UK Foundation Programme Research Articles

Shaping Allergy Training in the UK Foundation Programme: A National Survey.

Shaping Allergy Training in the UK Foundation Programme: A National Survey.

WP6.15 - A dedicated teaching programme in Colorectal Surgery: continuing education beyond medical school

Abstract Background The UK Foundation Programme (UKFP) Curriculum illustrates the need for educational progression for doctors in their first two years of work. Although UKFP recommends use of departmental teaching for this, there is limited guidance on structured and learning-objective focussed training. We designed a colorectal surgery lecture series to create a reproducible teaching programme with defined learning outcomes. Methods We developed a 6-part lecture series aimed at FY1 doctors working in General Surgery at our Teaching Hospital. Teaching was in the form of 30-minute powerpoint presentations, with 15 minutes for questions, at weekly departmental teaching meetings. Lectures were delivered by FY2 doctors and members of colorectal multidisciplinary team (Enhanced Recovery CNS, Stoma Care CNS). Each session was supervised by a Colorectal Consultant. Feedback was obtained using a 10-point Likert scale questionnaire, assessing various domains. Results FY1 trainees indicated an increase in their knowledge with each lecture. Furthermore, the domains of relevance (mean score 9.53±0.80); teaching style (mean score 9.66±0.94); and audiovisual aid (mean score 9.68±0.70) were all rated highly. Lecture duration was rated as perfect length (mean score 5.86±1.80). Conclusion We have demonstrated that weekly departmental teaching can be utilised to enhance training for FY1 doctors within a challenging surgical subspecialty. Feedback revealed high satisfaction, facilitating improvement in knowledge and thus empowerment in undertaking clinical duties. Strengthened by this positive outcome work is in progress to introduce this format of structured teaching into departmental teaching meetings in all disciplines of medicine and surgery across our Trust.

The new Foundation Programme Mental Health Curriculum: foundation doctors' perceptions of its importance and their competency: pre-post psychiatric placement evaluation study.

The new 2021 UK Foundation Programme Curriculum mandates foundation doctors to acquire mental health competencies. This study aimed to evaluate the effectiveness of psychiatry placements in facilitating competency attainment, foundation doctors' perceived importance of acquiring these and their preferred teaching methods. Utilising Kirkpatrick's evaluation framework, the study employed a pre-post intervention design assessing the impact of psychiatry placements on 135 foundation doctors across three cohorts from August 2021 to March 2022. Initially, foundation doctors assigned high importance to mental health competencies. Post-placements, this perceived importance improved slightly, whereas that of clinical skills scenarios slightly decreased. Significant confidence increases were observed in recognising and assessing specific psychiatric disorders. Foundation doctors favoured small seminar groups and on-the-job ad hoc teaching. Qualitative insights underscored the need for context-specific teaching. Psychiatry placements enhance foundation doctors' confidence and perceived importance of mental health competencies as specified by the curriculum. Addressing clinical scenario gaps through context-specific teaching and transferable skills development is essential. Customised teaching approaches, especially small seminars and ad hoc teaching, hold promise for effective mental health training.

What Training Do Foundation Doctors Feel They Require to Develop as Clinical Teachers?

PurposeTo explore the teaching that foundation doctors at the University Hospital of North Midlands undertake and what training they believe is necessary to develop as clinical educators.MethodsA mixed methods approach consisting of questionnaires and focus group discussions (FGDs), following an explanatory sequential design. FGD data was thematically analysed.ResultsThirty-four responses to the questionnaire were analysed. 97% respondents felt that teaching was an important part of their job role. The amount of time spent teaching each week varied from no time to more than two hours, and on average 25% of this teaching occurred outside of clinical hours.Foundation doctors enjoy teaching and want to help others. Challenges described were lack of time, shortage of opportunities and others’ perceptions of their ability to teach. Foundation doctors requested tailored training and formalised feedback to facilitate their development as teachers.ConclusionThis study has shown that foundation doctors undertake a significant amount of teaching and there is a clear desire for additional training. These doctors utilise different teaching methods to their seniors and therefore any training should focus on ad hoc sessions, ward supervision and bedside teaching. Local trusts, medical schools and the UK foundation programme could do more to support foundation doctors’ development as educators by giving them protected time and formalised feedback opportunities. Foundation doctors could be an untapped resource to support the medical school expansion plan in educating the increased numbers of medical students over the coming years.

Is the awarding gap at UK medical schools influenced by ethnicity and medical school attended? A retrospective cohort study

ObjectivesTo better characterise the Awarding Gap (AG) between black, Asian and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority...

Evaluating the Utility of a Near-Peer Situation-Based Course to Prepare Medical Students for the UK Foundation Programme: A Pilot Study.

Starting the Foundation Programme can be challenging for many medical graduates, as medical school alone may not adequately prepare them for complex tasks like managing comorbidities or emergencies. Growing evidence supports the role of transition interventions to meet this knowledge gap, however data on the utility of situation-based learning are limited. This pilot study aimed to assess the efficacy of a near-peer case-based course in improving knowledge and preparedness for foundation training in recent medical graduates. Recent Imperial College graduates who attended a "Junior Doctor on Call" course were eligible for inclusion. This transition intervention, designed and delivered by a Foundation Year 1 doctor, covered six patient cases that integrated high-yield clinical concepts and practical tips. An online questionnaire was distributed one week before and after the course to assess perceptions of knowledge, confidence, and preparedness for training. Participants were also invited to attend an online semi-structured after the course. Out of 19 attendees, 17 (89.5% response rate) completed the pre-course questionnaire, 14 (73.7% response rate) completed the post-course questionnaire, and 3 completed the interview. 68.75% (n=11) had not previously attended a preparatory course for foundation training. Results demonstrated that 85.7% of participants felt more knowledgeable than before in the key topics covered. Participants also demonstrated an increase in self-rated confidence in commencing work as a junior doctor following the course, with 92.9% of participants stating that they felt more confident. This study offers support for short-term situation-based courses in enhancing medical students' knowledge and confidence for foundation training. These findings add to the growing evidence-base encouraging implementation of short-term courses in preparing for practice. However, further research on the utility of such transition interventions is critical to inform the development of evidence-based recommendations for recent medical graduates, educators, and programme directors.

Evidence-based appraisal of the role of SJTs in selection

A recent opinion article in Clinical Medicine promoted a new preference-based algorithm to allocate training places for the UK Foundation Programme Office (UKFPO). This replaced the previous process, which ranked candidates based on medical school academic achievement (the educational performance measure; EPM) and the score on a situational judgement test (SJT). Although not without risks, we believe that the new system has positive potential. In presenting their case, Sam et al summarised evidence relating to the UKFPO in an unbalanced way, leading to what we believe are erroneous inferences, particularly with regard to differential attainment. Here, we provide an example of how the general evidence base and conceptual understanding of the validity of SJTs for medical selection is poorly understood. We highlight important research findings that were not cited by Sam et al and provide what we believe is a more balanced and accurate interpretation of the evidence base relating the UKFPO SJT, and SJTs used in medical selection in general. We do this with particular reference to the validity of such tools in this context, as well as their potential impact on under-represented groups in medicine, compared with other selection assessments.

Teaching in Paediatrics for UK Foundation Doctors: A Cross-Sectional Study.

Background Most doctors will care for children regularly during their careersin settings such as the emergency department, general practice, surgery,or, for a minority, during paediatric specialist training. As such, exposure to topics related to child health ought to be part of the broad curriculum of learning offered to UK Foundation Programme doctors. Objective This study aimed to quantify teaching in paediatrics that is accessed by Foundation doctors. Methods A cross-sectional electronic survey of foundation year one or two (F1/F2) doctors at the end of the 2020-2021 academic year. Ethical approval was granted by the Imperial College London (ICL) Education Ethics Review Process (EERP 2021-082). Results Two-hundred and five Foundation doctors completed the survey, from 16 of the 18 Foundation schools. Respondents attended a median of two hours (interquartile range (IQR) 0-10) of paediatric teaching during the past 12 months, including a median of one hour (IQR 0-2) of core teachingand a median of one hour (IQR 0-9) of non-core teaching. Those who had worked in a paediatric post in the past 12 months, or who were interested in Paediatrics as a career, attended more median hours of teaching. Conclusions Although many doctors will care for children routinely during their later careers, the number of teaching hours in paediatrics experienced by Foundation doctors is low. The UK Foundation Programme should incorporate more teaching in paediatrics to increase exposure to child health amongst newly graduated and as-yet unspecialised doctors.

Transforming healthcare documentation: harnessing the potential of AI to generate discharge summaries.

Hospital discharge summaries play an essential role in informing GPs of recent admissions to ensure excellent continuity of care and prevent adverse events; however, they are notoriously poorly written, time-consuming, and can result in delayed discharge. To evaluate the potential of artificial intelligence (AI) to produce high-quality discharge summaries equivalent to the level of a doctor who has completed the UK Foundation Programme. Feasibility study using 25 mock patient vignettes. Twenty-five mock patient vignettes were written by the authors. Five junior doctors wrote discharge summaries from the case vignettes (five each). The same case vignettes were input into ChatGPT. In total, 50 discharge summaries were generated; 25 by Al and 25 by junior doctors. Quality and suitability were determined through both independent GP evaluators and adherence to a minimum dataset. Of the 25 AI-written discharge summaries 100% were deemed by GPs to be of an acceptable quality compared with 92% of the junior doctor summaries. They both showed a mean compliance of 97% with the minimum dataset. In addition, the ability of GPs to determine if the summary was written by ChatGPT was poor, with only a 60% accuracy of detection. Similarly, when run through an AI-detection tool all were recognised as being very unlikely to be written by AI. AI has proven to produce discharge summaries of equivalent quality to a junior doctor who has completed the UK Foundation Programme; however, larger studies with real-world patient data with NHS-approved AI tools will need to be conducted.

Performance of ChatGPT on the Situational Judgement Test-A Professional Dilemmas-Based Examination for Doctors in the United Kingdom.

ChatGPT is a large language model that has performed well on professional examinations in the fields of medicine, law, and business. However, it is unclear how ChatGPT would perform on an examination assessing professionalism and situational judgement for doctors. We evaluated the performance of ChatGPT on the Situational Judgement Test (SJT): a national examination taken by all final-year medical students in the United Kingdom. This examination is designed to assess attributes such as communication, teamwork, patient safety, prioritization skills, professionalism, and ethics. All questions from the UK Foundation Programme Office's (UKFPO's) 2023 SJT practice examination were inputted into ChatGPT. For each question, ChatGPT's answers and rationales were recorded and assessed on the basis of the official UK Foundation Programme Office scoring template. Questions were categorized into domains of Good Medical Practice on the basis of the domains referenced in the rationales provided in the scoring sheet. Questions without clear domain links were screened by reviewers and assigned one or multiple domains. ChatGPT's overall performance, as well as its performance across the domains of Good Medical Practice, was evaluated. Overall, ChatGPT performed well, scoring 76% on the SJT but scoring full marks on only a few questions (9%), which may reflect possible flaws in ChatGPT's situational judgement or inconsistencies in the reasoning across questions (or both) in the examination itself. ChatGPT demonstrated consistent performance across the 4 outlined domains in Good Medical Practice for doctors. Further research is needed to understand the potential applications of large language models, such as ChatGPT, in medical education for standardizing questions and providing consistent rationales for examinations assessing professionalism and ethics.

An innovative and collaborative teaching approach to delivering mental health capabilities in the UK Foundation Programme Curriculum 2021.

About 45% of foundation doctors in the UK now have a placement in psychiatry. However, the current UK Foundation Programme Curriculum states that all foundation doctors need to demonstrate basic mental health-related capabilities. To address this we developed a novel teaching approach to cover these new capabilities using principles of team-based learning (TBL). This can be delivered to all foundation doctors both face to face and online using case scenarios and in no more than 4 hours over the 2-year foundation programme. The approach can be easily be replicated, but collaboration between mental health and acute trusts is essential for delivery.

A different state of mind: developing a mental health simulation programme for foundation doctors in Scotland

The new Foundation Curriculum 2021 for Doctors in Training (DiT) in the United Kingdom calls for an increased focus on developing mental health-related skills [1], bringing them into parity with physical health. The importance of developing the core clinical skills needed to work with patients who have mental illness is now well-recognised within medical education [2,3]. In collaboration with NHS Education Scotland (NES), we piloted a half-day programme of immersive high-fidelity simulation in Psychiatry for foundation year one (FY1) doctors working in NHS Lothian. Scenario design was by a core group consisting of simulation faculty and Foundation programme directors who were consultant psychiatrists and acted as content experts. The intended learning outcomes (ILOs) for these sessions were constructively aligned with key presentations set out in the revised Foundation Curriculum. The scenarios considered the limitations of practice for an FY1, particularly in regard to mental health law. The three immersive scenarios developed included management of an aggressive patient with delirium, challenging communication with relatives, and management of a depressed patient. Scenarios were based in general wards to maximise fidelity with FY1 experience. 18 sessions were run for FY1 doctors at the three main acute hospital sites in NHS Lothian to ensure equitable access. Participants completed a pre-session evaluation to determine their perceived ability to perform key skills, including assessment of a patient who has self-harmed, a patient with depressive symptoms, assessment of capacity and use of mental health legislation, use of verbal de-escalation, safe sedation, and how to take a collateral history. Assessments were made on a Likert scale and were repeated immediately following the session. We plan to repeat this questionnaire three months following the session. A total of 68 FY1 doctors attended the pilot sessions. When considering the percentage of participants who felt prepared or very prepared, substantial improvements were seen in all assessed domains following the session ( Percentage of candidates who reported feeling either prepared or very prepared to carry out they key skills included in the pilot sessions We have demonstrated that immersive simulation-based education can be used to improve knowledge and confidence in core aspects of psychiatry. With support from NES, we aim to offer this session to all FY1s in Scotland. 1. UK Foundation Programme (2021) UK Foundation Programme. 2. Piot MA, Dechartres A, Attoe C, Jollant F, Lemogne C, Layat Burn C, Rethans JJ, Michelet D, Cross S, Billon G, Guerrier G. Simulation in psychiatry for medical doctors: a systematic review and meta‐analysis. Medical Education. 2020;54(8):696–708. 3. Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation training in psychiatry for medical education: a review. Frontiers in Psychiatry. 2021;12:658967.

STR1DE: a novel near-peer, simulation-based approach to foundation year 1 doctors’ teaching

NHS Trusts must deliver 30 hours of teaching to Foundation Year 1 doctors (FY1s) per year [1]. Our Trust previously delivered weekly hour-long didactic teaching sessions. Feedback was poor, so a new approach was required. Our Trust employs nine FY3 and FY4 junior doctors as Clinical Fellows in Education and Simulation. It was felt that the team, having recently completed FY1 themselves, could develop a useful and enjoyable FY1 teaching program. STR1DE – Simulation, Teaching, and Reflection for FY1 Development and Education – was developed and delivered by the Fellows. STR1DE involves six full teaching days throughout the year. Each day runs four times with a quarter of FY1s attending, to ensure reasonable class sizes. The team felt that simulation would be beneficial in teaching newly-qualified junior doctors. Simulation is an excellent way to help learners put theory into clinical practice [2], and it was felt that using carefully-designed scenarios would ensure FY1s felt the teaching was useful and relevant. Each STR1DE day therefore involves half a day of simulation using the Trusts’ high-fidelity facilities, alongside half a day of teaching including practical skills, small group teaching, and reflective sessions. All scenarios are designed around clinical scenarios which are commonly faced by FY1s in their clinical practice, alongside a variety of human factors. The scenario is observed remotely by other FY1s and the Fellows. The Fellows lead post-scenario debriefings with emphasis on reflection and peer-to-peer discussion and learning. Feedback has been excellent, with 100% of FY1s rating each session as ‘good’ or ‘very good’. The usage of near-peer teachers, the post-simulation debriefings, and the relevance of scenarios to FY1s’ clinical practice have been noted as factors contributing to this success. The benefits of near-peer teaching have been widely discussed in the literature, though often focus on junior doctors teaching medical students [3]. STR1DE demonstrates that teaching (including simulations) developed and delivered by junior doctors for more junior doctors can be relevant, useful, and enjoyable. Full-day teaching sessions seem to be preferable to shorter weekly teaching, allowing FY1s to focus on learning without worrying about work building up back on the wards. This approach also allows the usage of simulation, which would be difficult to deliver in a shorter session. Full-day teaching sessions, delivered by near-peers, with heavy usage of simulation, can be a highly effective way to deliver FY1 core teaching. 1. UK Foundation Programme. UK Foundation Programme Curriculum. London: UKFPO; 2021. 2. Okuda Y, Bryson E, DeMaria S, Jacobson L, Quinones J, Shen B, Levine AI. The Utility of Simulation in Medical Education: What Is the Evidence?. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2009;76(4):330–343. 3. Rees E, Quinn P, Davies B, Fotheringham V. How does peer teaching compare to faculty teaching? A systematic review and meta-analysis. Medical Teacher. 2015;38(8):829–837.

Time for preference-informed foundation allocation?

Successful completion of year 1 of the UK Foundation Programme is a General Medical Council requirement that newly qualified doctors must achieve in order to gain full registration for licence to practise in the UK. We present compelling evidence that both sections of the UK Foundation Programme allocation process, consisting of the Educational Performance Measure and Situational Judgement Test scores, are not fit for purpose. The ranking process drives competitive behaviours among medical students and undermines NHS teamworking values. Furthermore, data from 2013-2020 show that UK minority ethnic students consistently receive significantly lower SJT scores than White students. The current process in the UK allocates lower ranked students, who often need more academic and social support, to undersubscribed regions. This can lead to vacancies in less popular regions, ultimately worsening health inequality. A preference-informed allocation process will improve trainee access to support and help retain trainees in underserved regions. We aim to summarise the flaws of the current system and report a potential radical solution.

13 FIGHTING FRAILTY FROM FOUNDATION UP

Abstract Background In 2021 the UK Foundation Programme introduced a new curriculum for UK Foundation Doctors (FDs). For the first time, frailty has been designated as a core learning topic. This means that all FDs are expected to undertake dedicated frailty training. Subsequently, a virtual frailty workshop was developed and delivered by Zoom to all F2 doctors in Northern Ireland. Entitled ‘Taking a Better Approach to the Frailer Adult’, the three hour workshop familiarises FDs with core frailty concepts including Comprehensive Geriatric Assessment (CGA), delirium, and deprescribing. Methods All attendees completed an online survey after workshops. They were asked to provide free text comments about what they felt were the most successful and useful aspects of the workshop. Attendees were also were asked to numerically rate the workshop relevance, handout quality and venue suitability. Results The frailty workshop was delivered to 222 F2 doctors over eight months. On average, attendees rated the relevance of the workshop as 4.8/5. Attendees rated the quality of the handouts and the venue suitability at 4.4/5 and 4.2/5 respectively. Thematic analysis of qualitative feedback on the most successful elements of the workshop showed that attendees found the session to be useful, relevant, and engaging, with particular preference for use of cases. For example, one attendee wrote that, ‘use of cases and breakout rooms to discuss CGA [allowed] us to get a feel of how this applies to patients in clinical settings”. Thematic analysis of qualitative feedback on what could be done to make the workshop better showed attendees had preferences for greater use of cases and smaller breakout rooms. This feedback was used to develop and improve the workshop. Conclusion FDs value teaching on frailty and consider it highly relevant for clinical practice. Frailty education can be delivered successfully in a virtual setting. Junior doctors prefer interactive case based learning, with use of breakout rooms with small numbers of participants in each room.

Developing an integrated national simulation-based educational programme for Scottish junior doctors through structured, multistep action research cycles

ObjectivesSimulation is widely employed to teach a range of skills, across healthcare professions and is most effective when embedded within a standarised curriculum. Although recommended by many governing bodies, establishing...

375 Points Mean Prizes, The Impact of Portfolio Points and Clinical Specialty on The Engagement of Trainees in Research

Abstract Aim Research and scholarship are key outcomes for medical education in order to learn transferable skills outside of the core curriculum as highlighted in 2018 by the General Medical Council. We have provided a historical snapshot of the key factors influencing medical undergraduates and trainees engaging in research. We distributed an anonymous survey to all UK Foundation Trusts and medical schools, which covered simple demographic information, factors influencing involvement in research and intended clinical specialty. Descriptive statistics were calculated for the responses. Results There were 264 responses to the survey, 119 (45.1%) from women. The strongest motivating factor for respondents was points for future applications, which accounted for 138 (52.2%) of responses, and became increasingly important with seniority of respondent. Time accounted for the largest obstacle to engagement in research, with 151 (57.3%) votes. For the 83 responses from aspiring surgeons, the mean number of PubMed citable publications was 2.52 compared to 1.28 for the respondents who listed a non-surgical specialty as their intended career path. Conclusions The UK Foundation Programme recently decided to remove additional educational achievement points (including two points for publications) for the 2023 intake of Foundation doctors. Such a decision, combined with our finding of point-driven reasoning for engagement in research, could result in fewer juniors conducting research. However, given our results highlighting increased engagement in research of aspiring surgeons, it is hoped that this decision will not affect the field of surgical research, but further qualitative analysis is required to explore this.

Is Academic Attainment or Situational Judgment Test Performance in Medical School Associated With the Likelihood of Disciplinary Action? A National Retrospective Cohort Study.

Disciplinary action imposed on physicians indicates their fitness to practice medicine is impaired and patient safety is potentially at risk. This national retrospective cohort study sought to examine whether there was an association between academic attainment or performance on a situational judgment test (SJT) in medical school and the risk of receiving disciplinary action within the first 5 years of professional practice in the United Kingdom. The authors included data from the UK Medical Education Database for 34,865 physicians from 33 U.K. medical schools that started the UK Foundation Programme (similar to internship) between 2014 and 2018. They analyzed data from 2 undergraduate medical assessments used in the United Kingdom: the Educational Performance Measure (EPM), which is based on academic attainment, and SJT, which is an assessment of professional attributes. The authors calculated hazard ratios (HRs) for EPM and SJT scores. The overall rate of disciplinary action was low (65/34,865, 0.19%) and the mean time to discipline was 810 days (standard deviation [SD] = 440). None of the physicians with fitness to practice concerns identified as students went on to receive disciplinary action after they qualified as physicians. The multivariate survival analysis demonstrated that a score increase of 1 SD (approximately 7.6 percentage points) on the EPM reduced the hazard of disciplinary action by approximately 50% (HR = 0.51; 95% confidence interval [CI]: 0.38, 0.69; P < .001). There was not a statistically significant association between the SJT score and the hazard of disciplinary action (HR = 0.84; 95% CI: 0.62, 1.13; P = .24). An increase in EPM score was significantly associated with a reduced hazard of disciplinary action, whereas performance on the SJT was not. Early identification of increased risk of disciplinary action may provide an opportunity for remediation and avoidance of patient harm.

Removing Educational Achievement Points From the Foundation Programme Application System: Is This the Right Decision?

The UK Foundation Programme Office has announced that medical students graduating from 2023 onward will not receive Foundation Programme Application System points for additional degrees or journal publications. In this viewpoint paper, we acknowledge the reasons for this decision, such as socioeconomically advantaged students having greater access to these achievements and the promotion of intercalated degrees for the sake of point accumulation. Additionally, the predictive value of these achievements with regard to junior doctors’ performance has been questioned when compared to that of other Foundation Programme Application System components. Conversely, we also highlight the drawbacks of the UK Foundation Programme Office’s decision, since this might discourage medical students from completing additional degrees and attempting to publish their work, thereby resulting in clinicians with little to no academic experience or interest. Finally, we attempt to provide suggestions for future improvements in this system by analyzing different medical schools’ approaches, such as the BMedSci Honors program offered at Nottingham University. Furthermore, promoting and supporting engagement with academia, especially among socioeconomically disadvantaged students, are the responsibility of all medical schools; such actions are needed in order to produce doctors who are both clinically and academically competent. We conclude that the aforementioned changes should only affect new cohorts in the interest of universities’ transparency and fairness to their students.

Early career doctors' experiences of psychiatry placements: A qualitative study

Introduction On completion of a medical degree, junior doctors in the UK undergo a 2 year Foundation Programme. Since 2016, 45% of Foundation Programme doctors are required to undertake a psychiatry placement during foundation training. During this time, recruitment to Core Psychiatry Training has fluctuated, dropping to a 69% fill rate in 2017. Methods With the support of the Royal College of Psychiatrists, Health Education England and the UK Foundation Programme Office, a large-scale study was formulated utilising semi-structured focus groups. These exploring participant experiences help to understand how and if the psychiatry foundation placements are valuable, and their potential influence on a trainee choosing psychiatry as a career. A framework analysis was used to analyse data. Results Seventy-four participants across 10 foundation schools in England participated. Experiences and perceptions were split into three broad themes; pre-placement, during placement, and post-placement. Within these, 12 sub-themes emerged. Doctors valued independence and responsibility especially if accompanied by a level of support from seniors. They also enjoyed working as part of a multi-disciplinary team. However, there were clear issues around staffing levels, stigma attached to psychiatry, and out of hours working. Discussion The pre-placement perceptions of psychiatry as a specialty as well as the trainees’ personal priorities for career selection were influenced by psychiatry placement experiences. The results have important implications for the recruitment to the specialty and need to be considered when designing and constructing placement aims.