SUMMARY Up to a fifth of people with intellectual disabilities display challenging behaviour that has a significant impact on their health and quality of life. Psychotropic medication does not appear to confer any clinical benefits beyond risk reduction in acute situations. However, very few non-pharmacological treatments have clear evidence of clinical and cost-effectiveness and there is therefore often a dearth of advice as to which components or interventions would be helpful. To our knowledge no single model has been developed to provide a clear path from understanding the behaviour to the implementation of a therapeutic approach for such a complex clinical problem. In this article we describe a stepped-care model that needs to be further operationalised in the assessment and management of behaviours that challenge in adults with intellectual disabilities.
AimsThe aim of this project was to create a Pan-London event to increase awareness and enthusiasm of medical students for Psychiatry as a specialty. In addition to a longer term goal of ultimately increasing recruitment to the specialty once students qualify, this event aimed to bring Mental Health to the forefront of the minds of future doctors.MethodsPsychiatry Teaching Fellows from different trusts created a virtual educational event targeted at medical students in all years across London universities. It was co-produced with the student Psychiatry Societies across the London Universities. This encouraged student engagement from the ground level and fostered an environment of collaboration between students and Doctors. The event was free to attend and was supported by the Royal College of Psychiatry, London Division. The conference programme showcased the various facets Psychiatry has to offer from a global perspective, including Women's Mental Health, Forensic Psychiatry, research and volunteering around the world.ResultsThe conference welcomed 263 attendees. 92 of the attendees completed a feedback questionnaire at the end of the session. The majority of respondents were from London universities and fairly evenly distributed amongst medical school year groups. 99% of those completing the questionnaire found the session interesting (scoring 3 or more out of 5 on a 5 point Likert scale). 98% of respondents reported that they found the session widened their view of Psychiatry. 78% were already considering a career in Psychiatry. 96% felt more likely to pursue a career in Psychiatry following the conference (scoring 3 or more out of 5 on a 5 point Likert scale). Open-text feedback indicated that attendees had found the sessions interesting and particularly valued the range of topics.ConclusionExtra-curricular events are a fantastic chance to broaden medical students’ views of the specialty of Psychiatry. A virtual platform creates opportunities for audiences to hear from a vast array of expert speakers, which might not otherwise be possible in person, and creates a community of like-minded students in a safe environment. Whether or not students go on to pursue the field themselves later on in their training, events such as this bring awareness of Psychiatry and its impacts to the foreground. It is hoped that, in future, further co-produced events between the Royal College of Psychiatry and university Psychiatry societies, can continue to inspire medical students.
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.
AimsThe COVID-19 pandemic impacted medical education with teaching moving online. The aim of this study was to evaluate whether online simulation is an effective tool for the delivery of student psychiatric clinical skills teaching. This has important implications for the future planning of psychiatric clinical skills teaching.Methods162 students were divided across nine online psychiatric simulation sessions held over a four month period. The sessions lasted 3.5 hours and consisted of three simulated scenarios with a professional actor and experienced facilitator. Students were asked to rate: confidence in taking a psychiatric history, conducting a mental state exam, formulating treatment plans, conducting risk assessment, assessing capacity and communicating with patients in psychiatry. Confidence ratings were completed pre and post session on Likert scale (1 = least confident, 10 = most confident). Students were also given the opportunity to provide qualitative feedback after the sessions. The study was conducted with permission from Associate Dean for Undergraduate Teaching and QMUL Centre Lead for Psychiatry.Results137 (92.7%) of students attending the workshop completed pre-session questionnaire and 122 (82.4%) completed post-session questionnaire. 95.1% students rated workshops as good/very good. Pre and post confidence comparisons showed significant increases in average confidence for all questions from pre (M = 5.1, SE = 0.2) to post (M = 7.1, SE = 0.2), t = 10.7 p < 0.001. Paired t-tests were used to compare average pre and post-session results for individual questions from the same session. All questions showed significant increases in scores. Qualitative feedback indicated that students valued the opportunity to practice, obtain feedback and requested more sessions.ConclusionResults show significant increases in confidence in psychiatric clinical skills using online psychiatric simulation. This supports our hypothesis that online simulation is an effective tool for delivery of student psychiatric clinical skills teaching. Students may benefit from online simulation increasing their confidence prior to attending psychiatric placements. This teaching method will also provide an additional method for practising clinical skills with increasing student numbers and demands on psychiatric placements. It therefore has important implications in the future of psychiatric education and could be adapted for use across clinical years and medical schools.
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