There are attempts to harmonise training in psychiatry across Europe but the very different political and social arrangements in European countries present a real challenge to attaining this goal. ^{Reference Strachan1} Harmonisation of postgraduate specialist training in the European Union (EU) within each medical specialty remains an important aim of the Union Européenne des Médecins Spécialistes (UEMS). ^{Reference Lotz-Rambaldi, Schafer, ten Doesschate and Hohagen2} Towards this aim, several surgical specialties have already established accreditation and examination procedures that are recognised throughout the EU. ^{Reference Strachan and Schudel3}

In 1992, the Psychiatric Trainees' Committee of the Royal College of Psychiatrists facilitated a meeting of European trainees and representatives from nine European countries convened in London. ^{Reference Gribbin4} At a subsequent meeting in 1993 the European Federation of Psychiatric Trainees (EFPT) was officially formed with the aim of facilitating the exchange of ideas, improving training and developing national trainee organisations for psychiatrists. ^{Reference Day, Grimmer and Lloyd5} Since its inception, EFPT has held a forum annually in a different European country and its membership now includes national trainee associations from over 20 countries. The EFPT has representation within the UEMS and the two work jointly on developing a European curriculum for postgraduate training in psychiatry. Comparing the developmental processes in postgraduate education in psychiatry in different countries can be invaluable in further development of these initiatives and ideas. ^{Reference Oakley, Malik and Kamphuis6}

Competency-based training is only one aspect of postgraduate training in psychiatry and there is limited knowledge about the variation and similarities in psychiatric training across Europe. This is of particular importance in the UK because of increasing professional migration to this country and the right of European Economic Area (EEA) nationals to apply for employment on an equal footing with psychiatrists who have trained in the UK. It is therefore crucial, especially for those involved in recruiting and supporting psychiatrists at all levels, to understand the diversity of training experiences that psychiatrists in different European countries have had access to.

Method

The 16th EFPT forum was held in Gothenburg, Sweden, in 2008 and was attended by 61 psychiatric trainee representatives from 22 national trainee associations across Europe. The diversity of the training experienced by delegates was apparent during the discussions and it was decided to gather more structured information about psychiatric training in Europe. Informed by these discussions a questionnaire was devised to obtain information about the training experience in different member countries of EFPT. It considered length, structure and content of training, psychotherapy and assessments. Delegates from all 22 countries at the EFPT 2008 forum (Box 1) completed the questionnaire. We then held a discussion with each participant, allowing any queries to be answered and accurate information to be obtained.

Box 1 Countries that completed the survey

Austria	Ireland
Belarus	Italy
Bosnia	The Netherlands
Croatia	Norway
Czech Republic	Portugal
Denmark	Romania
Estonia	Slovenia
Finland	Sweden
France	Switzerland
Germany	Turkey
Greece	UK

Results

Examinations and assessments

In 18 of the countries surveyed, trainees have to complete examinations before finishing training in psychiatry and becoming a specialist. There are no examinations in Denmark, France, Norway and Sweden. In most countries there is one examination but in Bosnia there are 30 throughout the course of the training. A variety of methods of examination are used (Table 1). Currently, seven countries are undertaking workplace-based assessments (Table 1).

Table 1 Examination and workplace-based assessment methods

Countrya	Multiple choice questions	Short answer	Essay	Short clinical cases	Long case	Oral exam	Multisource feedback	Observation of a patient assessment	Non-clinical skills	Case-based discussion
Austria			x		x					x
Belarus		x
Bosnia						x
Croatia					x	x
Czech Republic	x	x	x		x
Estonia				x		x	x
Finland			x
Germany						x
Greece	x	x				x
Ireland	x			x			x	x	x	x
Italy			x			x
The Netherlands	x						x	x	x	x
Portugal					x	x
Romania			x	x	x
Slovenia				x	x
Switzerland	x						x	x	x	x
Turkey		x	x		x
UK	x			x			x	x	x	x

Only in 10 countries do supervisors complete a regular report on the trainee's progress; in seven of those it is necessary to demonstrate satisfactory progress at each report in order to continue to the next stage of training. In 17 countries, trainees are required to keep a logbook or portfolio of evidence of their achievements.

Discussion

Knowledge of the differing training in psychiatry in Europe is of increasing importance in the UK due to migration of doctors. As more doctors move across borders it is important to consider equivalence of training, qualifications and experience across Europe. As highlighted by this survey, the discrepancies between the UK and other countries are apparent, for example there are no examinations or formal assessments in France and no compulsory placements in Italy. There are moves to standardise training across Europe but at present five of the countries surveyed do not even have nationally standardised training schemes. As UEMS develops a European competency-based curriculum and associated assessments, the challenge of harmonising training across Europe remains very real. The varying training systems in place inevitably result in diverse attitudes to training and assessment in different countries dependent on the culture of learning and apprenticeship.

In general, the overall length of undergraduate and postgraduate training in the countries involved in the survey was similar to that in the UK, with the majority spending 6 years at medical school and 4-6 years in specialist training. In half of the countries, doctors are able to undertake psychiatry placements in the equivalent of the UK foundation programme. Almost all countries specify mandatory placements during psychiatric training, for example a certain number of months spent in adult psychiatry placements. Of particular interest is that unlike the UK, placements in neurology and general medicine are quite common during specialist training. Psychotherapy training is very varied and is only compulsory in half the countries surveyed. Some trainees have to pay for supervision of psychotherapy patients and personal therapy, even though it may be a compulsory component of their training.

Conclusion

This survey provides useful information regarding postgraduate training in psychiatry across Europe. This is particularly relevant not only for individuals involved in recruiting and supporting psychiatrists who have trained in Europe, but also for statutory organisations like the UK General Medical Council who decide on issues such as equivalence of training. Additionally, an improved understanding of European postgraduate psychiatric training structures is the starting point in enhancing the quality of training across Europe.