The General Medical Council (GMC) is currently undertaking a review of the training and assessment of doctors in the UK, with a view to making a number of recommendations to improve the quality

Although higher specialist training examinations are not explicitly mentioned, the introduction of a clear means of ensuring that all doctors have been assessed as competent to practise independently before they are granted a Certificate of Completion of Training (CCT) is an important aspect of the GMC document. There is also inference that a final annual review of competence progression alone is not sufficiently rigorous and that some form of final, standardised assessment (an exit examination) is necessary. It has been acknowledged that an exit examination must be relevant and knowledge based, but its form and content has been left for individual medical Royal Colleges to decide. Since 2008, psychiatric trainees have been required to sit three written papers and undertake one clinical examination (Clinical Assessment of Skills and Competencies, CASC) before gaining Membership of the Royal College of Psychiatrists (MRCPsych). Before 2008, trainees would sit two written papers, an Objective Structured Clinical Examination (OSCE) and a long case examination. This increase in written papers was also accompanied by raising examination fees. These changes were viewed negatively by many trainees as it placed them under greater time and financial pressures. Further disquiet was caused among trainees in 2011, when it was revealed that the College had made a financial surplus from examination fees. In response to trainee concerns, the College has reduced the number of written papers to two and also cut exam fees. In this historical context, there are fears that the introduction of an exit examination might be perceived unfavourably. With this in mind, the Psychiatric Trainees’ Committee (PTC), an elected group of psychiatric trainees from across the UK supported by the Royal College of Psychiatrists, established an Examinations Working Group in 2012, which set the following priorities: