Psychiatric training for the next generation

Abstract

The assertion that British psychiatry faces an identity crisis and a devaluation of medical expertise 1 has prompted wide discussion about the future of the profession.2-4 However, a solution capable of addressing the complex and wideranging issues involved seems elusive. What is clear is that the next generation of psychiatrists need to be strong medical leaders and pioneers for change that results in better patient care. In order to achieve this, it is necessary to consider whether postgraduate training in psychiatry is capable of shaping the psychiatrists of the future and what changes need to be put in place to achieve this. Changes to postgraduate medical educationCurrent attention on the future of postgraduate medical education make it timely to consider what reforms could be beneficial to psychiatry specifically. Postgraduate medical training has undergone a significant period of change over the past 5 years under the Modernising Medical Careers (MMC) programme (www.mmc.nhs.uk) and is likely to undergo further change under the Shape of Training review. 5 The current structure and delivery of postgraduate training in psychiatry is summarised in Fig. 1.Government proposals for changes in postgraduate medical training have recently been outlined in an initial White Paper and subsequent policy accompanying the health bill. 6,7 Under new arrangements, postgraduate training of doctors, as well as all other health professionals, will be administered by Local Education and Training Boards (LETBs), with national oversight being provided by the newly formed Health Education England (HEE). Health Education England will replace Medical Education England (MEE), which is the independent advisory nondepartmental body set up following Sir John Tooke's inquiry into MMC.8 Health Education England will provide national leadership and oversight as well as being responsible for the allocation of education and training resources. 7,9 It should be noted that the HEE arrangements will apply only in England and not in the devolved administrations of the UK, although HEE state that because education and training issues operate within a UK-wide context they will build strong relationships with partners in Scotland, Wales and Northern Ireland to ensure consistency and coherence. 9The future picture is likely to be one of greater involvement of provider organisations (namely National Health Service (NHS) trusts and other organisations delivering healthcare) in the commissioning and provision of postgraduate training under the new LETB/HEE arrangements; with postgraduate medical education and training becoming more closely aligned with the training of other healthcare professionals. The risks are plain. Trusts and healthcare providers may have little incentive to commission the appropriate number of psychiatrists and may opt for the training of other cadres of staff instead. Indeed, it is probable that trusts may wish to influence the content and structure of training without reference to the long-term needs of patients with mental i...

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