An audit was undertaken looking at the information covered and length off discharge summaries in a psychiatric day hospital. Initially data were gathered from 90 multidisciplinary summaries over 18 months. This showed that although some key headings were being covered, 20% of summaries tailed to include a diagnosis and 63% were longer than two sides. The strategy devised to improve practice was the presentation off these findings to an audit meeting involving all staff which led to a general agreement to improve weaker areas. Over the following six months data were gathered on 26 discharge summaries. Headings were covered more frequently, 92% included a diagnosis and 88% were two sides or less in length.

The experience of detoxification and satisfaction of patients with their treatment in a community-based alcohol recovery unit established by a voluntary organisation and in a psychiatric unit in a general hospital were assessed with the help of a structured questionnaire. Patients admitted to the two units were satisfactorily matched on most, although not all, variables. The types of withdrawal symptoms and lengths of stay were similar. No patient was transferred to hospital from the community facility. Patient satisfaction was greater in the detoxification unit where the cost of treatment was about a third of that in the psychiatric unit.

This paper describes the process of lithium audit at Dingleton Hospital, showing that improvements in clinical practice can be achieved and maintained by implementation of the audit cycle. Even our small audit involved all of the medical staff and several other professional groups and we found this multidisciplinary approach encouraged change.

The idea for this committee of Council came from Professor Andrew Sims when President of the College. A Working Group of the Education Committee produced a report on continuing medical education (CME) and the first meeting was held in February 1992 under the chairmanship of Dr Fiona Caldicott, then Dean. Following her election to the Presidency in 1993 Professor Sims took on the chairmanship and the committee has now met ten times to date.

To determine the availability of career guidance within psychiatric training, the Collegiate Trainees Committee surveyed 300 trainees who had recently sat the MRCPsych Part II examination and 136 (45%) responded. Most trainees had received little or no career guidance and some had sought career advice without success. One third of trainees felt they had encountered discrimination within their psychiatric training. We urge trainees to be pro-active in seeking career guidance, identify sources of advice and make suggestions for topics to be discussed within consultant supervision sessions. We recommend that local access to career advice should be assessed by visiting College inspection panels.

A Regional Gender Identity Clinic was established in Yorkshire ten years ago. It is an entirely NHS-based service and is well used by the psychiatrists in the region. The Director of the clinic is a psychiatrist and there is a cohesive group consisting of a plastic surgeon, gynaecologist (who supervises medication) and a speech therapist. The clinic has won the recognition of the Leeds Community & Mental Health Services Teaching NHS Trust which supports its continuation. An audit of outcome of the first 12 male to female reassignment procedures was conducted by a independent assessor. The result gave the team clear indication that the work should continue. A plea is made for the establishment of more regional services.

We offer an account of training experience within an inner city service dedicated to home treatment as an alternative to hospital admission for acute psychiatric illness. The Ladywood service in Birmingham is described and the challenges and opportunities for trainees outlined. A dominantly institutional based training seemed to us deficient, after this exposure. We regarded home treatment very positively and felt that it enriched our professional development in both clinical and conceptual terms.

A working party of the Collegiate Trainees' Committee of the Royal College of Psychiatrists sent a questionnaire to all trainees taking Part II of the MRCPsych examination in October 1992, asking about their satisfaction with various aspects of their training. Almost 70% rated their training as ‘good’ or ‘excellent’, but specific areas showed wide variation. Cognitive/behavioural psychotherapy, family therapy, research, the management of dangerous patients and the use of ECT were all highlighted as areas in need of Improvement. The working party make recommendations in the light of these findings.

The limited previous research on usage of section 136 of the Mental Health Act 1983 (MHA) has either confined itself to description of socio-demographic and clinical data (Dunn ft Fahy, 1990) or considered procedural issues solely in urban areas (Rogers ft Faulkner, 1987). This is despite the repeated concern of the Mental Health Act Commission (1991), which has noted more widespread difficulties in the use of section 136, highlighting individual failures by local services to adhere to the Code of Practice MHA (Department of Health and Welsh Office, 1990). This study attempts a region-wide survey of section 136 agreements and the corresponding frequency of use of the procedures. This is in line with the Reed Committee recommendations (Department of Health/Home Office, 1992), which prioritised early diversion from custody as an area of research, and emphasised the desirability of multi-agency section 136 agreements.

The evaluation of medical practice dates back many centuries. However, the concept of systematic medical audit is relatively modern. It is recognised that audit of every area of health services (including that of trainee's work and training) has been taking place. This article briefly discusses some of the basic issues in audit, which include the principles, levels and types of audit, from a trainee's point of view.

Referrals from general practitioners to a sectorised mental health team were audited for time delays and quality over three months. A referrers' guide was then designed to reduce referral delays and improve their quality. This was sent to all GPs. Referrals were again audited over two three month periods. There was no significant difference between corresponding time delays in the three periods. Only one item, the presence or absence of past history, was significantly improved in the third period. These results and their implications are discussed.

The remit of our monthly training committee is to facilitate and audit postgraduate training. A clear remit, attention to the organisation and composition of the committee and clear links with other committees have helped us in our aims. Input to the committee from consultants, management and trainees are all essential to the maintenance of high training standards, particularly in a period of rapid change in the health service. The achievements and future plans of the committee are discussed.

This paper summarises some of the key points raised at a workshop held in 1993 on the new undergraduate medical curriculum. At the workshop, the General Medical Council's recommendations were summarised, and examples were presented of current undergraduate courses which met them. There was widespread support among workshop participants for psychiatrists having an expanded role in the new curriculum, beyond a single clinical attachment, particularly in the teaching of communication skills and in collaborative teaching with other medical specialties.

In an era where management training is vital for any would-be consultant, the Kings Fund training course for senior registrars is the best known and most expensive. Examining it critically, we feel that despite its flaws it is still worth the extra money both for its wealth of practical exercises and for the unique, although not very reassuring, glimpse it affords us of management ideology at source. Local courses, although unable to reproduce the atmosphere, could benefit from its practical emphasis.

This is the second of two interviews with Sir Aubrey Lewis at the time of his retirement. The first interview by Professor Michael Shepherd in 1966 was published in the Psychiatric Bulletin in 1993 (17, 738–747).

The three special hospitals of England and Wales are provided for patients subject to detention on account of their dangerous, violent or criminal properties. Special hospital psychiatrists cannot admit patients directly to hospital – the psychiatrist's recommendations can be overturned by a local admissions panel. A two year retrospective study in Rampton Hospital compared the outcomes of the psychiatrists' recommendations to admit or not to admit, with the decisions of the local admissions panel. There was complete agreement in over 90% of cases. This survey lends support to the view that special hospital psychiatrists could admit patients directly to hospital.

Registrars in psychiatry do not routinely have the opportunity to learn about systems theory and its application to psychiatric practice. The authors describe their experience of organising and teaching a course on the application of systems thinking to psychiatry and family therapy. The trainees and their tutor welcomed the broad and interactive approach to teaching which was thought to be very relevant to training in all psychiatric sub-specialities.