Margariti M, Kontaxakis V, Ploumpidis D
Ast. Professor of Psychiatry, University of Athens.
Em. Professor of Psychiatry, University of Athens.
Psychiatriki. 2017 Jan-Mar;28(1):15-18. doi: 10.22365/jpsych.2017.281.15.
The reform and development of psychiatric services require, in addition to financial resources, reserves in specialized human resources. The role of psychiatrists in this process, and at reducing the consequences of mental morbidity is evident. Psychiatrists are required to play a multifaceted role as clinicians, as experts in multidisciplinary team environments and as advisors in the recognition of public needs in mental health issues, as teachers and mentors for students and other health professionals, as researchers in order to enrich our knowledge in the scientific field of psychiatry, and as public health specialists in the development of the mental health services system. This multifaceted role requires the continuous education of modern psychiatrists, but above all a broad, substantial and comprehensive training regime in the initial stage of their professional career, that is to say during specialization. Training in Psychiatry, as indeed has happened in all other medical specialties, has evolved considerably in recent decades, both in the content of education due to scientific advances in the fields of neurobiology, cognitive neuroscience, genetics, psychopharmacology, epidemiology and psychiatric nosology, and also because of advances in the educational process itself. Simple apprenticeship next to an experienced clinician, despite its importance in the clinical training of young psychiatrists, is no longer sufficient to meet the increased demands of the modern role of psychiatrists, resulting in the creation of educational programs defined by setting and pursuing minimum, though comprehensive educational objectives. This development has created the global need to develop organizations intended to supervise training programs. These organizations have various forms worldwide. In the European Union, the competent supervising body for medical specialties is the UEMS (European Union of Medical Specialities) and particularly in the case of the psychiatric specialty, the European Board of Psychiatry. In the US, the supervising bodies are the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology, in the United Kingdom the Royal College of Psychiatrists, in Canada the Royal College of Physicians and Surgeons, etc. In our country, the debate on the need to reform the institutional framework for Psychiatric training has been underway since the mid-90s, with initiatives especially by the Hellenic Psychiatric Association, aiming to raise awareness and concern among psychiatrists while responding to requests from competent central bodies of the state, as well as establishing Panhellenic training programs for psychiatric trainees and continuing education programs. But what is the situation of the educational map in the country today, what would be the objectives, and how might we proceed? These questions we will try to answer in an effort initiated by Hellenic Psychiatric Association (HPA) and the journal "Psychiatriki" with the publication of thematic articles starting by presenting in the next issue of "Psychiatriki"a comparative study of the training in the specialty of psychiatry at two distinct periods of time (2000 and 2014). These time-frames are of great importance, since the first is a period that in retrospect can be considered as wealthier yet missing robust priorities, while the second, at the peak of the economic crisis, constitutes a difficult environment with limited resources. Already in the year 2000, psychiatric residency training in our country had major difficulties due to its outdated framework and its fragmentation. All areas in which training is assessed (clinical experience, theoretical training and training in psychotherapy exhibited inadequacies and limited convergence with European golden standards, in the absence of a plan and the implementation of a national education curriculum. Certain university clinics constituted an important exception, though the bulk of the country's future psychiatrists were lagging behind in educational opportunities. Fifteen years later and under the weight of the consequences of the financial crisis, the institutional framework has not yet changed, and the overall situation seems to have worsened dramatically. Nevertheless, there are positive aspects to be evaluated, reinforced, and utilized in order to minimize the adverse effects of the economic crisis and lay sound foundations for the future. Preparations of a national framework is imperative today more than ever and initiatives to amend the legislation on medical specialties as far as it concerns the field of Psychiatry, could benefit from the evidence, from the willingness of the trainers and trainees concerned, as well as from the elaborated proposals of the Hellenic Psychiatric Association (HPA).
精神科服务的改革与发展,除了资金之外,还需要专业人力资源储备。精神科医生在这一过程中以及在减轻精神疾病后果方面的作用是显而易见的。精神科医生需要扮演多方面角色,如临床医生、多学科团队环境中的专家、心理健康问题公共需求识别方面的顾问、学生和其他卫生专业人员的教师和导师、丰富精神病学科学领域知识的研究人员以及精神卫生服务体系发展方面的公共卫生专家。这种多方面角色要求现代精神科医生持续接受教育,但最重要的是在其职业生涯初期,即在专科培训阶段接受广泛、充实且全面的培训体系。与其他所有医学专科一样,近几十年来,精神病学培训在教育内容方面因神经生物学、认知神经科学、遗传学、精神药理学、流行病学和精神病学分类学等领域的科学进展而有了很大发展,在教育过程本身也有进步。仅在经验丰富的临床医生旁进行简单学徒式学习,尽管对年轻精神科医生的临床培训很重要,但已不足以满足现代精神科医生角色增加的需求,因此产生了通过设定和追求最低限度但全面的教育目标来界定的教育项目。这一发展使得全球都需要建立旨在监督培训项目的组织。这些组织在全球有多种形式。在欧盟,医学专科的主管监督机构是欧洲医学专科联盟(UEMS),特别是在精神病学专科方面,是欧洲精神病学委员会。在美国,监督机构是毕业后医学教育认证委员会(ACGME)和美国精神病学与神经学委员会;在英国是皇家精神科医学院;在加拿大是皇家内科医师与外科医师学院等。在我国,自90年代中期以来就一直在进行关于改革精神病学培训制度框架必要性的辩论,希腊精神病学协会尤其积极主动,旨在提高精神科医生的认识和关注度,同时回应国家主管中央机构的要求,并为精神病学实习生建立全希腊培训项目以及继续教育项目。但我国如今的教育版图状况如何、目标是什么以及我们该如何推进?希腊精神病学协会(HPA)和《精神病学》杂志发起了一项努力,将通过在下一期《精神病学》上发表专题文章来尝试回答这些问题,首先会呈现精神病学专科在两个不同时期(2000年和2014年)培训情况的比较研究。这两个时间框架非常重要,因为第一个时期回顾起来可被视为资源更丰富但缺乏有力重点,而第二个时期处于经济危机高峰期,是资源有限的艰难环境。早在2000年,我国的精神科住院医师培训就因框架过时和碎片化而面临重大困难。在评估培训的所有领域(临床经验、理论培训和心理治疗培训)都存在不足,与欧洲黄金标准的融合有限,且缺乏国家教育课程计划和实施。某些大学诊所是重要例外,但该国未来的大多数精神科医生在教育机会方面滞后。十五年后,在金融危机后果的重压下,制度框架尚未改变,总体情况似乎急剧恶化。然而,仍有一些积极方面需要评估、强化并加以利用,以尽量减少经济危机的不利影响,并为未来奠定良好基础。如今比以往任何时候都更迫切需要制定国家框架,修改医学专科立法中涉及精神病学领域的举措,可以借鉴相关证据、培训人员和学员的意愿以及希腊精神病学协会(HPA)精心制定的提议。