Developing an FY1 post in a Crisis Resolution & Home Treatment Team Newly created in community psychiatry with Merton Home Treatment Team (MHTT) (South Thames deanery), based at Springfield University Hospital, South West London & St George’s Mental Health NHS Trust (Image 1). By Dr Holly Blair

Introduction Aims Background Methods Results Key messages Conclusion References

Aims To describe and review this innovative four month FY1 post To evaluate the extent to which it meets FY1 curriculum To view this post as an enriched training opportunity

Background FY1 Psychiatry FY1 posts have been increasing nationally Aims Requirements Psychiatry FY1 posts have been increasing nationally St George’s Hospital saw a 75% increase from 2012-2013 This post was awarded to the home treatment team in 2013 FY1 curriculum based on GMC good medical practice. The UK foundation programme curriculum states FY1 aims as to 1.build on undergraduate education 2. offer generic training to provide a range of interpersonal and clinical skills 3. To develop leadership, team working and supervisory skills 4. To offer a variety of workplace experience which will help will career decision. Requirements include assessments for e-portfolio to demonstrate clinical competencies. To meet FY1 curriculum and provides a unique training opportunity. The responsibilities of an FY1 working in MHTT include assessing people presenting in crisis on home visits and in A&E, psychiatric history taking, risk assessments, clinical documentation, formulation, management planning and contribution to team meetings.

Methods Evaluate the HTT FY1 doctor’s experience Assess the extent to which it meets the FY1 core curriculum. Review a logged record of activities undertaken during the firm

Weekly timetable during post. Importantly there were good teaching opportunities including FY1 compulsory teaching, grand round and additional education meetings depending on work commitments. Additionally one day per week was dedicated to an AMU on call doing the take. The aim of this was to ensure integration with other FY1s as the rotation was based off site, however this also enabled achievement of core procedures and the maintenance of medical skills and confidence.

Results FY1 assessments: Curriculum SLE’s TAB Core procedures Mini CEX CBD DOPS Developing the clinical teacher LEADER TAB Core procedures Additional: audit, presentations, teaching, courses Firstly touching on key curriculum aspects, with how this firm successfully achieves them as a model of psychiatry education, doctor in training and service development. • Professionalism o Leadership: The opportunity to closely observe a leadership role. The FY1 doctor working alongside the consultant as one of only two doctors in the team. o Continuity of care: Patients are monitored within the community for up to six weeks alongside re-referrals before or after hospital admission. Team working: all work undertaken as an MDT with daily meetings, opportunity to see the value of each individual. • Relationship and communication with patients o Clear communication with patients in a crisis is vital and challenging. Patients may be unwilling to engage due to the nature of their symptoms. • Ethical and legal issues o Exposure to making complex risk assessments and prescribing decisions, as well as Mental Health Act assessments. o Home visits enable a unique view on how people live and cope with mental illness.. This includes developing an awareness of the stigma and social barriers faced by people living with mental illness. • Teaching o Regular 1-to-1 teaching sessions and opportunities to learn from other healthcare professionals as part of a multidisciplinary team. FY1 assessments are based upon supervised learning events. The nature of working in pairs within a multidisciplinary team results in the majority of clinical work being under direct observation which is not achieved to the same extent within other foundation year posts. Additionally there are many opportunities for multidisciplinary feedback. One day a week on the acute medical ward (AMU) enables completion of the core clinical procedures aspect of the curriculum which is not normally possible in a community psychiatry firm. Finally as an unbanded job (which has its pros and cons) hours are generally 9am-5pm. This means there is opportunity for further career development in which other firms there is not always time.

Summary Aims Background Methods Results

References GMC. Annual speciality report for 2010-11. http://www.gmc- uk.org/RCPsych_ASR.pdf_48266345.pdf (accessed 27 September 2013) UKFPO. The UK Foundation Programme Curriculum. The Foundation Programme 2012. Dein K, Livingston C et al. ‘Why did I become a psychaitrist?’: survey of consultant psychiatrists. Psychiatric Bulletin 2007; 31:227-30

Key Messages New FY1 psychiatry posts provide an enriched opportunity for new doctors. Skills are transferrable. Analytical and holistic formulation Decision making HTT offers a different challenge for FY1 doctors which will enhance them in their future careers. This firm successfully achieves key curriculum aspects as a model of psychiatry education, doctor in training and service development. Resulting in a well rounded FY1.