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Until 2003 the long case was the clinical component of the two summative
examinations for the Membership of the Royal College of Psychiatrists
(MRCPsych). This changed to an Objective Structured Clinical Examination
(OSCE) format, initially for the Part I examination, and more recently to
the Clinical Assessment of Skills and Competencies (CASC) at the end of 3
years of basic training. Although there are distinct advantages to the
objective, competency-based assessment, questions remain on its validity.
The expectation that formative workplace-based assessments would fill in the
void left by the loss of the long case has not materialised. The options for
retaining the advantages of the long case within the CASC framework while
minimising the shortcomings of the CASC are suggested as a way forward.
In their editorial, Michael et al focus on what they see as
shortcomings in one important area of clinical assessment of psychiatrists
in training and they suggest that methods of workplace-based assessment have
failed. However, current thinking in assessment of doctors is to consider
assessment systems as a whole and we contend that both forms of assessment –
clinical examinations and workplace-based assessments – are needed because
they fulfil different needs. This is not to argue that more should not be
done to ensure that all who are involved in the assessment of doctors are
better prepared for the task or that the current portfolio of assessment
methods is complete.
A baseline audit of trainees' ability to recognise Wernicke's
encephalopathy and initiate appropriate thiamine regimes in an in-patient
alcohol detoxification unit was carried out. Based on the findings, gaps
were addressed using targeted education and training, and their impact on
improving standards of managing Wernicke's encephalopathy was
The initial audit revealed that trainees' ability to recognise Wernicke's
encephalopathy and initiate thiamine was inadequate. Significant
improvement in appropriate use of treatment regime (P < 0.05) of
thiamine and the monitoring of clinical response was observed after
addressing the initial gaps through education.
Treatment of Wernicke's encephalopathy can be inadequate, given a lack of
awareness of clinical presentation and appropriate management. This can
be addressed through education and training.
To ascertain the efficacy of custody health screening for mental
disorders. We assessed a sample of detainees for the presence of mental
disorders and the need for an appropriate adult. The assessments were
carried out using pragmatic interviews and examinations supported by
structured tools. Where possible, we attributed a probable clinical
diagnosis based on the information available to us. The need for an
appropriate adult was judged based on this information and capacity
Existing screening procedures missed a quarter of cases of severe mental
illness and moderate depression; they also failed to detect about a half
of those at risk of alcohol withdrawal and 70% of those at risk of
withdrawal from crack cocaine. The need for an appropriate adult was not
recognised in more than half of cases.
Consideration should be given to modifying police screening procedures
for mental and associated disorders so that detainees receive the
To document the number and type of adverse medication events in a
psychiatric sector service. Significant new adverse events were collated
by the author and team over 30 months. Intervention to prevent any
adverse event was enacted as soon as any were noticed or anticipated.
Thirty-six significant events occurred including three deaths and nine
near misses. Corrective action was taken immediately any adverse event
occurred. Inadequate communication between various hospital clinics,
general practitioner practices, psychiatric clinics and pharmacies was
the biggest avoidable cause of adverse events.
Awareness of adverse drug events is essential in psychiatry. Clear,
transparent pathways of prescribing are a key requirement to reduce
avoidable adverse medication events. Psychopharmacology is a core module
for psychiatric training.
The structure of academic training in psychiatry has changed in recent
years and little is known about the trainees currently pursuing this
career path. Two surveys were conducted of academic trainees in
psychiatry and the heads of departments of psychiatry. These surveys
aimed to identify the number of trainees currently in academic training,
the nature of their positions and opinions about the current system of
training in academic psychiatry.
There were 165 academic trainees identified, of whom 101 were not
currently in academic clinical fellow (ACF) or academic clinical lecturer
(ACL) posts. Academic trainees are located in a relatively small number
of universities, with a quarter being based at one institution. In total,
60% of the trainees were in general adult psychiatry. Only 4.6% of
respondents rated their academic training as excellent and just over half
were certain that they wished to pursue an academic career in the future.
Various challenges to academic training in psychiatry were identified by
both the heads of departments and trainees.
Current difficulties in academic training in psychiatry, such as lack of
flexibility of the training pathway, need addressing to ensure the
provision of high-quality research and teaching in psychiatry in the