Psychiatry peer review groups in Australia: a mixed-methods exploration of structure and function

Australian healthcare workers experiences of peer support during COVID-19: Hand-n-Hand peer support

INTRODUCTION

Founded at the beginning of the COVID-19 pandemic, Hand-n-Hand Peer Support (HnH) offers free, confidential peer support to healthcare workers (HCWs) across Australia and New Zealand. This survey aimed to evaluate HCWs experiences of peer support and collect demographic data about what groups of HCWs were seeking support.

METHODS

An online survey was conducted in November 2021 of HCWs who were either active or past HnH participants (n = 158). Questions included 5-point Likert scales, multiple choice and free text responses.

RESULTS

We received 66 responses (42% response rate). The median age range of respondents was 41-45 years and most were female (87.9%). Most respondents (57.4%) reported experiencing no barriers to accessing peer support. The vast majority (81.4%) of HCWs reported a 'good' or 'very good' peer support experience. Respondents felt peer support helped in multiple ways, particularly in feeling less alone and having a safe space to discuss issues.

CONCLUSION

Australian HCWs accessing peer support tended to be female and more senior clinicians. Most HCWs engaged in HnH reported overall very positive experiences. Our survey helped to identify several areas for improvement in HnH, including clearer marketing about peer support and more targeted triage assessments.

How peer review groups support learning and wellbeing in psychiatrists

OBJECTIVE

To explore the self-reported value of Peer Review Groups (PRGs) by Australian psychiatrists, focussing on learning and wellbeing.

METHODS

A cross-sectional mixed-methods online survey of psychiatrists registered with the NSW Branch Royal Australian and New Zealand College of Psychiatrists (RANZCP) who had attended a PRG in the previous 12 months.

RESULTS

Respondents described PRG participation as supportive to their learning and to their professional wellbeing by sharing professional experiences, emotional support for the inherent stresses of practice, the provision of a space for debriefing and the amelioration of professional isolation. Difficulties or challenges in group functioning were reported rarely and included new group member selection and limitations to individual support provided by the group.

CONCLUSIONS

The PRG form of Continuing Professional Development (CPD) is unique, popular and highly valued by psychiatrists. In addition to supporting learning, PRGs provide a collegial space for processing of emotional aspects of practice that in turn supports wellbeing. Other healthcare professionals might benefit from similar self-directed, self-selected small group peer contact for CPD.

Understanding how and why quality circles improve standards of practice, enhance professional development and increase psychological well-being of general practitioners: a realist synthesis

OBJECTIVES

To understand how and why participation in quality circles (QCs) improves general practitioners' (GPs) psychological well-being and the quality of their clinical practice. To provide evidence-informed and practical guidance to maintain QCs at local and policy levels.

DESIGN

A theory-driven mixed method.

SETTING

Primary healthcare.

METHOD

We collected data in four stages to develop and refine the programme theory of QCs: (1) coinquiry with Swiss and European expert stakeholders to develop a preliminary programme theory; (2) realist review with systematic searches in MEDLINE, Embase, PsycINFO and CINHAL (1980-2020) to inform the preliminary programme theory; (3) programme refinement through interviews with participants, facilitators, tutors and managers of QCs and (4) consolidation of theory through interviews with QC experts across Europe and examining existing theories.

SOURCES OF DATA

The coinquiry comprised 4 interviews and 3 focus groups with 50 European experts. From the literature search, we included 108 papers to develop the literature-based programme theory. In stage 3, we used data from 40 participants gathered in 6 interviews and 2 focus groups to refine the programme theory. In stage 4, five interviewees from different healthcare systems consolidated our programme theory.

RESULT

Requirements for successful QCs are governmental trust in GPs' abilities to deliver quality improvement, training, access to educational material and performance data, protected time and financial resources. Group dynamics strongly influence success; facilitators should ensure participants exchange knowledge and generate new concepts in a safe environment. Peer interaction promotes professional development and psychological well-being. With repetition, participants gain confidence to put their new concepts into practice.

CONCLUSION

With expert facilitation, clinical review and practice opportunities, QCs can improve the quality of standard practice, enhance professional development and increase psychological well-being in the context of adequate professional and administrative support.

PROSPERO REGISTRATION NUMBER

CRD42013004826.

Imposter syndrome in doctors beyond training: a narrative review

OBJECTIVE

To undertake a narrative literature review of imposter syndrome (IS) in doctors beyond training.

METHOD

Twelve studies met inclusion criteria from a systematised search of three databases.

RESULTS

There is a paucity of literature on IS, although it has been observed across a diverse range of specialties. IS appears to be more common in female doctors but is also seen amongst male doctors. IS impacts career progression, leadership and mental health.

CONCLUSIONS

IS causes professional and personal detriment. Solutions must include institutional changes to foster safer workplaces and to address systemic barriers to help-seeking and peer support. Systemic interventions are the only solution to the systemic drivers of IS.

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Purpose

The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice.

Case Presentation

Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted.

Conclusion

There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.