Core Competencies for Psychiatric Practice: What Clinicians Need to Know (A Report of the American Board of Psychiatry and Neurology)
This book by Stephen C. Scheiber, M.D., and colleagues is an excellent brief yet comprehensive review of core competencies in psychiatry. The product of an invitational conference sponsored by the American Board of Psychiatry and Neurology, Core Competencies for Psychiatric Practice: What Clinicians Need to Know offers a detailed description and analysis of the core psychiatric competencies, a description of the methods to demonstrate and test these competencies, and the impact of a competency-based system on both educational programs and the practicing psychiatrist.
The first two sections provide a thoughtful review of the evolution of the core competency initiative, flowing from the focus by the U.S. Department of Education in the 1980s on educational outcomes. The increased demands of third-party payers and the public for more intense scrutiny of medical credentials and competencies are also identified as contributing to these developments. The book includes an excellent chapter by Nadia Mikhael, M.D., which explores the Canadian concept of specialty competencies and compares the work with the efforts in the United States.
The third section reviews in detail the evolving delineation of the psychiatric competencies within each of the six categories of core competencies identified by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). These six chapters, each written by a highly accomplished academic psychiatrist, are clear and convincing descriptions of the knowledge and skills psychiatrists should possess in each category. The six categories are patient care, medical knowledge, interpersonal communication skills, practice-based learning and improvement, professionalism, and system-based practice. Neurology-specific competencies for psychiatrists are part of the patient care category but in this report are discussed in a separate chapter called "Cross Competencies: What Psychiatrists Should Know About Neurology." It is perhaps a reflection of the difficulty of this topic for the field that educators and clinicians are not likely to find this chapter as helpful as the others in guiding curriculum development or continuing education. For example, to indicate that neuroimaging and neurogenetics or molecular neurology, among other subject areas, are judged to be "of the highest priority for psychiatrists to understand fully" is too vague to be useful or, if literally interpreted, too ambitious and unrealistic.
The fourth section considers the impact of core competencies on practicing psychiatrists, residents, and training programs. Increasingly, we are told, before an individual completes his or her residency, training programs will have to demonstrate that the person has developed the competencies required for independent practice. Lifelong learning and the maintenance of competency will also be measured, although the mechanisms and tools for accomplishing those assessments are in an early stage of development.
Core Competencies for Psychiatric Practice is both a hopeful and a helpful report. Its authors have brought much wisdom and insight to these discussions, and most readers will be convinced that defining and assessing core competencies not only will be a central feature of training programs and practice but also will contribute to the improved care of patients and their families.
Dr. McIntyre is chair of the department of psychiatry and behavioral health at Unity Health System in Rochester, New York.
