The similarities between the Asian and white adolescents suggest that some common aetiological factors may be at play. The risk factors may be related to gender rather than ethnicity in this age group.

Complaints of delays at out-patient clinics are common; a Newham patient's complaint that she had not been kept waiting long enough was correspondingly puzzling but has subsequently proved very fruitful. Her explanation that discussions with other waiting patients and the OPD nurse were often more helpful than the interview with the doctor triggered the development of a clinic designed for fuller participation of patients and staff.

Training the Trainers of Tomorrow Today (T4) is a new way to deliver “Training for Trainers”. Responding to local dissatisfaction with existing arrangements, T4 builds on 3 essential requirements for a future shape of training:1. Clinical Leadership and a Collaborative Approach2. Cross-Specialty Design and Participation3. Local Delivery and Governance NetworksDesign principles also included: 3 levels of training to reflect differing needs of clinical supervisors, educational supervisors and medical education leader, mapping to GMC requirements and the London Deanery's Professional Development Framework; alignment of service, educational theory and research; recognition of challenges in delivering and ensuring attendance in busy acute and mental health settings, and the development of a faculty network.The delivery plan took into account census of professional development uptake and GMC Trainee Surveys. Strong engagement and uptake from the 11 Trusts in NW London has been achieved, with powerful penetration into all specialties. Attendance has exceeded expectations. Against an initial 12 month target of 350 attendances, 693 were achieved in the first 8 months.Evaluation of content demonstrates modules are pitched appropriately to attendees needs, with positive feedback from trainers new to the role. Delivery style has attracted high ratings of satisfaction: 87% attendees rating delivery as “good\excellent”. External evaluation of impact demonstrated improved training experiences through changes in supervision, the learning environment and understanding of learning styles.We have addressed sustainability of the programme by advertising and recruiting Local Faculty Development Trainers. Volunteer consultants and higher trainees are trained to deliver the programme on a cascade model, supported by the Specialty Tutors, individual coaching and educational bursaries. The Trainers are local champions for excellence in training, provide a communication between the programme and local providers, are a repository of expertise in their service, and trouble shoot local barriers to engagement.

The aim of this paper is to continue a dialogue regarding the possible future use of log-books during training. The Royal College of Psychiatrists has been considering their use at various stages of training in psychiatry. Cole & Scott (1991) rejected log-books as a tool for self-audit during registrar training because they were often not kept up to date. The situation in higher professional training is more complex; there is not the clear focus of studying for the Membership examination and there are many more training components to cover during a four year period. Thus, we feel that a system for self-audit and monitoring could well prove valuable at the senior registrar level. There is a tension for senior registrars with whom we discussed this issue at the last Annual Meeting of the Section and among colleagues on our rotation.