As a foundation year 2 (F2) doctor currently rotating through a pilot post in psychiatry in the Northern Deanery, I read ‘Improving psychiatry training in the Foundation Programme’ ^{Reference Welch, Bridge, Firth and Forrest1} with great interest. I am in broad agreement with the authors that psychiatry placement in the foundation programme is of great benefit both to the new doctor in terms of experience and to the profession as a whole, boosting awareness of the specialty and recruitment. However, based on my experience so far in psychiatry I have become aware of several possible detrimental effects of psychiatry as an early foundation placement for F1 doctors.

In their article, Welch et al stated that there may be ‘difficulties maintaining medical skills’ and ‘acquiring acute medical competences’. A newly qualified F1 doctor working in a medical or surgical job experiences an extremely steep learning curve as they develop skills in grappling with acute medical problems and basic everyday tasks such as prescribing medications and fluids, phlebotomy, cannulation and traditional ward rounds. Although some of these experiences are common to psychiatry, the role of the foundation doctor in the mental health multidisciplinary team is quite different and unique. Often the mental health multidisciplinary team looks on the foundation doctor for medical advice and management of patients with physical health problems. I perceive two problems with a newly qualified F1 doctor rotating through psychiatry during their first or even second placements. First, the F1 doctor is unlikely to be able to complete the steep learning curve for practical tasks at the beginning of their year, when general hospitals offer more support and are often more lenient as the new doctor develops basic skills. This could leave the F1 doctor with feelings of incompetence and possibly lead to them being viewed so by peers, seniors and ward teams when commencing a medical or surgical job later in their first year. Second, without a good grounding in dealing with common medical problems with supervision from a medical team in a general hospital, the F1 doctor is likely to lack skills and confidence in the management of physical health problems on a psychiatric ward. Therefore the benefit for the mental health multidisciplinary team of having a foundation doctor with some competence in managing physical problems is lost and the doctor may feel out of depth. Doing medical on-call work may help to minimise these effects, but infrequent duties may exacerbate lack of confidence and F1 doctors may feel thrown in at the deep end during out-of-hours work compared with peers working daily in medical jobs. I feel it is the daily work of an F1 doctor on medical or surgical wards that allows for these skills to be developed and consolidated.

Therefore, it is my opinion that F1 doctors should not be rotating through 3- to 4-month psychiatry placements for the first 8 months of their training year, but that a placement would be beneficial for the trainee in the later months once a firm medical foundation is in place. This would allow the trainee to approach their psychiatry placement with more confidence and therefore value the experience more, while not being detrimental to their initial medical training as a whole. However, given that experience in psychiatry is important in terms of recruitment and allowing foundation trainees to experience the specialty as a graduate, ^{Reference Brokington and Mumford2} in addition to longer placements at the end of F1 and through F2, perhaps shorter 1-month tasters as suggested could be considered at any stage in foundation training. This is especially pertinent given that applications for core training are submitted early in the F2 year.