The training of Psychiatry resident: Summary of the discussion table held during the XXII National Congress of Psychiatry. Spain, 2019

Dear Editor,

In accordance with the Union Européenne des Médecins Spécialistes (UEMS, European Union of Medical Specialists),the quality of medical care and expertise of healthcare professionals is directly related to the quality of their training.¹

Competency based training (CBT) has become the dominant approach in training healthcare specialists^2,3 and has been used in the United Kingdom, the United States and Canada.^4–6

This training model is the one recommended by the psychiatry Section of the UEMS⁷. The World Psychiatric Association also recommends assessment based on competences as part of the training programmes in psychiatry which seek excellence.⁸

Against this backdrop, during the 22nd National Psychiatry Congress (Bilbao, 2019) a round table debate took place where the authors of this letter participated as speakers. Among the attendees were resident tutors and psychiatrists interested in the subject matter. During the course of the forum the 2 representative from Spain in the UEMS Psychiatric Section were present.

The aim of the round table was to debate competency based training (CBT), the previous experience applying this model in hospitals in Spain and the opportunities of extending it to Specialist Training in Psychiatry in Spain. The following conclusions were reached.

Competency-based training in the Spanish resident system

In Spain there was no CBT background in the training of internal resident doctors (MIR for its initials in Spanish) until the period between 2008–2012 with the creation, implementation and assessment of a competency based model in the Hospital Universitario Cruces (Basque country).⁹ During the application of this model in all hospital specialties (including Psychiatry), it was determined that a need existed for a definition of professional profiles for the healthcare professionals, together with the integration of specific technical scientific competences for each speciality with common core subject competences in all specialities, such as ethics, professionalism, practice based on the healthcare system, and team work.

Application of the CBT in the psychiatry MIR programme

The termination of the core subject decree has delayed the appearance of a regulatory framework to support specialised healthcare competency based training in Spain. This has provided to be an obstacle for the extension of this model to the different teaching units, and to research and contextualisation in the Spanish environment. Despite these delays, with the CBT international recommendations and experience, it is hoped that this will be established in the near future in Spain.

Towards a CBT culture

In the expectation of a regulatory framework, the extension of a CBT culture, through education to all levels (tutors, residents, teaching units and healthcare personnel) would enable greater facility in the transition to this type of model and would improve the training of current resident physicians.

At present both the Spanish Society of Specialist Healthcare training (SEFSE) and the Spanish Society of Psychiatry (SEP) have made efforts at this level. The former has organized annual congresses for tutors and study managers and the latter has joined in the petition for a new tutor statute to guarantee recognition and accreditation of this figure, as well as recertification of psychiatry professionals. A reference book is also being created for the training of resident doctors and tutors based on competences.

During the debate the following questions were raised by the public:

• 1

  The current assessment system is unable to reward professionals of excellence and hinders non concession of the title of specialist to resident doctors who do not achieve minimum objectives. To facilitate these processes, organised copies and forms of all resident assessment processes have to be made available by tutors and teaching units.

• 2

  The teaching units and psychiatric services must provide quality markers in health education as part of hospital management.

• 3

  It is important to specify the role and participation of other social agents in CBT implementation.

Conflict of interests

Daniel Martínez-Uribe, Jon-Iñaki Etxeandia-Pradera, Julio Bobes García, Margarita Sáenz-Herrero and Eduardo-Jesús Aguilar García-Iturrospe have no conflicts of interest to declare.

Jesús Morán-Barrios and Pilar Ruiz de Gauna participated in the training, research and dissemination of the competency based training in different institutions in Spain.