Overview of Training in the Twenty-First Century

Child and adolescent psychiatry training in the early decades of the twenty-first century is faced with many challenges that are replete with exciting opportunities. Recruitment challenges may stimulate us to develop innovative training sequences and evaluate carefully alternative portals to entry into child and adolescent training while increasing visibility of the profession at all levels of secondary, undergraduate, and graduate education. Funding challenges require close collaboration between local programs, community mental health services, and ultimately advocacy efforts through state and national organizations. From a curriculum perspective, training programs are challenged to incorporate the ACGME core competencies across all educational endeavors while identifying core clinical and cognitive skills necessary for the preparation of child and adolescent psychiatrists who progress through the twenty-first century and incorporate the newest, most evidence-based interventions while ensuring that the physicians retain the commitment to duty and altruism. Finally, training programs must develop methods of evaluation that enable faculty and program directors to effectively ascertain that resident physicians acquire the core competencies necessary to provide child and adolescent psychiatric services to their patients and families. Integral to the evaluation process is a commitment to remediation when indicated, and, whenever necessary, to guiding those determined to lack the capability to function competently as a child and adolescent psychiatrist to other fields of medicine. This modern era is truly a time of exciting advances in our field, changes that often seem to make medical knowledge, and even some clinical interventions, almost immediately obsolete. In view of our rapidly changing field, program directors and faculty may need to ensure that basic medical knowledge and clinical skills are attained. It may be even more important to focus on the underpinnings of our physician responsibilities, that is, emphasizing in our training programs those core competencies of interpersonal skills and communication, practice-based learning and improvement, professionalism, and ethical behavior. If a resident physician is able to communicate with patients and families, assessment and interventions will be facilitated. If training effectively can teach its resident physicians to embrace practice-based learning, effectively evaluate the literature and incorporate appropriate findings into an ongoing practice improvement plan, surely as practicing child and adolescent psychiatrists, they will stay up-to-date, constantly updating their medical knowledge and clinical skills. Finally, addressing issues of professionalism and ethical behavior throughout training may have the greatest impact on the competency of future child and adolescent psychiatrists. Recent research demonstrates that unprofessional behavior, particularly lack of reliability and responsibility, lack of motivation, initiative, and inability to adapt to and improve identified weaknesses, predicts future disciplinary problems during practice [25]. Behaviors that predict later problems must be recognized and addressed across faculty and resident physicians. Fostering the development of complete physicians across all these competencies is truly the goal of child and adolescent psychiatry training in the twenty-first century.