Training Issues in Psychiatry in Canada

Abstract

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.