Psychiatry currently lags behind other specialties, both in formalised national procedures and internationally recognised procedures. Although many European countries rely on teaching centres of psychiatry to complete locally-based assessment procedures, few have a national system of accreditation. Even fewer have national post-graduate examinations based on a detailed curriculum. Most rely on the completion of a prescribed training programme of attendance and clinical experience. Assessment of specialist knowledge via an independent national examination is considerably more straightforward to organise than assessment of clinical skills.
The European Union of Medical Specialists (UEMS) Board and Section of Psychiatry have attempted to delineate a European process of accreditation, but have met with difficulty. In particular, the diverse cultural, social and political contexts of psychiatric care systems and the variety of training programmes within them have proved daunting. Defining the constitution of a training scheme has also proved problematic. Is this to be regarded as that of a university training centre only, or can it include a wider training environment incorporating regional hospitals, out-patient clinics and community care? What sanctions can an international committee bring to bear if training in a specific centre proves inadequate?
After much debate, the UEMS Section of Psychiatry has recognised that development of national training accreditation processes must precede international accreditation. It is also aware that this must involve the major issue of assessment and examination of individual practitioner skills and knowledge.
The UEMS Accreditation of Training Schemes Questionnaire
As a first step, the UEMS Section of Psychiatry has developed an agreed assessment protocol, now circulated to all national psychiatric organisations Footnote * . This attempts to specify what must be taken into consideration. It includes, for example, an enquiry into supervision, training rotation, areas of particular experience (such as the psychotherapies), safety of the work environment, practicalities of study and access to academic facilities. In order to pilot whether such a protocol can be used effectively across national borders, UEMS representatives of the Netherlands Psychiatric Association and the Royal College of Psychiatrists have each participated as observers in approval visits in the other country.
Currently, in both countries, there is recognition that extensive preliminary preparation is needed prior to undertaking a visit. Before a visit, the tutors are invited to complete documentation outlining facts and figures pertaining to training. They also identify strengths and weaknesses affecting local training experiences. In The Netherlands, this is further developed than in the UK, with detailed written assessments of the training experience expected from trainees prior to the visit. There then follows a preliminary visit of a local team, and then a visitation by the National Panel. As in the UK, there is a convenor for each National Panel.
In The Netherlands, the visiting team consists of multiple independent subgroups, each with a consultant chair. Senior trainees are represented on the assessing panels in both countries and independently meet with trainees in the scheme visited.
From observing these visits, the UEMS found a preoccupation with very similar training issues in both countries. Tensions are apparent between service demand and training needs. Adequacy of supervision and access to psychotherapy training were also commonly discussed. Conditions of training, most notably safety and adequacy of office provision, also arose as general issues.
Both national psychiatric organisations have committees that consider reports, identify strengths and problems and recommend any necessary changes. This clearly allows for a unity of approach to national training strategies within these two countries. An area of marked contrast, however, is the position of national examinations. In the UK, examinations are contributory to gaining a Certificate of Completion of Specialist Training (CCST). The yearly Dutch examination, in contrast, is utilised to give trainees an opportunity for peer comparison only. It is not, as in the UK, regarded as essential to gaining a CCST. The difference that this makes is evident in the Dutch training programmes, which are not preoccupied with examination curricula and exam practice. None the less, a national comparison between these two countries shows many areas of common experience and concern.
Conclusions
The European Union of Medical Specialists pilot found that its international protocol for accreditation of training schemes could be successfully utilised without notable modification, albeit when tested in countries with already established processes of nationally agreed professional review by peers.
The UEMS Board of Psychiatry now faces the major challenge of encouraging all its national psychiatric organisations to engage in formalising assessment of training programmes in line with the protocol and assisting the further development of internationally recognised accreditation processes, including the assessment of individual specialist practitioners’ skills and knowledge through examination.
Psychiatric associations not currently familiar with nationwide assessment procedures may wish to convene a symposium of training scheme organisers to consider implementation. The UEMS Board of Psychiatry are in a position to offer consultative assistance in taking a variety of aspects further.
Declaration of interest
Dr Strachan and Professor Schudel are members of the UEMS Section and Board of Psychiatry.
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