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The new Foundation Programme Mental Health Curriculum: foundation doctors’ perceptions of its importance and their competency: pre–post psychiatric placement evaluation study
- Ioana Varvari, Thomas Dewhurst, Corinne Jones, Richard Haslam
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- Journal:
- BJPsych Bulletin , FirstView
- Published online by Cambridge University Press:
- 08 April 2024, pp. 1-8
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Aims and method
The new 2021 UK Foundation Programme Curriculum mandates foundation doctors to acquire mental health competencies. This study aimed to evaluate the effectiveness of psychiatry placements in facilitating competency attainment, foundation doctors’ perceived importance of acquiring these and their preferred teaching methods. Utilising Kirkpatrick's evaluation framework, the study employed a pre–post intervention design assessing the impact of psychiatry placements on 135 foundation doctors across three cohorts from August 2021 to March 2022.
ResultsInitially, foundation doctors assigned high importance to mental health competencies. Post-placements, this perceived importance improved slightly, whereas that of clinical skills scenarios slightly decreased. Significant confidence increases were observed in recognising and assessing specific psychiatric disorders. Foundation doctors favoured small seminar groups and on-the-job ad hoc teaching. Qualitative insights underscored the need for context-specific teaching.
Clinical implicationsPsychiatry placements enhance foundation doctors’ confidence and perceived importance of mental health competencies as specified by the curriculum. Addressing clinical scenario gaps through context-specific teaching and transferable skills development is essential. Customised teaching approaches, especially small seminars and ad hoc teaching, hold promise for effective mental health training.
Managing diabetes in the psychiatric in-patient setting: knowledge, attitudes and skills of healthcare professionals
- Zoe Goff, Vishal Sharma, Ioana Varvari
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- Journal:
- BJPsych Bulletin , FirstView
- Published online by Cambridge University Press:
- 05 September 2023, pp. 1-7
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Aims and method
There is currently a lack of monitoring and standardisation of diabetes care in the National Health Service (NHS) psychiatric in-patient setting. We surveyed healthcare professionals in psychiatric in-patient units across England to understand current diabetes care. A 13-item questionnaire was piloted via think-aloud interviews. The survey was completed by healthcare professionals across 19 wards in 11 NHS mental health trusts. Results were analysed via descriptive statistics and thematic analysis.
ResultsOf 150 respondents, 98% agreed that addressing physical health needs was an important part of the mental health team's role; 68% agreed that they had adequate skills and knowledge to manage diabetes safely. Thematic analysis identified themes relating to individual, organisational and patient-level factors.
Clinical implicationsPsychiatric admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and severe mental illness. This national survey highlights areas that need to be addressed to optimise diabetes care in this setting.
Foundation Doctors and the New Mental Health Curricula: What They Think and What They Want
- Ioana Varvari, Tom Dewhurst, Corinne Jones, Richard Haslam
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S38-S39
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Aims
The new United Kingdom Foundation Programme Curriculum was implemented in 2021 and emphasizes the importance of Foundation Trainees (FTs) acquiring mandatory core skills and knowledge in mental health. The primary aim of our study was to enquire if the FTs perceive the new psychiatry competencies to be important and relevant to their needs. Secondarily we compared what the curriculum is offering with what FTs wished to have been offered.
MethodsA hybrid questionnaire was delivered online via Google forms to all foundation doctors before and after their psychiatry rotation. Data collection took place between August 2021 and March 2023 from a sample of 85 FTs. The quantitative data were elicited via 5-point Likert scales that mapped FTs' perception of importance across areas of required knowledge and core psychiatric skills from ‘not at all’ important to ‘extremely’ important. The data were imported into Microsoft Excel and analysed via descriptive statistics. The qualitative component of eliciting what FTs want by using open-ended questions was analysed using content analysis.
ResultsThe entry survey data show a combined median perceived importance of 4 (Very important) for recognizing, assessing, and managing mental health conditions. Out of these, personality disorder rated lowest with a median answer of 3 (Fairly important). These scores have seen a significant improvement in the exit survey with an overall combined median result of 5 (Extremely important). But not all areas have seen improvement, for example, eating disorders and Somatisation disorders remained unchanged with a median of 4. Interestingly, the median perceived importance of practicing core skills and managing clinical scenarios has not shown an improvement, but a slight decrease over a few categories, going from a median answer of 5 to 4. The qualitative data show that FTs would have liked to learn more about Child and Developmental Psychiatry, Bereavement, and acute health context teaching. They also wanted to learn communication skills and about psychiatry career paths and academic opportunities.
ConclusionThe overall baseline perceived importance of psychiatry competencies was satisfactory, with most conditions being rated as very important. Post placements there was a shift in responses, with the same conditions being rated as extremely important. Supraspecialised areas continue to be perceived as least important and curiously, FT's importance perception of practicing core skills in the acute setting decreased. Future research should qualitatively look at why their perceptions changed and how we can improve context teaching in a heterogeneous group.
The New 2022 Curriculum for Postgraduate Training in Psychiatry in the UK – Experiences of Trainees Within a London Deanery
- Karolos Dionelis, Ioana Varvari, Gopinath Ranjith
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S5-S6
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Aims
The Royal College of Psychiatry introduced a new postgraduate training curriculum in August 2022. One of the main changes is the introduction of a new collaborative tool between supervisor and trainee, the placement-specific personal development plan (PSPDP). The aim of this project is to locally explore trainee's views and experiences with the PSPDP.
MethodsWe explored the views and experiences of seven psychiatry trainees within the South London and Maudsley NHS Foundation Trust in a single 60-minute focus group, co-facilitated by two authors over Microsoft Teams. The participants were purposively identified to have started core and higher training under the new curricula and a snowballing approach was used to recruit them. The data were recorded, transcribed, and analysed in line with ethical guidelines. The analysis was done by using Clarke and Braun's approach to thematic analysis.
ResultsThree overarching themes were identified:
1. Positives of using a collaborative tool with a psychiatric supervisor (PS),
2. Challenges in implementation and
3. Trainees’ perspectives on directions forward.
The most notable subtheme of theme one was the improved curricular alignment between learning opportunities, curriculum content, and assessment tools. As one participant mentioned: “When we were going through [the PSPDP], it definitely guided us, what we wanted to (…) get out of this placement in particular, and also the kind of workplace-based assessments needed.”. The time-effective and structured approach to learning, regular progress follow-up, as well as improved motivation to engage with the placement were further subthemes mentioned. Examples of subthemes emerging from theme two were lack of PS knowledge about the PSPDP, as well as lack of training and information for trainees. Participants commented that “supervisors really didn't know what they were supposed to do” and that “the information [shared during induction] was outdated”. One example of subthemes from theme three was the need for additional training both for trainees and PSs. As one participant mentioned: “Training is required for supervisors (…) and for us as well to get really used to the system. Because it's a good system if we know how to use it.”
ConclusionTo the best of our knowledge this is the first study exploring trainees’ views on the new PSPDP. Whilst trainees appreciated the potential benefits of working through the PSPDP together with their supervisor, significant challenges remained and may hinder its meaningful use. Our next steps are designing and running a hybrid questionnaire to gather views from a larger sample.
Foundation Trainees and Their Perceived Confidence in Practicing Mental Health Competencies Post Their Psychiatry Placements: An Evaluation Study
- Ioana Varvari, Tom Dewhurst, Corinne Jones, Richard Haslam
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S38
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Aims
The new United Kingdom Foundation Programme Curriculum was implemented in 2021 and emphasizes the importance of Foundation Trainees (FTs) acquiring mandatory core skills and knowledge in mental health. The primary aim of this evaluation study is to assess the effectiveness of Maudsley's Training Programme in teaching these skills. Secondarily, it looks at FTs' preferred method of acquiring the mandated competencies. Finally, it aims to shine a light on an area of program evaluation that is lacking in the literature.
MethodsAn outcome analysis evaluation design was used with a pre and post-quantitative questionnaire as the preferred data collection tool. The outcome measured was confidence and corresponds to Level 2 – Learning on Kirkpatrick's Evaluation Hierarchy. Our questionnaire comprised 4 stem questions, using a 5-point anchor Likert scale. The scales were tailored to reflect the core curricular competencies. Data were collected from a sample of 85 FTs between August 2021 and March 2023 and analysed using Excel functions and a Power Shell Script to calculate measures of central tendency.
ResultsEntry median confidence levels were: 3 (Fairly confident) for recognition, 3 for assessment, and 2 (Slightly confident) in managing common mental health conditions. Post-training, the median confidence level in our sample increased to 4 for recognition, 4 for assessment, and 3 for management which denotes a significant positive impact. Examples of outliers are the median confidence seen in assessing Personality Disorders, which increased from 1 (Not at all important) to 3, whereas for recognizing and assessing Delirium and Substance use disorder the median did not change. Looking at teaching methods preferred by the trainees, ad-hoc training on the job and small group seminars were by far most preferred with 24% and 23.6% of responses respectively followed by Self-directed learning and Simulation with 13.8% each and the least preferred were reflective practice (Balint) and mentoring with 3.7% each.
ConclusionThere is a trend of FTs becoming confident post 4 months of psychiatric training in recognizing assessing and managing mental health conditions. Ad hoc and seminar teaching being is the preferred method of acquiring these skills. Moving forward, efforts should be made in evaluating training programs for FTs in psychiatry with the purpose of improving the acquisition of such skills and understanding the best way to teach these. Then, consideration should be given to how we apply these to FTs that don't rotate in psychiatry.
Diabetes Care in the Psychiatric Inpatient Setting: A National Survey of Mental Health Professionals Knowledge, Attitudes and Skills
- Zoe Goff, Ioana Varvari, Vishal Sharma
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S52-S53
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Aims
People with Severe Mental Illness (SMI) are at increased risk of developing diabetes. There is currently a lack of monitoring and standardisation of diabetes care in the NHS psychiatric inpatient setting. This presents as a missed opportunity, as inpatient admission could be used to improve diabetes care for this population. We surveyed the multi-disciplinary teams in psychiatric inpatient units across England to develop understanding of current diabetes care in this setting.
MethodsA 13-item questionnaire was designed to assess the knowledge, attitudes and skills relating to diabetes care. This was piloted via think out loud interviews with 5 staff at a Forensic unit. Amendments were then made to the questionnaire to improve the validity prior to national roll-out.
Site coordinators working within General Adult, Old Age, Rehabilitation and Forensic inpatient services were recruited via medical education and academic links. This included 19 inpatient sites within 11 NHS Mental Health Trusts across England. Site coordinators circulated the questionnaire, primarily via electronic survey. A small number of paper responses were also collected.
Results156 responses were collected via the national survey (electronic = 136, paper = 20). 6 responses were excluded due to missing professional role information or roles not involving physical healthcare. Respondents included within the analysis comprised 43 Doctors, 55 Nurses and 52 Allied Healthcare Professionals.
93% of respondents agreed that addressing physical health needs was an important part of the mental health team's role, although only 28% had received physical healthcare training within the last 12 months.
68% agreed that they had adequate skills and knowledge to manage diabetes safely on the ward. 69% agreed that the diabetic care on the ward was of an acceptable standard according to National Institute for Health and Care Excellent (NICE) guidelines. This reflects a need for appropriate training and guidance to help improve this aspect of care.
Additionally, only 51% agreed that they felt able to refer a patient with diabetes to the most appropriate diabetes service based on type of diabetes and medication prescribed. This highlights an important issue, as cohesive shared-care and clear referral pathways are key when considering effective diabetes management.
ConclusionPsychiatric inpatient admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and SMI. This national survey highlights key areas that would need to be addressed to standardise and optimise diabetes care in this setting. This includes appropriate training, clear guidelines and cohesive shared-care pathways.
Mental Health Literacy in Foundation Doctors - a Survey in the York and Humber Area
- Ioana Varvari, Harry Foster, Pratibha Nirodi
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S38
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Aims
We aimed to measure the baseline mental health literacy in Foundation Doctors in the Yorkshire and Humber area, identify any gaps in knowledge with the purpose of addressing these within the new foundation psychiatry teaching program, developed by North Yorkshire Health Education England.
MethodsIn January 2021, a questionnaire comprising of O'Connor's Mental Health Literacy Scale was sent electronically to all Foundation Doctors in the York and Humber area, that were in a placement at that time. The O'Connor's Mental Health Literacy Scale (MHLS) has been used since its publication in 2015 and is a 35 item, univariate scale that demonstrated good internal and test-retest reliability. It covers the following attributes: a) ability to identify disorders, b) knowledge about seeking information, risk factors and etiology, self-treatment, resources and support available, c) attitudes about mental disorders and seeking professional help. The anonymized data were collected and analysed in Microsoft Excel.
ResultsIn total, we received 49 responses to the questionnaire. Overall, 85% of respondents demonstrated good mental health literacy. Breaking this down further, 91% demonstrated knowledge of core psychiatric diagnostic criteria, 68.4% were literate in etiology and risk factors, 92% and respectively 95.9% understand what resources for treatment and professional help are available. Importantly when looking at attitudes about mental disorders overall 17% of respondents showed a degree of stigma and barriers in seeking professional help. For example, 2% strongly agreed that mental health conditions are not real illnesses, 34.7% were unsure whether people with mental illness are dangerous, 40.9% neither agreed nor disagreed they would move next door with someone with a mental illness and 14.3% would not be willing to have someone with a mental illness marrying into the family. When looking at barriers to seeking help, 12% answered they would not tell someone if they had a mental health problem, with 16.3% unsure whether they would tell someone if they had a mental health problem.
ConclusionOverall, our survey demonstrated good mental health literacy in our cohort, however, there are areas of improvement, the main ones being etiology, risk factors, and attitudes towards mental health. It is important to recognize these deficits, as they have been linked with poor health outcomes and barriers in seeking and providing care. Moving forward, standardization of teaching programs and anti-stigma training could be an evidence-based approach to tackling these issues.
The SHIELD Project: Designing an Intervention for Social Media With Young People
- Gloria Cheung, Ioana Varvari, Clare Fenton
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S46-S47
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Aims
The primary aims of our study is to gather ideas from young people about developing an intervention for children who first started using social media. Our study also aims to investigate whether different types of social media use are associated with impact of social media on emotions and self-esteem.
MethodsAn anonymous questionnaire was distributed to young people (16–25 years old), who were UK residents, through word of mouth, social media and university newsletters. We assessed participants’ baseline characteristics, including types of social media use (active, active-passive and passive), impact of social media. We also explored young people's idea on developing a social media intervention, including how it should be delivered, topics that needs to be covered. Quantitative data were analysed using descriptive statistics and ordinal regression analysis.
Results90 young people completed the questionnaire. 37.8% of the participants started using social media before 13 years old. Analysis has shown that interacting with other users and creating social media content is associated with higher self-rated negative impact on self-esteem from social media, but there is no association between impact on self-esteem and reacting to other's social media content or browsing other's social media content. Types of social media use were not associated with a self-rated impact of social media on emotions. Regarding the co-development of an intervention for social media, young people believe the best ways to distribute information about social media is through an interactive session by professionals (36.7%) or teaching it in class (28.9%) while the least popular ways are poster/booklet (1.11%) and mobile phone app (1.11%). The majority of young people felt the following topics on social media to be useful to cover during interventions, including risks on social media (85.6%), emotional safety on social media (81.1%), social media hygiene (70.0%), coping strategies and finding help on social media (66.7%), communication on social media (58.9%).
ConclusionAlthough types of social media use are not associated with impact on emotions from social media, those who create social media content are at higher risk of having more impact on self-esteem. Interventions should be developed to help protect or improve self-esteem while using social media. This could be done by focusing on different topics. Future interventions for young social media users should be interactive and led by experts. They should also start before children reaches the common legal age of social media use to make them more resilient to the digital world.
Recognizing Early Deterioration in Elderly Care Home Setting - a Snapshot
- Ioana Varvari, Pratibha Nirodi
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S38
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Aims
Our aim is to measure the baseline physical and mental health early deterioration recognition of carers in the care home setting in Harrogate, North Yorkshire. This is part of a larger undergoing quality improvement project that looks at improving elderly care in care homes in the region by implementing a training package.
MethodsThe approach was to contact local authorities, in this case, the NHS clinical commissioning group North Yorkshire to identify a struggling care home. We then engaged the care home and designated a leader to coordinate the project. We collected common themes by using focus groups with both carers and our professionals which led to the creation of a 16-item questionnaire covering deterioration literacy. Finally, we electronically and anonymously surveyed the carers (December 2021) and analysed the data via Google Forms.
ResultsWe had 22 responses out of 30 possible. As an overview, 100% felt confident in recognizing deterioration, however, 31.8% don't feel confident in managing deterioration. 90.9% need tools to aid recognition, from which 45.5% find tools confusing. Only 50% feel confident to appropriately escalate the incident, from which 36.4% did not know when or to whom to escalate and 13.6% were not sure if escalation was needed but will refer to secondary care regardless. 27.3% think their escalation process needs improvement. When it comes to deterioration themes, 4.6% don't feel confident in identifying confusion, 13.6% feel their knowledge on confusion could be improved and 9.1% don't know how to identify, manage, or escalate confusion. 22.7% don't feel confident in identifying mobility decline and 9.1% don't know how to manage this accordingly. 9.1% feel like their knowledge of skin changes needs improvement. 22.7% feel that their confidence in identifying toilet habits could be improved and 4.5% don't know how to manage or escalate these changes. In terms of carers’ mental health, 50% and 13.6% have mild and moderate anxiety, respectively.
ConclusionDeterioration recognition in the elderly is currently a hot topic. Recent studies highlight the need to improve deterioration management to minimize inappropriate referrals and admissions and unnecessary infection exposure of a vulnerable elderly individual. Our results show that besides improving the theoretical knowledge we also must think about a clear escalation process, an easy-to-read deterioration tool, and managing carers' anxiety as part of the training package.
Improving the patient involvement in research and development on acute psychiatric wards – an audit and quality improvement project
- Ioana Varvari, Hany El – Sayeh, Shona McIlrae, Susan Bonner
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S110
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Aims
The local audit aimed at measuring awareness of research and development policies and implementation of local and national standards. Our findings generated a quality improvement project with two main objectives: first, improving patient approach and recruitment in research and second, improving trainee satisfaction within our trust.
MethodA cohort of new inpatient admissions was identified over a period of 4 weeks, between October 2019 and November 2019, on the two psychiatric wards at the Briary Wing, Harrogate District Hospital. Based on local and national standards, we designed and developed a qualitative (questionnaire) and quantitative (audit tool) approach that was aimed at both staff and patients. Our steps included: assessing awareness and implementation of standards, a retrospective collection of data on the wards, and analysis of the data in Microsoft Excel.
ResultOnly one ward implemented the local guidance from which we identified a sample of 14 consecutive new admissions that were currently present on the ward and were able to answer our questions. 13 of those patients were noted as ‘approached’ on our visual board from which only 3 patients remembered reading a leaflet about research options in the admission pack, however, they have not been verbally informed. There was no process in place to assure the re-approaching of initially unwell patients or to follow up on discharge for those interested. Documentation was available in only 9 of the cases and was nonspecific: ‘admission pack done’.
ConclusionThe awareness and understanding of Research and Development policies are poor and they are difficult to apply in practice in a busy inpatient environment without a clear process in place. This results in patients missing the opportunity to learn and understand more about research or to participate in ongoing studies. Quality improvement work needs to be done to improve patient recruitment in research in inpatient settings. Simple flow charts and stepwise processes as exemplified by our action plan have the potential to improve service quality, as well as patient and trainee satisfaction.