Table 4 Psychological safety of educational framework for trainees

Comprehensive and transparent curriculum

 Curriculum with high level of structure and standardisation

“Being a trainee in my country is exciting because the place where I am studying has a structured educational curriculum.” (Asia)

 Strong knowledge-basis on normal development

“I appreciate being able to learn about typical development prior to taking care of children with psychopathology.” (North-America)

“It is crucial that CAPs are trained to have a deep understanding of ‘normal’ child development, including brain and cognitive development, family development across the lifecycle, developmental trauma…” (Oceania)

 Broad enough range of clinical experiences (age and setting)

“… the specialty curriculum is wide enough, comprising lots of both hospital and ambulatory psychiatry settings, as well as other interrelated professional fields (pediatrics, neurology, social work, special education, psychology…). (Europe)

“I have tried to provide a range of experiences for the trainees e.g., working as co-therapist with a range of clinicians in the team, opportunities to prescribe, to deliver individual therapy while also being involved in family therapy… meetings to learn about the roles and responsibilities of consultants,…” (Oceania)

 Transparent process of certification

“There seem to be bureaucratic processes that might make trainees seem'infantilised'—yet on reflection, there needs to be a system of assessment—both summative and formative.” (Europe)

 Maintaining quality after certification

“There is no indicator to properly evaluate the quality of physicians. Almost all psychiatrists do not disclose their treatment outcomes” (Asia)

Social support

 Trainer’s attitude

“What I appreciate most is the safe training climate (…). There is an open atmosphere, in which contact with supervisor/trainer is easily accessible.” (Europe)

“It is a balance between compassion with the trainees and consideration of their boundaries, and on the other hand encouragement to go beyond their limits and drawing lines to keep them up to the demands of the traineeship.”. “I try to… generate qualified professionals with self-esteem.” (Europe)

 Support availability

“Challenges include the lack of certified (and uncertified, but trained) faculty in university hospitals, and the insufficiency of CAP service infrastructure in many places—all of what would make it difficult to host quality training programs in many hospitals, and to ensure a right balance between self-direction and always having senior consultant support.” (Europe)

 A good work-life balance

“It was a burden on my social and familial life.” (Africa)

“Having their own children and the interaction with them often amplify the struggle of their own emotional processes and a new adequate work-life balance has to be found.” (Europe)

Recognition of influence of contextual issues

 A perception of high heterogeneity in training practices

“The experience of being a CAP trainee in Portugal really depends on the hospital in which you work. (…) Because of the lack of universal prevention programs and bad articulation with community structures, as well as millions of Portuguese people lacking a family doctor” (Europe)

“I think the main challenge to organize a national training program is to keep an equilibrium between harmonization of practices and a degree of local freedom.” (Europe)

 Heterogeneity in care-provision related to social and economic context

“Despite being trained in a skillful way to perform as evidence-based and resource-aware therapists and clinicians, our current healthcare-system does not accommodate very well to the state-of-the-art treatments that we often learn in the program.” (South-America)

“After 20 years, none of us worked anymore for the public health system, as the salary was low and burn out was high. All of us changed careers to more fulfilling and financially rewarding ones!” (Europe)

 Scaffolding to deal with socio-economic issues for trainees

“Well, I can say that being a trainee for child and adolescent in Albania has a lot of difficulties. First of all, you don't get paid during your residency and this make it really hard in the economic point of view.” (Europe)

“Some of the challenges we face [for CAP training in our country] are… the unsatisfactory quality of the delivered services due to workload and limited… services… shortage of medications and… digital system.” (Egypt)