In the field of psychosomatic medicine, the teaching of competences for out-patient care is of fundamental importance. In our field, even more strongly than, for example, in internal medicine, obstetrics and gynaecology or surgery, in-patient problems have a different focus to out-patient problems. Thus many treatment cases span time-frames ranging from several months to, perhaps, years. Some patients even require on-going psychosomatic care. The acquisition of sound routine and self-confidence by the trainee, particularly in the out-patient sector, is indispensable to later professional activities. The sheer multitude and complexity of the contents to be conveyed, that is, practical medical experience as a trainee, theory, training analysis in both group and one-to-one settings, supervision, Balint groups, etc, makes cooperation between the authorised specialists absolutely essential. Only in a cooperative of in-patient and out-patient training centres can the high quality requirements of structure and process be fulfilled.

When a group of specialists active within the DGPM came together in Berlin in 1996 to develop a model for a specialty-oriented high-level training programme in the form of the Academy for Psychosomatic Medicine and Psychotherapy, this was a ground-breaking idea and numerous obstacles related to form, content and organisation had to be overcome. For this reason, it was extremely helpful to be able to refer to the well tried and tested regulations and procedures in out-patient training for other medical specialties. These were the foundations on which the particular procedures necessary for our specialty could be developed by the medical council, ASHIP and the Academy.

The first step is taken at Medical Council level. The Medical Council is responsible for recognising the respective practices as specialist training centres and granting the training licences. The out-patient practice must represent the medical spectrum of the specialty in diagnosis and treatment, and be able to care for a sufficiently large number of patients. Documentary evidence of this must be submitted in the form of summaries of ASHIP accounts. In addition to providing psycho-dynamic individual therapy, group therapy is also compulsory. A minimum of 50 treatment cases per quarter would make a one-year training licence possible. With over 100 cases, a licence could be granted for a maximum of 2 years. One individual prerequisite for the granting of the training licence is that the physician must provide evidence of at least 5 years’ professional experience in the field. Spatial criteria must also be fulfilled. A separate consulting room must be made available to the trainee, who must also have access to the necessary literature, scientific journals, etc. The training licence is granted to the individual physician for his or her own training centre. It is dependent on participation within a cooperative. This is essential for the provision of theory, training analysis, external supervision and Balint groups. The cooperative guarantees the teaching of the previously mentioned contents by qualified specialists. Lectures and work-shops take place according to a regular schedule, and the trainee must be released from duties at the training centre to attend these. The individual training analysis takes place outside the training centre and is strictly confidential.

The second step is taken at ASHIP level. The trainee has the status of a full-time, or at least part-time, salaried employee, who must work in the training centre under the close and constant supervision of the licensed physician. The necessary approval by the ASHIP for this employment is granted when the applying physician is authorised as a trainer by the Medical Council. This must not, however, lead to an excessive increase in the volume of patient care in the practice. The licensed physician calculates the fees for the services provided by the trainee within the framework of the quarterly statement of accounts and pays the trainee an appropriate salary.

The Berlin Medical Council recognises up to two years’ out-patient training. This time-frame of two years ensures the long-term treatments necessary. For training in psychosomatic medicine, 50% part-time employment is often advantageous for gaining experience in extended long-term treatment procedures in day-to-day patient care. Thus the trainee can be 50% employed in the out-patient psychosomatic training centre and 50% in an in-patient psychosomatic, internal or psychiatric training centre. From a didactic point of view, this networking of in-patient and out-patient care has proved extremely valuable.

The founding of the Academy for Psychosomatic Medicine and Psychotherapy (APM) has set in motion a very lively training programme. Working together in this cooperative, at present, are: two clinics, an out-patient health centre, a university department, two day-clinics and fifteen out-patient practices. Forty-eight trainees have placements at the present time. The licensed doctors cooperate to provide lectures, work-shops, training analysis, external supervision and Balint groups. In addition to this, support must be given to the trainee with regard to rotation. This applies to moving between the compulsory subject areas and between out-patient and in-patient training centres.