Foundation Training in Psychiatry

Foundation trainees are able to undertake a 4 month placement in psychiatry during their 2 year foundation programme. Placements can include inpatient and outpatient settings, and cover specialities such as general adult, psychiatric liaison, old age, forensics, home treatment team, early intervention team and the assertive outreach team. Psychiatry offers trainees a perfect opportunity to develop skills in a mental health environment as well as sustain and nourish clinical skills which are transferrable to any clinical setting.

Trainees in inpatient settings play a crucial role in the multi disciplinary team. They play a role in managing physical health, particularly recognising and manging acutely unwell patients as well as looking after long term health conditions. Trainees will quickly learn the challenges of physical health presentations in patients with a mental health diagnosis especially with regards to history taking and examinations. This offers the opportunity to learn how to manage patients who may not always engage with the physical health assessment. Trainees will regularly discuss their findings with specialists in secondary care as well as liaising with GPs in primary care in order to ensure patients are being given the best standard of care. Foundation Doctors are able to perform core clinical procedures during their placements. These include venepuncture, cannulation (in emergency settings), ECG, peak flows, and IM injections.

They also play a huge role in delivering mental health care to patients by history taking, assessing mental health status, reviewing medication and performing capacity assessments. This allows a development of core skills relevant to the management of mentally unwell patients in any setting. Trainees will be expected to be on the front line to deliver empathic and compassionate care. Trainees will also learn about the legislation surrounding the Mental Health Act and Mental Capacity act.

Trainees work very closely with other health professions e.g. mental health nurses, occupational therapists, psychologists and physiotherapists. Trainees have a valuable learning opportunity to further develop communication skills by talking with other professionals, patients and their families.

In the community, there is less of an emphasis on physical health management. As a result the main focus of these placements is the development of a doctor's communication skills and broaden the understanding of mental health management. During a community placement, there will be numerous opportunities to practice taking full psychiatric history and to develop insight into how the personal history of each patient may contribute to the development of mental health pathology. Trainees will also gain experience conducting mental state examinations, and develop skills in formulating a differential diagnosis. Trainees will then be able to discuss cases with their consultant supervisor in order to help to develop a bespoke management plan for each patient. Foundation Doctors will also be able to improve their ability to risk assess patients in order to decide whether patients may need further support through the home treatment team or hospital admission.

Foundation Year 2 Doctors will also be expected to conduct psychiatry on-call shifts, including night shifts. The nature of these shifts include clerking new admissions to acute wards, reviewing any medical issues on the ward and reviewing patients in the Accident and Emergency Department who may need admission or further review by a doctor.

Trainees have supervisions with their primary consultant once a week, where they are able to discuss challenging cases as well as their own experiences during their placement. This is particularly helpful when completing work place based assessments and also in the development of reflective practice, both of which are requirements for the Foundation Programme. Moreover, trainees are also encouraged to attend weekly foundation programme psychiatry teaching. During these sessions trainees have opportunities to present cases and teach peers and seniors. Trainees also continue to attend their Lead Trust's generic weekly teaching. There are many opportunities to undertake audits within the trust and help with quality improvement projects. These projects can then be presented at regional meetings and some trainees have had their work accepted into national and international conferences. This is an excellent opportunity for Foundation Doctors to develop their CVs, no matter what career they are interested in. Trainees particularly interested in psychiatry are encouraged to approach consultants in other specialities within the trust and undertake taster days.