Use of the Mental State Examination by psychiatric trainees

Sir : I agree with Kareem & Ashby (Psychiatric Bulletin, March 2000, 24, 109-110) that the Mental State Examination (MSE) is fundamental to psychiatric evaluations. The result of their audit showing inadequate recording of the MSE by psychiatric trainees, although the presentation of the data begs a number of questions, is, therefore, a cause for concern.

A “standardised format” is suggested as the solution lest trainees should “employ their discretion” such that “important MSE headings and parameters are often unexamined and unrecorded”. The implication is that as long as every box on the audit sheet can be ticked then all will be well with the world. Surely the important thing is the content and quality of the MSE and that it meaningfully relates to the patient's condition at the time. Of course, the form in which this information is set out is relevant, but making an industry out of this is to miss the point. There is, excluding hair-splitting, a well-established convention for recording the MSE and a trainee forgetting to ask about abnormal perceptions (or indeed to examine the nervous system) is down to the trainee and not to the absence of a proforma.

I would also argue that it is self-evidently the responsibility of the consultant, as the educational supervisor of the trainee and the doctor in charge of the patient's care, to review the quality of information in the case notes, including admission-clerking and MSE, as well as admission and discharge summaries and clinic letters. How else is one to know what the standards, strengths and weaknesses of a trainee in these important areas are and, therefore, to be in a position to help them to address any short-comings and contribute to an improved level of clinical care ? The audit process can be useful, but is not an alternative to the fundamentals of good practice or the rigorous clinical teaching of trainees, nor should it have to be a means to this end.