Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness – study protocol for an international multisite non-randomised controlled study

Abstract

BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students’ ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students’ knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients’ experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.

Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

“…In OSCEs, communication skills can be observed directly. The use of such an OSCE is described in a protocol for a study in which an anti-stigma intervention will be tested among medical students in several low-, middle-, and high-income countries (Deb et al ., 2018). In this study, outcomes will be measured with an OSCE that includes communication skills in patient contact, as well as the ability to acknowledge empathetically the impact of stigma when a patient raises this issue.…”

Prospective Study on a Fast-Track Training in Psychiatry for Medical Students: The Psychiatric Hat Game

“…including mental health stigma questionnaire in the pre/post evaluation design [32,33] and adapting and piloting e cient interventions retrieved from the stigma-reducing literature. The PHG could be cofacilitated with a person living with a mental health di culty or complemented with a testimony as direct (in-person) and indirect contact (video) have been documented and proven to be e cient in medical students [34,35]; include perspective-taking exercises and/or debriefs and anti-stigma training in the medical curriculum [36,37]; include re exive exercises to encourage medical students to identify selfstigma and seek help when appropriate, as medical students are vulnerable to mental health di culties and related stigma [38,39]. Since mental health stigma in medical professions is under-researched in France, both medical students and service users would bene t from further research about integrative training addressing stigma, participants' concerns and ensuring knowledge acquisition.…”

Prospective study on a fast-track training in psychiatry for medical students: The Psychiatric Hat Game

“…include perspective-taking exercises and/or debriefs and anti-stigma training in the medical curriculum [39,40]; iii) include re exive exercises to encourage medical students to identify self-stigma and seek help when appropriate, as medical students are vulnerable to mental health di culties and related stigma [41,42]. Since mental health stigma in medical professions is under-researched in France, both medical students and service users would bene t from further research about integrative training addressing stigma, participants' concerns and ensuring knowledge acquisition.…”