The stated aim of the new Foundation Programme is to equip all doctors with a range of generic competencies before they embark on a specialist training programme, following the advice in Modernising Medical Careers (Department of Health, 2003, 2004), which built upon Unfinished Business, Proposals for the Reform of the Senior House Officer Grade (Department of Health, 2002). The educational aims of this 2-year programme are to develop generic skills, competencies and attitudes to ensure professional conduct that will reflect ‘good medical practice’ as defined by the General Medical Council (1998). Any education for the Foundation Programme must concentrate on these areas. A Curriculum for the Foundation Years in Postgraduate Education and Training is being produced by the Academy of Medical Royal Colleges in co-operation with the Modernising Medical Careers Implementation Team at the Department of Health (Department of Health, 2005).

The internet is rapidly becoming a first-line source for clinicians and patients alike, and it is increasingly necessary that clinicians maintain an open dialogue with their patients about their information sources. In this paper, I look at the emergence of ‘brain shivers' as a side-effect that appears to have emerged online, in the context of antidepressant side-effects and withdrawal. I discuss possible biological explanations for this strange, possibly new, complaint, as well as the emergence of particular symptoms as a sociological phenomenon aided by new technology.

The care of those with mental illness has moved away from asylums and in-patient care facilities. Community mental health teams (CMHTs) now deliver care but these vary widely in terms of personnel and function (Simmonds et al, 2001). Evidence suggests that CMHT management is not inferior to non-team standard care in any important respect, and that it may even be superior in promoting greater acceptance of treatment, reducing hospital admission and avoiding death by suicide (Tyrer et al, 2000). Despite this apparent improvement, there are problems for the CMHTs and the general practitioners (GPs) who refer individuals. CMHTs are often overstretched, with large workloads, increasing amounts of administration and lack of resources, leading to concerns that individuals with more severe illness may be neglected (Harrison, 2000). Various initiatives have been undertaken to combat these problems, including forging stronger links between the CMHT and GPs, by having an on-site mental health worker (Hamilton et al, 2002; Bower & Sibbald, 2003).

Buprenorphine is prescribed as a treatment for opioid dependence (Barnett et al, 2001; Lintzeris et al, 2002). Methadone substitute prescribing is the primary maintenance treatment in Britain and is well established (Ward, 1997). Despite the advantages of methadone maintenance there are associated disadvantages, including potential death following overdose, the inconvenience of daily dosing, the risk of the drug being used by others and stigma (Walsh, 1994).

Postgraduate medical education has recently been the subject of major and fundamental review. The four UK Health Departments have set out the underpinning principles in Modernising Medical Careers (Department of Health, 2003), which sees the adoption of a number of trends that have emerged in medical education. One such trend is an emphasis on learning and the development of skills, including continuing professional development, with a move away from the apprenticeship model towards more structured and systematic training. This also means that structured training programmes that have defined curricula and show clear quality assurance processes will become the norm. The aim is to have a flexible, trainee-centred approach within which individuals can develop at their own pace and take increasing responsibility for their own training in a variety of clinical settings.