4 results
Perception of Trainees and Trainers Working in Birmingham and Solihull Mental Health NHS Foundation Trust About Exception Reporting and Its Implication on Medical Education - a Qualitative and Quantitative Research
- Saima Jehanzeb, Asma Javed, Katie Williams, George Tadros, Sajid Muzaffar
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S56
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Aims
The aim of this research was to explore if exception reporting (ER) has improved the work life balance of junior doctors, and if safeguards proposed during junior doctors’ contract have helped doctors in raising concerns about unsafe work patterns or any missed training opportunities.
MethodsThis study was reviewed and approved by the Health Research Authority (HRA). We reviewed the number and nature of exception reports completed by trainees between January 2017 and February 2020 by analysing the available ER data (obtained from Guardian of Safe Working) and explored perception of trainees and trainers about exception reporting (ER) by using semi structured and structured surveys. The target population included Core Psychiatry Trainees, GPVTS, Speciality Trainees, Foundation year Trainees and Consultant Psychiatrists.
ResultsAbout 383 exceptions were reported between February 2017 and February 2020 by trainees in BSMHFT. Two separate surveys emailed to trainees and trainers (between December 2020 and July 2021) collected 35 responses from trainees and 22 from trainers.
80% of the trainees had not reported any exceptions in the last one year and 57.14% of the trainers never got involved in exception reporting. Main issues reported were working unsafe hours by trainees (15%), working beyond rostered hours (52.38%) trainers and (52.38%) trainees, failing to achieve educational goals (4.76%) trainers and (10%) trainees, impact on clinical supervision (4.76%) trainers. Reasons for failing ER “Too busy (58.06%), reporting makes no difference (29.03%), a culture to discourage exceptions (29.03%), didn't have logins (16.13%), did not know how to report (35.48%), other reasons. Time off in lieu (TOIL) was commonly reported outcome by trainees (69%) and trainers (62%). 62.07% trainees and 57.14% of trainers neither agreed nor disagreed that ER had improved the quality of training.
Trainees (43.67%) and trainers (58.82%) both did not think that TOIL had resulted in reduction in training time (never 44%). 51.74 % trainees neither agreed nor disagreed that ER made any improvement to their work life balance.
ConclusionThis is the first, mixed method, research looking at both exception reporting data and perception of trainees and trainers. Emerging themes for failure to exception report are guilt, self-blame, culture to discourage, too time consuming, busy workplace, not to offend, reflects being weak.
This research can have wider implications if applied across other trusts nationally, exploring emerging themes. Reasons for declining number of ER needs further exploring of trainees’ anxiety, regarding implications and repercussions of ER, impact of TOIL on continuity of care.
“It's All in the Head” Well! Not Always: Mental Health Patients Are Not Immune to Physical Pain
- Asma Javed, Rajasee Sharma
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S123
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Aims
Emotionally unstable personality disorder (EUPD) patients are known to frequently present to acute hospitals with pain symptoms. Multiple pain syndromes like fibromyalgia, chronic fatigue syndrome etc. are also commonly diagnosed in this group of population. It can be difficult to differentiate psychosomatic pain from physical pain during these hospital presentations. Failure to exclude physical causes of pain can lead to inadequate pain relief and missed serious diagnosis.
MethodsWe describe a 29-year-old lady known to have Type 1 Diabetes, chronic pancreatitis and past history of several overdoses. She was being supported by Home Treatment Team (HTT) before coming to the hospital. She presented to the Emergency Department (ED) after ingesting 40 tablets of Pregabalin. She was referred to mental health liaison service for ongoing suicidal thoughts. On assessment, she admitted taking multiple overdoses to relieve her of severe abdominal pain. Her pain symptoms had been attributed as attention seeking behaviour. She disclosed feelings of rejection and abandonment by hospital staff. Liaison team negotiated with emergency department staff to complete a physical health examination that revealed tenderness and guarding in the abdomen. She was booked for elective cholecystectomy after surgical review. However, she had to be admitted from ED for laparoscopic cholecystectomy because of worsening of pain and vomiting. She was referred to Pain Management Team after surgery. The team was cautious in providing her with pain medications considering past history of overdoses. She was unable to tolerate pain and voiced thoughts of overdose. We liaised with Pain Management Team to optimise her analgesics and arranged daily supervision of pain medications with HTT
ResultsOur patient's physical symptoms of acute cholecystitis and frequent overdoses with pain medications were attributed to her personality disorder that resulted in dismissal of her real pain that “Its is all in the head”. This led to persistent pain affecting her mental health.
ConclusionPatients diagnosed with EUPD should be carefully assessed to exclude organic causes of pain before attributing their symptoms to mental health disorders. A thorough assessment and treatment of physical symptoms can improve their mental health as well as reduce attendance in health facilities.
What Factors Influence the Outcome of Psychiatry Postgraduate Written Exams, MRCPsych Paper a and B? a Qualitative Analysis From Trainees’ Perspective in West Midlands School of Psychiatry in UK
- Asma Javed, Rania Alkhadragy
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S8
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Aims
Analysis of the Annual Report of Examination Results published by General Medical Council (GMC, 2020) revealed that trainees of West Midlands School of Psychiatry didn't perform well in written components of MRCPsych exams and showed pass rate between 2014 and 2019 as 54.6%. Therefore, this qualitative study was conducted to assess West Midlands School of Psychiatry core psychiatry trainees’ perception of factors that influence the outcome of MRCPsych Paper A and Paper B.
MethodsQualitative research methodology with a grounded theory approach was used to systematically analyse the data and to evolve the theory rather than appraising the existing theory. The purposive and theoretical sampling strategies were used. Study population included all core psychiatry trainees in the West Midlands School of Psychiatry in 2021 who were invited via email for a semi-structured focus group interview. The participants’ information sheet and consent forms were sent with the interview invite. A total of 38 participants contributed. The data were collected through 3 focus groups and 2 one-to-one interviews. The interviews were recorded using the recording and transcription feature of Microsoft Teams. The transcription was checked manually for accuracy. The data were collected and analysed simultaneously till the point of theoretical saturation, thereafter a thematic analysis was conducted.
ResultsThemes emerged were grouped under challenges faced by the participants such as work and time pressures, financial constraints, and lack of family support. Other challenges were related to virtual learning, a mismatch between local teaching course and exam schedule and lack of contextualisation in local course content. Most of the trainees had to rely on private courses which were adding financial burden. The majority felt that social isolation due to COVID-19 had a negative impact on their well-being. Participants suggested various recommendations for their local course content and delivery.
ConclusionThe study highlighted the need for the local course content to be contextualised and tailored to the examination course. This could be achieved by including a variety of multiple-choice questions, case-based discussion, and small group teaching for the purpose of preparing and practising examination questions/scenarios. It also highlighted trainees’ need to utilise the study leave budget for private courses to ease financial burden. The International Medical Graduates (IMG) cohort identified that they need extra support and feedback about the examination preparation from the early beginning of the training to overcome differential attainment.
Core psychiatry trainees views on MRCPsych course structure and delivery at East Midlands Deanery
- Asma Javed, Hetal Acharya, Ian Yanson
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S141-S142
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Aims
The RCPsych curriculum for core training in Psychiatry (2013) requires each Deanery to run regional MRCPsych teaching programme.
The East Midlands School of Psychiatry run a local MRCPsych course aimed at all core psychiatry trainees in the deanery. Before the pandemic, the course took place between two venues – Nottingham and Leicester. During the pandemic, the course was delivered via Microsoft teams. We aimed to collect the feedback from trainees regarding the course to help shape the MRCPsych Course programme according to their training needs.
MethodWe devised an online Microsoft forms questionnaire which included:
Level of training
Number of exams passed
Relevance of MRCPsych content to clinical practice and membership exam
Usefulness of mock exams, simulation scenarios and workshops towards clinical and exam practice
Overall experience of the course
Which additional sessions they would like to be included
The effect of COVID-19 on their ability to attend in MRCPsych programme
These forms were sent to all the trainees in the region via email.
ResultOut of 44 trainees, 9 responded. 66.6% of the trainees who responded were CT1 and 33.3% CT2. 45% had passed Paper A and 55% had not passed any exams. 78% of them agreed and 11% strongly agreed that course was relevant to the clinical practice. 55.6% agreed that course was relevant to membership course. 44.4% agreed and 11% strongly agreed that mock exams were useful. 66.7% agreed and 11% strongly agreed that simulation case scenarios and workshops were useful for exam and clinical practice. 22.2% strongly agreed and 33.3% agreed that sessions were engaging and motivating. Overall experience of MRCPsych exam was rated as excellent (11%), good (55%), satisfactory (22%) and poor (11%).
Suggestions to add additional sessions included antiracism in psychiatry, more mock exams, practical management of cases, to organise more interactive sessions on Microsoft teams, in-depth coverage of exam topics, to organise full day teaching sessions instead of half day.
33.3% of trainees commented that COVID-19 had impacted on their ability to attend the exam as initially face to face sessions were cancelled till end of May 2020 and when started there were technical issues with the online platform
ConclusionConsider feedback received in modifying aspects of the MRCPsych course
To share the results with trainers and course tutors
Arrange relevant mock exam sessions
Include the topics suggested by trainees and improve the experience of online learning by making it more interactive
Limitations: small sample size.