Stage 3 Trainee and Supervisor Training

50 Pages·2015·0.92 MB·English

2012 RANZCP Fellowship Program
Stage 3
Fellowship Generalist Pathway and
Certificates of Advanced Training
Dr Shane Gill
DOT, SAPBTC, November 2015
With grateful acknowledgement to input from Jimsie Cutbush and
Jackie Higginbottom, QBTC, and Warren-Kealy-Bateman, Chair CFT
Stage 3
• 4th and 5th year of Fellowship training
• Must have completed all stage 2 EPA’s (except only need 2 out of 3 psychotherapy EPA’s)
and passed all rotations in stage 2
• Progression to stage 3 is automatic and does not require application
• Development of advanced competencies in general psychiatry or a chosen sub-specialty
• The end of Stage 3 standard is that of a junior consultant
• Centrally Administered Fellowship Exams
– Most of these will be sat or submitted during stage 3.
– MCQ should be passed in stage 2 (remediation at 36/12) but a trainee can still commence stage 3 (in remediation) if
not passed. However, cannot commence an advanced training certificate until MCQ is passed
– Essay Paper, PWC and Scholarly Project can be submitted in either stage 2 or 3, but most will pass these in stage 3
– OSCE can only be attempted in Stage 3
https://www.ranzcp.org/Files/PreFellowship/2012-Fellowship-Program/RPP-TRAINING.aspx
Stage 1 Stage 2 Stage 3
vs vs
• Stage 1: Basic competencies in adult psychiatry
– Low level of independent practice
– High level of direct supervision required
– Manages straightforward clinical tasks
• Stage 2: Proficient competencies in various areas of practice
– Identifies issues but needs assistance to identify at what level intervention would be most effective
– Uses supervision to identify areas of knowledge deficiency and review the existing literature to enhance
understanding
– Reliably attends to required clinical responsibilities and, with assistance, manages complex and unfamiliar
situations
• Stage 3: Advanced competencies in general or sub-specialty areas
– High level of independent practice
– Low level of supervision required
– Can complete complex tasks
– Shows initiative in problem solving
– Takes into account system issues related to governance structures
– Can supervise practice of more junior staff
Who will be in stage 3
• 2003 Fellowship Trainees
– Those who have completed all 2003 Basic Training requirements
– Exam/case passes do not preclude transition to stage 3
– Transition Matrix: documented tasks are recognized and given credit under 2012
stage 3 program.
– 2003 advanced trainees
• Given credit for FTE already completed under 2003
• > 12/12 AT – not required to do 3 psychotherapy cases
• Leadership and Management credited if completed
• No credit for learning objectives and ethical activities
• Each certificate has its own transition matrix
• 2012 Trainees who commenced in 2013 (current 3rd years)
What are the Stage 3 requirements?
• Every trainee has to meet generalist requirements – a certificate adds others
that must be met concurrently
• Universal CBFP requirements that are similar to stages 1 & 2
– 24 months FTE – 4 x 6/12 FTE rotations
– ITA must be passed at end of every rotation. Must be submitted within 60 days (+30)
– Minimum 2 EPA’s per rotation (8 in total)
– Minimum 3 WBA’s per EPA achieved
– Mandatory OCA per rotation unless exempt via OCI pass
– 4 hours per week protected time to attend FEC
– 4 hours supervision per week for 40 weeks, one hour individual from principal supervisor
• Things that are in Stage 2 that are not in stage 3
– No “general stage EPA’s”. Only the 8 rotation linked EPA’s required (with exception of the
third stage 2 psychotherapy EPA if not achieved in stage 2)
Additional requirements unique to Stage 3
• Psychotherapy requirements
– Three patients treated for at least 6 sessions each with psychotherapy, under
supervision. There is a form to submit when completed.
– Can be any school or type, but must be indicated for the patient, must be the main
intervention, and not just psychoeducation or supportive therapy
– Can’t include PWC patient or patients seen in WBA’s to inform stage 2 psychotherapy
EPA’s
• Leadership and Management
– Most commonly, a series embedded in stage 3 FEC
– Can be a conference, workshop, course (must be approved by BTC)
– Can be through involvement in a QI or service development activity
– Can be through achievement of 2 medical admin EPA’s
• Most trainees will be attempting exams simultaneously whilst in stage 3
• Can enrol in an advanced training certificate from start of 4th year
• Final qualitative report about training experience at end of training
Developmental Descriptors
https://www.ranzcp.org/Files/PreFellowship/2012-Fellowship-Program/Developmental-Descriptors.aspx
• Developmental descriptors articulate how a standard applies to each Fellowship competency, at
each of the three stages.
• Each competency, organised along CANMEDS domains, has a descriptor for the standard of
competent performance at “end of stage” level
• These are similar to “learning outcomes” (which are rated in every ITA) and should be seen as a
companion to these
• The advanced descriptors can be used by supervisors to determine whether or not their stage 3
trainee is performing at the stage 3 standard, when completing a WBA or ITA
• Below is an example of developmental descriptors for MSE across the three stages
Stage 3 rotations
• Need to be accredited for stage 3 (if previously accredited for advanced training, will be accredited for
stage 3)
• Must provide opportunities to work at a “senior registrar” capacity with leadership roles and opportunity
to work with distant, reactive supervision
• Need to provide opportunity for trainee to attain stage 3 Learning Outcomes
• These are tracked on stage 3 ITA’s
• Examples of stage 1,2 and 3 learning outcomes below
• Rotations need to separately accredited for Advanced Training certificates (each DOAT is responsible for
this). All AT certificate rotations must be accredited for stage 3 fellowship training
• Most will be accredited for the certificate related to their Area of Practice (AOP) e.g. adult, CAP, POA etc
Formal Education Course
• All stage 3 trainees required to have 4 hours per week of “protected time” to attend to
formal education (the 4 hours includes travel time from worksite to the course)
• Most certificates mandate attendance at a FEC +/- self-directed learning as an option
– Adult certificate mandates an adult FEC approved by SATAP (we already have this in SA)
– CAP mandates a program approved by SATCAP (we already have this in SA)
– Forensic mandates a formal program that is “at University Level and externally assessed, equivalent
to a Graduate Certificate”. SAPBTC Stage 3 FEC NOT suitable. Need to be done externally. Three
courses (all interstate) approved so far by SATFP
– POA requires a formal “Learning Plan” to describe how the Stage 3 POA curriculum will be learnt.
Must include a POA FEC if available, but will need to include other self-directed learning, seminars,
courses if only a general/adult FEC available. Formal POA FEC not currently in SA – may change?
– Psychotherapy requires a formal 40 hour foundational course on core topics, and 120 hours in
chosen modality (can be self-directed). SATPsych offers the 40 session core course in SA
– Addiction and C-L require attendance at a dedicated FEC is available ,or self-directed learning if not
• Generalist trainees are encouraged, rather than mandated, to attend the Adult Stage 3 FEC
– SAPBTC Stage 3 FEC will be a SATAP-approved adult FEC, but will include modules from all of the
sub-specialties and will have the 40 hour core foundational psychotherapy course embedded in it.
– The mandated Leadership and Management Training will also be embedded as a module in the
SAPBTC stage 3 FEC. In addition, exam preparation will also be embedded within the FEC
Leadership and Management Training
• BTC-approved module embedded within the FEC
– SAPBTC will embed this in their FEC (as we have done before). We have approved our own course!
– Covers the following content areas
 Awareness of National Mental Health Policy Framework and funding models for mental health
 Awareness of competencies required in management roles and how these differ from clinical roles
 Clinical Governance (improving care delivery)
 Operational management (effective administration of a team/service), inc.change management principles
 Quality Improvement within a service setting
 Engagement of consumers and carers within mental health services
 Ethical issues in service management, e.g. Equity, access, population health principles
 Managing a career as a psychiatrist in diverse roles, inc.broader roles outside of clinical, and maintaining one’s own welfare
 Private Practice
• Other alternative methods of meeting this requirement
– Can be elected to be done by a trainee if FEC module unavailable or unsuitable
– SAPBTC must approve a trainee electing any of these, in advance
 2 Administration EPAs (if done must be in addition to two EPA’s achieved per rotation)
 Policy or Procedure Development (Team or Service)
 Implementation and evaluation of a Clinical Practice Guideline or Clinical Pathway
 Development or facilitation of a specific quality improvement cycle
 Development of a program for increasing engagement of people with mental health problems and illness in MH services