Historically, training in psychiatry, in line with all other medical training, followed an apprentice model in which a trainee was attached to senior practitioners and, through observation and supervision, learnt the skills applicable to the treatment of mental illness. Each trainee was offered a range of experience in a variety of contexts and with different trainers in the hope that a diversity of skills would be developed over time to ensure safe and independent practice. The achievement of adequate knowledge and clinical skill was assessed by national examinations. It was only in national examinations that trainees were formally assessed by independent practitioners external to their training. Until then trainees could rely on the benign opinions of their educators and assessments from people with whom they had a personal relationship.

It is not surprising that the variability inherent in this style of training led to questions about its reliability in producing competent doctors. Extremes of training experience were obvious, some trainees gaining excellent clinical experience and receiving consummate teaching, whereas others received limited experience and poor tuition. The lack of frequent assessment points led to delays in progression late in training when it was too late for failing trainees to consider a different specialty. Although there was limited information about what type of alternative training would result in more competent doctors, training was reorganised by central directive with greater emphasis on assessment of competencies in the workplace, workplace-based assessments (WPBAs) and frequent local evaluation and certification. In this brief chapter I will argue that, within the context of local assessment, national examinations are more important than ever.

The importance of examinations

Examinations are part of a wide range of evaluators of a trainee's ability. There are a number of reasons why centrally organised exams should continue. To start with, they are fair, reliable, informative, defensible and can easily be integrated with a local summative appraisal.