For almost an hour Marie Bismark sat at her computer, refreshing the screen, waiting to complete the final exam to become a registered psychiatrist after six years of study.
But the online link didn't work.
"It's like running a marathon and you're absolutely exhausted and you get to the end of the marathon and it's like somebody says, 'Just joking the marathon isn't over yet. You've got to keep running,'" Professor Bismark said.
The link had been set up by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) for hundreds of trainees sitting its November clinical exams.
"There were over 200 psychiatry trainees absolutely devastated," she said.
"We had given everything to our clinical work, our families, caring for people during the pandemic, studying for this exam. And then because the college hadn't been able to organise functioning Zoom breakout rooms we were unable to sit the exam."
For the past year, the public health physician and lawyer had been working at the Royal Melbourne Hospital, across COVID-19, trauma and intensive care wards and the emergency department.
A mother of a year 12 student, she had also been helping with remote learning. But despite that, the 48-year-old had dedicated six months to preparing for what was the culmination of years of studying.
"Every evening after work, every weekend we studied for these exams. You really organise your life around these exams," Professor Bismark said.
"I was devastated. I just wanted the exam to be over. I wanted to be able to progress with my training.
She's yet to hear from the college about whether she will be able to re-enrol for an alternative assessment in March.
"There are no clear external appeal processes," she said.
"You really don't know where to go, and so many trainees are scared to speak out … people really worry there will be retribution if they speak out.
"It feels to me as though the college has let down the trainees and, more importantly, the college has let down the communities that we want to serve."
Online problems cause 'bottleneck' for trainee psychiatrists
"It was a foreseeable failure," said Benjamin Veness, advocacy officer at the Victorian Association of Psychiatry Trainees.
"There wasn't enough effort put into contingency planning to make sure an online exam would actually work with the number of candidates who were trying to sit it.
"Unfortunately that means many, many candidates who are having to wait in limbo. Some of them were hoping to complete their training already, which means there are potentially fewer psychiatrists graduating now to be able to serve Australians."
Dr Veness said the pandemic had tested all medical colleges.
"All of the specialist medical colleges are essentially self-regulated," he said.
"They have the ability to set their own examinations and processes.
"That might work in pre-pandemic times, but the pandemic has really tested them and unfortunately several of them have come up short.
"There really needs to be a prompt adaptation to 21st-century methods of examination and assessment."
He is calling on the RANZCP to explain what its contingency plans are for the next exams — and he wants the Australian Medical Council to step in.
"When trainees have attempted to offer feedback, largely they feel that has been ignored," Dr Veness said.
"Part of the problem is that most of the specialist medical colleges are operating as monopolies.
"Trainees don't have a choice in where they train and therefore there's really not much imperative for the colleges to improve.
"At the end of the day, the Australian public needs fully qualified psychiatrists."
RANZCP cancels further virtual exams
The RANZCP has confirmed it will not hold any further virtual clinical exams this year.
RANZCP president Vinay Lakra said the college had come up with an alternate program in which previous clinical work was assessed instead, with 96 of the 197 people enrolled in the program having since passed.
"We're very, very sorry for the exam cancellation. We've reached out to all trainees," Dr Lakra said.
"We're continuing to engage in a dialogue with the Australian Medical Council on going forward what needs to happen."
A spokesperson for the Australian Medical Council said it was monitoring the development of the assessments closely, and had a scheduled re-accreditation assessment of the college later this year.
Mental health system struggling under overwhelming demand
Patrick McGorry, the executive director of youth mental health group Orygen, said COVID-19 had caused a 25 per cent rise in the need for care, putting more pressure on an already struggling system.
"At the moment that's a big problem and even workforces that we already have like trainee psychiatrists are really struggling because of the challenges in supporting their training and graduation," Professor McGorry said.
Professor McGorry said it was estimated 1 million Australians were currently without appropriate help — those whose health was too complex for general practice but not severe enough for emergency care.
"There are very few options for people seeking mental health care at the moment, with private practitioners basically closing their books, with Headspace with long waiting lists, and with public mental health services trying to rebuild but trying to rebuild under very adverse conditions," he said.
"Mental health reform and investment must be a number one priority in the forthcoming federal election and beyond as part of the recovery from COVID."
