bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foundation doctor preparedness for treating mental health conditions: results from a national survey
Authors: Gillett George , Davis Owen , Gill Amarit , van Hamel Clare 
Published: June 2021

AimsPrevious research suggests the prevalence of mental health conditions among medical inpatients may be as high as 38%. Anecdotally, junior doctors report lacking the confidence, knowledge and skills to assess and treat patients with psychiatric conditions. Identifying this unmet need offers potential to improve standards of care and achieve parity of esteem between psychiatric and medical conditions within the general hospital. Aims:To assess self-reported preparedness of newly-qualified Foundation Doctors to care for patients with acute or chronic psychiatric symptoms in comparison to physical health conditions.MethodIn September of each year (2017, 2018, 2019), a survey was cascaded to all incoming Foundation Year 1 Doctors. For each respective year there were 1673, 961 & 1301 respondents. Respondents were asked to rate their agreement with statements on a Likert scale. Statements pertaining to mental health included “a) I am competent in acute mental health care provision, b) I am competent in chronic mental health care provision” and “I feel confident in prescribing the following drugs; c) drugs for mental health problems”. Comparison statements assessed confidence caring for medically unwell patients, performing practical procedures and prescribing drugs for physical health conditions.ResultPreparedness for acute and chronic mental health were lower than both physical health comparison items; preparedness to care for patients with critical illness (acute: r = 0.794, p < 0.001, chronic: r = 0.556, p < 0.001) and preparedness to perform practical procedures (acute: r = 0.724, p < 0.001, chronic: r = 0.433, p < 0.001).Confidence prescribing mental health drugs was lower than all other comparison items (simple analgesia: r = 0.854, bronchodilators: r = 0.789, antimicrobials: r = 0.772, inhaled steroids: r = 0.720, intravenous fluids: r = 0.702, oral anti-diabetics: r = 0.611, anticoagulants: r = 0.515, narcotics: r = 0.514, insulin: r = 0.206; p < 0.001)ConclusionThese results identify a disparity in foundation doctors’ self-reported preparedness to treat acute and chronic mental health conditions and prescribe psychotropic medications, compared to a variety of physical health domains. To our knowledge this is the first large-scale study to empirically test a potential discrepancy between newly-qualified doctors’ preparedness to treat patients’ mental and physical health needs. Medical school education and foundation training may therefore present a fruitful opportunity to improve care for patients with psychiatric conditions within general hospital settings.
A pilot project to increase trainee engagement using a social media platform – outcomes and lessons learnt
Authors: Grimason Amy , Matheiken Shevonne , Somerville Laura , Martin Fiona , Baker Luke , Garg Kabir , Sharma Aastha , Morris Simon George 
Published: June 2021

AimsEngagement with members is an important issue for the Royal College of Psychiatrists (RCPsych) and an area for ongoing development. This is an issue that extends to Psychiatry trainees and the Psychiatric Trainees’ Committee (PTC) has adopted increasing engagement as one of its key aims. Divisional representatives in different areas of the UK had noted that trainees had limited knowledge of the PTC or its roles and projects both within the College and local areas. To improve this it was decided to pilot a project that established a social media platform for trainees to improve communication between the PTC, it's representatives and trainees. It was decided that Workplace (a professional version of Facebook) would be used. This had already been established in the Severn Deanery.MethodNorthern Ireland (NI) and the East of England (EoE) deaneries were selected as pilot areas for the project. Preparation for the project included collaboration with trainees from the Severn deanery and meeting with the RCPsych Digital team. A scoping questionnaire was circulated to trainees in each deanery.Following this, two closed groups were initiated on Workplace in August 2019 for Northern Ireland and East of England trainees.ResultResults from the survey sent prior to the social media pages being established indicated there was appetite among trainees for the project. The pages were established in July 2019. The pilot project was promoted by representatives.In the initial phases, approximately 40% of trainees signed up. Information regarding college and local events, committee meeting updates and training opportunities was disseminated on the platform. There was evidence of early use by trainees outside of the representative group.This however was not sustained and gradually use of the platform reduced over the pilot period, both in postings and membership. A further questionnaire circulated in July 2020 highlighted trainees’ concerns relating to the platform, including concerns around data protection and a high number of notifications associated with the Workplace medium. The ultimate impact on engagement was also felt to be minimal.ConclusionFollowing feedback and increasing usage costs by Workplace, it was decided not to continue with a nationwide role out of the project. COVID-19 has seen the successful use of platforms such as Microsoft Teams and these may be considered in the future, given their integration with existing trust systems.
An analysis of the views of different members of the inpatient team on the role of the physician associate on the general adult psychiatric wards
Authors: Hyland Declan , Uddin Mohammed 
Published: June 2021

AimsPhysician Associates (PAs) are healthcare professionals who have a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.
Responding to a pandemic with Simulation Based Education (SBE)? Sharing lessons learned from Sussex Partnership Foundation Trust (SPFT)
Authors: McEwan Craig , Kerslake Richard , Hobkirk Michael 
Published: June 2021

AimsIn March 2020 SPFT was preparing for the first wave of the COVID-19 pandemic. Senior medical leadership supported the rapid development and delivery of SBE workshop for assessment and management of physically unwell patients in a psychiatric setting in the context of COVID-19. The training was delivered to 102 psychiatrists across 10 sessions over 4 weeks.A learning review was completed to identify lessons learned from the delivery of this SBE workshop.MethodThe intervention was reviewed using open-space feedback from attendees, interviews with facilitators and medical leadership, and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis.ResultOverall, the simulation project met its pre-determined objectives of increasing confidence and competence in the medical workforce in the context of COVID-19 and physical health. Development and delivery of the workshop was rapid, with request to delivery taking 4 days.A summary of the key lessons include:An existing simulation faculty within the trust was essential, allowing for rapid identification of key stakeholders and those able to deliver the project.A “direct-line” relationship to senior leadership enabled the project to be dynamic and responsive to changing demands as COVID-19 guidelines and objectives evolved.Redeploying higher trainees with SBE experience to develop the project as a focussed team allowed for rapid delivery which was resource-effective.The workforce found reassurance from understanding what was not expected of them, as much as what was. For example, making clear that Arterial Blood Gases would not be introduced to the psychiatric setting.There is an ongoing learning need for physical health training through SBE in non-covid scenarios.SBE can be an effective intervention for a range of medical grades and covering a large geographical area.There are opportunities for developing multi-disciplinary training on physical health in psychiatry.ConclusionWe have outlined some of the key learning outcomes from a successfully implemented SBE project during the first COVID-19 wave in spring 2020. The project has cemented the role of the relatively new simulation faculty within the trust and highlighted the effectiveness of close collaboration between leadership and a small, dedicated group of facilitators. The project has continued to be used for training new staff members and the resources have been widely shared, used by other NHS trusts and also internationally.
Peer-led medication education in the time of COVID-19
Authors: Roberts Rosa 
Published: June 2021

AimsTo set up an online peer-led medical education programme for core psychiatry trainees during the COVID-19 pandemic.To determine trainees’ views regarding the role of peer-led education in psychiatry.MethodA peer-led education programme was set up for psychiatry trainees in their third year of core training, held over an online video-conferencing platform. The weekly sessions were organised and led by trainees. Each week a trainee either presented a journal article or a particular psychiatric topic, with a group discussion afterwards.An online survey was sent to psychiatry trainees that had participated in the programme to determine their views. Close-ended questions were asked as well as open-ended questions for more qualitative responses.ResultThere were 9 peer-led sessions in total, with 11 trainees (out of 18 invited) attending at least one session, and an average of 5 trainees at each session.Five core trainee psychiatrists responded to the survey following the sessions. All of the respondents found the sessions either “very” or “fairly” useful. 80% stated that there should be more peer teaching opportunities as part of normal psychiatry training. All respondents found engaging with online teaching either “easy” or “OK”.Open-ended questions showed that respondents found the sessions were useful for: 1) connecting with peers during a difficult time 2) free discussion due to being around peers 3) wide interest and variety of topics. Improvements that could have been made were: 1) more sessions 2) advance knowledge of journal articles being presented.ConclusionPeer-led sessions are a useful form of medical education for core psychiatry trainees. During the restrictions brought about by the COVID-19 pandemic they are a way to connect with colleagues during an isolating time. They are easy to organise and access; and can take pressure off medical institutions, whilst having the advantages of allowing trainees to feel they can discuss topics in a more open manner and can follow their own interests.
Balint in the time of COVID-19: participant and facilitator experience of virtual Balint groups compared with in-person
Authors: Samnani Sheliza , Awal Masud 
Published: June 2021

AimsOur Trust increased Balint group provision, relocating virtually for psychiatry doctors to explore the emotional impact of clinical practice and doctor-patient relationships, during unfamiliar challenges of the pandemic. This unique context allowed comparison of multiple virtual and face-to-face (F2F) Balint-type group experiences for participants and facilitators.MethodIn March 2020, existing core trainee (CT) year 1 and 2, higher trainee (ST) and consultant Balint groups became virtual, with new CT3 and Speciality Doctor and Associate Specialist (SAS) virtual Balint groups established.All 57 participants and 5 facilitators were sent an anonymous electronic survey to retrospectively rate virtual Balint (March-August 2020) and their preceding F2F Balint group (suggesting September 2019-February 2020) experience.ResultThe response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents).For group participants, 90% (virtual) and 78% (F2F) agreed or strongly agreed that Balint group provided an opportunity to explore challenging aspects of clinical work. 76% (virtual) and 71% (F2F) agreed or strongly agreed that it made them feel more supported. Almost 50% agreed or strongly agreed that virtual and F2F Balint group helped work feel less stressful. Both ratings and free-text feedback emphasised virtual Balint attendance being easier.Facilitators rated virtual and F2F formats similarly highly with regards to exploring difficult doctor-patient interactions, richness of discussions and their enjoyment. Facilitators felt virtual attendance was easier but more draining, with more difficult adherence to Balint group etiquette and boundaries.82% of participants and 75% of facilitators agreed or strongly agreed that virtual format made them more likely to attend future Balint groups. The rich pool of free-text comments received were predominantly positive, whilst noting challenges during virtual Balint in remaining present, with more distractions (for participants) and additional difficulty accessing group dynamics (for facilitators).ConclusionParticipant and facilitator responses indicate Balint-type groups being professionally and clinically beneficial across different psychiatrist grades, and promoting clinician wellbeing when both F2F and virtual during pandemic-related restrictions. Facilitator ratings (unlike participants) suggested specific virtual process challenges such as feeling more drained, perhaps in part due to technical application issues around this emerging format.Both participants and facilitators reported attendance being easier when virtual. Although some suggested returning to F2F post-COVID, more preferred to continue virtually or utilise a blended format. This was particularly for non-CT groups where geographical challenges (e.g. region-wide ST Balint) or competing clinical demands (e.g. consultant/SAS Balint) made regular commitment and attendance more difficult.
Improving the confidence and competence of junior doctors in conducting seclusion reviews
Authors: Shalaby Mostafa , Rahman Mehtab 
Published: June 2021

Aims•To improve the quality and consistency of medical seclusion reviews at St Charles Hospital and across the Trust.•To ensure at least 80% compliance with minimum standards for seclusion review documentation by the end of December 2020.•To increase doctors' mean perceived competence and confidence scores to 4.5/5 by the end of December 2020MethodSeclusion is commonly used to manage patients at high risk of aggression or violence, but is a high risk and very restrictive intervention. As such, it requires regular nursing and medical reviews. Work has been done recently at St Charles to improve the timeliness and effectiveness of nursing reviews including detailed guidance. Medical reviews are usually performed by junior doctors, many with limited experience in psychiatry. There is
•A lack of consistent local or national guidance for junior doctors undertaking seclusion reviews•The quality and scope of these reviews is not consistent•There may be a need to ensure that there is more standardization and to improve junior doctors' confidence – and therefore patient safety and experience – overall.•The following interventions were used to improve the quality of seclusion reviews at the hospital:•Minimum standard guidelines•Presenting in Restrictive interventions meeting.•Feedback from PICU consultants for guidelines•Changing guidelinesFuture plans:
•Guidelines teaching (Early November)•Re-audit and new survey (Early November)•Simulation training (Mid November)•Seclusion teaching video (Early December- to be ready for Induction)•Re-audit and new survey (Beginning of April)ResultSurveys were conducted before and after quality improvement interventions were put in place. The average confidence levels of junior doctors increased from 38.5% to 87% following these interventions.ConclusionRevision of seclusion guidelines, junior doctor teaching and simulation training are effective interventions to improve junior doctor confidence levels in conducting seclusion reviews.
Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India
Authors: Sheth Shabinabegam A M , Bairy Bhavya , Ganesh Aurobind , Jain Sumi , Chand Prabhat , Murthy Pratima , Arora Sanjeev 
Published: June 2021

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.
Survive and thrive wellbeing programme: an innovative experiential wellbeing programme for trainees in Health Education England- Thames Valley (HEE-TV)
Authors: Vlachos Haido , Higham Aisling , McDouall Sara 
Published: June 2021

AimsThe aim of this project was to develop an experiential programme which encouraged trainees to develop their own processes for mental resilience acting to mitigate difficult work and life environments.BackgroundDoctors are at considerable risk of work-related stress, burnout and mental health problems, particularly trainees, many of whom are experiencing symptoms earlier in their career. The Thriving at Work Review, the British Medical Association and HEE all call for cultural and organizational change that works to prioritise, promote and enhance wellbeing by providing good working conditions and an atmosphere that encourages open discussion about mental health with access to appropriate support that destigmatises mental health.MethodAcross HEE-TV we identified that there were no regular wellbeing initiatives for trainees, and specifically no psychologist-facilitated Cognitive Behavioural Therapy-style sessions to enhance resilience. Six schools identified a specific need for HETV-targeted resources focused on enhancing trainee mental wellbeing.The current course has morning sessions that cover self-awareness, and afternoons are psychologist-facilitated sessions. The initial pilot was run for the School of Anaesthetics, and later offered to specialties with a General Medical Council-survey identified need. Multiple improved iterations of the course have been driven by detailed trainee feedback, including adding the psychology sessions to give trainees tools for self-help.ResultWe triangulated feedback from attendees at the sessions, nominated trainee representatives from all specialties across Thames Valley via the Trainee Advisory Committee (TAC), and HEE-TV quality assessors. Feedback from trainees who attended was almost universally positive. The Quality Committee noted improvement of trainee morale in Anaesthetics and direct improvement in aspects of the learner environment that would not have happened without this intervention. The TAC endorsed this as one of the measures to support trainees in difficult learner environments. They also recommended it be rolled out for all as a preventative measure as there can be a time lag before items appear on the Risk Registers and are officially recognized as requiring support. The biggest measure of success is that HEE-TV have agreed to fund these sessions ongoing.ConclusionWe learned that an iterative response to trainee feedback and careful co-ordination is key to successful engagement via the training programme directors who arrange regional training programmes. This, and making the SAT course free at the point of use, makes it easier for trainees to access this programme. In addition we will be including the trainee voice is shaping bespoke aspects of the day for each specialty.