bluuebunny/crossref_metadata_2025_split huggingface dataset:
The long and short of it!
Authors: Chaudhry Sidra , Ghosh Adwaita 
Published: June 2021

AimsThe aim of this study was to conduct a literature search on long and short QTc and its implications on prescribing medications.We also intended to assess the knowledge of psychiatry core trainees in the South Yorkshire region regarding QTc and its implications on prescribing for patients.BackgroundThe majority of emphasis lies in ensuring the QTc interval is within range for our patients before initiation of psychotropic medication and as part of monitoring during the maintenance phase. The main dread for most psychiatrists is a prolonged QTc interval, however, a short QTc is equally important to identify and manage.MethodA literature search was performed using the key words “QTc, psychotropics, and ECG”. Results revealed extensive data on long QTc, but very few articles on prescribing psychotropics and short QTc. Most psychotropics are known to prolong QTc interval, which is what clinicians are worried about most when deciding to prescribe medications in mental health services. However, short QTc is also an equally important ECG finding which should not be ignored. We conducted a survey amongst core trainees in the South Yorkshire training scheme to gauge trainees’ knowledge of QTc and its implications when prescribing psychotropic medications. The survey was designed with SurveyMonkey and had seven questions to keep it user friendly.ResultThe survey was distributed to 47 core trainees working in the South Yorkshire region with a response rate of 42.5%. CT1s comprised 30%, CT2s comprised 40% and CT3s comprised 30% of the total number of responders. 60% trainees reported performing and reviewing ECGs as an integral part of their jobs. 50% trainees believed both a short and long QTc interval were life threatening with 50% considering only long QTc as being fatal. 95% of the responders reported not knowing any medications causing QTc shortening; however 100% reported knowing medications causing QTc prolongation.ConclusionThe results clearly show that we need to increase awareness regarding short QTc interval and its implications on patient health. Review of literature also highlights the challenges in treating patients with QTc abnormalities. In such situations, it's advised to seek advice from Cardiology colleagues to ensure safe and effective patient care. It would also be beneficial to arrange refresher workshops to help psychiatrists brush on their ECG skills.
An enquiry into my use of supervised clinical assessments in the supervision of junior trainees
Authors: Choo Yuan 
Published: June 2021

AimsAs a particular example of action research, to enquire into my use of Assessments of Clinical Expertise in my supervision of junior trainees, with the intention of further developing my own practice as an educator.BackgroundWork-Place Based Assessments (WPBAs) play an established role currently in the assessment of trainee doctors(tenCate, 2017). In psychiatry, supervised clinical assessments(ACE/mini-ACE) assess a trainee's proficiency in various areas. As part of my PGCert in Medical Education, I was inspired to examine how I conduct and utilise this form of assessment, and indeed the underpinning values and beliefs, about learning, and developing professional wisdom.MethodThis enquiry was situated within the interpretivist tradition. I interrogated my views about the epistemology of knowledge, and how they had changed from pre-university. I made clear my influences from Coles (Fish & Coles, 1998) on professional practice. I investigated my values in performing an assessment, comparing them to those of the wider community. I examined the literature on the validity of this as a tool. I then performed an assessment of a junior, with a consultant observing, before interviewing them separately.ResultThere has been a paradigm shift in how I view assessments, from pre-university in Singapore, to medical training in the UK. The history of WPBAs and the values espoused is intriguing. Consultants and experts may view assessments differently from trainees, but a core value of developing professional judgement is common.In my interview with the consultant, there were themes around having a clear focus for an assessment, and provision of feedback; the rating scales and how they used them to stimulate feedback; and our shared values in performing an assessment. With the junior, the themes were around the delivery of feedback (including non-verbal), an appreciation of my encouraging self-reflection and understanding, and the observable values in my carrying out of the assessment, which could be compared to those of other assessors.ConclusionWPBAs have their merits, and shortfalls. I am aware of my values and beliefs when utilising them, and have identified a plan to further develop my own practice. This case study is particular, but possibly not unique, in how WPBAs are used in medical education.
Tackling constipation in patients on high dose antipsychotics
Authors: Eappen Sandhya 
Published: June 2021

AimsThe aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .BackgroundAntipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.MethodDuring ward rounds enquired on bowel habits and diet.Physical examination of patients complaining of abdominal pain.Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.Result3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.RecommendationBristol stool chart introduced as part of care plan for all patients.Teaching presentation of constipation and its treatment management was given to the PICU team.Involving medical team early on for assessment and prophylactic laxatives prescription.Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.Data and material handed over to next trainee to Re-audit and complete audit cycle.ConclusionAppropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.
The challenges of delivering addictions psychiatry teaching in the COVID era
Authors: Hammersley Rebecca , Martin Amy 
Published: June 2021

AimsDuring the pandemic, addiction psychiatry moved from face-to-face lectures (delivered by Addictions Psychiatrists) to bitesize pre-recorded lectures (delivered by clinical teaching fellows) alongside interactive tutorials (delivered by Addictions Psychiatrists). The Addictions Team developed an online tutorial (delivered via Blackboard Collaborate) containing a combination of information slides, case studies, interactive quizzes, and short videos. These were delivered ‘live’ to small groups of students in up to four simultaneous virtual classrooms on a 6-weekly rolling basis. We aimed to assess student and tutor feedback regarding the move to interactive online tutorials in addiction psychiatry.MethodTwo questionnaires sought feedback from students and tutors, focussing on the change from face-to-face to virtual teaching during a 20-week period.Result21 (of 161) students completed the questionnaire.
•100% ‘strongly agreed’ or ‘agreed’ that the content of the tutorial was relevant to learning outcomes.•52% felt ‘somewhat comfortable’ unmuting their microphones to contribute verbally, contrasting to 24% feeling ‘not very’ or ‘extremely uncomfortable’. In practice, only 30% of students contributed verbally.•57% felt most comfortable contributing via the written ‘chat’ function (rather than audio or camera).•65% felt either ‘somewhat’ or ‘very comfortable’ turning their cameras on, but only 1 student turned their camera on across all tutorials.•48% felt the tutorial was more accessible virtually than face-to-face; 5% considered it less so.•When COVID restrictions are lifted, 14% would prefer the tutorial to remain virtual, 53% would rather it returned face-to-face, and 33% had no preference.7 (of 7) tutors completed the questionnaire.
•100% felt that students having their camera on would make their experience of delivering teaching ‘much better’ or ‘better’.•71% of tutors felt that students contributed ‘slightly’ or ‘significantly’ less in the virtual classroom.•Only 29% of tutors found the experience of virtual teaching ‘very’ or ‘somewhat’ enjoyable, contrasting 43% finding it ‘somewhat’ or ‘very’ unenjoyable.•Several white space tutor comments suggested the lack of audio-visual engagement made teaching less rewarding, whilst also preventing them from adapting content, pace, and teaching style to suit the group's needs. Tutors felt that the ease of delivering teaching from any location was beneficial.ConclusionVirtual teaching has become embedded in medical education and will likely remain so post-pandemic. For it to be an effective and enjoyable experience, for both students and teachers, there needs to be adaptation of content, technology, etiquette and culture.
More than just the mental health act – foundation-specific teaching to inspire psychiatrists
Authors: Heminway Robert , Fitzmaurice Lauren , Alhaj Hamid , Fearnley Edward 
Published: June 2021

AimsThis project aimed to further develop a teaching programme for Foundation Doctors attached to a psychiatry rotation. The purpose was threefold – to educate foundation doctors about important psychiatric topics; to encourage them to think about wider impacts of psychiatry; and to inspire them to consider psychiatric training in the longer term.BackgroundThe Royal College of Psychiatrists’ mission statement includes actively promoting psychiatry as a career and improving knowledge of mental health, including its interactions with people's physical and social backgrounds. Targeting foundation doctors rotating into psychiatry posts is a good opportunity to achieve these objectives, as they will be the cross-speciality doctors of the future, and have specific learning needs given their unique rotations and new medical careers.MethodOn one Wednesday morning per month Foundation Doctors had a specific teaching session for them. The sessions consisted of four 30-minute teaching blocks which, crucially, were given by foundation doctors. They were facilitated by a core psychiatry trainee, and the topics were decided by the doctor teaching each 30-minute block. The foundation doctors were able teach on any topic related to psychiatry that interested them. Feedback forms were developed and provided at the end of each session for the foundation doctors, as well as at the end of each recent foundation rotation, to get feedback on the overall quality of the course delivered.ResultThe programme has now had 6 complete cohorts of foundation doctors. We have built a varied topic bank from past sessions, including the Mental Health Act, dementia, the Mind-Body Problem, psychiatry in video games and sociology of psychiatric illness, amongst other topics. All foundation doctors questioned have agreed or strongly agreed that the sessions were helpful for their psychiatric rotation and general medical training. Particularly praised aspects were the ability to discuss psychiatric topics that weren't normally discussed in an academic environment, being able to take ownership over learning and practicing giving teaching. Vitally, core trainee facilitators also found the sessions inspiring for their training.ConclusionThe Foundation Teaching Programme has increased doctors’ knowledge of a range of psychiatric topics, the breadth of which and agency in choosing topics has increased engagement with psychiatry, regardless of planned medical training speciality. Areas to explore in the future include potentially opening attendance to medical students and physician associate students, and to other regions of the deanery. Evaluating the long-term impact of this training is also warranted.
Reverse-mentorship of the core concepts in philosophy and mental health: a medical education case report
Authors: Jewell Michael , Kamal Manzar , Bayney Richard , Hales Heidi 
Published: June 2021

AimsThe aim of this medical education case report was to outline the development and outcomes of a reverse-mentorship project that enabled cross-generational collaborative learning. The project took the shape of a philosophy of psychiatry journal club facilitated by a psychiatry core trainee in west London, UK.BackgroundReverse-mentorship reverses traditional roles of mentor and mentee. It is an increasingly fashionable concept in medical education. The junior mentors the senior clinician. The implicit learning outcomes include provision of a two-way learning process, development of mentoring skills for the more junior clinician and collaboration that builds social capital within the workplace. Reverse-mentorship is effective when the junior mentor is recognised for their expertise in a particular area. In this instance, the junior mentor has a special interest in the philosophy of psychiatry.MethodJunior mentor and senior mentees formed a monthly journal club. The club tracked arguments from anti- and biological psychiatry on the meaning of mental illness. The debate offered insight into a semantic analysis of mental illness and a deeper conceptual understanding of medicine. The learning material derived from the core concepts of philosophy and mental health (Fulford et al.). The role of the mentor was to facilitate group discussion around arguments from relevant papers. A survey, adapted from a recent reverse-mentorship review article, measured the quality of educational experience for mentor and mentees.ResultOverall, mentees (senior clinicians) agreed that the mentor (junior clinician) displayed attributes and behaviours for effective mentoring across most domains, including enthusiasm, effective communication, respect for mentee expertise and active listening to the needs of the mentee. The mentor was particularly impressed with the mentees’ openness to learn new concepts and respect shown. General reflections on the experience of reverse-mentorship were positive overall. A thematic review highlighted particular aspects, including: a good way to learn a new skill and great opportunity to develop professional skills of mentoring.ConclusionThe importance of mentoring in medical education is well established. Reverse-mentorship is a new concept that looks to harness the unique qualities of millennials, including their aptitudes for empowerment, innovation and collaboration. This medical education case report shows that an enthusiastic junior clinician can successfully pilot an educational-mentoring scheme aimed at senior clinicians. To make more explicit the intuitive benefits of reverse-mentorship, longitudinal reviews are needed. However, this case report contributes important insights into this burgeoning field of medical education.
Digital frontiers in international psychiatric recruitment: the lessons of the Northwest School of Psychiatry careers event November 2020
Authors: Kazmi Nosheen , Rodrigues dos Santos Catarina , Lewis Emily , Olety Sahana 
Published: June 2021

AimsA low level of psychiatric recruitment is a global issue[1]. The RCPsych & UK Mental Health Trusts jointly run School Events as part of a recruitment strategy. The North West has been running such events for the past years. After our first virtual event, we compare the quality, effectiveness and experience of a face-to-face (F2F) recruitment programme in 2018 with our first remote recruitment programme in 2020. In a world of fast paced technology, we reflect on what lies in the horizon for international psychiatric recruitment.MethodThe recruitment programme was organised by 4 psychiatric trainees affiliated to each mental health trust. A two-day remote programme on the Zoom platform comprising of 45-minute slots was created. Through their own experiences of inspirational speakers, trainees contacted speakers representing different specialities, teaching styles and philosophical outlooks.Pre and Post Programme questionnaires and certificates of attendance were shared with speakers and attendees. These were compared with Pre and Post Programme questionnaires from the F2F event in 2018.ResultWhen compared to the 2018 F2F programme, the 2020 virtual recruitment programme attracted a higher number and wider variety of applicants, in gender (62% female/38%male), nationality (UK 79%/Non-UK 22%), as well as wider distribution in age, UK deanery and training position. Despite the elimination of cost, the quality of teaching was rated higher than F2F due to the availability of high quality speakers (100% would recommend to a friend; 72% rated excellent). Whilst the programme was effective in changing minds, this did not exceed F2F recruitment rates. F2F recruitment feedback focussed on inclusion of sub-specialities, whereas virtual programme feedback focussed on ways to enhance interaction. Feedback focussed on technological applications such as interactive quizzes, breakout rooms, play-acting, and having the benefit of clinical vignettes or speakers’ personal stories to bring talks to life.ConclusionThe use of remote technology transcended geographical and demographic frontiers. A variety of high-quality speakers, directly appealing to an international cohort were sourced, at no monetary cost. In future, the budget will be used in interactive applications, and time-limited session recordings. As the participants hungered for personal connections, we recommend a blended programme, with links to taster sessions, retaining the advantages of both strategies.
The Malaysian Northern Stars (supervision, training, and reflective system) project: a multi-facet ecosystem of producing local talents
Authors: Hadi Noor Melissa Nor , Loo Jiann Lin 
Published: June 2021

AimsThe MRCPsych (Membership of the Royal College of Psychiatrists, United Kingdom) parallel training pathway has been introduced in Malaysia to produce competent psychiatrists to deliver evidence-based psychiatric care. Certain training centres faced specific challenges during the process of implementation, including the lacking of supervisors with experience in the MRCPsych examination, over-reliance on self-study and existing continuous medical education (CME), logistic difficulty in accessing specific training courses, the sustainability of local training, and loss of manpower due to frequent mobilisation of trainees. This article is aimed to illustrate the Northern STARS (Supervision, Training, and Reflective System) project, i.e. a project implemented as a solution for those challenges and an effort to develop a sustainable model of training for the local talents in Perlis, a northern state in Malaysia.MethodThe Northern STARS initiatives included: setting up a library with more MRCPsych-related materials; introducing trainees to virtual MRCPsych support groups; organizing both physical and virtual training locally, collaborating with local and international experts for consultation and teaching, and the introduction of protected study time. Virtual platforms were used innovatively to minimise cost. Ongoing data were collected for programme evaluation and quality improvement. Trainees were actively involved in the process to facilitate the development of leadership and administrative skills.ResultA total of seven courses covering both skill and theory training had been organised: Ultra-brief Psychological Intervention Workshop, Dialectic Behavioural Therapy workshop, Personality Disorder Workshop, Critical Appraisal Workshop, MRCPsych Lecture Series, Addiction Psychiatry Lecture, and Basic Revision Course on Electroconvulsive Therapy. An estimated amount of twenty thousand Malaysian Ringgit had been generated and channelled into the community mental health centre, accounting for the indirect cost of a subscription to ZoomTM and the intangible cost of labour effort. Overall feedback revealed a high level of satisfaction together with some specific suggestions on areas of improvement, including the timing of course and coverage of the curriculum. To date, six medical officers are pursuing this pathway with three of them passing one paper and another two pursuing the final part.ConclusionThe Northern STARS project is an ecosystem of training solutions while generating income and producing more local talents to expand this project further. More long-term evaluation from the perspective of human resource and health economics can be considered to understand the efficiency of the current initiative.
Survey of junior doctors' perspective of serious incident reviews
Authors: Popoola Olusegun , Naidoo Kuben , Shetty Amrith 
Published: June 2021

AimsSerious incidents according to NHS England (2015) are incidents where the consequences to patients, families and carers, staff or organisations are so significant or potential for learning are so great that a heightened response is justified. There is anectoctal evidence that this process is potentially difficult for junior doctors and the primary purpose of learning may be lost due to the stress involved.Our aim was to evaluate junior doctors perspective of serious incident reviews. A secondary aim was to organise local and regional workshops based on the outcome of our findings to address misconceptions around serious incident investigations.MethodA survey was developed using survey monkey and distributed to all trainees across the Mersey region through the Medical Education teams.The junior doctors range from core trainees to higher trainees. The survey encouraged the use of free texting if necessary.Results from the survey were then analysedResult18 junior doctors across the 3 mental health Trusts in the Mersey region responded.12 respondents have been involved in a serious incident investigation in the past and 9 of the respondents stated that they did not recieve any support during the process. Out of the 3 that were supported, one rated the support as poor and frightening.55.56% af all respondents found the process of serious incident reviews hard to understand.66% of all respondents admitted that they are aware that the purpose of the review is for learning purposes.100% of respondents agreed that a workshop to discuss the purpose and process of serious incidents investigation to aid their understanding would be useful.ConclusionFrom the survey, we concluded that junior doctors do have some understanding of incident reviews process but they still do not feel comfortable with the idea of being under ‘investigation'.It is also important that formal support is made available during the process.We organised a workshop in one of the 3 Trusts which was well attended and junior doctors asked if they could sit on review panels for experiential learning. This is to be presented to govenance teams across the mental health trusts in the region.Further workshop across the 2 remaining Trusts could not be organised due to COVID-19 pandemic.