Abed & Teodorczuk Reference Abed and Teodorczuk1 make a valid point in their article, but their proposed solution has been advocated for some time and, while it may be a necessary condition to improve undergraduate psychiatric teaching, it is unlikely to be sufficient. Reference Dave, Dogra and Leask2 Training (and psychiatry is not alone in this) is heavily dependent on service configuration for its delivery. As psychiatry has become more community based, it has also become more fragmented. The answer to this lies partly in making educational contracts more transparent, but surely we need a more radical solution. Given that the vast majority of psychiatric morbidity and care occur in primary care and given that most of our medical students will work in non-psychiatric settings, there is an urgent need for most if not all of undergraduate psychiatric education to take place in primary care.
There is an opportunity to deliver this fundamental shift through the changes recommended in the Shape of Training review. Reference Greenway3 The key themes of making medical training more flexible and focused on generalist training, and getting the balance between service provision and training right to ensure that patient needs drive medical training, should lead to a shift of undergraduate psychiatric teaching to primary care. An added benefit of this may be that, for once, the change in the educational tail may wag the service-provision dog, leading to more integrated services at the primary/secondary care interface.
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