The weekly educational supervision sessions between consultant psychiatrists and their trainees have emerged as a central pillar of psychiatric training. The College has set out, in various Statements on Approval of Training Schemes for General Professional Training for the MRCPsych, what it expects of these sessions: they should happen weekly, be devoted entirely to the needs of the trainee, and be applied to the development of the trainee's clinical skills as opposed to academic knowledge.

At the Council meeting of the Royal Medico-Psychological Association in November 1963 the Treasurer reported that “a handsome legacy of about £20,000 in shares had been made to the association by the late Dr Blake Marsh and arrangements are being made to take over these shares”. The actual amount was in fact a little over £23,500 – a considerable sum by today's standards. Numerous suggestions were made as to how this generous gift might be honoured including naming the Association's Bronze Medal after Blake Marsh but Council finally accepted a recommendation of the Education Committee “to found an annual lecture of a standing equal to the Maudsley Lecture on a subject connected with Mental Deficiency to be known by his (Dr Blake Marsh's) name” and this was ratified at the Annual Meeting in 1965.

The undergraduate medical curriculum in Nottingham has recently undergone dramatic change in response to General Medical Council recommendations. As part of the changes, the examination procedure in psychiatry has been altered, replacing the clinical ‘long case’ with an objective structured clinical examination (OSCE). The OSCE has long been seen as a valuable assessment tool in more ‘procedure-orientated’ specialities, but its use in psychiatry is not widely reported. This paper discusses the reasons behind the change, the design and implementation of the OSCE, and benefits and problems encountered during its first application.

The case notes of 100 consecutive admissions to a general adult psychiatry service revealed that no sexual history was recorded in 73 cases. Only one patient had a detailed sexual history taken. In 22 cases the sex history was limited to a single mention of ‘reduced libido’ and in another four cases a brief explanation was done. Sexual side-effects of medication were not explored in any case. Sex history was more likely to be recorded when the doctor and patient were of the same sex; in cases with a history of sexual abuse or relationship problems; and where psychopathology had a sexual content.

This paper discusses a training opportunity based on an adaptation of the Infant Observation method. This is a much shorter module, of ten weekly visits.

We describe three training components: (a) an opportunity to learn directly about child development and to become familiar with children's verbal and nonverbal communications; (b) a direct experience of the emotional impact and strength of primitive feelings, both in the children and in the trainees themselves, and (c) learning to be a ‘non-participant’ observer. We believe that the ability to observe without intervention is extremely important in the development of clinical skids. We suggest that this is the cornerstone of the method and that it may have a wider application to the training of those in the caring professions, including psychiatrists, nurses and social workers.

Data on day time referrals to a liaison psychiatry team from an inner London accident and emergency department (A&E) were analysed over a two-year period. Despite the availability of local community-based alternatives for urgent assessment almost 5000 patients were seen. A quarter were self-referrals and two-thirds had had no previous contact with psychiatric services. The most common reason for referral was aggressive or disruptive behaviour. Characteristics of patients in this inner-city population suggest a continuing need for a high quality liaison service to the A&E department.

Recent studies in child mental health show that fundholding general practitioners regard sexual abuse work as a priority service, and also that sexually abused clients take up more out-patient time than others in the same diagnostic group. This paper provides supporting data on the issue of workload and argues that specific purchasing arrangements should be made to cover this area of well recognised need.

This is the final contribution to a five part series on risk in psychiatry. Bowden (1997) has cast a bleak eye on the realities of making risk decisions about difficult and dangerous patients, identifying the essential subjectivity of these decisions and the cognitive distortions that psychiatrists can undergo to make them apparently easier; distortions that can blind the clinician to impending disaster. Morgan (1997) emphasised the limitations of a simplistic ‘risk factor’ approach to the management of potentially suicidal patients, concluding that the priority is the refinement of our basic clinical skills (and by implication deployment of successful treatments for our patients' illnesses). Prins (1997) analysed the particular difficulties faced by mental health review tribunals hearing the cases of Restricted patients. The perhaps unsurprising conclusion is that tribunals make bad decisions when presented with inadequate information (which begs the question why not adjourn and seek the information required before proceeding?). Roy (1997) has addressed a range of risks faced by Trusts and the clinicians who work for them. There is a clear demand that Trusts develop risk management strategies: of necessity these strategies will discourage inherently risky behaviour such as inadequate staffing of in-patient units and the devolution of inappropriate levels of responsibility to staff who are inadequately trained or supported.

The value and efficacy of psychotherapy is currently being debated both within (Gabbard et al, 1997) and outside the profession. One commentator has spoken of psychotherapy's populist synonym ‘counselling’, as the ‘valium of this era”, where counselling “does not cause the same clouding of consciousness as drugs, but its side-effects are twice as bad” (Dalrymple, 1996).

A postal survey of old age psychiatrists was carried out to examine the pattern of services currently available for elderly people with chronic functional mental disorder, and to identify innovative models of care for this group. The opinion of respondents was sought regarding problems with service provision and additional resources that would be desirable. The majority of respondents felt that the needs of individual patients should determine whether they should be cared for by old age, general or rehabilitation services. Seventy-three per cent of respondents felt that more specialist residential care outside hospital was needed to improve the care of this group.

A consensus of available information is used to produce a working table of conversion for the most commonly used drugs to chlorpromazine equivalents. A user-friendly computer program has also been developed from this information. The use of the concept In the clinical setting and for research purposes is briefly discussed.

There is an increasing body of research literature investigating the effects of parental mental illness on children. This study investigates the views of psychiatric in-patients on consequences of their admission to hospital and their mental illness for their children. The results suggest that the parents do not readily acknowledge that their children have problems, and that interventional approaches require good liaison between adult mental health services and child-focused agencies.

This study surveys the extent of substance misuse behaviour among secondary students in Hong Kong. One-fifth of the sample were misusing substances themselves and one-quarter had friends misusing substances. On seeking help regarding substance misuse, two-thirds would see the school social worker; the second preferred helper was a friend.

Some recent criticisms of Mental Health Review Tribunal practices are reviewed against the background of concerns about public protection.

Many trainees in psychiatry have only a vague idea about what the Collegiate Trainees' Committee (CTC) is or what it does. The Royal College of Psychiatrists is unique among the medical Royal Colleges in having a CTC. It was established in 1979, although its roots go back to the previously established Association of Psychiatrists in Training, which was independent of the College.

This paper offers a descriptive survey of RAF community psychiatry. It shows that most of the morbidity encountered in the community now served by RAF psychiatrists is at the ‘minor’ end of the psychiatric spectrum. It mostly requires supportive psychotherapy and the key worker is often the community psychiatric nurse. The study allows discussion of four related issues: the essential nature of military psychiatry; the future provision of community psychiatry to the RAF; psychiatric training and continuing professional development in the RAF; and the possibility of research.

Few recent studies have investigated the prescription of electroconvulsive therapy (ECT) to depressed patients and their progress thereafter under ordinary clinical conditions. From case records, 412 courses of ECT were studied. ECT was efficacious in the short term, especially for patients with psychotic depression and for those over 65 years of age. Fifty-three per cent of patients required readmission in the six months following the index course. Neither age nor psychosis predicted whether readmission occurred. While short-term outcome is good, notably for the elderly and the psychotically depressed, patients are highly liable to relapse after ECT. High quality after-care is thus of paramount importance.

Recent advances in knowledge about effective administration of electroconvulsive therapy (ECT) has placed great emphasis on the importance of good training and supervision of those administering it. The American Psychiatric Associaton requires that doctors be specifically accredited before they are allowed to give ECT. In England and Wales training is much more informal and ECT is often given by junior doctors. Doctors rostered to administer ECT in Wales and in two areas of England were surveyed as part of the College's third audit of ECT. About two-thirds of respondents were at senior house officer level. The training in ECT appeared of variable quality and one-half had not been supervised by an experienced psychiatrist on the first occasion they administered ECT. Responses to exam-type questions revealed that 45% lacked knowledge about one or more basic issue related to effective administration of ECT.

Little is known about how posts are allocated to enable Individuals to experience a comprehensive pre-membership psychiatric training. A questionnaire survey of 26 teaching hospital training schemes was carried out. This concentrated on registrar training – post-Part 1 MRCPsych (now known as senior house officers since the Caiman changes). Four main methods of allocation, with varying degrees of trainee involvement, were identified. The amount of prior notice given of the trainees' next placement and perceived advantages and disadvantages were compared between the four methods. Implications for practice are discussed.