bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychoeducation for the Frontline: Ealing Liaison Psychiatry Service (ELPS) pilot training day for London Ambulance Service (LAS)
Authors: McLean Emma , Alexander Mariam 
Published: June 2021

AimsTo host the first ELPS training day specifically for LAS staff to improve their knowledge and understanding about mental health issues and the role of ELPS.On average 13,000 calls are received by LAS relating to mental health issues every month. Many patients seen by ELPS will have multiple interactions with LAS. ELPS has previously held training for the Emergency Department team but this innovative day was designed to extend this training commitment to pre-hospital cliniciansMethodLAS training needs were initially assessed by a bespoke questionnaire and ELPS attending another LAS training event held by the new mental health joint response car team.We then developed a training programme to match the identified training needs and which utilised the specific expertise of individual ELPS staff.14 members of the local LAS stations attended including both Paramedics and Emergency Ambulance Clinicians. The presentations covered mental state examination, suicide, risk assessment, substance misuse, legal frameworks and then a ‘challenging cases’ session to bring it all together.Pre and post course questionnaires were completed by participants, exploring attitudes and knowledge.ResultThere was a statistically significant improvement in the average self-ratings for all of the categories assessed including attitudes to mental health, confidence in assessment and knowledge relating to the process the patient will experience in the emergency department.The knowledge about the pathway and role of liaison psychiatry showed the greatest improvement with an average 4.25 increase in pre and post course rating.Almost all participants (9.2/10) would recommend this training day to a colleagueConclusionWe met our objective of improving LAS staff knowledge and understanding about mental health issues and the role of ELPS. We plan to build on this successful pilot and expand our training programme for LAS with the ultimate aim of improving patient care.
Peer mentoring in psychiatry: a trainee-led initiative
Authors: Moore Zoe , Irwin Linda , Brown Stuart , Anderson Julie , Moore Stephen 
Published: June 2021

AimsOur aim was to establish a Peer Mentoring Network within Psychiatry Training in Northern Ireland.Recognising that starting a new job can be a stressful time in any junior doctor's career, we wanted to ensure that new Core Trainees (CT1s) joining our Specialty Programme were well supported through this transition.Although Clinical and Educational Supervision is well established in providing a support structure for trainees, we believed that a peer mentoring relationship, (with allocation of a Higher Psychiatry Trainee as mentor), would be of additional benefit.It was hoped that the scheme would prove mutually beneficial to both mentee and mentor.MethodWe delivered a presentation at CT1 induction and sent out follow-up emails to encourage participation. Higher trainees were also sent information via email and asked to complete a basic application form if interested in becoming a mentor. Prospective mentors then attended a one-day training session.Two lead mentors, (also higher trainees), were allocated to oversee the scheme, with additional supervision from two lead Consultants. Mentor-Mentee matches were made based on information such as location, sub-specialty affiliations and outside interests.Matched pairs were advised about the intended frequency and nature of contacts. Check-in emails were sent halfway through the year and feedback evaluations completed at the end.Result95% of trainees who completed the evaluations said they would recommend the scheme to colleagues.Mentees reported benefits in terms of personal and professional development, whilst mentors reported improved listening, coaching, and supervisory skills.A small number of trainees highlighted that 6 monthly rotations impacted on ability to maintain face to face contacts.Recruitment and engagement have improved annually. We are currently running the third year of the scheme and have achieved 100% uptake amongst CT1s and are over-subscribed with mentors, (19 mentors to 13 mentees).ConclusionThe majority of feedback received has been positive and interest in the scheme continues to grow.Potential issues relating to location of postings has been overcome, at least in part, by recent changes to ways of working and the use of alternative forms of contact, such as video calling.Having exceeded demand in terms of mentor recruitment, we hope to extend the scheme to include trainees of other grades, and particularly those who are new to Northern Ireland.We are excited to see where the next stage of our journey takes us and hope that others will be inspired to embark on similar schemes within their areas of work.
Quantitative and qualitative analysis of feedback from The Psychiatry Teaching Programme for Foundation Year doctors rotating through Pennine acute trust from 2010 to 2020
Authors: Namuddu Angel , Gani Margaret , Burlinson Sarah 
Published: June 2021

AimsTo monitor the year on year trend of feedback scores regarding content, presentation and relevance of sessions delivered as part of the programme by analysing the average Likert scales. To review the confidence post topic from FY feedback. To review qualitative data on the written feedback annually using a word cloud.MethodCollated data from teaching programme from the various teaching sessions from the past decade and analysed previous teaching reports completed by previous ST leads.ResultFinding: Relevance: Improvement in the average score year on year, highest in 2018/19 at 4.8/5Content: Improvement in the average score year on year, highest in 2018/19 at 4.6/5.Delivery: Improvement in the average score year on year, highest in 2018/19 at 4.6/5.Qualitative analysis showed that the common themes that were commented on as positives for the session were: interactive, relevant and interesting, for areas for improvements the common themes were: more interaction, split into shorter sessions, faster pace and the need practical adviceConclusionRecommendations: teaching for FYs should aim to be interactive, relevant and interesting and include practical advice, be shorter and faster paced. Teaching programme organisers to contine to use the foundation year feedback to improve the teaching programme including advising future trainees and organising different topics.
Demystifying the pathway of assessment and treatment for bipolar disorder – utilising co-production and algorithms to personalise the approach
Authors: Nicholls-Mindlin Jessica , McLellan Angus , Gee David , Fuzi Lauren , Taylor Matthew , Quested Digby 
Published: June 2021

AimsTo develop an evidence based, patient centred treatment pathway for people experiencing symptoms of bipolar disorder (BD), modifiable to include local resources.MethodThis project was developed in line with current approaches to service development such as coproduction, with patient and public involvement (PPI) and enhancing personalisation of treatment in medicine. As part of a local initiative, a multi-disciplinary team was brought together to understand and analyse the current local pathway for those affected by BD. It was found that the approach to assessment and management was not consistent between locality teams. Two experts by experience who have a diagnosis of BD were invited to become involved with the development of the pathway. Meetings were set up to enable coproduction and elicit information from those with the diagnosis. The responses provided insight into the effectiveness of different approaches used nationally to inform the methods and resources that are most helpful and appropriate to comprehensively support those with the illness.NICE guideline evidence was used to create two algorithms to streamline the care of those with BD in both primary and secondary care. These algorithms include pharmacological, psychological and social approaches. It also considers the junctions at which referrals should be made and the criteria on which decisions are based.ResultOne algorithm was designed for use in primary care and will be distributed to local GPs to clarify the initial steps for assessment and management of BD and the criteria for referral. A second decision tree will be made available to all doctors working in mental health services with detailed medication options, when they are appropriate and whether additional psychological intervention should be considered e.g. post-discharge groups. Other specialist options such as Early Intervention for Psychosis and Perinatal Mental Health Services were also included. An information pack was created to be offered to all those with a diagnosis or possible diagnosis of BD. This contains useful resources such as skills and exercises that patients may find of benefit, external resources and websites regarding additional support and further information on BD, its nature and management.ConclusionThe approach and resources collated here will help to streamline the management of those with bipolar disorder whilst also ensuring a more consistent approach. The involvement of experts by experience and the incorporation of NICE guidelines ensures a well-rounded and comprehensive set of documents that will be helpful to both clinicians and patients.
An audit on prescribing practice and risk of serotonin syndrome among patients with chronic pain
Authors: Rai Salakan , Yusof Aizad 
Published: June 2021

AimsTo determine the incidence of prescribing practice with associated risk of serotonin toxicity among patients with chronic pain conditions.BackgroundSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity, usually from drug interactions. Concurrent use of antidepressants is strongly linked to serotonin syndrome, with recent data revealing record numbers of NHS prescribed antidepressants in 2019. Antidepressant medications are also used in chronic pain management for their anti-neuropathic pain properties. However, it is well-recognised that a significant number of chronic pain patients suffer from anxiety and depression. This cohort of patients is therefore vulnerable to being exposed to multiple concurrent antidepressant agents, and thus at relatively higher risk of serotonin syndrome compared to other patient groups. Additionally, these patients are likely to be exposed to the concurrent use of antidepressants and certain analgesic agents particularly phenylpiperidine derivatives which increases serotonin toxicity risk.MethodMedications of patients presenting to a secondary care pain clinic within the last year were looked into. Patients were selected at random by pain management secretaries. Concurrent use of multiple antidepressant agents including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Noradrenaline Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) or Tetracyclic Antidepressant (TeCA) was noted. Additionally, concurrent use of any of these antidepressant agents and phenylpiperidine derivatives such as Fentanyl and Tramadol was noted.ResultData on medications of 97 patients were collected. A total of 28 patients (28.8%) were observed to have at-risk medication combinations. Out of these, five patients were on both SSRI and TCA. Two patients were on both TCA and TeCA. Four other patients were on either a combination of SSRI and SNRI, SNRI and TCA, SSRI and TeCA, or TCA and TCA. Three patients were on both Fentanyl patches and an antidepressant. Fourteen patients were on both an antidepressant and Tramadol. None of these patients were diagnosed with serotonin syndrome; however, it is unclear as to whether these patients experienced milder symptoms of the syndrome.ConclusionA considerable number of patients in this group were on medication combinations putting them at risk of serotonin syndrome. Despite no documented patient harm, there is an urgent need for an increased awareness among prescribers on drug interactions which may lead to this syndrome and a subsequent change in prescribing practice.
Bedside teaching: an invaluable tool in undergraduate medical education
Authors: Ruddock Kenneth 
Published: June 2021

AimsBedside teaching is one of the most important modalities in medical education. Sir William Osler stated, “Medicine is learned by the bedside and not in the classroom”. Despite this, the use of bedside teaching in the undergraduate curriculum has been declining, potentially due to changes in course design, increasing clinical workloads and reducing inpatient numbers. In my role as a Clinical Teaching Fellow (CTF), I have aimed to maximise bedside teaching and promote it as the primary approach for student learning.MethodAs a CTF, I deliver teaching to students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. Weekly teaching is provided to groups of 2-4 students, with around 50% of sessions delivered ‘at the bedside’.Within psychiatry, there is a vast range of potential bedside teaching topics. Given the length of time required to conduct a full psychiatric history and mental state examination (MSE), teaching sessions instead focus on one specific component of the patient interview, for example, assessing perceptual abnormalities or delusions, conducting a substance use history or exploring social circumstances and the functional impact of illness. This approach allows for more focussed feedback and teaching. Session structure is based upon Cox's model of bedside teaching, which I have modified slightly for the psychiatry setting.Student feedback has been collected via an anonymous electronic end-of-block questionnaire.ResultQualitative feedback reveals that students in NHS Lanarkshire value bedside teaching, with one student describing it as “informative, comprehensive and relevant for upcoming exams and clinical practice”.There are a number of potential barriers to consider when delivering bedside teaching in psychiatry. These include issues identifying suitable patients who can provide informed consent to participate and the ethical concerns regarding exploring difficult subjects such as suicide risk assessment with patients for purely educational purposes.These issues can be overcome; in inpatient units, there is usually a small cohort of patients who are able to consent and engage in student teaching, and difficult subjects can alternatively be addressed during role-play or simulation sessions.ConclusionDespite its challenges, bedside teaching can be an enjoyable and rewarding approach in undergraduate medical education, with feedback revealing it is positively received in NHS Lanarkshire. By utilising Cox's model and focussing on specific aspects of MSE and history-taking, bedside teaching is more accessible and an invaluable tool for psychiatric teaching. Clinicians and educators are encouraged to keep the patient at the centre of student learning.
GMC training survey and missing trainees in psychiatry
Authors: Schmidt Martin , Leung Timothy 
Published: June 2021

AimsTo investigate the extent of misattributed responses in the General Medical Council (GMC) National Training Surveys (NTS).BackgroundAs part of its role in quality assurance of medical training, the GMC conducts an annual survey of trainers and trainees. Benchmarking of trusts’ performance is indicated by red flags denoting outlying poor performance. The validity of this depends on the correct attribution of responses to trusts. We have previously found that responses for Foundation Year One (FY1) trainees undertaking psychiatry placements were misattributed to trainees’ affiliated acute trusts (AT), even though the mental health trusts (MHT) were providing the training placements.MethodData from the online reporting tool were used to calculate the numbers of FY1, Foundation Year Two (FY2), and General Practice Speciality trainees (GPST) on psychiatry placements attributed to ATs and MHTs in 2019. A range is provided for the data, as results for trusts with one or two trainees are not reported. The data were analysed by training level and the 13 Health Education England (HEE) regions to give a proportion of trainees missing from the MHT data (% missing), an indication of response misattribution.Result296-302 FY1s were attributed to MHTs and 114-148 to ATs, giving a % missing of 27.4-33.3%. 261-275 FY2s were attributed to MHTs and 89-125 to ATs, giving a % missing of 24.4-30.0%. 507-511 GPSTs were attributed to MHTs and 49-73 to ATs, giving a % missing of 8.8-12.6%.Across the three training levels, all HEE regions were affected by data misattribution. The regions most affected were South London, Kent Surrey Sussex, and North West London, with missing % of 51.6-54.3%, 33.9-40.7% and 29.9-32.5% respectively. The HEE regions least affected were East Midlands, North Central and East London, and East of England, with missing % of 4.3-6.0%, 5.6-8.1% and 5.5-10.4% respectively.ConclusionResponse misattribution for psychiatry placements in the NTS is rife, with the greatest impact on FY1s. While this issue affects all HEE regions, wide variation exists. Response misattribution means that the calculation of outliers is based on incomplete data, threatening the validity of the results. By liaising with our local HEE office to ensure correct attribution of our trainees, Surrey and Borders Partnership NHS Foundation Trust reduced our % missing from 50.0-56.8% in 2018 to 5.4-10.1% in 2019, thus proving that it is possible to remedy the situation on a local level.
Core Trainees' study budget and study leave: a survey exploring trainees' needs and understanding of local processes in place within the North West
Authors: Shroff Chirag 
Published: June 2021

AimsHealth Education England launched a new system for study leave and study budget on 1st April 2018, in response to trainees' concerns regarding the previous system. According to this, Health Education England would manage the study leave budget through its local offices, making the process of accessing study ‘more transparent, equitable and streamlined' for all trainees. At the RAP Oversight Committee meeting of the North West Deanery in 2019, trainees' uncertainties over the process was discussed by the local reps. It was aimed that there was a need to gather information on trainees' needs and understanding of local processes in place by the deanery to access study leave and study budgetMethodA cross sectional survey was sent out to all the trainees by the Core Trainees year 1 RAP rep. A total of 6 relevant questions were designed and sent out to the trainees, allowing them 2 weeks’ time to respond. There were a total of 66 trainees who were sent the survey. The guidance mentioned in the 2016 Gold guide was used for reference to ensure the questions are relevant.ResultOf the total of 66 trainees who were sent the survey, there were 48 respondents. The results indicated that all 48 responders preferred study budget and leave process explained at induction. 47 of 48 respnders sought access to their study budget, 46 of 48 responders sought use of budget for external course and exam fees fudning, 27 of the 48 responders struggled to get study leave and 27 of 48 responders felt the current leave process was not satisfactory with 14 opining that there was scope for improvemement.ConclusionThe responses were collated by the trainee rep as a PowerPoint presentation containing graphical representation of trainees’ views regarding their study leaves and budget access. The survey results were made aware to the local board at the subsequent RAP Oversight Committee meeting to seek response and new guidance. There is a new system in place for study leave and study budgets, overseen by Health Education England. Overall, the survery attempted to understand and collate trainees' wants and needs, in effect improving trainee experiences.
‘What is psychiatry?’ – an exploration of the effect of a psychiatry summer school on school students’ attitudes towards psychiatry, through the medium of word clouds
Authors: Wyke Clementine , Jones Charlotte Wilson , Chivers James 
Published: June 2021

AimsTo explore if attending a psychiatry summer school would change the understanding of school students as to what the word ‘Psychiatry’ represents.BackgroundThe Institute of Psychiatry, Psychology and Neuroscience (IoPPN) and the local mental health trust, South London and Maudsley NHS Foundation Trust (SLaM) ran a free five-day summer school for 16-year-old school students, who had just completed their GCSE exams, from state and private secondary schools within South-East London.MethodWe asked all 26 student attendees to anonymously write down as many single words relating to ‘Psychiatry’ as they could think of. They were given approximately 5 minutes to complete this and they were asked to do this at the beginning of the first day and at the end of the final day of the summer school. These words were then transcribed with the number of times each word was submitted being documented. This information was then formatted into a word cloud, with the size of the word varying according to how many times it had been submitted.ResultAt the start of the summer school, the students submitted a total of 208 words which included a total of 94 distinct words. Of these, the 2 most common were brain (n = 15) and mental (n = 10). At the end of the summer school, the students submitted a total of 199 words which included a total of 100 distinct words. The 2 most common were psychosis (n = 12) and forensic (n = 8). Of the words submitted pre-summer school, there were 8 distinct words that described positive attributes of psychiatry – such as ‘helping’. This increased to 17 distinct positive words post-summer school.ConclusionWe note from our outcomes that the number of words submitted by the students pre and post the summer school were similar but the words submitted most frequently differed. The most common words submitted post the summer school were more consistent with medical terminology than those submitted pre the summer school, which suggests that their knowledge of this had increased. The increase in the number of distinct positive words submitted at the end of the summer school implies that the students had a more positive view of psychiatry following the summer school.