Examinations have been a feature of medical training for centuries both in undergraduate and postgraduate education. The primary purpose of such examinations has been to define a minimum standard that the public and fellow professionals have confidence in. In recent years there has been a drive for examinations to also inform the learning process and to be conducted in a format that is evidence based. The current MRCPsych examination was introduced in 2008 within parameters laid out by the Postgraduate Medical Education and Training Board (PMETB; Principles for Assessment Systems). The requirements of PMETB were for all Colleges to use assessment formats that were supported by evidence in the literature as being a reliable assessment method. As a consequence, all Colleges developed written paper examinations that were based on the multiple-choice question (MCQ) format and clinical examinations in an Objective Structured Clinical Examination (OSCE) format. These two formats are regarded as the most reliable. The written papers moved away from short-answer and essay questions as there are concerns about the reliability of these formats. The current MRCPsych written papers have extremely good reliability (Chronbach's α consistently greater than 0.9) and the Clinical Assessment of Skills and Competencies (CASC) also has good reliability (Chronbach's α 0.75–0.85).

The performance of the examination is closely monitored by the Royal College of Psychiatrists' Examinations Sub-Committee with robust quality assurance processes in place. The content and performance of each item is scrutinised pre- and post-examination. The College is also required to provide data and reports to the regulator (the General Medical Council, GMC) and any proposed changes to the examination require GMC's approval. Recent changes approved by the GMC include a reduction from three written papers to two (introduced from this year) and a change to the CASC marking scheme from the Hofstee method to borderline regression (from diet 2 this year). As part of the process to reduce the number of written papers, the written paper question banks have been fully reviewed and updated. The statement that MCQs are continuously recycled year after year is incorrect. New questions are constantly being developed and every examination paper has about 40% of new questions. All questions have been mapped to the examinations syllabus and new question writing is focused on areas of the question bank where the range of questions is limited. There is also a focus on developing a greater range of questions testing clinical management within Paper B.

The MRCPsych examination is under continuous review and development by the Examinations Sub-Committee. An external review of the examinations was commissioned in 2014 and we are following up on recommendations for further enhancements to the MRCPsych. These are due to be published at the end of 2015.

The curriculum, like the examination, is under constant review in a process that involves a wide community including lay people, trainees, medical managers, psychiatry experts and trainers. All changes have to be approved by the GMC and there is regular dialogue between the College and the GMC. A major revision of the core curriculum is being planned and will include the incorporation of the examination syllabus.

While we understand that trainees may feel the MRCPsych is another hurdle, ultimately, the College is responsible for ensuring that quality and patient safety are at the forefront of its examination processes. We are satisfied that the current standard is appropriate for entry into higher training. While it is our ambition to drive up the standard, we are aware that a significant proportion of core trainees struggle to achieve the standards set by the examination. The College is keen to influence training and the learning experience of trainees. To this end we have introduced Trainees Online (TrOn; http://tron.rcpsych.ac.uk), a series of online learning modules for trainees that will eventually cover the whole MRCPsych examination syllabus. We have also been working with MRCPsych course organisers to improve the standard and consistency of courses. We hope that increased clarity about what trainees need to know will lead to higher examination pass rates as well as the acquisition of knowledge that will support clinical practice.