Communication is Key

Amidst the upcoming RANZCP elections and the ongoing stalemate between NSW public sector psychiatrists and the NSW government, it is important to remember that some of those with the burden of continuing to provide a psychiatry workforce are sitting their essay examinations tomorrow.

I’ve written and advocated extensively about the CEQ essay exam being a inappropriate way to examine our future psychiatrists and that the only way we can put them through their paces to ensure exemplary standards is to offer clinical exams again.

In August 2024 we saw very poor pass rates for both the CEQ and MEQ essay exam, and six months later, some of those who were unsuccessful will be attempting this exam again.

Since August 2024, so much has changed in the lives of some of those sitting, especially if they have been trying to work and study in NSW.

Despite real concerns for their wellbeing and safety as a result of many having no direct clinical supervision due to the mass resignation of psychiatrists, these trainees have been left in their posts with no clear direction. They have had to juggle their study commitments as well as act up in many cases to shoulder the burden of a diminished workforce left by the psychiatrists who are striking for pay parity.

Last week, they received an email from the RANZCP to inform them that the College was considering the future of the CEQ essay exam and as such there will be no discrimination for candidates who fail this time — this attempt won’t count against the number of unsuccessful attempts that triggers a performance review.

The concern was the communication in both the timing and the content. An email a week before an exam offering refunds, and preventing trainees from applying if they consider this might be a good time to attempt the exam, given the “no discrimination”. An examination which had a pass rate in the 60’s in 2024, costing $1200 to sit each time, and a hurdle for some trainees trying to get to consultant level.

An examination which has been notoriously more difficult for IMG’s to pass, and focused on the ability to write an essay based on a quote from a source such as a poem or a journal article.

However, the lack of communication following the release of this email last Tuesday has made everything worse — people who know people have told me that it is likely this round will signal the demise of the CEQ essay exam but nobody knows what will take its place. There is no clarity about whether passing this round of the CEQ exam will mean that the candidates won’t have to do whatever is replacing it, or what candidates will do if they are unsuccessful this time.

And it is not just the trainees that are suffering as a result of this. Many posts are waiting to be filled by new consultants, some of who just need to clear one more requirement, such as this CEQ exam. I know because I have been working closely with a candidate for the past 3 months, preparing her to pass this last hurdle on her 4th attempt, so she can finally work as a child and adolescent psychiatrist.

It is really hard not to notice the irony here, that RANZCP exam candidates are being assessed on their written communication skills tomorrow, when a piece of written communication they received last week has left them completely confused and misinformed.

All of this is happening at a time when psychiatry definitely needs a massive branding makeover. I am feeling it, as many of us are. We have been run down as a profession in the media, largely replaceable by other clinicians making up the mental health workforce, and it seems to be working. According to any communication from the NSW Government, despite huge “challenges”, the system is still operating with a few workarounds. The general public perception is that the public sector psychiatrists are striking about money and not to highlight the conditions they operate in. By all accounts, this is a pay dispute, and that is evidenced by the fact that the next hearing at the Industrial Relations Commission is about whether they should get their 25% pay rise. I haven’t heard about any other inquiries or investigations into working conditions, or investigations into the state of the public health system as a whole.

Overall, it is not a great time to be a psychiatrist, although I am very proud that I am one, and I know many of my colleagues are as well. Lack of communication is fueling the despondency, well it is for me anyway. More than ever we need strong leadership, not just in NSW but across Australia and New Zealand, and with the elections for President-Elect currently underway, communication about planned next steps would be timely and crucial, to stave off further damage to our reputation and our integrity. And as a voice for trainees who can’t communicate their grievances or concerns, I say let’s do better and be better for their sake.