3 results
INSIGHT: Evaluation of the Psychological Medicine Student Placements at HMP Berwyn, North Wales: Year One Findings
- Sadia Nafees, Jakub Matusiak, Andrea Taylor-Clutton, Simon Newman, Rob Poole
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S30-S31
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Aims/Background
Social determinants of health (SDOH) are social factors that have a causal role in ill health and have an adverse effect on health outcomes. SDOH are part of the UK medical student curriculum but mainly discusses epidemiologically. There are few educational approaches that aim to incorporate an understanding of SDOH into the experiential and competency-based elements of undergraduate medical education. Prisoners are a population who experience high levels of stigma, social adversity and health disadvantage. Clinical attachments in prison may teach students about the impact of SDOH in a vivid and memorable way. Aims: We aim to explore changes in medical students' knowledge/attitude towards SDOH during and after psychiatry placements at HMP-Berwyn prison.
MethodsAll year four medical students on psychiatry placement in North East Wales during 2021–2022 participated. In each of the six placement cohorts, one student did their psychiatry placement in prison. All the other students visited for one day. All students participated in two seminars focused on their prison experience and SDOH in psychiatry. Baseline and mid-placement bespoke questionnaires were completed, and all students participated in end-of-placement individual interviews.
Results29 students participated. Student assessment of the importance of SDOH did not show a significant change between baseline and mid-placement. However, student attitudes to experience in prison became more positive at end-of-placement. Comparing baseline to mid-placement questionnaires showed a 14% increase in students' rating of prison placements as educationally beneficial. 14% of students mentioned improved confidence in dealing with challenging patients, and 28% commented on the benefits of exposure to incarcerated patients. Interestingly, only 3% of students considered hospital placement more beneficial than prison placement. Prison placement was considered an exceptional experience than other settings by 17%.
ConclusionThere are no previous UK empirical studies on medical student placements in prison. Overseas studies identify reduced anxiety over dealing with demanding patients. Our findings so far lack statistical power but show positive satisfaction and knowledge trends amongst participants. Prison placement appears to be acceptable and educationally valuable. It offers opportunities for experiential teaching about SDOH. In addition, it may improve student understanding of a marginalised and stigmatised population.
Implication for practice, policy and researchOn completion, this study may provide evidence on one method of improving attitudes toward marginalised people and understanding SDOH in the medical profession.
This research was funded by Betsi Cadwaladr University Health Board and sponsored by Bangor University.
The Goldberg–Huxley model of the pathway to psychiatric care: 21st-century systematic review
- Peter Huxley, Anne Krayer, Rob Poole, Alicja Gromadzka, Daniel Lai Jie, Sadia Nafees
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- Journal:
- BJPsych Open / Volume 9 / Issue 4 / July 2023
- Published online by Cambridge University Press:
- 23 June 2023, e114
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Background
The classification of mental disorders used to be based only on people seen by hospital psychiatrists. In fact, most people with a mental disorder were, and are, not seen by psychiatrists because of decisions made prior to psychiatric consultation. The first description of this ‘pathway’ to care and its levels and filters was published by Goldberg and Huxley in 1980.
AimsTo conduct a review of papers relevant to the application of the Goldberg–Huxley model in the 21st century.
MethodSystematic review (PROSPERO registration CRD42021270603) of the pathway to psychiatric care in the 21st century. The review concentrates on community surveys and passage through the first filter (consultation in primary care or its equivalent). Ten databases were searched for papers meeting the defined inclusion criteria published between 2000 and 2019 and completed on 15 February 2020.
ResultsIn total, 1824 papers were retrieved, 137 screened fully and 31 included in this review. The results are presented in a table comparing them with previous research. Despite major social, economic and health service changes since 1980, community prevalence and consultation rates remain remarkably consistent and in line with World Health Organization findings. Passage through the first filter is largely unchanged and there is evidence that the same factors operate internationally, especially gender and social parameters.
ConclusionsThe Goldberg–Huxley model remains applicable internationally, but this may change owing to an increasingly mixed mental health economy and reduced access to primary care services.
INSIGHT: Evaluation of the Year Four Psychological Medicine Student Placements at HMP Berwyn, North Wales
- Sadia Nafees, Andrea Taylor-Clutton, Simon Newman, Rob Poole
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S141
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Aims
Background: Although social determinants of health (SDOH) are to some extent incorporated within preclinical medical education, little validated educational methodology exists to provide guidance on how to integrate teaching about SDOH within the competency-based training of medical students’ clinical years. This is potentially important. The COVID-19 pandemic has highlighted the importance of SDOH, and social determinants have become topical, with increasing discussion in journals about equity, inequality, and sustainability. Sir Michael Marmot's 2020 review has highlighted these issues. Consequently, the evaluation of medical students’ experience of prison placements is an interesting area to investigate. This will help us to explore their understanding of SDOH, and implications of gained knowledge for their future practice. Aims: This study explores changes in year four psychological medicine students’ knowledge and attitude towards SDOH during prison placements.
MethodsA mixed-methods study between Sep 2021 to Apr 2022 recruiting all year four medical students on their psychiatry placement in North Wales. Data collection involves baseline and mid-placement questionnaires and end-of-placement individual interviews to explore their understanding of SDOH.
Thematic analysis will be used to describe students’ reflection on placement satisfaction; explore impacts on trainee doctors and supporting staff; make suggestions to improve placement structure in the future; and evaluate the utility of placements in prison.
ResultsData collection is in progress. However, early indications suggest that students view these placements favourably and find them a helpful learning experience. Preliminary results will be reported at the conference.
ConclusionWe are hopeful that this evaluation will suggest a way forward to raise awareness about SDOH during clinical placements and will give these students confidence in working with socially excluded populations in the future.
Implication for practise, policy and researchFindings of this study may provide exploration of means of capacity building and training with improved knowledge of the SDOH in partnership between the medical school, the local health board and the prison.
We have developed systems and processes to raise awareness of social factors to be considered by medical students in their future practice. These can guide further development of such placements at HMP Berwyn and in other prisons.
This research was funded by Betsi Cadwaladr University Health Board and sponsored by Bangor University in North Wales, UK.