[The Importance of Remaining a Psychiatric Medical Specialist].

As a member of the Japanese Society of Psychiatry and Neurology's Committee to Improve the Medical Specialist System, I have used the Committee's discussions as my start- ing point for describing what action needs to be taken to update psychiatric medical specialist qualifications under the new medical specialist framework while retaining its key principles. The gist of the reform of the medical specialist system is that tasks such as clearing up confusion at clinical sites and restoring the public's trust in physicians should not be assigned to outside institutions. Instead, groups of physicians will themselves set up and run a self-reg- ulating organization that sets out their ideals as to quality, etc., and holds the profession to these ideals. To prevent any loss of professional pride and autonomy, they must establish, on their own initiative, a highly transparent system that the general public will accept, and which will support and develop high-quality medical professionals. In other words, building a system such as this cannot be considered separately from the process of educating specialized medical doctors. Medical specialists are expected to continue undergoing appropriate training and to maintain and enhance their competencies. Qualification as a medical specialist shows that the individual is continuing to undergo training to enhance his or her excellence as a medical spe- cialist and, at the same time, ensures his or her professional value. The key requirement for updating medical specialist qualifications is for the individual to be engaged in medical practice. Medical care provided at departments of psychiatry differs somewhat from that offered by other clinical departments and/or fields, since it covers a broad range of areas that can extend outside the clinical services offered at hospitals. Knowledge, skills and attitudes as a psychiatric medical specialist are evaluated based on a review of case reports. In addition to psychiatry-related content, training must cover themes related to pro- fessionalism such as medical ethics and legislation, as well as subjects necessary to obtain the latest medical knowledge such as clinical research and evidence-based medicine (EBM). Physi- cians intending to newly qualify as medical specialists need to be engaged in some sort of research, and to have the competency to compile and present the outcomes of their studies, as well as having a proven track record. Out of consideration to the actual circumstances, in the field of psychiatry, academic achievement is not a necessary condition for updating medical specialist qualifications. Japanese Medical Specialty Board supports this position. As defined in the upcoming reform of the medical specialist system, a medical specialist is a personal qualification. At the same time, it is individuals who play a role as a member of an autonomous group, responsible for maintaining the value of this qualification.