Child And Adolescent Psychiatry Training Research Articles

Are Psychiatrists Trained to Address the Mental Health Needs of Young People Transitioning From Child to Adult Services? Insights From a European Survey.

BackgroundIn mental health, transition refers to the pathway of young people from child and adolescent to adult services. Training of mental health psychiatrists on transition-related topics offers the opportunity to improve clinical practice and experiences of young people reaching the upper age limit of child and adolescent care.MethodsNational psychiatrist's organizations or experts from 21 European countries were surveyed 1/ to describe the status of transition in adult psychiatry (AP) and child and adolescent psychiatry (CAP) postgraduate training in Europe; 2/ to explore the amount of cross-training between both specialties. This survey was a part of the MILESTONE project aiming to study and improve the transition process of young people at the service boundary.ResultsTransition was a mandatory topic in the AP curriculum of 1/19 countries (5%) and in the CAP curriculum of 4/17 countries (24%). Most topics relevant for transition planning were addressed during AP training in 7/17 countries (41%) to 10/17 countries (59%), and during CAP training in 9/11 countries (82%) to 13/13 countries (100%). Depending on the training models, theoretical education in CAP was mandatory during AP training in 94% (15/16) to 100% of the countries (3/3); and in AP during CAP training in 81% (13/16) to 100% of the countries (3/3). Placements were mandatory in CAP during AP training in 67% (2/3) to 71% of the countries (12/17); and in AP during CAP training in 87% (13/15) to 100% of the countries (3/3).Discussion and ConclusionSpecific training about transition is limited during CAP and AP postgraduate training in Europe. Cross-training between both specialties offers a basis for improved communication between child and adult services but efforts should be sustained in practical training. Recommendations are provided to foster further development and meet the specific needs of young people transitioning to adult services.

Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry.

This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.

A comparison of child and adolescent psychiatry in the Far East, the Middle East, and Southeast Europe.

Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies. This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data. This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals. There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy.

Reforming cap training in latvia: Nowhere to go but up

There is still substantial variation in the amount, structure and quality of child and adolescent psychiatry (CAP) training across European countries, both in the training process of general adult psychiatry and CAP specialists. Inconsistency, scarcity and low quality of CAP exposure has been consistently identified by psychiatric trainees as one of major issues in organization of training. In the decades of independence, following the collapse of the Soviet Union, Latvia has witnessed a gradual decline in the number of CAP specialists in the country due to chronically low recruitment rates, that has subsequently led to a critical human resource deficit in the field, and rapid deterioration of availability and quality of CAP care. Only since the year 2018, when the normative regulation, structure and contents of CAP training in Latvia have been significantly reformed, there was a change in recruitment trends, that gives hope for resolution of the human resource crisis in the CAP field in the years to come. In this talk the author will share his experience of redesigning the CAP training program in Latvia, and discuss the motivations, challenges and successes one might face while trying to improve CAP training in a particular European country.DisclosureNo significant relationships.

Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients.

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs).Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country.Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with “awkward” and “uncomfortable” the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each).Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

Child and adolescent psychiatry training in Nepal: early career psychiatrists\u2019 perspective

BackgroundNepal is a developing low-income country in Southeast Asia. There is a huge burden of child and adolescent mental health (CAMH) in Nepal which has a population of around 29 million and 40–50% of the population comprises of children and adolescents. Child and Adolescent Psychiatry (CAP) has not been formally recognized as a subspecialty in Nepal and there is no standardized curriculum for CAP training. The objectives of the survey were to identify the current status of training, shortfalls and to explore the training experiences of early career psychiatrists (ECPs) in Nepal.MethodsThe participants were ECPs in Nepal. An online questionnaire was created consisting of 20 questions including 3 questions requiring an answer indicating a level of agreement scored on a ten-point scale. Questionnaire using google form was e-mailed with the uniform resource locator (URL). Respondents anonymously answered the questions. The survey was open from 01/01/2019 to 01/04/2019.ResultsResponse rate was 83.69%. Around 42% (n = 32) were trainees in Doctor of Medicine (MD) Psychiatry and 58% (n = 45) of respondents had completed their MD Psychiatry. More than half of the ECPs had not received formal training specific to CAP. Seventy percent (n = 54) ECPs reported that their current workplace did not have a specific unit to address psychological problems in children and adolescents. However, 62% (n = 48) of ECPs came across 10 CAP cases per week. On a ten-point scale, mean score of ECPs confidence in diagnosing, management and overall confidence in CAP cases were 5.18 ± 1.56, 4.58 ± 1.59 and 4.67 ± 1.62 respectively. Fifty-four percent (n = 42) of respondents rated their training as limited and 74% (n = 57) of them wanted additional training in CAP. Psychological intervention, psychotherapy and a fellowship course were the additional training most of the ECPs wanted to receive.ConclusionDespite significant exposure to CAP patients in daily practice, ECPs self-evaluated their training as inadequate and there is no standardized CAP training program in Nepal for ECPs. The desire of ECPs to receive additional training in CAP is highly encouraging and positive. We advocate for the development and incorporation of CAP training in current psychiatry training to fulfill these unmet training needs in Nepal.

Child and adolescent psychiatry training in Brazil, Argentina, Uruguay and Chile: current panorama and future challenges.

Mental disorders affect approximately 10-15% of children and adolescents worldwide. In South America these numbers are probably higher due to poverty and adverse life events that frequently affect this region. The availability of qualified services and well-trained professionals to care for those children are by far insufficient. The aim of this study was to assess and describe child and adolescent psychiatry (CAP) training in Brazil, Argentina, Uruguay, and Chile, to support the development and strengthen training standards. The coordinators of CAP residency programs in Brazil, Argentina, Uruguay, and Chile were invited to answer an online questionnaire about the characteristics of their training programs. Twelve programs from Brazil, three programs from Chile, two from Argentina, and one from Uruguay completed the questionnaires. In the last three countries, CAP is recognized as an independent specialty, while in Brazil it is considered a subspecialty of psychiatry. None of the countries have a national guideline for CAP residency training. Recently, there has been an increase in the number of professionals interested in pursuing a formal CAP training. This is the first study aiming to evaluate the current scenario of CAP training in South America. The results point to a great potential in the evaluated programs, but also to the need for homogeneous criteria for CAP training and evaluation of residents. A more efficient communication among programs would be an enriching strategy for their development, which may be facilitated by the results of this study.

Child and adolescent psychiatry training and mental health care in Southeast Europe.

There is very limited information available on child and adolescent psychiatry (CAP) training in the Southeast European (SEE) region. The objective of this study was to fill in this gap by presenting descriptive data on CAP training and national mental health services for children and adolescent in 11 SEE countries. On the initiative of World Psychiatric Association-CAP section, national CAP association boards from each SEE country allocated one member to the Consortium on Academic Child and Adolescent Psychiatry in SEE (CACAP SEE) in 2018. Using an internally distributed questionnaire, CACAP SEE members provided information on the CAP training structure and mental health care. Ten out of eleven SEE countries recognized CAP as a separate specialty. Duration of training did not differ much between the SEE countries. Other components were more variable (availability of rotations, overseas electives, and inclusion of psychotherapy). Ten countries were familiar with the CAP requirements of the European Union of Medical Specialists (UEMS-CAP) and five provided the training in accordance with it. Nine countries had less than 36 board-certified child and adolescent psychiatrists practicing in the country. The number of general psychiatrists treating children and adolescents with mental disorders was higher than the number of CAP specialists in five of the countries. Although CAP was recognized as a separate specialty in the vast majority of SEE countries, there was a substantial variation among them in available CAP training. In most of the countries, there is a considerable lack of CAP specialists for several reasons, including loss of trained specialists to other countries.

Child and adolescent psychiatry in the Far East: A 5‐year follow up on the Consortium on Academic Child and Adolescent Psychiatry in the Far East (CACAP‐FE) study

Data pertaining to child and adolescent psychiatry (CAP) training systems are limited as extant research has mostly been derived from one-time data collection. This 5-year follow-up survey collects updated information on CAP training systems in the Far East, allowing for the tracking of system changes over the past 5 years. Data were obtained from 18 countries, or functionally self-governing areas, in the Far East, 17 of which were also included in the original study. An online questionnaire was completed by leading CAP professionals in each country. Questions were expanded in the present study to capture the contents of CAP training. When compared to data from the original study, there has been progress in CAP training systems in the last 5 years. Specifically, there has been an increase in the number of countries with CAP training programs and national guidelines for the training. In addition, the number of CAP departments/divisions affiliated with academic institutions/universities has increased. Findings from 12 of 18 countries in the present study provide data on clinical contents. All informants of the present study reported the need for more child and adolescent psychiatrists and allied professionals. Despite progress in CAP training systems over the last 5 years, the need for more professionals in child and adolescent mental health care in all the relevant areas in this region have yet to be adequately addressed. Continued national efforts and international collaborations are imperative to developing and sustaining new CAP training systems while facilitating improvements in existing programs.

P100 – 2260: Child and adolescent psychiatry training: The experience of UK neurodisability trainees

Objective Neurology and neurodisability trainees should gain child and adolescent psychiatry (CAP) experience equivalent to three months during their training programme. The aim of our survey was to gather information and analyse this training in the current trainees. Methods A questionnaire based survey which was sent out to 26 neurodisability trainees in the UK via email. Total 10 questions were asked relating to their CAP training experience. Results 6/26 trainees responded (61.5%). The neurodisability grid programme was of two years for 60% of the trainees. Most of them (73%) had already started their neuropsychiatry placement. Only 6% found it easy to access the training, and 26% thought that it was very difficult. 15% had to have a separate honorary contract with the child and family mental health (CAMHS) department. None was on a separate 3 month contract. In terms of satisfaction, one third seemed dissatisfied for various reasons and only 6% were very satisfied. Comments included “CAMHS team members are reluctant to have the neurodisability trainee in the clinic unless it was a pre-school child with possible developmental problems”; “No learning disability CAMHS consultant in the service”; “CAMHS services were not sure of the competencies needed to be achieved”; “Difficult to get the placement and the service was quite stretched”; “Spent a lot of time chasing sessions”; “CAMHS consultants should be involved while submitting the grid posts to RCPCH”. Conclusion CAP services in the UK are reported to lack the expertise and resources required to provide comprehensive assessments and ongoing management for those with developmental disabilities. Our survey highlights the need for these services to understand the competencies neurology and neurodisability grid trainees need to achieve in CAP. Equally, the respective CSACs should work in partnership with the child mental health CSAC to design a smooth and well-structured training programme.

US Military Child and Adolescent Psychiatry Training Programs and Careers of Military Child Psychiatrists.

Military child and adolescent psychiatry (CAP) fellowship programs offer educational experiences universal to all civilian training programs in the USA. They also offer unique training opportunities not found in civilian CAP fellowships in order to prepare graduates to serve the needs of military families. Military-specific curricula and exposures prepare trainees to address various issues faced by military families, in contending with frequent military moves, parental deployments, and disrupted social ties. Curricula are also designed to provide the psychiatrist with a greater understanding of the rigors of military service. CAP training and subsequent assignments prepare military psychiatrists for diverse career paths in the military environment. CAP military careers often include duties in addition to treating patients. Administrative roles, academic teaching positions, as well as school consultation positions are all career options available to military CAP.

Child and adolescent psychiatry in the Far East.

Despite the general consensus on the importance of youth mental health, the scarcity of child and adolescent mental health services is prominent all over the world. Child and adolescent psychiatry (CAP) postgraduate training can play a pivotal role in increasing access to youth mental health services. In comparison to Europe and North America, however, little is reported regarding CAP training in the Far East, one of the most dynamic and rapidly developing world regions with a very young population. This paper presents an original study on the current status of academic child and adolescent psychiatry training across the Far East. We collected data from 17 countries in the Far East using an internally distributed questionnaire to the Consortium members invited for this study, consisting of leading academic child and adolescent psychiatrists in each country. Based on informants' input, we found an overall underdevelopment of CAP postgraduate training systems despite CAP's recognition as a subspecialty in 12 of 17 of the nations or functionally self-governing areas in the Far East. Paucity of official guidelines for CAP training was also evident. All informants reported a need for additional child and adolescent mental health professionals. There seems to be several obstacles to the development of CAP postgraduate training in the Far East, including stigma towards mental health issues and lack of funding. International collaboration is desired to develop evidence-based and culture-tailored CAP training systems.

Evaluating the utility, reliability, and validity of a resident performance evaluation instrument.

The primary goal of this project was to create and evaluate the utility, validity, and reliability of an instrument assessing resident performance during child and adolescent psychiatry (CAP) training. In three stages, the instrument was developed and evaluated for utility in assessing skills critical to CAP. Items on the Global Assessment Evaluation (GAE) were derived from the six core competencies identified by the American College of Graduate Medical Education (ACGME). Secondary goals included producing an instrument that could be used by other CAP training programs and describing a process that could be followed by training programs to create their own assessment instruments. Faculty members developed a CAP resident performance evaluation instrument. In a three-stage process, faculty utilized the tool to evaluate residents during and after rotations. Statistical findings guided revisions to improve the utility and reliability of the instrument. For the final version of the GAE, intra-class correlation coefficients were calculated to assess inter-rater reliability, and Principal Components Analysis provided further insight into the dimensions of resident assessment. The final version of the GAE showed overall and construct validity by capturing significant differences among residents and matched faculty members' overall impressions of resident performance. Intra-class correlation coefficient values for the overall score (0.945) and individual scales showed good reliability. Resident performance was not correlated with rotation site or model of care. The GAE has proved a valuable instrument in tracking the progress, strengths, and weaknesses in resident performance over the course of training. Data from multiple evaluations over time provide useful information about resident performance in a way that one or few evaluations does not. This finding is consistent with the practice of semiannual reviews and the new Clinical Competency Committees, both of which are required by the ACGME.

Improving Child and Adolescent Psychiatry Education for Medical Students: An Inter-Organizational Collaborative Action Plan

A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Trainee experiences of Child and Adolescent Psychiatry (CAP) training in Europe: 2010–2011 survey of the European Federation of Psychiatric Trainees (EFPT) CAP working group

The objective of this study was to investigate trainee experiences of Child and Adolescent Psychiatry (CAP) training across Europe in the following domains: (A) structure and organisation of training; (B) training quality and content; and (C) working conditions and recruitment. CAP trainee representatives were contacted via email across 34 countries in Europe using the European Federation of Psychiatric Trainees (EFPT) email list to complete a survey on CAP training in 2010-2011. The European Union of Medical Specialties CAP group and trainees at the 2011 EFPT forum validated the survey data. Full surveys were submitted by 28 of the 34 countries who have national CAP training schemes. These 28 countries are subject to the following further analysis. 7/28 countries (25 %) have a core common trunk in general psychiatry before trainees specialise in CAP. All countries bar one have national training standards for CAP. Training standards are implemented in practice to a variable extent. There is a CAP-specific theoretical education programme and national CAP conference in 25/28 countries (89 %). Supervision occurs at least weekly in 19/28 countries (68 %); emergency duty supervision is available in 18/28 (64 %) countries; educational supervision is available in 13/28 countries (46 %). Psychotherapy training is obligatory in 19/28 countries (68 %). Research training is obligatory in 8/28 countries (29 %). Sub-specialty experience is extremely variable. Recruitment into CAP is a problem in 19/28 countries (68 %). Training experiences in CAP varies widely across European countries.

AS34-01 - Training in Europe. different systems and similar challenges

“Children are not simply small adults”, states the UEMS CAPP training Logbook. Nevertheless, the core identity of Child and Adolescent Psychiatry (CAP) has been at stake for the last few decades in Europe. CAP is now an independent specialty in 23 countries and a subspecialty in 8 countries, but 5 countries do not have any structured CAP training. Training differences are marked even within the EU member countries, and are not only in terms of content of training programs, but are also relevant to duration, trainee selection, and graduation procedures. More importantly, while almost half of the countries have integrated structured psychotherapy training as a full component of CAP training, the other half has not. Within the UEMS, CAP psychiatrists used to be represented in the section and board of Psychiatry until recently: it is only in 1994 that UEMS established the European Child and Adolescent Psychiatry/Psychotherapy (CAPP) Section and Board. The idea behind this initiative to split among UEMS was to promote high standards of mental health care for children across Europe, both directly and indirectly, by establishing standards and improving the quality of postgraduate CAP training, with a particular focus on training in psychotherapy. The UEMS CAP Board published a Training Logbook, which has already proven to be important in helping new EU member countries to develop their own training program in CAP. We will discuss the discrepancies and similarities in CAP training programs across Europe, and the challenges that have arisen through harmonization processes.

AS34-03 - How we know what we know now about training in Europe? current opportunities for European Trainees

Background, Aims and Objectives • The European Federation of Psychiatric Trainees is an independent federation of psychiatric trainees associations. 37 Countries were represented at the annual Forum in 2011. • A Child and Adolescent Psychiatry (CAP) Working Group meets at this annual forum to discuss issues of relevance to CAP trainees. At the 2009 meeting, the group reflected on difficulties in collecting data on training across Euro. Methods 1. Ten item survey was was circulated to trainee representatives to the European Federation of Psychiatric Trainees who attended the annual Forum in 2009. 2. Following this pilot study, a much larger study was conducted from 2010–2011. Results • EFPT survey: In 2009–2010 pilot survey - 27 countries responded. • The EFPT CAP group expanded this in 2010–2011. This survey collected data from 34 countries, 28 of whom provided full data-sets in the following domains: ○ Structure and organisation of training; ○ Training quality and content; and ○ Working conditions and recruitment . ○ Statistical analysis was performed on the data to achieve overall rankings of CAP training quality. Conclusions • This symposium will look at developing national and international surveys. Results from two completed EFPT CAP studies and ongoing work presented. These studies add significantly to extant literature- it is clear that training across Europe is extremely variable. • This symposium will also highlight current opportunities for European Trainees. International collaborations and opportunities for trainees will be explored, and we will consider the role of trainees in international organisations

P01-578 - Training in child and adolescent psychiatry (CAP) in Europe: 2010–11 survey by the European Federation of psychiatric trainees CAP working group

IntroductionThe education and training of doctors specialising in Child and Adolescent Psychiatry (CAP) varies substantially across Europe. There is a paucity of information available about training quality. This prompted an initial training survey led by Dr E Barrett (2010) which was expanded upon by the CAP working group in the 2010 EFPT international forum in Dubrovnik to create ‘country reports’ for 2010–2011.ObjectivesThe objectives of this study were to collect information relating to key aspects of CAP training programmes in Europe in a systematic way in order to start a ‘Training Database’ that can be held centrally by the EFPT. Information will be added to the database every year following EFPT annual international meetings.AimsWe aim to better understand the training structures in CAP across europe to help inform best practice standards for training.MethodsA pro-forma word document was emailed to all EFPT CAP contacts: there were 20 contacts emailed.ResultsSo far we have a response rate of over 60% and we are continuing to collect and collate relevant data. This survey highlighted a large variation in CAP training across Europe. It represents the basis for systematic data collection on an international level, and will help focus on areas where CAP training could be improved.ConclusionsThis survey highlights a large variation in CAP training across Europe. It represents the basis for systematic data collection on an international level, and will help focus on areas where CAP training could be improved.

Models of Integrated Training in Psychiatry and Child and Adolescent Psychiatry

Previous studies indicate declining interest in child and adolescent psychiatry (CAP) as a career choice during psychiatry residency training. Programs have developed integrated training in psychiatry and CAP as a means to address the workforce shortage in CAP, but little is known about the number or nature of these training tracks. A survey was conducted among all program directors of Accreditation Council for Graduate Medical Education (ACGME) accredited CAP residency training programs in the United States. Those reporting integrated training with their affiliated psychiatry training programs were contacted for in-depth interview. Integrated research programs were not included in this survey. Of the 115 ACGME accredited CAP programs at the time of the survey, 93 responded and 33 of those indicated having some form of integrated training in psychiatry and CAP. Only seven programs identified residents in integrated training in the first year of residency. There is no consensus regarding a definition of integrated psychiatry and CAP training. Even though integrated training may provide opportunities for recruitment and retention of child and adolescent psychiatrists, few programs currently offer fully integrated training. This article describes several potential models for integrated training tracks, identifying factors to consider when developing such pathways.

Child and adolescent psychiatry training in Europe: differences and challenges in harmonization

To investigate the current situation of Child and Adolescent Psychiatry (CAP) training in European countries. In addition, current agenda of different organizations in order to harmonize the training across Europe are reported. In order to collect data for this descriptive documentation on CAP training in European countries, we have communicated with "European Union of Medical Specialists Section on Child and Adolescent Psychiatry" (UEMS-CAP) and "The European Federation of Psychiatric Trainees" (EFPT) representatives of each country via e-mail. In addition, we used UEMS and EFPT annual forum minutes and web sites of national CAP societies to validate the data. The structure of CAP training has many differences between 34 European countries. For instance, in 32.4% of the countries, CAP is not a specialty in its own right but is mostly linked to general psychiatry. After medical school, the minimum training duration to become a CAP specialist ranges between 12 and 96 (mean: 59.71 +/- 17.1) months. While, a trainee should pass an examination to begin CAP training in 37.9% of the countries, 64.7% have an examination to graduate and both is the case in 29.7% of the countries. By the year 2006, European countries still have large differences in the structure of CAP training. It is assumed that the same holds true for content of training, which was not the focus of this documentation. UEMS-CAP, ESCAP (European Society of Child and Adolescent Psychiatry) and EFPT are the major bodies that have to manage the harmonization of CAP training across Europe. The obligatory conditions of a fruitful training, the high quality of teachers and teaching facilities, essential ingredients of an efficient training programme, are prone to be determined by evidence-based evaluations in the process of harmonization.