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Foundation for what? Commentary on … Current position of psychiatry in UK foundation schools

  • Dinesh Bhugra (a1)
Summary

Two years of foundation training were added to the medical students' transition from learning theory in medical school to trainee clinical practice, replacing one year of house jobs or internship. In the recent few years there has been a tremendous amount of debate about undergraduate medical training and changes in regulations which led to the Collins review in 2010. The review proposed that trainees need more exposure to community-based placements such as psychiatry, public health and community paediatrics and that they also need to learn to deal with chronic conditions. Bearing in mind that nearly a third of the general practitioner's patients will have psychiatric problems, it is essential that all doctors gain some exposure to psychiatric practice. It is crucial that this exposure is appropriate and adequate so that the next generation of doctors can provide accessible services that patients will be willing to use.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Dinesh Bhugra (dinesh.bhugra@kcl.ac.uk)
Footnotes
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See education and training, pp. 65–68, this issue.

Declaration of interest

D.B. was a member of the John Collins Review Panel. These are his personal views.

Footnotes
References
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1 Department of Health. Modernising Medical Careers: The Next Steps. Department of Health, 2004.
2 Goldacre, MJ, Turner, G, Fazel, S, Lambert, T. Career choices for psychiatry: national surveys of graduates of 1974–2000 from UK medical schools. Br J Psychiatry 2005; 186: 158–64.
3 Collins, J. Foundation for Excellence: An Evaluation of the Foundation Programme. Medical Education England, 2010.
4 General Medical Council. The Trainee Doctor. GMC, 2011.
5 Academy of Medical Royal Colleges, NHS Institute for Innovation and Improvement. Medical Leadership Competency Framework: Enhancing Engagement in Medical Leadership (3rd edn). NHS Institute for Innovation and Improvement, 2010.
6 Lowe, J, Rands, G. Current position of psychiatry in UK foundation schools. Psychiatrist 2012; 36: 6871.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Foundation for what? Commentary on … Current position of psychiatry in UK foundation schools

  • Dinesh Bhugra (a1)
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eLetters

Ensuring Firm Foundations For Nascent Psychiatrists

Gareth Thomas, ST4 Old Age Psychiatrist
09 February 2012

The importance of the Foundation Year (FY) experience cannot be understated. It is disappointing to read that only 'one in five doctors have the likelihood of securing a FY psychiatry post'(3) but hopefully this may improve. We must consider carefully however that it is not just the number of posts but also the quality of the experience.

Foundation doctors apply for Specialty Training early in FY2, so would increasing the numbers of FY2 doctors impact on their career choice given that 2 out of these 3 doctors in FY2 would have applied for specialty training by the time they rotate into psychiatry? The interview process in all the specialties are relying increasingly heavily on the foundation portfolio and perhaps appointing more FY1 Doctors would give them enough time not only to consider a career in psychiatry but also timeto develop their portfolio in readiness for the core training application process.

There are concerns that some FY2 posts are being used to 'fill the void' in rotas left by the recruitment and retention problems. Although these posts undergo a quality assurance process with each Deanery to meet the curriculum requirements, there must be concerns that eroding experiences by working more out of hours shifts and covering for vacanciesin a diminishing service will in fact have a negative effect on training and subsequent recruitment.

We must also consider whether each subspecialty provides the right sort of experience. We must carefully map the post to the foundation programme curriculum and provide the FY Doctor a diverse and rewarding experience that is integrative to their other posts, expectations and career development.

The 'promoting psychiatry' agenda is likely to be a major feature of the professional landscape in the years to come. It may take some time to increase the numbers of posts but the specialty must act now. Every psychiatrist needs to be more proactive and take on greater roles within the Foundation programme and this may include offering to teach on the Foundation Programme, offering more tasters, approaching the foundation programme directors with audits and other projects and organise recruitment events. We must also encourage the Trusts to create foundationdoctor posts. Whilst there are restrictions to practice and the investmentof supervision time, the reward of what the Foundation Doctor can bring tothe service both now and potentially for much of their career must be considered. Deaneries also have a role in providing novel and unique opportunities for Foundation Doctors to enhance psychiatry recruitment

Psychiatry is a rewarding specialty but we must give very careful thought to the foundation posts and their role in recruitment.

References:

1.Thomas G and Knapp J. Bringing psychiatry to the next generation: a Foundation Year 1 doctor's tale. Psychiatric Bulletin 2008; 32, 312-313.

2.Department of Health. Modernising Medical careers: The Next Steps.Department of Health, 2004.

3.Bhugra D. Foundation for what? The Psychiatrist 2012, 36, 69-70

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Conflict of interest: None declared

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