Margariti M, Papageorgiou Ch
1st Department of Psychiatry, National & Kapodestrian University of Athens, Medical School, Eginition Hospital, Athens, Greece.
Psychiatriki. 2017 Apr-Jun;28(2):111-119. doi: 10.22365/jpsych.2017.282.111.
Modern educational programs for specialization in psychiatry should follow the developments in psychiatric science, both in the part of acquired knowledge about mental disorders and their treatment, as well as in the part of clinical practice in the diverse spectrum of modern psychiatric services. In Greece, the institutional framework for psychiatric training during specialization has yet to modernize and conform to European standards. For the moment, it is covered by a 1994 Presidential Decree, which briefly describes the time of specialization in psychiatry and the duration of clinical practice in the relevant educational subjects. This study presents a comparative analysis of training in the specialty of Psychiatry in two distinct periods (2000 vs 2014). Already by the year 2000, psychiatric training showed many structural weaknesses. The areas of clinical experience, theoretical and psychotherapeutic training have shown wide divergences among training centers, and limited potential for convergence with European standards under the existing framework. Important exceptions were certain university clinics, with the bulk of future psychiatrists in the country falling short of educational benefits. Fifteen years later and under the burden of the consequences of the economic crisis, the institutional framework has not yet changed, and the overall situation seems to have deteriorated dramatically. The number of training centers offering full specialization and the number of psychiatrists who receive training increased in reverse proportion to the number of specialized psychiatrists employed in hospitals, which has been drastically reduced due to restrictive measures on staff recruitment. Almost all training indicators show deterioration, but mainly the area of theoretical training shows the most dramatic degradation. Nevertheless, it is noteworthy that nowadays several psychiatric clinics endeavor to develop training programs in conjunction with psychiatric services not under their own administration, a practice not provided for in the current legislative framework. At the same time, there is an increase in the number of training centers that adopt some statutory procedures to monitor and evaluate trainees during the training process. The long-term restrictions recorded however, reveal the difficulty hospitals and psychiatric clinics have in developing training programs responding to the full range of modern clinical and theoretical training in psychiatry independently and autonomously. The recent economic crisis in the country and the attempts for much needed administrational reforms, create now more than ever the appropriate conditions for a reform of the educational framework for specialization in psychiatry, taking into account national resources and future expectations for the mental health system of our country.
现代精神病学专业教育项目应紧跟精神病学科学的发展步伐，这既体现在关于精神障碍及其治疗的知识获取方面，也体现在现代精神病学服务多元领域的临床实践方面。在希腊，专科培训期间的精神病学培训制度框架尚未实现现代化并符合欧洲标准。目前，它仍受1994年总统令的约束，该法令简要描述了精神病学专科培训时间以及相关教育科目中的临床实践时长。本研究对两个不同时期（2000年与2014年）的精神病学专业培训进行了比较分析。早在2000年，精神病学培训就已显现出诸多结构上的弱点。临床经验、理论及心理治疗培训领域在各培训中心之间存在很大差异，并且在现有框架下与欧洲标准接轨的潜力有限。某些大学诊所是重要的例外情况，该国未来的大多数精神科医生未能获得充分的教育收益。十五年后，在经济危机后果的重压之下，制度框架仍未改变，整体情况似乎急剧恶化。提供完整专科培训的培训中心数量以及接受培训的精神科医生数量与医院雇佣的专科精神科医生数量成反比，由于人员招聘的限制措施，专科精神科医生数量已大幅减少。几乎所有培训指标都显示出恶化，但理论培训领域的退化最为显著。然而，值得注意的是，如今一些精神病诊所努力与非自身管理的精神病学服务机构联合开展培训项目，这是当前立法框架中未规定的做法。与此同时，采用一些法定程序在培训过程中对学员进行监督和评估的培训中心数量有所增加。然而，长期存在的限制表明，医院和精神病诊所难以独立自主地制定出能满足精神病学全方位现代临床和理论培训要求的培训项目。该国近期的经济危机以及急需的行政改革尝试，比以往任何时候都更创造了改革精神病学专科教育框架的合适条件，同时要考虑到国家资源以及我国心理健康系统的未来期望。
