Assessors reports on Advisory Appointments Committees Changes since 1974

information on applicants, and those interviewed, to the Registrar by completing a form containing information on the number of applicants, numbers interviewed and their quality together with any deficiencies in qualifications and experience in those seen and those appointed. Prior to 1979the assessors gave their opinion on qualifications and experience on all applicants but the form then in use did not allow for any quantitative analysis. Since the intro duction of a new form in that year, such an analysis has been possible. A summary of assessors reports from 1974 to 1977was published in the Bulletin.1 An analysis has now been made of 995 returns (a 69% response rate) from England and Wales for the years 1980-86 inclusive, covering all psychiatric specialities. However, substance abuse has not been analysed because of very small numbers in post and community psychiatry and rehabilitation have been included in the figures for general psychiatry.


Psychiatric Bulletin
Assessors reports on Advisory Appointments Committees Changes since 1974 PETERBROOK, Consultant Psychogeriatrician, Fulbourn Hospital, Cambridge From the time of its foundation the College has been represented on Advisory Appointments Committees for consultant posts. One of the College nominated assessors' responsibilities is to supply confidential information on applicants, and those interviewed, to the Registrar by completing a form containing information on the number of applicants, numbers interviewed and their quality together with any deficiencies in qualifications and experience in those seen and those appointed. Prior to 1979the assessors gave their opinion on qualifications and experience on all applicants but the form then in use did not allow for any quantitative analysis. Since the intro duction of a new form in that year, such an analysis has been possible. A summary of assessors reports from 1974 to 1977 was published in the Bulletin.1 An analysis has now been made of 995 returns (a 69% response rate) from England and Wales for the years 1980-86 inclusive, covering all psychiatric specialities. However, substance abuse has not been analysed because of very small numbers in post and community psychiatry and rehabilitation have been included in the figures for general psychiatry. Table I gives figures for the total number of posts for each specialty, the number of times when no appointment was made and the number of times where reservations were expressed about candidates who were appointed: the 1974/1977 results are included for comparison. Frequently the reser vations were solely that the appointee had held a senior registrar post for less than the recommended minimum of three years but sometimes other and more serious reservations were expressed.

Thefindings
The first-and most striking feature-is the increase in the number of consultant posts over the years: this is particularly so for psychogeriatrics.
In general psychiatry there has been a diminution overall in the frequency where no appointment was made (either because no candidate appeared or none were considered suitable) and fewer occasions where reservations were expressed about successful candidates except for a marked rise in 1986.Similarly in psychogeriatrics and child psychiatry there has been a substantial falling off in the numbers where reservations have been expressed but the reverse holds true of psychotherapy and forensic psychiatry.
Tables II and III show assessors' opinions on the overall quality of candidates interviewed and include the figures for 1974/1977 for comparison.
For general psychiatry, because of the large number of candidates, the figures for 1980/86 are given separately for each year in addition to the total for the whole period. There have been fluctuations over time but overall the proportion of very good and good candidates interviewed has increased sharply with a corresponding diminution in the proportion of average and indifferent and poor candidates. Psychogeriatrics has also shown a substantial rise in very good and good interviewees, largely at the expense of the average group, while the proportion of indifferent and poor candidates has risen slightly. Child psychiatry has changed little, retaining a high proportion of good quality interviewees, but psycho therapy and forensic psychiatry have apparently lost ground but even so the proportions of very good and good psychotherapy interviewees are still compar able to general and child psychiatry and higher than other specialties. There has been no change in mental handicap and the proportions of very good and good candidates are lower in this field than in any other specialty. The same overall comments apply also to the ratings of the experience of candidates.

Comment
Although the form was revised in 1979by the present author it remains deficient in one important respect, namely that no attempt was made to define the qual ities 'qualifications' and 'experience'. The figures suggest that by and large assessors treated these two qualities in a similar fashion.
For the specialties of psychotherapy and forensic psychiatry the relatively small numbers involved make it difficult to be certain about changes over time.
At first sight the results cast doubts on the effective ness of the College and the JCHPT in improving the numbers of good quality applicants for consultant posts since their formation respectively in 1971 and 1974;a number of factors must be taken into account before adopting such a pessimistic viewpoint. First, there has been the need to generate large numbers of well qualified candidates for a rapidly expanding specialty. The College has contended in its submission to the Joint Planning Advisory Com mittee (JPAC) that the number of higher training posts has been insufficient to match consultant vacancies.2 This mismatch would account in large measure for the failure to fill posts, reservations about successful candidates and the large numbers of insufficiently qualified and experienced applicants demonstrated in the assessors' reports. It would also explain the fact that some of these applicants had obtained the MRCPsych but failed to obtain senior registrar posts, (because of the discrepancy in numbers between registrars and senior registrars), often being forced in consequence into a succession of locum jobs rather than proceeding to approved higher training.
A second factor has been the even more rapid expansion in the numbers of consultants in certain specialties such as psychogeriatrics which has not been matched by an increase in the number of appro priate training placements.3 This again, would lead to difficulty in filling posts, together with the appoint ment of relatively inexperienced candidates and a general low level of applicants.
JPAC has accepted and acted on the College's arguments that more senior registrar posts are needed in general psychiatry (with a particular em phasis on psychogeriatrics and substance abuse) child psychiatry and psychotherapy by sanctioning an increase in the numbers of senior trainees. JPAC has still to consider the number of senior registrars in forensic psychiatry and handicap in the light of the Colleges' submission. A third and paradoxical factor is that standards of training both at general professional and higher levels have undoubtedly been greatly raised by the College and JCHPT with the consequence that assessors' expectations have been correspondingly raised so that the 'good' candidate of the 1970smight be seen as only 'average' in the 1980s.
A fourth factor is that advertised posts were ad versely commented on by assessors in terms of their being poorly resourced; this comment was made frequently in the field of psychogeriatrics most especially in the earlier years. The result would be that the best applicants, aware of these deficiencies, might well withdraw their applications thus leaving only indifferent candidates or none at all.
Finally, another factor influencing these results would be that, until recently, mental handicap and forensic psychiatry have been unpopular specialities so that available senior registrar posts have not been filled, resulting in a dearth of applicants for consult ant posts. This trend has recently been sharply reversed in forensic psychiatry, with a fall in the per centage of senior registrar posts not permanently filled from 29% in 1984 to only 9% in 1986. Handi cap was, until recently, an unpopular specialty in these terms with 24% of posts not filled permanently in 1984 but dropping to 19% in 1986 and there are Psychiatric Bulletin good indications that a further drop has taken place in the last year. In comparison mental illness, child psychiatry and psychotherapy have some 8-10% only of senior registrars not permanently filled. 4'5 The assessors' reports reflect in part therefore the problems produced by a rapidly expanding specialty, which embraces even more rapidly expanding subspecialties, compounded by a marked inbalance between the numbers of registrars and senior registrars, a situation which should be relieved by the implementation of the recommendations in Achieving a Balance? In addition, psychiatric spe cialties remain less popular than others and there are inadequate numbers of higher training posts in psychogeriatrics, a relatively new and very rapidly expanding specialty. Having made these points  however, there must still be concern about standards of training which will continue to need attention both of the College and JCHPT through their inspections and visitations. The vigilance of College advisers on assessment committees offers an important oppor tunity for monitoring standards of training and the data they provide on candidates and posts should continue to be collected and assessed by the College.