A Guide to Psychiatry in the

Foundation Programme
forSupervisors and
Foundation Trainees
2015

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Introduction from the President of Royal College of Psychiatrists, Professor
Sir Simon Wessely

The expansion of the Foundation Programme in psychiatry is, I believe, a heaven

sent opportunity for us to get serious about ensuring that the next generation of
doctors are better prepared for life in the health service, than frankly was the case
for my generation. Admittedly, that is not hard, given that back in my generation
when myself, and probably many of you, qualified it was considered that all you
needed to start you on your career was experience in medicine and surgery,
irrespective of your own intentions and irrespective of what were the true needs of
the population. So now we have a chance to get it right.

Psychiatry foundation training offers specific opportunities for trainees to develop

transferable skills that are appropriate for managing the patient in any setting.
Words like “patient centred”, “whole patient” or “holistic” have all become clichés
these days- but no matter how you phrase it, the truth is that good care depends on
being familiar with both the physical and psychological in illness. Patients now expect
more of doctors than just high intelligence and technical skills – although neither of
these will ever go out of fashion. Patients now expect that their doctor will show
equal skills of self-awareness, reflection, caring with compassion and an empathic
understanding of patients. All of us are now familiar with the lessons of the Francis
Report. What had failed in that setting was not technical knowledge, but deficiencies
in caring and compassion – whole patient care. A small prize is available to anyone
who can find a better word than that, but you all know what I mean. Psychiatry
foundation placements, I hope, will also help to reduce some of the stigma which is
still associated with mental illness, and also counter some of the rather daft myths
that still exist around psychiatry.

The purpose of increasing the exposure of the next generation of doctors to

psychiatry is not to persuade them to become psychiatrists. Even if not a single
extra junior doctor opts for a career in psychiatry, provided that they have learned
something from their placement that will ensure that they are better equipped to
meet the challenges of the future NHS, it will be a job well done. But it would be
disingenuous to pretend that this is also not an opportunity to improve recruitment
to our own speciality.

We really need to embrace this opportunity to ensure that we are offering high
quality foundation training in psychiatry to our doctors. The stakes are high – the
rewards even higher – for patients, for the next generation of doctors, and for our
profession.

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 Introduction

Welcome to this guide to foundation training in psychiatry for trainees and

supervisors. This guide is designed to give an overview of the Foundation
Programme, specifically focusing on placements in psychiatry. It sets out important
quality guidance on how to ensure high quality foundation posts.

This guide has been designed by Dr Ann Boyle (Foundation Programme Lead) and Dr
Jen Perry (FMLM Clinical Fellow in Leadership and Management) using multiple
sources of information, which are listed in the reference section.

Key Contacts

Name Role Contact

UK Website:
Facilitate the operation and
Foundation http://www.foundationprogramme.nhs.uk/pages/
continuing development of
Programme home
the Foundation Programme
Office Email: [email protected]
(UKPFO)
Head of Training &
Nikki Workforce Operations [email protected]
Cochrane Royal College of
Psychiatrists
Specialist Adviser for
Dr Ann Boyle Foundation, Royal College of [email protected]
Psychiatrists

If you would like the contact details of the Foundation Psychiatry Lead within a
specific LETB or Foundation School please contact Alexandra Menzies.

Contents

Background to the Foundation Programme

- What is the UK Foundation Programme?

- How is the Foundation Programme organised?

Foundation Doctors in Psychiatry

- Changes to the Foundation Programme and what this means for psychiatry
- What is the difference between Foundation Year 1 and Foundation Year 2?
- What is the difference between Foundation Training and Psychiatry Specialty
Training?
- Are Foundation Doctors able to prescribe?
- Can Foundation Doctors do out of hours’ shifts and what level of supervision is
required?
- How much study leave are Foundation Doctors entitled to?
- What are the requirements of their generic teaching programme?

How to Organise Training

- Introduction
- Quality Guidance:
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1. Post development and curriculum delivery
- Working within an MDT
- Communication Skills
- Reflective Practice
- Working across service
- Experience of holistic care and patients with long term conditions
- History taking, mental state examination and core medical skills
- Recognising and managing the acutely unwell patient
- Medico-legal issues
- Tasters
- Teaching opportunities
- Attendance at generic teaching programme
- Attendance at local site teaching
- Development of specific mental health teaching programmes
- Audit and Quality Improvement (QI)
- Induction
- Experience beyond the curriculum

2. Learning environment and culture

3. Educational governance

4. The Foundation Programme E-Portfolio, Curriculum and Assessment Process

- What is the e-portfolio?
- What is the role of supervisors in relation to the e-portfolio?
- What are supervised learning events (SLEs)?
- What is the recommended minimum number of SLEs per placement?
- What is the frequency of assessments?
- What are procedures?
- What are the key themes from the curriculum?
- What is an ARCP?

FAQs
1) What are the benefits of having an increased number of psychiatry foundation posts?
2) How do graduates apply for foundation training and who decides which placements
Foundation Doctors get?
3) What are academic foundation posts?
4) How can Foundation Doctors who have not managed to do a psychiatry placement,
but are interested in the specialty, get experience?
5) What about Foundation Doctors who have concerns/negative views about placements
within psychiatry?
6) Can Foundation Doctors do home visits?
7) Who holds the contract of for employment for Foundation Doctors?
8) How much sick leave/annual leave are Foundation Doctors entitled to?

Appendix 1: Sample generic foundation teaching programme

Appendix 2: Mental Health Review Tribunals timetable
Appendix 3: Sample timetables
Appendix 4: Sample local workplace induction

References

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Background to the Foundation Programme

What is the UK Foundation Programme?

The Foundation Programme is a two-year structured, supervised programme of

workplace-based learning for medical school graduates. It exists to prepare junior
doctors for specialty training by providing them with the medical knowledge and skills to
meet the requirements of the Foundation Programme Curriculumi. Foundation Year 1
(FY1) is the pre-registration year and Foundation Year 2 (FY2) is a post registration year
of generic training.

The Foundation Programme aims to:

1. Build on undergraduate education by instilling recently graduated doctors with the

attributes of professionalism and the primacy of patient welfare

2. Provide generic training that ensures Foundation Doctors develop and demonstrate a
range of essential interpersonal and clinical skills for managing both acute and long
term conditions

3. Provide the opportunity to develop leadership, team working and supervisory skills

4. Provide each Foundation Doctor with a variety of workplace experience in order to

inform their career choiceii.

All Foundation Doctors must make patient safety paramount and must practise with
professionalism. They must learn how to empathise with patients’ conditions and develop
professional attributes in accordance with the GMC’s Good Medical Practiceiii and The
Trainee Doctoriv including:

 Integrity
 Compassion
 Altruism
 Aspiration to excellence via continuous improvement
 Respect of cultural and ethnic diversity
 Regard to the principles of equity
 Ethical behaviour
 Probity
 Honesty
 Leadership

At all times Foundation Doctors must promote patient safety by:

 Practising within their competence

 Practising in accordance with prevailing professional standards and requirements
including those expected in their placement
 Seeking advice from more experienced clinicians whenever appropriate in the
workplace
 All doctors must ensure that they have adequate indemnity insurance for their
practice

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How is the Foundation Programme organised?

The Foundation Programme is Quality Assured by the GMC. The Local Education and
Training Boards (LETBs) are responsible for ensuring they meet or exceed the standards
for training for the Foundation Programme in The Trainee Doctor as set by the GMC.

Health Education England has set up LETBs which are responsible for the training and
education of doctors within their area. LETBs deliver foundation training through
Foundation Schools.

The FY1 and FY2 programmes consist of a series of placements which last 4-6 months (4
months minimum). The programmes are usually hosted by Acute Trusts and can include
experience in a wide variety of areas, including community placements (Psychiatry,
general practice, community paediatrics), medicine and surgery. Foundation doctors will
complete a ‘Preparing for Professional Practice Programme’ or shadowing period prior to
starting their placements.

The national co-ordinating body for the Foundation Programme is the UK Foundation
Programme Office which is commissioned by the four UK health departments.

Foundation Doctors in Psychiatry

Changes to the Foundation Programme and what this means for psychiatry

The Broadening the Foundation Programme (BTFP) Reportv details how the UK’s health
and social care landscape is changing and recognises the need for a more patient
centred, integrated model of care. It recognises that more care should be community
based and that doctors’ training needs to change to reflect this.

The recommendations from the BTFP report are:

1) Educational Supervisors should be assigned to Foundation Doctors for at least one

year, so they can provide supervision for the whole of FY1, FY2 or both years.

2) Foundation Doctors should not rotate through a placement in the same specialty or
specialty grouping more than once, unless this is required to enable them to meet
the outcomes set out in the Curriculum.

However, where the experience will be significantly different between the posts, then
two posts within a specialty grouping will be permitted (e.g. Acute Internal Medicine
(admitting) posts and General Medicine (ward-based) posts). In such circumstances,
the sub-specialties should not be the same.

3) a) At least 80% of Foundation Doctors should undertake a community placement or

an integrated placement from August 2015.

b) All Foundation Doctors should undertake a community placement or an

integrated placement from August 2017.

Psychiatry posts in mental health hospitals which are not on the site of an acute
hospital will be counted as being community posts. Posts located within the acute
hospital where the trainee will have the opportunity to look after patients with long-
term conditions, work with community services/MDT will also be counted as
community posts. Liaison psychiatry would fall under this definition.
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The target set by the psychiatry taskforce is to have 22.5% of all FY1 and 22.5% of
all F2 posts in psychiatry. This means that nearly half of all doctors will participate in
at least four months of postgraduate psychiatry training, which represents a significant
increase.

Key Definitions:
Community placement: This is primarily based in a community setting (e.g.
community paediatrics or community psychiatry).

Community-facing placement: This is primarily based within an acute setting;

however, the placement should also include opportunities to develop skills in the
care of the total patient, long-term conditions and the increasing role of community
care.

Integrated placement: The doctor is primarily based in a community setting, which

crosses traditional care boundaries and supports the development of capabilities in
the care of patients along a care pathway.

What is the difference between Foundation Year 1 (FY1) and Foundation Year 2 (FY2)?

FY1 enables Medical Graduates to begin to take supervised responsibility for patient care
and consolidate the skills they have learned at medical school. Satisfactory completion of
FY1 allows the relevant university (or their designated representative in a Postgraduate
Deanery or Foundation School) to recommend to the GMC that the Foundation Doctor
can be granted full registrationi . It is worth noting that this may change in the future as
the Shape of Training Reportvi has recommended that full registration should move to
the point of graduation from medical school.

Most FY1 doctors when they first start will be very inexperienced and will
require a substantial amount of support from their supervisors and the team.
This will change as the year goes on and they move into FY2, as they will start to
develop skills, knowledge and confidence in their clinical work.

FY2 doctors remain under clinical supervision but take on increasing responsibility for
patient care. They begin to make management decisions, develop their core generic
skills and contribute more to the education/training of the wider healthcare workforce. At
the end of FY2 they will have begun to demonstrate clinical effectiveness, leadership and
decision-making responsibilities. Satisfactory completion of FY2 will lead to the award of
a Foundation Achievement of Competence Document (FACD) which indicates that the
Foundation Doctor is ready to enter a core, specialty or general practice training
programmeii.

What is the difference between Foundation Training and Psychiatry Specialty Training?

The Foundation Doctor is NOT learning to be a psychiatrist. The aim of the rotation is to
give Foundation Doctors a meaningful experience in psychiatry and to allow the doctor to
achieve the Foundation Programme competencies. However, if Foundation Doctors have
an interest in psychiatry, they should be supported in accessing other additional learning
opportunities.

All trainees play a key role in the delivery of NHS care and are not supernumerary to
service requirements. It is important that Foundation Doctors ‘learn by doing’, as they
7
will learn more effectively when they are responsible for their actions. However, it is
important to remember that FY1 doctors are new Medical Graduates and will be
inexperienced compared with psychiatry Core Trainees. Therefore they need to be well
supervised to allow them to develop as doctors whilst ensuring patient safety.

After completing foundation training the doctor may wish to apply for GP, core or
specialty training. The current process within psychiatry is that doctors apply for three
years of core training (CT1-3) during which they complete their membership exams.
Following this, the doctor will then apply for specialty training in one or more of the
following specialties; general adult, CAMHS, forensics, old age, psychotherapy and
learning disability. At the end of this, doctors will be awarded a Certificate of Completion
of Training (CCT).

Are Foundation Doctors able to prescribe?

The safety of patients must be paramount at all times. Foundation doctors must not be
put in a position where they are asked to work beyond their competence without
appropriate support and supervision. Technically F1s can prescribe in any setting
including the community. The College has concerns about the possibility of unsupervised
prescribing in community settings and for this reason would recommend that F1s only
prescribe in inpatient settings. Any derogation from this would need to be negotiated
locally with the deanery/foundation school and will depend on supervision and other
safeguards.

Can Foundation Doctors do out of hours shifts and what level of supervision is required?

Foundation Doctors can do out of hours shifts, however FY1 doctors should not be on
Core Trainee rotas. Any on-call for FY1s must be separate from core rotas and be
carefully designed.

FY1s are not allowed to do locum shifts.

The Royal College of Psychiatrists (RCPsych), in discussion with the GMC, has agreed
the following guidance in relation to Foundation Doctors undertaking out of hours
experiencevii:

 Availability of robust clinical supervision should be considered in the planning and

development of all foundation posts in psychiatry. Arrangements should include
supervision in the in hours placement and any associated out of hours work/on-call
responsibilities.

 A review of the supervisory roles and relationships should be considered as part of

the quality control of new placements at a Local Education Provider (LEP) level
informed by the Foundation School/School of Psychiatry

 Trainees must be supervised according to their experience and competence, and

must only undertake tasks in which they are competent or are learning to be
competent, and with adequate supervision. Trainees must never be put in a situation
where they are asked to work beyond the limits of their competence without
appropriate support and supervision from a Clinical Supervisor.

 Foundation doctors must always have direct access to a senior colleague who can
advise them in any clinical situation. Foundation doctors must never be left in a
situation where their only help is outside the hospital or the place where they work.
8
 A senior colleague does not have to be a doctor but can be a senior nurse,
provided they have the necessary knowledge and skills to advise the trainee
appropriately.

 If immediate supervision at the place of work comes from a nurse the trainee must
also have access to a senior doctor who can attend if necessary.

 FY1 doctors should not be on Core Trainee rotas; any on-call for them must be
separate from core rotas and be carefully designed.

 The level of supervision necessary may be different at the beginning of the four
month placement to the end of the four months and different at the beginning of the
year and the end. Employers need to undertake a 'risk assessment' to ensure that
the appropriate clinical cover is in place for the number and level of complexity of
the patients that the doctor may be required to see .This is not an exhaustive list
and should include: decision making about emergency inpatient admissions, CPR and
medical emergencies in an inpatient setting, work in Emergency Department and the
responsibilities delegated OOH to them as the on-call doctor under the relevant
Mental Health Act.

 The Foundation Doctor must feel they are adequately supported by the clinician on
site.

How much study leave are Foundation Doctors entitled to? What are the requirements of
their generic Foundation Teaching Programme?

LETBs/Foundation Schools will have their own study leave policies. Generally speaking
FY1 doctors are not eligible for study leave, however, local arrangements may exist to
enable them to undertake tasters. FY2 doctors may request up to 30 days study leave.
The majority of this is allocated to the teaching programme, taster sessions and
Advanced Life Support.

FY1 and FY2 doctors are entitled to three hours a week of protected in-house, formal
education which is organised by the LEP. This may be aggregated to form whole days of
generic training. Supervisors should release the Foundation Doctors so they can attend.
This teaching offers the opportunity to meet with their other FY1/FY2 colleagues and is
usually held at the host Trust.

Further information can be found here: The UK Foundation Programme Office. The UK
Foundation Programme Reference Guide, July 2012, Updated for August 2014 (2) p33-
34
Please see Appendix 1for a sample generic teaching programme timetable

How to Organise Training

Introduction

The RCPsych has produced guidance to support the development of high quality
psychiatry foundation placements. The guidance is not intended to be prescriptive
although there are some requirements in any training placement which should be
considered to be mandatory.

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There is no single model of post/placement as service models present different strengths
and learning opportunities across different sub specialties in psychiatry and the
geographies across the four UK nations. The RCPsych has contributed to the
development of the Foundation Programme curriculumi, which covers generic and mental
health specific learning outcomes. The quality control and quality management of all
foundation posts and programmes is at an LEP and Foundation School level. The role of
the College is an advisory one only and this guidance should be viewed as national best
practice.

Quality Guidance

Post development and curriculum delivery

Foundation posts in psychiatry must provide significant practical experience to enable

doctors to achieve and maintain clinical and generic competencies. Posts must enable
doctors to demonstrate the knowledge, skills and behaviour required by the foundation
curriculum.

Ideally, psychiatry posts included in a 2 year Foundation Programme should be subject

to a curriculum mapping exercise. This will ensure that the outcomes delivered in each
post integrate well into a proposed 2 year Foundation Programme.

Working within an MD

All foundation psychiatry posts should aspire to give a Foundation Doctor a high quality
experience of MDT working. This could include attendance at CPA meetings as a gold
standard of multi-professional working in mental health. Foundation Doctors should be
supported in making useful contributions to the MDT meeting. The environment should
allow other team members to make reliable judgements about the Foundation Doctor’s
ability and performance.

Communication skills

Foundation psychiatry posts should provide excellent learning opportunities for

Foundation Doctors to acquire and develop communication skills. This should be through
working with patients, their families and other professionals in both straightforward and
more complex situations.

Reflective practice

The development of reflective ability is a Foundation Programme outcome. This can be

developed in psychiatry with 1 hour face-to-face weekly supervision with a named
clinical supervisor. There may also be the opportunity to attend a specific Balint Group
developed for Foundation Doctors.

Working across services

There will be opportunities to allow the Foundation Doctor to experience working across
the health and social care boundaries. Doctors will be able to maximise learning
opportunities across acute and mental health services, primary and secondary care
services, social care and voluntary sector services.

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Experience of holistic care and patients with long-term conditions

Community visits are not an absolute requirement of a Foundation psychiatry post.

However, opportunities to have experience of holistic care in both acute presentations
and in long-term conditions are likely to be widely available in all psychiatry placements.
Home visit selection is the responsibility of the trainee’s named Clinical Supervisor and
should be undertaken at their discretion, with careful patient selection and due oversight
of the LEPs lone worker policy. Appropriate and timely debriefing for the Foundation
Doctors should be available immediately following the visits.

History taking, mental state examination and core medical skills

A Foundation Doctor should have the opportunity to develop skills in history taking and
mental state examination in their placement. There should be opportunities available to
doctors to acquire core medical skills within their day-to-day clinical work (for example,
physical health assessment of new admissions in an inpatient setting). Placements could
also be developed which have timetabled sessions in an acute medical setting (for
example, one day a week on-call in a co-located acute trust).

Recognising and managing the acutely unwell patient

Learning opportunities could include both recognising and managing acutely ill patients
in a mental health setting. This would include experience of managing acute mental
disorder and self-harm both in routine and out of hours work. It would also include
managing patients with long-term conditions, and recognising the interplay between
long-term physical illness/psychological factors/mental disorder. This would enable the
trainee to appreciate the implications for both patient management and outcomes.

Medico-legal issues

Psychiatry posts are well placed to deliver Foundation Programme experiential learning
opportunities. Foundation Doctors will be able to acquire an understanding of medico
legal and ethical issues within healthcare through teaching and clinical work .There are
specific opportunities within psychiatry to develop an understanding of the Mental
Capacity Act and experience of using it. Specific support for FY2 doctors who are on-call
out of hours and are deputising for the Responsible Clinician under the Mental Health Act
should have supervision around the powers of detention for an on-call junior doctor.
These competencies should be acquired prior to participation in any out of hours work.
FY1 doctors should never be the only doctor on site out of hours.

Tasters

In order to complement any clinical exposure in a psychiatry foundation placement, the

RCPsych suggests that LEPs and Foundation Schools develop posts which include 5
taster days. The taster days should be within other sub-specialty areas of psychiatry.
They should be bespoke, compliment trainees’ interests and ideally inform future career
intentions within and outside of specialty training in psychiatry. For example, an FY2
may wish to be a paediatrician in the future and so could do a taster in CAMHS.

FY2 doctors can use study leave to undertake tasters. FY1 doctors are not eligible for
study leave; however, local arrangements may exist to enable them to undertake tasters
towards the end of the FY1 year.

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Further information can be found here: UK Foundation Programme Office. Specialty
Tasters in the Foundation Programme: Guidance for Foundation Schools. March 2011viii
www.foundationprogramme.nhs.uk/download.asp?file=Tasters_guidance

Teaching Opportunities

All Foundation Doctors should be presented with opportunities to teach others. For
Foundation Doctors in psychiatry this could include teaching undergraduate Medical
Students or teaching a medical topic to the MDT. It may be helpful for the foundation
doctor to do this in conjunction with a senior colleague who can provide supervision and
support.

Attendance at generic teaching programme

Foundation Doctors must be supported to attend their generic foundation teaching

programmes. Attendance at this teaching programme is a mandatory requirement for
the Annual Review of Competence Progression (ARCP) for Foundation Doctors.

Attendance at local site psychiatry teaching

Trusts may wish to consider developing opportunities for Foundation Doctors which are
integrated into local existing specialty training opportunities; for example Journal Club,
Case Conferences and targeted attendance at MRCPsych teaching sessions.

Development of specific mental health teaching programmes

LEPs and Foundation Schools should consider the development of specific mental health
teaching programmes for all Foundation Doctors. Not all Foundation Doctors will have
had the opportunity to complete a psychiatry post in the course of their 2 year
Foundation Programme.

Audit and Quality Improvement (QI)

Foundation Doctors should have time protected to engage in audit and QI work. It is
recommended that one half day per week is embedded in all foundation psychiatry
placement timetables to support this activity.

Induction

All placements need to be developed with due regard for appropriate induction for
Foundation Doctors to ensure patient safety.

There are at least three levels of induction:

 Deanery/Foundation School;
 Employer/Local Education Provider (LEP);
 Departmental/workplace.

How to prepare for the arrival of a Foundation Doctor in your place of work:

Ensure the whole team/ward is informed and involved in the Foundation Doctor’s
placement. Members of the team should be engaged in the process and will be able to
support the doctors’ training. FY1 doctors should normally undertake a “shadowing”
period of the FY1 job that they will be taking up at the start of their year. This ensures
12
they will have the necessary local knowledge and skills to provide safe patient careii It is
important to ensure that the Clinical Supervisor is present for the FY1s shadowing period
to provide the necessary support.

It is important to describe to the team the level of training the FY1 or FY2 has. It should
be explicitly stated to the team what should and should not be expected from the
Foundation Doctors and what support they will require. This is particularly relevant if
psychiatry is the FY1s’ first placement.

Identify a workplace induction process and timetable for your trainee. The induction
should ensure that the doctor is introduced to all team members, familiarised with the
working environment (including health and safety procedures) and should involve a
period of shadowing/observation.

The doctor should also be provided with a thorough handover of patients (see Appendix
4 for a sample workplace induction programme). More information can be found on the
different types of induction here: The UK Foundation Programme Office. The UK
Foundation Programme Reference Guide, July 2012, Updated for August 2014 (2) p24.

Experience beyond the curriculum

There are a proportion of Foundation Doctors in psychiatry who may wish to acquire
competencies beyond the Foundation Programme over the course of their placement.
This will include Foundation Doctors who have already committed to a career in
psychiatry, who may have a particular aptitude and interest in exploring options beyond
the curriculum. There are also doctors whose final career intentions are unclear or who
have chosen another speciality, who may wish to maximise any learning opportunities
within their psychiatry placement. A list of possible additional achievements /learning
opportunities could include:

1) Additional psychotherapy experience. For example, observation/undertaking

individual/group psychotherapy training or participation in a psychotherapy
supervision group.

2) Additional emergency experience. For example, involvement/observation of a 136

assessment or seclusion review.

3) Additional medico-legal experience to include observation of a Mental Health Tribunal

or Mental Health Act Assessment. See Appendix 2 for a guide for Foundation Doctors
who are observing tribunals.

4) Other experience. For example, presentation of a project at a regional or national

meeting.

5) Attendance at a prison visit, court diversion or visit to a secure mental health unit.

6) Observation or undertaking of ECT

A weekly timetable should be designed to try and incorporate these experiences where
possible. See Appendix 3 for sample timetables.

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Learning environment and culture

It is critical that any psychiatry placement in the Foundation Programme should be in an

environment that is safe and delivers a good standard of care for patients. The clinical
environment should be intrinsically multi-professional to allow Foundation Doctors to
learn with and from a range of clinical staff.

Foundation Schools, with LEPs, need to identify suitable learning environments for
foundation posts in psychiatry. Most established psychiatry posts in the Foundation
Programme exist in general adult psychiatry. Other clinical environments such as old age
psychiatry, liaison psychiatry and some community settings are also likely to be able to
effectively deliver the foundation curriculum outcomes. The potential of other learning
environments, such as CAMHS and learning disability psychiatry, have yet to be
completely explored.

Hospital based placements have a number of advantages as foundation placements in

psychiatry. An inpatient environment allows for a high degree of senior and
multidisciplinary team support. There is co-location with other trainees, particularly
when the mental health unit is co-located on an acute hospital site. An inpatient
environment provides more potential for Foundation Doctors to achieve physical
healthcare competencies. Inpatient placements should be complemented with supervised
community exposure. This could be facilitated, for example, by utilising the links a
specific inpatient area has with a Community Mental Health Team (CMHT), which would
allow doctors to follow patients along a care pathway.

Multi-professional teams which can provide a high level of support for FY1 doctors are
particularly suitable placements. Teams with a relatively stable caseload which do not
have an acute undifferentiated take (for example early intervention, assertive outreach
and treatment and recovery services) are suitable. Ideally there should be a consultant
who is familiar with the patients and can ideally provide supervision. In FY2, doctors are
more experienced and may be able to benefit greatly from the potential learning
opportunities in a CMHT setting. Careful consideration and planning should be given to
enabling a community based Foundation Doctor to make a smooth transition back to the
general hospital setting. There is also a need to be mindful of mitigating against the
potential of Foundation Doctor isolation, particularly if the doctor is the only early years
trainee in a community team.

Trainees should receive 1 hour face-to-face supervision from a senior clinician each
week. This should be timetabled and considered a mandatory requirement for any
placement to deliver. Further detail is given on this in ‘Supporting Foundation Doctors
and Trainers’ (below).

Educational governance

There needs to be effective, transparent and clearly understood educational governance

systems and processes for quality management and quality control of foundation
training. The co-located speciality school for psychiatry may be involved in this
arrangement. Accountability for educational governance at a LETB level between the
Foundation School and co-located specialty school for psychiatry must be clearly
assigned. Ideally, consideration should be given for a named individual at an LEP level. It
is recognised that in smaller LEPs this may not be feasible and that different models of
educational governance have the potential to work very well.

14
The role of the RCPsych in the Foundation Programme educational governance is
involvement in the development of the curriculum through the Academy of Medical Royal
Colleges (AoMRC). The RCPsych has an advisory role to help identify and disseminate
good practice. The College can provide support to LEPs and Foundation Schools in
improving the quality of training in psychiatry foundation placements.

Supporting Foundation Doctors and Trainers

All Foundation Doctors must have the appropriate educational and pastoral support so
they are able to achieve the curriculum outcomes over the 2 year programme.
Psychiatry placements contribute to this by providing learning opportunities to enable
the acquisition of knowledge, skills and behaviour consistent with the FY1 and FY2
outcomes.

A Foundation Doctor should have a named Clinical and a named Educational Supervisor.
A Clinical Supervisor is responsible for overseeing a specified Foundation Doctor’s
clinical work and providing constructive feedback during a training placement. An
Educational Supervisor is responsible for the overall supervision and management of a
specified Foundation Doctor’s educational progress during a training placement or series
of placements.

At an LEP level, named Clinical Supervisors must be clearly identified, competent to

supervise and have had specific training to equip them with supervision skills.
Foundation doctors should receive 1 hour face to face supervision from a senior
clinician each week. This should be agreed at the start of each placement, timetabled
and considered a mandatory requirement. There should also be clear lines of supervision
identified when the named Clinical Supervisor is absent, for example this could be from a
higher trainee. LEPs should be mindful that FY1 doctors require onsite access to a
dedicated supervisor with the required knowledge and skills to deal with problems that
might arise in any clinical situation. Due to the multi-professional nature of mental
health services this may not always be a doctor. Arrangements should be made so that
foundation doctors have the contact details of those who are supervising them.

Any rota at an LEP level that includes Foundation Doctors must enable appropriate
supervision and provide learning opportunities to meet the foundation curriculum
requirements.

All consultant supervisors in psychiatry for the Foundation Programme need to have a
commitment to developing this group of doctors. Supervisors need to be selected,
inducted, trained and appraised to reflect the responsibilities of Foundation Supervisors.
Mental health LEPs will need to work in partnership with the Foundation School and the
co-located acute trusts within a geographical location. Together they will need to ensure
that psychiatrists involved in the Foundation Programme are part of an integrated faculty
of Foundation Educators.

Named Clinical Supervisors and Educational Supervisors for foundation placements need
to be provided with support, resources and time to deliver effective training. In light of
the greater requirement for direct supervision of these doctors, especially early in the
FY1 year, the time requirement is likely to exceed 0.25PA per week. Medical Directors
and Directors of Medical Education need to be mindful of this. There is a need to clearly
allocate time in consultant job plans to provide this. This will help ensure a high quality
education and training experience and will enable patient safety.

15
Supervisory arrangements for locum consultants who are supervising Foundation
Doctors need to be agreed by the Trust Director of Medical Education/Trust Foundation
Lead and FTPD.

One of the particular strengths of psychiatry is that the majority of Supervised Learning
Events (SLEs) are consultant led. This is in great contrast to other specialties in
secondary care. FY1 and FY2 doctors must have opportunities to receive regular
constructive and meaningful feedback on their performance. The model of clinical
supervision of psychiatry, with 1 hour face to face supervision with a senior consultant,
should maximise the opportunity for constructive developmental feedback to occur.

Further information on the roles and requirements of clinical/educational supervisors can

be found here: The UK Foundation Programme Office. The UK Foundation Programme
Reference Guide, July 2012, Updated for August 2014, P16-18

The Foundation Programme E-Portfolio, Curriculum and Assessment Process

What is the e-portfolio?

All Foundation Doctors must maintain an e-portfolio and use it to support their
educational and professional development and career planning. There are two providers
of the e-Portfolio; NES and Horus.

The e-portfolio includes personal development plans, summaries of feedback from the
Educational Supervisor, Clinical Supervisors’ reports, significant achievements or
difficulties, reflections of educational activity, career reflections and the results of the
Foundation Programme assessments.

The e-portfolio is reviewed to inform the judgement about whether a Foundation Doctor
has met the requirements for satisfactory completion of FY1 and FY2ii.

What is the role of supervisors in relation to the e-portfolio?

Supervisors should know what Foundation Doctors’ e-portfolios should contain and
should have an awareness of the foundation competencies.

Supervisors should take an active interest in the Foundation Doctors’ work and check
their portfolios regularly within supervision.

Supervisors should complete Supervised Learning Events (SLEs) with doctors and
complete their supervisor reportsError! Bookmark not defined.. At start of
placements, supervisors should take active role in timetabling in SLEs with the
foundation doctor.

What are Supervised Learning Events (SLEs)?

A SLE is an interaction between a Foundation Doctor and trainer which leads to

immediate feedback and reflective learning. SLEs are not summative and there is no
numerical marking; the focus is on narrative formative feedback.

SLEs use the following tools:

- Mini-clinical evaluation exercise (Mini-CEX)
16
 - Direct observation of procedural skills (DOPS)
- Clinical based discussion (CBD)
- Developing the clinical teacher

The SLE process is described in further detail in the Curriculum: Academy of Medical
Royal Colleges. The UK Foundation Programme Curriculum, July 2012 updated for 2014,
P56

What is the recommended minimum number of SLEs per placement? (Based on a clinical
placement of four month duration)

 Direct observation of doctor/patient interaction: Mini-CEX, DOPS-3 or more.

 Case-based discussion (CBD)- 2 or more
 Developing the clinical teacher -1 or morei

What is the frequency of assessments?

 E-portfolio -Contemporaneous
 Core procedures -Throughout FY1
 Team assessment of behaviour (TAB- Multisource feedback tool) -Once in first
placement in both FY1 and FY2, optional repetition
 Clinical Supervisor end of placement report -Once per placement
 Educational Supervisor end of placement report- Once per placement
 Educational Supervisor end of year report- Once per yeari

What are procedures?

There are a number of core and clinical procedures which Foundation Doctors need to
get signed off during their training. Foundation Doctors may find opportunities to
undertake the following during their psychiatry placements:

 Venepuncture
 Perform and interpret ECGs
 Perform and interpret peak flows
 Intramuscular injection
 Blood culture (peripheral)

There needs to be an appropriate level of supervision in place for Foundation Doctors

undertaking these procedures. For example, the Foundation Doctor could be supervised
in performing and interpreting ECGs by a Core Trainee who is experienced in this area.

Foundation Doctors should not be expected to perform procedures such as IV

cannulation, arterial punctures, IV preparation/administration of medications/fluids/other
infusions whilst doing their psychiatry placements. Patients requiring this level of medical
intervention should be transferred to a general hospital and should not be managed in a
psychiatric settingi.

What are the key themes from the curriculum?

The key message from the curriculumi is that Foundation training is underpinned by two
central concepts:
-Patient safety
-Personal development

17
There are two sections to the curriculum. The first is on ‘The Foundation Doctor as a
professional and a scholar’ which has generic outcomes and competencies. The second
section is entitled; ‘The Foundation Doctor as a safe and effective practitioner’ which has
clinical outcomes and competencies.

The vast majority of competencies from the curriculum can be developed in a mental
health setting. Specific learning opportunities in foundation psychiatry are highlighted in
the quality guidance section 1 (‘Post development and curriculum delivery’)

The South Thames Foundation School has developed the following psychiatry
competenciesix:

During a foundation placement, the doctor should obtain the following competences,
with the relevant competency assessment completed on the e-portfolio.

1. Elicit a basic clinical history for a common psychiatric disorder

2. Perform a mental state examination (MSE) for a common psychiatric disorder
3. Perform a cognitive screening assessment
4. Perform a risk assessment
5. Make a concise case presentation and initial management plan for a common
psychiatric disorder
6. Write an accurate and concise report, assessment or referral

What is an ARCP?

Towards the end of FY1 and FY2, the Foundation Training Programme Director/Tutor,
under the guidance of the Foundation School, should convene an ARCP panel to review
the progress of all Foundation Doctors in their programme. The ARCP provides a formal
process for reviewing Foundation Doctors’ progress, which uses the evidence gathered
by them and supplied by their supervisors.

Doctors are given an outcome from their ARCP which can be;
Outcome 1- Satisfactory completion of FY1/FY2
Outcome 3- Inadequate progress - additional training time required.
Outcome 4-Released from training programme
Outcome 5- Incomplete evidence presented – additional training time may be
required
(Note; no outcome 2)

After a doctor has successfully passed their ARCP they are able to proceed to the next
stage of their trainingii.

18
Frequently Asked Questions (FAQs)

1) What are the benefits of having an increased number of psychiatry foundation posts?

All doctors will come into contact with patients suffering from mental illness throughout
their careers. It is important therefore that doctors develop the knowledge and skills to
deliver good quality care to this patient group early on in their training and this has been
recognised by the Broadening the Foundation Programme Report. Foundation Doctors
working in psychiatry will have the opportunity to meet patients with mental illness,
particularly those with long term conditions and those in community settings. They will
gain experience of navigating the boundaries of acute and mental health services,
inpatient and outpatient services and primary and secondary care. They will learn more
about working with social care services and the voluntary sector.

Psychiatry foundation training offers specific opportunities for trainees to develop

transferable skills that are appropriate for managing the ‘whole’ patient in any setting.
Doctors will develop skills of self-awareness, reflection, caring with compassion and an
empathic understanding of patients. This is extremely important in light of the Francis
Report which highlighted the need to have a caring and compassionate medical
workforce. Psychiatry foundation placements will help to reduce some of the stigma
which is still associated with mental illness.

Mental illness does not have parity of esteem with physical illness. 23% of the UK
population will suffer with mental ill health at some point in their lifetimes. This can have
a wide variety of consequences, including increased physical health problems, increased
health risk behaviours (e.g. smoking, drug and alcohol use) and reduced life expectancy
amongst some groups. Vice versa, physical illness can also lead to mental illness. At
present, there is a funding gap between mental health and other medical specialities.
Increasing the number of psychiatry foundation posts so that doctors, early in their
careers, are able to understand the relationship between physical and mental illness is a
key step in achieving parity of esteem.

There is evidence to show that recruitment at foundation level encourages recruitment

into psychiatry as a specialty. It is well recognised that there have been serious
problems in psychiatry recruitment. In 2011, only 78% of the 478 core trainee year 1
(CT1) vacancies were filled in England and Wales. A study was carried out by Kelley et
alx in which a survey was distributed to all FY2 doctors in the UK. This was to determine
what proportion had exposure to psychiatry before specialty applications and whether
such exposure correlated with choosing psychiatry as a career. The study showed that
14.6% of Foundation Doctors had exposure to psychiatry prior to specialty applications.
Of these, 14.9% chose psychiatry as a career in contrast to only 1.8% of those who did
not have psychiatry exposure. It is important therefore that Foundation Doctors have
high quality psychiatry placements.

These changes to training will also offer multiple benefits to supervisors and
organisations. For the consultant psychiatrist, having Foundation Doctors is an
opportunity to expand their trainer experience, contribute to their own professional
development and promote their specialty. There will be opportunities for other psychiatry
doctors of different grades to teach Foundation Doctors and to enhance their teaching
skills.

19
2) How do graduates apply for foundation training and who decides which placements
foundation doctors get?

Applicants register on the Foundation Programme Application System (FPAS). They then
complete an online application form and sit a situational judgement test. Applicants are
given a score based on educational performance (this is based on two elements: medical
school performance and educational achievements) and the results from their test.
Applicants are allocated to a Foundation School and matched to programmes based on
their scores and personal preferences.

More details can be found here: The UK Foundation Programme Office. FP/AFP 2015,
Applicants Handbook, June 2014xi.

3) What are Academic Foundation Programmes?

Foundation schools in partnership with universities offer a small number of Academic

Foundation Programmes. They provide doctors with the opportunity to develop their
research, teaching and/or leadership skills and explore academia as a career alongside
their clinical work.

The programmes typically last two years although occasionally vacancies arise at FY2.
Academic training, whether structured as a stand-alone placement or regular time
throughout the programme, should not exceed one third of the time allocated to training
in FY2.

As Academic Foundation Programmes typically provide less time for the development of
clinical and generic skills, there is a different application process to identify applicants
who are likely to be able to meet all of the clinical and academic requirements.

All doctors appointed to academic programmes must have an Academic Supervisor or

equivalent with whom they should agree learning outcomes.

Further information can be found here: The UK Foundation Programme Office. The UK
Foundation Programme Reference Guide, July 2012, Updated for August 2014, P9-10

4) How can Foundation Doctors who have not managed to do a psychiatry placement,
but are interested in the specialty, get experience?

Foundation Doctors can undertake external tasters, for example a Foundation Doctor
undertaking an orthopaedic placement who is interested in psychiatry may wish to
undertake 2-5 days in a CMHT.

5) What about Foundation Doctors who have concerns/negative views about placements
within psychiatry?

Doctors may have pre-conceived negative views about foundation psychiatry

placements. These include fears about a lack of exposure to acute care or procedural
experience relevant to the curriculum. An overview of the literature suggests that
concerns about psychiatry placements being of little value are common but are almost
always universally overturned once the placement is completed. The BTFP report (5)
highlights that there is overall a high level of satisfaction amongst those who do
psychiatry placements (BTFP).

20
It is important that all stakeholders are mindful of this concern and welcome any models
to support Foundation Doctors in maintaining acute skills in a mental health setting.

6) Can Foundation Doctors do home visits?

Yes Foundation Doctors can do home visits. Home visit selection is the responsibility of
the trainee’s named Clinical Supervisor and should be undertaken at their discretion,
with careful patient selection and due oversight of the LEPs lone worker policy. Suitable
patients would include those who have already been seen and risk assessed by the
service. Foundation Doctors should not undertake home visits alone, home visits should
be undertaken jointly with another team member. Appropriate and timely debriefing for
the Foundation Doctors should be available immediately following the visits.

7) Who holds the Contract of Employment for Foundation Doctors?

The Contract of Employment for Foundation Doctors is held by the Lead Employer which
is usually the Acute Trust; although in some circumstances may be another body such as
the LETB.

8) How much sick leave/annual leave are Foundation Doctors entitled to?

It is worth highlighting that the maximum period of permitted absence from training,
other than annual leave, during the FY1 year is four weeks. Further details on sick leave
and annual leave can be found here:

The NHS Careers guide: ‘Welcome to the medical team’

http://www.nhscareers.nhs.uk/media/1916250/2902505-hee-welcome-brochure-
final.pdfxii

Appendix 1: Sample generic foundation teaching programme

FY2 Teaching Programme Day 4 October 4th 2014

09.00 – 09.15 Welcome and learning objectives for the day

09.15 – 10.30 Managing the septic patient
10.30 – 11.30 Antibiotic prescribing
11.30 – 12.15 Working in acute care
12.15 – 13.00 LUNCH
13.00 – 14.00 DNAR and End of Life issues
14.00 – 15.00 Managing palliative care patients/ Use of the Liverpool Care Pathway
15.00 – 15.30 BREAK
15.30 – 16.45 Teaching Presentations e.g. Managing a patient with chronic renal
failure
16.45 – 1700 Reflective practice of learning objectives

Appendix 2: Mental Health Tribunals

A Guide for Foundation Doctors who are observing tribunals

Background to the Mental Health Tribunal

A patient with a mental disorder who is presenting risks to themselves or others, and
who is unwilling to be treated, can be detained in hospital for treatment using the Mental
Health Act, often referred to as ‘being sectioned’ (due to sections of the MHA being relied
21
upon to do this). Patients detained under the Mental Health Act have a right of appeal to
the Tribunal (the full title is First Tier Tribunal –Mental Health); the time at which a
patient can apply depends on the section. Patients who appeal are entitled to free legal
representation at their tribunal.

Process of a tribunal hearing

The tribunal is a panel that is made up of three people – a Judge (who chairs the
hearing), a Tribunal Doctor who is a Consultant Psychiatrist, and a Specialist Lay
member who has knowledge of mental health care. The panel’s powers depend on the
section of the Mental Health Act that the patient is detained under. The panel comes to
the hospital for a meeting with the patient, their legal representative and clinical team
which is a formal meeting called a hearing.

Seating plan at the hearing

Tribunal doctor Judge Specialist Lay member (SLM)

__________________________________________________________________
Clinical team doctor Patient’s legal rep Patient Nurse Care Co-ordinator

Before the hearing starts, the panel and (separately) the patient’s legal representative
reads the reports from the clinical team (a medical report, nursing and a report from the
care co-ordinator who is usually a social worker or community psychiatric nurse) and
discusses issues such as order of evidence: if the patient is agitated, they will be
encouraged to give their evidence first.
After the patient’s legal representative says what the patient is requesting, the panel
question the clinical team: i.e. the doctor, nurse and care-co-ordinator, and take notes.
These questions cover the statutory criteria: these are the legal criteria on which the
patient’s detention under section is justified, and typical answers are shown below.

Q. Is the patient suffering from a mental A. The actual diagnosis may not yet be
disorder? confirmed; the two most common diagnoses
for detained patients are paranoid
schizophrenia and schizo-affective disorder.
Q. Is the patient’s disorder of a nature A. Nature includes diagnosis, pattern of illness
that requires detention? i.e. relapsing and remitting, response to
treatment, perpetuating factors, including
compliance and insight
Q. Is the patient’s disorder of a degree A. Current mental state so delusions,
that requires detention? hallucinations, depression or mania, and
negative symptoms such as self neglect.
Q. What is the appropriate treatment for A. Includes medication, nursing care,
the patient? occupational therapy, psychology, input from
other teams, accommodation, benefit advice,
carers support, employment support AND
follow up arrangements when the patient
leaves hospital e.g. community mental health
team or Crisis/Home Treatment team
Q. What is the risk if the Section is A. Risk to health: mental (distress), physical
lifted? There are three categories of risk: (self care, neglect of medical conditions) Risk
risk to the patient’s health, risk to the to safety: self harm, suicide attempts, putting
patient’s safety, and risk to others by the self in risky situations and vulnerability,
patient’s actions retribution from others, road safety.
Protection of others e.g. from physical assaults
22
The patient’s legal representative questions the clinical team with an aim to show that
the patient either: does not meet the criteria above, is willing to stay in hospital and
take treatment as a voluntary patient or will accept treatment in the community, and
that any risks can be managed.

Sometimes hearings do not proceed (the panel will adjourn) if there is missing
information that would mean it would not be in the interests of justice for the patient to
proceed.

The patient’s evidence

The patient may wish to give evidence first or wait to see what their clinical team say
first in order to respond to the clinical team’s concerns with the help of their legal
representative

After this the panel discuss the evidence privately and decide their options, which are:

 Immediate discharge from section if the criteria are not met- the patient may leave
immediately or may agree to stay voluntarily in hospital
 Deferred discharge: section is to be lifted at a specified date in the future – usually a
few days- to allow time for follow up arrangements
 Not discharged but recommendations are made to clinical team regarding care such
as considering a community treatment order or a move to another hospital nearer
the patient’s home
 in restricted cases, conditional discharge

The patient, their representative and the clinical team are told the decision and a written
version of the decision is sent to the hospital and to the patient’s legal representative
within a set time scale (a few days) as a record of the hearing.

The practice direction specifies the contents of reports: http://www.judiciary.gov.uk/wp-

content/uploads/JCO/Documents/Practice+Directions/Tribunals/statements-in-mental-
health-cases-hesc-28102013.pdf

Readable information about Mental Health Act: A Clinician’s brief guide to the Mental
Health Act, 3rd Ed. 2014 Tony Zigmond RCPsych publications ISBN 978-1-909726-24-6

Appendix 3: Sample timetables

FY1 Old Age Inpatient Psychiatry Placement

Monday Tuesday Wednesday Thursday Friday

AM Ward Work Supervision Ward work Ward Academic
(1 hour) Round Meeting (1
hour)

FY1 Generic Audit (1

Teaching (3 hour)
hours) Journal
Club (1 Bailint Group
hour) (1 hour)
PM Ward Speciality Ward Work Specialty Ward Work
Round experience Experience

23
This is an FY1 placement on a functional old age psychiatry ward. There are two
consultants and 3 early years trainees (GP, CT, FY2) working alongside the FY1.
The FY1 will have the opportunity to:

 Gain experience of working on an old age psychiatry ward through clerking new
patients, assessing patients’ mental and physical healthcare needs, attending ward
rounds.
 Attend their specialty experience twice a week, such as supervised community and
outpatient experience (e.g. memory clinic), liaison old age psychiatry
 Attend 2 hours/week postgraduate psychiatric learning experience (Academic
meeting, Journal club)
 Attend 3 hours weekly FY1 generic teaching (protected)
 Undertake 1 hour audit/quality improvement work each week
 Have weekly supervision with their clinical supervisor
 Attend Balint group (reflective practice group)

This model can be adapted for general adult psychiatry

FY2 Crisis Resolution/Home Treatment Team

Monday Tuesday Wednesday Thursday Friday

AM Home Home visit/ Home visits/new Home Home
visits/new new assessments visits/new visits/new
assessments assessments assessments assessment

Journal Club Academic

(1 hour) meeting (1
hour)
PM MDT Speciality Balint Group (1 MDT MDT
Handover Experience hour) Handover Handover

Audit/QI (1 hour) Generic FY2

teaching ( 3
Supervision (1 hour) hours)

This is an FY2 placement in the Home Treatment team. The FY2 will be working
alongside a Consultant Psychiatrist (supervisor) and an ST5 Psychiatry Trainee. The FY2
doctor will have the opportunity to:

 Undertake home visits and new patient assessments, as well as attending MDT
handovers
 Undertake 1 session each week in ‘specialty experience’, this could include attending
a general adult outpatient clinic or working on an inpatient ward
 Attend 2 hours protected postgraduate psychiatry teaching (academic meeting,
journal club)
 Attend the FY2 generic teaching programme (protected time)
 Have weekly supervision (1 hour) with their consultant psychiatrist supervisor
 Undertake 1 hour audit/quality improvement work each week
 Attend the Balint Group (reflective practice group)

24
 Appendix 4: Sample local workplace induction timetable

Inpatient ward with some community experience

Mon Tues Wed Thurs Fri

AM Introductory Attend Shadow Attend Academic
meeting with ward CT3 ward round teaching (2
supervisor (1 hour) round hours)

Introduction to
team members
(include ward staff,
CMHT, pharmacy, Attend Supervision Teaching
MHA office etc) (2 Balint (1 hour) from
hours) Group (1 Psychiatry
hour) SHOs (1
hour)
PM Observe outpatient Shadow Go out on FY2 Shadow
clinic ward CT3 home visits teaching ward CT3
with CPN programme

References

i
1) Academy of Medical Royal Colleges. The UK Foundation Programme Curriculum, July
2012 updated for 2014

2) The UK Foundation Programme Office. The UK Foundation Programme Reference

ii

Guide, July 2012, Updated for August 2014

3) GMC Good Medical Practice. http://www.gmc-

iii

uk.org/guidance/good_medical_practice.asp

4) iv
GMC. The Trainee Doctor. 2011

5) v
Health Education England. Broadening the Foundation Programme Report. February
2014

6) Greenway D. Shape of Training Report: Securing the future of excellent patient

vi

care. 2013

7) RCPsych. Foundation Trainees and supervision out of hours in Psychiatry Guidance.

vii

September 2014.

8) UK Foundation Programme Office. Specialty Tasters in the Foundation Programme:

viii

Guidance for Foundation Schools. March 2011

9) Marcus Hughes (South Thames Foundation School), Educational and Clinical

ix

Supervision in the Foundation Programme Presentation. July 2014

25
10) x Kelley T, Brown J and Carney S. Foundation Programme psychiatry placement and
doctors’ decision to pursue a career in psychiatry. Psychiatric Bulletin (2013) 37: 30-
32

11) xi The UK Foundation Programme Office. FP/AFP 2015, Applicants Handbook, June
2014

12) xii The NHS Careers guide: ‘Welcome to the medical team’
http://www.nhscareers.nhs.uk/media/1916250/2902505-hee-welcome-brochure-
final.pdf

26