On compassion for the SHOs

Sir: I run a weekly group for senior house officers (SHOs) in psychiatry to help them make sense of their clinical experiences in general psychiatry and develop a depth of sensitivity with their patients. A patient was presented with the problem that no one in the team felt any compassion for her and her behaviour, and this clearly affected any notion of therapeutic progress. The staff needed help to become understanding of the difficulties from the patient's angle.

Preceding the seminar, I was talking with the SHO's about the anxiety that dominates all their minds, namely the MRCPsych examination. One was left with the question, what example is the College giving the SHO's in relation to sensitivity and compassion for their ordeal?

If the SHO's pass their multiple choice, they are then sent anywhere throughout the UK and Eire for the clinical. This clearly is an antiquated system in need of revision. There is no reason for not holding the clinicals within defined local areas e.g. London, South East England, The Midlands, Scotland, Wales, Ireland etc. At present our SHO's are being sent unnecessarily all over the place for their clinicals, for example from London to Bangor, Paisley, Aberdeen and Dublin and vice versa. They are already in a very stressed state, waiting to do their clinicals. They are then made to travel great distances to far-flung places, which may even operate under an unfamiliar Mental Health Act.

In many cases, the travel and hotel expenses are considerable for the SHO's to pay. If they do eventually pass the exam, the letter of congratulations asks straight away for the membership fee. It leaves an impression that all the College is interested in is money, and is lacking in human compassion and thought for their SHO's.

The SHO's do not seem to have an effective voice in the College. In general psychiatry, we now have effective users' groups representing the patients. We need a similar effective voice representing the SHO's. My SHO's said that they would be most grateful if I would write to the College on their behalf.

If the College is experienced by the trainees as insensitive to their feelings, this should be a matter of general concern for the membership. I wonder if there are others in the College, whether affiliates, or members who also feel that there is a need to alter the MRCPsych exam arrangements with more thought and compassion for the SHO's position?