The Royal College of Psychiatrists is well on the way to introducing its new curriculum and revised Membership (MRCPsych) examinations and assessments, in line with the requirements of the Postgraduate Medical Education and Training Board. The new structures might encourage trainees to ask themselves how and why they are studying and learning. Organisers of local MRCPsych courses will need to tailor their courses to fit these new structures, and this might be an optimum time for the College to consider whether it should take a more formal role in approving courses and judging trainees' participation in them.

This article is aimed at organisers of courses for the Royal College of Psychiatrists' membership examinations (MRCPsych) and College tutors preparing trainees for the MRCPsych. Running revision courses requires planning and a good deal of work but should be possible for most MRCPsych preparation courses. The theoretical background of assessments is explained. An overview of the type of examination used in the MRCPsych is provided and advice as to how trainees can best prepare for them given. Advice is given on the recruitment and retention of examiners for mock clinical exams, how to deal with simulated patients and what equipment is useful to buy for the use of trainees. We also explain how trainees can practice for the written papers and how feedback is best given to them. The new MRCPsych formal examination and workplace-based assessment programme are also discussed.

Palliative care is an approach that stands well with the aims of person-centred dementia care. There is no doubt that the standards of care for many people with advanced dementia are poor. There is a lack of good-quality evidence, however, to support any particular approach for palliative care in dementia. Still, there are a number of areas in relation to caring for people with severe dementia where a palliative approach might be beneficial. In general, the relevant decisions have to be made on an individual basis but within a palliative framework. Advance care planning is likely to be crucial in encouraging this process. There is certainly a moral imperative behind the idea that care at the end of life for people with dementia should be improved.

This article describes the literature specific to partnership working across the National Health Service, social services and voluntary and community sector in order to summarise the potential advantages and challenges of partnerships. We explore the meaning of partnership working and review the policy developments and investment initiatives underpinning the Government's emphasis on partnership working between statutory services and the voluntary and community sector. A number of barriers hinder effective partnership working and we examine some possible solutions to overcome these. We then address the key issues influencing the approach to increasing the voluntary sector's participation in partnership activities within mental health services and provide brief examples of good practice. Finally, we discuss practical issues relevant to planning partnerships and the role consultant psychiatrists can play in initiating and developing partnership working between the voluntary sector and statutory mental health services.

Partnership working with the voluntary sector is developing across mental health services. Such partnerships have the support of the Royal College of Psychiatrists and the Department of Health. Setting up a partnership requires enthusiastic psychiatrists who are willing to work in new ways. These psychiatrists will face issues of personal and clinical responsibility, confidentiality and fairness. They will also have to deal with continuing changes that could unsettle a new and developing collaboration. Early intervention services may use partnerships more than other adult psychiatry services, but partnerships could be established in any specialty. Psychiatrists should make sure that appropriate evaluation is built into any new partnership.

The Royal College of Psychiatrists' requirements for psychotherapy training and the role of the local psychotherapy tutor are summarised. Practical issues concerning the provision of this training are discussed, taking into account the anxieties that trainees experience. Suggestions are made about conducting case discussion groups, providing case supervision in small groups, locating short cases and arranging group and systemic therapy experience.

This article outlines the changes to psychotherapy training for psychiatrists proposed in the Royal College of Psychiatrists' new specialist training curriculum. There is some debate about whether this curriculum should be taken up in its present form because of the limitation of resources to implement it. I describe the effect of taking the College at its word that psychotherapy training should be mandatory and the improvement this has already brought about in psychotherapy training on the Exeter and South Devon training rotations. I also discuss what will be required to implement the new requirements.

Risk assessment has become a large and anxiety-provoking part of the work of many psychiatrists. This article unpicks the different meanings of the word ‘risk’ to seek out the source of that anxiety, looking at both statistical and sociological ideas about risk. A risk assessment is often a subjective, plastic and context-dependent statement about a patient that carries strong moral overtones. Risk management is also highly anxiogenic for those charged with carrying it out, because uncertainty about the future is impossible to eliminate and the consequences of an adverse outcome in the patient may also carry hazards to the doctor making the risk assessment. This leads to behaviour change in people carrying out risk assessments as they attempt to minimise their anxiety in a rationally selfish way, often with unintended negative consequences for patients, doctors and health service providers generally. Some possible strategies for minimising this effect are considered.

The purpose of this article is to update practitioners on the latest published research into the prevalence of prolonged cerebral seizure activity following electroconvulsive therapy (ECT). This research is drawing attention to the real practical challenges of recording and reading an electroencephalogram (EEG) tracing in the ECT clinic. In particular, determination of the seizure end-point is not always practicable and this poses a major problem in the detection and management of prolonged cerebral seizure activity. Some practical tips are suggested, and an update is given on the status of EEG monitoring in the assessment of seizure adequacy.

The article covers the state of play of adoption from local authority care in the UK and research into the factors influencing placement outcomes. The major contentious issues about placement are discussed in relation to competing opinions and available evidence. Ways of intervening in adoptive families in difficulty are considered, together with current efforts to establish what makes for effective support services. This article recommends comprehensive assessments of the children to be placed and carefully targeted adoption-aware psychosocial interventions.

Herbal remedies are used by many people suffering from anxiety or depression. It is therefore important to know whether they generate more good than harm. A systematic review of the published literature revealed trial data for Ginkgo biloba, Lavandula angustifolia, Hypericum perforatum, Valeriana officinalis, Crataegus oxyacantha, Eschscholzia californica, Matricaria recutita, Melissa officinalis, Passiflora incarnate and Piper methysticum. Only two of these herbal remedies are supported by sound evidence: Hypericum perforatum (St John's wort) for mild to moderate depression and Piper methysticum (kava) for anxiety. Neither is free of risks. Our knowledge of herbal remedies is incomplete and the subject merits rigorous study.