The last year has been a fascinating one for me as a British medical graduate in many ways, constituting, as it did, my introduction to both American culture and a career in psychiatry. I have just completed my first year of a three-year psychiatric training programme (residency) at Harvard Medical School, roughly equivalent to a combined SHO and registrar training in Britain.

Here is a good teaching case:

Mr Watene, aged 25, was put in prison for seven days on a charge of offensive behaviour, with a charge of robbery pending. On the third day he was recommended for transfer to a psychiatric hospital because he was sullen, depressed and uncommunicative; he had barricaded himself in his cell because he was scared of other prisoners, and he carried a knife for his protection, as he said. Two doctors wrote the order. One noted: ‘It is very difficult to gain his attention. He cerebrates slowly, and replies to repeated questioning are in the main irrelevant.’ The other said: ‘It is not really possible to have a conversation with him, but he does indicate his fear of being left alone in the cell and wished me to stay with him. Says he is mixed up.’

A consultant psychotherapist's main concern should be the development and organization of a specialized psychotherapy service. Other functions such as teaching, supervising, consultative and administrative work are derived from and subordinate to this task.

In the autumn of 1981 the College meeting was held jointly with the Danish Psychiatric Association, many of whose members came to London for a few days. Planning for the recent study tour by College members to Denmark started soon afterwards. By fortunate timing, Dr Tove Aarkrog's article on psychiatry in Denmark was published in the Bulletin (May 1983, 7, 90–91) on the eve of the group's departure.

‘Our first concern must be to improve the psychotherapeutic skills of psychiatrists in general, as a means of providing a better service to our patients.’ Thus, Sydney Brandon concluded his personal view on psychotherapy in the Bulletin last year (July 1982, 6, 120). It was a similar concern that motivated us, two years ago, to set up a scheme which initially aimed to provide trainees in psychiatry with some form of regular teaching, experience and supervision in dynamic psychotherapy.

Candidates from our Institution have not been uniformly successful in passing the MRCPsych Examination. It was therefore decided to offer some specific guidance to our trainees who were about to take Part II, in the form of a short ‘revision’ course incorporating mock clinical and viva examinations. A small working party was set up to organize this.

A recent survey of the views of clinicians at St George's Hospital on the content of the psychiatric formulation (Hollyman and Hemsi, 1983) revealed much diversity of opinion and confirmed our hypothesis that the notion is open to different interpretations. It seemed appropriate therefore to conduct a similar survey of College Examiners to discover whether there is similar variation in that group.