Recent developments in postgraduate medical education for the training of junior doctors in the UK necessitate changes in all parts of the curriculum, including the assessment system. There is a move away from the limited, traditional one-off assessment towards multidimensional, broader assessments of a doctor's longer-term performance. This is accompanied by the rapid development of assessment tools, collectively termed workplace-based assessments, and is in keeping with an outcome-based approach to medical education and its increasing professionalisation. In addition to clinical skills, other aspects of being a good practitioner are being assessed, including team-working, working with colleagues and patients, probity and communication skills. Using a combination of tools gives the assessment process high validity. Of the many challenges posed by these changes is the need for data on their reliability in psychiatry. There must be a clear process for applying assessments, national standardisation and training for those using asessment tools.

In the most radical (and politically driven) changes to the National Health Service since it was founded, the training and assessment of doctors will focus more on what they do than on what they know. The UK's lack of tools to assess doctors' performance in the workplace has caused the Postgraduate Medical Education and Training Board to turn to US workplace assessement tools developed for medical practice. These have not been designed or evaluated for application to psychiatric practice, nor do they allow for independent evaluation. It remains unclear how workplace assessment in psychiatric training will tie in with national examinations such as the Royal College of Psychiatrists' membership examination (the MRCPsych); nor is it clear whether service users are yet to have a say in such an important matter as the training of their doctors.

Teaching methods to help students appreciate the value of psychodynamic formulation and to become more skilled in producing formulations are described. These are closely related to the four levels of our model formulation, each level corresponding to a set of competencies through which students should normally progress. Accurate diagnosis of a student's current capabilities and needs is crucial to effective teaching. Teaching methods at each level are illustrated through detailed reference to a case example. The usefulness of small-group discussion for assimilating clinical material within a clear framework is emphasised throughout.

Cardiac safety of antipsychotic drugs continues to be a concern for both typical and atypical antipsychotics. Risk appears greatest in those with pre-existing cardiac disease but many patients may have occult cardiovascular disease. In addition, several drugs appear to increase the likelihood of diabetes and weight gain, which may have an additive adverse effect. On the basis of risk of sudden cardiac death and risk of QTc prolongation we suggest considering antipsychotics in two categories – higher and lower risk. Of most concern is the use of large cumulative doses of antipsychotics that are sometimes given inadvertently by different prescribers. Clinicians need to be aware how to read an ECG, and how to monitor physical parameters and interpret the significance of QTc prolongation in relation to antipsychotic prescribing. We suggest provisional guidance on antipsychotic monitoring in relation to cardiac safety but acknowledge that future studies will help clarify which antipsychotic drugs and which concomitant risk factors are most important for those with and without established cardiac disease.

Recent work suggests that a broad clinical spectrum of bipolar disorder is more common than previously thought and that the disorder may affect up to 5% of the population. The correct definition and diagnosis of hypomania is central to the identification of bipolar disorder. In this review we focus on recent diagnostic and clinical advances relating to bipolar disorder, with particular reference to hypomanic states. We also highlight some of the controversies in this field and discuss ways in which clinicians might improve their detection of bipolar disorders.

The non-motor symptoms of Parkinson's disease, which include cognitive, behavioural and psychological problems, are significant not just in epidemiological terms but also in their impact on patients and carers. Each symptom requires careful evaluation, owing to the potential overlap with comorbid conditions and also to the multiple aetiological pathways in Parkinson's disease. Such monitoring allows enhanced management. However, the diagnostic difficulties arising from these non-motor symptoms require further research. Here we describe the efficacy and some of the problems of medication used for non-motor symptoms, including antiparkinsonian medication, antipsychotics and acetylcholinesterase inhibitors.

Children and adolescents with learning disabilities have high rates of mental health problems and behavioural difficulties. Comorbid disorders such as epilepsy, autism and attention-deficit hyperactivity disorder are common. Despite this, many areas in the UK are failing to provide a psychiatric service for these young people and their families. The children suffer as a result and may have to move away from home unnecessarily, at enormous emotional and financial cost. Each area should have a specialised multidisciplinary health team working closely with colleagues from education and social services to assist these complex children and give them the best chance to fulfil their potential.

Psychiatric services for children and adolescents with learning disabilities have been subject to fashion and aspiration rather than pragmatic planning, at different times being claimed by different specialties. As services have atrophied, it has become clear how distinct are the clinical issues that arise in this group; issues that show developmental psychiatry at its starkest with a combination of organic, dynamic and systemic factors that require community teamwork. As services and specialties regroup, this evolving area is likely to continue defining itself, perhaps taking in adults with developmental disorders, to emerge as a new specialty, developmental psychiatry. It remains to be seen where this will sit within the health service.

The quality, completeness and coverage of ethnicity data in mental health services has long been regarded as unsatisfactory. The Department of Health's new 5-year action plan for delivering race equality in mental healthcare seeks to improve this key building block by setting out actions to improve both the quality of information and its analysis and dissemination. However, those that are tangible and specific are few: annual surveys of service users, national censuses of mental health in-patients and tables of National Confidential Inquiry suicide cases and in-patient deaths by ethnicity. The opportunity to seek improvements in the quality and coverage of key routine data-sets such as ethnic monitoring in primary care and the Hospital Episode Statistics database has not been seized. Moreover, the plan does not mention proposed changes in civil registration (births and deaths) and the coroner service and their potential benefit. The continuing gaps in the information base justify a stronger emphasis on the processes necessary to bring about change rather than on what ethnic monitoring should provide.

Conversion disorders tend to be poorly understood and diagnosis can be difficult. In this article, we aim to clarify what conversion disorders are and how they can be distinguished from other psychiatric disorders that involve physical symptoms. Prevalence, prognosis and relationship to organic disease are controversial areas; we outline what is known about them and provide some historical context. Aetiological theories and management strategies are discussed, the latter with the aid of case vignettes.