The
Canadian Journal of Psychiatry
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| Volume
48 |
Ottawa,
Canada, May 2003 mai
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Number
4
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Guest Editorial
Training Issues in Psychiatry in Canada
Emmanuel Persad, MB, BS, FRCPC1, John Leverette, MD, FRCPC2
In this issue, we are pleased to include a series of articles on training issues in psychiatry. Our interest in a national strategy for postgraduate education in psychiatry evolved in the course of contributing a chapter to the Canadian Psychiatric Association (CPA) publication Psychiatry in Canada, 50 Years 1951–2001 (1). Covering a wide range of relevant topics, we commented on the factors influencing the current training context, including changes in the practice field of psychiatry, technological and research advances, the emphasis on community-based care, and the emergence of new initiatives from the Royal College of Physicians and Surgeons of Canada (RCPSC). We also noted decreasing interest among residents in pursuing a career in academic psychiatry, accompanied by a recruitment crisis in the field: fewer than 25% of residents expressed an interest in an academic career (2). Directors of postgraduate programs were asked to identify the challenges that they face in providing postgraduate education at the dawn of this century, and their comments may be generally applicable. They identified difficulties in accommodating new training content; the preoccupation with the current resident recruitment process through the Canadian Resident Matching Service (CaRMS); the responsibility for organizing and maintaining the integrity of the postgraduate year 1 (PGY1); the emergence of mental health care shared with family physicians; the emphasis on community-based care; the development of training sites outside academic centres; and more recently, the impact of subspecialization. While these challenges are ongoing, new initiatives from the RCPSC place additional pressures on training programs. The introduction of competency-based training objectives promises more valid assessment procedures, as in the new Final In-Training Evaluation Report (FITER) that is completed for each resident proceeding to the certification examination. We note that these developments in Canada reflect global changes in postgraduate training.
For this In Review series, we have commissioned 3 articles. Dr Stephen Scheiber and his colleagues from the American Board of Psychiatry and Neurology provide a paper on developments in the US. This is valuable in that they comment on the differences between Canada and the US in the training environment and in assessment procedures (3).
It is interesting that postgraduate educators in both Canada and the US are currently focused on the matter of core competencies in the training of psychiatric generalists. The Americans have completed this process, and we can only benefit from their work. Over the past 2 years, the Canadian review of core competencies has been evolving consensually among the senior postgraduate educators on various national education committees. A new delineation of core competencies is recognized as imperative, given the relatively few psychiatrists in Canada, our need for generalists to provide care across the lifespan, and the pressures on our training programs. Dr Scheiber points out that Canadian psychiatry is privileged in this exercise by its small number of medical schools and by the unique overview of the RCPSC in setting training standards, accrediting programs, and examining candidates. In addition, the close working relations between the CPA, the subspecialty academies, and the RCPSC Committee in Psychiatry potentially allow Canadian psychiatry to develop a more detailed and prescriptive set of core competencies across the lifespan for generalists, compared with those developed in the US.
The second article (4) is by Dr Isolda Tuhan, a recent graduate. She offers a consumer point of view regarding her training and its relation to fulfilling the CanMEDS 2000 roles.
It has been acknowledged that postgraduate educators and trainees have been better able to orient themselves to the CanMEDS roles that represent more traditional clinical academic competencies. Conversely, they have felt less prepared to fulfill many of the less traditional systems-related roles, such as that of advocate or manager. Thus, to fine-tune training experiences so that competencies are attained, it is especially helpful for psychiatric educators to receive their trainees’ observations in these areas. Ultimately, the core competencies that are being reworked for Canadian psychiatric generalists will need to be articulated within the CanMEDS roles.
Dr Lawrence Martin of the Department of Psychiatry and Behavioural Neurosciences, McMaster University, is the lead author of the third In Review article (5). He leads a writing team representative of postgraduate education directors and front-line educators in psychiatry. Directors of postgraduate education occupy a unique position charged with operationalizing national training standards at the local level. In doing so, they frequently collectively bring a reality-based perspective to implementing national initiatives. In the context of their close association with trainees, they are often the first to identify training challenges that, conversely, require national initiatives to resolve. Dr Martin and colleagues identify several specific challenges and offer their collective wisdom, opinions, and evidence to support the training directions they see as necessary. Their suggestions concerning a focus on evidence-based training, innovative models of mental health care delivery, the monitoring of trainee progress, the evaluation of the competencies, and residents’ role attainment will be read with interest by psychiatrist clinicians, psychiatrist educators, and trainees.
Dr Martin and colleagues call for further reflection and articulation of the core competencies necessary to produce a sophisticated general psychiatrist capable of providing care across the lifespan—a call that resonates with the directions discussed earlier in this editorial. Our current challenge is to find a training model that enhances generalist acquisition of these competencies and promotes the development of knowledge and recognition of colleagues who care for the subspecialty populations.
References
1. Leverette J, Persad E. Postgraduate education in psychiatry. In: Rae-Grant Q, editor. Psychiatry in Canada: 50 years, 1951–2001. Ottawa (ON): Canadian Psychiatric Association; 2001. p 163–84.
2. Leverette J, Leichner P, Meltzer S, Flynn L. Postgraduate education in Canadian psychiatry: 23 years later. Book of abstracts, 49th Annual Meeting of the Canadian Psychiatric Association. Ottawa (ON): Canadian Psychiatric Association; 1999. p 30–1.
3. Scheiber SC, Kramer TAM, Adamowski SE. The implications of core competencies for psychiatric education and practice in the US. Can J Psychiatry 2003;48:215–21.
4. Tuhan I. Mastering CanMEDS roles in psychiatric residency: a resident’s perspective. Can J Psychiatry 2003;48:222–4.
5. Martin L, Saperson K, Maddigan B. Residency training: challenges and opportunities in preparing trainees for the 21st century. Can J Psychiatry 2003;48:225–31.
Author(s)
1. Professor Emeritus, Department of Psychiatry, University of Western Ontario, London, Ontario.
2. Deputy Head and Chair, Division of Child and Adolescent Psychiatry, Queens University, Kingston, Ontario.
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