Psychiatric Education Research Articles

Undergraduate psychiatric education: current situation and way forward – CORRIGENDUM

[This corrects the article DOI: 10.1192/bji.2021.48.].

A quantitative study on completeness rate of documentation in psychiatric medical records.

Background:Mental disorders are one of the leading causes of illness and disability worldwide. According to the World Health Organization (WHO), one in four people in the world will be affected by mental or neurological disorders during their lifetime. Regular evaluation of mental health outcomes plays an important role in making decisions about timely treatment of the patient. Studies show that a medical record does not provide enough information about the diagnosis, current symptoms, psychiatric medications, and side effects of current medications and treatments for ongoing health care. In this study, the completeness of paper-based psychiatric records was investigated.Aim:The current study aimed to explore the completeness rate of paper-based psychiatric medical records (PMRs) and to investigate the factors effective on documentation status.Setting:The study was conducted in Ebnesina and Dr. Hejazi Psychiatric Hospital and Education Center. The case hospital is a psychiatric teaching hospital, which has 900 beds.Materials and Methods:The completeness rate of PMRs was determined using descriptive statistics. Fleiss’ Kappa agreement and effective factors on PMRs’ documentation status were assessed.Results:In total, 83.65% (n = 312) of the PMRs had at least one documentation defect. A significantly higher level of documentation completeness rate between different psychiatric wards was observed.Conclusion:Based on our results, it is suggested to conduct regular evaluation and provide feedback to the health-care providers, and conduct training courses.

Technical competency required by postgraduate psychiatric nursing students: A qualitative research.

Technical skills result in the patient's safety. Psychiatric nurses need to learn and apply them to provide effective and secure cares. This study explains the technical competency required for postgraduate psychiatric nursing students. This conventional qualitative content analysis study is part of a larger study on the clinical competency of postgraduate psychiatric nursing students performed in Iran in 2020. A qualitative study was conducted at universities holding master's degree courses in psychiatric nursing. Participants were instructors and postgraduate psychiatric nursing students, psychiatric nurses, psychologists, and psychiatrists selected by purposeful sampling method. Sampling continued until data saturation was achieved. Data were collected through a semi-structured individual interview and were analyzed by conventional qualitative content analysis. The "technical competency" has two subcategories of "specialized knowledge" (including general nursing knowledge, psychiatric nursing knowledge, and basic knowledge of psychology) and "application of knowledge in practice" (including clinical experience, skills of psychiatric nursing interventions, educational skills, and research and evidence-based practice skills). The psychiatric nursing student learns and operates knowledge of psychiatric nursing, psychology, education, and research, besides improving their knowledge of general nursing.

Thirty-Minute Psychiatric Management Visits in Academic Medical Centers: Framing and Exploring Distinct Clinical-Educational Social Processes.

To address high clinical demand and manage workflow, some university-based practice settings are tending to replace traditional hour-long outpatient appointments with 30-minute psychiatric management visits, which must comply with multiple regulatory requirements for documentation and billing. This care model can significantly shape the culture of psychiatric treatment and education. Based on the limited published literature on this topic and pooled experiences of faculty, residents, and administrators, this article offers observations and raises questions concerning 1) clinical, educational and administrative benefits, limitations, and challenges for conducting 30-minute psychiatric visits in training contexts; 2) how administrative impositions affecting resident and faculty time and attention impact clinical encounters; 3) how various teaching settings manage regulatory requirements differently; and 4) considerations for education needs and opportunities, research gaps, and policy implications. Quality of care and education could be improved by judicious overhaul of administrative requirements to minimize burdens offering little clinical or educational value.

Social distance towards schizophrenia in health professionals.

The stigma and prejudice of the public regarding psychiatric disorders are a long-standing social problem. However, health professionals are more likely to have negative attitudes and label people with mental health conditions. This study aimed to investigate how self-rated familiarity and literacy about schizophrenia are related to social distancing towards schizophrenia patients among health professionals in Taiwan. This study used a cross-sectional questionnaire survey and invited respondents to complete the survey either electronically or in a pencil/paper format. Respondents included health professionals in different disciplines and students under medical placements. The survey instrument consists of three parts: sociodemographic information, the 18-item Social Distance Scale for schizophrenia, and the 19-item Schizophrenia Experience and Knowledge Questionnaires. Data were analyzed using linear regression models to explore sociodemographic factors, self-rated familiarity, and literacy total scores about social distance, attitude, and opinions towards schizophrenia. In total, 420 health professionals completed the questionnaire, of which 24.5% were physicians, 36.0% nurses, 6.7% pharmacists, and 28.6% interns. The majority of respondents (n=360, 85.7%) had contact experience with schizophrenia patients, and approximately 60% rated their experience as a positive impression. Although 62.9% of respondents had received psychiatric education or training, 86% believed that such education/training was insufficient. Moreover, over half of the respondents did not have confidence in their knowledge of schizophrenia. Older age, being married, and having more working experience were associated with high social distance, a negative attitude, and high prejudice. More familiarity with schizophrenia was associated with low social distance, a positive attitude, and less prejudice. A high literacy score was associated with a positive attitude and less prejudice, but no significant correlation was observed with social distance (β ± SE=-0.26 ± 0.14, p=.057). Among respondents who rated their past contact experiences as negative, neither familiarity nor literacy was associated with social distance. High levels of self-rated familiarity and high literacy about schizophrenia were associated with low social distance, a positive attitude, and less prejudice towards schizophrenia among health professionals. Therefore, sufficient education and training are imperative to increase familiarity and knowledge of schizophrenia. Appropriate education could be implemented from different perspectives, including communication skills, resources of social support, and topics to reduce stigma and prejudice.

Education and training in psychiatry in South Asian countries.

"Show me a sane man and I will cure him for you."-Carl Jung. Essentially, Jung was saying that a sane man does not exist. Emotional problems and difficulties are present in a benign form in the vast majority of people. Therefore, psychiatric education should focus on the very common nature of mental and emotional problems. Training of psychiatrists to provide the best quality care and conduct the highest quality research continues to remain a priority across the globe. The treatment and training gaps in many countries continue despite the sustained efforts at improving these, especially in low- and middle-income (LAMI) countries. Although many LAMI countries have improved curricula for undergraduate and postgraduate training, yet the treatment and training gap continues. This article will look to explore education and training in psychiatry in some of the South Asian countries with a special focus on India.

Art and psychiatry in the 21st century: here's to more messy - and magical - entanglements.

In a volatile world, during a time of multiple crises and amid a projected upsurge in mental illnesses as an aftermath of the COVID-19 pandemic, now is a critical time to consider how art and psychiatry can entangle with each other. Submissions like that of Lily Aston can create new spaces for conversation, reflection and constructive collisions. This can help disrupt and extend the state of psychiatry, management of psychiatric services, and education and training in mental healthcare, and advance how we understand other bodies and minds around us, and how knowledge can be created.

Multidisciplinary team members' perceptions regarding advanced psychiatric nurses' attitudes on mental healthcare.

BackgroundThe attitudes of advanced psychiatric nurses significantly contribute to the management, treatment plan and care of the mental healthcare users, and resultantly affects the quality and standards of mental healthcare. Considering these effects, it is imperative to understand how the attitudes of advanced psychiatric nurses are perceived by other multidisciplinary team members.AimTo describe the perceptions of the multidisciplinary team members regarding advanced psychiatric nurses’ attitudes in clinical practice.SettingThree mental health institutions were utilised to obtain the perceptions related to the attitudes displayed by advanced psychiatric nurses in the clinical environment.MethodA qualitative research descriptive approach was adopted to obtain in-depth descriptions of the attitudes portrayed by advanced psychiatric nurses. Eight purposefully sampled multidisciplinary team members were interviewed to obtain information. Data were analysed using Colaizzi’s method.ResultsThemes and sub-themes emerged. Mental healthcare providers exhibited both negative and positive attitudes towards mental health patients. By perception, unfavorable attitudes hindered effective communication and psychosocial rehabilitation programs for mental health patients. Positivity enhanced feedback during ward rounds and during clinical meetings.ConclusionDespite the positive impact advanced psychiatric nurses have on mental health care, views regarding mental health patients remain negative. It is recommended that advanced psychiatric nursing education curriculum address negative attitudes, views, and stereotypes. Mental healthcare users need to be provided with psychosocial rehabilitation programs and activities that address advance psychiatric nurses’ lack of initiatives.ContributionA clear set of principles and protocols underpins the collaborative effort among multidisciplinary teams in mental health care.

Undergraduate psychiatric education: current situation and way forward.

Undergraduate psychiatric education is essential for the training of medical students and for their recruitment into psychiatry. A significant shortage of graduates choosing a career in psychiatry has been recently documented, and this trend might have many causes. When medical students have positive experiences of teaching, elective placements and exposure to psychiatric patients, their attitudes towards psychiatry are significantly better. Therefore, there is a need to improve the quality of undergraduate training courses in psychiatry. Innovative teaching strategies are suggested, including the use of movies, virtual reality, simulated patients and multiprofessional training wards.

Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education.

Childhood maltreatment is the most important preventable risk factor for psychiatric disorders. Maltreated individuals typically develop psychiatric disorders at an earlier age, have a more pernicious course, more comorbidities, greater symptom severity, and respond less favorably to treatments than non-maltreated individuals with the same primary DSM-5 diagnosis. Furthermore, maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response, and inflammatory marker levels not discernible in their non-maltreated counterparts. Hence, maltreated and non-maltreated individuals with the same primary DSM-5 diagnoses appear to be clinically and neurobiologically distinct. The failure to embody this distinction in DSM-5 has interfered with our ability to discover novel treatments, to recommend currently available treatments most likely to be efficacious, and has been a largely unrecognized confound that has thwarted our ability to identify the biological basis for major psychiatric disorders. Incorporating this distinction into DSM will help transform this sign and symptom-based classification system to a more etiologically informed nosology. We discuss several diagnostic alternatives and recommend the inclusion of a Developmental Trauma Disorder diagnosis for severely dysregulated individuals, of all ages, with numerous comorbidities, who experienced interpersonal victimization and disruptions in attachment, such as emotional maltreatment or neglect. For less severely affected maltreated individuals, we suggest using conventional diagnostic categories, such as major depression, but with an essential modifier indicating a history of childhood maltreatment, or early life stress, to delineate the ecophenotypic variant. Implementing this strategy should improve our ability to effectively diagnose and treat individuals with psychiatric disorders and to accelerate discovery.

Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education.

ObjectiveInnovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them.MethodsIn blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarching heuristic with practical relevance and concrete applications to psychiatric education.ResultsWe identify three areas to enhance psychiatric education embedded into this blended framework: 1) Showing, or the more accurate depiction or imaging of mental illnesses and of psychiatric practice, as exemplified by the incorporation into didactic content of asynchronous video-based clinical materials produced with specific educational objectives in mind; 2) Sharing, or addressing the image problem of mental illnesses, of those living with or affected by them, and of psychiatry as a profession, as exemplified by psychiatrists embracing their role as experts by professional and personal experience when sharing their own journeys with mental illness, treatment, and recovery; and 3) Doing, or reimagining reflective psychiatric practice, as exemplified by the novel methodology of co-constructive patient simulation (CCPS), through which learners can engage in reflective practice and supervision in a participatory and democratic setting that does not privilege participants’ hierarchical standing.ConclusionThe blended model and the sample applications we describe offer a range of teaching, learning, and professional development opportunities, should psychiatric educators choose to pursue them and reap their promise.

22.2 LESSONS LEARNED FROM AN OUTPATIENT CATATONIA CLINIC

Objectives: This session aims to provide an overview of an outpatient approach to the diagnosis and treatment of catatonia in individuals with Down syndrome and unexplained regression in the Down Syndrome Psychiatric Specialty Clinic at the Indiana University Neuroscience Center. Methods: This session will: 1) review 2 cases of patients with Down syndrome and unexplained regression, illustrating the proposed “tiers” for medical workup and treatment algorithm based on current literature and clinical practice among providers in the Down syndrome medical community;2) discuss the creation of a Down syndrome and pediatric catatonia outpatient specialty clinic, and modifications made for evaluation and treatment via telehealth during the COVID-19 pandemic;and 3) review how collaboration with pediatrics, pediatric subspecialties, and psychiatry led to improved catatonia awareness, and improved access to ECT for pediatric patients with and without neurodevelopmental disorders. Results: Recognition of unexplained regression and catatonia in Down syndrome leading to formal medical workup and treatment improved with the development of a dedicated specialty psychiatric clinic, institutional and community education, and ongoing coordination between pediatrics, pediatric subspecialties, psychiatry, and child and adolescent psychiatry. Conclusions: It is important to create bridges between pediatrics, pediatric subspecialties, psychiatry, and child and adolescent psychiatry to provide increased awareness of unexplained regression and catatonia in Down syndrome, which facilitates appropriate diagnosis and treatment of catatonia in both neurodevelopmental and pediatric populations. GS, ID

46.1 ADVANCING EQUITY THROUGH PSYCHIATRIC EDUCATION

Addressing the structural racism inherent in the medical and psychiatric education process, from medical school admissions up through fellowship training, requires an intentional, multilayered strategy. This presentation will: 1) summarize efforts to help increase workforce diversity and true representation; 2) describe examples of learning experiences that do not recreate or perpetuate the extant structural injustice present in the psychiatric training process; and 3) provide meaningful ways that training program directors, faculty, and mentors can support psychiatry trainees and early career psychiatrists’ role in health equity efforts. Medical and psychiatric educational processes must engage in meaningful practice change in order to realize a more socioeconomically and racially representative mental health workforce that is well-educated and supported to address health disparities in the mental health care of Black and Latinx children. Academic literature is available to guide training programs interested in improving their health equity education. Attendees will learn how each pillar of psychiatric training program development, including didactics, readings, supervision, and advisement, can be re-examined and recreated to provide a health equity lens to all psychiatry trainees and foster their interest and involvement in health equity work. There is a need for a social justice framework throughout the medical and psychiatric education process about topics including a holistic review of applicants, knowledge of structural trauma, creation of pipeline programs in collaborations with historically Black colleges and universities (HBCUs) and majority-minority medical schools, and collaborations of an interdisciplinary nature.

MANAGEMENT OF DEPRESSION IN CHILDREN WITH LUPUS ERYTHEMATOSUS SYSTEM

CASE REPORTMANAGEMENT OF DEPRESSION IN CHILDREN WITH LUPUS ERYTHEMATOSUS SYSTEMRisza Subiantoro*, Nining Febriyana**, Lestari Basoeki**, Endang Wasiki** *Participant in Specialist I Psychiatric / Psychiatric Education Program, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia Bumi Panua Hospital, Pohuwato, Gorontalo, Indonesia** Psychiatrist (Consultant), Teaching Staff at Department / SMF Psychiatry, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Surabaya, Indonesia ABSTRACT Depression is a comorbid in patients with Systemic Lupus Erythematus (SLE). Depression can affect up to 60% of adolescents who are comorbid. Depression in adolescents is likely many factors, etiology, psychological burden, chronic disease, effects of long term steroid treatment, social, cultural and genetic factors. Depression is frequently associated with poorer treatment outcomes and poor treatment and health care outcomes in individuals with SLE. In this case, we will discuss the available treatment options. Keyword: Child Depression, Erythematous Systemic Lupus, Management.

Michael Thompson, MD

Michael Thompson, MD

Burnout: modeling, measuring, and managing.

As burnout has been neglected in medical and psychiatric education, we seek to provide a summary overview. We extract salient findings from the published literature and offer some challenges. We critique the current principal model of burnout, argue for broadening the symptom constructs and for a diathesis-stress model where a perfectionistic personality style is a key predisposing factor, and observe that burnout is not limited by those in formal work. We argue that burnout is not synonymous with depression, overview biological underpinnings, and summarise a three-fold management model. As many burnout patients are referred to psychiatrists, awareness of its symptom pattern and management nuances is of key importance.

Teaching LGBT+ Health and Gender Education to Future Doctors: Implementation of Case-Based Teaching.

Improving the education of medical students and physicians can address the disparities in LGBT+ (lesbian, gay, bisexual, transgender, and others) health care. This study explored how teachers used case-based teaching to teach medical students about gender and LGBT+ health care and discussed the implementation and effectiveness of case-based teaching from the perspective of the teachers and students. This study employed the case study method and collected data through semi-structured interviews. This study used two gender courses in clinical psychiatric education as case studies. Two teachers and 19 medical students were recruited as participants. The findings of this study were as follows: (1) effective cases links theory to clinical practice and competency learning; (2) experience sharing by LGBT+ is highly effective; (3) discussions promote the effectiveness of case-based teaching; and (4) the challenges of case-based teaching included time limitations, the multiplexity of the cases, and multilevel learning. This study also found that using narrative cases is a form of narrative pedagogy, which can help students to integrate medicine, gender, and LGBT+ competency education. A successful narrative case–based teaching strategy involves teachers integrating knowledge related to gender, guiding students through the cases to understand the importance of these cases, and reflecting on the medical profession to make improvements. However, teachers face challenges in this approach, such as changes in the school’s teaching culture and a lack of institutional support.

Achievements and challenges in psychiatric education and training in Sri Lanka.

When compared with other Asian countries, psychiatric education and training in Sri Lanka has made significant developments during the past two decades, such as introducing psychiatry as a separate final year subject in the undergraduate medical curricula. However, further developments in psychiatric training in medical education are needed.

Setting the Stage for Psychiatric Mental Health Nursing Education: Outcomes of a Simulated Patient Pilot Program

BackgroundSimulation-based learning experiences (SBLEs) with simulated patients provide valuable and realistic learning opportunities for psychiatric mental health nursing skill building in a safe environment. MethodAn interprofessional faculty group collaborated and trained undergraduate theater students to serve as simulated patients in psychiatric mental health SBLEs for pre-licensure nursing students in two cases focused on therapeutic communication and psychiatric nursing assessment. ResultsA total of 147 nursing students and 13 theater students participated in the SBLEs of two clinical scenarios. Responses to the Simulation Evaluation Tool-Modified (SET-M) and open-ended questions revealed that both student groups benefited from this learning experience and reported increased confidence in relevant skills as a result. ConclusionNursing students reported increased confidence in assessment and communication. Theater students gained confidence in acting skills and appreciation for the SP role. Lessons learned will improve future iterations of the SBLEs and inform program scale.

Tutors' Perceptions of the Transition to Video and Simulated Patients in Pre-clinical Psychiatry Training.

ObjectiveThe use of virtual learning in psychiatric education has been required to address COVID-19-related challenges. Research regarding the implementation of virtual teaching environments and standardized patients for simulation remains limited. Here, educators’ outcomes were evaluated following a transition from in-person teaching with “real” patients, to a standardized patient-based simulation in pre-clerkship psychiatric clinical skills teaching for medical students.MethodsThe Integrated Clinical Experiences course at the University of Toronto is a pre-clerkship clinical skills curriculum for second-year medical students. Four psychiatric clinical skills sessions were transitioned from in-person teaching to virtual teaching environments with standardized patient-based simulation. Educators (tutors) were assigned to teach groups of four to seven medical students, with a total of 45 groups. Tutors were then asked to complete an online questionnaire, and data was analyzed by quantitative and qualitative means.ResultsOf 30 tutors, 21 (75.0%) had previously taught the course for an average of 6.52 ± 6.85 years. Twenty-four of 30 (80%) tutors described their ease of virtual teaching as “extremely easy” or “moderately easy”. Twenty-three of 30 (76.6%) were “extremely satisfied” or “moderately satisfied” with standardized patient-based simulation. Various advantages and disadvantages of the virtual teaching environment with standardized patient-based simulation were identified.ConclusionsThe transition to a virtual teaching environment utilizing standardized patients in a pre-clerkship simulation-based curriculum did not result in significant challenges that would limit educators’ use of these teaching tools. Implementation of virtual teaching environments with standardized patients may thus serve to address challenges related to COVID-19 and resource limitations.