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.