Skip to main content
×
×
Home

Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey

  • Jacqueline Therese Gordon (a1)
Abstract
Aims and method

To determine knowledge, skills and confidence of junior medical emergency department staff in managing mental health patients. Over a 2-year period new emergency department junior doctors were given a questionnaire to complete early on in their post and prior to any mental health training. The questionnaire asked about knowledge, confidence, concerns and skills in the management of mental health patients in accident and emergency services.

Results

More than half of the 32 doctors surveyed said they lacked knowledge, skills and confidence when assessing mental health patients.

Clinical implications

The survey has demonstrated a need for mental health training of new doctors working in the emergency department. Effective training for such doctors can be offered by a liaison psychiatry service. This should be embedded in their teaching programme and be continually responsive to their perceived training needs.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Jacqueline Therese Gordon (jackie.gordon@sussexpartnership.nhs.uk)
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Johnson, S, Thornicroft, G. Emergency psychiatric services in England and Wales. BMJ 2005; 311: 287–8.
2 Saliou, V, Fichelle, A, McLoughlin, M, Thauvin, I, Lejoyeux, M. Psychiatric disorders among patients admitted to a French medical emergency service. Gen Hosp Psychiatry 2005; 27: 263–8.
3 Cassar, S, Hodgkiss, A, Ramirez, A, Williams, D. Mental health presentations to an inner-city accident and emergency department. Psychiatr Bull 2002; 26: 134–6.
4 Keene, J, Rodriguez, J. Are mental health problems associated with use of accident and emergency and health-related harm? Eur J Public Health 2006; 17: 387–93.
5 Hisley, F, Meldon, S. The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med 2002; 39: 248–53.
6 Royal College of Psychiatrists. Psychiatric Services to Accident and Emergency Departments (Council Report CR118). Royal College of Psychiatrists, 2004.
7 National Institute for Health and Clinical Excellence. Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care (Clinical Guidelines CG16). NICE, 2004.
8 Patterson, WM, Dohn, HH, Bird, J, Patterson, GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics 1983; 24: 343–5, 348–9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 10 *
Loading metrics...

Abstract views

Total abstract views: 46 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st July 2018. This data will be updated every 24 hours.

Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey

  • Jacqueline Therese Gordon (a1)
Submit a response

eLetters

Simulation Training: A Tool to Improve Junior Doctors' Confidence

Rhodri S. David, Fellow in Medical Education and Honorary Clinical Lecturer
08 June 2012

We read Dr Gordon's paper(1) with great interest as it echoes our ownwork while surveying the confidence of junior doctors new to psychiatry. Like Dr Gordon we felt there was a specific need to combat their self-perceived lack of confidence, particularly in the out-of-hours environment, as often more senior supervision is based off-site. However we do feel that Dr Gordon's recommendations for 'mental health training ofnew doctors working in the emergency department' should perhaps be expanded to all those new to psychiatry, as the identified difficulties are not unique to the liaison service.

This issue has potential effects on patient safety, which is substantiated by one third of Foundation Year 1 respondents in the BritishMedical Association's Cohort Study Third Report reporting that they had been asked 'to undertake tasks which they felt were beyond their capabilities' during their placements.(2)

In our own work, we expressly aimed to target this phenomenon, consequently designing and implementing a simulation-based programme as part of the induction process of our trust. Simulation-based training has been recommended as a risk-free and efficient way of improving the qualityof junior doctors' training.(3) Junior doctors new to psychiatry participated in a range of complex clinical out-of-hours simulated scenarios under the observation of experienced Consultants and patient representatives. Timely focused feedback was given by the observers present, alongside the opportunity to discuss their performance within clinical supervision sessions using recorded video. We received positive feedback from the participants, including a self-reported increase in their confidence when this was measured in follow-up sessions. They also felt that this would impact their performance on real cases. The patient representatives gave a unique viewpoint and they felt that there were clear improvements in trainees' performance following the first session.

We recently presented our small scale pilot in a London Deanery Quality and Innovation conference, which was well-received. Additionally it generated interest from other trusts that were keen to potentially implement similar programmes locally.

We ultimately hope that our project will be used to increase and focus supervision in out of hours' work, while also improving patient safety using engaging and interactive learning through simulation.

References

1. Gordon JT. Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey. Psychiatrist 2012; 36:186-188.

2. British Medical Association (2009) Cohort study 2006: Third report. BMA.

3. Temple J, on behalf of Medical Education England. (2010) Time for training. A review of the impact of the European Working Time Directive ontraining. Medical Education England.

... More

Conflict of interest: None declared

Write a reply

Emergency Department junior medical staff's knowledge, skills and confidence with psychiatric patients: a survey

Thomas J Burden, Junior Doctor (CT1)
18 May 2012

Dear Sir,

As a junior doctor who has moved to psychiatry after previously spending two years training in emergency medicine, I read Dr Gordon's article with interest. The survey clearly highlighted a need for mental health training of new doctors working in the emergency department (ED). During one of my training posts in emergency medicine, I completed an audit, which showed that 75% of patients presenting to the department withself-harm were being seen by junior medical staff and highlighted the needfor increased training and supervision of junior emergency department doctors. In addition, many such patients present out of hours when access to senior support and psychiatric services may be more limited.

I think that it is also important to consider the knowledge, skills and attitudes of senior doctors working in the ED. Assessment and treatment of the patient presenting with self harm and behavioural disturbance does form part of the College of Emergency Medicine curriculum (1,2). However in my experience, many senior doctors working in the ED - with some exceptions - have little interest in assessing and treating patients who present with self-harm or other mental health problems. As my audit showed, many such patients are left to junior emergency department doctors to see. When asked for advice about such patients, a common response from senior doctors is to advise that the patient should be referred to 'psych', without any meaningful discussion or assessment of the patient; this is in contrast to patients presenting with other problems such as trauma or minor injuries, when they may show more interest in seeing the patient and teaching their junior staff.

I think that it would be beneficial for patients to improve links between emergency departments and psychiatric liaison services and to consider increasing the amount of mental health training available for allgrades of doctors working in the ED.

1.Acute Care Common Stem Core Training Programme, Curriculum and Assessment System, College of Emergency Medicine, May 2010 (www.collemergencymed.ac.uk)2.College of Emergency Medicine Curriculum and Assessment Systems for Core Specialty Training and Higher Speciality Training, June 2010 (www.collemergencymed.ac.uk)

Dr Thomas BurdenCT1 in General Adult PsychiatryLinks Community Mental Health Team, Longcross Street, Cardiff, CF24 0SZ.Telephone 029 2033 5555 Fax 029 2033 5310thomasburden@doctors.org.ukthomas.burden@wales.nhs.uk

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *