New exams and missed opportunities

After months of advocating, the RANZCP announced this month that they would scrap the CEQ essay exam, effective immediately.

This was welcome news for those of us who believed that an essay, which was set as a high stakes exam, was not the best way to discern who was the best and brightest amongst our next generation of consultant psychiatrists.

Many of us psychiatrists with skin in the game still hang on to the hope that clinical exams will return, and that they will be the exit exams most specialty colleges use to examine and progress their trainees to consultancy.

It seems very unlikely the OSCE style of exam will ever return, not because it wasn’t a valuable way to assess candidates, and also prepare them for the real thing, but because of the exam failures during the pandemic, related to IT meltdowns and leaving many trainees distressed and aimless after the system crashed mid exam.

Now that we can return to face to face examinations and not have to rely on IT systems, some of us are still calling for the return of the OSCE’s but to no avail. At one recent meeting I heard that the OSCE exams were “dead and buried”.

There has been some progression to a new assessment task that examines interview skills and presentation of clinical cases. Known as the “I-OCA” this assessment will be added to the other workplace based assessments psychiatry trainees must attempt during their training. There is no requirement to pass these assessments, just to attempt them, and the onerous task of assessing trainees falls on consultant psychiatrists working in the public system.

The “I” in I-OCA stands for independent, and when myself and my colleagues heard of this assessment, we signed up to examiner training, believing that these observed clinical assessments would be run independently of the trainee’s workplace. We were of the belief that they would be like the old style observed clinical interview, which was an exit clinical exam phased out over seven years ago. We were wrong.

When the I-OCA’s come into play in August 2025, they will be run largely by consultant psychiatrists working in the public system, and the only stipulation is that the psychiatrist must be somebody who is working independently of the trainee. They can have experience working together in other rotations previously. There is little expectation that the workplaces will rely on outside supervisors and consultants such as myself, and we wouldn’t be remunerated for our time. This workplace assessment task, not an exam, is also very time consuming for both the trainee and the consultant psychiatrist who must allocate three hours in one sitting to complete the assessment. There is no pass/fail grading, only feedback given, and if the trainee is not happy with their attempt, they can repeat it.

Given the state of our psychiatry workforce currently, which is barely existent in NSW, and unlikely to improve in the foreseeable future, it doesn’t make a lot of sense that this task has been unleashed at this time, away from the responsibility of the RANZCP, and with this burden placed on the public mental health system. This assessment has the capacity to delay progression to fellowship if trainees are waiting to complete one more workplace based assessment. Many trainees in NSW have endured months of lack or very minimal supervision and will find it difficult to prepare for the assessment to the stage that is required.

Given the state of play and the new-normal workplace shortages, this was a missed opportunity to develop and administer an external based exam, away from the workplace, and draw on the investment of consultant psychiatrists like myself who love to give back by being an examiner, paid or not, and ensuring that the trainee pathway is facilitated.

We all know clinical exams are the way to go, including the RANZCP, but we have currently lost the opportunity to assist our public psychiatry colleagues, get the best of our trainees through and into a workforce that desperately needs them.

[AS PUBLISHED ON MEDIUM 25th June 2025: https://doctorhelens11.medium.com/new-exams-and-missed-opportunities-670c4e82115a ]