In my first three columns, I set out why the work of the Taskforce matters now, what we have heard from members and stakeholders, and what Fellowship itself is intended to represent.

As we move into the next phase of our work, we face decisions about structure, progression, breadth, assessment, feasibility, and what belongs in the core program. This is an inflection point. Before we turn to design choices, we need to recalibrate by asking what principles should guide the redesign?

This matters because once a process turns to structure, decisions can quickly be shaped by what seems easiest to alter, or by strongly held views about what matters most. A program can become driven by inherited habits, immediate pressures, or local preferences, rather than by a coherent and shared set of educational and professional commitments.

If the New Fellowship Program is to be credible, it must be designed from a clear educational and professional centre. That centre is not blank or ahistorical. It must draw on the evidence base in medical education, the lessons of previous programs, the realities of contemporary practice, and the values and responsibilities of the profession. For the Taskforce, that centre is becoming clearer as the vision, guiding philosophy and principles take shape.

Our emerging vision for the Fellowship Program is that it should develop psychiatrists for Australia and Aotearoa New Zealand who are clinically expert and committed to patient-centred, high-quality care; and who practise collaboratively. They will be equipped to meet evolving mental health needs through scientifically grounded clinical reasoning, culturally safe care, meaningful engagement with communities, accountability, and reflective practice. In doing so, the program should honour psychiatry’s social contract, advance the public good, and strengthen public trust in our profession.

That vision is aspirational, but it is not abstract. It has direct implications for how the Fellowship Program should be built.

The Taskforce has also articulated a guiding philosophy for the redesign. At its heart are several linked commitments: a strong focus on breadth and foundational capability; alignment with workforce needs across Australia and Aotearoa New Zealand, including rural, regional and remote communities; a competency-based medical education framework; a hybrid assessment model combining programmatic assessment with externally administered high-stakes exams, including a clinical component; a program that is sustainable for trainees, supervisors, Directors of Training and services; and a Fellowship that should be achievable within five years full-time equivalent.

Each of these propositions carries weight.

The emphasis on sustainability and five-year delivery is not simply a matter of efficiency. It is an acknowledgment that the design must be workable in real services and fair to the people who carry it.

A hybrid assessment model rejects the false choice between workplace-based judgement and external examination. Fellows have told us clearly that both matter.

A competency-based framework means that progression must increasingly be understood in terms of capability and readiness, not simply the accumulation of time or completion of fragmented requirements. At the same time, competence is not demonstrated through isolated tasks alone. It develops through experience over time, reflective practice, supervision, feedback, and increasing responsibility in real clinical settings.

And finally, the emphasis on breadth does not imply superficiality. It points to an integrative foundation that equips psychiatrists to work with complexity, comorbidity, uncertainty, and varied systems of care. Breadth must not mean dilution; it requires sufficient depth in the clinical capabilities that define psychiatry as a medical specialty, including mental state examination, formulation, psychotherapeutic understanding, pharmacological expertise, and their integration in real-world clinical judgement. It also recognises the need for equity across training settings, so that trainees in rural, regional, and remote areas are not disadvantaged by metropolitan assumptions. Breadth should enable flexibility and later differentiation, not create new barriers.

Alongside this vision and philosophy, the Taskforce has begun to organise its guiding principles into a broader narrative.

The first is a moral and professional foundation: and a person-centred and trauma-informed approach to care that values lived and living experience, cultural safety, and ethical practice. These should shape training from the outset. They are not optional additions, but integral to good psychiatric practice.

The second is a clear clinical orientation grounded in biopsychosocial formulation and care. It emphasises a strong foundational capability that can extend through flexible pathways into sub-specialisation and focused areas of practice. This speaks directly to the kind of psychiatrist Fellowship should develop, one who is not defined by checklists or settings alone, but can bring multiple perspectives together in the service of sound clinical judgement.

The third is contemporary practice capability. This includes therapeutic excellence and integration, digital and technological adaptability, research- and data-informed practice, and the ability to lead, supervise, collaborate, and work across systems. Psychiatry is changing, and the program must prepare Fellows for current practice and for what is already emerging.

The fourth is professional formation, grounded in lifelong learning and reflective practice. Fellowship is not the end of learning, but the formation of a psychiatrist who can practise independently in complexity and continue to grow, adapt, and exercise professional judgement over time.

The fifth is responsibility to the future and the capacity to advance the profession through research, innovation and thought leadership, while upholding commitments to sustainability, feasibility, and social accountability. A Fellowship program cannot simply reproduce the present. It must be capable of evolving as practice, systems, evidence, technology and community expectations change.

These principles do not tell us exactly what the final program should look like. But they do help us judge the choices ahead.

One implication is that we must first be clear about what a psychiatrist does, and therefore what the common core of Fellowship should be, before determining how differentiated or advanced areas of practice should sit in relation to that core.

Questions about sub-specialisation, advanced practice, and the recognition of focused capability are important, but they are not the starting point.

As the work progresses, there will be pressure to compromise, simplify, or defer parts of the design. Some trade-offs are inevitable.

But some things should not be traded away lightly, because they go to the heart of what Fellowship means.

These are not minor design preferences. They go to the heart of what Fellowship must continue to signify: not simply completion of a program, but readiness for independent psychiatric practice, sound judgement in complexity, and a standard of training that is culturally safe, clinically credible, equitable across settings, and trusted by the public, the profession and trainees themselves.

To put it another way, the Taskforce is not trying simply to make the program easier, shorter, or more flexible in the abstract. We are trying to make it clearer in purpose, more coherent in design, more sustainable in delivery, more adaptable over time, and more defensible as a standard.

That distinction matters, because in the months ahead many of the questions before us will involve real trade-offs.

How should breadth be ensured?

What should every Fellow be expected to demonstrate?

Which experiences are essential, and which might be achieved in different ways?

What must be assessed independently, and what can be judged over time in the workplace?

How do we reduce burden without weakening confidence in standards?

How do we design a program that can evolve without becoming fragmented again?

These questions cannot be answered well unless the principles guiding the work are explicit. That is why this point in the process feels like an inflection point. We are moving from describing the problem and clarifying purpose to identifying the design logic that should shape the program from here.

As always, we welcome your reflections at newfellowshipprogram@ranzcp.org. Please rest assured that we are reading everything that comes through and that many of the ideas are being integrated into these columns. Also consider attending our session at Congress on Monday 4 May at 4 pm, where we will have the opportunity to engage with you all in our ongoing dialogue.