I read with interest the informative editorial on the MRCPsych examination by Dr Tyrer and Professor Oyebode (Reference Tyrer and Oyebode2004). I agree with the authors’ view that examinations require continuous assessment and refinement and also note their admission that political and external factors are likely to drive further changes.

However, I am still puzzled to note their ambiguity over defining the direction of change in the future. They give three examples of potential future directions: modularisation of courses with assessment at the conclusion of modules; continuation of high-stakes tests; and regrading of the record of in-service training (RITA) as an exit examination at the completion of higher specialist training. However, their description of these examples is vague.

This is an era of heightened societal expectations, increased regulatory control and external scrutiny of professionals. There remains at least a theoretical possibility of external quality assurance standards and mechanisms being imposed on the medical Royal Colleges, including the Royal College of Psychiatrists.

Eraut (Reference Eraut1994) has argued that a professional's competence has at least two dimensions, scope and quality. Scope concerns what a person is competent in – the range of roles, tasks and situations for which their competence is established or may be reliably inferred. Quality concerns judgements on the quality of that work along a continuum. Determining the acceptable and measurable cut-off points on the quality dimension for senior house officers, specialist registrars and consultants remains an important task for the profession.

Schön (Reference Schön1987) has argued that if professions are blamed for ineffectiveness and impropriety, their schools are blamed for failing to teach the rudiments of effective and ethical practice. Greater emphasis on the processes of training, reflective practice, training the trainers, continuing professional development, relevant educational research and interprofessional learning would help to sustain and enhance the profile of psychiatry in the society. The profession requires a clear direction from its leaders.