Hunter New England Training (HNET): how to effect culture change in a psychiatry medical workforce

Does ComPsych Communication Skills Training Alter Trainee Self-Efficacy?

OBJECTIVE

ComPsych communication skills training is designed to teach psychiatry trainees effective skills and strategies for undertaking key communication tasks relating to mental illness, such as schizophrenia, with patients and their families/carers. This study examined the program's feasibility, utility, and trainees' self-efficacy.

METHODS

Trainee cohorts attending their first year formal education course were recruited annually over 4 years between 2015 and 2018. Each trainee attended at least one session of training in their cohort year. Trainees completed a questionnaire presenting questions about personal demographics, their perceived confidence in communication, and the effectiveness of elements of training delivery. A total of 41 trainee psychiatrists (15 male) completed the questionnaires presented at four time points (two pre-training and two post-training).

RESULTS

Participants reported a significant increase in confidence in their own communication skills post-training (d = 1.12) and rated elements of training delivery (video feedback, feedback from peers in small groups, small group facilitation, and use of simulated patients) as significantly more helpful or effective post-training (d = 0.42). Trainees also reported a significantly increased ability to critically evaluate their own communication skills post-training (d = 0.59), suggesting an increased ability to recognize their own communication skill competence.

CONCLUSIONS

Following ComPsych training, trainees were more confident discussing information about schizophrenia with patients and their families/carers and were more able to critically evaluate their own communication skills: an important feature of good clinical acumen. These subjective ratings provide important self-efficacy information, including the benefits perceived and evidence of the program's feasibility and utility.

Psychiatry training experiences: a narrative synthesis

OBJECTIVE

In Australia and internationally, psychiatry has struggled to fill training places to keep up with demand for service. The objective of this study was to review the components of psychiatry terms and placements that determine a positive experience and potentially influence interest in vocational training in psychiatry.

METHOD

A literature review and narrative synthesis was undertaken on 20 papers identified as meeting inclusion criteria.

RESULTS

The top themes contributing to positive experiences during the psychiatry term were: receiving high quality supervision; supported autonomy; and witnessing patient recovery. There was a paucity of Australian literature preventing investigation of the Australian context alone.

CONCLUSIONS

There is a need to better understand how the junior doctor and medical student psychiatry experience influences perceptions of psychiatry and intention to specialise, especially in the Australian context.

Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees

OBJECTIVE

Important gaps are observed in clinicians' communication with patients and families about psychiatric disorders such as schizophrenia. Communication skills can be taught, and models for education in these skills have been developed in other fields of medicine, such as oncology, providing a framework for training communication skills relevant to psychiatric practice. This study evaluated a pilot communication skills education program for psychiatry trainees, focusing on discussing schizophrenia diagnosis and prognosis.

METHOD

Communication skills training modules were developed based on an existing theoretical framework (ComSkil), adapted for discussing a schizophrenia diagnosis and prognosis. Pre-post training rating of self-reported confidence in a range of communication tasks was obtained, along with trainee views on the training methods.

RESULTS

Thirty-eight participants completed the training. Significant improvements in confidence were reported post training for discussing schizophrenia prognosis, including an increased capacity to critically evaluate their own communication skills. Participants reported high levels of satisfaction with the program.

CONCLUSION

This preliminary study provides support for the translation of a well-established educational model to psychiatric training addressing core clinical communication tasks and provides the foundation for the development of a more comprehensive evaluation and an extended curriculum regarding other aspects of care for patients with schizophrenia: ongoing management and recovery, dealing with conflict, and conducting a family interview.

Clinical placements in mental health: a literature review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

The experience of psychiatry training in rural NSW

OBJECTIVE

To examine the experience of psychiatry training in rural New South Wales.

METHOD

All rural trainees in New South Wales and key psychiatrists involved in their training were invited to complete a survey in May-July 2013.

RESULTS

Responses were received from 26 out of 44 rurally placed psychiatry trainees (57% response rate) and 37 out of 55 psychiatrists involved in training in a rural area (67% response rate). Positive and negative aspects of rural training were reported. In general, trainees reported positive experiences regarding supervision, consultant input and their Site Coordinator of training. Their experience of other aspects of training and education in rural areas was often negative with 52% of trainees feeling at a disadvantage due to fewer registrar peers and 60% feeling educationally isolated. Difficulty progressing through training, workforce shortages, difficulty accessing formal aspects of training and limited options for advanced training were reported. Metropolitan trainees on rotation to rural terms receive accommodation, travel and an increase in wage from the rural Local Health District. Rural trainees on rotation to the city for their mandatory subspecialty training receive no such support.

CONCLUSIONS

There are many challenges for rural trainees. Support from the Royal Australian and New Zealand College of Psychiatrists and state and federal governments to enhance the rural training experience is vital.

[Perception of Psychiatry among Undergraduate Students of a School of Medicine]

OBJECTIVE

Learn about perceptions and beliefs regarding psychiatry among undergraduate medicine students and compare their conceptions and appreciations concerning positive and negative aspects, before and after specific training in psychiatry.

METHODS

Observational, cross-sectional study; qualitative and quantitative research with application of a survey for undergraduate medicine students of the Universidad de La Sabana, before and after a specific psychiatry course. 90 students answered the survey in two groups: one of them before the course, and the other one afterwards;

RESULTS

52,2% corresponded to semesters prior to the course of psychiatry; 25.5% expressed the purpose to specialize in Psychiatry before the course, and such percentage decreased to 13.4% after the course. Association was found between the purpose of not specializing in Psychiatry with the fact of having taken said course (Fisher's exact test, p=0,042). Most students would not specialize in psychiatry because they are interested in other areas. Before the course, students made emphasis on the biological aspects of mental disease. After the course, they also directed their attention to other factors. The two groups believe that the management of these patients is mainly pharmacological. The incurable character of mental illness was also highlighted together with the risk of getting ill and the stigma it entails.

CONCLUSIONS

Psychiatry is perceived as a medical specialization with emphasis on pharmacological treatment. There is a low frequency of students interested in this area. The course of psychiatry is associated with reduction of this frequency and limits the variability of the psychiatric concept.