bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Training the Trainer Course for Psychiatry Higher Trainees in the West Midlands
Authors: Murugan Meena , Sangoi Bijal , Nainar Feroz 
Published: August 2024

AimsThe Royal College of Psychiatrists sets out ‘Education and Training’ as one of the High Level Outcomes (HLOs) in its GMC approved curriculum for higher speciality trainees in Psychiatry. The West Midlands (WM) School of Psychiatry runs a well-established 3-day Training the Trainer (TTT) course to support acquisition of teaching skills and key capabilities to help prepare trainees to become trainers as Consultants.We aim to explore the views and attitudes held by WM Psychiatry higher trainees towards the current TTT course and other teaching opportunities available across the region.MethodsAn anonymous online scoping survey was sent to all WM Psychiatry higher trainees, via Microsoft Forms, in January 2023. This comprehensive survey included questions on the trainees’ awareness of the TTT course and available teaching opportunities, as well as support and barriers in accessing these. We designed dichotomous, rating and free text questions to generate both quantitative and qualitative data.ResultsKey findings of the survey included:
•27 out of 40 trainees responded. All subspecialty training programmes were represented.•Many trainees were aware of the WM TTT course (81%). No trainees had accessed private TTT courses.•Most trainees felt the current available opportunities allowed them to meet the curriculum requirements (82%) and felt their supervisor could provide support in gaining teaching experiences (93%).•Only two-thirds of trainees felt the current opportunities prepared them to be an effective Consultant trainer (67%). Some were also uncertain of teaching opportunities available in the deanery (41%).•Trainees expressed a preference of learning through small group tutorials, interactive workshops and experiential learning.•Trainees requested incorporating content around innovative technology in medical education including artificial intelligence and simulation as well as formal qualifications in medical education.ConclusionThe project has shown that the current TTT course is effective in supporting Psychiatry higher trainees meet their curriculum requirements, however there is a scope to adjust the content to meet their changing needs and align with digital advancements in medical education. We suggest the course should be delivered in a more interactive and engaging manner for example using breakout rooms and workshops. To ensure all trainees are aware of the course and teaching opportunities available, an information leaflet outlining the TTT course will be sent out as part of the induction process. It is hoped that with these improvements, the needs of Psychiatry higher trainees will be better met as they move forwards in their careers and become Consultant trainers.
Royal College of Psychiatrists Paediatric Liaison Network: Training Initiative, 2021–2024
Authors: Rengit Ashy 
Published: August 2024

AimsThe primary objective of this project was to gather information from psychiatric trainees across the UK regarding paediatric liaison psychiatry training. It was envisioned that a national survey would yield important information regarding trainee awareness of this sub-specialty, and their training experiences.The secondary objective of this project was to build an online resource, that could practically address unmet training needs in this area.MethodsA national survey was undertaken between 29th November 2021 and 17th January 2022, with trainees from RCPsych Liaison Psychiatry, and Child & Adolescent Psychiatry faculties, invited to participate.Following this survey, the predominant themes in trainee feedback informed the design of an online resource for psychiatry trainees interested in paediatric liaison psychiatry.ResultsOverall, 40 trainees across the UK completed the survey, detailing their views and experiences of paediatric liaison psychiatry training.While 65% of trainees were aware of paediatric liaison psychiatry as a field, only 37.5% had exposure to the specialty. Approximately 48% of respondents were in training programs that included paediatric liaison psychiatry placements.Common challenges in accessing paediatric liaison training included; lack of qualified trainers, limited paediatric liaison psychiatry services locally, and competing training commitments. Trainees highlighted the need for a wider network to raise awareness of this sub-specialty, and advertise formal clinical/ research opportunities.Following this survey, an online resource was constructed with input from the wider Paediatric Liaison Network (PLN) membership, including the following features –
•Clinical opportunities – Paediatric liaison psychiatry department contacts for trainees to access training opportunities.•Research & Education – Resources useful for trainees interested in paediatric liaison psychiatry.•Careers – Articles on different career pathways in paediatric liaison psychiatry.ConclusionTrainees predominantly reported systemic issues with accessing experience in paediatric liaison psychiatry, especially regarding training program structure and local clinical systems. It is likely that time, and the involvement of health and training providers, is required to address these issues.However, it is hoped that building this digitally accessible initiative is a step forward in raising awareness, and supporting trainees in building positive experiences within paediatric liaison psychiatry.Many thanks to all the psychiatry trainees, and members of the Paediatric Liaison Network, who supported this digital project with their feedback. For further details on this initiative, please visit – https://sites.google.com/view/plntrainees/pln-home.
The Use Of Coaching as a Novel Tool in Medical Education to Support Psychiatry Trainees in Developing Leadership Skills
Authors: Szczap Aleksandra 
Published: August 2024

AimsIn recent years, there has been an increasing recognition of the importance of leadership skills to doctors. However, these skills are not usually formally taught or assessed. This study aims to evaluate the impact of using coaching as a novel technique to support Psychiatry trainees in developing leadership skills.MethodsThis poster summarises a primary research study which evaluated an educational intervention using a mixed-method approach.All Higher Psychiatry Trainees at the Tavistock and Portman NHS Foundation Trusts were given an opportunity to enrol on the Coaching for Consultant Psychiatrist Leadership Pilot Programme. Those who enrolled (coachees) were offered five 90-minute one-to-one sessions with Psychiatry consultants (coaches) who received training in Coaching for Leadership. Coachees completed a self-assessment questionnaire examining their views on their own leadership skills before and after completing the programme. Questions used were adopted from the High-Performance People Skills questionnaire (HPPS) – a tool used to collect 360° feedback as part of leadership training. Coachees and coaches also attended separate focus groups to discuss their subjective experiences of receiving and providing coaching. Thematic analysis was carried out.ResultsEight coaches and seven coachees participated in the study. Most HPPS self-assessment scores post-intervention have increased after completion of the course. Overall coachees' satisfaction with their leadership skills increased from 3.4/5.0 to 4.0/5.0 after completing the programme.Focus groups yielded rich qualitative data. The themes identified were: a broad range of reasons for Trainees and Consultants to join the programme, positive impact on coaches’ coaching skills, positive impact on coachees’ leadership skills and ideas on how to improve the programme to inform future curriculum design or improve implementation of any educational interventions.ConclusionPsychiatry Trainees’ self-perception of leadership skills can improve after receiving coaching. They find coaching helpful due to its individualised nature and the fact that it promotes the application of skills in real-life settings. Coaches also benefit by gaining new skills in coaching and leadership. Coachees and coaches share similar motivations for joining, including the desire to learn new skills, support others and be supported. More research is needed to evaluate the practical aspects of delivering coaching for leadership programmes as part of speciality training, but its potential is promising.
Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)
Authors: Bakshi Alisha , Bell Zora , Stafford Matthew , Jennings-Cole Kate , Ceesay Sanna 
Published: August 2024

AimsThe community mental health team (CMHT) is actively involved in reviewing mental health patients who require commencing psychotropic medications. The responsibility to prescribe the psychotropic medications falls on the CMHT for the first 3 months. After this period, if the patient's mental health is stable, the prescribing role can be transferred to the GP by completion of an electronic shared care agreement (ESCA).This project aimed to improve the management of emergency prescriptions (FP10s) requiring ESCA within the North Hub CMHT, BSMHFT focussing on reducing administrative time in receiving numerous urgent phone calls for repeat prescriptions, timely completion of ESCA and updating the electronic prescribing system.MethodsData collection was done by logging the numbers of the following on a weekly basis:
1.FP10s issued.2.Calls related to FP10s.3.ESCA sent. Baseline data was collected over 11 weeks to analyse practice. Plan-do-study-act (PDSA) cycle was used to improve the processes from January to August 2023. Identified PDSA cycles included:
1.Clinician prompt reminders to check ESCA status.2.Document FP10s instances on issue and inform patient about ESCA during outpatient appointments.3.A 4-week system for managing FP10s at reception desk.4.Increase consistent use of and access to EPMA. Data was collected again for 4 weeks in December 2023 to assess sustainability of the implemented changes.ResultsThis project resulted in a 14% reduction in the number of FP10s requiring ESCA and a 27% reduction in the number of calls for FP10s from January to August 2023. Data measuring sustainability in December 2023 showed a total reduction of 64% from the baseline of 28 FP10s per week at the beginning of the project (January 2023) to an average of 10 FP10s issued per week in December 2023.ConclusionIn conclusion, patients benefit from having a clear understanding of where their medications will be issued from thus improving their experience with the mental health service. Having effective processes in the CMHT enables medical professionals to complete the ESCA in a timely manner. Altogether this reduces burden on all professionals and reduces costs of prescribing by transferring the prescribing responsibilities to GPs. This project has been effective in reducing the number of weekly emergency FP10s issued. The 4-week system of managing FP10s at reception has now been included in the Medication Management's new procedure and guidance and is being introduced across all CMHTs in BSMHFT.
Physical Health Monitoring in Waverley Community Mental Health Recovery Service (CMHRS)
Authors: Calvosa Steve 
Published: August 2024

AimsTo audit the recording of physical health parameters for the clients of Waverley Community Mental Health Recovery Service (CMHRS).To ensure Trust and NICE guidelines are met for monitoring of:
1)Psychiatric drug prescribing.2)Psychiatric disease monitoring.3)Past medical history and biophysical parameters relevant to prescribing decisions.To develop a clinical review process for the clients to ensure that physical health parameters are monitored longitudinally.MethodsA random sample of 100 patients from Waverley CMHRS was analysed. The data was collected between November 2022 and January 2023. The process involved establishing the cohort, dividing the caseload for review, and applying an audit questionnaire. The questionnaire was applied to both SystmOne Electronic Patient Records and GP Shared Care Records to assess compliance with physical health monitoring in both secondary and primary care. All data collected were compiled onto an Excel Spreadsheet. The level of compliance for monitoring of each parameter was calculated and audited against Trust and NICE guidance.ResultsFor secondary care:
1.Compliance with physical health monitoring requirements is consistently low.2.Higher levels of compliance (>50%) for height, weight, Audit C (Alcohol), Smoking status.3.Lowest compliance levels observed for: blood tests, ECG request, substance misuse status, sleep, medication side effects.4.Evidence of a comprehensive physical health review was found in 1% of patients.For primary care:
1.95% of patients from our sample consented to giving access to their Shared Care Record.2.Compliance with physical health monitoring requirements in primary care was higher.3.Compliance was particularly high (> 87%) for: height, weight and BMI, BP, evidence of alcohol monitoring, evidence of smoking monitoring.4.Smoking monitoring is the parameter with the highest level of compliance (95%).5.Parameters are monitored more regularly.ConclusionThe audit identified gaps in the documentation and assessment of physical health parameters within Waverley CMHRS. Compliance with monitoring requirements was significantly lower in secondary care, highlighting the need for intervention. Conversely, primary care demonstrated higher adherence to monitoring guidelines. The results show deficiencies in physical health monitoring that need to be addressed to ensure comprehensive psychiatric care.The project was crucial in optimizing physical health monitoring within Waverley CMHRS. Recommendations include targeted training, improved communication between primary and secondary care, and the designation of physical health coordinators. An action plan was developed with assigned responsibilities and a timeline for implementation. A re-audit will follow to assess the impact of implemented changes.
Reducing the Use of Physical Restraints in Patients With Dementia Who Are Admitted to Acute Old Age Psychiatry Wards With Agitation
Authors: Goveas Richard , Lai Damien , Yao Fengyuan 
Published: August 2024

AimsThe Institute of Mental Health is the only tertiary Psychiatric Hospital in Singapore. It has two 29 bedded inpatient wards which provide acute care for the elderly with severe mental health conditions including dementia. Restraints are one of the methods employed in managing agitation in patients with dementia. The physical consequences of restraints are reduced mobility resulting in decreased muscle tone and mass, bone demineralisation, orthostatic hypotension, and atelectasis. This results in patients who are more prone to falls, aspiration pneumonia, deep vein thrombosis/pulmonary embolism and ulcers. The psychological consequences include aggravating agitation, feelings of humiliation, negative emotions like anger and despair. Hence, we embarked on a program to reduce the use of physical restraints in the management of agitation in patients with dementia.MethodsBaseline restraint hours were collected from 7am to 9pm for all dementia patients who were restrained for agitation for a period of 5 months. Patients on Geri chair with seatbelt used primarily for fall prevention were not included. The Pittsburgh Agitation Scale was used to measure agitation.The nursing staff were trained on the Enriched model for targeting behaviour and on the VIPS (Valuing people, Individualised care, Personal perspectives, Social environment) framework for person centred care. Restraint hours were collected post intervention as well as benzodiazepine usage data over both periods to monitor any changes in the usage.ResultsThe baseline data (preintervention) over a 5-month period determined that patients with dementia who were agitated were being restrained on an average for 3.33 hrs per day from the period of January to May 2021. Following the training of nursing staff on the enriched model of care and the use of VIPS framework for person centered care the restraint hours reduced to 1.48hr per day over 5 months from January to May 2022. Benzodiazepines usage went down from 0.34mg at baseline to 0.17mg per dementia patient per day post intervention.ConclusionNonpharmacological interventions (enriched model and VIPS framework for person centered care) using a multidisciplinary team approach is effective in the management of agitation resulting from dementia and should be used as a first line in the management of such conditions.
Using a Systems Wide Approach to Improve Medical Emergencies in a High Secure Forensic Psychiatry Setting
Authors: Marron Brooke , Maguire Cormac 
Published: August 2024

AimsPatients with severe mental illness are at a significantly higher risk of poor physical health outcomes than the general population and die on average 15–20 years earlier. The Royal College of Psychiatrists has published extensively on how to improve routine physical health monitoring in this cohort. Despite this, there is little data or guidance on improving emergency medical care for this cohort. We aimed to analyse and optimise the process of patients being sent to general hospital on an emergency basis.MethodsA review was undertaken of the clinical notes for medical emergencies over a 12 month period by two core psychiatry trainees. Site visits and interviews with local A&E department clinicians, the covering General Practitioner and pharmacy were completed. A questionnaire was distributed to all nursing staff to gather their perspective on the considerations for emergency medical transfers out of The State Hospital.ResultsOn review of the case notes, 44/44 emergency outings were deemed to be clinically necessary for investigations/interventions that would not have been possible on-site. Qualitative methodology highlighted a disconnect amongst staff groups and stake holders regarding thresholds for transfers relating to medical emergencies leading to a high level of staff dissatisfaction.ConclusionThe interface between psychiatric and medical services is an area of risk to patients. Levels of staff confidence, knowledge and available resources all contribute to the risk of transfer. Further work is required to explore other aspects of patient care and treatment which can be impacted as a consequence of emergency transfers.
Effective Induction Programme for Higher Specialist Trainees: A Quality Improvement Project
Authors: un Nisa Zaib , Krishnan Deepa , Junaid Kehinde , Suárez Lori Edwards , Lankappa Sudheer 
Published: August 2024

AimsTo create a safe and effective induction programme for Higher Specialist Trainees (HST) at Nottinghamshire Healthcare NHS Foundation Trust.An effective induction improves trainees' satisfaction, they feel welcomed and valued. It improves patient safety, retention, and recruitment (GMC Report 2020).MethodsBased on GMC report, published in 2020, a survey was developed locally and data for 2021 HST induction was collected using digital platform. Initial stakeholder analysis completed, and relevant parties were invited to share the results. Two key deliverables were identified after consultation, one was a dedicated induction programme for HST which was co-produced along with trainees and stakeholders. The other deliverable was updating the induction booklet. The proposed induction plan was implemented in August 2023, the survey was repeated to the new HST cohort following induction via digital platform. Results of the survey were analysed via mixed methods (qualitative & quantitative).ResultsThe surveys conducted in 2021 and 2023 were compared and there was an increase in response rate from 50% to 64%. The domains were devised from GMC standards and assessed by if staff had received everything in the domain within a week of starting their placement and results evaluated using a t-test.Domain A is gaining access to places and system (keys, fobs, security passes, computers, ID badges, mobile phones, IT system). This significantly improved from 27% to 88% with a p-value of < 0.001.Domain B is physical orientation of the setting (staff facilities such as lockers, parking, library, and site layout). This significantly improved from 45% to 88% with a p-value of < 0.018.Domain C is gaining day to day knowledge (HR, rota, annual leave, study leave, pay-roll, mandatory training, e-expenses, and guardian of safe working). There was no significant change between 9% and 19% with a p-value of < 0.48.Domain D is an understanding of expectations (duties and responsibility during working hours, on-call, team introduction). This significantly improved from 9% to 69% with a p-value of < 0.002.HSTs were given the chance to add comments and the responses in 2023 were more positive “excellent induction compared to previous years” compared with 2021 when HSTs felt isolated and devalued “worst ever induction in whole career in NHS”.ConclusionOverall, the results of the 2023 survey showed considerable improvement in all the key areas of induction within one week of starting the placement. Domain C demonstrates a challenge still and needs further work.
An Audit of the First Stage of Service Development Initiatives Undertaken as Part of a Quality Improvement Process to Improve the Screening and Management of Older Adults Presenting With Delirium in Queen's Hospital (NELFT)
Authors: Paul Jeeano , Smith Gareth , O'Connor Stephen 
Published: August 2024

AimsTo improve the detection of delirium amongst patients aged over 65 in Queen's Hospital, and then incorporate a clearer management pathway for these patients to be treated safely with more appropriate intervention and better follow up care. As part of the management pathway, the aim was to increase the delirium referrals made to the local Dementia and Delirium Team for quicker implementation and education regarding non-pharmacological interventions in treating delirium, whilst ensuring that Psychiatric Liaison Service (PLS) referrals for delirium were also appropriate.MethodsA multi-phase approach to quality improvement and service development for patients with delirium has been adopted, and the first step is to improve the screening of patients over 65 years old with delirium and then to refer to appropriate teams accordingly. Our first intervention was changing the PLS referral form. It has been simplified with less input data required, and now includes a mandatory 4AT screening score for delirium, as well as a mandatory referral to the Dementia and Delirium Team for any patient with positive screening for delirium. The intervention was implemented in November 2023, with pre and post intervention data collected in October and December 2023 respectively. Data was collected prospectively and retrospectively using medical notes.ResultsQueen's Hospital PLS received a total of 60 older adult referrals in October 2023 and 49 referrals in December 2023, of which the total proportion of referrals diagnosed with delirium was 47% and 35% respectively (12% absolute reduction). The proportion of patients referred to the PLS team with delirium, who did not require further intervention after initial assessment, had reduced by 29% (87% to 58%). The proportion of patients with delirium referred to PLS, who had also been appropriately screened and referred to the Dementia and Delirium Team prior to PLS assessment, has also increased by 4%. There has been a marked increase in total delirium referrals to the Dementia and Delirium team after intervention, from 31 referrals in October to 85 referrals in December (174% increase).ConclusionThere is an improvement in screening for delirium, with marked increase in referrals made to the Dementia and Delirium team. There is a decrease in uncomplicated delirium referrals who do not require further PLS intervention and can be appropriately managed with the Dementia and Delirium team input.