bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Impact of a Simulation Based Training Course in Intellectual Disability Psychiatry and Autism Co-Delivered by Actors With Intellectual Disability
Authors: Rudra Sonya , Dave Rupal , Eady Nicole , Smith James , McNamara Eileen 
Published: June 2022

AimsInequalities in health outcomes, and avoidable deaths, in people with intellectual disability has highlighted the need for improved training and education in Intellectual Disability and Autism. Simulation training facilitated by actors with intellectual disability has been shown to improve connection with people with intellectual disability (Attoe et al 2017). The aim of this project was to develop a simulation-based training course, focused on topics in mental health, intellectual disability and autism, to improve participant confidence in clinical knowledge and skills, as well as support leadership and professionalism training. Here we evaluate the impact of the training on participants’ confidence, and the longer-term effect on attitudes and working practice after attendance.MethodsA novel simulation-based training course, directed at Specialty Trainees, was developed based on the Specialty Training in Learning Disability curriculum. The course was co-delivered by a person with intellectual disability. Participants who attended the simulation training completed general feedback, pre-course and post-course confidence questionnaires and attended a semi-structured group interview at 2 months. Questionnaire data weres analysed using descriptive and inferential statistics. Group interview data were analysed using open & axial coding, and thematic analysis of content. The project was approved by East London NHS Foundation Trust Governance and Ethics Committee for Studies and Evaluations.ResultsEight psychiatrists participated in the training and completed the pre-course and post-course questionnaires. Independent t-test found significant increase in confidence for all scores from pre-course (M = 6.54, SE0.24) to post-course (M = 7.81, SE = 0.36), t= –2.93 p = 0.01. This included ratings of confidence in knowledge in areas such as mental health legislation, and improved confidence in skills such as communication with families of people with intellectual disability and difficult conversations with senior supervisors. In follow-up interviews we elucidated themes of the importance of supported, structured training opportunities with people with intellectual disability, and the value of connection with peers and supervisors.ConclusionSimulation based training in psychiatry, co-delivered with actors with intellectual disability, was reported to be an engaging and enjoyable form of learning. The evaluation suggests such training is effective in increasing trainee confidence in knowledge and skills at the time of training as well as resulting in a lasting change in attitudes after the training. We recommend such training be further developed and delivered at both postgraduate and undergraduate level.
Raising Concerns and Trainee Well-being: What Are the Issues?
Authors: Hasnaoui Sabrina , Ibbett Vicki , Navaratnarajah Sambavi , Harsh Rajendra , Pantall Shay-Anne , Scally Ruth 
Published: June 2022

AimsRaising concerns is an important part of being a doctor and part of the GMC ‘Good Medical Practice’ guidelines, however as a trainee it often comes with specific challenges. Historically trainees are often left feeling that their concerns are not taken seriously and there is no resolution to problems raised. Here we present the findings of a scoping exercise undertaken as part of a Quality Improvement project exploring these issues within a large mental health Trust.MethodsTrainees across all training grades from Foundation doctors to higher trainees were invited to engage in virtual focus groups specific to their training programme. Contributions were analysed anonymously using a thematic analysis approach by two independent coders. Quantitative data were also gathered using an online survey to capture trainees who had been unable to attend a focus group.ResultsKey results included:
•A total of 6 focus groups were attended by more than 35 trainees, with high turnout particularly within Foundation trainees and CT1 doctors.•Three key themes were identified from the qualitative data: difficulties with the process of raising concerns, fear of the consequences and challenging the culture of the organisation.•It was noted that senior trainees felt more comfortable with the process of raising concerns compared with junior colleagues but were more apathetic about the impact of doing so.•12 trainees completed the online survey. Of these, 6 (50%) reported having had patient safety concerns and 7 (58%) had had concerns about their training.•The most common reported barriers to raising concerns were the impact on working relationships (67%), lack of support (50%) and fear of repercussions on their training (50%). 42% of respondents were unsure of how to raise concerns.•Trainee suggestions for change included improved information for trainees and trainers about the process for raising concerns, sharing of feedback about concerns raised more widely and regular opportunity to meet with key stakeholders.ConclusionThe majority of trainees had experienced concerns about either patient safety or training issues. It will be necessary to address the multiple barriers highlighted to enable trainees to feel more confident and able to raise concerns. Increasing awareness of escalation processes, improving the processes themselves and fostering a supportive environment which encourages and supports trainees to raise concerns will be important given the implications for patient safety and trainee well-being.
A Systematic Approach for the Interview of the Application to Psychiatry Specialty Training: The “I AM” Approach
Authors: Loo Jiann Lin 
Published: June 2022

AimsJob interviews are the platform for employers to identify suitable candidates for vacant posts, i.e. those who are able to demonstrate a certain set of competencies specified in the job description. In the recent psychiatry specialty training (ST) application process, candidates are required to propose a management plan for two complex scenarios. This interview can be stressful given the high-stakes nature of the outcome, i.e. the successful enrolment into a training programme of a preferred deanery. Candidates who are unable to have an organised approach to problem-solving will likely have an unfavourable result. To overcome this difficulty, a simplified “I AM” approach is being proposed to assist applicants to organise their thoughts during their ST application interview.MethodsThe “I AM” approach stands for “Issues, Assessments, and Management”, which is adapted from the “Handbook of Psychiatry: Surviving Consultation Viva Examination of Malaysian Conjoint Board”. The “Issues” are the problems identified in a scenario, “Assessments” are the investigation required to get a clearer picture of the problems, and “Management” is the action plan to solve the problems. This approach was piloted with five applicants of ST in psychiatry prior to their interview practices.ResultsFor a complex clinical case scenario, the “I AM” approach can be put into the matrix of 3 × 3 tables together with a biopsychosocial model to ensure the issues in different domains are explored thoroughly. Further sub-classification into necessary subheadings, including ideas, concerns, and expectations from different parties, can be included in the assessment matrix. Lastly, a management plan using a multidisciplinary team and collaborative decision-making model with the patient and family can be proposed. For a complex managerial scenario, the seven pillars of the National Health Service's clinical governance model involving different stakeholders can be incorporated into the “I AM” approach to explore problem-solving strategies from different angles. Positive reactions had been received from all five trainees (Kirkpatrick's Evaluation Model Level One).ConclusionThe “I AM” approach can be flexibly applied in different problem-solving scenarios and it works well with other models. The approach may be limited by inadequate information and a failure to prioritise. Further systematic evaluation of the effectiveness and generalisability of the “I AM” approach to other disciplines is required.
The Royal College of Psychiatrists Physician Associate Inceptorship Programme: Developing Educational Programmes to Support the Integration of This New Role in Psychiatric Services
Authors: Mahajan Pranav , Crimlisk Helen , Kenworthy Chris 
Published: June 2022

AimsPhysician associates (PAs) are becoming more commonplace in psychiatric services in the UK to help address long term workforce difficulties. In 2019, the NHS Long Term Plan detailed a commitment to transforming mental health care in England recognising that services were not meeting current or future increase in demand. Health Education England's (HEE) report, Stepping Forward to 2020/21: The Mental Health Workforce Plan for England, described a longer-term strategy to expand the mental health workforce, including recruiting 5,000 people into ‘new roles’ including physician associates. The NHS Mental Health Implementation Plan 2019/20–2023/24 stated an aim of recruiting 140 PAs to the workforce over five years in addition to the requirements specified in the HEE report. HEE and the Royal College of Psychiatrists (RCPsych) have sought to support the integration of PAs into psychiatric teams through the development of the Inceptorship programme. The aim was to develop a bespoke training programme for PAs to bridge the gap between university and working in mental health to be rolled out nationally.MethodsSince 2018, Sheffield Health and Social Care Trust (SHSC) have been providing an Inceptorship Programme for PAs at the trust. Unlike with trainee doctors, there was no curriculum that could be followed. The programme covers the aetiology, diagnosis and management of common psychiatric problems, communication skills and reflective practice. This programme has provided the basis for the RCPsych Inceptorship Programme supported by HEE.ResultsThe SHSC programme has been well received by the 11PAs that have been through the programme, with all PAs recommending other mental health organisations take a similar approach. There have been many additional benefits of the sessions. They allow PAs to gain peer support and it has been a forum to raise issues which often arise when integrating new roles into pre-existing MDTs.ConclusionThe RCPsych Inceptorship Programme is a PA specific educational programme. It is an important tool in addressing the gap between variable mental health experience as a student (which is limited to a 3-week placement and is variable in content) and working in a psychiatric setting. RCPsych and HEE recommend that all mental health organisations employing PAs implement an inceptorship programme based on the work carried out at SHSC. These should comprise of regular, protected sessions that provide PAs with bespoke mental health training to support their integration into psychiatric multidisciplinary teams. HEE have agreed to provide funding to help organisations facilitate it.
Curriculum Development: A National Curriculum for Physician Associates in Mental Health
Authors: Mahajan Pranav , Crimlisk Helen , Wildbore Ellie , Tatt-Smith Paris , Roth Tony 
Published: June 2022

AimsPhysician associates (PAs) are becoming more commonplace in psychiatric services in the UK to help address long term workforce difficulties. The 2019 NHS Long Term Plan detailed a commitment to transforming mental health care in England recognising that services were not meeting current or future increase in demand. Health Education England's (HEE) report, Stepping Forward to 2020/21: The Mental Health Workforce Plan for England, described a longer-term strategy to expand the mental health workforce, including recruiting 5,000 people into ‘new roles’ including physician associates. The NHS Mental Health Implementation Plan 2019/20–2023/243 stated an aim of recruiting 140 PAs to the workforce over five years in addition to the requirements specified in the HEE report. A curriculum for PAs working in mental health would set out the competencies required to work in mental health services.MethodsThe curriculum was developed by the National Collaborating Centre for Mental Health (NCCMH). The work was overseen by an expert reference group, comprising experts in training PAs in mental health, PAs, researchers and experts by experience, all selected for their expertise in research, training and service delivery.ResultsThe overarching aims and objectives of the curriculum was to convey a practical understanding of the attitudes, knowledge and skills that underpin the role, thus enabling PAs to offer effective and value-driven support to patients.The completed curriculum has been arranged into seven modules: Knowledge, Professional/Legal Issues, Engagement and Communication, Diagnostic Assessment and Treatment Planning, Interventions, Managing the Interface of Mental and Physical Health and Team Working. This reflects the expected roles and responsibilities of PAs working in mental health.ConclusionHEE and the Royal College of Psychiatrist have recommended all mental health organisations implement an educational programme for new PAs. The curriculum will inform the training requirements for PAs and standardise the training they receive from mental health organisations. It should support the work of PA supervisors and peer coordinators, and those delivering education and training to them. The curriculum will be a dynamic document and work will be needed to adapt it as the role changes, for example with incoming regulation and potential prescribing rights that follow.
An Evaluation of the Impact of Psychiatry-Based High-Fidelity Simulation Training for Undergraduate Medical Students in the West Midlands
Authors: Navaratnarajah Sambavi , Wheeldon Helen , Brickstock Amanda , Barrow Emma 
Published: June 2022

AimsSimulation (sim) is an excellent but underused tool suited to key skills in psychiatry such as communication, managing agitated patients and exploring the mental-physical health interface. Access to complex psychiatric patients has always been challenging and this has been exacerbated by the current COVID-19 pandemic. This has further increased fear amongst students creating another barrier to engaging with psychiatric patients. Our aim of the study was to evaluate the use of simulation within psychiatry as the literature in this field is underrepresented compared to other medical specialities. We hope to advocate its use in future undergraduate training.MethodsWe developed 3 simulated scenarios for fourth year medical students; these involved identifying lithium toxicity and steroid-induced psychosis in ward settings and conducting an A&E risk assessment. The scenarios were developed following feedback from a focus group of foundation doctors on their psychiatry rotations. Data were collected pre- and post-simulation from a cohort of psychiatry students in this academic year. We assessed confidence levels in 7 domains using a 10-point Likert scale and obtained qualitative data to give context to the data collected.Results81 and 83 students respectively completed the pre and post questionnaires. Quantitative data found that the student's confidence in all domains improved from pre to post simulation training. For example, confidence in performing a risk assessment improved from M = 4.12 to M = 7.04 and in making a basic management plan from M = 3.43 to M = 6.72. Qualitative data looked at skills gained, empathy and how the scenarios related to clinical practice. Key themes found improvements in de-escalation skills, handing over and self-reflection.ConclusionThe study supports the evidence that high-fidelity simulation is an important education tool in psychiatry. As facilitators, we feel that confidence scores improved due to the debrief. The standard tool often used is the diamond debrief however we found we had to adapt this model due to fourth year students not having developed sufficient skills to reflect on complex psychiatric scenarios. Therefore, an adjusted debrief was developed featuring technical knowledge and constructive feedback. In the future, we hope to explore the long-term benefits of simulation and its impact on clinical practice.
Balint Group Sessions for Medical Students, a Pilot Study
Authors: Ros Annette , Older Abby , Gaynor Eleanor , Shittu Bayode , Bu Christopher , Sullivan Kathia 
Published: June 2022

AimsCore trainees in psychiatry all complete a year of Balint group sessions. These sessions are invaluable, as improved awareness of our own thoughts and feelings is a crucial part of our development as clinicians. We considered that it may have been helpful to have started these sessions at an earlier stage of medical training, for example, in medical school.MethodsWe approached the University of Liverpool School of Medicine and proposed a pilot Balint programme with 4th year medical students rotating through psychiatry in Cheshire Wirral Partnership Trust.Sessions were conducted in 4-week blocks, corresponding with the students’ psychiatry rotations. To allow sufficient time for all students to contribute in each hour-long session, groups were limited to a maximum of 7 students. Each group was allocated 2 facilitators and was conducted on Microsoft Teams because of COVID-19-related restrictions. Facilitators had fortnightly supervision with a consultant psychotherapist.At the end of each 4-week block, anonymous feedback was collected. Small alterations were made to the programme during the course of the pilot in response to attendance rates, punctuality and feedback.Results18 (approximately 50%) of the students from the first 3 cohorts submitted feedback:
•All said the experience helped them reflect more on their interactions with patients and colleagues and improved their insight into how others think/feel in caring for patients.•94% said they enjoyed it; they thought they would use the skills they had developed; and they would participate again in future if given the option.•83% said 4 sessions was ‘just right’, 11% said ‘not enough’ and 6% said ‘maybe too much’;•72% rated their overall experience of the programme as ‘excellent,’ 17% as ‘good,’ 11% as ‘fair’.Free-text feedback was positive. Students valued the opportunity to reflect on the emotions and interpersonal dynamics experienced in clinical scenarios. Critical feedback was mostly around a preference to have sessions face-to-face and a desire to have more sessions.As facilitators, the experience has helped us increase our reflective capacity and gain confidence in leading, managing group dynamics and setting boundaries.ConclusionStudent experience of the Balint programme was positive for the majority. From a facilitator perspective, we found the experience rewarding and beneficial for professional development. Currently only approximately 1/3 students rotate through this trust and can therefore benefit from the sessions. This pilot study provides supporting evidence for extending the scheme to all 4th year Liverpool University medical students.
Learning Needs Assessment of Multidisciplinary Staff Working Within the Memory Assessment Services – Survey Study
Authors: Sameem Hafeesa , Ahmed Raja Adnan 
Published: June 2022

AimsTo assess the learning needs of the memory team multidisciplinary (MDT) staff working in South East Wales, in relation to diagnosis of dementia, types of dementia, anti-dementia medications and risk associated with dementia.MethodsAn online anonymised survey was designed and distributed via email among memory team MDT staff of 3 different health boards of the South East Wales area which included Aneurin Bevan University Health Board, Cwm Taf Morgannwg University Health Board and Cardiff and Vale University Health Board.The survey was designed to gather information about their understanding of the common type of dementia, treatment with medication, indications and cautions related to medications, the potential side effects and risks associated with Dementia. The survey had a mixture of `Likert Scale` format with free text segments where their opinion was sought in their own words.ResultsTwenty-one (21) staff members responded to the survey. The majority (16) were psychiatric nurses, rest were psychologists and support workers.Thirteen (13) staff members reported they feel confident in identifying subtypes of dementia whereas the rest reported they can benefit from additional knowledge. Majority of staff felt they understood the indications of anti-dementia medication side effects of medications and risks associated with Dementia but do not fully understand the contra-indications and cautions related to anti-dementia medications.Participants suggested that regular teaching, lectures and updates should be arranged especially targeting the diagnostic criteria, medication and risk assessment. Sessions providing bite-size information on a regular basis to build on their knowledge base were suggested.Participants also suggested shadowing doctors and consultants in memory clinics as a useful tool to improve their knowledge base.ConclusionMDT staff working with memory teams are at the front line of screening, assessments and providing help and treatment to patients and their families. It is important to make sure our staff are equipped with evidence-based accurate knowledge and training.This survey study indicated that MDT staff working within the memory team appreciate more training and helped identify the specific areas and mode of teaching required.Prescription of medication may be seen as a doctor's responsibility but we need to ensure our MDT staff has up to date knowledge of types of medications used, their indications, contra-indications, monitoring requirements, and side effects.Regular teaching, online modules and experience of shadowing with doctor's clinics should be offered to all the MDT staff.