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The Royal College of Psychiatrists Improving the lives of people with mental illness

Foundation training

 

Find out how these two doctors fared when they decided to go in at the deep end and fully immerse themselves in psychiatry. Did their experiences live up to their expectations?


Foundation Year 1 training personal perspective

When people think about jobs in their first year as a doctor, the mind tends to focus on the traditional surgical and medical specialties that dominated what was once the PRHO year. However, with the new foundation year 1 (FY1) year in place, opportunities to step outside these areas at an early stage have become common throughout the country. I knew from the start of medical school that I wanted to specialise in psychiatry, however I was concerned that I may have to dedicate myself to a training programme with no experience of this specialty as a qualified doctor, so when the opportunity to work in this area during my FY1 year arose, I jumped at the chance.

 

A giant leap

As an FY1 in acute medicine, I spent little time with my patients as a majority of my day was taken up with filling out forms and chasing up tests while my senior house officer saw the ‘interesting stuff’. When I arrived on my ward on the first day of psychiatry it soon became clear that this would no longer be the case.

As a psychiatric FY1, I would not be doing on calls or out-of-hours work as I had been used to, but my responsibilities on the ward were much greater than my previous job. I was responsible for the day-to-day care of 20 inpatients on the ward, all over 65 years of age. I would be helping with the initial assessments of new admissions and monitoring their treatment and feeding back this information to the responsible consultant via daily meetings and a weekly New Patient Meeting to ensure all the patients’ needs had been met.

I would be the first port of call for the ward staff if they had any concerns about a patient, as well as keeping family members informed, whilst also planning the long-term management of their condition. 

Initially, this appeared to be quite a leap from the FY1 role I had been used to. However, thanks to the support of the ward staff, I soon found my way. I was allowed to take responsibility and make management plans of my own whist having the safety net of senior colleagues at hand. I found both consultants on site were always available, in addition to other senior members of the medical staff, if I needed advice or help. I attended between two to three hours of consultant teaching a week which helped me to develop my theoretical knowledge of the specialty whilst also becoming more familiar with the hands on nature of the job.

 

Multidisciplinary

I enjoyed the ability to work in a real ‘multidisciplinary team’ that we were often taught about in medical school, but so rarely see in practice. I had daily contact and meetings with the nursing staff, occupational therapists, physiotherapists and pharmacists and they were all keen to show me how the system worked from their point of view.

I soon became familiar with home visits, kitchen assessments, art therapy and all kinds of things you don’t see in the textbooks. I was also given the opportunity to participate in the Care Planning Meetings that took place for each patient on the ward. I found this to be really beneficial as it not only helped me to understand the long term management of these patients but also to get a better understanding of psychiatry in practice in the community.

Now, as I reach the end of my FY1 year, I can safely say that the four months I spent in psychiatry was the most enjoyable and the most informative part of my year. I was given the opportunity to work independently, making my own differential diagnosis and management plans whilst having advice of those around me. I found I developed not only my psychiatric skills but also my general medical and clinical skills in a way that was just not possible in other jobs. On top of all this, it helped confirm the idea that psychiatry is the area of medicine in which I want to specialise in.

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Foundation Year 2 training personal perspective

 

My perceptions of psychiatry were very similar to the majority of my colleagues and seniors prior to my Foundation Year 2 (FY2) placement. There are many pre-formed ideas regarding psychiatry which start from those two or three weeks as a medical student.  I’ve been told by a number of colleagues “psychiatry isn’t really a proper specialty is it?”, “none of the patients get better” and “it’s for those who aren’t good enough to get into anything else.”

I started my FY2 job with these voices and thoughts echoing in my head. One year on, I hold my own thoughts, my own experiences.

 

Not so wishy washy

I think back to those four months in psychiatry and all the patients I admitted, treated and most importantly helped reform the pieces of their lives – the elderly woman with schizophrenia who would not leave her house in fear the police would kill her, the young mother with postnatal depression who jumped out of a window to save her child from herself, the suicidal young asylum seeker with post-traumatic stress disorder following his experiences in war.

This may all sound very dramatic but this was the reality of the ‘wishy-washy’ specialty. These were the patients who were admitted to hospital not being able to cope or function, but were able to leave functioning independently. It was after my contact with these patients that I realised not only did they get better, but you were able to watch them do so, play a part in it and experience the reward once they were no longer unwell. 

 

For those who care

With such a huge role, it’s not just "those who aren’t good enough" that want to or should do the specialty; it should be those who care and are aware that psychiatry is both a consequence and cause of many of the medical and surgical conditions that are presented to juniors like me currently in the Emergency Department.

Although I secured an Emergency Medicine training post, I now plan to reapply for psychiatry next year. I miss the variety, the continuity of care, the patient contact and the pleasure and satisfaction of knowing I have helped someone function again.

As clichéd as it may sound, I decided to do medicine because I wanted to help people. All specialties do this but for me, none more than psychiatry. If you form your own opinions you may just find it as interesting and rewarding as me.

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Page updated: 5 June 2014

 

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