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Psychiatry in the Foundation Programme: an Overview for Supervisors

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Psychiatry in the Foundation Programme: an Overview for Supervisors BJPsych Advances (2017), vol. 23, 123–130 doi: 10.1192/apt.bp.116.015909 Psychiatry in the Foundation ARTICLE Programme: an overview for supervisors† Jennifer Perry, Howard Ryland, Lesley Thoms & Ann Boyle house officer grade and the first year of the senior Jennifer Perry is an ST5 in SUMMARY house officer grade (UK Foundation Programme general adult psychiatry with the South London and Maudsley NHS Health Education England’s 2014 report Broadening Office 2015). This created an integrated 2­year the Foundation Programme has led to a rapid Foundation Trust. Howard Ryland programme, governed by a single curriculum is an ST5 in forensic psychiatry with increase in the number of psychiatry placements produced by the Academy of Medical Royal the West London Mental Health for foundation doctors. This will have implications Colleges (2016). The majority of students NHS Trust. Lesley Thoms is a for existing psychiatrists in that they will start to Clinical Fellow in Leadership and teach, train and supervise foundation doctors. completing undergraduate medical training in the Management at the Royal College This article outlines how to develop high-quality UK will enter the Foundation Programme directly of Psychiatrists. Ann Boyle is a foundation posts and how to support doctors in after leaving medical school. consultant old age psychiatrist with meeting the foundation curriculum competencies, The Foundation Programme is coordinated Leicestershire Partnership NHS Trust, Associate Postgraduate Dean which include experience of working in multi- nationally by the UK Foundation Programme of Health Education England East disciplinary teams and developing communication Office, which is commissioned by the four UK Midlands, and a Specialist Advisor skills. The knowledge and skills gained in psy- national health departments: Health Education for the Foundation Programme, Royal College of Psychiatrists. chiatry placements will be valuable to all doctors, England (HEE), NHS Education for Scotland no matter what their future career intentions. Correspondence Dr Jennifer Perry, (NES), the Northern Ireland Medical and Dental c/o BJPsych Advances, The Royal LEARNING OBJECTIVES Training Agency (NIMDTA) and the Wales College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK. Email: • Describe the recent changes to the Foundation Deanery. These four bodies are responsible for [email protected] Programme in psychiatry and how they will affect ensuring that the Foundation Programme is supervisors delivered across the UK in accordance with the Copyright and usage © The Royal College of Psychiatrists • standards set by the General Medical Council Learn how high-quality placements for foundation 2017. doctors can be developed (GMC). Foundation schools are the structures • Recognise how foundation doctors can be through which each of the education authorities † supported to achieve the generic and mental (HEE/NES/NIMDTA/Wales Deanery) delivers For a related article see pp. 131–142, this issue. health-specific competencies of the foundation foundation training. Training is provided by local curriculum in psychiatry placements education providers (LEPs) through primary, DECLARATION OF INTEREST secondary and academic placements (UK Foundation Programme Office 2016). Outside of None the UK, the Foundation Programme has been This article gives a succinct, practical and access­ BOX 1 The aims of the Foundation Programme ible overview of the changes to the Foundation Pro­ gramme. Much of the information is based on the • Build on undergraduate education by instilling Royal College of Psychiatrist’s A Guide to Psychiatry recently graduated doctors with the attributes of in the Foundation Programme for Supervisors professionalism and the primacy of patient welfare (Boyle 2015) and a BJPsych Bulletin paper entitled • Provide generic training that ensures that foundation ‘The expansion of the Foundation Programme doctors develop and demonstrate a range of essential in psychiatry’, which describes the changes and interpersonal and clinical skills for managing both acute focuses on the support being put in place by the and long-term conditions College to ensure that foundation doctors have a • Provide the opportunity to develop leadership, team good experience of psychiatry (Perry 2016). working and supervisory skills • Provide each foundation doctor with a variety of work- Introduction to the Foundation Programme place experience in order to inform their career choice The Foundation Programme (Box 1) was instituted (UK Foundation Programme Office 2016) in 2005 and brought together the pre­registration 123 Downloaded from https://www.cambridge.org/core. 29 Sep 2021 at 00:10:02, subject to the Cambridge Core terms of use. Perry et al replicated in Malta. The Maltese programme was Medical Education England and subsequently launched in 2009 and it uses the same curriculum HEE (Health Education England 2015). In and provides the same educational and training February 2014, HEE released its report entitled opportunities (Foundation Programme Malta Broadening the Foundation Programme (Health 2016). As far as we are aware, the Foundation Education England 2014). This set out radical Programme is not being used elsewhere. However, changes to the Foundation Programme (Box 2), in other countries, such as Australia and the USA, constituting a move away from the traditional graduates undertake an internship during which 6 months of medicine and 6 months of surgery that they are supervised until they gain full registration used to make up the typical pre­registration house (Wilson 2015). officer year (Bleakley 2002). Foundation training consists of a series of place­ The HEE report recommended that, by 2017, ments over 2 years in a wide variety of specialty 100% of doctors should rotate through a commu­ areas, including psychiatry. Each placement lasts nity placement in their Foundation Programme a minimum of 4 months and a maximum of 6 (all psychiatry placements are counted as commu­ months. Founda tion doctors complete a ‘Preparing nity placements). The target set by the psychiatry for Professional Practice Programme’ or shadow­ task force is that 45% of all doctors completing ing period before starting their placements (Miles the programme in England, with 22.5% in each 2015). of the 2 years, should undertake a placement in psychiatry. Recent changes to the Foundation The report specifically focused on the need Programme to achieve parity of mental and physical health. A review of the Foundation Programme in 2010 Mental illness is responsible for 23% of the burden by Professor John Collins recommended that the of disease in England, affecting one in four people placements offered should represent a wider range and costing around £105 billion each year (Davies of specialties (Collins 2010). This recommendation 2014). There is a need for this parity to be reflected helped inform a programme of work called ‘Better in the training of doctors. In 2012, figures showed Training, Better Care’, under the auspices of that psychiatry represented 6% of core training posts, and only 2% of foundation year 1 (FY1 or F1) posts. This contrasted sharply with the BOX 2 Recommendations of the Broadening the Foundation Programme situation in surgery, which in the same year had report 9% of core training posts and 37% of FY1 posts (Health Education England 2014). Recommendation 1 Recommendation 3 The report also noted that, despite initial ‘Educational supervisors should be assigned ‘a At least 80 per cent of foundation doctors negative attitudes towards placements in psychiatry to foundation doctors for at least one should undertake a community placement among many foundation doctors, these were year, so they can provide supervision for or an integrated placement from August mostly overturned by the end of the placements. the whole of Foundation Stage 1 (F1), 2015. Participants identified many positive aspects, Foundation Stage 2 (F2), or both years.’ b All foundation doctors should undertake including opportunities to learn about whole­ Recommendation 2 a community placement or an integrated person care, high­quality clinical supervision and placement from August 2017. It should be ‘Foundation doctors should not rotate the chance to develop skills in history­taking and noted that both community and integrated through a placement in the same specialty mental state examination. placements are based in a community set- or specialty grouping more than once, unless ting, and that an acute-based community- this is required to enable them to meet the facing placement is not a substitute.’ What does this mean for psychiatrists? outcomes set out in the Curriculum. Any placements repeated in F2 must include Clarification The principal implication of these changes for opportunities to learn outside the traditional Psychiatry posts in mental health hospitals the medical workforce in psychiatry is a large hospital setting.’ that are not on the site of an acute hospital and rapid increase in the number of foundation placements in psychiatry. Many more consultants Clarification will be counted as being community posts. Psychiatry posts located within acute will become supervisors of foundation doctors. Where the experience will be significantly hospitals where the trainee will have the different between the posts, then two Other non­consultant grade psychiatrists will opportunity to look after patients with posts within a specialty grouping are encounter foundation doctors in their teams and
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