Foundation pic

Foundation Psychiatry Placements

Good Practice Guide


Doing a psychiatry post in the Foundation years
Key personnel
The Foundation Curriculum
Mental health in the Foundation Programme Curriculum
Assessment during foundation training
The syllabus
Recommendations for training in a psychiatry foundation post
Report authors


  1. Example of detailed syllabus; FPC1 and FPC2


If you are considering a psychiatry foundation post or are looking at how to plan your Foundation training, we hope this guidance will encourage you to apply for one of our posts and welcome you to this lively group of trainers and doctors in training.

This guidance has been compiled by reviewing national guidance and literature in this field, by using data from the local GMC survey, by liaison with foundation doctors, trainers and others associated with the Foundation psychiatry training posts in Severn PGME. If you have any queries, please contact any of the staff below, who will try to help.

We have included information for potential new foundation doctors to help them to make their decision about training in psychiatry, and to show them some of the opportunities available. It is also for trainers (including potential new trainers and existing) to make clear their requirements and what they need to offer. We have included up to date information about the curriculum. We also hope the guidance will be useful for foundation doctors in post, to help them to understand the range of training opportunities we would like them to have. In this way the guidance may help over time to influence standards of training and foundation doctor experience. The document could be used in induction and also to help us to look at future post development.

The Foundation Programme was established in the UK in 2005 as part of Modernising Medical Careers. It is a national 2-year generic training programme, consisting of three different placements in each of the first (F1) and second (F2) years, which forms the bridge between medical school and specialist/general practice training.

The Foundation Programme curriculum, which underpins the training and professional development of newly graduated doctors, relaunched in summer 2021. The UKFPO provides a curriculum resource with national guidance and protocols available to support each of the curriculum's foundation professional capabilities. The Gold Guide (9th edition) is a reference guide for postgraduate foundation and specialty training in the UK.

Doing a psychiatry post in the Foundation years

There are many positive reasons for considering a psychiatry post in the Foundation training years:

  • Psychiatry is interesting and thought provoking. Psychiatric practice is holistic and provides an opportunity to develop a real understanding of psychological problems.
  • Psychiatry is largely a community based specialty and provides opportunities to work in many varied settings.
  • Psychiatric problems are very common and every doctor will face these in their professional lives.
  • The reason for medical problems being difficult to treat is often only understood through an understanding of complicating personality or mental health factors.
  • There is a growing evidence base demonstrating the links between physical and mental health, and thus having an understanding of the psychological basis of illness will be relevant across specialties.
  • For people considering a career in General Practice, some experience of Psychiatry will be enormously useful, as mental health difficulties are some of the most common presentations to primary care.
  • There will be many opportunities in psychiatry posts to hone your history taking style and communication skills. If you work on these skills at the start of your career it will aid the rest of your work in medicine, whatever you choose to do. Better communication is linked to better patient experience and improved general healthcare outcomes.
  • It is important to understand how mental health services work so that you can signpost patients effectively to various sources of help.

Foundation doctors often like working in psychiatry because they have time to fully assess a patient’s difficulties and get an understanding of social and psychological aspects of the presentation.

There are many opportunities for teaching, research, quality improvement, audit and service development in psychiatry. Some of the posts have more time to complete this work than acute medical/surgical posts.

Psychiatric foundation doctors receive weekly psychiatric teaching. This is protected time, and a good opportunity to consolidate knowledge base and meet with the peer group. Towards the start of the post all foundation doctors are invited to attend a day long day of training which involves simulation of commonly occurring scenarios in psychiatry. Foundation doctors are also welcome to attend their local academic programme, where they are invited to be involved in presenting case presentations. They are also welcome to attend our Trust-wide webinars. 

Key personnel

Dr Clare van Hamel, Foundation School Director, Severn PGME: Main responsibility is to oversee the education and training of all Foundation doctors in the Severn region, ensuring that all programmes provide foundation doctors with appropriate experience to fulfil the curriculum.

Dr Liz Ewins, Associate Director of Medical Education and Foundation lead, Avon and Wiltshire Mental Health Partnership NHS Trust
Dr Latha Guruvaiah, Foundation lead, Gloucestershire Health and Care NHS Foundation Trust
Dr Linda Heaney, Director of Medical Education, Somerset NHS Foundation Trust
Dr Sian Hughes, Head of School of Psychiatry

Please feel free to contact any of the above individuals through the appropriate Trust or Severn PGME website.

Psychiatry Posts in Severn Foundation School

Placement descriptions for each post can be found under the Trust pages.

The Foundation Curriculum

The Foundation curriculum in psychiatry has been revised in 2021.

The Curriculum is written to link explicitly with the General Medical Council's (GMC) Generic professional capabilities framework.  

Satisfactory completion of foundation year 1 (F1) will satisfy the needs of the GMC, making the foundation doctor eligible to apply for full registration. Satisfactory performance in foundation year 2 (F2) will lead to the award of a Foundation Programme Certificate of Completion (FPCC), which will indicate that the foundation doctor may progress to specialty or GP training or work in other healthcare settings. 

The curriculum sets out a holistic approach to care including physical health, mental health and social health and the skills required to manage this in both acute and community settings and for patients with chronic conditions. Foundation doctors must demonstrate that they are competent in the traditional elements of medical training but also in areas such as communication and consultation skills, patient safety and teamwork. The curriculum provides a framework for educational progression that will help them achieve these skills and supports them through the first two years of professional development after graduation from medical school.

Mental health in the Foundation Programme Curriculum

Mental health disorders are common and frequently go unrecognised and untreated. The Foundation programme curriculum explicitly emphasises the need for physical and mental health to be considered in tandem (see the statement on: The 'Parity of Mental Health' and the importance of social wellbeing).

The following topics must be included in the FD core training programme if they are not available to all FDs, either via direct presentations or recognition of these disorders in patients presenting with other conditions.

Training should cover the recognition and assessment of:

  • Depression
  • Mania
  • Psychosis
  • Anxiety/panic
  • Personality disorder
  • Delirium
  • Chronic cognitive impairment/dementia
  • Eating disorders
  • Addictions
  • Somatisation disorders, including functional syndromes

FDs also need to develop skills in managing clinical scenarios where they may be required to apply knowledge of mental health legislation/treatment to a patient with a physical health presentation:

  • assessing capacity and using Mental Capacity Act;
  • Mental Health Act 1983 (or equivalent, e.g. Mental Health Scotland Act 2015) including but not limited to 5(2)*;
  • relevant ethical framework around difficult decision-making, e.g. treating patients with eating disorders or self-harm;
  • understanding that physical disease can present with psychiatric symptoms (e.g. multiple sclerosis, Cushing’s, hypothyroidism) when ordering and interpreting investigations;
  • serious adverse effects of common psychotropic medications, e.g. neuroleptic malignant syndrome, QTc prolongation, serotonin syndrome;
  • communicating with and managing a disturbed or challenging patient, and understanding the risks some patients with mental health conditions pose to themselves and to others;
  • explaining a diagnosis to a patient (or carer) who has Medically Unexplained Symptoms (MUS) or a non-organic cause for their symptoms, e.g. panic disorder presenting as chest pain.

* The limitations on practice for pre-registration doctors in this area should form part of this discussion.

Assessment during foundation training

The UK Foundation Curriculum is an outcomes-based curriculum with three Higher Level Outcomes (HLOs), underpinned by 13 Foundation Professional Capabilities (FPCs).

Formal assessment of progress will be made at the end of each placement and at the end of F1 and F2. The clinical and/or educational supervisor’s end of placement assessments will be based on multiple sources of evidence including feedback from colleagues who have observed practice in the workplace (Placement Supervision Group). Other important evidence will be provided through the e-portfolio including team assessments of behaviour (TAB), engagement with SLEs, reflective practice throughout the placement and satisfactory demonstration of the core procedural skills required by the GMC.

Supervised Learning Events (SLEs)

An SLE is an interaction between a foundation doctor and a trainer which leads to immediate feedback and reflective learning. This is recorded in the e-portfolio using dedicated SLE forms. SLEs are designed to help FDs develop and improve their clinical and professional practice and to identify targets for future achievements. 

There is no specific number of SLEs required in a particular level of training or in a particular placement. Numbers will depend on the availability of opportunities to undertake them and the benefits to the FD of formal feedback. Higher numbers should provide more robust evidence of progress against the curriculum. Different teachers/trainers should be used for each SLE wherever possible, to gain a variety of different viewpoints. Foundation doctors should ensure that SLEs are evenly spread throughout each placement.

SLE types:

  • Mini-CEX
  • Direct observation of procedural skills (DOPS)
  • Case-based discussion (CBD)
  • Developing the clinical teacher (DCT)
  • LEADER (clinical leadership)
  • LEARN (learning encounter and reflection note)

Frequency of assessments per 4 month placement

E-portfolio: Contemporaneous
Team assessment of behaviour (TAB): Once in first placement in both F1 and F2, with optional repetition.
Placement Supervision Group (PSG) feedback: One in the first or second placement of both F1 and F2, optional repetition
Clinical supervisor end of placement report: Once per placement
Educational supervisor end of placement report: Once per placement (except final placement, when ES end of year report required)
Educational Supervisor’s End of Year Report: Once per year
Curriculum mapping: Throughout the year
Personal learning log: Throughout the year

The e-portfolio is a record of a foundation doctor’s progress and development through the foundation years. Successful completion of the Curriculum requires the achievement of competence in a variety of domains based on Good Medical Practice. Evidence of achievement of outcomes and increasingly sophisticated performance will be recorded in the e-portfolio. The Syllabus lists competences into subsections. Each subsection is headed by behaviour descriptors indicating the levels of performance that foundation doctors must achieve in foundation year 1 (F1) and how they should be developing their ability to work with increasing independence in foundation year 2 (F2).

At the first session with the educational supervisor, the foundation doctor may wish to discuss aspects of the Curriculum, which might include:

  • how to build on strengths from undergraduate training
  • particular areas of interest to explore
  • any potential targets for development which may need to be addressed
  • how to record achievements in the e-portfolio.

The foundation doctor and educational supervisor should also agree a timeline for this undertaking and recording of achievements, and they should agree the time and dates for subsequent meetings.

The syllabus

The purpose of the UK FP is to establish the newly qualified doctor as:

  1. an accountable, capable and compassionate clinician;
  2. a valuable member of healthcare workforce and;
  3. a professional, responsible for their own practice and portfolio development.

These form the three Higher Level Outcomes (HLOs) of the Foundation Programme. For convenience, the three Higher Level Outcomes are each divided into a number of capabilities (between three and five), known as Foundation Professional Capabilities (FPCs), with guidance about key areas to cover in the F1 and F2 years. An example of the section on FPC1, Clinical assessment, and FPC2, Clinical prioritisation, is given in Appendix 1.

Recommendations for training in a psychiatry foundation post

These recommendations recognise the contractual differences resulting from the F1 being a pre-registration training year and the differences in clinical experience in foundation doctors undertaking the F1 and F2 years.

Taster days 

Foundation doctors have a number of days available to take as taster days in medical fields of interest for further training. These may be of particular use if it is not possible to do a post in this specialty as part of foundation training or if the placement would occur after the application process.

If you are a foundation doctor interested in applying for psychiatry, we would like to encourage you to spend 1-2 days as taster days. This would involve following a junior psychiatrist and their team to learn about what the job and training entails. Please view the psychiatry taster days page for information on available tasters and contact information to arrange.

In addition to the taster days, there is also a programme of Deanery teaching days, regional events where all the foundation year 2 doctors can attend a day of teaching in psychiatry. Please log onto Maxcourse to book on.

Structure of full time posts

All posts are of 4 months duration.

Groups of foundation training posts have been developed across the region, to promote peer support, enable joint learning and cover arrangements and to reduce isolation. Posts provide breadth of experience, including inpatients and community work. 


At the start of their posts, foundation doctors attend a local induction to provide information about the area they are working in and an overview of the key roles, responsibilities and working relationships.


All foundation doctors must be appropriately supervised at all times, and should initially be directly supervised by a more senior colleague when seeing patients, until they gain confidence and can feed back to a consultant.

Psychiatric foundation doctors have weekly protected, one hour supervision with their consultant and this provides particular opportunities for support and broadening the doctor's understanding of the field. This is an opportunity to bring a topic of cases for discussion, for completion of assessments, to provide clinical and educational support, and for career guidance.

Independent practice

F1 doctors in psychiatry should not assess patients independently and they should always work jointly in the community, with senior and fully trained team members, rather than alone. Patients seen by foundation doctors in clinic should also be seen by the consultant after the foundation doctor has made their assessment so that the assessment can be verified and there are further opportunities for the foundation doctor to learn from how the consultant interacts with the patient.

Both F1 and F2 doctors should be supported carefully to develop skills in carrying out and documenting risk assessment. Clinical risk assessment may be carried out under supervision by a trainer, a more senior trainee or an experienced team member. Risk assessment should be viewed as another specific responsibility with potential legal consequences, for which training and competency assessment should be provided and formally confirmed before foundation doctors carry out these duties independently.

Responsibilities for work carried out under the Mental Health Act

F1 doctors are not fully registered and cannot therefore undertake the role of the deputy for the Responsible Clinician and cannot assess patients under the Mental Health Act for Section 5(2) or 4.

F2 doctors are often part of psychiatry duty doctor rotas, together with core psychiatry trainees. The duty doctor customarily has particular responsibility to assess voluntary in-patients for detention under the Mental Health Act, by signing Section 5(2).

F2 doctors should only sign Section 5(2) forms (or carry out any other Mental Health Act responsibility) or carry out risk assessment once shown to be competent (e.g. by evidence in the portfolio of supervisors confirming specific supervised experience and discussion in personal supervision).

On call

F1 doctors should not be doing psychiatry on call, but ideally should continue to do medical on call in their acute hospital even when in a psychiatry placement. This will help to maintain links with peers and to build on medical skills being developed.

F2 doctors will generally be on call on the standard core training rota, but require close supervision from the on call consultant when making any assessment or clinical decisions. This supervision gradually reduces as the F2 feels more confident in the psychiatry post.

The experience of being on-call in psychiatry is very different to being on-call in a general hospital. The Advanced Trainees and Consultants who are on-call with you are there to supervise and support you, and will expect you to be contacting them with any questions or concerns. If you are unsure about anything at all, please call them! We recommend reaching out to them at the start of a shift to introduce yourself and say hello (by text or email); this can help when you need to contact them later on with an issue.

In addition, prior to your first on-call shift, we encourage you to speak with other trainees on your rota. Following discussion with them, please do feel free to arrange to shadow a period of one of their on-call shifts prior to your own first on-call shift, if you would like to do so. This will allow you to ask any questions you may have, find out the logistics of being on-call, and hopefully will alleviate any worries you may have about being on-call in psychiatry! This should be easy to arrange once you start in psychiatry, and your rota coordinator can help put you in touch with other trainees on the rota if needed. If you do arrange some on-call shadowing, please arrange with your supervising consultant to take the time back in lieu.

Assessment of Medically Ill Patients:

The following guidance is given routinely to Foundation doctors starting in psychiatry.

A Foundation doctor may be called upon to assess patients who are medically unfit either in the psychiatry in-patient units or possibly in the community.

It is important to be aware that psychiatric hospitals do not have facilities to support patients with serious physical health problems and the foundation doctor is not in a position working in these settings to facilitate urgent investigation, or initiate immediate and complex treatment such as IV support or catheterisation.

In many respects the support available may even be less than in a standard community setting as there is a lack of access to GP level medical advice.

Most patients are not acutely physically ill. Some patients will have general medical needs, as in any other community setting. In this regard, psychiatric hospitals are like other community hospitals, residential and nursing homes, and crisis houses. None of these sites, in common with many psychiatric hospitals, have resident doctors of any grade.

In the event that a patient needs more immediate and complex physical assessment, it is expected that the foundation doctor should discuss with a senior psychiatry colleague and it is generally necessary to have these individuals seen in the nearest A&E department. It would of course be helpful if a patient was referred, to discuss the case with the casualty team, while the transfer is being organised. This would normally require an ambulance, which the in-patient team would generally organise.

As a Foundation doctor working in psychiatry, you would not normally be expected to initiate complex physical treatments. If you are uncertain about appropriate physical care of an individual, you should always discuss this issue with a senior psychiatry colleague, who may be the local core/advanced trainee in your unit or your consultant or the consultant on-call.

It may be useful to contact the specialist team in the general hospital for advice, but where a complex decision is being made this should always be shared with senior colleagues in the psychiatric team, who will be responsible for the treatment while the patient is in a psychiatric hospital.

Note that discussion of the physical problems with a more senior psychiatric colleague is not generally to get expert medical advice (bearing in mind that as the psychiatric specialists become more senior their physical medicine skills tend to become out of date), but to bring the concerns to their attention so they can advise on the need to contact local acute medical/surgical services and how best to do this.

Some Foundation doctors have expressed reluctance to contact the consultant on call. It should be stressed that reluctance plays no part in this decision. It is a duty of any doctor to seek advice when feeling out of depth or uncomfortable with clinical decision making, and this is expected as part of good medical practice (GMC).


Handover arrangements in psychiatry posts are often rather different in mental health trusts, as compared with acute Trusts. The typical medical model of handover may not be suited to services which include multiple community and in-patient mental health teams and where members of the crisis team often hold and carry forward key risk information, but it is important to note that as they enter the culture of mental health services, foundation doctors bring knowledge and skills associated with other medical cultures with them and these ways of working may operate equally well in mental health services. It is vital that key information is handed over effectively from and to teams working out of standard 9-5 working hours.

Clinical learning experiences

Foundation doctors and their trainers should recognise the importance of maximising the wide variety of learning opportunities in the clinical workplace and undertake SLEs to capture this:

  • Work as a medical professional, including clinical practice, meetings and documentation
  • Accounts by patients, service users and carers of their experiences
  • Analysis of care scenarios supported by literature reviews
  • Quality improvement and audit projects
  • Audio/video recording of personal practice or a colleague's practice
  • Computer-controlled simulator
  • Discussion of one's own or another's practice
  • E-learning: e-LfH, BMJ Learning
  • Group discussion of typical cases

Responsibilities of trainers

Across each level of training (F1 and F2), the foundation doctor will be assigned an educational supervisor (ES) who will support and monitor the FD's progress in a long-term manner and help guide their personal and professional development. The ES should meet the FD regularly and discuss what they have done and what they still need to do to complete the training year. At a minimum, these meetings should be at the start of the year, at the end of each placement, and at the end of the year (before the ARCP takes place). At the end of each training year the ES will make a recommendation to the ARCP panel in the form of an ES end of year report.

Every foundation doctor will have a named clinical supervisor (CS) for each placement, who will usually be a specialist in the area in which they are training for that period.

The CS should meet the foundation doctor at the start of the placement to ensure they are familiar with their work environment, responsibilities, the other staff with whom they will be working, and to advise them on how to obtain the most from the placement. A further meeting should take place in the middle of the placement to provide feedback, highlight areas of good practice, and address any areas of weakness. At the end of the placement, the CS should meet the FD to complete the CS end of placement report, which forms a vital part of the FD's assessment. Evidence of all meetings and the end of placement report should be recorded in the e-portfolio. At least once in each training year, the end of placement report must include formally recorded comments from other healthcare professionals alongside whom they have worked. These professionals make up the placement supervision group (PSG). 

Study leave during foundation training

Please refer to the Study Leave page.

Report Authors

Dr Liz Ewins, Consultant Psychiatrist, Associate Director of Medical Education, Lead for Foundation Training, AWP

Rani Achhireddy, Education Programme Coordinator, Severn Foundation School


Boyle AM, Chaloner DA, Millward T, Rao V, Messer C. Recruitment from
foundation year 2 posts into specialty training: a potential success
story? Psychiatric Bulletin. 2009; 33: 306-8.

Brown T, Addie K, Eagles J. Recruitment into psychiatry: views of consultants in Scotland. The Psychiatrist, 2007; 31:411–413.

Collins J. Foundation for Excellence. An Evaluation of the Foundation
Programme. Medical Education England, 2010.

Herzberg, J., Forrest, A. & Heard, S. (2004). Modernising medical careers:
An opportunity for psychiatry? Psychiatric Bulletin, 28, 233-234.

Royal College of Psychiatrists (2011). 101 Recipes for Audit in Psychiatry
Eds: C Oakley, F Coccia, N Masson, I McKinnon and M Simmons. Gaskell.

Welch, J, Bridge, C, Firth D et al (2010)Improving psychiatry training in the Foundation Programme. The Psychiatrist, 35, 389-393.

Appendix 1: Example of detailed syllabus; FPC 1: Clinical assessment

Assess patient needs in a variety of clinical settings including acute, non-acute and community

F1 Behaviours

  • Communicates with patients sensitively and compassionately to assess their physical, psychological and social needs.
  • Understands that presentation, including some physical signs, will vary in patients of different backgrounds at different ages and sometimes between men and women.
  • Uses collateral history and alternative sources of information when appropriate.
  • Examines the physical and mental state of patients sensitively, with a chaperone where necessary, eliciting and interpreting clinical signs including those elicited by the mental state examination.
  • Recognises vulnerable individuals including those at risk of abuse or exploitation, and demonstrates appropriate consideration of safeguarding issues. 

F2 Behaviours (in addition to F1)

  • Is confident in patient interactions in acute, non-acute and community settings.
  • Appropriately instigates a range of standardised assessments routinely (e.g. mental state, suicide risk scores, confusion assessments, pain scores, continence, VTE, nutritional assessments etc.).
  • Actively seeks symptoms and clinical signs that confirm or refute diagnostic possibilities.
  • Demonstrates focused assessments in an appropriate context and in a safe manner.

FPC 2: Clinical prioritisation

Recognise and, where appropriate, initiate urgent treatment of deterioration in physical and mental health.

F1 Behaviours

  • Recognises the need for urgent intervention to treat both mental and physical health problems.*
  • Demonstrates the skills needed to initiate immediate management in the critically ill patient.*
  • Knows when to seek advice and/or physical support as required.
  • Provides comfort and support to the dying patient.

*To complete F1, the foundation doctor must demonstrate the following in the simulated environment:

  • identify the causes and promote the prevention of cardiopulmonary arrest;
  • recognise and treat the deteriorating patient using the ABCDE approach;
  • undertake the skills of quality CPR and defibrillation (manual and/or AED) and simple airway manoeuvres;
  • utilise non-technical skills to facilitate initial leadership and effective team membership.

F2 Behaviours (in addition to F1)

  • Takes responsibility for initial management of critically ill patients, seeking advice and/or physical support as required.*
  • Demonstrates the knowledge and skills required to manage a variety of common urgent care scenarios, including mental health presentations and the ability to take a leading role in these situations.
  • Recognises 'the dying patient' and ensures comfort and support.

*To complete F2, the foundation doctor must demonstrate the following in the simulated environment:

  • recognise and treat the deteriorating patient using a structured ABCDE approach;
  • deliver standardised CPR in adults;
  • manage a cardiac arrest by working with a multidisciplinary team in an emergency situation;
  • utilise non-technical skills to facilitate strong team leadership and effective team membership;
  • communicate with and manage a disturbed or challenging patient with a mental health condition.