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Through the back door: the College and award of Membership without examination

  • Murad M. Khan (a1)
Extract

Every year the Royal College of Psychiatrists awards a number of memberships to psychiatrists without examination. This is done under Bye-Law III 2 (ii). The sub-category Bye-Law III 2 (ii) (a) states that the ‘Membership of the College may be extended to senior psychiatrists who have practised with distinction over many years and are of international repute’. Candidates should be nominated, proposed and seconded by two members or fellows of the College. If the candidate is from outside the UK, one of the sponsors must be from the applicant's home country. Nominations are accepted from all over the world (Royal College of Psychiatrists, 2001).

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Khan, M. M. (2004) The NHS International Fellowship Scheme in Psychiatry: robbing the poor to pay the rich? Psychiatric Bulletin, 28, 435437.
Mumford, D. B., Minhas, F. S., Akhtar, I., et al (2000) Stress and psychiatric disorder in urban Rawalpindi: Community survey. British Journal of Psychiatry, 177, 557562.
Royal College of Psychiatrists (2001) Supplemental Charter, Bye-Laws and Regulations. Occasional paper OP52. London: The Royal College of Psychiatrists.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Through the back door: the College and award of Membership without examination

  • Murad M. Khan (a1)
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eLetters

Membership and Fellowship without Examination

Amir Bashir, Consultant Psychiatrist
20 April 2006

I read Prof. Murad M. Khan’s article, “through the back door” with interest (Psychiatric Bulletin (2006), 30, 3-5). In 3 years from 2002 as many as 90 doctors were given membership without MRCPsych examination, 67 of those under Bye-Law III 2 (ii) (b) and (c) and rest under Bye-Law III, 2 (ii) (a). This is so unfair with hard working psychiatrists who keep attempting extremely tough and competitive MRCPsych examination without success inspite of being competitive psychiatrists in their practice.

I am against the award of any degree to doctors without passing its examination even if they have overseas equivalent qualification. I howeverfail to understand why Prof. Khan particularly focused on award of membership to Pakistani psychiatrists only. A very small number of psychiatrists given membership under the clause 2 (ii) (a) of Bye- law in 3 years from 2002 were from Pakistan. Prof. Khan’s assumption that all those 5 members from Pakistan through this route did not qualify criteria set by the Bye-Law III, 2 (ii) (a) was overgeneralization. He should not have identified individual psychiatrists and Psychiatric Bulletin should not have published what appears to be a personal attack on a few senior psychiatrists. One of those senior psychiatrists identified in his articleis well known to me and many other UK psychiatrists. His contribution to mental health services is not only admired in Pakistan but recognized internationally. He has a long list of publications in national and international journals. His support and promotion of voluntary sector in mental health is exemplary. In my opinion college cannot be wrong in awarding membership under the given law to such an eminent psychiatrist.

On the other hand I agree with some other member’s suggestion that all psychiatrists who received membership or fellowship in past without examination should be forced to write WE (Without Exam)or Honorary after MRCPsych or FRCPsych. This is the only way to be fair with members who spent their years working hard in training and whose social and family lives were affected while taking MRCPsych exam. No psychiatrist no matter with whatever previous qualification should be given membership of the Royal College of Psychiatrists without passing examination in future.
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Conflict of interest: None Declared

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We feel it is unfair!

arvind kumar sharma, Consultant Psychaitrist
17 March 2006

Bylaw III(2) (ii) subsection (b) and (c), which has been in existence since 2000 has been frozen following legal advice and the consultation process has begun to amend the bylaws. The bylaws were enacted for overseas-qualified psychiatrists working in UK as consultants with a spirit to assimilate, recognise their training and skills and bring them in the mainstream of UK trained consultants. The Royal College had been very generous and non-discriminatory in conferring the membership without examination to those who have been qualified as psychiatrists outside UK and whose qualifications have been screened and considered equivalent to MRCPsych. There have been many psychiatrists of EEA or non-EEA origin who have been awarded this membership since 2000. A majority of the consultants on the IFP were refused the membership recently although membership without examination under bylaw III(2)ii(a) was still awarded to eminent psychiatrists.

Psychiatric training in India is similar to the training of psychiatrists in UK. Any person who has to work as a Consultant in India has also to go through a well-structured intensive psychiatric training. Thereis an all India entrance examination to join the training scheme as a Postgraduate. As part of this process, the person is expected to successfully clear both written and oral examinations andsubmit a thesis, leading to the award of Doctor of Medicine in Psychiatry (MD). Thereafter, this makes the person eligible to join as a Senior Resident. He is eligible to become a consultant only after completion of three years of senior residency.

All the Consultants on fellowship schemes have not only completed at least five years of training but many have several years of experience in their clinical practice. Dr.Holsgrove, Medical Education Advisor (1) has described the whole process of recognising equivalence of qualification asvery rigorous and the quality of consultant psychiatrists recruited under IFP very good. It is worthwhile to consider here that the consultants from Indiawho are recruited under international fellowship or international recruitment have never appeared in the MRCPsych exam and they are not entering through back door as has been said by some, and are Psychiatristswith considerable post qualification experience, which has been recognisedequivalent by Royal College of Psychiatrists themselves. It is really strange to equate this group of consultants with those who are preparing for the MRCPsych exams or those who appeared but failed and will be considered for inclusion in the specialist register.

1.Dr.Gareth J.Holsgrove(2005) The International Fellowship Programme: some personal thoughts. International Psychiatry,Issue 7,January 2005,7-9.

*Dr.A.K.Sharma, Consultant Psychiatrist, Hertfordshire Partnership NHS Trust, 01992624600, Fax.01992624958, arvind.Sharma@hpt.nhs.uk

* Dr Pradeep Agrawal, Consultant Psychiatrist, Southmead Hospital, Bristol. 0117955814, p_agrawal@bol.net.in

Declaration of interest: Both the authors were trained in India and having extensive experience in psychiatry. One of the author’s was awardedand another refused the membership under the ByeLawIII(2)ii.
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Conflict of interest: None Declared

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MRCPsych Exams and proposed changes in training

Chaudhry Liqa Hussain, Specialist Registrar Child and Adolescent Psychiatry
17 March 2006

Dear Sir/Madam

I am writing this letter after reading various views by my colleaguesregarding the award of MRCPsych without examination.

I believe this practice should be stopped because it would affect notonly the morale of those who have either passed these examinations but also who are in the process of training and are aspiring to take these examinations. How can a college justify giving MRCPsych to those who haven't sat in the examination at all. It also affects the standing of the MRCPsych degree on the international scene. Has anyone heard of the American Board ofPsychiatry and Neurology giving diplomas to those who haven't been trained in the USA. The Royal College of Physicians and Surgeons in Canada has very strict criteria for even sitting their examination much less examption from it. They carry reciprocal exemption from training to sit inthe examination with the American Board but there is no exemption from examinations as such. So what are we doing here? We are actually degradingthis prestigious qualification just to fulfil health service needs or a political agenda. I believe the Royal College of Psychiiatrists shouldstrongly resist it. At best an Associate Membership can be institute and they should be allowed to sit in the examination to prove their worth.

Dr Chaudhry Liqa HussainCardiff
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Conflict of interest: None Declared

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How the College can regain its credibility

Murad M Khan, Professor, Dept of Psychiatry
17 March 2006

I have read with interest the letters in response to my article ‘Through the back door….’ (Khan, 2006) as well the many emails I have received from Members, mostly from the UK.

Dr. Ahmed from Milton Keynes has raised an interesting point re. promise of MRCPsych to International Fellows. Although in the article I was particular in focusing on Pakistani psychiatrists of `international eminence’, it appears the issue of Membership without examination is more murkier than what it appears. The MRCPsych was dangled in front of many International Fellows as a carrot- many of whom were more than happy to take it, only to now find that it will no longer be awarded to them.

Dr. Ahmed is disappointed it is no longer being awarded. Almost all International Fellows from Pakistan possess the Fellowship of College of Physicians & Surgeons, Pakistan (FCPS). Why do they desire the MRCPsych? What additional purpose would it serve? By doing so they are actually devaluing the FCPS and by default, admitting it is not upto standard.

As far as the College is concerned it needs to consider and act on the following points urgently:

1.Publish the full list of all Pakistani psychiatrists who have beenawarded the Membership without examinations.2.Publish the full list of their Pakistani and UK sponsors.3.Publish the full list of all Pakistani International Fellows awarded the Membership without examinations. 4.Require all Pakistani psychiatrists who have been awarded the Membership without examination to immediately start writing either ‘Honorary’ or ‘WE’(without examination) or some other denomination after the MRCPsych. This should be done retrospectively for all awardees of Membership without examination. 5.Publish the full list of all Pakistani psychiatrists who have been awarded the Membership without examinations and who have been elected Fellows of the College.

The College must make the whole process completely transparent. Enough damage has been done to its credibility and reputation. If the College is to regain the trust and confidence of its many genuine Pakistani Members then it must act immediately and decisively. Hiding and ignoring the issue as the College did when the issue was first raised in 2001 will not resolve the problem.

References:

KHAN MM (2006). Through the back door: the College and the award of the Membership without examinations, 30; 3-5.
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Conflict of interest: None Declared

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Differing views

Kavita Arora, Consultant Psychiatrist
21 February 2006

Declaration of interest: International fellow practising as a consultant in the NHS for two years.Membership application to the College deferred in October 2004, considered in 2005 and finally frozen/denied now on legal advise taken by the College for all applications under the byelaws.

It seems that being nominated for and being awarded membership is quite different from being capable of practising as a consultant in the NHS.So while the RC is actively involved and its approval needed by the DOH and employing trusts in recruiting to consultant posts (even in the International Fellowship scheme), the then "capable of practising with thepatients" Consultants (who are on the GMC's specialist register)are not entirely "worthy" of being awarded membership even if they are nominated by two members (whom we presume would be willing to provide a reference asper college regulations).

Of course, once one is a practising consultant (with a CCST)and on the register one cannot take membership exams (as the post is not a training post), therefore essentially a grade of consultants (please mark not trainess) is being created which will always remain excluded from its own professional network within the country i.e.the Royal College. I only wish that this had been represented in its true colour when the recruitment to the scheme was done.

I wonder why we recommend "inclusion " to education and rehabilitation into society when we speak of our patients, when we as professionals work to create more boundaries.
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Conflict of interest: None Declared

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