EPA-UEMS: Joint Workshop on education and training - European Congress of Psychiatry

Dear all,

We are delighted to announce UEMS will be holding a joint workshop with EPA at the upcoming 32nd European Congress of Psychiatry taking place 6-9 April 2024 in Budapest, Hungary.

Most of the UEMS Psychiatry Section officers will be in attendance and we would be delighted to see you at the session. There will be a chance after the session for a discussion with the officers so we hope you be able to stick around.  

EPA-UEMS: Joint Workshop on education and training

09.04.2024 | 08:00 - 09:30 | F1-F2-F3

Code: JW01

Type: Joint Workshop

Topic: Joint Session

Chair: Marisa Casanova Dias (United Kingdom) , Geert Dom (Belgium)

08:00 - 08:14

Updates on the European Training Requirements (ETR)  for psychiatry

Speaker: Andrew Brittlebank (United Kingdom)

08:14 - 08:28

MOOC courses in psychiatry; future perspectives

Speaker: Cecile Hanon (France)

08:28 - 08:42

Survey on psychiatry training in Europe

Speaker: Asilay Seker (United Kingdom)

08:42 - 08:56

How to train community psychiatry in Europe

Speaker: Marianne Destoop (Belgium)

08:56 - 09:10

The future of training in psychiatry in Europe

Speaker: Krzysztof Krysta (Poland)

UEMS officer Prof. Dr. Slađana Štrkalj Ivezić will also be presenting a poster (attached) on ‘Assessing the recovery process in a mobile rehabilitation team for people with severe mental disorders by using the Recovery Helm’.

Times and location below:

08.04.2024 | 09:30 - 10:00 | e-Poster area station 05

Code: EPP0298

Type: ePoster Presentation

Topic: Rehabilitation and psychoeducation

Speaker: Sladana Strkalj Ivezic (Croatia)

UEMS Section of Psychiatry Advocates for Human Rights and Recovery in Coercive Practices

November 2023

The UEMS Section of Psychiatry Human Rights Working Group, has published a Position Paper addressing the critical issue of maintaining human rights and recovery principles when coercive practices are considered in psychiatric treatment.

Ensuring Human Rights and Recovery Principles

The paper emphasises the necessity of aligning psychiatric practices and training with fundamental human rights and recovery principles. Coercive practices, defined as non-consensual treatments or interventions, must be approached as a last resort, subject to rigorous scrutiny, and alternatives should always be sought.

The paper acknowledges the challenging situations where coercive practices may be unavoidable due to extreme risks or cases of severe mental illness. However, it stresses the importance of strictly adhering to relevant and protective legislation to safeguard individuals' fundamental rights.

Educating Psychiatrists for Change

To address this complex issue, the UEMS Section of Psychiatry advocates for comprehensive education in key areas, including human rights, medical ethics, informed consent, and a holistic bio-psycho-social approach to mental disorders. Psychiatrists should be equipped with the knowledge of international laws, such as the UN Convention on the Rights of Persons with Disabilities (CRPD), and be trained in evidence-based interventions to reduce or eliminate coercive measures.

A Call for Systemic Change

The paper stresses the need for a holistic, recovery-focused approach to reduce coercive practices. Psychiatrists should be skilled in conflict resolution, de-escalation, and emotional regulation. The creation of a welcoming environment, free from potential triggers of aggression, is vital.

Moreover, the Section advocates for the use of evidence-based interventions, such as de-escalation techniques, comfort rooms, crisis intervention teams, advance directives, and individualised plans to identify and manage triggers. A systemic change at the institutional level is crucial for the successful reduction of coercive measures.

Involving Stakeholders for Change

The Section underscores the importance of involving all stakeholders, including people with lived experiences, their families, health systems, communities, and legislators, in changing policies and implementing evidence-based practices.

Appendix: Recovery Principles

The paper concludes with an appendix outlining recovery principles, highlighting the importance of hope, person-driven pathways, identity, holistic approaches, cultural sensitivity, strengths, and responsibilities, relationships, trauma-informed care, and more.

The UEMS Section of Psychiatry encourages continued dialogue, collaboration, and action to ensure that psychiatric practices align with human rights and recovery principles, fostering a culture of respect and optimism for those facing mental health challenges.

PSYCHIATRIC EXCELLENCE AWARD - Extended Deadline 25 Feb 2024

UEMS Psychiatry Excellence Award

Psychiatry Excellence Awards Application Form

(An editable application form is available on the members-protected part of the website)

---

An interview with Dr Rachael Cullivan-Elliott, Vice President for CME

---

What inspired you to become a psychiatrist, and what continues to motivate you in your work?

I studied Medicine in Trinity College in Dublin and my undergraduate placement in Psychiatry was in St Patrick’s Hospital – one of the oldest psychiatric hospitals in the world.  It was opened in 1757 thanks to a bequest from the author Jonathan Swift. The patients I had the privilege of seeing during that time greatly sparked my interest. During a subsequent “summer job” with the Irish Medico Social Research Board (for 30 Irish Pounds a week!) I had an opportunity to work with the then Inspector of Mental Hospitals, the late Dr. Dermot Walsh.  With another colleague we published a paper on the reporting of suicide that involved many broader discussions and my decision to train in psychiatry was made.

 There was a personal aspect to that decision also as two close friends at the time suffered from major psychiatric illness requiring hospitalisation. The impact on their lives and families and the stigma they suffered was considerable and convinced me that things could - and should – be better.

That view continues to inspire me. So although I do believe that stigma has reduced and many new treatments and approaches have been developed that are more tolerable, I still see new challenges arising all the time for those suffering from mental illness and I still want to make a difference!

What do you find most rewarding about working in psychiatry, and what keeps you passionate about your work?

I sometimes joke that – to attract new recruits – we need a “glove in the bucket” moment. By that I mean that often seen shot in a movie – where the surgeon/obstetrician pulls off their gloves and tosses them into the bin as the grateful patient/new parents look on admiringly – the sign of a successful “job done”! The successes in the specialty of Psychiatry tend to be less dramatic and responses more gradual but we need to remind ourselves that we have saved lives – those of patients and others and we have improved the quality of those and other lives. Reflecting on that is what I find most rewarding about my work – at its simplest level it is the genuine satisfaction that comes from helping others and gratitude that I am in a position to do so.

I enjoy teaching and training at all levels – undergraduate, post graduate and assisting in the continuing medical education of colleagues – which is why I am delighted to be involved with the UEMS. I also stay involved with public education, special interest and various voluntary groups. The questions I am asked - including the challenges to the way services are delivered (or are not delivered!)- keep me on my toes and require me to stay passionate about what I do. There is nothing quite like a fresh perspective to help reinvigorate a determination to persist with something that is working or to find an alternative to something that it now appears is not!

How do you maintain a sense of empathy and compassion for your patients, even when dealing with challenging cases?

I definitely noticed a gradual increase in my ability to be truly empathic as I gained experience over the years and I think that mirrors my experience of those I teach. Initially it can be hard to grasp the depths of suffering that psychiatric symptoms can inflict and the limitations and devastation they can cause. Cases I found challenging when training no longer evoke the sense of helplessness I sometimes experienced then. The emotions that arise from having responsibility for something you feel unable to manage can stifle attempts to be empathic.  This is why training can help to develop and maintain empathy and compassion although sometimes it can be hard to convince people! Of course there are times a lack of compassion or empathy can result from fear and frustration and at this stage in my career burnout can impact negatively.  I can honestly say however that I still maintain a genuine interest in and concern for those in my care. It is a very privileged position to be in – where patients trust me with their most personal and at times painful thoughts and experiences and allow and trust me to intervene.

 Even with the most challenging patients – including the very small number who are aggressive or particularly hostile - it is important to understand what lies beneath that behaviour. We must remember that those with serious mental illness have often had difficult lives and negative experiences with many opportunities destroyed by that illness. We would not choose to have their lives but might find ourselves behaving similarly if we had.   

How do you stay current with advances in psychiatric research and treatments? What is your preferred way to engage with CME?

That should be an easy question for me as Vice President for CME in the Section! In order to maintain my Irish Medical Registration I am obliged to provide annual evidence of ongoing engagement in CME. Attendance at the Winter and Spring Conferences of my National Association (The Irish College of Psychiatrists) as well as International Congresses ensures I am updated on current research and advances in diagnosis and treatments as these often form a major component of such events.   I maintain subscriptions to several relevant journals and during the pandemic became much more comfortable attending Webinars and using e-learning opportunities so it has definitely become easier to access the learning I need to keep my practice updated.

As President for CME I also review proposals for live events and e-learning modules that are seeking EACCME accreditation. This has provided me with an incredible opportunity to keep in touch with new developments as their champions seek to promote the adaptation of new therapies or approaches through scientific meetings and courses.

My involvement in teaching and in the examination of medical students and trainees in psychiatry has also been an excellent incentive to keep up with what is current!

Notwithstanding all the major technological developments however I still enjoy an opportunity to simply sit and read a well-written journal article followed by a “quiz” and I believe that face to face conversations/discussions/workshops are still one of the best ways to learn. The knowledge amassed by experienced colleagues is immense and robust questioning by those new to the Specialty is vital in ensuring a balanced view!  

What do you see as the biggest challenge facing CME in the field of psychiatry, and how would you address it?

In the past there was less confidence in CME where it was funded by Pharma and vested interests but that has been recognized and is being addressed by the accrediting bodies such as EACCME who make it clear that CME activities must be free from Commercial Interest and bias. There is also increasing recognition of the need for practicing psychiatrists to not only maintain current skills but to adapt to changing demands and to be in a position to critically consider and potentially utilise newly developed treatments and interventions for the benefit of patients. The main challenge here is in ensuring that busy practicing psychiatrists have both the time and the resources to do this. Some of the adaptations to the Pandemic – virtual meetings and on-line learning – have increased access to CME for many and reduced costs including travel costs. My Predecessor in this role however noticed and drew attention to a significant gender imbalance in those leading out on CME. As a result EACCME will be including equality, diversity and inclusivity in its future considerations.

To address other challenges it is important to learn from models of good practice where CME is working well.  A previous Working Group of the Section has looked at CME across Europe and produced a “snapshot” of how CME was operating in different countries just before the Covid Pandemic. We had observed differences including in how it was financed and whether or not it was compulsory. Harmonization is the major focus of the Section and working towards this will help us in meeting the challenges faced in ensuring quality CME as we learn from each other.

How do you see the field of psychiatry evolving in the coming years, and what do you see as the biggest challenges facing the specialty?

We are certainly moving away from traditional institutional care and developing more individualised approaches using community –based working with a recovery focus. Harmonisation in training for the benefit of patients is the objective of the Section and the development of a European Board Exam in Psychiatry will assist with this. The Section promotes awareness of the need to respect Human Rights in a specialty with a past history of restrictive treatments. The relevant Working Group in the Section plans to have a CME course on the topic at the next EPA Congress and the ultimate goal is that coercive interventions will be minimised and seen as a last resort rather than part of routine practice. 

Artificial Intelligence (AI) is the big news story at present ( although I think psychiatrists will be a challenge to replace)and while remote consultations were a necessity during the Pandemic  and have become more established, we are still too close to those events to know what the longer term consequences of this will be. It has been clear however that the value of the face to face interaction has not been diminished and we still need to work towards more effective and better tolerated treatments for the major mental illnesses. The use of algorithms and machine learning from large amounts of clinical data will certainly be part of our future.

The biggest challenges to future development are nothing new: Insufficient resources for psychiatric services, societal challenges including stigma, war and poverty, and a lack of sufficiently early interventions that might prevent the development of severe mental illness. I would also have to add from experience in my current practice, that recreational drug use - of cannabis in particular - is resulting in large numbers of young people presenting to overstretched psychiatric services with negative impact on all concerned.

If you had to give advice to someone considering a career in psychiatry, what would it be?

Go for it!

It is a wonderful specialty that can allow you to integrate every bit of your medical learning, knowledge and personal attributes resulting in an immensely challenging but enormously rewarding professional life!

The effects of COVID-19 on patients with severe mental illness

The webinar focused on the changes in psychiatry due to the COVID-19 pandemic and what that means for the future of the specialty.

---

The UEMS Section of Psychiatry elected Dr. Marisa Dias as the new President

at the Spring 2022 meeting in Zagreb, Croatia.

---

Marisa, what was the first thought that came to your mind when you were confirmed as the new President of the Section?

I felt beyond grateful for the confidence of my colleagues to elect me as the new UEMS Psychiatry Section President.

Sir Isaac Newton’s famous quote came to mind “Standing on the shoulders of giants”. And luckily, I have an excellent group of Officers to rely on whom I look forward to continuing working with.

What best defines your mission and vision as President of the UEMS Psychiatric Section? What is top priority?

My aim is to continue the Section’s outstanding contributions to the work and reputation of UEMS. My vision is a Section with engaged members and engaged external stakeholders who together champion “Quality in Training and Practice.”

In the next four years, I look forward to progressing our

• equality, diversity, and inclusion agenda,

• engaging with members across Europe as well as new partners,

• supporting the European Board Exam project,

• and working to harmonise not only training but the human rights aspects of psychiatric practice.

The post COVID era, volatile geopolitics and a string of global crises meant demanding times for everyone. What do you think is the most challenging aspect, in terms of activities of the Section, for the next few months?

We are still living with COVID-19! These are indeed challenging times for everyone and will inevitably have an impact on the Section’s work. We will need to continue to work in our spirit of collaboration and inclusion.

When the pandemic started, we created a repository of COVID-19-related educational materials to help people in different countries to adapt to the changing situation. We also participated in advocacy campaigns and policy work to champion the interests of our patients. We have done this by making sure that the most up-to-date evidence was translated into policy. For instance, we advocated for people with severe mental illness to be prioritised for COVID-19 vaccines in line with the evidence that they were at higher risk of severe outcomes. This work, which we published in The Lancet Psychiatry , has been shortlisted for an award because of its impact. We continued to work with our colleagues from European psychiatric organisations, including patients and families, to develop policies to that effect, the most recent one published in the scientific journal European Psychiatry.

We have supported our colleagues directly and indirectly affected by the war in Ukraine, signposting to links and initiatives of interest and took a practical decision to donate money to a support fund. We regularly linked up with colleagues from EPA (European Psychiatric Association) and UEMS Child and Adolescent Section to ensure we’re united in our advocacy for colleagues in Ukraine. We held a plenary on support for refugees and asylum seekers at our last meeting and disseminated our Section document on ‘knowledge, skills and professionalism required for the care of refugees and asylum seekers’.

We’re very happy to have the Ukrainian Psychiatric Association attend our Section meeting as observers. This will help us better understand their needs on-ground and how  we can meaningfully contribute to the speciality’s relief efforts.

Furthermore, UEMS-EACCME (the UEMS body that accredits educational events) has now adopted a flexible approach and will allow postponements or cancellations without costs of any event; and encouraged providers across Europe to allow free registration for Ukrainian colleagues.

You’ve had some presidential practice before, as you’re a past president of the EFPT (European Federation of Psychiatric Trainees (2013-2014)) and current Secretary for the Women’s Mental Health Section of the European Psychiatric Association (EPA). Will your experiences from these roles influence your Psychiatry Section leadership?

I feel I have gained valuable experience inside and outside of the UEMS orbit, which I feel has moulded me into a President who is practiced in navigating mental health advocacy at national and international levels and to lead further impactful work that supports the promotion of excellent patient care across Europe.

This past decade of experience really helps, as I gained such priceless insight into dealing with issues related to diversity of training and practices across Europe. I became well acquainted with some of the challenges in policy making and the importance of respecting the diversity of cultures we have within Europe.

EFPT benefits from a particular position within the Section, not just because they’re dear to my heart, but also because they are fully integrated as Members with voting rights. And this is because trainees are naturally very critical stakeholders in issues of training, assessment, and education.

Relationship with our partner organisations is also very important, and I have worked very closely with a number of them on several projects and aim to continue that close collaboration in all areas of common interest. I am also keen to put patients and families at the forefront, to strengthen their presence  in all our projects, especially the European Exam project.

Thanks to your initiative, the topic of diversity, equality and inclusion is broadly discussed within the Section. Do you have any other topics you’d like to incorporate to the Section’s business as usual?

In my previous role, as a Vice-President for CME, I identified serious biases in the events that we were accrediting. For example, only 14% of psychiatry eLearning module presenters are women. Which is a figure in correlation with what the academic community has come to realise – that during peak COVID, there were significantly lower number of publications put forward by women. We raised this with UEMS-EACCME, who have now included an assessment of equality, diversity, and inclusion in their criteria for the accreditation of educational events. We also held a plenary discussion at our Section meeting which attracted enthusiasm from our members and shared good practice examples that we have compiled in a repository.

Fortunately, the UEMS central is now also looking into the issues of diversity, equality and inclusion, with the help of a newly established Thematic Federation. Our Section will actively contribute to this group to not only address issues related to inclusion of people with mental illness, but also make sure that all medical training and continuous medical education takes it into account, regardless of specialty.

Are there any new initiatives in the pipeline?

We have a very active Section, which despite the challenges faced by all in the last couple of years, managed to remain responsive to events. The core business of our Section is about promoting the highest standards of care, by encouraging excellence in psychiatric education and training. This is done by contributing to the work of harmonisation, producing guidance, setting standards as well as monitoring how those are met. To recognise excellence, we are planning to launch the UEMS Psychiatry Excellence Awards and will be proposing this as a pilot for other medical specialties.

This is a way to recognise and further engage with our members, make our Section more visible and promote as well as reward good practices for the benefit of our patients.

Our Section is made by our members, who in exchange benefit from the amazing pool of shared learning we foster  and essentially make it all happen. I’m sure new initiatives are coming – stay tuned! 

World Mental Health Day 2022 - A call to Action

Dr. Marisa Dias speaks on behalf of our Section in support of the World Mental Health Day 2022

---

Severe mental illness and European COVID-19 vaccination strategies

The EU advises prioritising vaccination for people whose health makes them particularly at risk for severe COVID-19, but leaves it to member states to decide which medical conditions get prioritised. Ethical, neuroscientific, and public health considerations have been used to prioritise individuals with severe mental illness (ie, psychotic disorders, bipolar disorders, and severe major depressive disorders). […]

---

---

This work was shortlisted for RCPsych awards “Global Health contributor of the year”. It was also featured by the Lancet (mother journal) in their world report.

Joint European policy on the COVID-19 risks for people with mental disorders

An umbrella review and evidence- and consensus-based recommendations for mental and public health.

---

---

Abstract

As COVID-19 becomes endemic, identifying vulnerable population groups for severe infection outcomes and defining rapid and effective preventive and therapeutic strategies remains a public health priority.

We performed an umbrella review, including comprehensive studies (meta-analyses and systematic reviews) investigating COVID-19 risk for infection, hospitalization, intensive care unit (ICU) admission, and mortality in people with psychiatric disorders, and outlined evidence- and consensus-based recommendations for overcoming potential barriers that psychiatric patients may experience in preventing and managing COVID-19, and defining optimal therapeutic options and current research priorities in psychiatry.

We searched Web of Science, PubMed, and Ovid/PsycINFO databases up to 17 January 2022 for the umbrella review.

We synthesized evidence, extracting when available pooled odd ratio estimates for the categories “any mental disorder” and “severe mental disorders.” The quality of each study was assessed using the AMSTAR-2 approach and ranking evidence quality.

We identified four systematic review/meta-analysis combinations, one meta-analysis, and three systematic reviews, each including up to 28 original studies. Although we rated the quality of studies from moderate to low and the evidence ranged from highly suggestive to non-significant, we found consistent evidence that people with mental illness are at increased risk of COVID-19 infection, hospitalization, and most importantly mortality, but not of ICU admission. The risk and the burden of COVID-19 in people with mental disorders, in particular those with severe mental illness, can no longer be ignored but demands urgent targeted and persistent action. Twenty-two recommendations are proposed to facilitate this process.

The sudden and unexpected passing of Professor Petr V. Morozov

Download communication

New COVID-19 Document Library

The UEMS Psychiatry Section has created a document library of national information / guidance for doctors related to the COVID-19 pandemic.  This library includes national information relevant to the practice of psychiatry, the measures taken to support psychiatric trainees as well as public information materials. Information will be added as it becomes available. 

If you have any materials you would like to add, you can send them to Elen Cook. Please include the original source of the material so that it can be properly credited. Documents do not need to be in English. All submissions will be assessed by the Officers before being uploaded. 

TYOT: The “Trip advisor for Training”

Anna Szczegielniak, EFPT External Relations General Manager, and Howard Ryland, EFPT Past President

Have you ever been disappointed by what you ordered in a restaurant?  You excitedly select that delicious looking, succulent burger depicted in the menu.  But what is this? Your eager anticipation turns to bitter disappointment. Instead of the expected culinary masterpiece, you are presented with a sorry excuse for a meal, a piece of soggy lettuce wilting out of one side.

As it often is with training in psychiatry.  A training programme may promise the earth but fail to deliver. Others may not even make any such guarantees.

So how can you know what a good training programme looks like?  Enter the UEMS stage left with the answer. As far back as 2000, the Section of Psychiatry published guidelines on training in psychiatry.  These set out the minimum standards that training in psychiatry must adhere to. This provides a useful benchmark that all training programmes can aspire to and seek to exceed. Despite support from the European Psychiatric Association and many other key players for this harmonisation, these standards have still not been fully implemented. Data from the European Federation of Psychiatric Trainees (EFPT) annual survey shows a highly variable picture of training across the continent. Even the length of training varies from just one year, up to seven, depending on which country you are in.

Now we know what a good training programme looks like, how do we compare individual schemes to the expected standard?  The EFPT have worked with the UEMS Psychiatry Section to develop an innovative solution. Test your Own Training (TYOT) is the ‘Tripadvisor for training’ that empowers trainees to compare their own experiences with the standards to see if the training they receive matches the picture on the menu.

TYOT is a free to use, easily accessible, online platform that can be accessed here https://efpt.eu/tyot/.  It consists of 27 questions, each related to parts of the UEMS SoP guidelines. After answering each question, the respondent is given feedback as to whether it meets the standards and if not, what the minimum standard should be.  At the end of the questionnaire a summary score is supplied.

An analysis of the preliminary data collected shortly after the launch of TYOT suggests that the reality may be more soggy lettuce than tasty sandwich. Out of 77 respondents from 27 countries the mean overall score was just 42%, Almost half of trainees received their national guidelines at the beginning of training, with another large chunk at least knowing that such guidelines existed. These proportions dropped significantly for the European guidelines, with over half having no idea of their existence. Almost half had no option to complete training less than full time, more than half reported not having access to psychotherapy training during working hours as part of the curriculum and one in four described paying for mandatory parts of training themselves. Particularly problematic issues were 71% reporting that training needs were subordinated to service demands, 30% had felt unsafe in their working environments, 21% had had to stay in unacceptable hospital accommodation and 16% felt punished for seeking help when unwell.

Continuing with the restaurant analogy, let’s consider our next steps together. What do you do when the burgers you’ve ordered in the restaurant are recommended as paradise for the taste buds, but after the first bite you already know it was a big fat lie? You know you’re hungry, nothing else in the menu looks appealing and your shift starts in 20 minutes, so the only reasonable thing to do is to swallow what you have on your plate as fast as possible and never think of it again. Clean your fingers of grease, smile to your companion in misery on the other side of the table and lie to the waiter that, of course, it was a great choice. But can you afford to do that? The feeling of regret lingers all day, until you finally arrive home and put your tired body to bed.

It’s not unusual to experience frustration, disappointment, detachment or even a lack of positive therapeutic accomplishment during our specialist training. Many early career psychiatrists admit that they have lost their idealism and passion for the work, even before obtaining specialist qualifications. It can take long time to find a satisfactory path again.  Ensuring that training is an enjoyable and worthwhile process, that properly equips trainees for their future role as specialists, is essential to preventing such burnout.  There are many excellent psychiatrists who love cooking up a good training programme.  It is essential that they are equipped with the right resources and support to enable them to deliver excellent training.

Optimising the quality of specialty training is a popular topic for governments in many countries, but these discussions may not adequately take account of the international standards promoted by the UEMS. People say the grass is always greener on the other side of the fence, but does this mean that we should simply avoid comparing our working conditions with others?

EFPT and UEMS Psychiatry Section hope that TYOT will provide an overview of the international guidelines, give people the opportunity to identify and consider any existing gaps within training programmes, then empower them to use the evidence to make improvements. Trainees and early career psychiatrists are best placed to lead advocacy efforts to improve the quality of education we are offered, supported by more experienced specialists who understand why our perspective must not to be overlooked. Regular review of curricula is essential to adapt to changing conditions, yet meaningful participation from trainees and early career psychiatrist is vital for real reform.  

Take your training into your hands by evaluating it through Test your Own Training (TYOT) and make psychiatry great again.