Mixed messaging and staying on track

I've been busy preparing for the next round of #RANZCP written exams, and while I prepare content and schedule workshops, I am uncertain about how trainees will be examined in the near future.

As somebody who is on the other side I can only imagine how concerning that must be for our next generation of consultant psychiatrists, some caught up in the NSW psychiatry catastrophe that continues to grumble along. 

Over the past 12 months, I have increased my messaging and spoken about the current #CEQ essay exam, and whether it should be the high-stakes exam that it currently is. I hope it goes as a high-stakes exit exam, and I hope we return to something that directly examines a candidates clinical skills and knowledge. 

I have been surprised by how many of my colleagues are unaware that the RANZCP no longer uses clinical examinations to assess trainees that are external to their workplace. There are workplace based assessments that require a mark of completion, not whether the trainee passed or failed it. And they are conducted by the trainee's supervisors, so measures of objectivity can be brought into question. 

Coupled with the trainee bottleneck created with notoriously low pass rates, we continue to have successful and competent trainees caught up waiting to sit an essay exam that will not examine their clinical competency and safety. 

In recent days we have had mixed messaging coming from the RANZCP about the status of the CEQ exam. On one hand, there is a workshop being offered at the upcoming Congress to be held next week, designed to prepare candidates for the CEQ essay exam. On the other hand, we received communication that committee for examination members were deliberating about its future, with an announcement expected at the start of June 2025. 

It remains uncertain whether trainees will be informed about what will take the place if the CEQ exam goes, and what the rollout is expected to look like. It also remains uncertain that the trainees caught in a holding pattern waiting for a resit will be spared or if they have to start all over again with a new examination or assessment task. 

When the OSCE exams fell over spectacularly during the COVID lockdowns, and while the exam was running, there was literal pandemonium. In the aftermath, rather than attempting to ever run OSCE's again, these clinical exams were replaced with clinical competency assessments, which are still running. Some candidates who were sitting a the time of the IT meltdown were pushed through. Many trainees continue to experience distress talking about this situation and are still affected by it. There is a real chance that by scrapping the CEQ without clear and formal pathways for trainee progression, this may happen again. 

And now is exactly the wrong time to be holding up or putting off our future consultant psychiatrists.

I am mindful that many trainees are going without regular supervision in NSW while their consultants have resigned and haven't been replaced. They also run the real risk that this whole six-month rotation, from February to August 2025 may be unaccredited because of a lack of teaching and supervision, a direct result of the mass resignation of psychiatrists. 

I am also mindful that the crucial part of training is sadly lacking for these trainees, and that is support. Support in the workplace, but also support with managing these ongoing times of uncertainty. 

My advice for trainees and IMG's in this predicament is to continue to map your own journey and control what you can. If the RANZCP continues to offer "no strikes" exams, where a fail does not count towards the number of available attempts, then perhaps hit the books and sit earlier than planned. Be really strong pushing back against demands to pick up extra shifts or on calls to mop up the levels of work outstanding at a time of strike action, resignations and burnout. Rather than put off your exams and assessments while waiting for news, get as much done as you can, as quick as you can. 

The sooner a trainee becomes a consultant, the sooner they claw back some control over their career and their lives. This approach will benefit not only the trainee, but the patients that rely on us and the services we staff. Now more than ever, with all of the pressures the system is facing, the wellbeing and the progression of every trainee must be paramount, and in the forefront of the minds of those who impact this.