esidents Need to Know sychiatry in Canada ersad ostgraduate Education What Educators and R Approaches to P in P Edited by: John Leverette Gary Hnatko Emmanuel P Approaches to Postgraduate Education in Psychiatry in Canada: What Educators and Residents Need to Know fect in July 2008. The tools ficials in the provincial ministries raining (OTR) and Specialty T All of this serves to support the practice of orking Group on a National Strategy for Postgraduate Education These partners substantially contributed to the revisions to the . It is directed primarily to psychiatric educators and residency raining Requirements (STR) in Psychiatry which came into ef of Canada's (RCPSC) updated Objectives of This book is written in support of the Royal College of Physicians and Surgeons T them by presenting a toolbox approach to training paradigms. It is intended to enhance understanding of these documents and breathe life into psychiatry competencies required for contemporary practice. recognizing the variable resources available to Canadian departments of psychiatric residents in order that they may have in-depth knowledge of the exemplify strategies that will realize the RCPSC training objectives while program directors to assist in the implementation of RCPSC standards and to of postgraduate medical education in Canada, of community of educators in the medical and surgical disciplines, associate deans It will advance knowledge about the specialty of psychiatry to the broad competencies and practice of the sophisticated psychiatric generalist in Canada. The book will also help develop awareness about the breadth and depth of the Association's W many were extensively involved as members of the Canadian Psychiatric The contributing authors are representative experts and leaders in their field and of health and education and international psychiatric educators. in Psychiatry anchoring of the core competencies. RCPSC OTR and STR in Psychiatry including the definition and behavioural variety of settings in collaboration with others. the sophisticated general psychiatrist delivering care across the life span in a Approaches to Postgraduate Education in Psychiatry in Canada What Educators and Residents Need to Know Edited by: John Leverette, Gary Hnatko, Emmanuel Persad Books published by the Canadian Psychiatric Association represent the views and opinions of the individual authors and do not neccessarily represent the policies and opinions of the Canadian Psychiatric Association. Ó Copyright 2009 Canadian Psychiatric Association 141 Laurier Avenue West Ottawa ON K1P 5J3 ALL RIGHTS RESERVED Approaches to Postgraduate Education in Psychiatry in Canada: What Educators and Residents Need to Know ISBN 978-0-9699992-8-7 Editorial Manager Hélène Côte Copy Editors Jadranka Bacic Virgina St-Denis Candace Taylor Graphic Designer Smita Hamzeh Printed in Canada by Tri-graphic Printing Limited, Ottawa, Ontario. The editors wish to express their appreciation to their spouses, Katherine, Diane and Decima for their support during this project. Contents Contributors........................................................................................ xvii Foreword ............................................................................................. xix A message from the editors .................................................................xxi Chapter 1: The road to renewal in postgraduate education in psychiatry Introduction........................................................................................................... 1 The Working Group on a National Strategy for Postgraduate Education in Psychiatry (NSPGE) priorities..............................................................................2 Shifting the culture by consensus .........................................................................3 The present and the future ..................................................................................11 Acknowledgements............................................................................................. 12 Chapter 2: The evolution of training in general psychiatry and its relationship to subspecialization within psychiatry Introduction......................................................................................................... 15 Curriculum, training guidelines, assessment methods and examinations ...........16 History and background prior to July 1, 2008................................................16 General Standards for Accreditation (GSA) ..................................................16 The 1970s and 1980s......................................................................................17 The 1990s....................................................................................................... 17 The early 2000s.............................................................................................. 18 Evaluation of training.....................................................................................19 International training in psychiatry ....................................................................21 United States of America ...............................................................................21 United Kingdom............................................................................................. 22 vi Approaches to Postgraduate Education in Psychiatry in Canada Australia and New Zealand............................................................................23 South Africa ................................................................................................... 24 Europe ............................................................................................................ 25 Analysis ......................................................................................................... 25 What was happening in psychiatry to necessitate consideration of change? ......26 Royal College expectations.................................................................................27 What is a general psychiatrist and what should he/she be able to do?................29 The relationship of subspecialization to generalism ...........................................30 Chapter 3: General considerations in psychiatric education Introduction......................................................................................................... 35 The characteristics of the learner ........................................................................39 Principles of adult education...............................................................................42 Success in curriculum change (not just training the trainer)...............................44 Culture and context............................................................................................. 47 CanMEDS competencies ....................................................................................48 Concurrent and longitudinal training: integration versus fragmentation ............49 Lessons from accreditation .................................................................................50 What about the future?........................................................................................ 52 Chapter 4: Basic clinical training Introduction......................................................................................................... 57 Review of the Royal College of Physicians and Surgeons of Canada (RCPSC) Objectives in Training (OTR)/Specialty Training Requirements (STR) in Psychiatry............................................................................................................ 59 Training targets/detailed goals and objectives ....................................................61 Training in medical–surgical rotations during basic clinical training in psychiatry....................................................................................................... 61 Contents vii Training in psychiatry during basic clinical training in psychiatry................62 Suggested strategies/enabling objectives ............................................................62 Table 4.1 Basic template for PGY1 medical rotations objectives ............63 Table 4.2 PGY1 rotation objectives for emergency psychiatry................65 Medical–surgical training...............................................................................66 Psychiatry training ......................................................................................... 67 Other considerations .......................................................................................... 67 Conclusion .......................................................................................................... 68 Chapter 5: Psychotherapies Introduction......................................................................................................... 71 Review of RCPSC OTR/STR .............................................................................72 Therapeutic alliance .......................................................................................73 Training targets/detailed goals and objectives ....................................................74 Proficiency ..................................................................................................... 74 Supportive therapy ...................................................................................75 Crisis intervention .....................................................................................75