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CORRESPONDENCE
and standards of postgraduate training and
methods of accrediting schemes are already well
developed in the College. We need to concentrate
on improving the translation of these policies
into high quality psychiatric training throughout
the country. The other vitally important factor in
ensuring the College's compliance with the re
quirements of the CMO's Report, particularly
with regard to the length of training, is the fund
ing of the latest allocation of senior registrar
posts. This will allow us to address our own
bottleneck which occurs between registrar and
senior registrar grades and fill the large numbers
of vacant consultant posts in some areas. This is
in contrast to the excess of senior registrars to
consultants in many other specialities.
On behalf of the CTC I would also like to correct
the impression which may have been gained from
Dr Kisely's article that we have not been active or
responsive to the issues raised by Caiman. The
statement that the CTC recommends only mini
mal changes to the present system is true in as
much as we only see a need for continuing the
progress made in psychiatry over recent years.
This view is not intended to apply to the other
Royal colleges where more radical changes may
be needed. The CTC is an integral part of the
Royal College of Psychiatrists and as such has
been working to ensure that the standards of
psychiatric training are high and continue to
improve, since our foundation in 1979. We do not
feel that radical change is necessary and are
proud of the College's record of setting standards
for training and involvement of trainees at all
levels. As far as comments about reducing the
length of postgraduate training to five or six
years, we do not find a great deal of support for
this among trainees themselves, as long as the
time is spent in useful postgraduate training and
not repeating previous experience while waiting
for an SR (or to a lesser extent registrar) post.
There is so much material in the psychiatric
curriculum that trainees feel the need to expand
the length of time spent in educational activities
during the current training period.
The future for psychiatric training is to build
on the progress made and to address the short
age of posts at SR level to allow a smoother
transition through the training grades. We do not
need radical changes, designed to address the
problems of other specialities, imposed on us
again. Trainees can be assured that the CTC will
continue to be vociferous in its support of train
ees and training standards within the College.
STEFFANDAVIES,Chair. Collegiate Trainees Com
mittee (CTC), The Royal College of Psychiatrists
Sir: I am sorry that Dr Steffan Davies, Chairman
of the Collegiate Training Committee (CTC),
should take such exception to the suggestion
that his committee should carefully consider
whether psychiatric training could be further
improved in the light of the Caiman Report
(Kisely, 1993).
I am well aware of the views of the CTC, given
that I was one of the representatives on the
committee for North Western Region until six
months ago. Unless the committee has changed
radically since, I found that many representa
tives were more open-minded about possible
changes to training following Caiman. In my
experience, trainees in general certainly are.
While training in psychiatry has many advan
tages over many other specialties, this does not
mean that there is no room for improvement.
Psychiatric trainees may wonder why training
to be a psychiatrist in the UK should take so
long; the Colleges of other medical specialities in
Britain may soon require only five to six years of
training, while the Royal Australian and New
Zealand College of Psychiatrists stipulate only
five years. Is the answer to an expanding psy
chiatric curriculum simply to increase the time
spent in education activities within the current
framework, or to critically examine the relevance
of some of the training?
KISELY.S.R. (1993) The future of psychiatric training after
the Caiman report: a trainee's perspective. Psychiatric
Bulletin. 17, 610-612.
STEVE KISELY, Northampton Health Authority,
Department of Public Health Medicine, District
Headquarters, Cltftonville Road, Northampton
NN1 5DN
CT scans in the elderly
Sir: We read with interest the article by Jon Spear
(Psychiatric Bulletin, 1993, 17, 536-537) which
compares the quality of the use of computerised
tomography (CT) scans in two psychogeriatric
services. The author does not define the term
'quality' and it is assumed that this is measured
in terms of identifying potentially treatable
structural lesions (PTLs).
If diagnosing these PTLs is the only aim, as
seems implied, then there is evidence supporting
the finding that the most useful predictor is the
presence on examination of focal neurological
signs although further clinical prediction rules
for the use of CT scans in the elderly are required
(Martin et al, 1987; Wasson et al, 1985; Deitch,
1983).
In Spears study, patients of Service X, which
only had access to CT scans through neuro-
surgical referral, suffered proportionately more
'risk factors' and had a greater rate of PTLs
diagnosed. This implies that the application of
neurosurgical criteria leads to more efficient
use of CT scans. Discovering PTLs is obviously
important but psychogeriatricians need to adopt
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