Already strained public sector psychiatrists have yet another burden to deal with, and these exams delay much-needed reinforcements.
After months of advocating, the RANZCP announced in June that it 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 among our next generation of consultant psychiatrists.
It was also welcome news for psychiatry registrars and IMGs caught up in their training journey. They were trying to get through an exam that was largely assessing their ability to write an essay on perspectives in psychiatry and how they pertained to a broader context. Not an easy task when essay writing skills were never their forte and had nothing to do with their work as a psychiatrist.
At the same time, the RANZCP has made changes to the assessment process, bringing in a new clinical assessment task, called the Independent Objective Clinical Assessment, or “I-OCA”. Unfortunately, however, the burden of administering the task will rely on the very psychiatry workforce the RANZCP is currently supporting in their pay disputes, especially in NSW.
At a time when the NSW psychiatry workforce is beyond critical and completely devastated, the remaining public sector psychiatrists will be adding another task to their burden of work — to examine and progress trainees through to becoming the consultants we desperately need, by administering the I-OCA.
Many of us psychiatrists with skin in the game still believe that clinical exams are the best and only way to assess whether a trainee is safe, competent and ready to progress to the role of a consultant psychiatrist. After all, these exit exams are what most specialty colleges use to examine and progress their trainees to consultancy.
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It seems very unlikely the OSCE style of exam will ever return, not because it wasn’t a valuable way to assess candidates, but because of the exam failures during the pandemic, related to IT meltdowns. These IT failures left many trainees distressed and aimless for months after the system crashed mid-exam. It caused a very real bottleneck and delayed progression of many trainees that we needed to contribute to the workforce.
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 OSCEs, but to no avail. At one recent meeting I heard that the OSCE exams were “dead and buried”.
And many of us were surprised to hear the I-OCA would be run in the workplace rather than college-administered. If that was the case, as in the past, keen and passionate psychiatrists such as myself would have volunteered our time to examine for the RANZCP, as we used to do.
When the I-OCAs 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.
There are also very real concerns about how trainees will prepare for the I-OCA, given their sub-optimal access to direct clinical supervision and guidance.
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 a lack of 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, and get the best of our trainees through and into a workforce that desperately needs them.
Dr Helen Schultz is a consultant psychiatrist, a coach and mentor to RANZCP psychiatry trainees. This piece was originally published at medium.com.
