The seven competencies of a psychiatrist are based on the CanMEDS physician competency framework as amended in 2015 (Frank et al, 2015). The CanMEDS framework is a set of competencies used in medical education, to guide the training and assessment of physicians in various specialties, including psychiatry. This framework is used by the European Union of Medical Specialists (UEMS) in the development of their European Training Requirements (ETRs) as a way to foster harmonisation.
In 1994, the UEMS adopted its Charter on Postgraduate Training aiming at providing recommendations at the European level for high quality training. This Charter set the basis for the European approach in the field of harmonisation of Postgraduate Specialist Medical Training, most importantly with the ongoing dissemination of its periodically updated Chapter 6s, specific to each specialty. After the most recent version of the EU Directive on the recognition of Professional Qualifications was introduced in 2011, the UEMS Specialist Sections and other UEMS Bodies have continued working on developing the ETR documents. They reflect modern medical practice and current scientific findings in each of the specialty fields. It is one among the clear aims of the UEMS ETRs to raise standards of training to make sure that European patients find high quality standards of safe specialist care.
I had the privilege of being able to present our updated Psychiatry ETR at the last UEMS council meeting this month (October 2023 – Editor’s note) and see it being adopted by the various European National Medical Associations and Specialty boards.
This reflects the work of many people over many years, and a strong collaboration with our trainees, represented by the European Federation of Psychiatric Trainees (EFPT), patients’ and carers’ organisations and scientific societies. This most recent iteration was led by our immediate past-president, Dr Andrew Brittlebank.
We were congratulated by colleagues from other specialties on our document and they were intrigued by the nature of the ‘Profile of a Psychiatrist’, one of the documents which contributed to the ETR. We have since shared it with colleagues as this may inspire them to develop a similar one for their specialties.
In the context of CanMEDS, there are seven key competencies, underpinned by supporting competencies, that psychiatrists need to have and continually develop to provide comprehensive patient care and excel in their field. They are reflected in the Psychiatry ETR, the ‘European Framework for Competencies in Psychiatry’ and the ‘Profile of a Psychiatrist’.
Medical expert. This competency is the foundation of a psychiatrist's skillset. To be a competent medical expert, psychiatrists must possess a deep understanding of the biological, psychological, and social aspects of mental health and illness. They need to prevent, diagnose, and treat mental disorders, taking into account both pharmacological and psychotherapeutic interventions. Their role also includes priority setting and clinical decision-making in contexts of uncertainty and complex healthcare systems. Additionally, they must stay up to date with the latest research and evidence-based practices in the field.
Communicator. Effective communication is essential in psychiatry. Psychiatrists need to be skilled in establishing therapeutic relationships with their patients. They must be empathetic and compassionate, actively listening to patients to understand their concerns, and communicating complex medical information in a clear and accessible manner. Effective communication is crucial in building trust, reducing stigma, and ensuring patient adherence to treatment plans as well as developing relationships with colleagues.
Leader. In psychiatric settings, psychiatrists often play leadership roles in treatment teams. They work in a multidisciplinary team and provide guidance and supervision to other healthcare professionals, including residents and medical students. They also participate in shaping mental health policies and advocating for the needs of their patients. Strong leadership skills are essential for ensuring that patients receive high-quality care and for advancing the field of psychiatry as a whole.
Health advocate. As advocates for their patients, psychiatrists must address the social and systemic factors that impact mental health. They work to reduce stigma surrounding mental illness and advocate for policies and resources that support better mental health outcomes. Health advocacy also includes promoting early intervention and prevention strategies to improve mental health on a population level.
Scholar. Psychiatry is a dynamic field, with ongoing research and advances in treatment modalities. Psychiatrists must be committed to lifelong learning and scholarly activities. This includes staying updated with the latest research, conducting their own research, and contributing to the body of knowledge in the field. It also includes achieving excellence in teaching patients, colleagues, doctors in training, medical students, and the general public. By engaging in scholarly activities, psychiatrists can provide the best possible care to their patients and contribute to the overall advancement of the field.
Professional. The professionalism competency encompasses ethical and legal aspects of psychiatric practice. Psychiatrists must adhere to a high standard of ethical conduct, respecting patient confidentiality and informed consent. They must also be aware of the legal and regulatory aspects of their practice, ensuring that they comply with the relevant laws and regulations. Professionalism also involves self-awareness and self-regulation, as psychiatrists need to manage their own well-being to provide effective care.
In conclusion, the CanMEDS framework outlines seven key competencies for psychiatrists, encompassing a wide range of skills and attributes. To be successful in their practice, psychiatrists need to be not only medical experts but also skilled communicators, collaborators, leaders, health advocates, scholars, and professionals. These competencies help ensure that individuals with mental health issues receive comprehensive, compassionate, and effective care, while also contributing to the advancement of the field of psychiatry as a whole. Psychiatrists who excel in these competencies are well-equipped to make a positive impact on the mental health and well-being of their patients and society at large.
References by request
Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 physician competency framework. Ottawa: College of Physicians and Surgeons of Canada. https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e.
UEMS Section of Psychiatry (2023) Charter on training of Medical Specialists in the EU. Training requirements for the specialty of Psychiatry. https://www.uemspsychiatry.org/section-training-reports
UEMS Section of Psychiatry/European Board of Psychiatry (2003) Charter on Training of Medical Specialists in the EU (Chapter 6): Requirements for the Specialty of Psychiatry.
UEMS Section of Psychiatry (2018) The Profile of a Psychiatrist (Revised) https://www.uemspsychiatry.org/section-training-reports