Are there differences between training curricula on paper and in practice? Views of European trainees

Despite the directives of the European Union of Medical Specialties 1 and reforms of training curricula on paper, recent publications still demonstrate significant differences in content and quality of training curricula across Europe 2,3,4,5,6. The harmonization and improvement of psychiatric training in Europe is the most important objective of the European Federation of Psychiatric Trainees’ (EFPT), a non-governmental organization representing national associations of trainees of more than 30 countries. The EFPT conducted a survey among European psychiatric trainees to assess problems in the implementation of psychiatric training curricula and the quality control mechanisms of training available in European countries. Representatives from 29 EFPT member countries filled in a country report survey form. They were asked to rate the differences between the psychiatric curriculum on paper and the curriculum in practice in their countries as significant, existing to some extent or not existing. They were also asked to explain their understanding of such discrepancies in open ended questions. In 13 countries (45%), trainee representatives reported some differences between the psychiatric curriculum on paper and curriculum in practice, and in nine countries (31%) significant differences were reported. In only seven (24%) countries the curriculum was in line with training conditions in practice. The most problematic placements were psychotherapy (n=13), research (n=12) and addictions (n=5). A number of reasons were given by trainees for the discrepancies between the curriculum and its implementation. The most commonly reported reasons were the lack of time for teaching activities (n=11), the lack of appropriate rewards for trainers (n=9), the lack of quality control measures (n=9), and a general shortage of supervisors (n=7). In 6 out of 29 countries (21%), no audits of psychiatry training programmes of any kind are performed. For one country, data are not available. In the remaining 22 countries, the main quality control mechanisms consist of commissioned questionnaire reviews of placements, trainers/supervisors and working conditions. These are directed at trainees, supervisors or training providers (heads of departments or hospital directors). Interestingly, in countries where training was reported to be in line with the curriculum, regular audit of training programmes existed more frequently (6 out of 7 countries, compared with only 8 out of 22 countries where significant differences between curriculum on paper and in practice were reported). These results are in line with those of previous surveys 2,3,4, demonstrating that several problems still influence the correct implementation of training curricula in practice. They also emphasize the importance of establishing adequate quality control mechanisms for all national training programs as one of the crucial steps in the improvement and harmonization of psychiatric training in Europe.