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 2-year 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 pre-registration

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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 pre-registration 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. Founda­tion 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, high-quality clinical supervision and placement from August 2017. It should be ‘Foundation doctors should not rotate the chance to develop skills in history-taking 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 non-consultant grade psychiatrists will opportunity to look after patients with posts within a specialty grouping are encounter foundation doctors in their teams and long-term psychiatric conditions and/or work permitted – for example, acute internal many will also be involved in their training. Many with community services/MDTs will also medicine (admitting) posts and general psychiatrists will not have had experience of working be counted as community posts. Liaison medicine (ward-based) posts. In such with foundation doctors before. Psychiatrists are psychiatry would fall under this definition circumstances, the subspecialties should used to providing core and specialist training; with not be the same. (Health Education England 2014: p. 9) foundation doctors they will need to provide more generalist training which meets the requirements

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of the Foundation Programme curriculum. A key All trainees play a key role in the delivery of aim of the Foundation Programme in psychiatry National Health Service (NHS) care and it is is that doctors will be able to develop generic, important that foundation doctors ‘learn by doing’, transferrable skills that will be useful in their as they will learn more effectively when they are future careers, regardless of the specialty. responsible for their actions (Swanwick 2014). FY1 doctors are new medical graduates and will What do psychiatrists need to know about be inexperienced compared with core psychiatry foundation doctors? trainees. Therefore they need to be well supervised What is the difference between foundation year 1 to allow them to develop as doctors while ensuring (FY1) and foundation year 2 (FY2)? patient safety. Foundation year 1 enables medical graduates to What are the boundaries of responsibility for begin to take supervised responsibility for patient foundation doctors? care and consolidate the skills they have learned Although technically FY1 doctors can prescribe at medical school. Satisfactory completion of FY1 anywhere, including in the community, the Royal allows the relevant university (or their designated College of Psychiatrists recommends that those in representative in a foundation school) to psychiatry placements should only prescribe in an recommend to the GMC that the foundation doctor in-patient setting. However, local exceptions to can be granted full registration (GMC 2015). It is this may occur if adequate safeguards are in place worth noting that this may change in the future, (Boyle 2015). Although FY1 doctors may work as the ‘Shape of Training’ review led by Professor out of hours, they should not be assigned to work David Greenaway (Shape of Training 2013) has on the same rotas as core trainees, and special recommended that full registration should move arrangements should be made to ensure that to the point of graduation from medical school. they are adequately supported and supervised. When they first start, most FY1 doctors will be In practice, this means that there must be a very inexperienced and will require a substantial senior colleague on site. This colleague could be amount of support from their supervisors and the a senior nurse, as long as they have the necessary wider multidisciplinary team (MDT). This will knowledge and skills to advise the foundation change as the year goes on and they move into doctor appropriately (Boyle 2015). FY2, as they will start to develop skills, knowledge and confidence in their clinical work. FY2 doctors How can supervisors ensure that their remain under clinical supervision, but take on increasing responsibility for patient care. They posts are of high quality? begin to make management decisions, develop High -quality training in new and existing their core generic skills and contribute more to foundation posts requires careful planning and the education/training of the wider healthcare execution in order to maintain patient safety, workforce. At the end of FY2, doctors should inspire trainees and preserve enthusiasm (Royal have started to demonstrate clinical effectiveness, College of Psychiatrists 2016). There are many leadership and decision-making responsibilities ways in which psychiatrists can develop high- (Goodyear 2014). Satisfactory completion of FY2 quality placements for foundation doctors. will lead to the award of a Foundation Programme Examples are detailed below. Certificate of Completion (FPCC), which indicates that the foundation doctor is ready to enter a core, Shadowing and induction specialty or general practice training programme Before beginning their first placement, FY1 doctors (UK Foundation Programme Office 2016). should undertake a shadowing period of at least 4 days’ duration (which includes induction) overseen What is the difference between foundation by their clinical supervisor (UK Foundation training and psychiatric specialty training? Programme Office 2016). It is important to remember that foundation All new foundation doctors should normally doctors are not learning to be psychiatrists, unlike have sat a Prescribing Safety Assessment (PSA) core and specialty psychiatry trainees. The aim before commencing the programme. UK medical of the programme is to give foundation doctors students should have been given the opportunity a meaningful experience of psychiatry and to to sit the PSA during their degree course. allow them to achieve the Foundation Programme Appointees from non-UK medical schools will be competencies. However, if foundation doctors have offered the opportunity to sit the PSA before or an interest in psychiatry, they can be supported in during their shadowing period where possible. accessing additional learning opportunities. Foundation doctors who have not passed the PSA

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before starting the programme are offered support Teaching and are required to sit/re-sit the assessment. All Supervisors should consider the specific learning foundation doctors are required to pass the PSA needs of foundation doctors and try to align within the 2 years immediately preceding the date teaching opportunities with their curriculum. All on which they are signed off as having completed foundation doctors are required to attend their their FY1 year (UK Foundation Programme mandatory foundation teaching programme; this Office 2016). usually takes place at the acute trust and forms Foundation doctors should have an induction part of doctors’ Annual Review of Competence from their foundation school and their employer/ Progression (ARCP) requirement. local education provider. To ensure patient safety, Supervisors may also consider supporting all rotations should also initiate foundation doctors foundation doctors to attend local educational through a formal induction to the department and activities for psychiatry trainees, such as journal place of work. clubs, case conferences or MRCPsych teaching Consultants should discuss the level of training sessions. For example, a foundation doctor could and competency of the new incoming doctor with be supported to attend a teaching session on members of the MDT, managing expectations ‘assessing capacity’, as this is in their curriculum. and clarifying the duties and responsibilities of Local education providers and foundation foundation doctors. Team members should be schools may also consider developing a teaching told explicitly what is and what is not expected programme specifically for foundation doctors. of a founda­tion doctor: for example, FY1 doctors should not undertake unsupervised section 136 Supervision Mental Health Act assessments and they do not Each foundation doctor will have a preassigned have powers of detention. educational supervisor for the year and will have one Supervisors should organise a workplace clinical supervisor for each placement. Foundation induction process and timetable which ensures doctors should aim to meet with each supervisor at that the foundation doctor is introduced to all team the beginning and end of each rotation. In addition, members and is familiarised with the working clinical supervisors in psychiatry rotations are environment (and health and safety procedures). expected to deliver weekly 1-hour face-to-face The supervisor should give the foundation doctor supervision. Part of the supervision process should an overview of key issues in psychiatry such as the involve a review of the foundation doctor’s progress Mental Health Act, the Mental Capacity Act, and and a review of which competencies they have met risk and safeguarding, which can be expanded on from the curriculum. From the outset, clinical in supervision sessions. supervisors should agree with the foundation doctor The MDT should be involved in the foundation the times of these meetings and the consultant or doctor’s induction and placement. Members of the higher trainee who will conduct the meetings in the team will be able to support the doctor’s training, clinical supervisor’s absence. This is particularly for example through conducting joint assess­ important in the first year of the Foundation Pro­ ments with the doctor, undertaking supervised gramme, as it helps to support doctors in the often learning events (SLEs) and giving feedback on difficult student-to-doctor transition (Steele 2013). their progress. Supervised learning events (SLEs) and assessments Supervised learning events (SLEs) Foundation doctors have to complete a number of Directly observed interactions • Mini-clinical evaluation exercises (mini-CEXs): a mini-CEX is an SLEs and obtain various other assessments for a observed clinical encounter, e.g. observing the doctor taking a successful ARCP. SLEs are formative workplace- patient history • Direct observation of procedural skills (DOPS): the primary aim of a based assessments that involve an interaction DOPS is to give feedback on the doctor’s interaction with a patient between the trainer and the foundation doctor, while performing a procedure, e.g. an ECG or taking bloods; the secondary aim is to demonstrate the progression of procedural leading to immediate qualitative feedback and skills reflective learning. They replaced workplace- based assessments (WBPAs) in the Foundation Case-based discussions (CBDs) • A CBD is a structured discussion of a clinical case managed by the doctor; it has a focus on clinical reasoning Programme from 2012. SLEs may appear superficially similar to WBPAs, but they Developing the clinical teacher • This tool aims to assess and develop the doctor’s teaching and presentation skills by observing a teaching session represent a desire to make the process more formative, although this shift was not universally FIG 1 The components of supervised learning events (SLEs) for foundation doctors in foundation well understood (Rees 2014). SLEs have three years 1 and 2 (Academy of Medical Royal Colleges 2016). components, which are outlined in Fig. 1:

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•• directly observed interactions Additional assessments, reports and evidence required for the ARCP •• case -based discussions (CBDs) •• developing the clinical teacher. Team assessment of behaviour (TAB) • A multisource feedback tool completed by a mix of appraisers recruited by the foundation doctor The additional assessments, reports and Reports • Clinical supervisor’s end of placement report: evidence that foundation doctors must obtain for  one per placement the ARCP are shown in Fig. 2. In brief, they are: • Educational supervisor’s reports:  at the end of the placement •• a team assessment of behaviour (TAB)  at the end of the year •• endf -o -placement and end-of-year reports Core procedures • E-portfolio evidence of satisfactory performance of core •• evidence of performance of core procedures. procedures (e.g. venepuncture, cannulation):­ FY1 only All SLEs and assessments are designed to monitor foundation doctors’ progress and provide FIG 2 The additional formal assessments and evidence required for successful completion of a platform for further development. They are all the Annual Review of Competence Progression (ARCP) for foundation doctors (Academy completed in the electronic portfolio (e-portfolio), of Medical Royal Colleges 2016). where further information about each SLE and assessment can be located. It is advised that MDT working. Care programme approach (CPA) consultant supervisors become familiar with the meetings are a gold standard of multiprofessional e-portfolio system in order to provide optimum working in mental healthcare, so supervisors support to their trainees. Completion of SLEs should encourage foundation doctors to attend should be consultant-led where possible and should them. Supervisors can organise for foundation be undertaken early in the placement, when the doctors to undertake joint assessments with other doctor has the most to learn (Academy of Medical MDT members to give them an appreciation of Royal Colleges 2016). the broad range of professions involved and the skills they bring to mental healthcare. Supervisors Tasters should support their foundation doctors to attend clinical team meetings and encourage them to Clinical exposure can be further complemented by contribute. These opportunities for MDT working taster days organised locally by supervisors. The should allow other team members to make reliable Royal College of Psychiatrists suggests that posts judgements about the foundation doctor’s ability should be developed to include five taster days in and performance. This feedback can be used in other subspecialty areas of psychiatry (Boyle 2015). their appraisal. These days are provided through study leave for FY2s, but the opportunity for FY1s to undertake Communication skills taster days will depend on local arrangements. Clinical supervisors can maintain quality through Supervisors should develop posts that allow founda­ the bespoke design of taster days, focusing on the tion doctors to acquire and develop communication two main objectives: namely, informing career skills. This could be done by enabling foundation intentions, within and outside psychiatry, and doctors to work with patients, their families and fitting with the foundation doctor’s interests (UK other professionals in both straightforward and Foundation Programme Office 2011). Examples of more complex situations. It might involve the suitable tasters might include child and adolescent foundation doctor explaining a treatment plan mental health services for a doctor who is interested to a patient with chronic schizophrenia and an in paediatrics as a career, or neuropsychiatry for a intellectual disability in a way that the patient can doctor who is interested in neurology. understand. It might involve breaking bad news, In the next section we will focus on how foundation such as a new diagnosis of dementia, to a patient placements in psychiatry can offer doctors the and their family in a sensitive and supportive opportunity to develop both generic and mental- manner. It is vital that foundation doctors are able health specific skills. These opportunities will also to communicate empathically in this post-Francis help to ensure that posts are of high quality. era (Francis 2013).

Supporting foundation doctors in achieving Reflective ability the generic and specific mental health The Foundation Programme curriculum encour­ competencies of the curriculum ages doctors to reflect on, and learn from, both their positive and negative experiences in order MDT working to demonstrate clinical development (Academy All supervisors should aspire to give their of Medical Royal Colleges 2016). Supervisors foundation doctors a high-quality experience of can support the development of reflective ability

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through the 1-hour face-to-face weekly supervision. doctor could undertake a case-based discussion of If there is the opportunity, supervisors should a patient with chronic schizophrenia and diabetes encourage their doctors to attend a specific Balint who experienced trauma in childhood. group for foundation doctors. Balint groups Opportunities to have experience of holistic enable doctors to gain experience of reflection, care in both acute presentations and in long-term listening and supporting others in the group, as conditions are likely to be widely available in all well as developing a deeper understanding of their psychiatry placements. patients (Salinsky 2015). Teaching and quality improvement Interface with different specialties and with other Supervisors must ensure that foundation doctors professionals have protected time to engage in audit and quality In mental health settings, the supervisor can improvement work (Cai 2009). It is recommended sign­post the foundation doctor to cases that will that half a day per week is embedded in all allow them to experience working across health foundation psychiatry placement timetables to and social care boundaries (Duncan 2015). For support this activity (Boyle 2015). example, a foundation doctor could observe a core Supervisors and other team members should trainee assess a patient on a psychiatric ward who seek out opportunities for foundation doctors to has a medical problem that requires discussion teach others. For foundation doctors in psychiatry with the on-call medical registrar and transfer to this could include teaching topics that align with the accident and emergency (A & E) department. their curriculum to medical students who are on This would allow the doctor to develop an psychiatry rotations, or teaching a medical topic understanding of working across mental health to the MDT. It may be helpful for the foundation and acute trusts. Another example might be doctor to do this in conjunction with a senior inviting a social worker to attend a ward round colleague who can provide supervision and for a patient about whom there are safeguarding feedback. This could also be done as an SLE concerns. This would allow the foundation doctor (developing the clinical teacher). to understand more about working across mental health and social care boundaries. Recognition and management of the acutely ill patient History-taking, mental state examination and Foundation doctors should be supported by their core medical skills supervisors to gain experience of recognising and The supervisor should ensure that the foundation managing patients who are acutely unwell and doctor has the opportunity to develop skills in those who have self-harmed. Supervisors could history-taking and mental state examination organise for foundation doctors to conduct home through teaching, practical experience and visits, undertake a taster in liaison psychiatry reflection (through SLEs and supervision). or observe a Mental Health Act assessment. Supervisors and other team members should This would enable foundation doctors to gain signpost foundation doctors to opportunities to experience of conducting risk assessments and acquire core medical skills within their day-to- considering underlying causes of severe mental day clinical work (e.g. physical health assessments disturbance, such as acute confusional states, of new admissions in an in-patient setting). Local psychosis and substance use/withdrawal. providers may like to consider developing posts that have timetabled sessions in an acute medical Medicolegal issues setting (e.g. 1 day a week on-call in a co-located Supervisors should help their foundation doctors acute trust). to acquire knowledge of medicolegal and ethical issues in healthcare. This could be, for example, Management of patients with long-term through the supervisor’s own teaching or through conditions a larger programme, such as MRCPsych teaching. The Foundation Programme curriculum outlines Teams should ensure that foundation doctors how doctors should gain experience of managing are able to gain an understanding of the Mental patients with long-term conditions (Academy of Capacity Act and experience of using it, for example Medical Royal Colleges 2016). In mental health through observing/participating in the assessment settings, the supervisor should highlight, through of whether a patient has capacity to consent to teaching and supervision, the interplay between treatment on an in-patient ward (Nicholson 2008). long-term physical illness, psychological factors Supervisors must ensure that they provide and mental disorders. For example, the foundation specific teaching and supervision concerning

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the powers of detention for FY2 doctors who are BOX 3 Foundation competencies that can be on call out of hours and are deputising for the acquired in psychiatric settings responsible clinician under the Mental Health Act.

• Team-working within a multidisciplinary team Learning opportunities • Communication skills Foundation doctors must be afforded equitable • Reflective ability access to learning opportunities in the psychiatry • Interfacing with different specialties and with other placement. It is a risk that the most routine service professionals delivery tasks such as ‘scribing’ in medical records • History-taking, mental state examination and core during ward rounds are regularly delegated to the medical skills foundation doctor by the more senior specialty trainees. Another risk is that the foundation • Management of patients with long-term conditions doctor may be forced to shadow more experienced • Teaching and quality improvement clinicians for the duration of their placement. • Recognition and management of the acutely ill patient

Teams will need to identify and support a range of • Knowledge of medicolegal issues experiential learning opportunities for the post to allow the foundation doctor to grow in confidence and to safely support their wider professional development as a doctor. developed to allow doctors to develop their team- working and communication skills and to gain Experience beyond the curriculum experience of navigating the boundaries of health and social care. Some foundation doctors will wish to acquire Throughout their careers all doctors will come competencies beyond the Foundation Programme into contact with patients suffering from mental over the course of their placement. They may illness. It is important therefore that they develop already have decided on psychiatry as a career, or the knowledge and skills to deliver good-quality they may wish to maximise their learning oppor­ care to such patients early on in their training. tu­nities. Further learning opportunities could The expansion of the Foundation Programme in include additional experience in psychotherapy (e.g. psychiatry enables this. participation in a psychotherapy group), emergency psychiatry (e.g. observation or supervised under­ References taking of Section 136 assessments) and medicolegal aspects of psychiatry (e.g. observation of a Mental Academy of Medical Royal Colleges (2016) The Foundation Programme Curriculum 2016. Academy of Medical Royal Colleges. Health Act assessment or a tribunal). Bleakley A (2002) Pre-registration house officers and ward-based learning: a ‘new apprenticeship’ model. Medical Education, 36: 9–15. Conclusions Boyle A, Perry J (2015) A Guide to Psychiatry in the Foundation The implication of the increase in the number Programme for Supervisors. Royal College of Psychiatrists. of psychiatry posts as a result of changes to Cai A, Greenall J, Ding DCD (2009) UK junior doctors’ experience of the Foundation Programme is that consultant clinical audit in the Foundation Programme. British Journal of Medical psychiatrists and the wider team will be Practitioners, 2: 42–5. supervising and training these foundation doctors. Collins J (2010) Foundation for Excellence: An Evaluation of the Foundation Programme. Medical Education England. There is a need to ensure that these new psychiatry foundation posts are of high quality Davies S (2014) Annual Report of the Chief Medical Officer 2013. Public Mental Health Priorities: Investing in the Evidence. Department of Health. so that doctors have a positive experience of Duncan E (2015) Liaison psychiatry is a good foundation for junior the specialty. Supervisors must ensure that doctors. BMJ Careers, 9 Nov. foundation doctors are well supported by weekly Foundation Programme Malta (2016) Welcome to the Foundation clinical supervision, a well-planned induction and Programme – Malta (http://fpmalta.com). Accessed 7 November 2016. access to good-quality teaching programmes. Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Foundation doctors must be able to obtain the Public Inquiry: vols 1–3. TSO (The Stationery Office). necessary generic and mental health-specific General Medical Council (2015) Foundation Programme year 1. GMC competencies within their respective psychiatric (http://www.gmc-uk.org/doctors/registration_applications/uk_ setting. Box 3 summarises the main foundation internships.asp). Accessed 7 November 2016. competencies concerned. Supervisors must Goodyear H, Bindal N, Bindal T, et al (2014) Foundation doctors’ provide opportunities for foundation doctors to experience and views of mentoring. British Journal of Hospital Medicine, 74: 682–6. meet patients with mental illness, particularly Health Education England (2014) Broadening the Foundation Programme: those with long-term conditions and those in Recommendations and Implementation Guidance. February 2014. Health community settings. Foundation posts should be Education England.

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Health Education England (2015) Better Training, Better Care: Evaluation Shape of Training (2013) Securing the Future of Excellent Patient MCQ answers of the National Elements Report. January 2015. Health Education Care: Final Report of the Independent Review Led by Professor David 1 b 2 c 3 c 4 b 5 d England. Greenaway. Shape of Training. Miles S, Kellett J, Leinster SJ (2015) Foundation doctors’ induction Steele R, Beattie S (2013) Development of foundation year 1 psychiatry experiences. BMC Medical Education, 15: 118. posts: implications for practice. Advances in Psychiatric Treatment, 19: 410–9. Nicholson TRJ, Cutter W, Hotopf M (2008) Assessing mental capacity: the Mental Capacity Act. BMJ, 336: 322–5. Swanwick T, Buckley G (2014) Introduction: understanding medical education. In Understanding Medical Education: Evidence, Theory and Perry J, Boyle A, Wessely S (2016) The expansion of the psychiatry Practice (ed T Stanwick): xv–xviii. Wiley Blackwell. Foundation Programme. BJPsych Bulletin, 40: 223–5. UK Foundation Programme Office (2011) Specialty Tasters in the Rees CE, Cleland JA, Dennis A, et al (2014) Supervised learning events Foundation Programme: Guidance for Foundation Schools. UK Foundation in the Foundation Programme: a UK-wide narrative interview study. BMJ Programme Office. Open, 4(10): e005980. UK Foundation Programme Office (2015) Rough Guide to the Foundation Royal College of Psychiatrists (2016) Foundation Doctor Blogs Programme (4th edn). UK Foundation Programme Office. (http://www.rcpsych.ac.uk/discoverpsychiatry/foundationdoctors/ UK Foundation Programme Office (2016) UK Foundation Programme foundationdoctorblogs.aspx). Reference Guide: May 2016. UK Foundation Programme Office (http:// www.foundationprogramme.nhs.uk/pages/home/reference-guide). Salinsky J (2015) A Very Short Introduction to Balint Groups. Balint Society (http://balint.co.uk/about/introduction/). Accessed 7 November Wilson A, Feyer AM (2015) Review of Medical Intern Training: Final 2016. Report. Australian Health Ministers’ Advisory Council.

MCQs d 80% d can undertake section 136 assessments Select the single best option for each question stem e 100%. independently when on call e can undertake seclusion reviews independently 1 FY1 doctors: when on call. a cannot prescribe depot medications 3 The foundation competencies that all b are recommended not to prescribe in an out- doctors would be expected to acquire in patient setting psychiatry placements do not include: 5 FY1 and FY2 doctors are not required to c can only prescribe if countersigned by a a team-working skills complete/obtain: consultant b communication skills a mini-clinical evaluation exercises (mini-CEXs) d can only prescribe medication for a maximum c undertaking a seclusion review b core procedures of 1 week d performing a mental state examination c team assessments of behaviour (TABs) e cannot initiate new medications. e managing patients with long-term conditions. d mini-assessed clinical encounters (mini-ACEs) e case-based discussions (CBDs). 2 From 2017, the target proportion of doctors 4 FY1 doctors: rotating through psychiatry in England by the a can never work out of hours end of their Foundation Programme years is: b should not work on the same rotas as core a 6% trainees b 22.5% c must always be supervised by a senior c 45% consultant psychiatrist on site out of hours

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