Thinking

differently in
psychiatry
training
narrative comparison of psychiatry
programs in Iran and Canada
MASOUD AHMADZADASL,

PGY2, PSYCHIATRY,

UNIVERSITY OF TORONTO, ON, CANADA

1400/10/20 | 2022/01/9-10!
Educational objectives
Understand core features of health/mental health system in Canada and Iran

Understand core features of psychiatry training in Canada and Iran

Disclosures
When this
begun
Historic perspectives on medical education

Expertise and Biomedical Technology and Patient-centered

skill knowledge procedural
 Historic
perspectives on
medical education
THE FLEXNER REPORT OF 1910

Duffy T. P. (2011). The Flexner Report--100 years later. The Yale journal of biology and
medicine, 84(3), 269–276.
Medicine practice as a social contract

PROFESSIONAL SELF- ETHICAL, ACCOUNTABLE, EMPATHETIC

AUTONOMY REGULATION COMPETENT,
Patient-Physician relationship

Dynamic Value-based Culture-based

Legal perspectives

1996
Health Care Consent Act

Mental Health Act

2007
Social and cultural perspective
Multicultural society

Social movements

• Patients right
• Diversity
• Reconciliation
Care model

Psychiatrist as a
Community vs.
member of team,
Team-based hospital-based Continuity of care
not essentially
care
the leader
Training vs. Education
UofT vs IUMS psychiatry program
Staff/faculty: 1000+ vs. 25+

Residents: 200+ vs. 60+

Fellows: 120+ vs. 5+

Academic sites: 22+ vs. 4+

CanMEDS: Better
standards, better
physicians, better
care
Competency-By-Design (CBD)
CBME principles

Focus on outcomes: Ensure progression Time is resource not Promote learner Greater transparency
graduate abilities of competence a framework centredness & utility
Benefits of Competence by Design
Clear learning expectations for trainees

Opportunities for feedback and coaching

Residents have more control of learning

Helps prevent gaps in knowledge = increased confidence and care

Promotes use of feedback in lifelong learning

Stages of
Training
Time-Based vs. Competency-Based
EPAs
Modes of evaluation
Point in time evaluation

Over-time evaluation
 ITARs

EPAs

STACERs
Assessments Logs (psychotherapy, grand rounds)

Written Exams
Entrustable
Professional
Activities (EPAs)
Residents’ Role in the Program
Resident led-organisation (PRAT)

Residents in program committees

Chief-residents

Residents Wellness
Patient’s involvement in training
Role transition in medical profession
Patient’s autonomy becoming more determining ethical factor

From expert to consultant, a communicator rather than an expert

Complexity of care demand team work and sharing responsibilities/power!

Take home messages
Psychiatric training is influenced by social and health system factor

The evolving social dynamics are going to change the proper psychiatric training model

skill training, based on each society’s potentials, could foster an efficient training model

Competency could be considered as an alternative to knowledge as a goal of training

Open
discussion