The February 2005 issue of Psychiatric Bulletin contains several articles about the future of psychiatric training.

A specialist should not only be competent in the day-to-day clinical aspects of a specialty. We should have knowledge of the underlying science from which new ideas might develop, the social system in which we practise, and aspects of related medical and non-medical fields. These should co-exist in the individual. How easy will it be for an educational supervisor to assess these?

May I propose a novel competency-based assessment? We could have a target such that trainees (call them candidates) are expected to have a breadth and depth of theoretical knowledge and to be able to apply this to clinical situations in an appropriate manner. This could be assessed by a mixture of written answers to set questions and a series of simulated clinical situations. This process could be called an ‘examination’.

How easy will it be for supervisors to ‘fail’ a trainee who, although adequate in the job does not have these other qualities? The College has rightly taken a lead on institutional racism. A central examination system (perhaps with some on-the-job assessment) may be a better safeguard against discrimination and recrimination than a relationship-based assessment – and protect both the assessor and the candidate from false accusations.

Medicine is practised in stressful situations, with limited time and competing needs. Perhaps an examination is not a bad test of this.

Incidentally trainees with extensive clinical experience in addition to theoretical knowledge are likely to succeed, those whose training has been too superficial may not.