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Table 3 Characteristics of selected full-papers: quantitative studies

From: Training of adult psychiatrists and child and adolescent psychiatrists in europe: a systematic review of training characteristics and transition from child/adolescent to adult mental health services

Study Aim Methods Results (aggregated data) and authors’ conclusion Quality
Score (/36)a
Margariti et al., 2002 [17] To investigate the training in psychiatry provided in Greece in relation to the EBP recommendations Quasi-experimental (quantitative) study: Structured questionnaire completed during an interview of the training directors of 14 institutions recognized bythe national authority as eligible to provide full-time training in psychiatry. Response rate: 14/14 (100%) training directors. 30
- Lack of a detailed national training plan
- The training provided shows great variability among institutions.
- Evaluation of the training programs not carried out by the national authority responsible for training centers (the Ministry of Health), leaving this task exclusively to the training centers themselves.
Karabekiroglu et al., 2006 [18] To provide a descriptive documentation on Child and Adolescent Psychiatry training in European countries Quasi-experimental (quantitative) study: Survey.
10 questions sent by email to UEMS-CAP and EFPT representatives of 34 member countries of WHO -European region
Response rate: unknown/34 countries 28
In 2006, European countries still have significant diversities in the structure of CAP training. There is still a long way to go for full harmonization across Europe.
- CAP is a known specialty in 23 countries and a subspecialty in 8 countries, but 5 countries do not have any structured CAP training. In 32.4% of the countries, CAP is not a specialty in its own right but is mostly linked to general psychiatry.
- After medical school, minimum training duration to become a CAP specialist: between 12 and 96 (mean: 59.71 ± 17.1) months.
- Only half of the countries have integrated a structured psychotherapy training in the programme
- More than two-thirds of the countries have started using logbooks to structure the curriculum.
- Around one-third of the countries have integrated structured research training into the CAP training programme.
- 37.9% of the countries: examination to begin CAP training. In 64.7%: examination to graduate. In 29.7% countries: both cases are reported.
Lotz-Rambaldi et al.,
2008 [19]
To evaluate the state of training in psychiatry in each member countries of UEMS and the current state of implementation of the UEMS recommended training requirements Quasi-experimental (quantitative) study: Survey.
Questionnaire: Part One to be completed by the national representative of each country in the EBP; Part Two to be completed by the chiefs of training and the representatives of trainees in training centres of the member states.
Response rate: Part One = 22/31 (71%) national representatives; Part Two = 409/923 (44%) questionnaires.
Conclusion: The training requirements formulated by the EBP have been partly introduced in Europe (e.g. integration of psychotherapy) but the training in Europe is still very heterogeneous.
- System of rotation not mandatory in most countries.
- Areas of theoretical training (e.g. learning difficulties and mental handicaps) often not included in the compulsory common trunk of national training schemes.
- No agreement within the EBP on the criteria for the definition of a sub-specialty.
Julyan, 2009 [20] To make a point on educational supervision (ES) as an essential component of basic specialist training in psychiatry in the UK, with a focus on workplace-based Assessments (WPBA) as a new tool Quasi-experimental (quantitative) study: Survey. Response rate: Data 1 = 11 trainees and 11 supervisors (73%); 30
Data 2 = 10 trainees and 10 supervisors (67%).
Conclusion: general agreement between trainees and supervisors, but some significant discrepancies.
All junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before (Data 1) and after (Data 2) the introduction of WPBAs
- Around 60% reported 1 h of ES per week or 3 times per month.
- ES was largely seen as useful.
- Around 50% of trainees and supervisors used 25–50% of ES time for WPBAs, with no impact on the usefulness of ES or the range of issues covered.
The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximized by remaining tailored to individual trainees’ needs.
Kuzman et al. 2009 [21] To evaluate the quality of the current residency training in psychiatry in Croatia using the subjective evaluations of the residency training that is being offered Quasi-experimental (quantitative) study: Survey
Questionnaire to residents from 15 Croatian psychiatric hospitals, clinics and wards in general hospitals
Response rate: 66/74 (89%) of all residents in September and October 2006 in Croatia.
About a third of participants are only partially satisfied with the residency training that is being offered and its application in practice.
They feel that most problems lie on the lack of practical psychotherapy, the inefficiency of the mentorship system and the lack of funding resources.
Nawka et al. 2010 [22] To present a trainee perspective on the major challenges in psychiatric training in Europe Quantitative: Survey
Survey of the 31 member countries of EFPT (trainees) about the 3 most important issues facing postgraduate training
Response rate: 28 /31 (90%) countries. 27
Implementation of new postgraduate curricula in a number of countries (for example, the UK, Ireland, and the Netherlands)
- Insufficient training opportunities.
- Inadequate psychotherapy training.
Substantial differences in quality of training exist across Europe. Educational systems in some European countries have undergone major reforms.
Major concern reported by trainees: on the implementation of these new programs rather than to the structure or content of the curricula themselves.
Oakley and Malik, 2010 [23] To establish the variations in the pre-defined aspects of postgraduate psychiatric training within the member countries of the EFPT Quantitative: Survey
Structured questionnaire to delegates (trainees) at the EFPT 2008 forum
Response rate: 22/22 (100%) countries. 27
Conclusion: The challenge of harmonizing training across Europe remains very real.
- Wide variations in the length, content and structure of postgraduate psychiatric training across Europe.
- Some countries have no examinations or formal assessments, others have no compulsory placements.
- Five of the surveyed countries do not even have nationally standardized training schemes.
- Psychotherapy training is only compulsory in half the countries surveyed.
Fiorillo et al., 2011 [24] To explore training and practice of psychotherapy in ECPC members (countries of Northern, Southern and Western Europe) Quasi-experimental (quantitative) study: Survey (Letter to editor)
Online 16-item questionnaire on: quality of psychotherapy training, organizational aspects of psychotherapy training, satisfaction with training in psychotherapy, self-confidence in the use of psychotherapy
Response rate: 12/13 (92%) ECPC members. 30
- Training in psychotherapy is mandatory in all of the 12 respondent countries, except Belgium and France.
- Training in psychodynamic and cognitive-behavioral therapies is available in almost all countries.
- Training in other therapies (systemic, interpersonal, supportive and psychoeducational, dialectical-behavioral) only in a few countries.
- Dedicated supervisor for training in psychotherapy not available in 5 countries out of 12.
- Psychotherapy competencies are evaluated differently, with no clear guidance regarding trainees’ evaluation in 15 countries.
Main barriers in accessing training in psychotherapy: difficulties to get time away from other duties, lack of supervisors, and lack of funding.
Gómez-Beneyto et al., 2011 [25] To know the psychiatry resident’s opinion and level of satisfaction on provided training Quasi-experimental (quantitative) study: Survey Questionnaire to 363 trainees in 3rd and 4th year Response rate: 216 (60%) residents. 24
- The majority of residents had complied with the National Program for Psychiatric Training requirements.
- Level of satisfaction is fair.
- A small but substantial percentage did not comply adequately with the program, as regards: training in psychotherapy, research methodology, old age psychiatry, neurology and general medicine.
Van Effenterre, 2011 [26] To get an overview of trainees’ wishes as regards research training Quasi-experimental (quantitative) study: Survey
Questionnaire to members of the French association of trainees in psychiatry
Response rate: 45% trainees. 21
- 25% of trainees achieved a research Master
- Lack of information on available possibilities in research during residency. Only 12% of residents think they were well informed. Tutorship would be a solution.
Kuzman et al., 2012a [27] To assess the problems in the implementation of psychiatric training curricula and the quality control mechanisms available in European countries Quasi-experimental (quantitative) study: Survey (letter to editor) Response rate: 29/ unknown total of countries 29
- In 13 countries (45%), trainee representatives reported some differences between the psychiatric curriculum on paper and curriculum in practice
Representatives from 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 9 countries (31%) significant differences were reported.
- In only 7 (24%) countries the curriculum was in line with training in practice.
- Placements considered as most problematic: psychotherapy (n = 13), research (n = 12) and addictions (n = 5).
- Most commonly reported reasons for discrepancies: lack of time for teaching activities (n = 11), lack of appropriate rewards for trainers (n = 9), lack of quality control measures (n = 9), and general shortage of supervisors (n = 7).
- In the countries with quality control (22/29), main mechanisms are: commissioned questionnaire reviews of placements, trainers/ supervisors and working conditions.
Conclusion: several problems still influence the correct implementation of training curricula in practice. Establishing adequate quality control mechanisms for all national training programs is identified as one of the crucial steps in the improvement and harmonization of psychiatric training in Europe.
Kuzman et al., 2012b [28] To describe the structure and quality assurance mechanisms of post-graduate psychiatric training in Europe Quasi-experimental (quantitative) study: Survey.
Self-reported questionnaire completed by members of EFPT. The questionnaire consists of 20 questions: 10 on the structure of training program and the methods of assessment of trainees; 10 on the methods of quality assurance of the training programs. In order to ensure the reliability of the data, the respondents were asked to provide an official reference source) to be contacted in case of ambiguous responses.
Response rate: 29/ unknown total of countries 21
Psychiatric training programmes and assessment methods are overall compatible in Europe but quality assurance mechanisms vary significantly.
- In 19/29 countries, the duration of the training programme is 5 years or more. - 26/29 countries have adapted a basic training programme that includes the ‘common trunk’ (according to UEMS definition) or a modified version of it.
- In 25/29 countries, trainees are evaluated several times during their training, with a final exam at the end.
- In 25/29 countries, official quality assurance mechanisms exist. However, results demonstrate great variations in their implementation.
Simmons et al.,2012 [29] To investigate trainee experiences of CAP training across Europe in 2010–2011 in three domains: structure and organization of training; training quality and content; and working conditions and recruitment Quasi-experimental (quantitative) study: Survey
Questions collated into a survey and addressed via email to CAP trainee representatives in 34 countries in Europe, using the EFPT email list
Response rate: 28/34 (82%) countries. 30
Training experiences in CAP varies widely across Europe
- 7/28 countries (25%) have a core common trunk in general psychiatry before specialization in CAP.
- No official CAP training programme in 6/28 countries. Training standards are implemented in practice to a variable extent.
- In 19/28 countries (68%), supervision occurs at least weekly.
- Educational supervision is available in 13/28 countries (46%).
- Psychotherapy training is mandatory in 19/28 countries (68%).
- Research training is obligatory in 8/28 countries (29%).
- Subspecialty experience is extremely variable.
Pinto Da Costa et al., 2013 [30] To describe Portuguese psychiatry trainee’s opinion about their training and the modifications they would want to witness in the near future Quasi-experimental (quantitative) study: Survey Response rate: 80/193 (41.5%) psychiatry trainees. 29
Changes claimed for: length and type of obligatory and optional placements, psychotherapy (who is obligatory in their training), easier access to research and clinical training opportunities abroad.
Structured questionnaire of 26 questions sent by email to Portuguese trainees
Van Effenterre et al., 2013 [31] To study the current situation of the academic training of French psychiatry trainees in psychotherapy during their residency Quasi-experimental (quantitative) study: Survey
Anonymous questionnaire sent to all French psychiatrist trainees through their local trainee association
Response rate: 869/1334 (65%) residents. 26
- Training is insufficient for 75% trainees (much higher than in other countries).
- Different satisfaction rates across universities.
- Only 51% trainees have supervision, with large disparities between regions. All major therapies are represented.
Van Effenterre et al., 2014 [32] To study the teachers’ point of view on psychiatric training in France (weaknesses and strengths of the training, recent improvements and problems) and to compare with residents’ opinion Quasi-experimental (quantitative) study: Survey Response rate = 79/125 (63%) teachers. 29
Emailed questionnaires sent in April 2012 to 125 academic professors and hospital practitioners (PU-PH) - A majority of PU-PH (78%) willing to maintain a single training pathway including AP and CAP within a single diploma.
- Almost all suggested the implementation of an assessment of teaching and a formal mentorship program.
- Length of the training is a more controversial aspect.
- Suggested areas of improvement: training in psychotherapy and research, access to supervision. Crucial need to implement an efficient supervision during residency.
Fàbrega Ribera & Ilzarbe, 2017 [33] To evaluate the current situation experience of trainees interested in CAP involved in general psychiatry training. Quasi-experimental (quantitative) study: Online survey Response rate: 55/94 (59%) trainees 25
- 4-month mandatory training in CAP included in the GAP programme
94 trainees identified as interested in working in CAP
- mandatory CAP placement
- CAP can also be a clinical elective rotation
- Time spent in CAP (mandatory placement + elective rotation): 3–20 months, median = 8 months  
- Wide variability, from trainees being in CAP placements for 3 months to others being there for almost 2 years
  1. (a) See Table 2 for details
  2. Abbreviations: UEMS CAP Union Européenne des Médecins Spécialistes section of Child and Adolescents Psychiatry, EFPT European Federation of Psychiatry Trainees, WHO World Health Organization, WPA World Psychiatric Association, EBP European Board of Psychiatry, ECPC Early Career Psychiatrists Committee, CAP Child and Adolescent Psychiatry, AP Adult Psychiatry, ESCAP European Society of Child and Adolescents Psychiatry, GAP General and Adult Psychiatry