Psychiatry Training Research Articles

A New Trainee-Run Insomnia Treatment Service for Patients Under Community Mental Health Teams

AimsChronic insomnia is a common mental disorder that severely impacts the quality of life of those affected, increases the risk of comorbid mental disorder and physical illness, and makes treatment of other mental disorders less effective. It is particularly common in patients under secondary care mental health services. Once chronic, insomnia rarely resolves spontaneously. Cognitive behavioural therapy for insomnia (CBT-I) is a highly effective treatment that is recommended by the UK's National Institute of Health and Care Excellence as the first-line treatment. Despite this, CBT-I is not universally available or accessible throughout the UK. Therefore, LW obtrained training at a sleep clinic and then initiated, ran and evaluated a new CBT-I service for existing community patients within her NHS trust.MethodsPatients received individual holistic assessments with a psychiatry trainee, a 5-session weekly virtual group intervention run by LW, and an individual 3-month follow-up. LW also trained other psychiatry trainees to run future groups, initially under supervision. Clinical rating scales were employed at initial assessment, following the final workshop and at follow-up.ResultsSeven patients completed all sessions, with five completing a 3-month follow-up review. All had suffered with chronic insomnia for over 5 years. All had moderate-to-severe insomnia on the Insomnia Severity Index (ISI) at assessment (mean 21.3), which had improved by the end of treatment (mean 14.3). All patients seen at follow-up either no longer had insomnia or had sub-threshold insomnia on the ISI (mean 7.2). From assessment to post-treatment to follow-up, mean scores on the Dysfunctional Beliefs and Attitudes About Sleep Scale reduced from 6.6 to 3.7 to 2.5, and mean scores on the Clinical Outcomes in Routine Evaluation–Outcome Measure reduced from 2.18 to 2.01 to 1.27. Mean scores on the Work and Social Adjustment Scale reduced from 23.6 (severe impairment) at assessment to 7.0 (low impairment) at follow-up. Two patients stopped taking sleeping tablets during the treatment, and remained off them at follow-up.ConclusionGroup CBT-I can be a highly effective treatment for insomnia for patients under CMHT services. In this service run by a psychiatry trainee without formal sleep medicine or CBT qualifications, the efficacy of the intervention on insomnia symptoms, as well as on anxiety and depressive symptoms, was similar to the efficacies found in clinical trials and in specialist sleep clinics. CBT-I can be easily learnt by psychiatry trainees and likely other professionals with psychological expertise, which could increase the availability and accessibility of this effective treatment.

Exploring the Barriers to Discussing Unconscious Racial Bias in Psychiatry Trainees

IntroductionRacism is present in most aspects of our society, including healthcare. Differences in health outcomes, and in the quality of mental health treatment for people coming from ethnic minority groups have been demonstrated in the literature. Psychiatry trainees are required to understand the impact of structural inequalities and power differences within mental health services, and to be able to deliver clinical care that is equitable for all.ObjectivesTo provide psychiatry trainees with a space to reflect on unconscious racial bias in clinical work and to explore potential barriers when talking about such topics.MethodsA Race and Equality Reflective Group for psychiatry trainees was organised as an opportunity to discuss unconscious racial bias. Due to an insufficient number of registrations, the session was cancelled. An anonymous feedback questionnaire was sent to all trainees to understand reasons behind this, and to explore potential barriers to participation. The results were analysed and were brought back to a regular Balint group for further exploration.Results Twelve trainees filled in the questionnaire. The main themes identified included this topic being a sensitive issue (5; 41.7%), discomfort in trainees (5; 41.7%), insufficient time to participate (4; 33%) and timetable clash (3; 25.9%). Barriers to discussing unconscious racial bias and inequality were identified in further exploration with trainees. The tendency for groups to adopt a split position that was observed, mirrors the dynamics seen in institutional racism.ConclusionsThis work has highlighted the need for ongoing focused, facilitated educational spaces where these issues can be openly discussed and reflected upon.DisclosureNo significant relationships.

Expanding the Scope of Mentoring for Psychiatry Trainees in Northern Ireland

AimsThe Northern Ireland psychiatry mentoring scheme, in which higher trainees mentor core trainee year 1 (CT1) doctors, has been running for four years. In this year's scheme, implemented in August 2021, we have expanded the scope of the scheme and implemented an online platform to match and connect mentors and mentees. Our aim was to gather baseline data regarding the experiences of mentors and mentees and to capture information regarding the content of mentoring meetings and attitudes towards format of meetings.MethodsHigher psychiatry trainees were invited to sign up as mentors through the Northern Ireland Medical and Dental Training Agency (NIMDTA) and Royal College of Psychiatry Northern Ireland (RCPsych NI) mailing lists. Mentors were obliged to complete a theoretical module on training before meeting their mentees. Core trainees in the first and second year of training were asked to opt-out of the scheme if they preferred not to be involved. CT3 trainees were offered the opportunity to opt-in to the scheme. There were a total of 16 mentors and 22 mentees at the outset. The NIMDTA Professional Support Unit provided an online platform, Mentornet, which allowed mentors and mentees to complete a profile, for mentees to rank their preferences for mentor, and to facilitate meetings. One of the authors (M.M.) presented the developments in the scheme to a nationwide audience in the RCPsych webinar on mentoring.ResultsSix mentors and two mentees responded to the call to complete a baseline online questionnaire. 83% of mentors responded that they had found their role enjoyable and rewarding, whilst 67% of mentors indicated that their role had helped them develop in other skill areas. Both mentees responded that they had found the scheme beneficial and would recommend participation to other trainees.ConclusionMentorship is a valuable opportunity for senior psychiatry trainees to facilitate the professional development of junior trainees and to pass on their experience. This is the first year that all core trainees have been invited to participate and that a new web platform has been used to facilitate meetings. Baseline feedback response numbers have been limited although the responses were universally positive. We intend to obtain further feedback at the end of this year in order to devise quality improvement measures for the 2022/2023 cohort.

Postgraduate Psychiatry Training Programme in Morocco

AimsThe field of psychiatry in Morocco has grown significantly since the 1970s, from less than 10 psychiatrists to the current number of around 400. The increased number of practising psychiatrists has enabled the expansion of local residency training programmes, which has been set up since 1974 to cater for the population needs of more than 36 million population of Morocco. This study is aimed to describe the current medical educational approach of the Moroccan postgraduate psychiatry training programme.MethodsThis descriptive medical educational study was based on official training documents and interviews with local faculty members involved in the training.ResultsThe entry requirement of the four-year Moroccan postgraduate psychiatry residency programme includes the completion of 1 year of foundation training and passing the entrance examination consisting of psychiatric semiology and pharmacology. The postgraduate residency programme is run by the local universities in collaboration with the Ministry of Health and accredited by the Moroccan government. Trainees have the option of taking up a voluntary or contractual position with the government or University Hospitals. All trainees will go through 34 months of general adult outpatient and inpatient, while liaison psychiatry training starts from the second year until the end of the training. On top of the core rotation, a trainee can opt for two months in old age and neuropsychiatry postings. Child and adolescent rotation is currently not available. Addiction psychiatry training is optional and can be done through a university diploma. The 4th year is a 12-month elective posting in any discipline that is relevant to psychiatry, which can be done either locally or abroad. Teaching methodologies involve lectures, seminars, ward rounds, case conferences, journal clubs, and skill training workshops. Formative assessments included case-based discussions and mini-clinical evaluation exercise. There are multiple high stakes summative assessments at year 1, year 2, year 3, and year 4. The summative assessment strategies includes modified essay question, clinical short case and long case. Viva voce is used to assess competency in research. Different mandatory skill competencies include electroconvulsive therapy, psychotherapy, and research.ConclusionThe advancement of local postgraduate psychiatry residency training in Morocco has improved the access of local trainees to quality training. Similar to other developing countries, Morocco requires more psychiatrists to improve the psychiatrists to population ratio so that the mental service can become more accessible to the local population.

What Do Medical Students Think About Incorporating VR Into Psychiatry Education and Training?

AimsThe authors hypothesised that medical students may be receptive to incorporating Virtual Reality (VR) within the psychiatric curriculum as a technological adjunct to existing teaching methods. Therefore, the aim was to evaluate medical students’ attitudes towards the role of VR in psychiatry education and training.MethodsIn this descriptive cross-sectional online survey, 76 medical students from all year groups across 10 medical schools in the UK answered a questionnaire consisting of 13 items regarding their views on the role of VR in psychiatry education and training, each on a 5-point Likert scale.Results96.1% of respondents had received some level of education and training in psychiatry. 57.9% had never undertaken a VR experience before, yet 79.0% ‘agreed/strongly agreed’ that they would feel comfortable using VR at medical school.71.1% ‘agreed/strongly agreed’ that experiencing the first-person perspectives of psychiatric patients in VR would enable them to develop greater empathy. 81.6% ‘agreed/strongly agreed’ that managing dangerous patient interactions in VR would increase their confidence in managing such interactions in real-world clinical settings. However, students were most ‘unsure’ about whether VR would reduce their anxiety (30.3%) and improve their interpersonal communication (27.6%) in real-world clinical settings.The majority of students ‘agreed/strongly agreed’ that VR would make educational experiences more engaging (80.3%), improve understanding of content (63.1%), and better prepare them for clinical practice (64.4%).Most significantly, 81.6% ‘agreed/strongly agreed’ that learning in VR would enhance experiential learning in ways that existing teaching methods outside of clinical settings cannot, and 84.2% ‘agreed/strongly agreed’ that they would rather learn from a mixture of VR plus existing methods over existing methods alone.ConclusionThese findings demonstrate that medical students believe VR would improve engagement, understanding, and preparation for clinical practice.VR holds the greatest potential in developing empathy for patients with mental illness and preparing students for dangerous patient interactions. However, further investigation is required to evaluate how educational experiences in VR translate to performance in real-world clinical settings.In times of restricted access to clinical care, such as during the COVID-19 pandemic, VR could play a vital role in teaching psychiatry. The preference for VR to be added to existing teaching methods was the strongest held and most relevant belief to the aim of this study, indicating the readiness of medical students to accept VR into psychiatry education and training.

Admission Clerking- Inpatient Adult Psychiatric Unit - a Quality Improvement Project

AimsTo improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.MethodsWe started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.With the findings obtained, we went ahead to create a proforma encompassing all the details.The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming resultsResultsThe baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 yearConclusionThis QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best

Developing a Systematic Training Programme in Women’s Mental Health

This presentataion outlines the development of a post-membership masterclass programme in Perinatal Psychiatry, funded by Health Education England and delivered through the Royal College of Psychiatrists. The masterclass programme renges from 5-15 days and there are separate programmes for consultants, SAS doctors and senior trainees in psychiatry. The course is delivered by experts in the area and contains a mix of didactic teaching and small group work. The programme was developed to meet the workforce needs of rapidly expanding perinatal mental services throughout England. The programme also helps facilitate the needs of perinatal psychiatrists from Ireland and from the devolved nations of the UK (Scotland, Wales and Northern Ireland).DisclosureNo significant relationships.

Enhancing Innovation and Creativity Amongst Trainees in Psychiatry: Linking the Clinical Practice, Academic, and Social Experiences

AimsIn the face of constant and rapid changes in the landscape of medical practices especially psychiatry, innovation and creativity are essential competencies for all trainees to remain future-proof and competent in facing the future healthcare-related challenges. Recognising this, the General Medical Council (GMC) has highlighted the need for trainees to undertake any form of quality improvement initiatives to improve patients’ care, which trainees can struggle with. This article is aimed to share the authors reflective experience on how to improve their creativity during their training in psychiatry.MethodsThis is a self-study based on the authors’ personal reflections on experiences on promoting innovation and creativity in academic and non-academic work.ResultsOne of the beginning points of learning how to be creative is to learn from others on how to formulate a question that can be answered using research. It can be achieved by reading journals, attending conferences, and watching up-to-date webinars. By modelling others, their ideas can be translated to local practice through adaptation which essentially involves the process of innovative work. Once a person has become more adept in asking questions, deliberate observation in clinical practice helps to consolidate creativity and ideas. With an appropriate level of curiosity, everyone's experience can potentially be transformed into research questions. Effort needs be invested to review available literatures. This will help to construct a clear picture of what is available and what is the gap that has yet to be filled in, i.e., the opportunity of improvement through innovation and creativity. Working in groups allows collaborative problem-solving approaches, which is a good platform to spark new ideas. It is common to encounter obstacles and pitfalls where perseverance is crucial as a trainee can explore alternative ways of problem-solving, which again is a source of innovation.ConclusionFrom the experience of the authors, a broad-based creative exploration is helpful at the initial stage and further narrowing of focus once a creative idea has taken off is important to ensure the vision of a project is achieved. Erich Fromm once said creativities requires the letting go of certainties. The core nature of psychiatry, i.e., the uncertainties is not a limitation but an opportunity to be capitalised. Rather than telling ourselves what is not possible, ask the question of “how can I do this differently”.

Balint Group Sessions for Medical Students, a Pilot Study

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.

Quality Assurance of the ‘MRCPsych Course’ in Wales

AimsThe ‘MRCPsych Course’ (Membership of the Royal College of Psychiatrists) is provided to all core trainees in psychiatry in Wales by the School of Psychiatry, Health Education and Improvement Wales (HEIW), now delivered online since the start of the COVID-19 pandemic. The aims of the HEIW MRCPsych course are: to prepare core trainees for the MRCPsych exams and to set a ‘robust platform’ for speciality training at the higher level in psychiatry. We undertook a quality assurance of the 2020/21 academic year to see how content and delivery of the course were serving these aims and make recommendations for improvement.MethodsOver the course of one academic year we triangulated trainee feedback, lecturer feedback and peer review. Trainee and trainer feedback forms were sent out following every session. We developed standards and criteria for peer review and reviewed 10% of sessions. We conducted focus groups with trainees using mentimeter to structure a real time, anonymous interaction with parallel verbal and written discussions using a virtual meeting.ResultsTrainee feedback forms were received for 31 lectures from an average of 11 trainees per session. 14 Lecturer feedback forms were received, and 48 trainees attended the two focus groups. 15 hours of teaching underwent peer review.ConclusionLecture content was universally accurate and up to date and all teachers were fluent and engaging, with almost all incorporating research data, guidelines and inspiration for further learning.Several lecturer feedback forms requested a curriculum be provided. Some trainees requested a more exam focused approach with more MCQs.Trainees found online sessions more accessible and convenient. The major downside being that they no longer get to know each other and feel very anonymous, which makes peer support and interaction more difficult.Interactive engagement was the lowest scored domain overall. Interaction seemed to work best when done as a continuous process from the start and when a variety of techniques were engaged. Trainee's suggestions for increasing interactivity included quizzes, polls, breakout rooms, use of interactive tools, and a general encouragement of cameras and microphones on and active discussion throughout the session.Speakers had no problems using the technology to deliver an online session, this triangulated with their high confidence and high satisfaction reported by lectures with HEIW practical support. Trainees reported a high satisfaction with the quality of teaching on the course.Our conclusions have informed changes which are currently being implemented and tested.

Redeveloping Leadership Training for Higher Trainees in the West Midlands

AimsMany of the competencies that trainees in psychiatry are required to achieve can be linked to leadership in the broadest sense, yet specific training is not often systematically provided. The West Midlands Psychiatry Leadership Development Programme aims to support the acquisition of important leadership skills already set out in the curriculum through provision of high-quality specialist leadership content within the existing programme. Here we present the findings of a scoping exercise exploring the views and attitudes towards leadership training held by higher trainees in psychiatry within the West Midlands.MethodsAll psychiatry higher trainees within West Midlands Deanery were invited to complete an anonymous online survey using Survey Monkey in November 2021. This survey incorporated questions about their preferred learning styles, confidence in their leadership skills and barriers to accessing leadership opportunities, generating both quantitative and qualitative data.ResultsKey results included: •37 responses were received. All subspeciality training programmes were represented. Almost half of respondents (46%) were ST6 or above and most were in training full time (84%).•Trainees expressed a preference for experiential learning about leadership (87%) as well as small group teaching (62%) and interactive workshop style content (62%).•Awareness of leadership opportunities was typically via their peer group (81%) or clinical supervisor (60%). Only 52% of trainees were aware of leadership opportunities within the Deanery.•Only 54% felt that existing leadership training met their curriculum requirements. Less than half of trainees (46%) felt confident to evidence their leadership experience within their training portfolio.•One-fifth of trainees (21%) reported experiencing barriers to leadership development. These included: inadequate awareness of opportunities, lack of senior support, time constraints and difficulty matching interests with available opportunities.ConclusionTrainees expressed interest in the redevelopment of a regional leadership training programme which would support them to achieve their curriculum competencies and prepare them for life as a consultant psychiatrist. The new multi-faceted regional leadership programme will offer resources in a variety of formats including webinars, podcasts, optional interactive workshops and action learning sets. It is hoped that this flexible programme, linked to the Medical Leadership Competency Framework, will better meet the needs of higher trainees as they pursue their own personal leadership journeys.

Evaluating the Impact of a Simulation Based Training Course in Intellectual Disability Psychiatry and Autism Co-Delivered by Actors With Intellectual Disability

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.

Implementing 360-Degree Simulation Training During Psychiatry Placement Inductions: A Mixed Methods Training Evaluation

AimsThe authors designed a simulation training programme for foundation doctors beginning psychiatry placements across a large mental health trust. The simulation training aimed to improve the confidence, competence, and well-being of foundation doctors through exposing them to realistic psychiatry scenarios and teaching clinical skills in a safe environment.MethodsFour clinical scenarios were filmed with a 360-degree camera, professional actress, and doctors working in psychiatry. The scenarios depicted the journey of a patient being admitted onto a psychiatry ward from the community. Various clinical skills were embedded into the videos including psychiatric history taking, risk assessment, managing acute distress, managing comorbid physical and mental health problems, using the Mental Health Act, and teamwork with colleagues. All videos were delivered to learners using simulation with head-mounted-displays (HMDs). Each video lasted 6–8 minutes and was accompanied by pre-briefing and de-briefing with experienced psychiatrists for a further 15–20 minutes. Participants rated their confidence regarding several skills in psychiatry on Likert scales from 1 to 5 immediately before and after the session. Wilcoxon signed rank tests were conducted to detect statistically significant differences in learner's median confidence ratings before and after the training. Free-text questions explored trainee's most and least favourite aspects of the simulation. A survey also was distributed to learners 2-months after the training to assess how it had influenced their clinical practice.Results20 foundation doctors completed the training and provided feedback. Following the simulation training, there were statistically significant improvements in foundation doctor's confidence in: completing psychiatric assessments (p < 0.01), managing physical health problems in psychiatry (p < 0.05), managing acute distress (p < 0.01), reporting information to senior colleagues (p < 0.05), and containing anxiety when communicating with patients (p < 0.05). Trainees highlighted the debriefing, group discussions, and “interactive” simulation videos as the most useful aspects of the training. Some trainees enjoyed viewing the 360-degree videos, whilst others found the HMDs difficult to use. Of the 8 trainees who completed feedback 2 months after the training, 7 (87.5%) felt that it had helped them in their current roles. All trainees agreed (37.5%) or strongly agreed (62.5%) that the simulation scenarios were closely aligned to real-life clinical encounters.ConclusionSimulation training in psychiatry using 360-degree videos and HMDs is generally well-received amongst foundation doctors. Embedding simulation training into placement induction can improve the confidence and skills of junior doctors starting psychiatry placements.

Leadership skills training in Psychiatry: A European-based cross-sectional survey

IntroductionLeadership in healthcare organisations is crucial to continually improve and provide high quality compassionate care. Leadership development and training enables the psychiatrists in developing these essential skills. Focusing on how to enhance leadership development through leadership skills training and experiential learning should be a priority. However, little is known about the extent to which this leadership skills training is available across Europe in the early stage of the career of psychiatrists.ObjectivesTo investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions related to leadership skills training.MethodsCross-sectional study, using an online survey consisting of multiple-choice questions and free text responses.ResultsParticipants from 33 European countries took part in this survey, where the majority were female. More than half were general adult psychiatric trainees and more than a quarter ECPs. About half indicated having no access to leadership skills training within their training program, with only about 10% being satisfied with the training received. About half sought additional training outside their program. A vast majority requested training in leadership skills to be included in a psychiatric training program.Conclusions Our study provides an overview of important gaps in availability and access to leadership skills training amongst psychiatric trainees and ECPs across Europe. We hope that this study will help inform future actions pertaining to development and improvement of leadership skills training for trainees and ECPs across Europe.DisclosureNo significant relationships.

Audit on Availability, Quality and Frequency of Clinical Supervision

AimsWe have completed a cycle of audit on the availability and quality of clinical supervision in Somerset NHS Foundation Trust. Last year we had highlighted the results of our first survey (run in 2020) in local teaching and audit meetings. We have now completed the cycle following the intervention. Both Severn deanery and Somerset NHS Foundation Trust both recommend psychiatry trainees have one hour of supervision per week, involving exploration of trainee clinical and educational needs. This audit is now part of a quality improvement project being run across Severn Deanery. This particular audit focuses on the results from Somerset NHS Foundation Trust.MethodsTrainees working in Somerset NHS Foundation Trust were invited to participate in this survey. We used the original survey from last year but added further white spaces to invite feedback and to explore what was particularly good about the clinical supervision currently offered. Questions on accomplishing workplace based assessments (WPBA), managing e-portfolio requirements were asked, with Likert scale responses available. The survey was sent out in the form of Microsoft Forms disseminated via email to all junior doctors (n = 27).Survey was run from May till June 2021 (nearing the end of placement). We sent out 3 reminders before closing the survey. The authors of the audit then reviewed the data.Results9 out of 27 doctors responded, response rate of 33%. Our last survey had a response rate of 63%. Supervision appears to be more regular now with only 11% stating that they were meeting their supervisor sometimes in comparison to 17% the last survey. Similar percentage of respondents were able to complete WBPAs as in the last survey (88% Vs 89%).QI project/audits were being discussed at a similar rate (60% Vs 66%). 75% of psychiatry trainee respondents were discussing their psychotherapy competencies (42% were having some discussion in the last survey). There was a better response from GP and FY doctors for this survey.ConclusionResponse rate appears to have fallen, however supervision appears to be more regular with more focus on competencies.White space answers showed that most trainees were satisfied with supervision. However, supervision could be more consistent and serious attempts must be made to protect it from clinical work overshadowing it.We will be comparing the results of our audit in Somerset NHS Foundation Trust to the results from other parts of the deanery.

Digital Psychiatry in the COVID-19 Era: the First Italian Cross-National Survey

IntroductionThe COVID-19 pandemic led to the implementation of digital psychiatry (DP) in everyday clinical practice, resulting in the need for a skilled healthcare workforce.ObjectivesOur purpose was to investigate the level of training, knowledge and expertise of young mental health professionals and medical students in DP, as well as exploring their beliefs and experiences in this field.MethodsAn ad hoc cross-sectional survey was designed and administered to Italian medical students, psychiatry trainees, and early career psychiatrists.ResultsMost of the sample declared that the topic of DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on DP. Nevertheless, they mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that the academic background should include a dedicated course/module (54.4%). Moreover, most subjects declared that DP is less effective than in-person interventions (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p≤0.05).ConclusionsDuring the current pandemic, DP represented an ideal response to the need for physical distancing by ensuring the advantage of greater access to care. However, DP interventions are still uncommon, and there remains a certain resistance to their use in mental health care. The lack of formal training during the academic training could be a limiting factor. Therefore, addressing these issues in academic settings could be crucial to spreading this innovative practice also in the post-COVID-19 era.DisclosureNo significant relationships.

Training and education in Digital Psychiatry: a perspective from Asia-Pacific Region

Introduction Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients’ needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills.ObjectivesOur aim is evaluating the level of training, knowledge, experience and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees and early career psychiatrists from WHO South-East Asia and Western Pacific Regions (APAC).Methods A web-based international cross-sectional survey was carried out to specifically investigating digita psychiatry in APAC regions.Results An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry has been observed. The level of training influences knowledge background, which, in turn, influences young professionals’ perceptions and opinions regarding digital psychiatry and interventions in mental health.ConclusionsImplementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity and other administrative related challenges observed in APAC.DisclosureNo significant relationships.

Is the Grass Greener on the Other Side? A Qualitative Comparison Study of Psychiatry Trainee Views in England Compared to New Zealand

AimsThe Royal College of Psychiatrists census (2019) highlighted that 10% of all consultant psychiatrist roles remain unfilled. This pattern is replicated elsewhere in the UK with 7.8% in Northern Ireland, 9.6% in Scotland and 12.7% in Wales. This increase in consultant vacant posts is indicative of the recruitment challenges to psychiatry. On the other hand, the 2017 New Zealand Medical Workforce survey report showed recruitment to psychiatry was up by 8.2% in 2018 compared to 2017. I conducted a qualitative comparison study to look at psychiatry trainee views regarding their training in a UK and New Zealand deanery at similar stages of their psychiatric training.MethodsQuestionnaires were distributed to current psychiatry trainees in the Capital and Coast District Health Board (CCDHB) based in Wellington, New Zealand and Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), UK who were between years 1–3 of their psychiatry training. Qualitative information was collated from the questionnaires regarding various aspects of their training. Areas of focus were; pros and cons of psychiatry training, suggestions for improvements, supervision, access to annual leave and study leave, teaching, encouragement to attend courses and involvement in research.ResultsOf the 33 current trainees working in CCDHB, 48% were immigrants from the UK, previously having worked in the NHS.17% of BSMHFT trainees felt valued in their organisation, compared to 64% in New Zealand.27% in New Zealand considered switching to another training programme, whereas none considered switching in the UK. Burn out was quoted as a problem in both New Zealand and the UK. 100% were able to take annual leave with ease in New Zealand, compared to 0% in BSMHFT.ConclusionThis small study gives a closer insight into the views of trainees in New Zealand, a place often thought as being more attractive for doctors to work in. What this study shows is 2 key factors; there are shocking differences in the quality of trainee experiences between New Zealand and the UK, however New Zealand is not free from issues around trainee retention, although the study does show overall trainee satisfaction being greater in New Zealand. Feeling valued, supported and leading a life with better work-life balance appear to be key driving factors for UK graduates leaving the UK and there is more that could be done to make trainees in the UK feel more valued and prevent burn out.

Psychodynamic Psychiatry Education and Training for Doctors

AimsBackground and Aim: Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that health care staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for doctors in psychiatry, gastroenterology, and emergency medicine, and to evaluate the perceived benefits of attending in terms of personal and professional development.MethodsMethods: The evaluation used a standardized mixed-methods approach, with the sample consisting of psychiatry core trainees (n = 9), gastroenterology higher trainees (n = 4), and emergency medicine doctors (n = 10). The evaluation period was between October 2021 and January 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions.ResultsResults: All participants (n = 23) scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. All participants reported that they have a better appreciation of group dynamics, the impact of the doctor's humanity and personality on their clinical work, and the symbolic meaning of the patient's symptoms. Notably, approximately 60% reported that the sessions were relevant to their ongoing training needs and that 95% of participants felt the sessions were a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.ConclusionConclusion: This evaluation reports early findings on psychodynamic psychiatry teaching for different medical groups. Overall, the participants felt the sessions were relevant to their training and improved their personal and professional development. Key benefits of the group were highlighted and included increased insight into the emotional and symbolic aspects of the patient's symptoms and clinical issues, team working through cohesion, and the humanity of the doctor in the clinical relationship with the patient. This suggests that the sessions provide a much-needed space to process and reflect on the often-intense demands of clinical work, individually and as a team. The main theme within barriers to the group processes was external in terms of other clinical demands requiring prioritization.

Late to the Party: Mental Health Professionals’ Knowledge on Party Drugs and Harm Reduction Advice

AimsKnowledge of illegal substances has long revolved around addictions in psychiatry training and not of party drugs or harm reduction. Reasons for this could include it being a fairly taboo subject, and it being an area where information and advice change frequently. However, drug related deaths are at their highest since records began, and as our patients use them, it is important that professionals are knowledgeable and can offer sound harm reduction advice. The aims were to establish whether there was a deficit in mental health professionals’ knowledge and understanding of party drugs and harm reduction, to give education on this subject, and to gain feedback on whether it is useful and/or important.MethodsA questionnaire of 10 questions on party drugs and harm reduction was devised using resources from charities ‘The Loop’ and ‘Talking Drugs’. These questions aimed to test general knowledge in this area that would be expected from professionals. The study was carried out using Mental Health professionals (MDT) in a busy South London Trust in November 2019 and March 2020.The questionnaires were given before and after teaching sessions on the subject. Feedback was then collected from the attendees on their experiences.ResultsBefore the teaching sessions, professionals answered 44% of the questions correctly, 48% incorrectly, and 8% were ‘don't know’. However, after the sessions these scores went up to 77% correct, 19% incorrect, and 4% were ‘don't know’. Feedback was extremely positive, with an Addictions Consultant even commenting that she didn't know a lot of what was being taught! Professionals recognised the gap in their knowledge and were keen for more teaching.ConclusionParty drugs and harm reduction knowledge is lacking in Mental Health professionals despite it being commonly seen in our patients. Informed, tailored teaching sessions can help improve this and it seems most professionals would welcome it. In the future it may be useful to include this type of teaching as part of the official Psychiatry curriculum.