We read Dr Gordon's paper ^{Reference Gordon1} with great interest as it echoes our own work while surveying the confidence of junior doctors new to psychiatry. Like Dr Gordon, we felt there was a specific need to combat their self-perceived lack of confidence, particularly in the out-of-hours environment, as often more senior supervision is based off site. However, we do feel that Dr Gordon's recommendations for ‘mental health training of new doctors working in the emergency department’ should perhaps be expanded to all those new to psychiatry, as the identified difficulties are not unique to the liaison service.

This issue has potential effects on patient safety, which is substantiated by a third of foundation year 1 respondents in the British Medical Association's study reporting that they had been asked ‘to undertake tasks which they felt were beyond their capabilities’ during their placements. ²

In our own work, we expressly aimed to target this situation, consequently designing and implementing a simulation-based programme as part of the induction process of our trust. Simulation-based training has been recommended as a risk-free and efficient way of improving the quality of junior doctors’ training. ^{Reference Temple3} Junior doctors new to psychiatry participated in a range of complex, clinical, out-of-hours simulated scenarios under the observation of experienced consultants and patient representatives. Timely focused feedback was given by the observers, and the doctors had an opportunity to discuss their performance within clinical supervision sessions using recorded video. We received positive feedback from the participants, including a self-reported increase in their confidence when this was measured in follow-up sessions. They also felt that this would have an impact on their performance with real patients. The patient representatives gave a unique viewpoint and they felt that there were clear improvements in trainees’ performance following the first session.

We recently presented our small-scale pilot in a London Deanery ‘Quality and innovation’ conference, where it was well received. It generated interest from other trusts that were keen to potentially implement similar programmes locally.

We ultimately hope that our project will be used to increase and focus supervision in out-of-hours work, while also improving patient safety using engaging and interactive learning through simulation.