Pixel-art doctor with an ID badge and a ticked checklist in a ward office, beside a wall calendar with one day circled in red and a computer showing a login box

Starting psychiatry training: your first month and your first on-call

Starting psychiatry training as an FY or CT1 doctor: induction, logins, supervisors, your first WPBAs, getting ready for on-call and looking after yourself.

By Dr Raj Joshi, ST6 General Adult Psychiatrist

30 October 20267 min read

Starting psychiatry training feels different from any job you've done before. The ward is quieter, the notes are longer, and the first on-call can arrive before you've worked out where the emergency bag lives. I'm writing this for foundation doctors on a psychiatry placement and for new CT1s, because the first month sets up the rest of the year.

Most of what goes wrong in that month is administrative, not clinical. A login that doesn't work at 2am, a supervisor you haven't met yet, or a sign-off nobody told you about. Each is easy to fix in daylight and miserable to fix at night.

The first month at a glance

A four-column timeline of the first month in psychiatry. Before day 1: do the induction e-learning, register with a GP near home, find your rota and first on-call date, work out travel between sites. Week 1: trust and team induction, test every login on a ward computer, finish prescribing training, meet your clinical and educational supervisors, book weekly supervision. Weeks 2 and 3: local sign-offs with history and mental state first if your school uses a checklist, shadow an on-call shift, book life support and breakaway training, ask for your first assessment. Week 4: agree your development plan, complete at least one case-based assessment, check weekly supervision is happening, and do your first on-call with the senior's number saved. — Rough guide

Week one: induction, logins and prescribing access

You'll usually get two inductions: a trust one, often a day of talks, and a local one for your ward or team. The trust day gives you the rules. The team induction tells you how things really work on your patch, so push for it if nobody offers.

A team induction worth having covers these:

Who's who. The ward manager, the nurse in charge each shift, the pharmacist, the psychologist and the occupational therapist.
Your duties. Ward rounds, clinics, home visits, and which patients are yours.
How to get senior help in the day, and who covers when your consultant is away.
Local practice. Where the policies live, how referrals and discharges work, and where the Mental Health Act office is.

Logins

Test every login on a ward computer in your first two days, not on the night you need it. That means the electronic record, the results system, the prescribing system, email and your smartcard. Write down the IT helpdesk number before anything breaks.

Tip: log in to everything once from the ward you'll cover at night. Some systems give you access by site or by team, and you only find the gap when you try.

Prescribing

Where a trust uses electronic prescribing, it usually makes you finish a training module before your prescribing access goes live. Do it in week one. Until it's done you may not be able to write up a drug, which means the nurses ring someone else, and that someone is usually busy.

Ask the ward pharmacist for twenty minutes early on. They know the local formulary, the rapid tranquillisation policy and the drugs that catch new doctors out. I've always found pharmacists the most useful people to know in a new trust.

Meeting your supervisors early

You'll have a clinical supervisor, usually your consultant, who oversees your day-to-day work. You'll also have an educational supervisor, who looks after your training across the year. Sometimes they're the same person.

For core trainees, the College's Silver Guide (July 2026) recommends psychiatric supervision for one hour a week. It's a protected, reflective hour with your consultant about your training, not a ward round. It also recommends meeting your educational supervisor three times in each placement, the first as early as possible (ideally in week one) and one around the midpoint. Your placement development plan should be in place within the first month.

Foundation doctors have their own supervisors and their own portfolio, but the habit is the same. Meet early, agree what you want from the post, and get a regular slot in the diary.

At the first meeting I'd say something like this:

"I'd like to agree what I should get out of this post. Can we book a weekly time for supervision now?"

"I haven't worked in psychiatry since medical school. Which patients would be good for me to start with?"

"Who should I go to when you're not around?"

Write down what you agree and put it in your development plan that week. If weekly supervision isn't happening, the Silver Guide tells you to raise it with your educational supervisor or training programme director. Raise it early, while it's easy.

Getting ready for your first on-call

Your first on-call is the moment the first month is building towards. You'll be the doctor on site, often covering several wards and sometimes more than one site, with a registrar on the phone and a consultant behind them.

Check whether you need a sign-off first

The College doesn't set a national checklist you must pass before on-call. Its current Silver Guide has none. Some schools of psychiatry do, under names like "competency checklist" or "initial competencies". In London, for example, the school's checklist says new core trainees must show they can take a history and do a mental state examination before working on call or in clinic unsupervised. The rest of the list follows within the first month.

Walk your patch in daylight. Find the emergency bag, the defibrillator and the oxygen on every ward you cover. Find out who responds to a collapse. On a mental health unit inside an acute hospital, that's usually the crash team. On a stand-alone unit there may be no medical team on site, so an emergency means 999.

Ask for a shadow shift if your trust offers one. An evening alongside an experienced colleague teaches you the geography and the rhythm of the bleep better than any talk.

What catches people out: section 5(2). If you're the on-call doctor, you may be the nominated deputy for patients on wards you've never visited.

The Code of Practice says deputies who aren't approved clinicians or section 12 doctors should, wherever possible, get advice from one first. In practice, ring the registrar.

A table of the calls you'll get most on a psychiatric on-call, what you do first and who you tell. A patient collapses: ABCDE and call the crash team on an acute site or 999 on a stand-alone unit, then tell the registrar. Worrying observations or a new physical symptom: see them, examine, repeat the observations and act, then tell the registrar or the medical team on an acute site. Someone agitated or threatening: talk them down first and use medication only by the trust's rapid tranquillisation policy, then tell the registrar and plan observations. An informal patient wants to leave: assess them now and find out if you're the nominated deputy for section 5(2), then tell the registrar before using it. A new admission: history, mental state, risk, physical examination, bloods and ECG, then agree the plan with the registrar. Anything you're unsure about: gather the facts, then ring the registrar.

Your first WPBAs

Its recommended numbers for a CT1 year look like this:

Assessment	What it is	CT1, per year
ACE	A whole new assessment, observed	2
Mini-ACE	Part of an encounter, such as a history, observed	4
CbD	A discussion of a case you've written up	4
CbDGA	Your part in a case discussion (Balint-type) group	2
Case presentation	A case presented to colleagues	1
Journal club presentation	A paper presented and assessed	1
Mini-PAT	Multi-source feedback from people you work with	2

That's 16 a year, from your first month on. Consultants and higher trainees can assess you, and so can nurses, psychologists, allied health professionals and social workers at band 7 or equivalent.

Foundation doctors use supervised learning events in their own portfolio, and the same habit works. For the whole-year picture, the ARCP and portfolio checklist sets out what each year needs.

Looking after yourself in the first month

Psychiatry is emotionally heavy in a way that's easy to underestimate. You'll hear stories of trauma and self-harm, see restraint, and sometimes meet hostility from patients who are frightened. None of that means you're doing it wrong.

What I'd do:

Register with a GP near where you live, in your first week, before you need one.
Eat and sleep on nights. After a night shift, don't drive home if you're too tired. Use the rest room or get a lift.
Debrief after hard events. After a restraint, a serious incident or a frightening call, talk it through with your registrar or supervisor the next day.
Use your supervision hour for the cases that stayed with you, not just your portfolio.
Know where confidential help is. NHS Practitioner Health is a free, confidential mental health and addiction service for doctors and other health professionals; its website says who it covers. The BMA runs a 24-hour counselling line open to all doctors.

What I'd do in your first four weeks

Get access sorted in week one and test it on the ward. Meet your supervisor and book the weekly hour. Find out whether your school needs a sign-off before on-call. Walk your patch, fill in the card, and save the registrar's number. Book one assessment early.

Then start thinking about the exams. You can sit Paper A once you have full GMC registration, and many people sit it in CT1. The exam dates page has the next windows. In the CASC, the stations that feel hardest are often the ones your on-calls teach you: the agitated patient, the person who wants to leave, the worried relative at night.

Welcome to psychiatry. It's a good place to be.

Raj

References

Royal College of Psychiatrists. Psychiatry Silver Guide: guidance for psychiatric training in the UK (version 2.0). 2026. https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/2022-curricula/silver-guide-version-july-2026.pdf
Royal College of Psychiatrists. Core Psychiatry curriculum (CT1 to CT3) (version 1.0). 2022. https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/2022-curricula/core-psychiatry-curriculum-final-17-august-2022.pdf?sfvrsn=36b5ba25_10
National Institute for Health and Care Excellence. Violence and aggression: short-term management in mental health, health and community settings (NG10). 2015. https://www.nice.org.uk/guidance/ng10