AimsAs more emphasis is placed on a move from the traditional hospital-based practice to care in the community, CMHTs are becoming the main channel for delivering specialist care in England. Access to most CMHTs occurs via written referrals, which vary significantly in content and quality. Such variability and inconsistency with the information provided can impact on the triage process and delay access to treatment for patients, making the process unnecessarily protracted and time consuming. One key factor that would drive the success and survival of CMHTs is how they gate-keep their service. This starts by adopting formal strategies when vetting and screening referrals. The aims were to determine if NW CMHT is responding to referrals appropriately, to consider if service users received good quality correspondence about referral decisions and if the outcomes of such meetings were properly documented.MethodsThe NW CMHT consists of 4 pods (A to D) and the audit included all GP referrals assessed by pod B over a month. A sample size of 28 referrals was included in the audit and the referrals were from 16 different GP practices. Data were obtained from patient electronic records and entered onto a SmartSurvey form for ease of collection prior to results being analysed.Results32% of referrals came from two GP surgeries. Areas of good practice included all referrals being discussed within 4 days of receipt, and 50% reviewed by the next day. For referrals identified as needing further information and discussion, this was also done quickly between 2–5 days of receiving the referral. Also 68% of service users (SU) had a letter sent out to them within 2–5 days. It was unclear in 75% of referrals whether the SU was aware of the referral to NW CMHT and the reasons for the referral were only ‘fully’ documented in 57%.ConclusionThe vast majority of GP referrals were treated in a timely manner, even if additional data gathering was needed and multiple referral discussions had. Recommendations included addressing the lack of consistency in documentation of referral discussions, developing effective ways to cut back on clinical time lost gathering what should be standard information, and education of GP practices around making good quality referrals. It was felt that a review of the referral forms would be beneficial, however a barrier to this change was that this is a trust wide form and there would need to be consensus across all CMHT localities.
AimsTardive dyskinesia (TD) is a disabling extra-pyramidal side effect (EPSE) associated with long-term antipsychotic medication, with an incidence rate of 5% per year of typical antipsychotic exposure. The Abnormal Involuntary Movement Scale (AIMS) is a validated tool for screening for TD and its use is recommended every 3–6 months in those taking antipsychotics. Atypical antipsychotics present a lower risk and have contributed to complacency in monitoring and treatment. The primary aim of this audit was to establish whether AIMS was completed for all patients taking regular antipsychotic medication for three months or more. Secondary aims were to investigate whether patients were informed about EPSEs on initiation, titration and change of antipsychotics, and whether they were assessed for the emergence of side effects during subsequent clinical reviews.MethodThis single-site audit examined the care of inpatients on Ward 4 of the Becklin Centre, a male working-age acute psychiatric ward, between 1st November 2020 and 31st January 2021. Patients aged 18–65 years who were prescribed regular antipsychotics were eligible for inclusion. Exclusion criteria included the presence of other neurological movement disorders. 50 patients were included. Data collection took place between 8th February and 6th March 2021; this involved reviewing patient records throughout their inpatient stay on Care Director, an electronic patient record system. Results were compiled using a pre-determined data collection tool and analysed using Microsoft Excel.ResultFor 14 (28.0%) patients there was documented evidence of the provision of verbal information surrounding EPSEs during initiation or change of antipsychotics, and 12 (24.0%) received written or verbal information about wider side effects. For 19 (38.0%) there was a documented assessment of side effects during clinical review following the initiation or change of antipsychotic medication. Of the 33 patients who took antipsychotics for over three months, 3 (9.1%) received an AIMS assessment.ConclusionAn inadequate proportion of inpatients prescribed long-term antipsychotics were assessed for TD, likely due to a lack of awareness of the relevant guidance. A substantial number of patients were not informed about side effects, suggesting an element of medical paternalism. This study provides opportunity to improve practice by educating the medical workforce and raising awareness of TD symptoms amongst the wider team. Valbenazine is a new FDA-approved treatment for adults with tardive dyskinesia, representing a further avenue for management. Greater focus on patient involvement, and communication surrounding anticipated side effects, is likely to benefit compliance with treatment and improve the doctor-patient relationship.
AimsFoundation Doctors are exposed to a range of specialties within the Foundation Programme, with 20.9% completing a psychiatry rotation. Those who do not have a psychiatry rotation may have little experience other than what was acquired in undergraduate training, despite being expected to care for patients with mental health problems. According to Mind (2017), one in four people will experience a mental health problem each year thus essential that our medical workforce know and understand the basic principles of psychiatry to aid their management of core psychiatric conditions. The aim of this project was to improve mental health literacy among Foundation Doctors by improving their communication, formulation and risk management skills. Another objective was to encourage uptake to Psychiatry and help plug the high number of unfilled Consultant posts.MethodsThe initial pilot was carried out between January and June 2021 over zoom and the sessions were optional. A survey was completed to find out which topics were most relevant and common themes included MCA/MHA interface, risk management and treatment of various conditions. These themes were incorporated into 90-minute sessions which included interactive case-based discussion in small breakout groups and some didactic teaching. The six session topics were EUPD, Dementia, Depression, Delirium, Substance Misuse and Alcohol Misuse. The sessions were facilitated by clinicians of mixed experience from Foundation Doctors to Consultants. Participant knowledge was tested using pre- and post-session quizzes and a working group reviewed feedback, making relevant changes subsequently.ResultsFeedback was majorly positive, and attendees valued the interactivity, breakout rooms, case studies and choice of topics. Suggested areas of improvement were having more time for discussion, technical difficulties, and less psychiatric ‘jargon’, but these tended to be isolated comments. Five out of six sessions showed an improvement in assessment scores afterwards, with an average improvement of 12.6% (average pre-session score of 70% and average post-session score of 82.6%). One session showed a decrease in the post-session quiz scores which on reflection showed that the questions in the assessment covered material not included in the session.ConclusionThe virtual programme was an effective way of improving knowledge and confidence in psychiatry. Whilst the sessions were positively received and showed improvements in post-session scores, there were some limitations which will be addressed and used to develop future training. There is now more mental health woven throughout the new Foundation curriculum and expected that much of this content will be covered during Foundation Training.
AimsThere are over 72 000 licensed IMGs in the UK who fill up crucial shortages in the NHS and provide diversity. In 2020 there were more IMGs than local graduates joining the General Medical Council register with over half (54%) identifying as Black and Minority Ethnic doctors. There are ongoing and extensive conversations about the best approach to tackle differential attainment between IMGs and local graduates. The aims were to identify what the perceived differences were between local graduates and IMGs in various domains and recognise what measures could be taken to improve the issues identified.MethodsThis survey utilised the Typeform survey software to ask 23 questions and was left open for 3 months. Participation in the survey was voluntary and anonymized and included feedback from both Core Trainees and Higher Trainees. Initial emails, texts and chats with the survey link and reminders were sent to the Medical Education departments and trainee groups. The qualitative and quantitative data from all 33 respondents were analysed.Results90.9% (30) of participants felt there were issues of differential attainment between IMGs and local graduates and felt that the gaps in differential attainment could be addressed by mentoring, networking, IMG lead roles, education of trainers and better support systems. 57.6% (19) of IMGs stated that they had felt bullied, undermined, treated unfairly, or intimidated; with only 29% (9) attempting to challenge this due to the fear of retribution, concerns about accountable, cultural and communication barriers. All respondents felt induction programmes, focusing on IMGs and cultural diversity would be helpful for all trainees, with 93.9% (31) of respondents recommending that more education was needed for trainers. 57.6% (19) stated that they had considered relocating outside the UK after training because they felt they would be better valued elsewhere. 90.9% (30) suggested that a book for IMGs would be a welcomed development. 87.9% (29) recommended that having IMG leads was important for offering well-being support, play a safeguarding role, offer pastoral care, and contribute to induction and education; with 68.8% (22) recommending the person was a College trainer.ConclusionThese findings highlight several challenges IMGs training in the UK face and must navigate to be successful. A greater awareness of their hurdles is critical to maximising what potentials lie within. As the numbers of IMGs within the system continue to rise, there is an even greater need to support and address the concerns this survey underscores.
AimsGathering honest feedback is challenging as trainees are often reluctant to do so due to the perceived impact on their reputation, future careers, and professional relationships. A lack of constructive feedback severely impacts future trainees and can prevent necessary improvements. There is considerable variation over collection of feedback. The aim of the project was to allow higher trainees and newly appointed consultants within two years of completing training, provide feedback on previous training posts in a confidential manner. The information obtained would be used to improve trainee experience, support a change in culture around feedback and highlight posts in need of input from Training Programme. Directors (TPDs).MethodsAnonymised questionnaires were sent to higher trainees and newly appointed consultants using a survey monkey link left open for a month. Reminders were sent via Medical Education, text messages, chats, and informal conversations. There were three basic open questions asked with free-text boxes. The questions were: What things were good about this post? What things could be improved? Would you recommend this post to a colleague? The data collected were in quantitative and qualitative formats.ResultsWe received 22 responses of 46 higher trainee posts within the scheme. The general themes from the project were that trainees wanted more focus on training rather than service provision, more independent working while still having good clinical support/supervision; based on their level of experience, better support to meet non-clinical Intended Learning Outcomes (ILOs) and ensuring a good balance of being busy while not finding it overwhelming. Trainees in community settings suggested allocation of selected cases focused on training experience, the opportunity to manage complex situations with supervision, being able to shadow and have joint reviews with consultants. The themes highlighted in the inpatient settings included having protected time to develop non-clinical ILOs, assuming greater leadership of clinical meetings, and having the opportunity to manage a patient from admission to discharge. A total of 4 posts were not recommended for reasons outlined above.ConclusionClearly there is a balance to be made between appropriate levels of independence and supervision. The vast majority of training posts reviewed have got the balance about right, however there are still some posts that require improvements. Careful consideration by both trainers and trainees needs to be given to various aspects of training, to achieve required ILOs, as not everyone fits the mould. This highlights the importance of creating individualised frameworks for trainee support and supervision.
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