We welcome the article ‘Patient-centred psychiatry’ (Bhugra & Holsgrove, Psychiatric Bulletin, February 2005, 29, 49–52) providing information and stimulating debate on the likely future of postgraduate psychiatric training.

Currently most trainees spend substantially longer than the proposed 5 years training. It seems that future trainees will have to learn less, learn more intensively or do less service work. The impact on patients and trainers, and resources necessary to implement changes, must be examined in advance. There may be further deterioration in continuity of care, particularly if all posts are for 6 months. Psychotherapy higher specialist training currently takes 5 years; how would this be incorporated into the proposed model? Will sub-specialist (‘super-specialist’?) training exist as we know it now? Will special interest and research sessions remain unchanged? Information is also needed on what form assessments might take. It is crucial that factual knowledge remains important within any new competency-based assessment.

What flexibility will exist within the new system; for example: if a trainee wants further experience in a sub-specialty; if a trainee does not achieve necessary competencies within the 5-year period; or achieves them well before this? Consideration should be given to transitional arrangements, for example, for trainees taking time away from psychiatry and returning to a new system.

The College runs training programmes and examinations in jurisdictions not affected by Modernising Medical Careers or the Postgraduate Medical Education and Training Board; trainees in such areas wonder how the proposed new system might affect them.

The authors suggest using the MRCPsych Part I as a ‘suitable screen for entry into the specialty’. We would welcome clarification of this. We worry that the College wishes to control entry to training by deeming people suitable or unsuitable for psychiatry. Currently even repeatedly failing the MRCPsych examination does not prevent one from working in psychiatry, but under the new system would this remain the case? Should it?