The future of psychiatry training in the UK – preparing for integrated care in a digital world

Psychiatry in the UK stands at a cross-roads, and this has significant implications for training. On the one hand the profession may have reached a limit in terms of of what can be achieved in a National Health Service now increasingly modelled on quasi- industrial processes designed to achieve ever greater effciencies. On the other hand, any return to the traditional idea of the stand-alone physician working in isolation in the clinic is untenable as it would obviously be unable to accommodate wider population needs, namely, the rising demand for mental health services, and an increasingly diverse and complex set of patients. In this paper we look to the past as well as the present, in order sketch out the future for training in psychiatry. An assortment of potential new 'horizons' are identified including integrative service models, transdiagnostic approaches, digital technologies, and psychometrics. There will need also to be an increased emphasis on 'system' skills eg advocacy, leadership, team working, network and cross-cultural working. Paradoxically, there is at the same time a strong appetite to reprise of some of the 'old' ways of working and training: greater flexibility and support for learners, the primacy of the therapeutic relationship, the importance of embedding discovery and research within practice, and the strengthening of a professional identity based on both the 'art and science' of psychiatry, as a branch of medicine. Combined with the 'new', the 'old' ways' will require shifts in training too.