bluuebunny/crossref_metadata_2025 huggingface dataset:
Embracing Diversity in Mental Health Education: A Primary Study on Cultivating Cultural Humility in Undergraduate Medicine
Authors: Axiaq Ariana
Published: August 2024

Aims

Training within medical schools often neglects that mental health patients are very culturally diverse, contributing to a lack of cultural competence in future doctors. This deficiency exacerbates access to healthcare barriers for this population. To address these issues early in the course, we initiated a student-led teaching programme on Cultural Humility (CH) for first-year medical students, aiming to enhance cultural awareness (CA) about mental health patients.

CH emphasises the lifelong development of skills, knowledge, and attitudes, fostering a perspective of ‘becoming the student of the patient' to address power imbalances between doctors and patients with mental illness, particularly from minority groups. It promotes culture as expansile incorporating many characteristics from race and religion to sexual orientation, disability and age.

This study assessed the knowledge and perceptions of first-year medical students following the introduction of CH.

Methods

After exposure to an author-developed CH learning resource, students participated in a baseline survey to gauge their understanding of CH. Subsequently, an interactive student-led workshop with a reflective exercise encouraged medical students to embrace their cultural diversity and that of others, emphasising the multifactorial nature of mental illness. The workshop incorporated prompts inspired by peer experiences of mental illness. Students then engaged in an early clinical contact programme, interacting with patients with mental illness to implement their understanding of CH into practice. Reflective blogs, written by students as part of the programme, were analysed for data inclusion using an author-selected framework.

Results

Out of 312 participants, 188 provided responses, revealing higher scores for perceived CH importance (4.83/5) compared with understanding (3.86/5) and perceived preparedness for CH implementation (3.98/5). Analysis of free-text survey responses identified learning gaps, particularly in demonstrating cultural sensitivity during patient interviews, and highlighted preferred pedagogies. Thematic analysis of ten collected blogs followed a 5R framework: Respect, Reflection, Regard, Relevance, and Resiliency. Findings indicated a demand for better training in identifying patient-specific sensitive topics and a preference for appreciating patient characteristics such as socioeconomic class without explicit labelling of these qualities as culturally engendered or directly linked to their diagnosis.

Conclusion

CH aims to foster a patient-centred approach, encouraging medical students to look beyond the diagnosis of mental illness. This study explored the multimodal integration of CH as a CA toolkit into the undergraduate curriculum, providing insights into the application of preclinical CA teaching and students’ perceptions of its clinical applicability in their learning about different patient populations experiencing mental illness.
An Audit of Core Trainees' Preferences of Teaching Format for Weekly MRCPsych Teaching at HPFT
Authors: Carno Ariela , Alihassan Afifa
Published: August 2024

Aims

The primary aim was to establish the preferences of the majority of core trainees regarding online, in-person, or hybrid teaching in order to assess if the online format created during the COVID 19 Pandemic should be maintained.

Secondary aims were:

•

To collect feedback regarding the barriers to in-person teaching.

•

To collect feedback regarding the course content.

•

To alter the way the course is presented (if required) and to incorporate the feedback regarding the course content into the course.

•

To re-audit to see if the intervention was successful.

Methods

•

Surveymonkey was used to generate an online survey with 5 questions.

•

There were a mix of quantitative and qualitative questions.

•

Responses were collected between 26th September 2022 and 10th October 2022 and results were presented at the Tutors Committee Meeting and Junior Doctors Forum.

•

Changes were implemented in the curriculum:

1.

Introduced specific neuroscience teaching.

2.

Small exam specific study groups were encouraged.

3.

It was decided that teaching would remain hybrid as per the majority preference and to allow equal access to teaching for all trainees (as per the GMC guidance).

A second survey with the same questions was sent out and responses collected between 19th November 2023 to 29th November 2023 to establish whether opinions had changed and to see if the intervention was successful.

Results

Sept – Oct 2022

•

There were 20 responses overall.

•

50% (n = 10) preferred online teaching; 45% (n = 9) preferred hybrid; 5% (n = 1) preferred in-person.

•

The most common barriers to in-person teaching were the difficulty in finding parking (70%, n = 14), and being unable to leave work on time due to clinical responsibilities (50%, n = 10).

•

The most common preferred frequency of in-person attendance for the hybrid model was monthly (45%, n = 9).

•

Topics requested to be covered (free-form question) included psychopharmacology, CAMHS, perinatal, geriatric, neuroanatomy and neuroscience.

Nov 2023

•

There were 22 responses overall, including new trainees that had not done the survey last year.

•

50% (n = 11) preferred online teaching, 41% (n = 9) preferred in-person; 9% (n = 2) preferred in-person.

•

The most common barriers were the same: difficulty finding parking (64%, n = 14) and clinical responsibilities (55%, n = 12).

•

It was commented that neuroscience related teaching had improved.

Conclusion

There was a clear preference in both surveys amongst trainees for either online or hybrid teaching formats. Hence a decision was made to continue the current format of flexible teaching.
Medical Coaching for Psychiatrists
Authors: Forge Jenny , Cornwall Peter L
Published: August 2024

Aims

Promoting recruitment and retention in psychiatry is one of the core objectives for the Royal College of Psychiatrists and coaching initiatives are recognised as a means of improving retention. We developed a programme of medical coaching, available to all career-grade doctors in an NHS Trust in Northern England to support professional development. This overview describes the results of the first 4 years of the programme.

Methods

The setting was a large NHS Trust covering County Durham, Teesside and North Yorkshire employing around 150 consultants and 60 SAS psychiatrists (mean age = 49 years, 51% female). Coaching was promoted to all these doctors through the feedback form sent following their annual appraisal meeting. This coaching was later also made available to locally employed doctors and core and higher specialist trainees working temporarily in the Trust. The intervention was initially provided as a single session coaching event delivered by a consultant psychiatrist trained in medical coaching, and the programme evolved following requests from doctors. It was stated explicitly that the purpose was professional development, not an attempt to retain doctors considering their future. The outcome was measured using a post-coaching questionnaire.

Results

Data was collected from coaching delivered from May 2019 to January 2024. 145 doctors (84 consultants, 23 SAS doctors, 6 Trust doctors, 26 training-grade doctors, 6 grade not-stated) took up the coaching offer. 524 sessions were provided in all. The mean (SD) number of sessions was 3.8 (3.7), for consultants 3.5 (3.9) and for SAS doctors 4.8 (4.4). 48 doctors accessed a single coaching session. 56% of the career-grade doctors receiving coaching were female. Data was collected from 127 post-coaching questionnaires with 116 strongly agreeing and 11 agreeing with the statement that the coaching provided was useful and many reporting a positive impact on well-being.

Conclusion

Findings show that the programme was popular with the medical workforce, with about half of career grade psychiatrists taking up the offer. It evolved following requests to both provide follow-up sessions and to extend the offer to trust doctors and trainees. The sessions were highly valued by the doctors with reported benefits to their well-being, but we cannot measure the impact on retention. The programme is valued by the Trust with an intention to make the programme sustainable into the long term and it now forms part of the Trust's medical workforce charter.
Elevating Interest and Expertise: Integrating Co-Design and Co-Production Into Foundation Year Development Initiatives During Psychiatry Rotations
Authors: Mallick Hassan Aquil , Doyama Mana , Ayeni Itunuayo , Obeng Isaac
Published: August 2024

Aims

To provide a bespoke development program for foundation year (FY) trainees on rotation at CNWL NHS trust.

To increase interest in foundation trainees in choosing Psychiatry as a career.

Specific: 100% self-reported satisfaction with the FY development program by April 2024.

50% increase from baseline of self-reported interest in choosing psychiatry as a specialty by April 2024.

Methods

We designed an online, 12 session teaching program for each 4 month cohort of foundation year doctors on rotation at St Charles Hospital, CNWL. We collect data at baseline, after each teaching session and at exit via online questionnaires. These are reviewed at PDSA meetings (including nominees from foundation cohort) by team quarterly. First cohort started in May 2023, we are currently in our 3rd cohort of this project. Each cohort has approximately 15 Foundation year Trainees. Our curricula integrates principles of Co-Design: 2 of the 12 teaching slot topics are voted by each cohort of foundation trainees. Co-Production: 2 of the 12 slots are always for a carer, service user or expert by experience. Bespoke: Each teacher is provided a written guide outlining the training grade of foundation trainees and highlights the needs for transferrable skills as FY trainees may not pursue psychiatry as a career. Quality Improvement: iterative learning from each cohort, with robust data collection methods (dedicated time set aside for feedback completion) and regular reviews by team. Teachers are canvassed via trust emails, trainee Whatsapp groups and patient liaison services at CNWL.

Results

Cohort 1= no data collected. Data collection methods required improvement.

Cohort 2= data collection of 3 responses (23% completion rate). Data collected insufficient. Data collection method improved.

Cohort 3= data collection of 13 responses (87% completion rate).

Self-reported satisfaction with training program: 95.3% Interest in choosing psychiatry as a specialty: 30.4% at baseline to 76.2% at time of submission.

Conclusion

This Foundation Year Development initiative provides a well-liked, bespoke and innovative approach to train foundation year doctors on placement at NHS trusts.

The majority of Foundation doctors (some surveys show 60%) are undecided on their specialty during foundation training and this is a unique opportunity to increase recruitment into psychiatry.
A Qualitative and Quantitative Analysis of a Pilot Psychotherapy Training and Simulation Workshop for a Cohort of Psychiatry Core Trainees Starting Their Long Case in SABP Foundation Trust
Authors: Fulmali Amit , Reddi Neelima
Published: August 2024

Aims

Background: The uncertainty and anxieties about psychotherapy long case among trainees was high. This training was designed to alleviate stress and to increase knowledge and confidence among trainees.

The Primary aim of this project was to improve individual skills and awareness for Psychodynamic Psychotherapy. Secondary aim was to get feedback from trainees to improve future psychotherapy training.

The Null hypothesis (H0): There is no difference between the Pre and Post training questionnaire scores.

Methods

This is a blinded study where the researcher cannot identify the participants. A mixed study approach is taken, with both quantitative and qualitative analysis used for this study. A pre training and post training questionnaire was provided to participants. This study collected quantitative data in the form of Likert scale questionnaire as a primary approach to test the hypothesis. The qualitative data was collected by open ended questions. The qualitative part is to understand the trainee's problems and what improvements have to be made in the workshop, to generate a structural model for effective practical psychotherapy training.

The sample consists of 13 Psychiatry Core Trainees at different levels of their training and 1 speciality doctor. 14 feedback questionnaires were available, 1 questionnaire was excluded as it did not fit the inclusion criteria.

Results

The paired t-test was used for all the three quantitative questions: Knowledge of psychotherapy, Theoretical and Clinical Application of Psychotherapy. The t-test showed the difference between pre-and post-questionnaires scores to be statistically significant (p value < 0.05). So, we reject the Null Hypothesis. The effect size was large, with Cohen's d score > 0.8 for all three questionnaires.

Thematic analysis of Qualitative data was done. Codes were formed from the supporting quotes. Themes were derived from the similar codes. Four themes were created:

•

Challenges experienced by core trainees.

•

Emotions and confidence.

•

Knowledge acquired.

•

Suggestions for improvements.

Conclusion

1.

We can conclude that the Psychotherapy workshop was effective, and the Core Trainees have better insight than before.

2.

The qualitative analysis results were in accordance with the quantitative analysis.

3.

Challenges experiences by trainees in managing their own emotions were addressed in the training. Quote (IV) “it was very good! calmed nerves.”

4.

There was increase in knowledge and confidence among trainees.

5.

Suggestions were full day of training and to have more role playing; to demonstrate the psychological concepts like transference, countertransference, defences, resistances in role play.
User Experience of Generating PSPDPs on Portfolio Online Amongst Psychiatry Trainees and Trainers
Authors: Gupta Aradhana , Chandra Pallavi
Published: August 2024

Aims

The Royal College of Psychiatrists (RCPsych) introduced the new psychiatry training curriculum in February 2022. Since then there have been various updates in both the e-portfolio platform and curriculum requirements.

A survey was undertaken to understand issues experienced in navigating these changes by psychiatry trainees and supervisors within the Black Country Healthcare NHS Foundation Trust (BCHFT), specifically assessing the generation of Placement Specific Personal Development Plans (PSPDPs) for each training placement.

The aim of this study was to survey user experience and reflect on the results to identify how best to support trainees and supervisors in using PSPDPs, a key curriculum requirement, with greater ease and confidence.

Methods

The survey comprised tailored questionnaires distributed to two cohorts- trainees (30) and supervisors (37) within the BCHFT. Anonymised responses were collected over one month. Likert scales were used to determine (a) confidence levels in setting up PSPDPs, (b) confidence in mapping activities to both PSPDPs and the curriculum, and (c) user-friendliness of RCPsych guidelines on this topic. Checklists and free-text responses were used to assess which support resources were being utilised by both groups. Suggestions were requested on how the whole process could be improved.

Results

Amongst trainees (response rate 63%), 78% did not feel confident in setting up PSPDPs. 94.7% sought additional support in PSPDP setup, of which peer support was the most utilised (77.8%). Other resources included the RCPsych website and emails as well as supervisors. 58% of trainees lacked confidence in linking activities to PSPDPs and the curriculum. Only 10.5% of the trainees found the RCPsych Implementation Hub user friendly.

In the supervisor cohort (40% response rate), 64% of the trainers felt confident in guiding their trainees in setting up PSPDPs. 85% utilised support from various sources including the Implementation Hub (91.7%), trainees (58.3%) and peers (50%). 64.2% of supervisors found the RCPsych website user friendly.

Conclusion

Common themes that emerged were that both trainees and supervisors felt the process of setting up PSPDPs was quite complex, with a confusing web interface. Resources on the RCPsych website required better signposting. Both cohorts felt they would like additional training e.g. step by step videos and training sessions (local peer trainee and supervisor run sessions were found useful).

This feedback has identified the importance of arranging local training sessions to improve engagement. Additionally, we hope that relaying this feedback to RCPsych may influence future systemic changes.
Improving Physical Health Knowledge of Mental Health Nurses on an Organic Old Age Psychiatry Ward, Woodlands Unit, RDASH, Rotherham site
Authors: Hartley Lauren , Osukoya Femi
Published: August 2024

Aims

1)

To improve the confidence of the nursing team in ensuring initial assessment and escalation of physical health concerns on an organic old age psychiatry ward, Glade ward, Woodlands unit, RDASH Rotherham.

2)

To equip them with the knowledge needed to recognise and promptly escalate concerns about physical health to medics.

3)

To foster the relationship between the nursing team and medics to facilitate communication between both teams for the improvement of physical health care of mental health patients.

Methods

Eight weekly teaching sessions were organised and delivered by FY1 and CT1, with each session lasting 10–30 minutes. Short 10-minute teachings followed by questions and answers. Topics were at the request of nursing staff and included physical observations, sepsis, head injury etc.

Attendees included members of the nursing team and allied health professionals (ward managers, mental staff nurses, nursing assistants, student nurses, pharmacy technicians etc.).

Post-Teaching questionnaires filled out after each session rating understanding before and after teaching.

Topics included the commonest physical health conditions on old age mental health wards, including physical observations monitoring and interpretation.

One overall feedback questionnaire was also obtained at the end of all sessions.

Results

Participants emphasised improvement in their level of knowledge and confidence in spotting signs and symptoms as well as derangements in all topics covered.

They reported feeling more included and heard as a member of the team, feeling more confident to escalate abnormal findings to ensure patient reviews. This is evidenced by comments and ratings on feedback forms.

All respondents believed that the teaching sessions should continue as 87.5% felt they were very helpful, while the remaining 12.5% rated it reasonably helpful (4/5).

Conclusion

While the physical health aspect of patients may be easy to overlook or neglect in mental health settings, continuous creation of awareness through interactive teaching sessions can improve staff knowledge and confidence. We need to re-emphasize the importance of a good working relationship between the nursing team and medics to improve the physical health of our patients (while caring for their mental health) and ultimately ensure patient safety at all times.
The Portfolio Pathway to Specialist Registration; Success in CESR for Applicants and Trusts
Authors: Holmes Sarah , Berry Neeraj
Published: August 2024

Aims

In line with the 2023 legislative change and move to the New Standard of CESR, this will be an informative and educational presentation directed at CESR applicants, and Local Trusts who wish to implement support for CESR. With this suite of support we aim to dispel concerns relating to CESR.

Methods

Mapping guidance to the New Standard of CESR. Production of College guidance in line with the legislative changes, to support success in CESR. Building a CESR Network for all stakeholders.

Results

Delivery of training, a suite of guidance and CESR Roadshows across the four nations.

Conclusion

Creating awareness and spreading communication. Ongoing support for Applicants, Trusts and other CESR stakeholders. Clarity for Applicants, particularly in relation to which Cohort to select, what evidence to include and how to submit a successful application first time.
Emotional Intelligence (EI) Workshops for Core Trainee Psychiatry Doctors
Authors: Mandair Kuljit , Narula Amitav
Published: August 2024

Aims

Emotional Intelligence (EI) is a skill that can help doctors be more effective leaders, work well with others and display the ability of self-control in stressful situations so one is able to act in a calm and rational manner. It is defined as the awareness of one's own emotions and emotions in others and how this affects behaviour. It is a skill that can be developed to allow doctors to manage their emotions to support personal strengths, solve problems and influence the performance of others for positive outcomes.

In the new Core psychiatry curriculum, under 5.1 Team work, trainees are to demonstrate an awareness of how individual personal qualities, emotions and behaviours of both yourself and your team, impact on teamworking and the quality of patient care.

The aim of the workshop was to uncover the definition, science and core components of EI, to reflect on one's own EI and to commit to developing an action plan for building EI skill.

Methods

4 small group-based interactive virtual workshops took place on a monthly basis from September 2022 till December 2022. They were facilitated by a Psychiatry Higher Trainee Emotional Intelligence Practitioner. 28 Black Country Healthcare NHS Foundation trust Core trainees (CT1-CT3) were invited. 60% (17) of trainees attended the 1 hour workshop and completed anonymous feedback at the end of the workshop.

Results

94% of attendees completed anonymous post-workshop feedback. The results showed the following: 100% agreed that the workshop clearly stated and met the objectives, 100% agreed that the workshop covered useful material, 100% felt that it was practical to needs and interests of trainees, 100% felt it was applicable to professional and personal life including mental wellbeing, 100% agreed that the workshop enabled them to reflect on EI skills that can be applied to work, 94% felt that the workshop is relevant and useful to doctors and 100% of participants would recommend this workshop to Psychiatry Doctors and Doctors from other specialities.

Conclusion

It can be concluded that all CT doctors who participated in the EI workshops found them helpful and relevant within their Core Psychiatry Training Programme. All participants found the benefits applicable to both professional and personal life as well as enhancing mental wellbeing. This is reflected by the positive and encouraging anonymous feedback results. Developing awareness of emotions and self-awareness is part of the new Psychiatry curriculum and therefore some teaching/training should be made available to trainee doctors.
Ten Years of Inspiration and Impact: The RANZCP Psychiatry Interest Forum
Authors: McGowan Sharon , Dipnall Sam
Published: August 2024

Aims

To illustrate the scale and impact of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Psychiatry Interest Forum (PIF) ten years since its inception.

Methods

Member data from 2013–2023 was analysed alongside recent event and engagement activity survey results, as well as qualitative feedback from medical students and prevocational doctors who took part in PIF engagement activities.

Results

PIF attracts and inspires the next generation of Australian and New Zealand psychiatrists.

It is a stepping stone into the RANZCP Fellowship program, and has a particular focus on increasing interest in rural careers and supporting more First Nations medical students and prevocational doctors into psychiatry.

PIF events, sponsorships, scholarships and information achieves this by:

•

providing a starting point for learning and exploring the specialty of psychiatry

•

fostering interest in psychiatry among medical students and junior doctors

•

creating a safe and enabling environment to explore the specialty, create networks, and build connections

•

challenging common misconceptions about psychiatry and reduce associated stigma

•

increasing applications to the RANZCP Fellowship program.

Established in September 2013 the program now has over 5,100 members.

In 2023, the program achieved its highest annual number of new members joining to date, with 1,056 medical students and junior doctors choosing to join PIF. That year, 77% of all new trainees that joined the Fellowship pathway were former PIF members.

Survey data from PIF members who took part in the PIF program hosted at the Perth Congress in 2023 demonstrated that:

•

100% reported an increase in psychiatry knowledge following Congress.

•

82% reported their likelihood of pursuing psychiatry had increased following Congress, and 18% reported ‘no change’, as they reported strong certainty prior to the Congress attendance.

•

75% reported that the PIF networking sessions helped clarify misconceptions or stigmas that they previously held about psychiatry following Congress.

The voices of PIF members best illustrates the influence that inspirational experiences like these can have on future career directions:

‘My favourite part of the PIF Congress was the ability to interact with likeminded PIF peers and psychiatrists and trainees from all over Australia and New Zealand. Another PIF member had said “I feel like I've found my tribe” which is a comment I particularly resonated with.

Conclusion

Ten years on, PIF continues to expand its reach and impact to increase the pipeline of psychiatry trainees in Australia and Aotearoa New Zealand.
Neuropsychiatry Teaching for Medical Students: A Narrative Review
Authors: Spani-Orchin Philip , Tsai-Goodman Elliott , Rathnaiah Mohan
Published: August 2024

Aims

Neuropsychiatry is a new and burgeoning field of medicine that combines neuroscientific principles with neurology and psychiatric medicine. Currently, there is little to none medical school literature and/or teaching in the subject. Re-integration of Neurology and Psychiatry disciplines has been recommended, especially in undergraduate and graduate medical training as well as in research. Neuropsychiatry disorders are considered one of the most important causes of disability by the World Health Organization. As a concept, Neuropsychiatry is still not clear on a global scale, from neurological examination to medical school teaching. There have already been active efforts to design and implement Neuropsychiatry training to post-graduate trainees worldwide, particularly in USA, Australia and UK. However, there seems to be no such endeavours towards teaching medical students the role of the brain in the manifestation of neurological as well as psychiatry symptoms. We set out to complete a targeted literature review looking for Neuropsychiatry teaching, if any, in medical schools worldwide.

Methods

A systematic literature search of relevant key phrases was carried out in PubMed and Google Scholar databases. These phrases were searched between 29–31 January 2024 aimed to encompass the full scope of available teaching resources and materials across psychiatry and neurosciences worldwide. These searches included:

(((Neuropsychiatry) AND (Medical students)) AND (Medical school)) AND (Medical education)

(((Neuropsychiatry education) AND (training)) AND (medical students)) AND (Medical education)

(Neuroscience-in-psychiatry) AND (medical school)

((Neuropsychiatry) AND (Medical education)) AND (Medical students)

Further reading was completed from the selected articles (six in total).

Results

A total of 324 results were found from systematic literature search after leaving out the duplicates, of which only 6 articles were included as relevant to aim of our study. None of the articles described clear Neuropsychiatry teaching to the medical students.

Conclusion

Our review highlighted a distinct lack of Neuropsychiatry learning outcomes within medical school curriculum. Neuroscientific principles and methodologies are incorporated in treatment of patients, rationalising clear differentiation between neurology or psychiatry, but the overall picture from both disciplines and utilisation towards diagnosing and managing the cluster of symptoms manifesting from aberrant brain processes is still unclear. In line with previous research around education measurement, we propose that fundamentals from both Neurology and Psychiatry need to be introduced as clinical neuroscience early in medical school and this can be further continued.
Psychiatry and the Cinema for the Wellbeing and Development of Psychiatry Trainees: A Survey and Thematic Analysis
Authors: Jones Tomos , Preston Kate , Stone Jonathan
Published: August 2024

Aims

The importance of the humanities has been highlighted in developing a holistic person-centred model of psychiatry. The use of film to explore topics related to psychiatry, known as ‘cinemeducation’, has been shown to encourage reflection. Wellbeing has been identified as a key area in the quality of psychiatry training, however there is currently no evidence exploring the wellbeing and educational benefits of ‘cinemeducation’ within psychaitry training programmes

Our primary aim was to measure the impact of ‘cinemeducation’ events on attendees’ wellbeing and professional development, with a secondary aim to explore attendees experience of ‘cinemeduation’.

The hypothesis is that attendees will experience a wellbeing and educational benefit from the initiative.

Methods

6 events were assessed between January and August 2023. Each event involved the showing of a feature length film, followed by a 30-minute discussion. 4 out of 6 events were facilitated by guest speakers, usually a consultant psychiatrist. Following events, questionnaires were distributed which included a series of statements with Likert scales and open ended questions. Mean Likert scale scores were calculated with qualitative data interpreted by the authors using thematic analysis.

Results

A total of 108 trainees attended events, predominantly core trainees (64.52%). All events scored consistently high for self-reported wellbeing, however facilitated events demonstrated higher scores for self-reported reflective and educational benefits. The themes derived from qualitative data were of ‘cinemeducation’ being a novel educational opportunity where attendees were able to use film to work through challenges associated with psychiatry, as well as being an opportunity for connecting with other trainees, where attendees could share experiences and foster a sense of community.

Conclusion

Core psychiatry trainees in particular, appear to value ‘cinemeducation’ as a tool to connect with their peers and develop their understanding of psychiatry in a relaxed, but stimulating environment, which is best achieved under the guidance of a senior colleague. The study suggests that the introduction of ‘cinemeducation’ across psychiatry training programmes would benefit trainees’ wellbeing and development. Further research is required to assess the impact of such initiatives across a broader cohort of trainees, using more robust methods of data collection, as well as formal measures of skills such as reflective functioning.
Optimising Care: Quality Improvement for Sustainable Practices in the Paediatric ADHD Clinic in Wrexham Maelor Hospital
Authors: Cunning Catherine , Abdellatif Mostafa , Jabeen Qamar
Published: August 2024

Aims

To make a case for E-prescribing within the Paediatric Neurodevelopmental Team in Wrexham Maelor Hospital.

To trial a different way of approaching 6 monthly reviews within the ADHD clinic (option for remote reviews).

To show how we could reduce the carbon footprint of the ADHD clinic.

Methods

Process mapping was completed to consider areas in the ADHD prescribing process that could be made more sustainable.

For each patient appointment in the ADHD clinic a questionnaire was completed. The data collection period was over 3 weeks during August and September 2023. Data was collected and interpreted.

Results

99 appointments were offered, 82 appointments attended. 77 appointments were face-to-face and 22 were via telephone. Of the face-to-face appointments, 54 families travelled in by car and 4 used public transport (2 taxis). Of those who commented 31 people found it hard to find parking by the clinic, 13 people did not.

Of the appointments attended face to face via car/taxi (57):

•

Average of 4.4 miles travel to the clinic (8.8 miles total journey)

•

Shortest journey 1.1 miles (2.2 miles total journey)

•

Longest journey 16 miles (32 miles total journey)

•

Total patient mileage for these appointments (assuming travel to and from clinic) 855.8 miles

Carbon emissions from the ADHD Clinic:

•

Average journey 0.005t CO2

•

Total journeys 0.472t CO2

•

Assuming average sized petrol car used

•

Extrapolating this data for a whole year approximately: 8.024t CO2 from patient journeys to and from the ADHD clinic

For context the average amount of CO2 generated by a single person in the EU is 7.2t.

Conclusion

We have made a case for e-prescribing within the ADHD clinic in Wrexham Maelor Hospital.

The current system impacts on:

•

Patient and carer's travel time and convenience.

•

Clinician's travel time.

•

Carbon emissions.

Alternative processes have the potential to streamline this process making it more sustainable socially, clinically and environmentally.
7-Day Follow-Up Appointments Following Discharge From a Psychiatric Hospital
Authors: Mizher Isra , Amamilo Ifeoma
Published: August 2024

Aims

Following discharge from inpatient to community psychiatric services, the first 7 days is the most vulnerable and associated with an increased risk of suicide. According to the NICE Guideline 53, it is recommended that patients discharged from inpatient psychiatric services should be reviewed within 7 days by the relevant community services. Our aim was to determine how well we are adhering to this recommendation, appropriately documenting the appointment in the patients' discharge documents as well as the number of patients that attended the appointment.

Methods

We collected data on an excel spreadsheet of patients discharged from Huntly ward (a General Adult Psychiatry ward) in the Royal Cornhill Hospital from 01/09/2022 and 14/10/2022 (a period of 6 weeks).

The data collected included name, CHI, date of admission and discharge, community mental health team, follow-up appointment offered, appropriate documentation on Core discharge document and whether the patient attended the appointment.

After the first audit cycle, we had a discussion with the junior doctors on the ward highlighting the importance of 7 day follow up and the need for arranging with the Community mental health team prior to the discharge, documenting a date, time and name of the clinician for the 7 day follow up in the Core discharge document. We also encouraged the use of reminders like using the doctors' diary book on the ward to document anticipated discharges and adequate hand over of patients to the community mental health team at the start of each week's Multidisciplinary Teams meeting.

We subsequently did a re-audit on patients discharged from Huntly ward between 04/04/2023 and 12/05/2023 (6 weeks). We compared the results from the first cycle and the second cycle to identify a change.

Results

First Audit cycle.

Over the 6-week period, 27 patients were admitted into the Huntly ward and 23 patients were discharged.

48% (n = 11/23) of discharged patients were offered a follow up appointment.

91% (n = 10/11) had this appointment documented in the Core discharge document.

100% (n = 7/7) attended the 7 day follow up appointment.

Re-Audit.

Over the 6 week period, 16 patients were admitted and discharged from Huntly ward.

81% (n = 13/16) were offered a 7 day follow up appointment and this was documented in the Core discharge document.

100% (n = 13/13) of the patients attended their 7 day follow up appointment.

The result showed good improvement from 48% to 81%.

Conclusion

Using reminders, properly liaising with the community mental health team, appropriately documenting a named clinician, date and time for the 7 day follow-up ensures that the patient attends.

The importance of offering support during the first week after discharge from psychiatric hospital should continue to be emphasized to prevent adverse outcome during this vulnerable period.
Mental Health Policies in Low and Lower Middle-Income Countries (LLMICs): A Narrative Synthesis
Authors: Arshad Usman , Chaudhry Imran , Chaudhry Nasim , Jenkin Rachel , Husain Nusrat
Published: August 2024

Aims

Background: Mental health policy is crucial for enhancing mental health and well-being. Despite the significant contribution of mental disorders to the global burden of disease, 68% of the countries possess a comprehensive mental health policy. This review aimed to identify similarities and differences between low-income countries' (LICs) and lower middle-income countries' (LMICs) mental health policies, along with key gaps, limitations, and strengths, to inform Pakistan's mental health policy.

Methods

We conducted searches on Google, the WHO Mental Health Atlas, and the country's Ministry of Health website for mental health and general health policies. Recent mental health policies were included from LMICs that were available in English, whether published or unpublished. Scholarly articles, commentaries, books, and health policies that did not address mental health were excluded. Data extraction covered document title, policy status, country, policy formulation process, human resources, suicide prevention, finances, health service delivery, governance, leadership, involvement of ministries, and implementation plans. We synthesized the data through a comparative narrative review in both text and tables.

Results

Fifty percent (8/16) of LICs and sixty-five percent (17/26) of LMICs have health and mental health policies in English. These policies cover topics like psychiatric disorders, psychotropic drugs, forensic mental health, substance abuse disorders, and communicable and non-communicable diseases. Approximately 65% of LMICs' policies outline the structure of their federal or national government, and 59% provide information on provincial and local government structures. Most LICs include their vision, mission, and objectives in their policies.

Conclusion

Mental health is often neglected in the healthcare policies of LICs and LMICs. To reduce the burden of mental illness and prevent self-harm, suicide, and substance misuse disorders, the implementation of evidence-based mental health policies in line with the Sustainable Development Goals (SDGs) is crucial.
Optimising MDT Huddles: A QIP Approach to Improving Efficiency and Satisfaction in an Older Adults Psychiatric Ward
Authors: Chowdhury Adnan-Mustafiz , Zacharia Tharun
Published: August 2024

Aims

At Chelsham House – an older adults, acute inpatient dementia mental health ward – morning handover meetings (‘huddles’) lacked structure and consistency, resulting in extended, inefficient patient handover discussions and unclear task allocation. These issues consumed valuable clinical time and impacted the continuity and effectiveness of care. Recognising these challenges, a need to revamp the huddle format emerged, prioritising clear communication, effective task distribution, and team cohesion to enhance patient safety and care efficiency.

This project aimed to improve the efficiency and effectiveness of morning huddles at Chelsham House by reducing their average duration by 10% and enhancing multidisciplinary team (MDT) staff satisfaction regarding patient handover dialogues, task distribution, and accountability within 2 weeks.

Methods

The intervention streamlined the huddle format by assigning a rotating MDT chairperson and task allocator, setting a strict 2-min per patient discussion target. New segments, such as a ward safety check and focused discussions on risks and discharge barriers within patient updates, were added. A task allocation board was implemented in the meeting room for assigning tasks. Staff surveys and data on meeting duration were collected pre- and post-implementation.

Results

The implementation led to a 16% reduction in huddle duration (from 64 to 54 minutes) and a 21% decrease in time spent per patient discussion (from 4.09 to 3.23 minutes). Staff surveys showed a significant increase in satisfaction regarding safety discussions (21%), task clarity (23%), and discharge planning efficiency (26%). The effectiveness of mental and physical health discussions was maintained, with a high average Likert score of 4.64 post-implementation, on a scale where 1 is ‘Strongly Disagree' and 5 is ‘Strongly Agree'.

Conclusion

This QIP achieved a notable 16% reduction in huddle duration, enhancing clinical operations on the ward. The progress, combined with improved staff satisfaction and maintained quality of discussions, underscores the QIP's success in boosting clinical efficiency and offers valuable insights for future initiatives in similar settings.
Consumer Survey on the Experience of Clozapine Treatment and Monitoring Process in an Australian Community Mental Health Service
Authors: Fernando Tharushi , Bhandarkar Ritesh
Published: August 2024

Aims

Clozapine is a well-established and widely practiced treatment for treatment-resistant schizophrenia. Due to its significant side effect profile, it requires intense monitoring, including monthly blood tests and medical reviews. A patient's attitude towards clozapine can impact compliance with treatment and its monitoring process. This survey intended to identify the community mental health patients' perception of the clozapine treatment and its monitoring process and to help improve current practices of the service.

Methods

A structured survey with 17 questions was administered to patients registered at the community clozapine clinic via face-to-face or phone conversation at an Australian Community Mental Health Service by the principal researcher and clozapine coordinators.

Results

17 out of 25 eligible patients (68%) participated; the mean age was 39.7 years. There were nine female and eight male participants. 94% of patients were on clozapine for more than one year. 70.5% agreed that clozapine helped to improve mental health, and they understand clozapine side effects and monitoring process. 76.5% agreed that the treating team provided psychoeducation. Seven participants reported clozapine improved side effects compared with previous medications. Three disagreed that clozapine improved side effects, and six remained neutral. Hypersalivation (35.2%), constipation (23.5%) and weight gain (17.6%) were identified as the worst side effects. Nine (52.9%) participants reported that they make healthy life choices. Factors affecting motivation for a healthy lifestyle are mental health symptoms (47%), finances (47%) and physical health well-being (52.9%). Only 35% identified motivation from others as necessary for a healthy lifestyle. Fatigue/poor motivation (47%) and mental health (35.2%) prevent them from making healthy choices. Side effects and finances equally (23.5%) impact healthy choices. Eleven participants (64.7%) felt clozapine monitoring was a positive experience, and 88.2% felt they had enough support during the clozapine monitoring process and were adequately informed about their treatment plan. Two participants disagreed that they were informed of their treatment plan. The majority (82.3%) said no change was needed in the monthly medical officer-led clozapine clinic or six-monthly psychiatrist-led clozapine clinics. Text messages (88.2%) and phone conversations (47%) were the most preferred method for treating team communication about treatment.

Conclusion

The majority of patients identified that clozapine helped to improve mental health, and the monitoring process was a positive experience. Most participants were aware of clozapine and its monitoring process. Psychosocial support will be essential to improve quality of life and might improve the negative perception of clozapine's side effects.
Improving Trainee Experience of Raising Concerns: Redefining a Representative Structure for Post-Graduate Doctors in Training
Authors: Hubbard Katherine , Davies Sian , Ibbett Vicki , Pantall Shay-Anne , Scally Ruth
Published: August 2024

Aims

As part of a wider quality improvement project (QIP) aiming to improve trainees’ experiences with ‘Raising Concerns’ in a large mental health trust, we sought to improve the trainee representative (rep) structure. This would give trainees more transparent processes and provide intermediaries by which to raise concerns. Based on change ideas generated from our driver diagram, roles were created to coordinate meetings and represent specific groups of trainees and on-call rotas.

Methods

Prior to August 2022, there were an undefined number of ‘Senior House Officer’ (SHO) reps who were recruited informally by the Post-Graduate Medical Education Team. The duties of these reps were not clearly detailed. As part of our first ‘Plan, Do, Study, Act’ (PDSA) cycle, we identified groups of trainees that needed additional representation (International Medical Graduates [IMGs], Less than Full Time trainees [LTFT]) and introduced a Wellbeing Rep to cover all training grades. Specifically for SHOs, we introduced three core roles (Rota/Placement, Inclusion, and Social) and individual roles for the six on-call rotas. Following the implementation of this rep structure, we gathered quantitative data, including whether trainees had utilised the reps and how effective they were in raising concerns, and qualitative feedback. We gathered data from both the reps and the whole cohort of trainees. We then started another PDSA cycle in August 2023.

Results

On a 1–5 scale (5 = very effective), the average response from trainees for how effective the trust reps were in supporting raising concerns was 3.8 (5 responders), with no trainees who responded feeling that any of the rep roles needed restructuring. However, the rep survey highlighted that the following roles needed restructuring: Rota/Placement rep, Social rep, and Rota reps. The Rota/Placement role was highlighted as being unnecessary due to the existence of individual rota reps, but there was a need for a ‘lead’ rep to coordinate rep meetings and induction. Unfortunately, a Social rep was not recruited, however it was identified that due to the importance of the role more than one trainee may be required to arrange social events.

Conclusion

Overall, the trainee response to the new rep structure has been neutral/effective, but we hope to obtain more responses in the next PDSA cycle. The rep feedback highlighted the need for coordinator roles to improve cohesion. The results have informed change ideas which we implemented in August 2023. The second PDSA cycle will be completed in July 2024.