In his excellent article Professor Khan raises concerns regarding the awarding of Membership of the College without adequate checks. He points towards the College's high standing and its ability to guide opinion in countries which have not yet developed such structures for themselves. The British Medical Royal Colleges have traditionally had this role throughout those Commonwealth countries that have largely adopted a UK-style postgraduate education system and teach in English. This is an enormous responsibility and at the same time reason for the College's dilemma. The College is not merely the guardian of professional standards and education but also provides professional guidance beyond its own borders. This is further complicated by the fact that to get a job as a specialist a psychiatrist does not necessarily have to be a member of the College, so the College has no effective role in controlling access to work as a specialist. This latter point is in stark contrast to Royal Colleges or similar bodies across the European Union whose primary role it is to control access to specialist jobs. It is this complex role with no effective control function regarding access to jobs that causes the dilemma faced by our College and exacerbates the problems described by Professor Khan. The answer could be to subdivide the three roles of: (a) controlling access to specialist jobs; (b) controlling education; and (c) setting standards and giving professional guidance at home and abroad.
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