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Harmjanz MV, Wu R, Zhang X, Cannell B, Voit JH. Increasing interest in geriatric medicine through participation of pre-medical students in a specialized HELP program. J Am Geriatr Soc 2024; 72:1566-1569. [PMID: 38566356 DOI: 10.1111/jgs.18900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/12/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Affiliation(s)
| | - Richard Wu
- UT Southwestern Medical School, Dallas, Texas, USA
| | - Xuan Zhang
- University of Texas Health Science Center (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Brad Cannell
- University of Texas Health Science Center (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Jessica H Voit
- Department of Internal Medicine, Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
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Gillett G, Davis O, Gill A, van Hamel C. Exploring foundation doctors' self-reported confidence in the assessment and management of mental health conditions. BJPsych Bull 2024; 48:139-144. [PMID: 37408445 PMCID: PMC10985717 DOI: 10.1192/bjb.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS AND METHOD This study assesses newly qualified doctors' confidence in practising clinical skills related to the assessment and management of mental health conditions and how this correlates with other areas of medicine. We conducted a national survey of 1311 Foundation Year 1 doctors in the UK. Survey items assessed confidence recognising mentally unwell patients, conducting a mental state examination, assessing cognition and mental capacity, formulating a psychiatric diagnosis and prescribing psychotropic medications. RESULTS A substantial proportion of surveyed doctors lacked confidence in their clinical skills related to mental health and prescribing psychotropic medications. Network analysis revealed that items corresponding to mental health were highly correlated, suggesting a potential generalised lack of confidence in mental healthcare. CLINICAL IMPLICATIONS We identify areas of lack of confidence in some newly qualified doctors' ability to assess and manage mental health conditions. Future research might explore how greater exposure to psychiatry, integrated teaching and clinical simulation might better support medical students for future clinical work.
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Affiliation(s)
- George Gillett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Owen Davis
- UK Foundation Programme Office, Birmingham, UK
| | - Amarit Gill
- UK Foundation Programme Office, Birmingham, UK
| | - Clare van Hamel
- Severn Postgraduate Medical Education Foundation School, Bristol, UK
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Lenouvel E, Lornsen F, Schüpbach B, Mattson J, Klöppel S, Pinilla S. Evidence-oriented teaching of geriatric psychiatry: a narrative literature synthesis and pilot evaluation of a clerkship seminar. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc20. [PMID: 35692363 PMCID: PMC9174071 DOI: 10.3205/zma001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education. PROJECT DESCRIPTION A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system "ILIAS". RESULTS A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen's d=1.28). CONCLUSION A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.
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Affiliation(s)
- Eric Lenouvel
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Finn Lornsen
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Brigitte Schüpbach
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Janet Mattson
- Karolinska Institute, LIME, Department of Learning, Informatics, Management and Ethics, Solna, Sweden
| | - Stefan Klöppel
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Severin Pinilla
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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Zhou W, Zheng Q, Huang M, Zhang C, Zhang H, Yang L, Wu T, Gan X. Knowledge, attitude, and practice toward delirium and subtype assessment among Chinese clinical nurses and determinant factors: A multicentre cross-section study. Front Psychiatry 2022; 13:1017283. [PMID: 36819944 PMCID: PMC9929153 DOI: 10.3389/fpsyt.2022.1017283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Delirium, a confused transient state of consciousness, can be divided into hyperactive, hypoactive, mixed, and no motor subtypes, according to different clinical manifestations. Several studies have investigated delirium subtypes in the knowledge dimension, but few studies have investigated delirium subtype in the attitude and practice dimensions. The barriers, knowledge sources, and practice details regarding subtype assessment are unclear. OBJECTIVES This study had three objectives. First, we planned to investigate the KAP status regarding delirium and subtypes for nurses. Second, we wanted to identify factors affecting clinical nurses' KAP scores. Third, this study expected to explore more details regarding delirium and subtypes assessment, including assessment barriers, assessment instruments, and knowledge sources. METHODS This multicentre cross-section study was conducted in 10 tertiary hospitals in three provinces, China, from January to April 2022. We investigated 477 nurses from six departments with a high prevalence. The self-developed KAP questionnaire regarding delirium and subtypes assessment had four parts: knowledge, attitude, practice, and source. Its reliability and validity were verified effectively by 2-round Delphi expert consultation. RESULTS A total of 477 nurses from the general intensive care unit (ICU), specialty ICU, orthopedics, thoracic surgery, operating room, and geriatrics were 28.3, 22.4, 22.2, 10.5, and 5.2%, respectively. The total KAP score regarding delirium and subtypes assessment was 60.01 ± 6.98, and the scoring rate was 73.18%. The scoring rate for knowledge, attitude, and practice was 58.55, 83.94, and 51.70%, respectively. More than half (54.1%) were unaware of the delirium subtypes assessment instruments. A total of 451 (94.6%) participants recognized the importance of nursing work for delirium prevention. A total of 250 (52.4%) nurses occasionally or sometimes assessed delirium subtypes, and 143 (30.0%) never assessed for delirium subtypes. We found that age, department, technical title, familiarity with delirium, familiarity with delirium subtypes, delirium training, and subtype training affected the total KAP scores. ICU nurses achieved the highest scores. CONCLUSION Chinese nurses' KAP status regarding delirium and subtypes assessment were barely acceptable, and the attitude score was positive, but knowledge and practice needed improvement. Meanwhile, the department was one of the significant KAP factors, and ICU nurses did better in delirium and subtype assessment in knowledge and practice dimension than other departments. Systematic and scientific training processes including subtype content and assessment tools are required. Experience still drives nurses' assessments of delirium and subtype. Adding the delirium assessment into routine tasks should be considered.
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Affiliation(s)
- Wen Zhou
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qiulan Zheng
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Miao Huang
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chuanlai Zhang
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Intensive Care Unit, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Huan Zhang
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Li Yang
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Taiqin Wu
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- The Second Department of Nursing School, Chongqing Medical University, Chongqing, China.,Department of Nursing, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Sampogna G, Elkholy H, Baessler F, Coskun B, Pinto da Costa M, Ramalho R, Riese F, Fiorillo A. Undergraduate psychiatric education: current situation and way forward. BJPsych Int 2021; 19:34-36. [PMID: 35532467 PMCID: PMC9046837 DOI: 10.1192/bji.2021.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022] Open
Abstract
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.
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Ewens B, Seaman K, Whitehead L, Towell-Barnard A, Young M. A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults. BMC Nurs 2021; 20:202. [PMID: 34666763 PMCID: PMC8525041 DOI: 10.1186/s12912-021-00692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Background Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium. Methods Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript. Results The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant. Conclusion An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00692-2.
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Affiliation(s)
- Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Michelle Young
- Joondalup Health Campus, Cnr Grand Boulevard and Shenton Avenue, Joondalup, WA, 6027, Australia
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Koelkebeck K, Baessler F, Bittner R, Frodl T, Gradl-Dietsch G, Janowitz D, Jordan KD, Kluge I, Matthes O, Pinilla S, Robitzsch A, Strauß M, Speerforck S, Watzke S, Spitzer P. [Medical education in psychosocial disciplines in times of the COVID-19 pandemic - first experiences]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:573-577. [PMID: 33946123 DOI: 10.1055/a-1480-7258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM In specialties that heavily rely on communication skills such as psychiatry, psychotherapy and psychosomatic medicine, teaching in times of the COVID-19 pandemic is especially challenging. In this overview, educators and course directors report their experiences in eteaching and share their innovative solutions. METHODS We present a collection of methods that relate to teaching and assessment as well as student activation. RESULTS A range of helpful tools for teaching were compiled. This includes instructional videos with simulated patients, structured homework to document a mental status examination, structured hand-offs, and practical examinations in video format. Motivational techniques include podcasts with interviews with clinicians and patients and teaching with the use of cinematic material. DISCUSSION Switching to online formats creates opportunities and advantages for the advancement of time- and location-independent learning. A fast conversion in this direction might also pose some disadvantages. A direct patient-student interaction is critical for engaging with transference, countertransference and situational aspects for teaching in psychosocial disciplines. Empirical studies of the effectiveness of these newly developed formats and faculty development for digital teaching are necessary.
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Affiliation(s)
- Katja Koelkebeck
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Franziska Baessler
- Universität Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - Robert Bittner
- Universität Frankfurt am Main, Klinik für Psychiatrie, Psychosomatik und Psychotherapie
| | - Thomas Frodl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Psychiatrie und Psychotherapie
| | - Gertraut Gradl-Dietsch
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Kliniken und Institut der Universität Duisburg-Essen
| | - Deborah Janowitz
- Universität Greifswald, Klinik für Psychiatrie und Psychotherapie
| | - Katja-Daniela Jordan
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Ina Kluge
- Philipps-Universität Marburg, Fachbereich Medizin, Klinik für Psychiatrie und Psychotherapie, Standort Marburg
| | - Oliver Matthes
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Severin Pinilla
- Universität Bern, Universitätsklinik für Alterspsychiatrie und Psychotherapie
| | - Anita Robitzsch
- Klinik für Psychosomatische Medizin und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Maria Strauß
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Sven Speerforck
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Stefan Watzke
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Philipp Spitzer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Klinik für Psychiatrie und Psychotherapie
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Mitchell G, McVeigh C, Carlisle S, Brown-Wilson C. Evaluation of a co-produced delirium awareness programme for undergraduate nursing students in Northern Ireland: a pre-test/post-test study. BMC Nurs 2020; 19:34. [PMID: 32351326 PMCID: PMC7183703 DOI: 10.1186/s12912-020-00427-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Delirium is recognised internationally as a common disorder that causes acute deterioration in a person's cognitive abilities. Healthcare professionals play a key role in the early identification and management of delirium and effective education can support timely recognition and treatment. There is currently a lack of research exploring the delirium education provided to undergraduate nursing students. The aim of this study was to evaluate the effectiveness of a co-produced delirium awareness programme on undergraduate nursing students in Northern Ireland. METHODS The intervention was a 2-h delirium workshop, delivered in April 2019, to a convenience sample of year one undergraduate nursing students (n = 206) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The workshop focused on four core elements: defining delirium, reflecting on practice, recognition of delirium and management of delirium. Participants completed a 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and post intervention using Socrative, a cloud-based student response system. In addition, students also completed a short questionnaire at baseline and post-workshop, designed by the authors, to ascertain perceived confidence about caring for people with delirium. Data were analysed using paired t-tests and descriptive statistics. RESULTS In the DKQ, Scores were normally distributed around the mean at baseline (71.89%) and post intervention (81.89%). Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.32% increase), causes and risk factors of delirium (17.91% increase) and management of delirium (5.72% increase). In relation to perceived confidence, students reported a 60.20% increase in confidence related to recognition of delirium, a 49.51% increase in relation to delirium management and a 45.04% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.01). CONCLUSIONS A 2-h workshop on delirium improved first year student nurse knowledge about delirium. Nursing students expressed that this approach to delirium education enabled collective thinking about how knowledge could be transferred into individual practises. Students also stated that learning incorporating the voice of the person who has experienced delirium, was an effective and powerful way to deliver education.
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Affiliation(s)
- Gary Mitchell
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Clare McVeigh
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Susan Carlisle
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
| | - Christine Brown-Wilson
- Queen’s University Belfast, School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, County Antrim, Belfast, Northern Ireland BT9 7BL
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Lee EE, Balasubramaniam M, Joo JH, Manning K, Pontone GM, Kirkham J. Innovations and Challenges of Training in Geriatric Mental Health. Am J Geriatr Psychiatry 2019; 27:655-659. [PMID: 31122754 DOI: 10.1016/j.jagp.2019.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ellen E Lee
- Department of Psychiatry (EEL), University of California San Diego, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging (EEL), University of California San Diego, La Jolla, CA.
| | | | - Jin Hui Joo
- Department of Psychiatry and Behavioral Sciences (JHJ), Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore
| | - Kevin Manning
- Department of Psychiatry (KM), University of Connecticut School of Medicine, Hartford, CT
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (GMP), Johns Hopkins University School of Medicine, Baltimore; Department of Neurology (GMP), Johns Hopkins University School of Medicine, Baltimore
| | - Julia Kirkham
- Department of Psychiatry (JK), Queen's University, Kingston, Ontario, Canada
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Schneider M, Binder T. E-Learning in medicine: Current status and future developments. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_74_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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