2012 Fellowship Program (2012FP) Stage 3 Fellowship and Certificates of Advanced Training Ppt and Presentation: Dr Jimsie Cutbush, Director of Training PGT Qld and Jacqueline Higginbottom, Senior Admin Officer PGT Qld Thanks to Dr Warren Kealy-Bateman, CFT Chair for additional slides

2012FP Stage 3  Stage 3 of the 2012 Fellowship Program focuses trainees on the development of advanced competencies in either general psychiatry or in a chosen subspecialty.  The attainment and demonstration of competence in psychiatry to an advanced standard, as defined by the Developmental Trajectory.  The emphasis in Stage 3 is on adult and self-directed learning. RANZCP>Pre-Fellowship>2012 Fellowship Program>Regulations, policies & procedures>Training chapter

base camp

Progressing to Stage 3  Completion of all Stage 2 training (24 months FTE) and the EPA requirements including o CAP (6 months FTE) o CL (6 months FTE)  No application required to enter Stage 3 generalist training

STAGE 2 TRAINEES: HOW TO ENSURE A SMOOTH CHANGE OVER TO BECOMING A STAGE 3 TRAINEE All of the following EPAs: ST2-EXP-EPA1 - Electroconvulsive therapy (ECT) ST2-EXP-EPA2 – Mental Health Act ST2-EXP-EPA3 – Risk assessment ST2-EXP-EPA5 - Cultural awareness ST2-CAP-EPA1 – Manage an adolescent ST2-CAP-EPA2 – Prepubertal child ST2-CL-EPA1 – Delirium ST2-CL-EPA2 – Psychological distress ST2-ADD-EPA1 – Intoxication and withdrawal ST2-ADD-EPA2 – Comorbid substance use ST2-POA-EPA1 – Behavioural and psychological symptoms in dementia ST2-POA-EPA2 – Medication in patients 75 and over Other EPAs as required by your rotations

TWO OF THE FOLLOWING THREE PSYCHOTHERAPY EPAS  ST2-PSY-EPA2 - Therapeutic alliance  ST2-PSY-EPA3 - Supportive psychotherapy  ST2-PSY-EPA4 - CBT: Anxiety management

Level of Performance End St 1  Low level of independence  High level of supervision  Completes straightforward tasks

Level of Performance End St 2  Proficient

Level of Performance End St 2 For example:  Identifies issues but needs assistance to identify at what level intervention would be most effective within the current governance structure.  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.

2003 FP Trainees Transition  Transition matrix  Everything documented and completed successfully is recognised  For Stage 3 transition all equivalent Stage 1&2 experiences completed  Training record  DOT meetings  Communication from College  Further information: separate ppt

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Stage 3: THE BIG TICKET ITEMS (MANDATORY REQUIREMENTS) 24 months FTE Two EPAs per 6-month rotation One OCA per rotation if you have always been enrolled in the 2012 program Leadership and Management Provision of psychotherapy Protected education time FEC – generalist trainees encouraged to attend adult FEC Fellowship Competencies Supervision Achievement of the centrally administered summative assessments Final qualitative report

Completion of Stage 3 If the trainee did not complete all the Stage 2 Psychotherapy EPAs in Stage 2 and elected to leave one to Stage 3, this needs to be completed in Stage 3

Advanced Level of Performance  High level of independence  Low level of supervision  Completes complex tasks  Developmental descriptors RANZCP>Pre-Fellowship>2012 Fellowship Program>About the training program>Fellowship competencies

Fellowship  Trainees are required to achieve the Fellowship competencies via the Generalist Pathway  The Fellowship competencies map back to the CanMEDS roles underpinning the Fellowship Program  In addition to Fellowship, trainees may undertake additional training to achieve a Certificate of Advanced Training in an area of practice

Developmental Descriptors  The Developmental Descriptors provide guidance on the skill level expected of trainees at the end of each stage of training  The Developmental Descriptors articulate how an advanced standard applies for each of the Fellowship Competencies  Provide a reference point for defining performance standards. RANZCP>Pre-Fellowship>2012 Fellowship Program>Training program documents>Developmental Descriptors

Training Rotations  Successful completion of a minimum of 24 months FTE training in College-accredited training posts  Learning outcomes: o The Learning Outcomes prescribe the minimum expectations of what trainees will need to attain in their rotations o The Stage 3 Learning Outcomes must be attained by trainees in order for them to be eligible for Fellowship. o The Learning Outcomes are tracked on the ITAs.

Knowledge required  Protected education time ◦ 4 hours per week over 40 weeks (pro rata for part- time trainees)  Formal Education Course (FEC) ◦ Generalist trainees encouraged to attend adult psychiatry FEC – preferred option ◦ Adult Certificate FEC – syllabus expected to be the same as 2003 curriculum ◦ Certificate program FEC as per certificate program regulations

Leadership & Management:  BTC approval required  Module or e-module in leadership and management  Training objectives identified in the Stage 3 Mandatory Requirements Policy

Leadership and Management Guidelines Guidelines for BTCs as they plan and approve formal leadership and management training options.  People management Strategy and policy (setting vision and direction)  Clinical Governance (improving care delivery)  Operational management (effective administration of a team/service)  Leadership  Ethics  Legislation  Private Practice

Leadership and Management other options to meet training objectives  2 Administration EPAs, prospectively approved by BTC o Any Administration EPAs completed must be in addition to the requirement to attain two EPAs in any 6-month 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 mental health services

Provision of Psychotherapy  Minimum 3 patients for at least 6 sessions each  Different patients to the 40 sessions related to Psychotherapy Written Case (PWC)  Different to patients for ST2-PSY-EPAs  Trainee must receive supervision for these sessions  Stage 3 psychotherapy sessions form RANZCP>Pre-Fellowship>2012 Fellowship Program>About the training program>Stages of training>Stage 3 Psychotherapy Sessions form

Stage 3 Supervision  Minimum 4 hours per week over 40 weeks for full time trainees  Minimum 1 hour per week individual clinical supervision

Forms WBAs (minimum 3 WBAs per EPA) EPAs OCAs Psychotherapy experience Mid term ITA (mandatory) End of term ITA (must be submitted prior to 60 days from end of term – failure to submit will result in a failed rotation) RANZCP>Pre-Fellowship>2012 Fellowship Program>Training program forms

Forms Trainees are required to maintain a portfolio of forms and reports and provide to the next supervisor prior to the start of each new rotation (now a requirement in Stage 1 and Stage 2)

ST 3 Gen - OCA requirement  One OCA per rotation for all 2012FP trainees i.e. all trainees in 2016  Protocol on website  Not a big deal: since 2013, trainees under the 2012FP have done anything from 1 to 4 OCAs in a rotation, and report them as a productive part of training

ST 3 Gen - OCA requirement Exceptions: 2003FP, no OCI pass  2012FP: min of 4x OCAs after transition 2003FP, OCI pass  2012FP St 3 Gen: no OCAs after transition 2003FP, OCI pass  2012FP Adult Certificate: no OCAs after transition 2003FP, OCI pass  2012FP all other Certificates: 1x OCA per rotation However: Trainees may still chose to complete OCAs as workplace-based assessments (WBAs) to inform the evidence base for the two Entrustable Professional Activities (EPAs) required per rotation.

Entrustable Professional Activities EPAs Specialised tasks that a trainee must demonstrate their ability to perform with only distant (reactive) supervision Summative assessments of specific competencies Confirmation of Entrustment (COE) forms

No eligibility to undertake Stage 3 EPAs prior to entering Stage 3 Trainees are not eligible to be entrusted with Stage 3 EPAs prior to entering Stage 3 of the Fellowship Program

Stage 3 EPAs Fellowship (FELL) EPAs: Can be attained in any rotation Area of Practice (AOP) EPAs: Can be attained in the area of practice only 103 St 3 EPAs currently identified (some still in development e.g. research) RANZCP>Pre-Fellowship>2012 Fellowship Program>EPA forms

Elective Areas of Practice (AOP) EPAs: Addiction psychiatry Adult psychiatry Child and Adolescent psychiatry Consultation-Liaison psychiatry Forensic psychiatry Indigenous psychiatry (AUS available; NZ in development) Psychiatry of Old Age Psychotherapies Medical Administration (in development) Medical Education (in development) Research (in development)

EPA Achievement – Generalist  A generalist trainee is eligible to achieve any of the Stage 3 Fellowship EPAs in any area of practice e.g. ◦ ST3-POA-FELL-EPA1 can be achieved in an adult term  A generalist trainee is eligible to achieve any of the Stage 3 EPAs for the area of practice for which their rotation is accredited (both FELL and AOP can be achieved) e.g. ◦ ST3-POA-AOP-EPA5 can only be achieved in a POA rotation  ST3-AP-AOP-EPAs 1–19 can only be achieved in adult rotations

Selection Criteria – all Certificates of Advanced Training (AT)  Certificates of AT cannot be commenced until eligible to enter stage 3 and satisfied the selection criteria of the relevant certificate.  Trainees must have at least ◦ Application form ◦ Passed MCQ (effective rotation 2, 2016) ◦ Interview with DOAT (or delegate) ◦ Formally selected

Certificate of AT- Forensic Psychiatry Additional selection criteria In addition to the previous criteria to enter AT, forensic psychiatry trainees must have: Passed one written assessment (e.g. Essay-style exam, psychotherapy written case, scholarly project) i.e. demonstrate acceptable ability in written English as demonstrated by one of these College assessments because report writing is an integral skill in forensic psychiatry Effective rotation 2, 2016

Certificate of AT– Psychotherapies Additional selection criteria In addition to the previous criteria to enter AT Psychotherapies trainees must have: Passed psychotherapy written case Effective rotation 2, 2016

Certificates of Advanced Training

Certificates of Advanced Training Mandatory training requirements

Training requirements There are mandatory requirements that apply to all certificates of advanced training (except psychotherapies) in addition to specific training requirements for each certificate Trainees undertaking a certificate of advanced training and Stage 3 of the Fellowship program concurrently must follow the requirements of both programs

Certificate Training and OCA Completing one OCA during each 6 month FTE rotation is required of the certificates of advanced training (except Adult Psychiatry). The rationale: it is important that the trainee do OCAs with patients in the respective areas of practice The OCA has to be relevant to the AOP Applies to all trainees and Fellows-in-training regardless of whether they have passed the OCI

Mandatory requirements – all certificate programs (except AT PSY)  Trainees and Fellows-in-training must enter into a training agreement with the College  Pre-Fellowship trainees must be in accredited training posts  Must attain two EPAs per 6 month FTE  Must submit end of term ITAs within 60 days of completion of rotation  Clinical supervision – minimum 4 hours per week, 1 hour individual  Undertake after hours and emergency duties required by the training post

Non clinical training  Research, teaching or medical admin  Maximum 12 months  Prospective approval from SAT and BTC  Mid and end of term reports (clinical and non clinical separately)  2 EPAs per 6 month rotation  1 OCA per 6 month rotation  Encouraged to maintain clinical currency by spending at least 0.2FTE or 1 day per week in direct clinical work

Dual Certificate Training

Trainees and Fellows-in-training are able to undertake two certificates of advanced training concurrently.  Satisfy selection criteria for both certificates  Fulfil the requirements of both certificates  Must spend a minimum of 18 months in each area of practice  Present detailed plan to both certificate of AT programs DOAT’s (see website for plan specifics)  Plan must be prospectively approved by both SAT Chairs

Completing Stage 3  Trainees will continue in Stage 3 until they complete all assessments. All requirements of training apply i.e. EPAs, OCA, supervision  Trainees who have not passed all required assessments by 24 months, may apply for a break in training to complete assessments.  BIT – maximum 5 years accumulative

Stage 3 Completion of summative assessments  Written MCQ exam36 months  Written Essay-style exam54 months  OSCE54 months  Scholarly Project54 months  Psychotherapy Written Case46 months

Junior Consultant Standard A junior consultant needs in-depth specialist knowledge to be able to act independently and safely, working with a broad overview of the related and significant issues.

Standards – Junior Consultant

Reminders  Break in training  Remediation  Deadlines  Show cause  Failure of term

Transitioning between programs RANZCP>Pre-Fellowship>Transition between programs Transition Matrices Certificate of Advanced Training in Addiction Psychiatry Certificate of Advanced Training in Adult Psychiatry Certificate of Advanced Training in Child and Adolescent Psychiatry Certificate of Advanced Training in Child and Adolescent Psychiatry Certificate of Advanced Training in Consultation-Liaison Psychiatry Certificate of Advanced Training in Consultation-Liaison Psychiatry Certificate of Advanced Training in Forensic Psychiatry Certificate of Advanced Training in Psychiatry of Old Age Certificate of Advanced Training in the Psychotherapies

Summit

AT Certificates: details follow

AT Adult Psychiatry Successful completion of 24 months FTE in an accredited ATAP post  Up to 6 months FTE can be spent in another clinical area of practice provided the training experience relates to adults (prospective approval on case-by-case basis from SATAP is required)  Up to 12 months FTE of research can be prospectively approved on a case-by-case basis

AT AP continued  Attainment of eight Stage 3 Adult Psychiatry EPAs - two per 6 month FTE rotation ◦ 5 are mandatory for certificate completion ◦ Trainees chose additional three EPAs from the remaining adult EPAs ◦ If an approved 6 month FTE elective rotation in another clinical area of practice is undertaken, then minimum 2 EPAs relevant to that area of practice are mandatory

AT AP cont.  Participation in two committees or planning groups  Completion of 10 case formulations – at least 5 per 12 month FTE  Cases as per following: o 2 patients with bipolar disorder o 2 patients with borderline personality disorder o 2 patients with schizophrenia o 2 patients with major depression o 2 patients with anxiety disorders

AT AP cont  Treatment of at least four adults with a mental disorder to completion with a structured psychotherapy  Completion of a formal adult psychiatry teaching program ◦ If a local SATAP approved program is available - trainees are required to attend ◦ No formal program available – trainees are required to complete self-directed learning ◦ Teaching program can be undertaken while on a break in training RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Adult Psychiatry

Certificate of AT-Addiction  24 months FTE training in accredited posts  Written outline of proposed training, agreed with the DOAT Add and submitted prior to the commencement of training and at the beginning of year 2  Attainment of eight stage 3 addiction psychiatry EPAs (2 per 6 month FTE)  Completion of mandatory minimum of 1 OCA each 6 month FTE  Completion of formal addiction psychiatry teaching program  Completion of one written case history words  Completion of 72 case summaries  Submission of final qualitative report to the DOAT RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Addiction psychiatry

Certificate of AT Child and Adolescent psychiatry Successful completion of 24 month FTE training Written learning plan Attainment of eight Stage 3 CAP EPAs Mandatory minimum 1 OCA per 6 month FTE rotation Provision of psychotherapy to nine discrete patients/dyads/families/groups for at least six sessions each Completion of recognised formal CAP teaching program Submission of final qualitative report to the DOAT RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Child and adolescent psychiatry

Certificate of AT Consultation- Liaison Psychiatry  Successful completion of 24 months FTE training  Attainment of eight Stage 3 EPAs  Mandatory minimum 1 OCA per 6 month FTE rotation  Completion of recognised formal CL teaching program  Completion of 20 case summaries (5 per 6 month FTE rotation)  Completion of a CL Scholarly Project

C-L Scholarly Project  Completion of a Scholarly Project relevant to CL o The SP submitted to the College for the purposes of the Fellowship Scholarly Project requirement can only be used for the C-L Certificate if it is relevant to the practice of C-L  Presentation of a scholarly project at a CPD-approved meeting or conference RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Consultation–liaison psychiatry

Certificate of AT Forensic Psychiatry  Successful completion of 24 months FTE training  Attainment of eight Stage 3 Forensic EPAs  Mandatory minimum 1 OCA per 6 month FTE rotation  Completion of formal Forensic teaching program, equivalent to graduate certificate  Successful completion of a research project: a SP submitted to the College for the Fellowship Scholarly Project requirements satisfies this criteria RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Forensic psychiatry

Certificate of AT Psychiatry of Old Age  Successful completion of 24 months FTE training  Written learning plan  Completion of formal psychiatry of old age teaching program  Attainment of eight Stage 3 POA EPAs  Mandatory minimum 1 OCA per 6 month FTE rotation  Management (pre and post) of two older people receiving ECT  Attendance at five half-day memory clinics  Completion of 40 discrete case summaries (10 per 6- month FTE rotation)

AT POA continued  Provision of psychotherapy to three older persons  Completion of five medico-legal reports  Successful completion of the Faculty of Psychiatry of Old Age research project o The SP submitted to the College for the purposes of the Fellowship Scholarly Project requirement can only be used for the POA Certificate if it is relevant to the practice of POA RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Psychiatry of old age

Certificate of AT-Psychotherapies  The rotation model of training does not apply to this certificate of advanced training program.  Certificate cannot be completed in less than 24 months (and must be completed within 6 calendar years)  Complete formal teaching program o Core program; and o Modality program  Attain eight Stage 3 Psychotherapies EPAs  Complete forms as progress is made  Psychotherapy modalities – complete requirements of one of the following – individual dynamic, structured and brief, group or family and couples therapies RANZCP>Pre-Fellowship>2012 Fellowship Program>Certificates of Advanced Training>Psychotherapies