Few postgraduate medical examinations have attracted so much comment and criticism as the MRCPsych. The main participants in the debate have been the College and its various training sub-committees, and APIT which has always been opposed to the MRCPsych examination in principle (Bulletin, April 1979). In a recent Newsletter (March, 1980) APIT stated that only 5 out of 90 trainees in their 1979 survey felt that passing the MRCPsych examination proved that one is a competent psychiatrist. It felt that the examination had ‘crystallized’, with no fundamental changes despite a number of Examination Forums held by the College. Radical changes in order to improve the examination were therefore advocated.

This article is based on work undertaken at the request of my fellow members of a DHSS Working Party chaired by Professor Norman Tutt, Department of Applied Social Studies at the University of Lancaster. The terms of reference were: ‘to consider observation and assessment services for children and young persons referred to local authority Social Services Departments; to clarify the role of observation and assessment centres; to consider the promotion of non-residential observation and assessment; to consider what improvements in present assessment practice might be helpful or necessary and to make recommendations’. The report is currently in its final draft and has been sent to the DHSS for approval; and, since my contribution has necessarily been compressed into a few paragraphs, my colleagues suggested that I should seek an additional route to publication.

What is the best way of maintaining and raising the quality of ‘higher’ (i.e. senior registrar) training, and the best way of ensuring that aspiring psychiatric specialists are competent to undertake the tasks ahead of them? Basically, three alternatives are available—examination, or ‘accreditation’ of individual trainees, or inspection of training posts—and my purpose is to discuss the advantages and disadvantages of these alternatives.

The Annual Meeting of the MPA in 1881 was held at University College, London; it coincided with an International Congress of Medicine and so there were an exceptional number of foreign visitors. A group photograph of members and visitors was reproduced in the Journal for June 1978 (132, facing p. 530).

A number of schemes exist to provide aid from the developed countries to those countries which are less privileged and belong to the Third World. For example, the official Guide Book (1978) of the Inter-University Council states: The Inter-University Council for Higher Education (IUC) was established in 1946 by the Universities in the United Kingdom, at the request of the British Government, to assist the advancement of higher education in developing countries and, to this end, to encourage co-operation between Universities in those countries and Universities in the United Kingdom … In 1970 the IUC became a corporate, independent body and entered into a general agreement with the Ministry of Overseas Development which provided that all British official aid to the Universities with which it was associated should as soon as possible be co-ordinated by the Council.’

The great leap forward from trainee to consultant ends with one well-grounded foot. Clinical training to current standards provides the novitiate with a firm base as far as taking clinical responsibility. Responsibilty for maintaining or developing service and the profession is another matter, and in this respect too many newly-appointed consultants find themselves with their other foot in a quagmire, at risk of being bogged down in administration. One foot that has received solid grounding is not enough to hit the ground running. Actually, the stumble goes unnoticed as often as not. Dead-end committee posts are hived off on to the new appointee and no-one remarks on his silence at table or the failure to grasp the politics of administration. Some, of course, take to the mud with squeals of glee, throwing their weight around without moving from the spot. Some colleagues get spattered. Some sink. No progress ensues. There may then evolve a distaste for administration, a spurning of bureaucracy, truancy from the Division (can there be worse?) and rotting relationships with hospital administrators. Does it matter? Surely people find out soon enough how the system works; if you can run a group you can chair a committee; individuals make better decisions than committees and nobody listens in any case.

Of recent years psychiatry has been assailed from many sides. Psychologists, political philosophers, social workers have had their say, but the most hurtful have been assaults from within the citadel itself, such as the forceful views expressed by R. D. Laing and Thomas Szasz. The essence of their argument is that mental disorder is not a disease nor an illness and should not therefore be the concern of doctors.

Staff groups of various kinds are an important part of the life of a psychiatric hospital, yet there have been few attempts to document and assess their functioning. This would seem particularly important at present when the ‘multidisciplinary approach’ is regarded as an ideal in the treatment of the psychiatrically ill. Yet, many who have had experience of multidisciplinary groups are aware that they sometimes create as many problems as they solve. In this project, three multidisciplinary groups were formed from within the staff of a psychiatric hospital, cutting across the usual boundaries of ward and administrative teams, with the aim of studying the groups as representations of the institution and attempting to facilitate participants' functioning in the wider interdisciplinary setting.

Senior registrar training is a preparation for consultantship. The Royal College recommends that when selecting senior registrars ‘potential suitability for a consultant post’ should be the prime consideration (1). The trainee, having concentrated on the acquisition of theoretical knowledge and basic clinical experience, now sets out to learn further management skills, improves on his special interests and fills gaps in the experience he has so far gained (2). The emphasis during his senior registrar tenure is therefore on a different set of objectives.

In anticipating the consultative paper A Review of the Mental Health Act, 1959 the College's Public Policy Committee prepared a report in 1974 (News and Notes, October, November 1974). The second of six points covered in the report related to compulsory detention and treatment. It reads:

I hope that this somewhat obscure title will assume some meaning over the next ten minutes or so. The aim of this talk is to examine the trainee's view of research. Trainees have a variety of reasons for not embarking on research at registrar or senior registrar level. The most commonly stated are the following.

The Uffculme Clinic opened 25 years ago as an early psychiatric treatment and research centre and has for the past 15 years functioned as a regional centre for psychotherapy in the West Midlands. Day and in-patients participate in a psychotherapeutic regime which includes a daily analytic psychotherapy group, relaxation therapy, projective art, psychodrama and more traditional occupational and recreational therapies. A weekly community meeting has recently been extended to give staff and patients a large group experience. Patients in intensive treatment are severely affected by neurotic or personality difficulties and are only admitted if they are incapable of functioning at work or at home.

The practice of child psychiatry depends upon clinical skills; the first requirement, then, of a training programme is that at the end of a given period the trainee should be really expert and rightly confident in his practical skills as a diagnostician and therapist. A total of four years, combining registrar and senior registrar experience, might be an appropriate period and would allow a full training, whereas at present some new consultants have spent only two and a half years in the specialty as senior registrars.