bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Psychiatrists' Knowledge of Eating Disorders
Authors: De Silva Daniel , Jurewicz Isabella
Published: August 2024

Aims

Wales is the only member of the home nations without Specialist Eating Disorders Training (SEDT) and does not currently have any Specialist Eating Disorder Units (SEDU). This has resulted in varied exposure and experience to eating disorder (ED) psychiatry within psychiatrists working in Wales. Patients with ED have the highest mortality out of all conditions in psychiatry and with hospital admissions for ED on the rise it is important that we understand current attitudes towards ED and use this data to improve understanding and services provided for these patients.

The aims of this project are to

1.

Gauge the experience and knowledge of eating disorders of psychiatrists in Wales.

2.

Examine attitudes towards management of different risks and which individuals should manage what aspects of care regarding eating disorders.

3.

Identify future avenues of development for eating disorders services in Wales.

Methods

An online survey was sent to the 518 members in the Royal College of Psychiatrists in Wales mailing list identifying their current position within psychiatry, experience in working with ED patients and then different questions regarding their attitudes towards ED, ED management, their opinions on development of SEDT posts and their opinions on the development of SEDU in Wales.

There were 36 anonymous responses from doctors working in or around psychiatry in Wales. Responses were collected between March and April 2022 with the survey taking on average less than 5 minutes to complete.

Results

36 individuals answered the survey with consultant/SAS (Senior) level doctors making up 69% of responses, the remaining 31% being psychiatry or GP trainees. Senior doctors mostly comprised general adult or CAHMS specialists, but other specialities were also present. 75% of responses reported some expertise in ED. 50% reported they were confident in the management of ED however there were varying responses when asked about the management of physical health in ED. 89% of responses indicated they would like to see the development of ED psychiatry posts and 78% of responses would like to see the development of SEDU in Wales for severely ill patients.

Conclusion

Many of the responses indicated some exposure to ED however 50% of responders did not feel confident in the management of ED. The development of ED psychiatry posts and SEDU would likely aid in increasing confidence of ED management.
SPEED (Supporting Psychiatry Experience and Education in District-Hospitals), a Pilot Program for Foundation Doctors
Authors: Fraser Sam , Clark Sophie
Published: August 2024

Aims

This pilot program aimed to enhance the psychiatry experience for foundation doctors (FYs) working at Ayr Hospital by identifying perceived areas where psychiatric support would benefit training, development or education. Subsequently strategies were aimed to be implemented by the psychiatry liaison service to enrich FYs' experience during their medical and surgical rotations. Feedback was aimed to be obtained to determine if the program would have value to other district hospitals and grades of junior doctors.

Methods

Unstructured interviews with 4 FYs were conducted in October 2023 to explore the current experience of psychiatry in medical or surgical placements at Ayr Hospital. Identified themes included barriers to completing supervised learning events (SLEs) for mental health cases (a requirement of the 2021 Foundation Curriculum), limited exposure to psychiatry teaching opportunities, and obstacles to pursuing development of interest in psychiatry (such as time to shadow psychiatry, or discuss career prospects in psychiatry).

A pilot program was initiated in November 2023 to improve the experience and education of psychiatry for FYs. This involved:

•

Providing dedicated time on wards for FYs to complete SLEs with a member of the liaison service.

•

Providing time for FYs to shadow the role of liaison psychiatry.

•

Providing additional teaching tutorials, focused on topics chosen by FYs.

•

Providing the opportunity to discuss and develop interest in psychiatry.

A survey to obtain both quantitative and qualitative feedback was sent to each FY that engaged in the program.

Results

17 FYs engaged in the pilot program, with 13 providing feedback. All respondents felt the program increased their knowledge and confidence in approaching cases with a psychiatry element. They also all found the experience positive and a productive use of time. All deemed the program would be useful for other foundation trainees in medical hospitals. Free text feedback highlighted the program's value in facilitating case discussions, removing obstacles in completing mental health SLEs, providing useful relevant tutorials and providing opportunity to discuss further interest of psychiatry.

Conclusion

The pilot program successfully achieved its aim to improve FYs' experience of psychiatry. Although not measured in the survey, the program also appeared to foster positive relationships between the liaison service and junior medical staff. It also helped identify new appropriate referrals for the liaison service. An expansion of the program is planned to other district hospitals in Ayrshire and Arran, including consideration of expanding the participation to wider members of the junior doctor cohort.
A Practical Guide to Developing a Research Communication Strategy for Low Income and Middle-Income Countries
Authors: Shah Bushra Ali , Gire Nadeem , Kashif Syed , Farooqui Salman , Fofana Mohamad Khalifa
Published: August 2024

Aims

Despite increasing research activities in low- and middle-income countries (LMICs), the impact of research is challenging to measure and assess, given the myriad of systemic challenges that exist in these settings. Socio-political constraints, limited education prospects, cultural stigma, restricted access to training and development, and the poor research infrastructure in low-resource settings contribute to the widening gap between evidence and policy, and in turn, creates serious barriers to mental health care in these countries. One of the main barriers to the effective implementation of research in LMIC settings is poor governance and dissemination. Given the lack of standard guidelines, there is an unmet need to develop a communication framework that will strengthen the implementation of evidence-based findings in policy and practice. As a first step towards this goal, our aim was to develop a research communication strategy to enhance research outcomes in LMICs.

Methods

We conducted a narrative synthesis to understand the key factors which may be used to measure both the reach and depth of research impact and communication within LMIC settings.

Results

Our analysis outlined metrics and indicators of research impact including academic outputs, social media insights, capacity building, Patient, Public Involvement & Engagement, policy development, collaboration and partnership, and health and economic benefits. Based on our findings, we formulated steps to support the development of a research communication strategy which has the potential to guide an effective research impact framework and ultimately help bridge the evidence-treatment gap in LMICs. 1) Identify stakeholder groups, 2) Employ Theory of Change approaches and community engagement, 3) Explore channels of communication, 4) Developing a ‘Plain English’ summary, 5) Incorporating cultural and contextual factors, 6) Leverage digital technology and social media.

Conclusion

Participatory approaches to research communications are of paramount importance in informing and implementing evidence-based findings in low-resource settings. Research communication is a prerequisite to the development of an effective impact assessment framework that supports the prioritisation of key areas of public mental health in low-resource settings. Developing a comprehensive communication strategy which leverages culturally appropriate communication strategies targeted at diverse stakeholder groups, may amplify research impact, under a holistic framework which prioritises the delivery of evidence-based mental health care in LMICs.
Narrative Review of Learning Methods for Junior Doctors Around Presenting Evidence at Mental Health Review Tribunals
Authors: Keat Lee Kenn Cheng
Published: August 2024

Aims

Introduction: During involuntary hospital commitment, patients are detained and receive treatment involuntarily without prior judicial authorisation. Instead, detentions are scrutinised after-the-fact through mental health review tribunals (MHRTs), where psychiatrists must satisfy the panel that hospital detention is the least restrictive option. Such settings are different from what doctors are typically trained to do – namely provide care to willing patients. Yet, presenting evidence at MHRTs is part of regular psychiatric practice. Thus, doctors training in psychiatry would need to learn this skill.

Objective: Review the available literature on learning methods that are effective at developing junior doctors’ capability to present evidence at MHRTs.

Methods

Methodology: Seven electronic databases (Medline, Embase, PsycINFO, Web of Science, Education Source, ERIC, Westlaw UK) were searched for studies evaluating the teaching/training of junior doctors to deliver evidence at MHRTs and related settings (inquests, criminal courts), published within the last 25 years. Due to the heterogeneity in methodology, the studies were reviewed narratively.

Results

2,206 articles were found, of which six met criteria (four quasi-experimental studies, two qualitative studies). All quasi-experimental studies were from the UK whilst both qualitative studies were of non-UK origin. Sample sizes were uniformly small (3–16 participants) or unclear/undocumented (2 studies). One study revolved around interprofessional learning in criminal court setting. The remainder were about MHRTs, using a mix of modalities (simulation = 2, workshop = 1, lecture with demonstration = 1, instructional document = 1). Simulation, lecture with demonstration, and workshop were effective at developing skills in oral presentation and being cross-examined. All methods were effective at developing report writing skills. However, articles mainly assessed efficacy through pre/post self-assessment of confidence without control/comparator.

Discussion: MHRT guidelines indicate hands-on learning as mainstay of how doctors develop their capabilities in MHRT. However, this is not reflected in or supported by the published evidence. Likewise, evidenced methods (e.g. simulation, workshops) are resource-intensive and may be difficult to replicate at scale. Additionally, identified articles lacked clear articulation of the pedagogy or theory underpinning the learning, though they appeared constructivist in nature.

Conclusion

The literature around training junior doctors to deliver evidence at MHRT is underdeveloped. Current standard methods are not supported by evidence whilst evidence-backed methods may be difficult to implement cohort-wide. What evidence that exists is weak and based on subjective self-assessment. Further research on the topic is needed, both around standard training/learning methods and more objective methods of assessing efficacy.
Evaluation of the Extended Induction Programme for International Medical Graduate Core Psychiatry Trainees in CNWL
Authors: Moghrabi Sara , Roy Saikat , Matras Bartlomiej
Published: August 2024

Aims

International Medical Graduate (IMG) doctors make up a significant proportion of the British medical workforce. In 2022, 26% of doctors in training graduated outside the UK. Psychiatry was one of the most frequently chosen specialties by IMGs. Doctors joining the NHS face several challenges such as differential attainment and discrimination. Increasing recognition of such issues led to the recent publication of a national guidance for IMG induction. In 2021, CNWL appointed an IMG lead to design and implement a comprehensive induction and ongoing support programme for all IMG doctors joining the trust. The first induction for new IMG core trainees consisted of six sessions and included a mixture of communication skills workshops and tutorials. It started in February 2021 and was delivered over four weeks. Since then, the programme has run twice a year with each intake of new core trainee doctors.

Methods

Nineteen CNWL IMG core trainees who participated in the induction programme between 2021 and 2023 were invited to complete an online survey. The data was collected between December 2023 and January 2024. It consisted of Likert scale ratings of the content of the programme, its relevance, and its impact on trainees’ confidence. The usefulness of each session was also measured. Trainees were encouraged to provide free-text comments with suggestions for improvements.

Results

Sixteen out of nineteen trainees submitted responses. There was a consensus amongst all trainees that the induction covered essential topics. Fifteen out of sixteen participants felt more confident in their role after the sessions. The first communication skills workshop covering history taking and mental state examination was considered to be the most useful with twelve participants rating it as excellent. The workshop on managing conflict with simulation scenarios was ranked second most helpful. Tutorials on NHS structure and a training portfolio did not receive as high ratings. Areas for improvement highlighted in free-text answers were: adding more face-to-face sessions and discussions about on-call scenarios.

Conclusion

Transition into NHS can be a challenging experience for doctors at all stages of their careers. However, early intervention and a comprehensive induction programme appear to have had a positive impact on new trainee doctors’ confidence and preparedness for work. The programme's structure and the sessions content were modified in response to feedback. Additionally, individual support sessions and a writing group were organised for trainees and SAS doctors.
Bringing Simulation-Based Education in Psychiatry Into the Virtual Sphere
Authors: Scurr Thomas , Adbelkerim Abdallah , Scott Jessica , Haupt Stephen
Published: August 2024

Aims

Simulation-based education (SBE) is widespread in both undergraduate and postgraduate medical education, but less frequently in psychiatry. Despite this, the relatively small evidence base suggests high levels of participant satisfaction and educational benefit from SBE in psychiatry. Bringing SBE into the virtual environment presents another set of challenges we identified both through current medical education research and through our own experience. Our poster will demonstrate our current model of virtual simulation, the evidence base we used to develop this, and the feedback we have had from this new venture.

Methods

Background – As part of our undergraduate CAMHS teaching, where students spend 1 week within our service as part of a 3-week psychiatry clinical placement, we provide a single session of CAMHS SBE. This is delivered by 2 facilitators and a professional medical actor providing the role of the adolescent patient. Our virtual simulation teaching session has now been integrated into our teaching program. We have developed this session in line with current medical education research, and have presented this at the Annual Medical Education Conference and integrated feedback on our session into the current model.

Results

We have successfully adapted this session to be delivered remotely, and have received overwhelmingly positive feedback from our students, citing improvements in their confidence and learning after our session. Along with the challenges to engagement, participation, and patient involvement of remote teaching, we further adapted our session to accommodate increased numbers of students attending – a national trend. However, from current research and our experience, there are also benefits to both educators and students from virtual SBE.

Conclusion

Our results show that simulation can be used effectively in psychiatry through virtual media to expand student clinical experience and provide excellent educational opportunities. We present our model for virtual SBE and the evidence base we have used to develop this session, along with the feedback we have had from students, staff, and teams across the country.
Assessing the Impact of the 2024 National Student Psychiatry Conference on Medical Student Career Aspirations and Subspecialty Interest
Authors: Taslim Dayo , Venkateswaran Karthik , Han Oscar , Ahmad Abdullah
Published: August 2024

Aims

The 2024 National Student Psychiatry Conference, hosted at the University of Sheffield with the theme 'Me, Myself and I,' explored the intersection of the ‘self' and the ‘other.' It delved into the dynamics of individuals in the context of their lived experiences, environment, and emerging paradigms within psychiatry and beyond. Talks and workshops aimed to heighten attendees’ interest in psychiatry by challenging societal stigma and traditional norms and expanding their perspectives of psychiatry.

Methods

The pre-conference questionnaire included attendees’ year of study, university/NHS trust affiliation, current likelihood of pursuing psychiatry and career aspirations, knowledge of conference themes, and ten subspecialties represented at the conference via a faculty carousel. The post-conference questionnaire enquired about changes to the above aforementioned factors, to explore changes in career aspirations. Standardized dropdown options were used in both forms to facilitate data evaluation.

Results

71 attendees were included in the final evaluation; 17 were excluded due to duplication or not completing both forms. Of the attendees, 31% were in their pre-clinical years, 56% were in their clinical years, and 4% were doctors. 9% of the participants were non-medical attendees.

Demographics of attendees included a majority from Yorkshire and Humber (52%), Midlands (11%), South England (6%), North England (10%), North East (8%) and Others (13%).

21% of attendees had been to a prior psychiatry-related conference and 34% were currently taking part in or had completed a psychiatry-related project in the past.

The level of interest in attendees aspiring to pursue psychiatry increased from 62% to 72%. An increased interest in medical psychotherapy (82%), forensic psychiatry (68%), and perinatal psychiatry (67%) after the faculty carousel was observed.

Following the conference, 97% reported increased knowledge of each theme. Findings from the faculty carousel revealed that, on average, over 90% of attendees reported an increased understanding of each speciality represented.

Conclusion

The National Student Psychiatry Conference plays a significant role in increasing exposure of psychiatry to medical students and increasing their understanding of the diverse career paths within the speciality. The conference fosters networking opportunities and facilitates meaningful connections within the field, positively influencing attendees' considerations and perceptions.
Virtual RAMPPS: A Virtual Teaching Method Inspired From the RAMPPS Model
Authors: Ali Lijna Harris , Teama Ramy , Ooi Kim
Published: August 2024

Aims

RAMPPS (Recognising and assessing medical problems in Psychiatric settings) training was set up over a decade ago by the then Health Education Yorkshire and Humber Task Group of Clinical skills project workers. Main aim was to address the Physical health agenda in mental health. It was felt that the clinical and support staff in psychiatric settings lacked confidence in recognising and managing physical health issues early on, possibly due to inadequate training in this area. RAMPPS course was designed to address this gap. The course is set up as a face to face multidisciplinary, interprofessional simulation based training with simulated actors, mannequins and other hybrid teaching models .Like any such training, there is a constant need for resources, mannequins, simulated actors, space and funding which could limit the extensive use of this training. We adapted this face to face teaching model for virtual audience to deliver an interprofessional interactive adaptable teaching module using realistic scenarios.

Methods

We adapted some of the scenarios from the RAMPPS module which suited the virtual audience and incorporated into Power point presentation and using an interactive teaching software called Slido we developed Virtual RAAMPPS.

Conducted a few trial sessions within the team and later produced a sample scenario and presented to the medical education team at the trust. The main teaching is the interactive discussion whilst going through the scenarios allowing an impact as close to a face to face teaching as possible.

Next is to do a PILOT Virtual RAMPPS morning session delivered to a group of trainees (psychiatry and foundation trainees) and gather detailed feedback and continue to deliver the pilot teaching a few more times at other avenues and continuously modify the teaching based on the feedback.

Results

Collecting Qualitative feedback from PILOT conducted.

Conclusion

The aim is not to replace simulation based face to face training, but to provide a near enough realistic virtual experience of real life scenarios and to think through them in a systematic and structured way thus enabling better management of some of the physical health dilemmas faced in our psychiatric settings.

It provides the multidisciplinary staff a functional working knowledge of common physical health conditions and its complications encountered in psychiatric setting. The teaching can be modified based on the audience by changing the scenarios relevant to that area of clinical practise or of the patient group.

Allowing anonymity in responses provides a non-judgemental and safe place to make mistakes and eventually improving patient safety and staff experience within Psychiatry.
Improving On-Call Support for Doctors: A Quality Improvement Project
Authors: Bennett Sharna , Williams Verity , Anslow James , Bhat Mohan
Published: August 2024

Aims

Doctors completing on-call shifts at sites across a mental health trust identified a need to improve aspects of on-call work. This quality improvement project (QIP) aimed to improve response to trainee concerns arising from on-call work and support to junior doctors on-call.

Methods

A previous QIP cycle identified trainee concerns regarding on-call processes. In our first QIP cycle, surveys were sent to all consultants and SpRs working on non-residential on-call rotas, and Foundation, GP and Core Psychiatry trainees (on residential on-call rotas) in the Trust, regarding perceptions of on-call processes, senior support and on-call issues. A monthly, online forum was introduced in August 2023 to improve on-call feedback and communication. Trainees, consultants and SpRs from 2 localities were invited, along with representatives from the medical staffing team, medical education team and medical management. After 4 forums, participants who had attended an on-call forum were sent a further feedback survey collecting quantitative and qualitative data. Subsequently, forum frequency and scheduling were amended, advertisement improved, and the forum was expanded to include on-call doctors across the whole Trust.

Results

First cycle data revealed consultant support for a regular meeting with trainees and senior colleagues to bring issues from on-calls for discussion (56% felt that an on-call forum would be helpful, 33% felt it might be helpful). Mean forum attendance was 14, with attendance from all grades. Feedback data from trainees (5 responses) was that most found the forum useful (80%); 80% felt listened to; all felt able to raise concerns, and all wanted the forums to continue. Qualitative feedback included: ‘we started a new QI project from the forum and many on-call guidelines became more defined.’ Consultant feedback (4 responses) was that most found the forums useful (75%); 100% gained a better understanding of trainee concerns; 100% thought forums should continue, although 50% thought the frequency should be reduced. Most consultants and trainees did not feel it would be useful to discuss clinical cases in the forums. Consultant qualitative feedback reported that the forum was helpful to understand trainee concerns, but there should be wider attendance.

Conclusion

Establishing an on-call forum was a valuable intervention for both consultants and trainees working on an on-call rota and has led to a further quality improvement project. Respondents felt that clinical supervision offered sufficient space to discuss clinical cases. Increasing trainee and consultant engagement with the forum is the next phase of this project.
Implementing a Digital Handover System to Improve Safety and Efficacy of Handover Across Acute Psychiatric Inpatient Sites
Authors: Harris Aaron
Published: August 2024

Aims

To implement a digital handover system within Oxleas inpatient sites to improve the visibility of tasks both completed and pending, to reduce the number of tasks missed and to provide a clear audit trail relating to tasks handed over.

Methods

Junior doctors providing on-call cover to acute sites across all 3 boroughs served by Oxleas were invited to complete a questionnaire relating to the efficacy of handover. With this data & information gathered through discussions with the trust's informatics team, a digital handover system, based in Microsoft Teams, was developed. This was piloted and refined through 6 PDSA cycles from September 2022 – August 2023 before being implemented across all Oxleas acute sites from August 2023. Further questionnaires were completed 1 month & 6 months after its roll out to assess the impact of the change.

Results

Doctors were asked to complete a questionnaire at 3 time points: pre-intervention (T0, 20 respondents), 1-month post-intervention (T1, 13 respondents), and 6-months post-intervention (T2, 12 respondents).

•

At T0, 92.3% of respondents reported tasks created by the on-call team had been missed due to staff not being aware, this reduced to 11.1% at T1, and 28.6% at T2.

•

At T0, 23.1% of respondents agree/strongly agree that it is easy to view tasks that have been done on their ward out-of-hours.

•

By comparison, at T1 69.2% reported the digital handover system has made it easier to view what had been done on a ward out-of-hours, rising to 83.3% at T2.

•

At T1, 76.9% reported the digital handover system has made it easier to view tasks when on-call, rising to 83.3% at T2.

•

At T0, 30% agree/strongly agree that the outgoing on-call doctor leaves a written record of tasks completed and outstanding. This rose to 69.3% at T1, and 41.7% at T2.

Conclusion

There is strong evidence that effective handover is a key aspect of clinical care, and failure of this is a preventable cause of patient harm. The initial questionnaire highlighted issues with the efficacy and safety of the handover process within acute sites at Oxleas, which the digital system sought to address. After implementation of the digital system, the findings demonstrated improvements in the handover process, with visibility increasing for tasks both completed & in progress, and fewer reports of tasks being missed by the ward-based doctors, which was maintained over the 6-month follow up period.
The Appropriateness and End Outcomes of Urgent Referrals to Outpatient General Adult Psychiatry
Authors: Johnston Zoe , Murdie Douglas , Murphy Kenneth
Published: August 2024

Aims

The urgent referral system to outpatient psychiatry in NHS Lothian is intended for patients who require to be seen within 5 days. However, many of the referrals are not deemed this urgent upon triage. This project aims to illustrate the extent of this issue and highlight potential reasons, in order to improve the pathway for patients referred on to secondary care services.

Methods

Over a 3 month period from August 2023 to November 2023, all urgent referrals received by an Edinburgh sector general adult psychiatry outpatient's department were reviewed. Data was collected on broad presenting complaint, whether or not the referral was deemed urgent upon triage, whether it contained a factor in line with RefHelp guidance for urgency, and what the end outcome of the referral was.

Results

During the 3 month period, there were 92 urgent referrals. Of these, only 12% were deemed urgent upon triage. Almost all accepted referrals related to concerns around potential psychotic illness (82%). Although only 12% of referrals were accepted as urgent, 35% had factors which, in accordance with RefHelp guidance, would be cause for considering an urgent referral.

There were a variety of disposals including “soon” appointments, redirection to other services such as Thrive or offering advice to the referring clinician. The most common outcome was the offer of a “soon” appointment, closely followed by redirection to the Thrive team.

Conclusion

The majority of urgent referrals were not deemed urgent at triage. There was a clear discrepancy between referrals containing urgency factors according to RefHelp and those offered urgent appointments. This would suggest that the available guidance is not sufficiently clear.

Many referrals were redirected to other services, including Thrive. This redirection may reflect a lack of awareness and a further project may examine Thrive referrals to establish if the number initially sent to psychiatry outpatients is significant.

Additionally, several referrals were triaged as “soon” and seen in 6–8 weeks, as opposed to waiting for a routine appointment. Though RefHelp advises highlighting routine referrals which may be a priority, this pathway was not being used and there is no direct route for “soon” referrals.

Next steps may include liaison with primary care teams to establish views and concerns, updating RefHelp guidance and adding a further referral pathway to address the apparent gap for “soon” referrals.
Empowering Psychiatric Trainees: Enhancing Portfolio Competence Through the Café of Royal College of Psychiatrists (CoRP) Quality Improvement Project
Authors: Loo Jiann Lin , Kumar Praveen , Leong Kok Keong , Akinlua Justina , Griffiths Sioned
Published: August 2024

Aims

The Quality Improvement Project (QIP) for the Café of Royal College of Psychiatrists (RCPsych) Portfolio (CoRP) was initiated to address the challenges faced by UK postgraduate psychiatric trainees in utilizing the RCPsych Portfolio effectively. The primary objective of this project is to enhance trainees' confidence and competence in using the portfolio. Additionally, CoRP aims to establish a robust, sustainable ecosystem of peer coaching and mentorship to support continuous learning and development among trainees.

Methods

The CoRP employs a unique, multi-faceted approach, leveraging a scalable coaching and mentoring model. Firstly, the program focuses on increasing its visibility among trainee groups through targeted communication and marketing efforts. Secondly, CoRP provides on-demand sessions to cater to the varied schedules and job plans of trainees, offering flexibility and accessibility. The sessions offer a mix of coaching, mentorship, and guidance, tailored to the specific needs and learning styles of each trainee. Furthermore, the project fosters an environment where trainees can learn from peers and experienced professionals, enhancing the learning experience and promoting a culture of collaborative learning.

Results

The implementation of the CoRP has led to significant improvements in trainees' confidence in using the RCPsych Portfolio. This outcome is evidenced by the data collected from pre- and post-session surveys, which show a marked increase in trainees' self-reported confidence levels. The project has successfully conducted a series of sessions that focus on various aspects of portfolio management and learning. These sessions have been well-received, with positive feedback from participants indicating that the program meets its intended objectives. However, the project acknowledges the need for long-term data to understand its impact on the Annual Review of Competency Progression (ARCP) outcomes and to assess its sustainability over time.

Conclusion

The CoRP has demonstrated immediate, positive effects in enhancing the skills of psychiatric trainees in using the portfolio. Its strengths lie in the scalability of the model and the incorporation of coaching and mentorship principles, which have proven effective in addressing the needs of trainees. However, the project recognizes that further evaluation is needed to establish a clear correlation between improved portfolio skills and ARCP outcomes. To this end, future plans include the continuous expansion and repetition of the program every six months to accommodate new trainees. Additionally, ongoing evaluation will be conducted to measure the program's long-term effectiveness and sustainability. This will ensure that CoRP continues to evolve and adapt to the changing needs of psychiatric trainees, ultimately contributing to their professional development and success in their field.
QI Project Aiming to Reduce the Use of Restrictive Practice in Belfast Trust Psychiatry With the Implementation of a Therapy Cross
Authors: McGucken Sara , Taylor Jordan , Corrigan Niall , McGucken Pamela , Dornan Robert
Published: August 2024

Aims

The aims of the study were to illustrate the number and type of restrictive practices that were used across two inpatient wards within the Acute Mental Health Inpatient Centre in the Belfast trust over a two year period. This initially would highlight the prevalence and use of such practices and allow for comparison against the data collected after the implementation of the therapy cross. We hoped that with the implementation of the therapy cross we would see a decline in the use of physical interventions, use of IM medications and also the number of aggressive or distressing incidents and behaviours would also decrease.

Methods

We utilized a statistical process control to collate and illustrate data. Daily data collection was carried out and compiled over a 2–3 year period and is ongoing with regards to ward incidents of aggressive behaviour, use of physical intervention, use of IM medications. In early October of 2023 the therapy cross was introduced and the run charts and data collection continued allowing for comparison of such behaviours and interventions pre and post intervention.

Results

A percentage decrease of 50% of the weekly average was noted in incidents of aggressive and violent behaviours on one ward in AMHIC following implementation of therapy. A percentage decrease in average weekly use of IM injections was noted to be 13%. A 12% decrease was found in the use of physical intervention on a weekly average following the therapy cross.

Conclusion

The implementation of a therapy cross in early October 2023 indicated improvement in the incidence of use of restrictive measures on two inpatient wards in the Belfast Trust, including the number of physical interventions such as holds that were required and also decreased the incidence of use of IM medications for rapid tranquillization. The data indicates a significant decrease in the number of cases of violent and aggressive behaviour on wards following implementation of a therapy cross.
Quality Improvement Project on the Use of Clinical Global Impression (CGI) Scores in a Female Adult Inpatient Mental Health Ward
Authors: Okwu Uchechukwu , Senasinghe Tharindi , Akinola Adeola
Published: August 2024

Aims

Clinical Global Impression Scale (CGI) is a recognised scoring system used to assess patients across a variety of medical specialties. In this study we aim to evaluate the use of the severity scale (CGI-S) in a female adult mental health unit. We aim to explore how frequently it is used to assess patients on admission and discharge and investigate its utility in predicting a variety of patient outcomes. We hypothesise that gaining a greater understanding of the significance of CGI-S scoring can enhance in-patient care by offering insights into factors such as probable length of stay and potential benefits of in-patient admission.

Methods

Patient data was collected retrospectively for the last 60 patients discharged. The resulting population data from an inpatient female ward which was then analysed using Microsoft Excel and Jamovi.

Results

59 patients were included in the final data set. Population age at time of admission ranged from 18–68 years with a mean age of 38. The mean length of stay was found to be 40.2 days. 80% of patients had an admission CGI-S recorded with a mean score of 2.77. 71% had a discharge CGI-S recorded with a mean score of 1.79. 58% of patients had both admission and discharge CGI-S score recorded. The key findings of the study were a mean reduction of 1.09 in CGI-S scores, indicating an overall improvement in patient presentation by the point of discharge. Length of admission was increased by 14 days per 1 integer increase in admission CGI-S score. The data also suggests that the correlation between admission CGI-S and length of stay is statistically significant (p value of 0.016). It was also noted that patients with a discharge diagnosis of ‘Emotionally Unstable Personality Disorder’ had a smaller reduction in CGI-S score at point of discharge and required shorter hospital stays, compared with other diagnoses.

Conclusion

The results of this study imply that use of CGI-S scoring in adult inpatient units is beneficial. However, its value can be better seen with improved adherence to regular completion of scores during patient reviews and is an important step to prioritise. Increase in utilisation of this tool will also likely provide clinicians with guidance in predicting which patients are likely to benefit from lengthier admissions and those that might fare better with community support.
A Clinical Audit of the Assessment and Management for Those Diagnosed With Young Onset Dementia Within the Shepway CMHSOP
Authors: Rice Rachel
Published: August 2024

Aims

To audit the Shepway CMHSOP against the NICE guidelines in dementia and the Royal College of Psychiatrists recommendations for service provision in young onset dementia.

Methods

Data was collected retrospectively for all patients open to CMHSOP within the last 2 years with a diagnosis listed as dementia under the age of 65 years old.

Results

The work up prior to diagnosis met some standards but improvements could be made in other areas. Mood was considered in all patients. The majority of patients (89%) had young onset blood tests if there was a clinical indication. However physical examination was only carried out in 43% of patients. In addition to this where physical examination was completed it was often limited to a brief note about the patient's gait and tremor.

Imaging standards were met within the Shepway CMHSOP with all patients having a scan, some patients being referred for additional specialist scans where indicated. There is also a neuroimaging MDT in which scans can be discussed with a neuro-radiologist.

The follow up care and support was an area that needs further development within Shepway CMHSOP. There is no named lead for those diagnosed with young onset dementia. Furthermore, only half of patients received a named practitioner to support their care. In addition to this only 79% were offered cognitive stimulation therapy and post diagnostic support which incorporate education for the carers. It is difficult to know if these options were discussed and declined by the patients, but if this is the case it would have been good practice to document.

Conclusion

The time from referral to diagnosis was similar in those with a dementia with a well established and clear subtype (Down syndrome) to those diagnosed with other types of young onset dementia, 6 months and 5.5 months respectively.

My audit identified areas for improvement in the workup to diagnosis and the aftercare to support those diagnosed and their carers in order to meet NICE guidelines and the Royal College of Psychiatrists recommendations for service provision in young onset dementia.

Shepway CMHSOP will develop a young onset dementia pathway to ensure those diagnosed are offered the appropriate investigations and support following their diagnosis in line with these guidelines.
Cambridgeshire Lifespan Autism Spectrum Service Clinic: Managing Demand, Capacity and Flow of Referrals for Adult Autism Assessment
Authors: Robinson Janine , Taylor Jasmine , Squire Mark , Woods Andrea , James Irene
Published: August 2024

Aims

Referrals for adult autism assessment to the Cambridgeshire Lifespan Autism Spectrum Service (CLASS) have increased from 430 in 2019 to 887 in 2023, with demand exceeding capacity. The team enrolled in the Royal College of Psychiatrists’ Quality Improvement (QI) Demand, Capacity and Flow (DCF) Collaborative. The agreed aim was to increase the number of diagnostic assessments by 51% per month.

Methods

Participants included the CLASS multi-disciplinary team (MDT), referrers, the provider improvement advisor and an autistic adult. Using the NHS Quality Service Improvement and Redesign (QSIR) six-step approach, a process map identified five key stages of the CLASS pathway. A project driver diagram was then used to identify change ideas in the referral, screening, pre-assessment, assessment and post-diagnostic stages.

Change ideas in the screening and assessment stages were prioritised and two Plan-Do-Study-Act (PDSA) cycles designed: PDSA 1) To reduce screening time by removing the first screening of referrals; PDSA 2) To increase the number of assessments conducted and completed in a single face-to-face appointment.

Data collected for PDSA 1 included: number of working days from date of referral to date added to waiting list and total screening time (minutes) per referral. Data were compared in a sample of 133 referrals from the two-stage screening process and 68 referrals from the one-stage process. Data collected for PDSA 2 included: average assessment time (minutes), average duration of open assessments, and the number of assessments completed within the same month. The data at Time 1 (before introducing PDSA 2) were compared with Time 2 (after PDSA 2) in a sample of 10 and nine referrals, respectively.

Results

PDSA 1) Statistical Process Control (SPC) charts show a reduction in mean working days from 160 to 30 working days. The mean screening time per referral reduced from 33 minutes to 23 minutes. PDSA 2) SPC charts show that between Time 1 and Time 2 there was (i) a reduction in clinician time in minutes per assessment (m = 236.8 to m = 210), (ii) a reduction in working days assessment remained open (m = 39.4 to m = 6.4), (iii) a reduction in number of assessments involving multiple appointments (6 of 10 to 3 of 9), (iv) an increase in the number of assessments completed in the same month (3 of 10 to 7 of 9).

Conclusion

These results show promise towards increasing DCF across the pathway, but further PDSAs (e.g., digitalising reporting, refining the post-diagnostic pathway) need to be implemented to achieve the overall aim.
Creating a Simulated On-Call Scenario to Measure Stress and Improve Confidence in Medical Students
Authors: Runicles Abigail , Alqeisi Tawfiq , Bradley Megan , Zuberi Sharukh , Gatenby Piers
Published: August 2024

Aims

Previous literature has reported that medical students are objectively and subjectively more stressed than the general population. The transition between medical school and commencing a career as a foundation doctor can cause a significant amount of stress. The first aim was to investigate stress and anxiety and how this may impact performance, with the aim being to better understand stress in medical students about to embark on a career as a doctor. The second aim was to create a simulated 1-1 on-call shift scenario to allow final year medical students to practice the skills and improve confidence.

Methods

16 final year medical students from two UK medical universities took part in a simulated on-call scenario acting as the foundation year 1 doctor. During the scenario, participants were scored on their performance. Fitbits measured heart rate data as an objective measure of stress. Subjective data was collected using the State-Trait Anxiety Inventory (STAI). They were asked a series of questions regarding their confidence before and after the scenario.

Results

Participants reported higher states of anxiety after the on-call simulation compared with a regular day on placement (t=-6.93, p <0.001). There was a trend between reported higher levels of state anxiety and lower performance scores (r=-0.475, p=0.063.) There was no correlation between average heart rate and reported levels of state anxiety (r=0.452, p=0.105). Prior to the on-call scenario participants reported their confidence as follows; 26.09% no confidence, 65.22% slightly confident, 8.7% somewhat confident, 0% confident/very confident. After the scenario participants reported their confidence as follows; 4.35% no confidence, 34.78% slightly confident, 52.17% somewhat confident, confident 8.7% and 0% very confident. 100% of participants reported that they would recommend the session to colleagues.

Conclusion

The results highlight that an on-call scenario has a significant impact on the feelings of stress in medical students. It also shows that stress can have a negative impact on performance. However, experience completing a simulated on-call scenario helped to improve confidence and was recommended to colleagues. Future research should aim to further investigate acute stress in a real-life setting and use objective measures of stress. Over time researchers should aim to create a targeted intervention aimed at supporting medical students and junior doctors during their on-call and provide opportunities to improve confidence.