Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review.

It is clear from existent literature that families and carers of relatives and friends with borderline personality disorder (BPD) experience high levels of burden. Whilst family interventions are considered vital to improving the outcomes of those with a range of mental health difficulties, there has been limited development of direct interventions for carers of people with BPD, despite a high level of need. This systematic review aimed to appraise and synthesize the existing research evidence for interventions for carers of people with BPD. Ten studies were included that were directly related to six interventions for families and carers of people with personality disorder. The findings of these studies, whilst limited, do provide some initial evidence that interventions for carers may lead to significant outcomes for the participants, particularly in improving carer well-being and reducing carer burden. © 2019 John Wiley & Sons, Ltd.

Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion.

BACKGROUND: Development of diagnostic reasoning (DR) is fundamental to medical students' training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR. METHODS: Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students' DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years. RESULTS: The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students' DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct. CONCLUSIONS: Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners' understanding of and approach to assessing DR.

Taking OSCE examiner training on the road: reaching the masses.

BACKGROUND: To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. METHODS: The 'OSCE Roadshow' comprised a short training session delivered in the context of teaching hospital 'Grand Rounds' to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners' role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. RESULTS: OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers (n=220). After training, participants' average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40), and the average scores did not differ according to the levels of clinical experience. CONCLUSION: The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

Teaching a fishbowl tutorial: sink or swim?

BACKGROUND: The fishbowl method is a small group teaching technique in which a number of students engage in a discussion while observers form a circle around them. We use this method to teach medical interviewing skills, with students interviewing a simulated patient (SP) whilst being observed by their peers and a clinical tutor. However, there is little evidence to guide teachers on how best to structure a fishbowl tutorial. METHODS: Our aim was to develop guidelines for teaching medical interviewing skills in the context of a fishbowl tutorial by assessing preferred teaching approaches for all participants (students, tutors and SPs). Participant preferences for teaching in the fishbowl were established using questionnaires designed to seek participants' opinions on various aspects of fishbowl tutorials, integrating key areas of difficulty highlighted during SP and tutor training sessions. RESULTS: Across most items there was a high degree of consistency in the preferences of tutors, students and SPs, which enabled us to develop a set of guidelines for running a fishbowl tutorial to be used for our teaching programme. DISCUSSION: We found this process to be acceptable to all parties and relatively simple to perform. It helped us to define our preferred procedures for teaching medical interviewing skills using the fishbowl method. The process of gauging participant opinion to develop teaching guidelines is appropriate for use by other institutions to inform their teaching practices in the fishbowl technique, although the nature of the guidelines may differ across teaching settings. Further research is required to determine if the implementation of these guidelines improves student satisfaction with fishbowl tutorials.

First-year medical students' willingness to participate in peer physical examination.

BACKGROUND: There is little research on student attitudes toward participating in peer physical examination (PPE). PURPOSE: This study explored first-year medical students' attitudes toward PPE and their willingness to participate in PPE before they had experience with PPE as part of their course. METHODS: First-year medical students (n = 119) rated their willingness to participate in PPE for 15 body regions, with male or female peers, and when examining or being examined by others. Attitudes toward participating in PPE were also assessed. RESULTS: Low-sensitivity examinations (e.g., hands, head) in PPE were generally accepted by male and female students. Significant variation in willingness across different body regions was, however, evident for male and female students depending on the type of examination and their examination partner's gender. Students generally held positive attitudes toward participating in PPE as part of the course. Moreover, students with more positive attitudes provided higher ratings of willingness to participate in PPE for all examination types. CONCLUSIONS: Findings suggest high levels of willingness to participate in PPE for low-sensitivity examinations of the kind employed in university teaching contexts. Nonetheless, gender effects appear more complex than previously described, and for some regions of the body, there are subtle preferences for particular examination types, in particular performing examinations, rather than being examined.

Self-pain enmeshment: future possible selves, sociotropy, autonomy and adjustment to chronic pain.

The aims of this study were to replicate and extend previous observations on the relationship between enmeshment of the self and pain and measures of adjustment [Morley et al., Possible selves in chronic pain: self-pain enmeshment, adjustment and acceptance, Pain 2005;115:84-94], and to test the hypothesis that individual variation in motivational preferences interacts with enmeshment. 82 chronic pain patients completed standardized self-report measures of depression, anxiety, acceptance and the possible selves interview which generated measures of their hoped-for (own and other perspectives) and feared-for selves. They made judgments about the conditionality of each self on the continuing presence of pain as a measure of self-pain enmeshment. A series of hierarchical regression analyses, that adjusted for demographics, pain characteristics and disability, confirmed the relationship between self enmeshment and depression and acceptance. When anxiety was considered, there was no main effect for any of the self aspects but there were specific interactions between the hoped-for (own) and (other) selves and two motivational preferences--autonomy and sociotropy.