Psychiatry training in 42 European countries: A comparative analysis

Franziska Baessler; Ali Zafar; Thomas Gargot; Mariana Pinto da Costa; Ewelina Maria Biskup; Livia De Picker; Katja Koelkebeck; Florian Riese; Howard Ryland; Olga Kazakova; Sarah Birkle; Thanos Kanellopoulos; Roland Grassl; Alina Braicu; Jobst-Hendrik Schultz; Marisa Casanova Dias

doi:10.1016/j.euroneuro.2021.02.003

Psychiatry training in 42 European countries: A comparative analysis

Eur Neuropsychopharmacol. 2021 May:46:68-82. doi: 10.1016/j.euroneuro.2021.02.003. Epub 2021 Mar 5.

Authors

Franziska Baessler¹, Ali Zafar², Thomas Gargot³, Mariana Pinto da Costa⁴, Ewelina Maria Biskup⁵, Livia De Picker⁶, Katja Koelkebeck⁷, Florian Riese⁸, Howard Ryland⁹, Olga Kazakova¹⁰, Sarah Birkle¹¹, Thanos Kanellopoulos¹², Roland Grassl¹³, Alina Braicu¹⁴, Jobst-Hendrik Schultz², Marisa Casanova Dias¹⁵

Affiliations

¹ Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: franziska.baessler@med.uni-heidelberg.de.
² Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
³ Psychiatrie de l'Enfant et de l'Adolescent, Pitié Salpêtriére - Charles Foix, Assistance Publique Hôpitaux de Paris, 47/83 boulevard de l'Hôpital, 75013, Paris, France; ISIR, Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; CHART Laboratory - EA 4004, TIM, Paris 8 University, 93526, Saint Denis, France.
⁴ Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Hospital de Magalhães Lemos, Porto, Portugal.
⁵ Shanghai University of Medicine and Health Sciences Basic Medical College, Shanghai, China; Division of Internal Medicine, University of Basel, Basel, Switzerland.
⁶ Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; University Psychiatric Department Campus Duffel, Duffel, Belgium.
⁷ LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
⁸ University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
⁹ Department of Psychiatry, University of Oxford, Oxford, UK.
¹⁰ Psychiatric Department, Psychiatric Clinic of Minsk City, Minsk, Belarus.
¹¹ Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany.
¹² Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children`s Hospital, Athens, Greece.
¹³ University Clinic for Child and Adolescent Psychiatry and Psychotherapy, Vienna, Austria.
¹⁴ National Centre for Mental Health, BSMHFT, Birmingham, UK.
¹⁵ Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.

PMID: 33678470
DOI: 10.1016/j.euroneuro.2021.02.003

Abstract

Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.

Keywords: European psychiatry; Medical education; Mental health; Professional qualifications; Psychiatry curricula; Psychiatry training.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Curriculum
Europe
European Union
Humans
Mental Disorders*
Psychiatry*