My jokey title, like most jokes, incorporates a serious truth. The truth is that, despite the apparent clinical expansion and academic wellbeing of our subject, the experience of being in a senior position within it is that it is under threat as a medical enterprise. The sense of threat is felt mostly from the stagnation of the retrenchment in the physical and human resources needed to mount a real service, although I grant that consultant numbers have increased. Management will opt for the least costly alternative when they are presented with a broad range of advice of apparently equivalent worth which is available from various professionals within the subject. Indeed, given the degrees of diversity of views that exist, managers might at times wonder what it is that purports to be the subject. It is not difficult for child psychiatry to achieve a negative image within health management since a number of negative stereotypes naturally accrete around people with serious problems of living and coping, or developmental failure, mental impairment, or chronic sickness. Combined with small size, often a single representative in a District, and dealing with small people who suffer lack of political clout, the management case for neglect of child psychiatry when faced by harsh choices may be overwhelming. Further, child psychiatry arose from a triune of social work, psychology and psychiatry and their quite proper individual professionalisation has afforded the possibility of splitting, not only as among psychiatrists but between psychiatrists and other professionals. In the current political climate and faced with resource shortages those splits are likely to accentuate in ways which leave managers rather than practitioners in control.

Families who have a child with a life-threatening disease need support during the illness and in the bereavement phase. Although few would disagree, the means to provide such a network is not easy. During 10 years working in an oncology clinic, I have become aware of the importance of close liaison links within the clinic itself and in the community. By the nature of life-threatening and terminal illness, staff members need opportunities to discuss their feelings towards their patients if such extremes as patient avoidance or identification are to be prevented. Once a close team spirit exists, the likelihood of an individual becoming over-stressed diminishes. Although all team personnel are potentially at risk, I would suggest that those at greatest risk are at opposite ends of the hierarchy, i.e. the consultant constantly faced with challenging medical decisions and involvement with emotionally drained parents and the junior nurses, seen as ‘safe’ people on whom to unburden. The latter spend more time with the families and have no legitimate mode of escape!

Child psychiatrists-in-training must become conversant with a range of inter-personal skills—psychotherapy, family therapy, management, consultation—in addition to their traditional expertise of assessment, differential diagnosis and psychiatric treatments in different settings. In the Riverside training scheme we have introduced a Consultation Workshop to help trainees learn this essential art, for although it is said to be practised widely it has seldom been taught systematically. This is a report from the first 18 months of the Workshop's studies.

In October 1987, the new Part I of the MRCPsych examination was introduced. One aim of the College in changing the Preliminary Test, which had been introduced in 1971, was to create a more appropriate screening procedure so that those who are unsuited to psychiatry can receive career advice at an early stage in their career. To this end there has been a shift in emphasis away from the basic sciences towards clinical psychiatry. The major change in format of the examination is the removal of the essay paper and the introduction of a clinical examination. In order to qualify to enter for the new Part I examination, candidates have to submit sponsor forms signed by a consultant for whom they have worked and by their clinical tutor. The sponsors are asked to certify that the candidate has been able to attend an appropriate course of instruction and has received training in interview skills.

In Autumn 1987 the new Part I Membership examination was held for the first time. The format was changed in response to the Royal College of Psychiatrists Working Party, who recommended that it should become an examination in basic clinical psychiatry. It was felt to be important that clinical skills were assessed early in training.

The clinical examination is an artificial but unbettered assessment of the candidate's ability to assess a patient humanely, produce a formulation and treatment plan and speak knowledgeably on random aspects of psychiatry. It is the most important single part of the Part II examination and it must be passed. The emphasis is on general psychiatry. The new MRCPsych Part I also has a clinical component and the same administrative principles apply.

Several authors have written articles giving advice from the examiners' standpoint regarding the Membership examination in psychiatry but surprisingly little has been written by those with recent first-hand knowledge of the examination. Having failed the examination on my first attempt due to poor technique, I feel other candidates should be made aware of some possible pitfalls which they may encounter. Examinations, unfortunately, do not always necessarily examine that which they purport to examine. I also feel that some useful tips, which may make the examinee's task an easier one, should be passed on.

The Joint Committee on Higher Psychiatric Training (JCHPT) requires senior registrars (SRs) training for special responsibility posts in old age psychiatry to spend between one year and 18 months in higher training posts in which psychiatry of old age forms the major part of the work. Although only about a third of consultants in a recent survey had such training, there was strong evidence that more recently appointed consultants were likely to have recommended training. The availability of suitable training ‘slots’ seems likely to play a major role in how quickly specialised psychiatric services for old people can develop in response to the rising challenge posed by demographic changes. Jolley has already demonstrated how developments have been delayed by a shortage of properly trained candidates. Despite this the situation has now been reached where over two-thirds of the elderly population of the UK are served by specialised consultants albeit sometimes at inadequate manpower levels.

Recent attention has been focused on divergent practices in the implementation of Section 136, problems in its practice encountered by the police, and possible means of improving the service and reducing unnecessary detention. In these studies, doubts have been raised about the justness of the section, both in principle and in practice, and about the efficiency and efficacy of its implementation. In the context of the closure of the large psychiatric institutions it seems probable that these issues will become increasingly acute. The purpose of our brief study was therefore to investigate the trends of admissions to Friern Hospital, not only of patients under Section 136, but of all patients accompanied by the police.