Thank you to everyone who attended our presentations during Congress and at the Membership Advisory Committee earlier this month.

We had the opportunity to discuss the ideas developed in the first four columns of this newsletter, including what Fellowship should signify, the principles and guardrails that should guide renewal, and some early thinking about curriculum design and medical education architecture.

Feedback from members, including at Congress, suggested broad support for designing backwards from Fellowship, distinguishing the stable core from the adaptive edges, and treating the prototype as a shared object for critique. The next step is to test the emerging direction in more detail with Faculties, Sections, Special Interest Groups, trainees, supervisors, Directors of Training and clinical services.

Members also asked, reasonably, to see more clearly what these principles might mean in the actual architecture of training. That is a fair expectation. Principles only matter when they shape concrete decisions about rotations and experiences, assessment and progression, breadth and depth, flexibility and consistency, advanced training, and overall program duration.

So, this column begins the next phase by making the emerging architecture more visible. Several features are now coming into view.

View draft prototype

1. Broad specialist readiness and a common foundation

The prototype starts from the premise that Fellowship is a broad specialist qualification. It must prepare new Fellows for independent psychiatric practice across the life course and major settings, and show how that readiness is developed, evidenced and judged over time. This does not require equal expertise in every domain on day one, but it does require a substantial common foundation across the populations, presentations, settings and systems of care psychiatrists are expected to understand, work within, consult to, or navigate safely.

That foundation must include assessment, formulation, diagnosis and treatment; risk, law and ethics; cultural safety and lived and living experience; family, carer and whānau engagement; teamwork, leadership, quality improvement and reflective practice.

This common foundation acts as a critical platform for developing later depth, special interest development or sub-specialisation in a career of life-long learning. It is what keeps later differentiation coherent with the shared standard of Fellowship. Without it, variation risks becoming fragmentation.

2. Structured clinical experience and capability development

If Fellowship signifies readiness for psychiatric practice across the life course and across major settings, the program must be able to show how that breadth is developed. Mandatory rotations have historically been one way of protecting breadth. They have ensured that trainees encounter important populations, presentations and systems of care that they might not otherwise experience. They do, however, create bottlenecks that slow progression and limit what can be achieved outside metropolitan areas, regional and rural pathways notwithstanding.

Moreover, a rotation is not the same thing as a capability, and time in a service does not, by itself, prove that the required learning has occurred.

The Taskforce is therefore testing how breadth might be better protected through a clearer relationship between required capabilities, structured experience domains, and, where necessary, minimum and maximum specifiers.

This is not a settled position. It will require further consultation with Faculties, Sections, Special Interest Groups and training settings. The next column will examine this issue more directly, including how we should think about rotations, experiences, settings and capabilities.

The principle, however, is clear: breadth must be guaranteed, but the mechanism for guaranteeing it must be educationally credible, equitable and deliverable.

3. Flexibility, special interest development and advanced capability

The emerging model is likely to include greater flexibility for special interest development and advanced capability, particularly in the later years of training.

This is one of the areas requiring further co-design. We need to be clear about what belongs within Fellowship, what may sit alongside it, and what should remain post-Fellowship advanced development.

One of the strongest areas of interest at Congress was the possibility of capability strands supported by communities of practice. Areas such as artificial intelligence, leadership, scholarship, psychotherapy, cultural safety and lived experience practice may be strengthened not only through formal curriculum requirements, but through communities that support teaching, supervision, shared resources and progressive capability development across training sites.

The principle is that advanced development should build on the common foundation, not narrow it. Areas that are essential to contemporary psychiatric practice must remain part of the shared Fellowship standard, even where some trainees pursue greater depth through special interest or advanced pathways.

4. A hybrid assessment system

Assessment is being considered as a hybrid system. This means avoiding a false choice between workplace-based judgement and external examination. A renewed Fellowship Program will need both.

Workplace-based assessment is essential because much of psychiatric practice can only be judged over time and in context. But public and professional confidence also require independent assurance. For that reason, the emerging prototype includes externally administered assessment, including a blueprinted clinical component.

Each assessment component must serve a clear purpose. EPAs, portfolios, written work, psychotherapy assessments, scholarly projects and examinations should be retained, redesigned or replaced according to whether they validly and proportionately evidence capabilities that matter.

Psychotherapy and scholarship should remain core to psychiatric formation. The question is whether the current assessment instruments are the best way to develop and demonstrate those capabilities in a renewed program.

5. Progression decisions and longitudinal educational support

If Fellowship is a statement of readiness, progression cannot be simply administrative. It should involve meaningful judgements about whether trainees are developing the expected capabilities at the right stage.

This points toward clearer phases of training, namely foundation, core and transition phases, and key progression points into registrar practice, more advanced or differentiated training, and final readiness for Fellowship.

A more coherent program will also need more coherent educational support. One idea attracting increasing attention is a longitudinal education coach or mentor who can help trainees make sense of feedback, plan learning, identify difficulty early, and navigate progression across the full training pathway.

This is not a substitute for clinical supervision. It is a way of strengthening continuity, wellbeing and educational judgement over time.

Progression decisions must not become another layer of opaque burden. They should help trainees, supervisors and training programs understand development, identify risk early, and support timely progression.

6. A five-year full-time equivalent Fellowship pathway

The emerging prototype is being developed around the ambition of a five-year full-time equivalent Fellowship pathway. The significance of five years should not be overstated. Duration alone does not protect standards. A longer program can still be poorly aligned, and a shorter program can still be overloaded or superficial.

The real question is whether the outcomes expected of Fellowship can be developed, demonstrated and judged within five years, and what sequencing, expectations and assessment system would make that credible. In that sense, five years becomes a design discipline: it forces us to clarify what belongs within Fellowship, what sits beyond it, and where accumulated requirements may have created duplication or delay without adding educational value.

7. Deliverability, piloting and implementation

No architecture will succeed if supervisors, Directors of Training, services and trainees cannot make it work.

The Taskforce will therefore need to consider supervision capacity, protected teaching time, rural and regional access, private and community-based training opportunities, cultural safety, trainee wellbeing, workforce and economic modelling, governance and transition arrangements.

We will also need to test how the model could be piloted. A renewed program of this scale cannot be implemented credibly without staged testing, evaluation, workforce modelling, and close attention to unintended consequences for trainees, supervisors, services and communities.

A renewed Fellowship Program cannot ignore service pressures, but nor can training be reduced to workforce supply.

The purpose of the Fellowship Program is to form psychiatrists who are fit for purpose now and into the future, and to meet workforce need across our communities. That requires services to value learning by supporting trainees and supervisors, rather than merely depending on them for throughput.

Finally

Many details remain unresolved. That is why this remains a prototype.

Further consultation with Faculties, Sections, Special Interest Groups, trainees, supervisors, Directors of Training and clinical services will continue in the coming months. That consultation will be essential to testing whether the prototype is coherent in principle and workable in practice.

But the direction of travel is becoming clearer: an outcomes-led, five-year, capability-based Fellowship Program with structured clinical experience, a defensible common foundation for all Fellows, greater flexibility in later training, hybrid assessment, stronger progression decisions, longitudinal educational support, and explicit commitments to sustainability, cultural safety, lived and living experience, and public trust.

The next columns will test the major components of that architecture: how capability, experience and setting should relate; how readiness should be assessed; how a five-year pathway should be staged; how breadth, depth and advanced development should be balanced; what must be common and what can vary; and what implementation would require.

The task now is to make the design visible enough to be tested, while being honest about what remains unresolved.

That is how we move from principles to architecture, and from inherited requirements to a Fellowship Program coherent enough to earn trust.

As always, we welcome your feedback.