The letter by Haeney (Psychiatric Bulletin, October 2004, 28, 383) raises an interesting conundrum.

I have recently been advising a number of my colleagues, who will be undertaking the clinical examination for Part II MRCPsych. A significant number undertook the Part I MRCPsych OSCE exam, so have not had experience of the unobserved long case.

With the introduction last year of the OSCE exam and its widespread use in undergraduate teaching, a large proportion of trainees have no experience of long case examination. As was mentioned in the letter by Haeney, candidates struggle with the uncontrollable variables of patient and examiners. My own feeling about this is that, with experience, candidates can often handle these situations better. During my undergraduate training, I was examined using the traditional long case format, and I believe this exposure to the format gave me greater confidence when dealing with long cases in both Part I, and more recently, in Part II examination.

It would be of interest to get an idea of how candidates who are now undertaking Part II are dealing with the lack of exposure to the long case. This would particularly apply to any proposed change in the Part II examination. Having reviewed previous articles it would appear that while most have highlighted the need for changes in the Part I clinical examination, there is little mention of what changes, if any, can be made to improve the Part II clinical examination.

It is my opinion that, having initiated the change to the OSCE format for the Part I clinical exam, the College would, inevitably have to review the current long case format in the Part II exam. The debate, I hope, will start sooner rather than later.