1. Implementation of the new competency-based Fellowship Program
Dr Wayne de Beer, Dr Stephen Jurd
Board of Education, RANZCP
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2. History – 2012 Fellowship Program
Commenced as a project in 2007
CIP then CBFP
Competency-based training aligns with best practice
Project developed Fellowship competencies based on CanMEDS roles
Define psychiatrist’s role in contemporary practice
Identifies endpoint/goal of training
Most detailed description of a psychiatrist that College has achieved to date
Program ensures trainees are observed and assessed performing key tasks in the workplace
The 2012 Fellowship Program commenced as a project of the College in 2007, first as the Curriculum Improvement Project (CIP) then the Competency-Based Fellowship Program (CBFP).
The College aims were to develop a competency-based training program to align with international best practice in medical education.
Based on the CanMEDS roles, the project developed the Fellowship competencies to define a psychiatrist’s role in contemporary practice.
Identifies endpoint/goal of training.
Most detailed description of a psychiatrist that the College has achieved to date.
The 2012 Fellowship Program ensures trainees are observed and assessed performing key tasks in the workplace.
CBFP, Competency-Based Fellowship Program; CIP, Curriculum Improvement Project
© Copyright 2005 The Royal College of Physicians and Surgeons of Canada. Reproduced with permission.
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3. Development – 2012 Fellowship Program
Each component of the program was outlined at Congress 2012
2012 presentations focused on
Program overview
Workplace-based assessment (WBAs)
Entrustable Professional Activities (EPAs)
Since then, development has continued
27 Stage 1and Stage 2 EPAs approved to date
80 Stage 3 EPAs works-in-progress
Psychotherapy requirements defined and approved
Scholarly Project policy and procedure approved
Many detailed policies and procedures written
Available on website
RANZCP>Pre-Fellowship>2012 Fellowship Program>Regulations, policies & procedures
Stage 1 implemented in December 2012
At Congress 2012, each component of the program was outlined with detailed presentations on Workplace-based Assessments (WBAs) and Entrustable Professional Activities (EPAs).
Since then, development of the program has continued:
27 Stage 1 and Stage 2 EPAs have been approved to date (includes mandatory and elective EPAs)
80 Stage 3 EPAs are in development
psychotherapy requirements have been defined and approved
Psychotherapy Written Case
Psychotherapy EPAs
Scholarly Project policy and procedure has been approved
many detailed policies and procedures that define the requirements of the program written and approved.
Stage 1 of the 2012 Fellowship Program commenced in December 2012.
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4. Does Shows How Knows How Knows Miller’s pyramid
Classifies medical education assessment methods
Does
Shows How
Knows How
Knows
In 1990, George Miller proposed a structure, in the form of a pyramid, for classifying methods of assessment in medical education. Knowledge (Knows) is at the lowest level of the pyramid, followed by ‘Knows How’, ‘Shows How’ (performance) and ‘Does’ (action).
Assessments based on workplace observation are representative of the top two levels of the pyramid.
Miller, 1990.
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5. Workplace-based assessment (WBAs)
Assess competence in an authentic setting (the workplace)
Means for supervisor to provide meaningful and effective feedback
Formative assessment
Four WBA tools approved for use
Case-based Discussion (CbD)
Mini-Clinical Evaluation Exercise
Observed Clinical Activity (OCA)
Professional Presentation
WBA tools are available on the 2012 Fellowship Program website
RANZCP>Pre-Fellowship>2012 Fellowship Program>Assessment overview> Workplace-based assessments (WBAs)
At least three WBAs must contribute to the evidence base for the assessment of each EPA
A supervisor may request further evidence (three WBAs ≠ an EPA)
WBAs are a new formative component of RANZCP training.
WBAs provide a mechanism for supervisors to give structured and effective feedback about a trainee’s performance in the workplace.
There are four WBA tools approved for use.
Case-based Discussion:
assesses clinical reasoning and decision making, integration of medical knowledge with case management.
Mini-Clinical Evaluation Exercise:
assesses predetermined clinical tasks, eg. history taking process, content, mental state exam, etc.
Observed Clinical Activity:
assesses trainee’s ability to conduct a psychiatry interview, synthesise information, formulate a management plan.
Professional Presentation:
assesses specific presentation skills, predetermined by the trainee and assessor.
WBAs will be undertaken by trainees throughout each rotation and stage of the Fellowship Program. Completed WBAs, along with other data, form part of the evidence base required for a trainee to be entrusted with an EPA.
At least three completed WBAs must be included in the evidence base for the assessment of each EPA; however, the completion of three WBAs does not necessarily result in the achievement of an EPA.
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6. Case-based Discussion WBA form
RANZCP>Pre-Fellowship>2012 Fellowship Program>Training Program Forms
<<Slide to be used if needed – Case-based Discussion WBA form>>
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7. Entrustable Professional Activities (EPAs)
New summative component of psychiatry training
In daily practice, ‘supervisors consider whether or not to delegate professional activities to trainees’
This informed decision can be considered a measure of competence
EPAs are specialised tasks that a trainee must
Demonstrate their ability to perform
With only distant (reactive) supervision
Supervisors must be confident that a trainee
Knows when to ask for additional help
Can be trusted to seek assistance in a timely manner
Ten Cate, 2005.
EPAs are a new key summative component of RANZCP training.
EPAs were first described by Professor Olle ten Cate as a way to help supervisors determine the competence of their trainees.
EPAs are specialised tasks that a trainee must demonstrate their ability to perform with only distant (reactive) supervision. Supervisors must be confident that a trainee knows when to ask for additional help and can be trusted to seek assistance in a timely manner.
EPAs are not set to assess every professional activity that trainees engage in; rather they assess a representative sample of the professional activities of psychiatry training.
The EPAs prescribed for RANZCP training are:
tasks of high importance for daily practice (core business)
high-risk or error-prone tasks
tasks that are exemplary of a number of CanMEDS roles.
EPAs formalise the process by which supervisors capture and record their judgements about trainee performance and competence throughout training.
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8. EPAs and progression
Trainees must achieve mandatory EPAs in order to progress
Confirmation of Entrustment (COE) forms mark EPA attainment
EPA attainment is
Recorded on the end-of-rotation ITA Report
Entered in the trainee’s College training record
EPAs are detailed in the
EPA Handbook
2012 Fellowship Program website
RANZCP>Pre-Fellowship>2012 Fellowship Program>Training Program Forms>EPA forms
ITA – In-Training Assessment
EPAs are summative assessments and trainees must achieve mandatory EPAs in order to progress through training.
Every EPA has a Confirmation of Entrustment (COE) form.
COEs must be signed by the supervisor assessing the EPA (and principal supervisor, if different), trainee and Director of Training (DOT) to confirm EPA attainment.
EPA attainment is :
recorded on the trainee’s end-of-rotation In-Training Assessment (ITA) Report
entered in the trainee’s College training record.
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9. COE form for Stage 1 EPA
RANZCP>Pre-Fellowship>2012 Fellowship Program>Training Program Forms>EPA forms
<<Slide to be used if needed – COE form for Communicating with a family about a young adult’s major mental illness EPA>>
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10. Trainees are responsible for their own progress through training.
Unlike the 2003 regulations, which have multiple barriers to entering Advanced Training (the Written Exam, the Case Histories, the Clinical Exams), the 2012 Fellowship Program follows an adult learning model, with minimal barriers to progression (achievement of EPAs, successful completion of rotations).
Rather than barriers, the 2012 Fellowship Program has progression rules detailed in the Trainee Progress Trajectory.
The Trainee Progress Trajectory details the mandatory deadlines for completion of training components within the 2012 Fellowship Program.
The trajectory is designed to assist trainees to plan for, and maintain, required trainee progress.
Trainees are responsible for their own progress through training.
The progression rules are managed by the Failure to Progress policy (more detail later) but are designed to help ensure trainees are progressing as they should be.
Progression rules will be highlighted throughout the presentation.
R – Remedial plan
SC – Show cause to Committee for Training
Grey boxes indicate when a trainee is eligible to attempt/submit each summative component.
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11. Stage 1 12 months FTE training in Adult psychiatry
Minimum of 6 months in an acute setting
Stage 1 training focuses on core (basic) psychiatry skills
Youth mental health posts that focus on core psychiatry skills acceptable
Supervision requirements have not changed
4 hours per week for 40 weeks
2 hours per week outside of ward rounds and case review including
1 hour individual supervision of clinical work
Stage 1 of the 2012 Fellowship Program was implemented in December 2012 in NZ and from January 2013 in Australia.
Stage 1 is year one of training . Trainees must complete a minimum of 12 months FTE training in Adult psychiatry of which 6 months must be completed in an acute setting.
Training in Stage1 focuses on core (basic) psychiatry skills.
The Adult psychiatry requirement is inclusive of Youth Mental Health posts that focus on core psychiatry skills.
Clinical supervision of trainees must be maintained at a minimum of 4 hours per week over 40 weeks.
2 hours per week must be supervision outside of ward rounds and case review for Stage 1 trainees, including:
a minimum of 1 hour per week individual supervision of a trainee’s clinical work.
The supervision requirements of the 2012 Fellowship Program have not changed from the previous training program (ie. the 2003 regulations).
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12. Stage 1 EPAs
A trainee must achieve the following four mandatory EPAs in Stage 1
Producing discharge summaries and organising appropriate transfer of care.
Initiating an antipsychotic medication in a patient with schizophrenia.
Active contribution to the multidisciplinary team meeting.
Communicating with a family about a young adult’s major mental illness.
Stage 1 EPAs will be assessed at basic (Stage 1) standard
Trainees must achieve two EPAs per 6-month FTE rotation
Stage 1 First 6 Months Exception Rule
Trainees may conditionally pass their first rotation before achieving two EPAs
Trainees must have undertaken required number of formative WBAs
Rule only applies to trainees in their first 6-month rotation of Stage 1
There are four mandatory EPAs that a trainee must achieve in Stage 1.
Producing discharge summaries and organising appropriate transfer of care.
Initiating an antipsychotic medication in a patient with schizophrenia.
Active contribution to the multidisciplinary team meeting.
Communicating with a family about a young adult’s major mental illness.
Trainees must achieve two of the mandatory Stage 1 EPAs in each 6-month FTE rotation.
These EPAs will be assessed at the standard expected of a Stage 1 trainee (basic standard) .
Stage 1 First 6 months FTE Exception Rule
A trainee in the first 6-month FTE rotation of Stage 1 may conditionally pass a rotation before being entrusted with two of the mandatory Stage 1 EPAs if:
the supervisor indicates a pass on the end-of-rotation ITA Report
the trainee has undertaken the required number of formative WBAs for the rotation.
This rule applies only to trainees in their first 6-month rotation of Stage 1 and cannot be applied in any other Stage or rotation.
This rule allows for flexibility during a period of adjustment for trainees entering psychiatry training.
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13. Stage 1 – Progression
Trainees must achieve all four Stage 1 EPAs to progress to Stage 2
Stage 1 EPAs must be achieved by the time the trainee has completed
18 months FTE accredited training in Stage 1
The trainee will not necessarily have entered rotational remediation at this point
Failure to achieve this will result in a requirement to
Show cause to the Committee for Training
Trainees will not be able to progress to Stage 2 until they have been entrusted with all four mandatory Stage 1 EPAs.
The Stage 1 EPAs must be achieved by the time the trainee has completed 18 months FTE accredited training in Stage 1.
The trainee will not necessarily have entered rotational remediation at this point (more detail on rotational remediation later).
Eg. if a trainee has passed their first 6-month rotation without achieving any Stage 1 EPAs (Stage 1 First 6 months FTE Exception Rule) and then achieves two EPAs in their next 6-month FTE rotation they will not be in rotational remediation but they will not be eligible to progress to Stage 2 (as they have not yet been entrusted with all four Stage 1 EPAs).
Additional time spent achieving the required EPAs for a stage is not eligible for recognition of prior learning (RPL) towards training time required by the next stage.
Failure to achieve the required EPAs by the time the trainee has completed 18 months FTE accredited training in Stage 1 will result in a requirement for the trainee to show cause to the Committee for Training (CFT) as to why they should be able to continue towards Fellowship.
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14. Stage 1 – Additional EPAs
Additionally, trainees in Stage 1 are eligible to achieve
Two Stage 2 Psychotherapy EPAs
Five Stage 2 General Psychiatry EPAs
Stage 2 EPAs will be assessed at proficient (Stage 2) standard
Stage 1 trainees are not required to attempt Stage 2 EPAs in Stage 1
But trainees should consider and plan EPA attainment across Stages 1 & 2
Plan 3–5 EPAs per 6 months FTE training
In exceptional circumstances...
Trainees can achieve other Stage 2 EPAs, eg. Addiction psychiatry EPAs
Directors of Training to determine if a trainee is eligible
Case-by-case decision
In addition to the four mandatory Stage 1 EPAs, trainees in Stage 1 are eligible to achieve:
two Stage 2 Psychotherapy EPAs
The provision of psychoeducation in a formal interactive session.
Psychodynamically informed patient encounters and managing the therapeutic alliance.
five Stage 2 General Psychiatry EPAs
Demonstrating proficiency in all the expected tasks associated with the prescription, administration and monitoring of ECT.
The application and use of the Mental Health Act.
Assessment and management of risk of harm to self and others.
The safe and effective use of clozapine in psychiatry.
Assess and manage adults with cultural and linguistic diversity. (Cultural awareness.)
These Stage 2 EPAs will be assessed at the standard expected of a Stage 2 trainee (proficient standard) .
Although trainees in Stage 1 are not required to attempt the above Stage 2 EPAs in Stage 1, trainees should consider and plan their EPA attainment across Stage 1 and Stage 2.
Trainees should plan to achieve 3–5 EPAs per 6 months FTE training (this includes the two mandatory EPAs trainees must achieve for each 6-month FTE rotation).
In exceptional circumstances, DOTs may determine that a trainee is eligible to be entrusted with other Stage 2 EPAs (eg. the Addiction psychiatry EPAs).
Case-by-case decision:
need to demonstrate appropriate supervision
consider trainee progress to date
consider ability of trainee to achieve EPAs set to a higher standard than their current stage of training
consider likelihood of trainee being able to attain the EPA(s) in Stage 2.
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15. Psychotherapy requirements
Psychotherapy Written Case (more detail later)
Four Stage 2 Psychotherapy EPAs
Psychoeducation (can be achieved in Stage 1)
Therapeutic alliance (can be achieved in Stage 1)
Supportive psychotherapy
CBT for management of anxiety
Trainees must achieve three Psychotherapy EPAs by end of Stage 2
EPAs 1 and 2 and either EPA 3 or EPA 4
Remaining EPA must be achieved by the end of Stage 3
Psychotherapy EPAs may be achieved in any area of practice rotation
The psychotherapy requirements of the 2012 Fellowship Program are completion of :
the Psychotherapy Written Case (the long case; more detail later)
four Stage 2 Psychotherapy EPAs.
By the end of Stage 2, trainees must be entrusted with three (of four possible) Psychotherapy EPAs.
Trainees must achieve EPA1, EPA2 and either EPA3 or EPA4 (see list below) by the end of Stage 2.
The provision of psychoeducation in a formal interactive session.
Psychodynamically informed patient encounters and managing the therapeutic alliance.
Supportive psychotherapy.
Cognitive–behavioural therapy (CBT) for management of anxiety.
EPA1 and EPA2 can be achieved during Stage 1.
Trainees must achieve the remaining (fourth) psychotherapy EPA by the end of Stage 3.
All Psychotherapy EPAs will be assessed at a proficient (ie. Stage 2) standard.
Psychotherapy EPAs may be achieved in any area of practice rotation.
These EPAs require trainees to demonstrate competence in psychotherapy (not just undergo the ‘experience’).
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16. Stage 2 24 months FTE training (years 2–3) Mandatory rotations
Child & Adolescent psychiatry (6 months FTE)
Consultation–Liaison psychiatry (6 months FTE)
Two elective rotations in other areas of practice
Supervision requirements have not changed
4 hours per week for 40 weeks including
1 hour individual supervision of clinical work
Stage 2 is years 2–3 of training. Trainees must complete a minimum of 24 months FTE training.
12 months FTE training must be completed in the following mandatory areas of practice:
Child & Adolescent psychiatry (6 months FTE)
Consultation–Liaison psychiatry (6 months FTE).
An additional 12 months FTE training must be undertaken in one or more of the following elective areas of practice:
Addiction psychiatry
Adult psychiatry
Forensic psychiatry
Indigenous mental health
Psychiatry of Old Age
Rural psychiatry.
Clinical supervision of trainees must be maintained at a minimum of 4 hours per week over 40 weeks.
A minimum of 1 hour per week must be individual supervision of a trainee’s clinical work.
The supervision requirements of the 2012 Fellowship Program have not changed from the previous training program (ie. the 2003 regulations).
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17. Stage 2 EPAs Trainees must achieve two EPAs per 6-month FTE rotation
Additionally, trainees continue to achieve the required
Three Psychotherapy EPAs
Five General Psychiatry EPAs
Addiction psychiatry and Psychiatry of Old Age requirements
Trainees must achieve two mandatory EPAs in
Addiction psychiatry
Psychiatry of Old Age
These EPAs can be achieved in
Elective Addiction or Psychiatry of Old Age rotations OR
At any other time during Stage 2
Therefore, 20–24 EPAs that must be achieved by the end of Stage 2 (includes Stage 1 EPAs)
As in Stage 1, trainees must achieve two EPAs per 6-month FTE rotation.
Therefore in Stage 2, trainees must achieve:
two EPAs in Child & Adolescent psychiatry
two EPAs in Consultation – Liaison psychiatry
two EPAs for each of their elective 6-month FTE rotations.
In addition, trainees must continue to achieve the required:
Psychotherapy EPAs
General Psychiatry EPAs.
Addiction psychiatry and Psychiatry of Old Age requirements
By the end of Stage 2, all trainees must be entrusted with:
two Addiction psychiatry EPAs
Management of substance intoxication and substance withdrawal.
Comorbid mental health and substance use problems.
two Psychiatry of Old Age EPAs.
Behavioural and psychological symptoms in dementia (BPSD).
The appropriate use of antidepressants and antipsychotics in patients aged 75 years and over (or under 75 with excessive frailty).
These EPAs can be achieved during completion of elective Addiction and/or Psychiatry of Old Age rotations.
However, if a trainee completes elective rotations in other areas of practice, they must achieve the two EPAs specific to those rotations and complete the Addiction psychiatry and/or Psychiatry of Old Age EPAs when opportunity arises (ie. in any area of practice rotation).
Therefore, there are 20–24 EPAs that must be achieved by the end of Stage 2 (includes Stage 1 EPAs.)
Trainees should plan to achieve 3–5 EPAs per 6 months FTE training (this includes the two mandatory EPAs trainees must achieve for each 6-month FTE rotation).
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18. WBA and EPA calculations
Stage 1
2 rotations x 2 EPAs = 4 EPAs x 3 WBAs = 12 WBAs
Stage 2
4 rotations x 2 EPAs = 8 EPAs
Stage 2 Psychotherapy EPAs = 3
Stage 2 General Psychiatry EPAs = 5
Addiction* EPAs = 2
Psychiatry of Old Age* EPAs = 2
20 EPAs x 3 WBAs = 60 WBAs
Trainees need to plan EPA attainment
Plan 3–5 EPAs per 6 months FTE training
*These EPAs may be achieved in elective rotations therefore: 16 EPAs x 3 WBAs = 48 WBAs
Trainees must consider and plan for the number of EPAs that they must attain in order to progress through the Fellowship Program.
Trainees should plan to achieve 3–5 EPAs per 6 months FTE training (this includes the two mandatory EPAs trainees must achieve for each 6-month FTE rotation).
Trainees should not expect to be able to achieve the majority of EPAs for a stage near the end of their accredited training time and expect a supervisor to be available.
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19. Stage 2 – Progression
Trainees cannot progress to Stage 3 until they have completed all required Stage 2 EPAs
Stage 2 EPAs must be achieved by the time the trainee has completed
36 months FTE accredited training in Stage 2
The trainee will not necessarily have entered rotational remediation at this point
Failure to achieve this will result in a requirement to
Show cause to the Committee for Training
Stage 2 will commence in December 2013
Trainees will not be able to progress to Stage 3 until they have been entrusted with all required Stage 2 EPAs.
All required Stage 2 EPAs must be achieved by the time the trainee has completed 36 months FTE accredited training in Stage 2.
The trainee will not necessarily have entered rotational remediation at this point (more detail on rotational remediation later).
Eg. if a trainee has successfully achieved two EPAs per 6-month FTE rotation they will not have entered rotational remediation; however, if they are yet to achieve the required Stage 2 Psychotherapy EPAs and the required Stage 2 General Psychiatry EPAs, the trainee will not be eligible to progress to Stage 3. Trainees have a further 12 months FTE accredited training time in Stage 2 to achieve any remaining EPAs.
Additional time spent achieving the required EPAs for a stage is not eligible for RPL towards training time required by the next stage.
Failure to achieve the required EPAs by the time the trainee has completed 36 months FTE accredited training in Stage 2 will result in a requirement for the trainee to show cause to the CFT as to why they should be able to continue towards Fellowship.
As per the trajectory, trainees in Stage 2 should be working on/towards:
attempting the MCQ paper of the Written exam
preparing to submit the Psychotherapy Written Case
considering the timeframes required for their Scholarly Project.
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20. Mid-rotation assessment
Mid-rotation ITA Form (formative)
To provide feedback on a trainee’s progress in the rotation
To highlight any potential progress concerns and/or identified issues
To document supportive plans if required
May be completed prior to mid-rotation point (if supervisor concerns)
Additional mid-rotation ITA Forms may be completed
Copy of mid-rotation ITA Forms held by trainee’s Director of Training
Do not need to be submitted to the College
The ITA Form is the mid-rotation formative assessment for each rotation.
The mid-rotation ITA form is used to:
provide feedback to the trainee on their progress in the rotation
to highlight any potential progress concerns and/or identified issues
to document supportive plans required to address these concerns.
At the discretion of the supervisor, the ITA Form (or relevant sections of it) may be completed prior to the mid-rotation point if the supervisor has concerns regarding the trainee’s competence and/or progress in the rotation.
Additional ITA Forms may be completed after the mid-rotation point at the discretion of the supervisor.
A copy of the trainee’s mid-rotation ITA Forms must be held by the trainee’s DOT.
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21. Mid-rotation ITA Form – Supportive plan
If supervisor concerned that trainee not meeting standard for rotation
Supportive plan must be documented on the mid-rotation ITA Form
To be commenced immediately
Supportive plan should document
Competencies identified which require attention
Action to be undertaken to support the trainee to achieve the standard
As part of a supportive plan, the supervisor must
Discuss their concerns with the trainee
Discuss their concerns with the Director of Training or their delegate
Try to identify factors affecting the trainee’s performance
Review progress towards goals with the trainee
The purpose of a supportive plan is to help a trainee achieve the standard required by the end of the rotation.
Should the supervisor become concerned that a trainee is not meeting the required standards of the rotation, a supportive plan must be documented on the mid-rotation ITA Form and commenced immediately.
The plan should include the:
competencies identified which require attention
action to be undertaken to support the trainee to achieve the standard required prior to the end of the rotation.
As part of a supportive plan, the supervisor must:
discuss their concerns with the trainee
discuss their concerns with the DOT or their delegate
try to identify factors affecting the trainee’s performance
review progress towards the identified goals with the trainee within 3 months or prior to the end of the rotation, whichever comes first.
As part of a supportive plan, the DOT must ensure that timely and adequate feedback and support is provided to the trainee by the supervisor to enable the trainee to identify and correct any perceived difficulties.
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22. End-of-rotation assessment
End-of-rotation ITA Report (summative)
Records which EPAs were entrusted during the rotation
And which WBAs were used to inform them
Indicates whether the trainee has passed or failed the rotation
Sent to the College upon completion of each rotation
The trainee’s record will be updated accordingly
ITA Reports must be received within 60 days of rotation completion
Must be signed by the trainee’s Director of Training
Non-receipt of completed ITA Reports by the deadline will result in
Failed ITA Report and rotation
The ITA Report is the end-of-rotation summative assessment.
The end-of-rotation ITA Report indicates:
whether or not the required EPAs were entrusted during the rotation
which WBAs were used to inform them
provides a record of the supervisor’s assessment of the trainee for the Learning Outcomes
indicates whether the trainee has passed or failed the overarching summative assessment for that rotation.
The end-of-rotation ITA Report must be sent to the College upon completion of the rotation.
The trainee’s College training record will be updated accordingly.
ITAs will be made available to subsequent supervisors in order to facilitate ongoing support throughout training.
The ITA Report for each rotation must be signed by the trainee’s DOT and be received by the College within 60 days of the completion of a rotation.
Non-receipt of a completed ITA Report by the deadline will result in a failed ITA Report and rotation unless exceptional circumstances have been accepted by the CFT on a case-by-case basis.
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23. Written exam papers To be split into two discrete exam papers
MCQ paper
Assess scientific knowledge and basic psychiatric knowledge
Essay-style paper
Clinical focus, assess capacity for critical thinking about clinical practice
MCQ paper (available 2014)
Can be attempted from the beginning of Stage 2
Expected to be passed by the time the trainee has completed
36 months FTE training
Essay-style paper (available 2015)
Can be attempted from 24 months FTE training
54 months FTE training
The Written exam currently comprises two papers which are sat at the same time. From 2014, the exam will be split into two discrete papers which can be attempted at different times.
The papers will not be linked, ie. if a trainee fails one paper, they will not need to re-sit both papers again but rather only the exam paper they failed.
The MCQ paper will be a multiple-choice exam comprising Extended Matching Questions and Critical Analysis Problems.
Designed to assess scientific knowledge and basic psychiatric knowledge.
Can be attempted from the beginning of Stage 2 (ie. from 12 months FTE training).
The MCQ paper is expected to be attempted and passed by the time the trainee has completed 36 months FTE training.
Available in 2014.
The Essay-style paper will comprise Modified Essay Questions and a Critical Essay Question.
Papers will have a clinical focus and assess capacity for critical thinking about clinical practice.
Can be attempted from 24 months FTE training but trainees are advised to complete 36 months training before attempting this paper.
The Essay-style paper is expected to be attempted and passed by the time the trainee has completed 54 months FTE training.
Available in 2015.
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24. Written exam papers – Progression
Papers will be assessed at Junior Consultant standard
For every two failed attempts at an exam paper, the trainee must
Complete a remedial plan
For every three failed attempts at an exam paper, the trainee must
Show cause to the Committee for Training
The written exam papers will be assessed at Junior Consultant standard, aligning them with the other assessments of the Fellowship Program.
For every two failed attempts at a written exam paper, the trainee must complete a remedial plan.
For every three failed attempts at a written exam paper, the trainee must show cause to the CFT as to why they should be able to continue towards Fellowship, even if the trainee is within the timeframes as mandated on the Trainee Progress Trajectory.
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25. SOCAs – OCI replacement
Summative Observed Clinical Activities (SOCAs)
Assess ability to
Interview, formulate and develop a management plan
Tested holistically in a variety of authentic workplace settings
Trainees must successfully complete seven SOCAs
All SOCAs will be completed with a trained SOCA assessor
Minimum of four assessors must conduct the SOCAs for each trainee
Trainee and assessor to agree on timing, location of SOCAs
Assessor and/or supervisor to identify suitable patient
Trainees may attempt as many SOCAs as necessary
Only the seven successful SOCAs will be submitted to the College
Following a review of the Observed Clinical Interview (OCI) format, a workplace-based model of Summative Observed Clinical Activities (SOCAs) was approved, designed to assess trainees’ ability to interview, formulate and develop a management plan in authentic, workplace settings.
Trainees must successfully complete seven SOCAs.
Trainees must complete the SOCAs in a range of settings and for a range of patient populations as prescribed by the Committee for Exams/CFT.
All seven SOCAs will be completed with a trained SOCA assessor.
A minimum of four assessors must conduct the SOCAs for each trainee. (A maximum of three SOCAs can be conducted by one assessor.)
The trainee and assessor will agree on the timing, location, etc. of each SOCA.
The assessor and/or supervisor will identify a suitable patient.
Trainees may attempt as many SOCAs as necessary.
Only the seven successful SOCAs will be submitted to the College to be entered into the trainee’s record.
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26. SOCAs – Progression Assessed at Junior Consultant standard
Two SOCAs can be completed in Stage 2
May commence SOCA attempts from 24 months FTE
The remaining SOCAs must be successfully completed in Stage 3
Trainees should aim to complete two SOCAs per rotation in Stage 3
Expected to have successfully completed seven SOCAs by
54 months FTE training
Failure to do so will result in a requirement to complete a remedial plan
Continued failure to successfully complete seven SOCAs by
60 months FTE training will result in a requirement to
Show cause to the Committee for Training
The SOCAs will be assessed at the standard of a Junior Consultant.
For trainees who are considered ready by their supervisors, two SOCAs can be completed in Stage 2.
Trainees may commence SOCA attempts after they have completed 24 months FTE training.
All seven SOCAs must be successfully completed by the end of Stage 3.
Trainees should aim to complete two SOCAs per rotation in Stage 3.
It is expected that seven SOCAs will have been successfully completed by the time the trainee has completed 54 months FTE training.
Failure to do so will require the development of a remedial plan.
Continued failure to successfully complete seven SOCAs by the time the trainee has completed 60 months FTE training will result in a requirement to show cause to the CFT as to why they should be able to continue towards Fellowship.
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27. OSCE – Clinical exam Objective Structured Clinical Examination (OSCE)
Ten stations
Eight short stations
10 minutes
Two long stations (and two bye stations – active or inactive)
20 minutes
May be attempted in Stage 3
Assessed at Junior Consultant standard
Expected to be passed by the time the trainee has completed
54 months FTE training
For every two failed attempts, the trainee must
Complete a remedial plan
For every three failed attempts, the trainee must
Show cause to the Committee for Training
The Objective Structured Clinical Examination (OSCE) comprises ten stations:
eight short stations
10 minutes (2 minutes reading, 8 minutes in station)
two long stations (and two bye stations – active or inactive)
20 minutes (5 minutes reading, 15 minutes in station).
The OSCE may be attempted once the trainee has successfully completed Stage 2.
It will be assessed at the standard of a Junior Consultant.
The OSCE is expected to be attempted and passed by the time the trainee has completed 54 months FTE training.
Failure to do so will require the development of a remedial plan.
Continued failure to pass the OSCE by the time the trainee has completed 60 months FTE training will result in a requirement to show cause to the CFT as to why they should be able to continue towards Fellowship.
For every two failed attempts at the OSCE, the trainee must complete a remedial plan.
Should a trainee fail the OSCE three times, the trainee must show cause to the CFT as to why they should be able to continue towards Fellowship, even if the trainee is whin the timeframes as mandated on the Trainee Progress Trajectory.
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28. Scholarly Project Summative assessment 3000–5000 words
Scholarly Project options
Quality assurance project or clinical audit
Literature review
Original research (qualitative or quantitative)
Case series
Other project as approved by the Scholarly Project Subcommittee
Trainees must submit their project proposal to their BTC
BTCs to verify local ethics committee approval
BTCs to forward approved proposals to the College
Two trainees may collaborate
If major author requirements are satisfied
More than two trainees collaborating requires prior approval
BTC – Branch Training Committee
Trainees must pass the Scholarly Project assessment to be eligible for Fellowship.
Trainees may select their own Scholarly Project topic in an area relevant to psychiatry or mental health based on their research interests.
The Scholarly Project must be based on novel research.
The Scholarly Project must be 3000–5000 words in length.
A Scholarly Project may take the form of:
a quality assurance project or clinical audit
a systematic and critical literature review
original and empirical research (qualitative or quantitative)
a case series
an equivalent other project as approved by the Scholarly Project Subcommittee.
Trainees must submit their Scholarly Project proposal to their BTC for review and approval after they seek ethics committee approval to conform to any local research ethics requirements (if relevant).
BTCs must confirm that ethics committee approval has been granted if required.
BTCs will notify trainees of the outcome of their proposal submission and forward approved proposals to the College.
A trainee must be a major author of the Scholarly Project. A major author is defined as an author who has made substantial contribution to the following areas:
study design
data collection
analysis and interpretation of data
writing of the manuscript.
Two trainees may collaborate; however, the intention to collaborate must be noted in the proposal. Trainees can apply to the Scholarly Project Subcommittee for approval to collaborate on a shared project of more than two trainees.
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29. Scholarly Project (continued)
Supervision requirements
Principal supervisor required to be College-accredited supervising Fellow
Can engage co-supervisor for specific research expertise
Can apply for exemption from the Scholarly Project if have completed
Doctoral thesis, research Masters, Honours thesis
Had article accepted for publication in peer-reviewed journal
Theses, articles must have been in fields relevant to psychiatry or mental health
Applications assessed by Scholarly Project Subcommittee
Trainees can also apply for Recognition of Prior Learning (RPL)
If believe they have completed an equivalent project
Applications assessed by the Committee for Training
The principal supervisor/co-supervisor must be recognised as having appropriate expertise in the area of study.
The (principal) Scholarly Project supervisor is required to a College-accredited supervising Fellow to ensure familiarity with the requirements and deadlines of the training program.
Trainees may seek an additional project co-supervisor (who is not required to be a Fellow of the College) for specific expertise in the area of study.
Trainees may be exempt from undertaking the Scholarly Project if they have completed a doctoral thesis, research Masters or Honours thesis in a field relevant to psychiatry or mental health or if they have had an article accepted for publication in a recognised peer-reviewed English-language journal relevant to psychiatry or mental health.
Applications for exemption should be submitted to the Scholarly Project Subcommittee.
Trainees who have completed a project that they believe to be equivalent may apply to the CFT for RPL within 6 months of the date on which their registration as a College trainee is confirmed.
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30. Scholarly Project – Progression
Can be submitted for assessment during any stage of training
Assessed at Junior Consultant standard regardless of when submitted
Expected to be passed by the time the trainee has completed
54 months FTE training
Failure to do so will result in a requirement to complete a remedial plan
Continued failure to pass by the time the trainee has completed
60 months FTE training will result in a requirement to
Show cause to the Committee for Training
Should a trainee fail the Scholarly Project twice
Must complete a remedial plan
Should a trainee fail three times
Must show cause to the Committee for Training
The Scholarly Project can be submitted for assessment at any time during any stage of training; however, it will be assessed at Junior Consultant standard regardless of when it is submitted.
The Scholarly Project is expected to be submitted and passed by the time the trainee has completed 54 months FTE training.
Failure to do so will require the development of a remedial plan.
Continued failure to pass the Scholarly Project by the time the trainee has completed 60 months FTE training will result in a requirement to show cause to the CFT as to why they should be able to continue towards Fellowship.
After two failed submissions of the Scholarly Project, the trainee must complete a remedial plan.
Should a trainee fail the Scholarly Project three times, the trainee must show cause to the CFT as to why they should be able to continue towards Fellowship, even if the trainee is whin the timeframes as mandated on the Trainee Progress Trajectory.
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31. Psychotherapy Written Case
Summative assessment
40 sessions of therapy together with written case report
6–12 months of therapy, at least one session weekly
Therapy informed by psychodynamic principles
Regular supervision with psychotherapy supervisor, including
Three formative psychotherapy case discussions
Encourage reflection on treatment progress
Provide opportunities to receive qualitative feedback
Case discussions spread throughout 40 sessions, may focus on
Milestones in the therapy process, eg. formulation, termination
Treatment dilemmas and/or emerging issues, eg. gift-giving, boundary issues
8000–10,000 word case report
Detailing assessment and subsequent psychological management
The Psychotherapy Written Case is a summative assessment component comprising:
provision of psychotherapy
formal written case report.
Trainees must treat a person, under supervision, using therapy informed by psychodynamic principles for at least 40 sessions.
The trainee must be the sole therapist/practitioner of psychological intervention for the case.
During the therapy process, the trainee must participate in three formative psychotherapy case discussions with their psychotherapy supervisor.
To encourage reflection on the treatment progress.
To provide opportunities to receive qualitative feedback.
The psychotherapy case discussions should be spread through the 40 sessions of psychotherapy and focus on:
pivotal points or milestones in the therapy process; or on
treatment dilemmas and/or emerging issues.
In addition, trainees should have regular supervision sessions with their psychotherapy supervisor to allow mutual examination of both the:
psychotherapy process
contributions of the trainee and patient to this process.
Trainees must write and submit a case report detailing their assessment and subsequent psychological management.
8000–10,000 word formal report.
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32. Psychotherapy Written Case – Progression
Can be submitted from Stage 1
Assessed at Junior Consultant standard
Expected to be passed by the time the trainee has completed
46 months FTE training
Failure to do so will result in a requirement to complete a remedial plan
Continued failure to pass by the time the trainee has completed
54 months FTE trainee will result in a requirement to
Show cause to the Committee for Training
Should a trainee fail the Psychotherapy Written Case twice
Must complete a remedial plan
Should a trainee fail three times
Must show cause to the Committee for Training
Trainees may begin the psychotherapy in Stage 1 (and the case report can be submitted for assessment during any stage of training).
The Psychotherapy Written Case will be assessed at Junior Consultant standard (aligning it with the exams and Scholarly Project).
The Written Case is expected to be attempted and passed by the time the trainee has completed 46 months FTE training.
Failure to do so will require the development of a remedial plan .
Continued failure to pass by the time the trainee has completed 54 months FTE training will result in a requirement to show cause to the CFT as to why they should be able to continue towards Fellowship.
After two failed submissions of the Psychotherapy Written Case, the trainee must complete a remedial plan.
Should a trainee fail the Psychotherapy Written Case three times, the trainee must show cause to the CFT as to why they should be able to continue towards Fellowship, even if the trainee is within the timeframes as mandated on the Trainee Progress Trajectory.
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33. Barriers and risk Barriers to progression Stage 1 → 2 Stage 2 →3
4 EPAs, 2 ITA Reports
Stage 2 →3
16–20 EPAs, 4 ITA Reports
Not barriers to entering Stage 3 of training
Written exam papers
Clinical exams
Psychotherapy Written Case
Risk to progression
Leaving required summative components until late in training
May delay attainment of Fellowship
Important to plan ahead
The 2012 Fellowship Program has minimal barriers to progression.
To progress from Stage 1 to Stage 2, trainees must:
attain the four mandatory Stage 1 EPAs
successfully complete two 6-month rotations (as demonstrated by two passed ITA Reports).
To progress from Stage 2 to Stage 3, trainees must:
attain the 16–20 required Stage 2 EPAs
successfully complete four 6-month rotations (as demonstrated by four passed ITA Reports).
The following summative assessments are not barriers to entering Stage 3 of training:
Written exam papers
Clinical exams
Psychotherapy Written Case.
Trainees are responsible for their own progress through training.
The risk to progression is if trainees fail to adequately plan and consider the number of summative components they must achieve in order to attain Fellowship, leaving them until late in training.
May delay attainment of Fellowship.
The Trainee Progress Trajectory and the Progression through Training policy mitigates the risk to progression by detailing the deadlines for completion for specific components of the Fellowship Program.
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34. Rotational remediation
A remedial plan is required when a trainee has
Failed a rotation
Failed to submit an end-of-rotation ITA Report within the 60 days required
Rotational remediation
Designed to support a trainee to achieve the standard required
Does not replace requirement to undertake the failed rotation again
Trainees are ineligible to attempt the OSCE
Rotational remedial plan
Written plan; jointly designed by trainee, supervisor and Director of Training
Minimum 3 months FTE
Failure to commence remedial program within 60 days of failed rotation
Show cause to Committee for Training
A remedial plan is required when there:
has been a failure to successfully complete a rotation
has been a failure to submit the end-of-rotation ITA Report within the time required (60 days following the completion of a rotation)
has been an ethical breach which requires remediation.
Rotational remediation is designed to support a trainee to achieve the standard required.
The successful completion of a rotational remedial program does not replace the requirement for a trainee to undertake the previously failed rotation again and/or to make up the accredited training time required for a rotation.
The written remedial plan should be jointly designed by the trainee, supervisor and DOT and must be a minimum of 3 months FTE in duration.
Rotational remedial plans must include agreed:
clear achievable goals aimed at improving the trainee’s progress
specified timeframe within which goals are to be achieved
review date
means of determining that specified goals have been met.
Failure to commence a required remedial program and submit the Commencement of a Remedial Program Form within 60 days of a failed rotation will result in a requirement for the trainee to show cause to the CFT as to why they should be able to continue towards Fellowship.
Trainees undertaking rotational remediation are ineligible to attempt the OSCE.
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35. Assessment remediation
Required for two different types of assessment failure
Failure to pass a summative assessment by the trajectory deadline
Two consecutive failures of the same summative assessment
Remedial plan should
Aim to identify the contributing problem(s)
Develop and implement a tailored solution for addressing the problem(s)
Be implemented for a jointly agreed period of time
Assessment remediation not a barrier to attempting other assessments
Failure to pass an assessment by the trajectory deadline
Still eligible for that assessment
Two consecutive failures of the same assessment
Not eligible for that assessment until have completed remedial program
Assessment remedial plans are required for two different types of assessment failure:
failure to pass a summative assessment by the Trainee Progress Trajectory deadline
two consecutive failures of the same summative assessment.
The development of an assessment remedial plan should aim to identify the contributing problem(s) and develop and implement a tailored solution for addressing the identified problems(s).
The remedial plan should be implemented for an agreed period of time as determined by the DOT, trainee and relevant supervisor.
Assessment remedial plans must include agreed:
clear achievable goals aimed at improving the trainee’s progress in successfully completing the assessment
specified timeframe within which goals are to be achieved
review date.
Assessment remediation for a particular assessment is not a barrier to attempting other summative assessments.
A trainee who is undertaking an assessment remedial program for failure to pass an assessment by the trajectory deadline remains eligible to attempt/submit that assessment.
However, a trainee who is undertaking an assessment remedial program for multiple failures of the same assessment is not eligible to re-attempt/resubmit that assessment until they have successfully completed that remedial program.
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36. Failure to progress
Manages identification, support and potentially exit of
Underperforming and/or non-progressing trainees
If trainee has not complied with progression deadlines
Remedial plan
Show cause to the Committee for Training
College Board has final sign-off on exit from training due to Failure to progress
On advice from Education Committees
The Failure to progress policy manages the identification, support and potentially the exit of underperforming and/or non-progressing trainees.
The Fellowship Program aims to ensure that all who are awarded Fellowship have attained the level of competence required for the practice of psychiatry. Consequently, the Fellowship Program must also offer a mechanism to address trainees who remain in training without progressing towards the qualification of Fellowship within the required time constraints.
The Failure to progress policy sets out the requirements for trainees who have not complied with the mandatory progression deadlines:
remedial plan
show cause to the CFT.
The CFT will make recommendations through the College’s governance processes.
The RANZCP Board will have final approval of the exit of any trainee from the 2012 Fellowship Program due to Failure to progress on advice from the Education Committees.
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37. Transition Staggered implementation of 2012 Fellowship Program
Stage 1: December 2012
Stage 2: December 2013
Stage 3: December 2015
Trainees will not be transitioned until the Stage 3 components finalised
Not envisaged that full-time trainees will transition before the end of 2015
Case-by-case exceptions may apply
There is a staggered implementation of the 2012 Fellowship Program.
Stage 1 commenced in December 2012.
Stage 2 will commence in December 2013.
Stage 3 will commence in December 2015.
Trainees will not be transitioned from the 2003 regulations until the Stage 3 components are clearly documented and approved.
At this stage, it is not envisaged that full-time trainees will transition to the Fellowship Program before the end of 2015.
Case-by-case exceptions may apply.
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38. What’s next? Stage 2 will commence in December 2013
College’s Education Committees to continue development work
Stage 3 requirements to be finalised
Generalist and Certificate pathways
Stage 3 EPAs
Stage 3 syllabus
Stage 3 policies and procedures
Stage 2 of the 2012 Fellowship Program will commence in December 2013.
The College’s Education Committees are continuing with the development work required for Stage 3:
generalist and Certificate pathways to be defined
Stage 3 EPAs to be approved
Stage 3 syllabus to be developed
Stage 3 policies and procedures to be developed and approved.
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39. Questions? Any questions? 2012 Fellowship Program website
References
Miller, G. The assessment of clinical skills/competence/performance. Acad Med 1990; 65 (Suppl.): 63–7.
Ten Cate, O. Entrustability of professional activities and competency-based training. Med Educ 2005; 39: 1176–7.
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