 

There is a growing awareness of the increasing psychiatric and psychological needs of patients with physical health problems. Even though the last few decades have seen significant development in diagnostic and treatment modalities in CLP, there seems to be lack of proportionate increase in CLP training opportunities. 

It is important to recognise the need for CLP training, not just as a subspeciality but also as a core competency in psychiatric training  across all ages. Each training programme should include opportunities to train in CLP as subspeciality and develop generic liaison skills that are essential for the practice of any aspect of psychiatry. 
 

Legal, ethical and human rights issues

(Cambridge 2004, Istanbul 2005, Cambridge 2009) 

It is mandatory for all trainees in psychiatry to have a theoretical and practical education and experience in the principles and practice of their own country’s mental health legislation.  Trainees should as well be trained to recognise ethical dilemmas, discuss them with colleagues and act in a manner that promotes human rights. These aspects should continuously be a part of the training in all fields of psychiatry. 

 

 

 

 

Flexible (part-time) training

(Ireland 1994, Gothenburg 2008) 

Sufficient opportunities should be made available (part-time) for less than full time training in psychiatry.  Standards and qualities of this training should be equivalent to full-time training. Flexible (part-time) training should be available in each training scheme across Europe. 

Exchange of trainees between different countries

(Copenhagen 1995; Napoli 2001; Sinaia 2002, Paris 2003) 

The EFPT wants a full funded Exchange program. Psychiatric trainees should be given the opportunity to participate in trainee programs outside their country, within other European countries if they desire to do so. It must be accredited towards final qualification to the specialist’s status in their country of origin. We recognise the complexities of making such arrangements, which may include barriers of language, differing practices of psychiatry and of fulfilling criteria for specialist training. Despite these or other obstacles, such training experiences should be encouraged and made feasible. These training arrangements will improve the quality of the practice of psychiatry in Europe while recognising the cultural diversity of this practice.  We believe an exchange program is of benefit to European populations. Trainees will not only promote and improve their personal training in psychiatry, but they will also obtain a thorough comprehension of other European cultures promoting the highest possible standards of training and service provision in Europe.  

Independent appeal procedure for the trainee

(Sinaia 2002) 

There should be an effective and independent appeal procedure for the trainee who wishes to express complaints or appeal decisions about training matters. 

Removal of a trainee from training

(Ghent 1998, Istanbul 2005) 

Unsuitability of a trainee to work with a medical speciality needs to be distinguished from unfitness to be a medical doctor. A trainee must not be expelled for political or personal reasons that are unrelated to his/her professional competence. Trainees should be treated like qualified doctors in the process of being assessed regarding their fitness to practice. Emphasis should lie on supporting a trainee whose suitability is questioned. The final decision of removing a trainee should rest with a national professional organization. Participation of trainee representatives in this process is desirable. 

Mental Health Promotion

(Tampere 1999, Cambridge 2004, Gothenburg 2008) 

Mental health promotion and mental illness prevention are integral parts of a public health approach to psychiatric treatment and therefore these areas of competence should be included in all psychiatric training programmes and opportunities should be made available for trainees to participate in government and public service programmes of these nature.  Similar efforts should be incorporated to promote destigmatisation of mental illness in modern European societies. 

Working conditions

(Cambridge 2009) 

We acknowledge that working conditions strongly affect training as well as patient care. We are aware of the variability of working conditions in different countries. 

 

 

 

 

Evaluation of knowledge

(Copenhagen 1995, Tampere 1999, Berlin 2000) 

The statement was removed from the list at the Cambridge forum 2009 and is currently under revision. 

Quality of supervision

(Copenhagen 1995, Napoli 2001, Sinaia 2002, Istanbul 2005, Gothenburg 2008) 

Supervision in psychiatry training includes educational supervision, clinical supervision, psychotherapy supervision and, if required, research supervision. This statement deals with educational and clinical supervision. We recommend that these kinds of supervisions are led by one or more adequately qualified and trained supervisors.  

An important component of good quality assurance of training should be ensuring continuity of training and adequate supervision of the trainees. This supervision should include at least 1 hour per week of educational supervision (i.e. skills training, clinical management, teaching, research, service management, tutorship and reciprocal evaluation).  

Additionally, regular clinical supervision (bedside teaching, frequent joint evaluation of patients) should form an integral part of a trainee's clinical experience.  

A central independent professional body should evaluate all programmes and posts. This evaluation, which must include trainees, should ensure, that regular and high quality supervision takes place in each training placement.  

Educational and clinical supervision

(Copenhagen 1995, Napoli 2001; Sinaia 2002, Istanbul 2005, Cambridge 2009) 

Educational supervision must be trainee-focused rather than patient-focused. It should be individual and personal and should involve tutorship, reciprocal evaluation in dialogue, professional skills training, teaching, career guidance, management, and critical appraisal of scientific literature. The trainee should, in consultation with their supervisor, determine the contents of the educational supervision appropriate to his stage of his training. Subjects covered during supervision sessions and agreed future plans should be documented.  Educational supervision should result in an open, flexible and confidential dialogue.  

One hour of educational supervision per week should be the irreducible minimum throughout the whole of psychiatry training. This should, in effect, make educational supervision  an integral, compulsory part of training that takes place during working hours and at no extra cost. The educational supervisor involved can be external or internal to the training centre. For reasons of continuity, educational supervision is provided by the same supervisor for reasonable length of time. Ideally, the trainee should be able to choose his/her supervisor. Educational supervision should be distinguished from trainee assessment. 

Clinical supervision should be systematic and involve sharing responsibility for individual patient care, day to day clinical guidance and training in matters as interview skills, phenomenology, diagnosis, treatment and clinical management. Every trainee should have constant access to clinical supervision when on duty, including when the trainee is on call. We recommend that the supervisor as well should organize systematic patient discussions and bedside teaching. Both regularly observing a supervisor's psychiatric interview and being observed while interviewing a patient, followed by discussion, are essential in clinical supervision. Clinical supervision on an individual basis can be complemented with interdisciplinary team discussion or ward rounds. Joint evaluation of new patients by trainee and supervisor should be rule in the beginning of training and readily available as training progresses. 

 

Quality assurance in training centres

(Athens 1997, Gothenburg 2008) 

An important part of quality assurance is visitation (auditing) of training centres. These regular visitations should be made by independent teams to training centres at least every 3 years or more frequently if this is needed. The team should include a psychiatric trainee.  Auditing of training centres should include significant clinical and academic aspects as well as working conditions. The statutory body for quality insurance should have the power to enforce recommended improvements to quality of training. In extreme cases, where these improvements cannot/are not implemented, consideration should be given to discontinuation of training in those circumstances.  A written report must be available to all parties, including trainees. 

Logbooks

(Athens 1997, Ghent 1998, Cambridge 2004, Istanbul 2005) 

The essence of the logbook should be to improve training within each country across Europe.  The trainees should have the ownership of the logbook. The logbook should  act as a guide for the trainee in both self-assessing the quality of training and providing indications for areas of improvement. The key requirements of psychiatric training according to European standards need to be clearly stated. The overarching purpose of the logbook should be formative and not summative. Trainee involvement should be integral to the development of any logbook and the monitor of its use.  

Competency Based Training

(Riga 2006, Gothenburg 2008, Cambridge 2009) 

The EFPT supports the on-going work of UEMS on competency based training (CBT) in postgraduate training in psychiatry. Implementation at national level should be appropriately paced, well resourced and not overly bureaucratic. Differences in healthcare infrastructure and cultural perspectives have to be considered. Trainers and trainees should collaborate at all stages of planning, implementation and continuous evaluation, both at national and European levels. Focus has to be on improved quality of training and thus, patient care.