Making the most of a foundation psychiatry placement

A foundation psychiatry placement is four months, and it goes faster than you'd think. The Royal College of Psychiatrists reckons about half of foundation doctors do one. Many of them won't become psychiatrists, and that's fine. The post still has a lot to give you.

I'm writing for FY1 and FY2 doctors who've just started in psychiatry, or are about to. Some of you chose it. Some of you were allocated it and aren't sure what you're for yet.

By the end you'll know what the job usually involves, how to plan the four months, which supervised learning events fit, and how to set up a psychiatry taster. I'll also cover how to tell whether psychiatry is for you, and how the route into core training works for August 2027.

What you'll actually do on a foundation psychiatry placement

Your post could be on an adult or older adult ward, in a community team, in liaison at the general hospital, or in addictions. The work differs, but the core of it is similar.

On a ward, you'll usually do these:

• Admissions. The physical examination, bloods, an ECG and the medication history, plus your part of the psychiatric assessment.

• Ward reviews. Seeing patients between ward rounds, doing a mental state examination, and telling a senior when something has changed.

• Physical health. The ward's medical problems: chest pain, falls, wounds, diabetes, side effects.

• Ward rounds and the MDT. Presenting patients, writing the plan, and following up the jobs.

• Discharges. The discharge summary, once the plan is agreed with your consultant.

There are also things a foundation doctor usually shouldn't do alone. Expect your trust to have its own list. In most places it covers assessing a new patient alone in A&E or the community, starting a psychotropic without senior agreement, and deciding leave or discharge.

Section 5(2) of the Mental Health Act is a separate question. Only the doctor or approved clinician in charge of an inpatient's treatment can use it, or the one person they nominate. Ask at induction whether that could ever be you, and don't assume it is.

If you're asked to do something beyond you, say so plainly. Teams new to foundation doctors sometimes expect too much, and sometimes too little.

"I haven't done that before. Could I do it with you this time, and on my own next time?"

That sentence keeps you safe and gets you the experience.

What catches people out: being treated as an observer. If you're only sitting in clinics or doing physical examinations, raise it with your clinical supervisor in week two, not month four.

Plan the four months in your first week

Meet your clinical supervisor early. Bring two or three things you want from the post, even if one of them is just "get through it and learn something useful".

"I'd like to leave here able to do a mental state examination and a risk assessment properly. Can we plan how I get there?"

"Could I spend a few days with the liaison or crisis team at some point?"

Your clinical supervisor writes an end-of-placement report for every post. If psychiatry is your first post of the year, your team assessment of behaviour (TAB) is due here too. The placement supervision group report falls in your first or second post.

I'd put all of it in the diary in week one. Four months leaves no slack, and a missed report is a miserable thing to chase in your next job.

Psychiatry is good for SLEs because so much of the work is talking. A mental state examination watched by your consultant makes a natural mini-CEX. If you want a refresher first, I've written up the mental state examination step by step.

Skills from your FY1 or FY2 psychiatry post that go everywhere

Whatever you do next, these skills come with you. I'd aim to leave the post confident in each:

• The mental state examination. You'll use it on every confused, low or frightening patient in every specialty.

• Risk after self-harm. Emergency departments and medical wards see self-harm every day.

• Capacity. Surgeons, physicians and GPs all assess it. Psychiatry is where you'll see it done carefully.

• Delirium and cognition. Old age and liaison posts teach you to tell delirium from dementia, and to screen cognition properly.

• De-escalation. Talking someone down is a skill. You'll need it at 3am on a medical ward.

• Alcohol. Withdrawal and its complications appear in every acute specialty.

• Long conversations. Taking a history from someone who is distressed, suspicious or disorganised, and still getting what you need.

• Physical health in severe mental illness. People with psychosis die younger, mostly from physical disease. You'll learn to look for it.

Notice how much of this is communication. That's what most foundation doctors tell me they took from psychiatry, whichever specialty they chose.

Psychiatry tasters, and how to set one up

There are two ways a psychiatry taster helps:

• You're on a psychiatry placement now. A few days in child and adolescent, forensic or learning disability psychiatry shows you how different the specialties are. Days with liaison or perinatal teams can often be arranged within your post.

• You haven't done psychiatry at all. A taster from another rotation is the cheapest way to find out if you'd like it.

Make the days count. Spend time with a consultant and with resident doctors at different grades. Ask about the rota, the exams and how they chose. Sit in an MDT meeting. Ask to do something hands-on under supervision.

Is psychiatry for me? How to tell

Signs it might suit you:

• You liked the long conversations and didn't want to rush them.

• You wanted to know why, not just what: why this person, why now.

• You could live with uncertainty. Diagnoses evolve, and people improve slowly.

• You liked the team. Nurses, psychologists, occupational therapists and social workers carry much of the care.

• You didn't miss procedures much, or you found them elsewhere, such as ECT or liaison work.

And the honest downsides. The work is emotionally heavy. You'll use compulsory powers on people who don't want them. Risk is uncertain, and you carry some of it home. If you find yourself thinking about a patient on the drive home, that's normal, but notice how often it happens.

Talk to a core trainee and a consultant, separately. Ask what a bad week looks like. If you're still keen, join the College as a Foundation Doctor Associate. It's free for UK foundation doctors and includes journals and MRCPsych e-learning.

From foundation to core psychiatry training

If you decide yes, here's how the August 2027 round works. NHS England runs one application for CT1 Core Psychiatry, ST1 Child and Adolescent Psychiatry and ST1 Psychiatry of Learning Disability. From 2027, Scotland has a separate vacancy run the same way, and you can only be considered for one.

There's no interview this round. Offers are made on your Multi-Specialty Recruitment Assessment (MSRA) score alone. It has two papers, professional dilemmas and clinical problem solving. You need at least 186 raw in each to be appointable.

If you're an FY2 reading this in October 2026, the window is open now and closes at 4pm on 19 November. You can't carry an old MSRA score into this round, so you'll sit it in January or February.

UK graduate prioritisation also applies. Under the Medical Training (Prioritisation) Act 2026, UK graduates, doctors who are on or have completed a UK foundation programme, and a few other groups are offered places first. For the 2027 round it runs from shortlisting through to offers.

Core training then runs three years, CT1 to CT3, and you sit the MRCPsych during it. You can sit Paper A once you have full GMC registration. The exam dates page has the next windows.

If psychiatry isn't for you, you'll still leave a better doctor. If it is, the door is open.

Raj

References

1. NHS England. Core Psychiatry Training: applying for core training, recruitment timelines and the MSRA. 2026. https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/psychiatry/core-psychiatry-training/overview-of-core-psychiatry-training/applying-for-core-training

2. UK Foundation Programme Office. Specialty tasters for foundation doctors. 2023. https://foundationprogramme.nhs.uk/resources/careers/tasters/

3. Royal College of Psychiatrists. Making the most of your psychiatry placement. Accessed 2026. https://www.rcpsych.ac.uk/become-a-psychiatrist/foundation-drs/making-the-most-of-your-psychiatry-placement