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Mental Health training in Foundation Programmes

Paul Baker

Deputy Postgraduate Dean

Health Education North West

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• What is foundation training? • National and regional context • Role of clinical supervisor • Post content • Meeting curriculum needs • Developing trainers • Foundation teaching programmes • Quality assurance • Hot topics

Overview

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• Created 2006

• Part of Modernising Medical Careers

• Replaced pre-registration house officer posts and aspects of SHO posts

• 2 year programme usually in 6 x 4 month posts

• Overseen by Foundation Programmes

What is Foundation training?

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Foundation training is a two-year programme

But with two definite waypoints

• ARCP at end of year 1

• Sign off entitles trainee to full GMC registration

Foundation Year 1

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• ARCP end of year 2

• Sign off entitles trainee to foundation achievement of competence document (FACD)

• Requirement for entering speciality/GP training

Foundation Year 2

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2006

Slow start for Psychiatry speciality

Patchy

National context

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2010 “Foundation for excellence” Collins

Distribution of posts by specialty does not reflect current/future workforce needs of NHS

Predominance of medical and surgical posts

Insufficient emphasis on community work and chronic disease

Workforce projections require 6% of doctors to train as psychiatrists

National context

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Speciality recruitment issues

2014

“Broadening the Foundation Programme”

7.5% placements in mental health

i.e. 45% of trainees will experience it

100% community placements

National context

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• Variation in implementation

• Some deaneries exceeded target

• Some struggling (‘‘it can’t be done!’’)

• ‘concerns’ over standards

National context

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NW : mental health posts

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Foundation programmes and mental health trust posts FY1+2

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Mental health trusts and foundation posts FY1 + 2

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Quality

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• They are not trainee psychiatrists

• Separate educational / clinical supervisor

• Educational supervisors not usually psychiatrists

• Higher level of supervision required for clinical work

What’s different from psychiatry?

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• Curriculum

• SLEs not WPBAs

• eportfolio

• Clinical supervision group identified

What’s different from psychiatry?

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• Similar to WPBAs but not scored

• Free text comments and developmental action points

Structured learning events (SLEs)

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• Reflective practice by trainee

– Mini CEX

– Directly Observed Procedural Skill DOPs

– Case based discussion

– Developing the clinical teacher

• Aim for 1 per month of each type

• Minimum 1 per placement of each type by CS

Structured learning events (SLEs)

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Initial meeting to discuss expectations, learning opportunities etc

Undertaking and facilitating SLEs Giving regular feedback and collating feedback

from the placement supervision group Discussing any concerns with Educational

Supervisor (performance, health, professional conduct)

Completing ‘End of placement report’ and provide a summative (pass/fail) assessment on the 4 months

Role of clinical supervisor

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• Guidance documents from Royal College of Psychiatrists

• Enthusiastic trainer with time to supervise

• Old age and liaison popular

• Ward based allows for clearer role

• Community work useful for managing long term conditions

• Some specialist posts eg mother and baby unit

Content of posts

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• Consent :

• Understanding capacity and best interests

• Legal framework:

• Understand and apply basic principles of Mental Health Act and use of restraint

• Undertakes regular patient reviews

• Ordering investigations, documenting reviews, understanding link between mental and physical health

Foundation competencies for psychiatry

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• History and examination:

• Undertake a mental state assessment

• Understand principles of child protection

• Safe prescribing

• Manages patients with long term conditions

• Health promotion and public health

• Impact of drug and alcohol misuse

• Physical morbidity in severe mental illness

• Deprivation and health

Foundation competencies for psychiatry

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• Take a detailed history including physical, psychological and social factors

• Carry out Mental State Examination

• Assess cognitive function

• Communication skills

• Summarise and document information

• Understand assessment of capacity, use of Mental Capacity Act and Mental Health Act

Competencies and SLEs

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• Foundation with School of Psychiatry

• Appointed lead

• Accredit trainers

• Accredit environments

• Tutors and DMEs

• Need for more training in foundation requirements, portfolio etc

• GMC Approval of trainers

Developing trainers

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• Average one session per week in NW

• Please volunteer

• Good way to develop local links

• Skills acquisition

• Role play / simulation

Foundation teaching programmes

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• Feeling left behind, first cohort of FY1s

• On call FY2

• Prescribing

• What to do when things are going wrong?

• Close contact with FPD

• May need to consider moving posts

Hot topics / troubleshooting

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• It can be done

• Psychiatrists can train

Summary

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Thanks for listening!

Keep in touch

[email protected]

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