Time for change to a developmental perspective in the education and training of psychiatrists

The practice of psychiatry in the UK has for most of its existence been focused on the needs of adults, and it has been with this age group in mind that educational programmes and training needs have been formulated. It is not surprising, then, that the content and shape of psychiatric training programmes have followed this clinically-driven pattern. Trainees entering psychiatry begin their clinical careers working with adults or older people and are expected to obtain a grasp of the fundamental clinical tools of the trade working with these populations. Experience with younger people’s mental health is explicitly excluded in the first year of training, emphasising the primacy of adulthood in the approach to learning clinical mental health skills. This approach to education and training in the subject has been in place since formal training programmes were established, emerging unscathed from the last major reform of training, ‘Calmanisation’. Currently, a further set of changes in postgraduate medical education is taking place. Two-year foundation programmes are being introduced, combining pre-registration house officer and first-year senior house officer training. These arise in the context of new political imperatives a drive to abbreviate specialist training, closer identification of core competencies for all specialists, and greater regulation and revalidation of medical competence. This provides an opportunity to examine whether the structure and philosophy of education and training in psychiatry needs review, a chance to ask if it remains ‘fit for purpose’. Although this paper addresses these questions from a child and adolescent perspective, we believe that the changes proposed are relevant to all psychiatrists. First, we consider current arrangements.