Postgraduate training in psychiatry in Poland: difficulties and potential solutions Tomasz M. Gondek Irena Wojciechowska Specialty Training Section, Polish Psychiatric Association

Psychiatry as a specialty Psychiatry is the most exciting, fulfilling and intellectually stimulating medical specialty, bar none. - Prof. Dinesh Bhugra

Quality of training Working conditions Salary Training curriculum Additional opportunities for early career psychiatrists

Working conditions in Poland Psychiatric wards usually localised in large mental health institutions outside city centres but rarely seen in general hospitals Heavily underfunded hospitals with very old facilities Low availability of specialist consultations No access to quick laboratory tests or imaging In some hospitals, a psychiatric trainee has to work with only „stethoscope and blood pressure meter”

Working conditions in Poland Not enough rooms for medical interview and mental health state examination performed with dignity Not enough equipment such as computers or printers, resulting in wasting trainees' time Constant inhaling of cigarette smoke on the ward due to lack of ventilation in older institutions Limited possibilities of the least invasive coercion method – lack of isolation rooms in some psychiatric hospitals

Working conditions in Poland Application for specialty: only one specialty in one voivodeship Difficulties with performing curriculum as planned: frequently resident has to do the internship on a ward with lacking staff instead of the planned one Obligatory courses usually offered in centres far away from the main intitution No training evaluation No possiblity to change specialty

Trainees' salary: €3 per hour

Trainees' salary 500 euro after tax per month Obligatiory courses and voluntary psychotherapy training (approx euro) are covered from trainee's own pocket Salary vs. fees for psychiatric congresses No overtime hours reimbursement or paid delegations to obligatory courses

Training curriculum In 2014 training curriculum in psychiatry in Poland has been changed, with the variety of training interships being severly restricted in the new document It prompted the initiative of establishing an association of psychiatric trainees in Poland, advocating for the improvement of the new training programme

Specialty Training Section of PPA Contact with over 200 trainees from various parts of Poland via , facebook groups or during psychiatry training courses Support received from: – Department of Psychiatry, Wroclaw Medical University – Lower Silesian regional consultant in psychiatry – Board of the Polish Psychiatric Association Section established in June 2015

Specialty Training Section of PPA Aims and challenges: – Working on the improvement of the training curricula in GAP and CAP, in line with the UEMS recommendations – Preparing additional courses for trainees and ECPs: leadership skills, research methodology and presentation of own work – Scientific collaboration within young psychiatrists network in Poland and abroad – Recruitment and promotion of psychiatry

Specialty Training Section of PPA Aims and challenges: – Working on the improvement of the training curricula in GAP and CAP, in line with the UEMS recommendations – Preparing additional courses for trainees and ECPs: leadership skills, research methodology and presentation of own work – Scientific collaboration within young psychiatrists network in Poland and abroad – Recruitment and promotion of psychiatry

Specialty Training Section of PPA Aims and challenges: – Anti mental health stigma actions and supporting patients' and families' NGOs – Development of collaboration with trainees of other specialties in order to promote consultation psychiatry (neurologists, cardiologists etc.) – Active participation in international organisations for trainees and ECPs working in the field of psychiatry: EFPT, YPN, EPA ECPC, WPA ECP Section

Polish Junior Doctors' Association A movement gathering over 16,000 trainees Part of the Nationwide Union of Medical Doctors (OZZL) Dispersed management, shared workload Innovative methods: „adoption of MPs” instead of protests as a first measure Intense social media campaigns, growing traditional media coverage Participation of Specialty Training Section

Training curriculum

Specialty training in GAP lasts 5 years (60 months) During this time a trainee is obliged to attend certain internships and courses. In 2014 the specialty training program has been updated. New specialty program consists of 6 courses and 5 internships. The internship on general ward for adults in a clinical ward and in an in-patient ward (40 months). Other internships include: neurology, CAP, neuroses treatment and addiction treatment. The variety of internships has been strongly decreased, with some of them being removed

Training curriculum Specialist training in Poland does not contain psychotherapy course. Following successful completion of 5 years of training, a trainee will take the final exam. Once a trainee has passed the written and oral exam, he becomes a specialist in adult psychiatry.

Additional opportunities for early career psychiatrists

EFPT Exchange Programme An opportunity for psychiatric trainees to go on exchange throughout Europe A short-term programme: between 2 and 6 weeks Enables the applicant to spend a period of time as an observer at an institution of a host country Programme addressed to trainees in GAP and CAP of any year of training

EFPT Exchange Programme Aim of the the exchange programme is to provide trainees with the opportunities to: – Get involved in clinical, research and teaching activities abroad – Experience another mental health care system – Experience a different trainee programme – Socialize with European trainees – Learn about transcultural psychiatry

EPA Summer School Topics: – Previously: Comorbidity between mental and physical disorders – focusing on the basics of consultation-liaison psychiatry – Currently: ABC of psychotherpy

EPA Summer School 3 day learning experience Teaching methods: Case studies & skills oriented sessions in small working groups supervised by senior Faculty members Lectures by esteemed psychiatrists

Leadership courses for ECPs Leadership and Professional Skills Course Berlin Summer School EPA Leadership Skills in Psychiatry

Thank you! Tomasz M. Gondek: Irena Wojciechowska: