Introducing a competency based Fellowship programme for psychiatry in Australia and New Zealand.

OBJECTIVES: The aim of this paper is to summarise the new psychiatry Fellowship programme and its rationale, highlighting the new inclusions, revised assessment structure, the benefits and structure of the programme. CONCLUSIONS: The 2012 Fellowship programme is based on the CanMEDs educational framework. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) underwent a comprehensive process, adapting the CanMEDs competencies to a psychiatric framework and mapping the curriculum to Fellowship competencies, learning outcomes and developmental descriptors of the various stages of training. The 2012 Fellowship programme introduced summative entrustable professional activities (EPAs), formative workplace-based assessments (WBAs) and revised external assessments.

Trajectory to Fellowship: further examination of the road to becoming a psychiatrist.

OBJECTIVES: In 2003 a revised RANZCP training program was implemented. This involved a revised training structure with Basic (years 1-3) and Advanced (years 4-5) requirements. All summative assessments occur during Basic Training and generalist or sub-specialty streams are available in Advanced Training. Trainees that started from2003 onwards have reached or exceeded the minimum time to attain Fellowship. This paper updates the original study to assess the progression of trainees through the elements of the training program and those that have attained Fellowship. METHODS: This paper examines the pathway and barriers to attaining Fellowship with a focus on assessments and time to complete. RESULTS: Data were extracted for all trainees commencing training between December 2003 and February 2006. Items on assessments, rotations, breaks in training, part-time training, and other items were analysed. Time taken to complete mandatory training requirements and outcomes were the key elements evaluated. CONCLUSIONS: For those who attained Fellowship, the median training time was 6.1 years. It was common for trainees to attain Fellowship in the minimum time of 5 years. Delaying the completion of assessments or examinations contributed to the expanded time to attain Fellowship Training, as did part-time training and breaks in training.

Drama as primary prevention: my life as a producer.

OBJECTIVE: This paper documents use of a historically accurate and psychiatrically relevant play written by a couple of visiting academics. CONCLUSION: The high recognisability of first author Samuel Shem's name was used to attract interest from both within the medical profession and the media, which was intrigued by the curiosity of a psychiatrist turning producer. Far-reaching publicity was achieved at no financial cost.

Trajectory to fellowship: an analysis of the current pathway to becoming a psychiatrist.

OBJECTIVE: This study sought to examine the pathway and barriers to attaining The Royal Australian and New Zealand College of Psychiatrists'(RANZCP) Fellowship for those undergoing the current training program, which was implemented in November 2003. This program involved a new training structure, with basic (years 1-3) and advanced (years 4-5) requirements. All formal assessments occur during Basic Training, while either generalist or sub-specialty streams are available during Advanced Training. We assessed 3 years' intake of trainees who had commenced with the current program and have reached the minimum time to attain RANZCP Fellowship. METHODS: Data were extracted from the College's database for all trainees who commenced training between December 2003 and February 2006; we analysed data on assessments, rotations, breaks in training, part-time status, and other items. The key elements evaluated were the time to complete mandatory training requirements and outcomes. CONCLUSIONS: For those attaining RANZCP Fellowship within this cohort, the median Training time was consistent with the structure of the 5-year training program. It was clear that the RANZCP Fellowship Training Program is flexible, because 43% of the trainees studied undertook periods of part-time training and/or breaks in training, plus a range of sub-speciality programs were commenced in the Advanced Training.

Alcohol and substance use by patients with psychosis presenting to an emergency department: changing patterns.

OBJECTIVES: The aim of this study was to determine the incidence of alcohol and other substance use in patients presenting to an emergency department with acute psychiatric illnesses and to clarify the role of urine drug screens. METHOD: This was an unblinded prospective (observational) cohort study incorporating retrospective review of patient medical records, history of alcohol and substance use, results of urine drug screens and blood alcohol concentrations. RESULTS: Of 196 acute psychotic patients, 104 were diagnosed with schizophrenia and 92 with "other psychosis". Results of urine drug screens were consistent with self-reported use of substances and only identified an additional 5% of substance users. Cannabis was the commonest illicit substance used by both groups of patients, followed by psychostimulants, mainly amphetamines. Younger males were more likely to use psychostimulants and to present with violence. CONCLUSIONS: Patients with co-existing mental health problems and substance use present a major problem for our emergency departments. Cannabis was the most common substance used. Youth, male gender and psychostimulant use are associated with violent presentations. A comprehensive history of alcohol and substance use is important to implement appropriate dual diagnosis treatment. Urine drug screening is recommended for patients who do not admit to substance use.

The marketing of pharmaceutical agents: friend or foe?

OBJECTIVE: The aim of this paper is to provide a viewpoint regarding the marketing of pharmaceutical agents to psychiatrists and examine the results of a brief survey of the nature of booths, and gifts they offered, during 2009 RANZCP Congress in Adelaide. CONCLUSIONS: The pharmaceutical industry is highly organized and scientifically sophisticated. Efforts to influence our prescribing are likely to have a proven scientific base and to be responsive to evidence.

Putting 'addiction' back into psychiatry: the RANZCP Section of Addiction Psychiatry.

OBJECTIVE: The aim of this paper is to provide an overview of the history and activities of the RANZCP Section of Addiction Psychiatry, as well as its current challenges and opportunities. CONCLUSIONS: From initial exclusion to an active and growing membership, the Section of Addiction Psychiatry continues to ensure that problematic substance use and gambling remain core issues within Australasian psychiatry. In addition to commenting and contributing to ongoing clinical and policy initiatives, the Section has recently introduced an advanced training curriculum and maintains a strong partnership with the relatively new Australasian Chapter of Addiction Medicine. Its active input into education, training, media and policy development within the College guarantees that psychiatry is represented within the addiction field, and that tomorrow's psychiatrists are competent to assess and treat comorbid addiction issues.

Naltrexone in alcohol dependence: a randomised controlled trial of effectiveness in a standard clinical setting.

OBJECTIVES: To determine whether naltrexone is beneficial in the treatment of alcohol dependence in the absence of obligatory psychosocial intervention. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. SETTING: Hospital-based drug and alcohol clinics, 18 March 1998 - 22 October 1999. PATIENTS: 107 patients (mean age, 45 years) fulfilling Diagnostic and statistical manual of mental disorders (4th edition) criteria for alcohol dependence. INTERVENTIONS: Patients with alcohol dependence were randomly allocated to naltrexone (50 mg/day) or placebo for 12 weeks. They were medically assessed, reviewed and advised by one physician, and encouraged to strive for abstinence and attend counselling and/or Alcoholics Anonymous, but this was not obligatory. MAIN OUTCOME MEASURES: Relapse rate; time to first relapse; side effects. RESULTS: On an intention-to-treat basis, the Kaplan-Meier survival curve showed a clear advantage in relapse rates for naltrexone over placebo (log-rank test, chi(2)(1) = 4.15; P = 0.042). This treatment effect was most marked in the first 6 weeks of the trial. The median time to relapse was 90 days for naltrexone, compared with 42 days for placebo. In absolute numbers, 19 of 56 patients (33.9%) taking naltrexone relapsed, compared with 27 of 51 patients (52.9%) taking placebo (P = 0.047). Naltrexone was well tolerated. CONCLUSIONS: Unlike previous studies, we have shown that naltrexone with adjunctive medical advice is effective in the treatment of alcohol dependence irrespective of whether it is accompanied by psychosocial interventions.