Medical specialist training is undergoing a significant transformation in Finland, and this has and will have a profound impact in psychiatry. Not so long ago a licensed medical doctor simply registered into a medical faculty, and starting training was a matter of an announcement. In fields of medicine with abundant numbers of trainees, the real trial was only later in getting a post at a university clinic. However, this is now past after the new act on medical specialist training on medical and dental specialist training in force since 2020.
Compentency-based training and national coordination
In the current system, every applicant to the training is interviewed, and acceptance to the training programme is based on sum of scores from the interviews, clinical services and scientific merits. Interviews of applicants focus on areas that are significant in evaluating the applicants’ aptitude to the specialty. Therefore, the interviews cover motivation, past work experience; interactional skills and cooperativeness in multidisciplinary teams; knowledge of substance of the field, and stress tolerance. This first acceptance is only provisional, and final acceptance is granted only after successful performance during a six-month trial period. The new act has also reduced the minimum duration of training from six to five years. However, the programme is competency-based, so duration depends on achieving the learning objectives, i.e. skills rather than calendar months.
During the earlier era, medical faculties of universities had autonomy in deciding the curriculum of their own specialist training, even if these were regularly discussed, negotiated and coordinated because of the national specialist exam. In the new era, the curriculum and guidance are national, and regulations similar between the universities. All universities still have their own scientific and clinical seminars and teaching, but the core curriculum and competency-based learning objectives are nationally the same. They are largely organized according to the principles of the CanMeds model; roles of medical experts as communicators, collaborators, leaders, health advocates, scholars, and professionals.
Specialist training in psychiatry has of course been developed already before the new regulations. Psychiatric departments have intensified their efforts in providing comprehensive theoretical and scientific education, content of which has been explicated in the core curriculum. Typically, this education has meant at least 2-5 weekly hours of theoretical education.
From a trainee’s perspective, the most important developments have included mandatory weekly supervision and increasing emphasis on assessment and feedback on performance. A forthcoming element will be application of entrustable professional activities (EPAs) in training. These will be applied across medical specialties, and involve evaluation of trainee’s performance in central tasks, in psychiatry such as structured diagnostic interviews formulating treatment plans. In important development is recruitment of senior experts into roles of part-time (20%) local coordinating educators, who will facilitate training by supervising, mentoring, evaluating following professional development of trainees.
Psychiatric training in Finland has overall improved a lot during the last few decades. The scope and aims of the training are increasingly more explicit, and the approach more systematic. Nevertheless, improving training is always work in progress. A hot potato is the extent of psychotherapy training, as there are questions pertaining both the resources of the medical faculties as well as the precise role of psychotherapy in future psychiatrists’ workload. Nor are the skills of pharmacotherapy or neuromodulatory treatments sharpened as much as needed, and that is true for many other aspects as well. A major challenge for the few psychiatric educators is the expansion of psychiatric knowledge, and the breadth of scientific fields it entails, from molecular genetic to epidemiological. This will keep us busy. □