Becoming a consultant is often viewed as the final hurdle in our lengthy professional training. Yet the consultant role carries with it additional responsibilities and stresses for which the recent appointee may feel ill-prepared. This paper describes a two-day course for recently appointed consultant psychiatrists. Feedback from the 24 offenders suggested the course was greatly valued.

Following a visit to the Royal College of Psychiatrists by Professor W. J. Schudel, it was decided to visit The Netherlands with a view to gathering information about the organisation of postgraduate medical education In psychiatry there. Several Dutch psychiatrists were interviewed during the visit. The ‘Calman’ Report recommends limiting the period of training for British trainees. Formative methods of assessment are to be introduced, with a review of progress at regular intervals. The present Dutch system relies solely upon formative assessment.

Freeman (1992) advocated the setting up of a network of College Research Training Coordinators to provide practical assistance and supervision for trainees engaging in research for the first time. A recent debate held at a College Research Training Coordinators meeting in York under the Chairmanship of Dr Chris Freeman debated the motion “All trainees should undertake research”. This has stimulated us to think again about our own attitudes towards this question.

Hyper and hypo-parathyroidism both lead to psychiatric disorder. In the former the hypercal-caemia is responsible for an acute or chronic organic reaction, depending on the speed with which the calcium has risen. The hypocalcaemia of the latter is more likely to present as tetany, and enters into the differential diagnosis of hysterical over-breathing (Hill et al, 1987). Hypo-parathyroidism most commonly follows inadvertent parathyroidectomy during thyroiddectomy when an abrupt fall in serum calcium can precipitate psychiatric disturbance. The mental state is closely related to the serum calcium level. If this is borderline there may only be symptoms such as anxiety, depression and tension, but with lower levels acute confusion may result. More chronic symptoms occur in long standing hypo-parathyroidism, such as poor concentration, emotional lability and impaired intelligence (Kendall & Zealley, 1983).

The Clinical Practice Guidelines (CPG) Steering Group commissioned a survey to find out which areas of clinical practice the mental health community view as priority for the development of clinical practice guidelines (CPGs). Fifty per cent of all professionals and service users surveyed considered the assessment of risk and management of deliberate self-harm and dangerousness' a priority area for guideline development. These findings provided the basis for a successful bid to the Department of Health for the development of The Royal College of Psychiatrists' first CPG.

The CPA encourages good psychiatric practice in the continuing care in the community of people who suffer with serious mental illness. The tiered CPA has recently been proposed with a view to channel resources towards those patients who are most in need. This study assesses whether the CPA is used appropriately and effectively among patients discharged in an inner city sector where there is a high level of serious mental illness. The results suggest that it is feasible provided there is an adequately developed community mental health team.

I am foolish enough to believe that just because I was successful at my senior registrar appointment interview, my preparation was good enough and my wisdom worthy of passing on to the next generation of candidates!

Although baseline blood tests are routinely checked on hospital admission when patients may be medication-free, it is frequently forgotten that psychotropic drugs can cause a wide range of abnormalities in such tests, some common and some very rare. These abnormalities, and the monitoring requirements associated with them are summarised in Table 1.

On 1 April the mental health section of the Home Office's C3 Division was renamed “Mental Health Unit”, as part of a wider initiative to streamline the Department and give more meaningful titles to the various different areas of work. The responsibilities of our Unit remain the same, however. First, we deal with the cases of restricted patients under mental health legislation. As well as advising Ministers or taking decisions on their behalf about leave, transfers and discharge, the Unit also authorises the transfer of mentally disordered prisoners to hospital. This prison transfer work is focused in a separate section of the Unit which is able to provide a very rapid response to urgent requests for transfer warrants. The number of transfers has gone up from 337 in 1990 to over 700 in each of the last three years.

A previous survey carried out in our unit revealed deficiencies in electroconvulsive therapy (ECT) documentation. With the aim of correcting these deficiencies, the standard procedure for completing the audit cycle was followed and the survey was repeated. The results question the assumption that simply completing the audit cycle ‘automatically’ leads to an improvement in practice. Possible reasons why Improvement did not come about in this study are discussed.

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

At least one ethical committee is not prepared to approve open continuation studies of treatments for dementia. The author considers that such studies are an ethical necessity if patients are to give six months of their illness to trying out what may be placebo. The reasons for this conflict are discussed. In particular, it is suggested that such studies contribute real scientific information.

There is a growing pressure on universities to review their curriculum for undergraduate medical students in the light of the new General Medical Council (GMC) Education Committee recommendations (1993). One major recommendation was for universities to develop a ‘core curriculum’ for every medical discipline. In psychiatry, the curriculum for undergraduate medical students has always varied between universities. We propose a broad design of a core curriculum that consists of eight modules covering what is considered vital to the subject and relevant to the student's future medical practice. The curriculum is designed to be taught in pre-clinical as well as clinical years in an attempt to achieve full integration and aspires to succeed in eliminating this traditional divide.

A course on management within a psychiatry training scheme contributes to senior registrars' preparation to become consultants. Sessions should impart factual knowledge and consider interpersonal components of the management process.

The Third European Trainees Forum met in Copenhagen in May 1995. Twenty-nine delegates from fourteen countries came together to discuss training issues in the European context. Newcomers representing France, Spain and Italy joined representatives from the United Kingdom, Ireland, Norway, Denmark, Sweden, Finland, Greece, Switzerland, Germany, The Netherlands, Belgium, and Portugal. As in previous years, the Forum addressed a number of specific training topics and discussed furthering links with other European psychiatric bodies.

Murphy's law states that if something can go wrong it will go wrong. Our recent experience in organising the MRCPsych exam at two centres confirms the general validity of this aphorism. We wish to share our experiences with other senior registrars who may find themselves in a similar predicament.

A psychosis workshop and its clinical role are presented. The workshop's mode of operation utilising basic psychodynamic concepts is described with related clinical illustrations. The value of the workshop in implementing College guideliness for general professional psychiatric training and the integration of psychotherapeutic skills into psychiatric practice is discussed.

The greatest unnameable fear for all of us who are parents is that of losing a child. We hear about it in others, we read about it in the papers and a cold chill touches us. The most common deaths are sudden in accidents but many parents have to cope with the long drawn-out trauma, alternating hope and fear, of sickness. No-one can ever know if or when or where they may experience the policeman at the door or the embarrassed compassion in the doctor's face.