In one sense, this is not new work. The competencies and graduate outcomes of the psychiatrist were articulated more clearly during the 2012 Curriculum Improvement Project, and that remains an important foundation. The current Program and Graduate Outcomes work does not begin from scratch. Rather, it seeks to reaffirm and refine that foundation in light of contemporary practice, community expectations, and the future needs of psychiatry.

Ultimately, Fellowship is not a collection of experiences. It is a statement of capability. At its core, Fellowship of the College signifies that psychiatrists have a foundational knowledge and demonstrated expertise that allows them to practise independently, safely, and effectively in the complexity of real-world settings.

This starts with clinical expertise in assessment, formulation, and the provision of treatment and care. But it extends much further to the ability to communicate, collaborate, lead, and advocate; to work with cultural humility and a focus on human rights; to engage thoughtfully with digital and technological change; and to practise in a trauma-informed way with professionalism and ethical integrity. It also requires the capacity to synthesise complex information, manage uncertainty, think systemically, and make sound decisions when clarity is not immediately available; and to work in partnership with patients, families, carers and whānau, and with the broader systems in which care is delivered.

In educational terms, this aligns with the progression described in Miller’s Pyramid: from what a trainee knows, to what they know how to do, to what they can show, and ultimately to what they consistently do in practice. Fellowship emerges from this developmental pathway, as performance in the real world, over time, and in all its complexity.

It also reflects something less tangible, but equally important: the development of professional identity. Fellowship is not only about what a psychiatrist knows and can do, but about the capacity to think, act, and carry responsibility as a psychiatrist in the service of patients, families, communities, and systems.

This implies a common foundation and a set of core capabilities that every Fellow of the College should be expected to demonstrate, even as careers later diverge across settings, populations, and areas of practice. Making that foundation clearer is part of the work now underway.

This has important implications.

If that is what Fellowship signifies, then training must be designed to develop and demonstrate it. The attributes we expect of all psychiatrists, the principles that should guide training, and the responsibilities we hold to the communities we serve should shape the program from the ground up. Structures such as rotations, assessments, and time requirements are not ends in themselves. They are a means to that end. Where they support capability, they should be strengthened. Where they do not, they should be reconsidered.

This shifts the centre of gravity of the program.

It moves us away from asking whether a trainee has completed a set of requirements, and towards asking whether they are ready to practise as a psychiatrist. It also sharpens the question of what every Fellow should be able to do. Psychiatry continues to evolve, and the scope of our work is broad. A clearer definition of Fellowship helps us clarify that shared foundation, while also recognising that some areas of practice will later involve additional depth, experience, or credentialed expertise.

This is not about lowering standards. If anything, it is about making them more explicit and more closely aligned with the capabilities we actually expect of psychiatrists at Fellowship.

A program that is clear about its purpose is better able to set expectations, support trainees and supervisors, and maintain confidence in its outcomes. It also provides a more stable foundation for the questions that follow: what breadth of capability is required of all psychiatrists, how best to judge whether that capability has been achieved, what kinds of experiences are most likely to support its development, and how long it should reasonably take to reach this standard.

Over the coming weeks, I will explore each of these areas in more detail. As I wrote in my last column, there is a reasonable degree of agreement about the broad direction of travel, but less agreement about the detail and the trade-offs involved in getting there. The task we are engaged in now is to work through those questions in a way that is coherent, credible, and anchored in a clear understanding of what Fellowship should represent.

Don’t forget to send any comments or reflections to newfellowshipprogram@ranzcp.org

Warm regards,

Associate Professor Simon Stafrace
Chair, New Fellowship Program Taskforce