Medical Students' Attitudes toward Self-harm, and Curricular Influences on Attitude Development.

OBJECTIVES: The authors explore attitudes that first and final year medical students have toward self-harm, and examine how the curriculum may influence the development of these attitudes. METHODS: Six focus groups, involving a total of 21 medical students, were used to explore the objectives. Thematic framework analysis was used to analyze the data through iterative development of a coding framework and identification of themes. RESULTS: Medical students demonstrated simultaneously positive and negative attitudes. Students reported minimal exposure to self-harm through the formal curriculum and being exposed to negative attitudes exhibited by healthcare professionals through the informal curriculum. Students felt that self-harm was not as important as other subjects competing for their attention in their curriculum. Many students were discouraged by healthcare staff from seeing people who self-harm, in particular on psychiatry placements. The hidden curriculum may be encouraging negative attitudes toward people who self-harm; students learn that self-harm is "not important." CONCLUSIONS: Findings from this study identify how the curriculum might influence the development of negative attitudes toward self-harm. Students would benefit from being encouraged to interact with people who self-harm and then having the opportunity to discuss the emotions these interactions create.

Experiences of Patients with Mental Illness' Interactions with Medical Students: A Systematic Review.

OBJECTIVES: Mental health is a key area for learning within undergraduate medical education. Given the nature of mental illness, interactions may have the potential to uniquely affect patients. This study set out to systematically review studies reporting experiences and perceptions of patients with mental illness' clinical interactions with medical students. This includes which factors encourage patients to interact with medical students and if patients perceive negative and positive effects from these interactions. METHOD: Studies reporting patient experiences of involvement in undergraduate medicine were included. A standardised search of online databases was carried out independently by 2 authors and consensus reached on the inclusion of studies. Data extraction and quality assessment were also completed independently, after which a content analysis of interventions was conducted and key themes extracted. Studies were included from peer-reviewed journals, in any language. RESULTS: Eight studies from 5 countries were included, totaling 1088 patients. Most patients regarded interacting with medical students as a positive experience. Patients described feeling comfortable with medical students, and the majority believed it is important for students to 'see real patients'. Patients described benefits to them as enjoyment, being involved in student education, and developing an illness narrative. CONCLUSIONS: Results suggest that most patients with mental illness want to interact with medical students, and this should be encouraged during student placements. Further research, however, is required to understand in more depth what else can be done to improve the comfort and willingness for patients to interact with students, including barriers to this.

Foundation trainees and changes in career intentions.

OBJECTIVES: To understand whether foundation trainees change their career intentions during psychiatry placements and explore what factors influence such changes. METHODS: Over a two-year period, foundation trainees completed questionnaires at the beginning, middle and end of their four-month placement. There were two questions, the first as to how likely they were to pursue a career in psychiatry and the second openly asked them to elaborate on their reasons. RESULTS: Twenty-one out of 41 eligible trainees returned all three questionnaires. The number of trainees 'highly likely' to choose psychiatry increased over the four-month period, from 4.5% to 19%. The number of trainees 'highly unlikely' to choose psychiatry decreased, from 27.3% to 9.5%. An increasingly positive intention towards a psychiatry career appeared to relate to enjoyment of the placement and the quality of supervision. The most common reason for not choosing psychiatry was a pre-existing interest in another specialty. CONCLUSIONS: Undertaking a psychiatry placement during the foundation programme continues to increase the likelihood of a positive attitude towards psychiatry as a career. The findings of our study suggest good practice in providing foundation placements in psychiatry includes identifying medical school experience, enjoyment, quality weekly supervision and mindful experiential design of placements.

Reflections on using a postgraduate educational environment measure.

OBJECTIVES: The aim was to use an educational environment measure to learn more about our postgraduate psychiatry education program, in order to gain further insights into areas for development. The educational environment includes such things as atmosphere and facilities. A secondary aim was to explore if different types of trainees experienced any aspects of the educational environment differently. CONCLUSIONS: The education environment measure used was able to reveal areas of the educational environment which trainees did not feel were adequate, as well as differences between how different trainees perceive some aspects of the educational environment. This allowed us to understand where improvements which we had not previously considered should be made to the educational environment.

Is Performance-Based Progress Testing in Psychiatry Feasible?

OBJECTIVE: The aim of this study was to explore if competency-based progress tests for postgraduate psychiatry are reliable, if they are able to discriminate trainees at different levels of training, and if they are able to demonstrate improvement of trainees' skills from 3 years of data. METHODS: Psychiatry trainees in the North Western Deanery, UK, were invited to participate in the annual progress test. The progress test simulated the Clinical Assessment of Skills and Competencies (CASC) exam, the final postgraduate examination for psychiatry trainees. The sum of global scores from all stations for each candidate was used for statistical analysis. Cronbach's alpha was used to calculate the interstation reliability. Analysis of variance (ANOVA) was used to explore if the progress test could discriminate between the three levels of trainees each year. Student's t test was used to explore if there was improvement and development of skills as a cohort progressed; ANOVA was used for the cohort with 3 years of data. RESULTS: The progress test is more likely to be reliable (alpha ≥ 0.8) when 12 stations are used. ANOVA revealed significantly improved scores with increasing level of seniority in 2012, with a mean total score increasing from 23.1 to 31.3 (p = 0.008) and 36.9 to 46.6 in 2013 (p = 0.004). In 2014, this effect was not observed, with a mean decreasing from 42.4 to 41.3. Over time, two cohorts demonstrated improving mean scores with Student's t tests from 26.4 to 32.4 (p = 0.01) and 26.9 to 42.6 (p = 0.01). The third cohort did not demonstrate a difference over time, with mean scores 23.1, 27.6, and 25.9 over 3 years. CONCLUSIONS: It is not conclusive if the progress test can accurately distinguish between trainee seniority or assess progress over time; possible explanations for non-significant results and further avenues of enquiry are discussed.

Medical professionalism education for psychiatry trainees: does it meet standards?

OBJECTIVE: Developing professionalism is an important part of a doctor's training. Developing professional attributes is an expected part of postgraduate psychiatry training, as indicated by the curriculum. It is unknown whether this requirement is being met. Our aim was to explore whether psychiatry trainees are meeting current standards of professionalism education. METHODS: This audit and evaluation was investigated using an online survey, inviting trainees from three National Health Service Trusts in North West England. Invitations were sent by email with a link to an online survey. RESULTS: The results suggest that current standards are not being met. Trainees value professionalism education and feel it is important. However, there is a lack of formal teaching and a lack of adequate educational opportunities: 25% of trainees get any formal teaching and 78% feel this teaching is not adequate. There is also a concern that 20% of supervisors are not considered good role models. CONCLUSIONS: Recommendations to address this educational gap are presented. Recommendations include making time in trainees' academic programmes for formal educational activities for professionalism development, and further exploration of why some supervisors are not considered good role models for professionalism.