Dropout from mentalization-based group treatment for adolescents with borderline personality features: A qualitative study.

Objective: Premature termination, or dropout, is a major concern in psychotherapy in general and an issue of particular importance in treatments for borderline personality disorder (BPD). Yet few studies investigating dropout from therapy in adolescent BPD populations exist. This study investigates reasons for dropping out from group-based mentalization-based treatment (MBT-G) for BPD or borderline features in an adolescent population.Method: Ten semi-structured interviews were performed with female adolescents who had dropped out from group-based MBT for BPD. The data were analyzed qualitatively using Systematic Text Condensation.Results: The results point to the existence of a subgroup of adolescent BPD patients who do not perceive the treatment sufficiently helpful or worthwhile, who experienced treatment as emotionally demanding, time-consuming and connected with unpleasant experiences. Positive reasons for early termination were reported in the form of experienced improvement in condition. Dropping out became understood as a process of weighing perceived benefits against perceived costs of staying in treatment. This understanding of dropout as a process implies the existence of a window of time where intervention to prevent dropout is possible, presupposing the detection of at-risk patients.

Clerkship students' use of a video library for training the mental status examination.

Aim: Fewer patient encounters and diminished bedside teaching pose a challenge to medical students' opportunity to learn during clinical clerkships in psychiatry. Videos can be used for close examination of signs and symptoms and to increase engagement and recall. A video library holding recordings of psychiatric patients with mental status examinations were prepared. We explored the students' use of this library during their clerkships.Methods and materials: The video library was introduced to three rotations of medical students and made accessible on hospital computers. Four students volunteered as key informants and were followed daily throughout the clerkship by the first author, using the ethnographic method of participant observation. At the end of the clerkship, group interviews were conducted with each rotation of students, including the key informants. Twelve students participated in the study. Field notes taken during participant observation and the transcribed interviews were merged in a thematic analysis.Results: The analysis reveals the students' autonomous and arbitrary use of the video library. Creatively extending the use of the videos, they scheduled their video sessions according to their individual needs. The students furthermore blended experiences gained from the library and in the ward, thus coping in various ways with the shortcomings of the video library.Conclusions: The medical students felt they benefited from the simplified learning situation offered by the video library. Their frequent shortcuts through the videos during sessions highlighted weaknesses in the feedback and reflection processes occasioned by the library.

E-Library of Authentic Patient Videos Improves Medical Students' Mental Status Examination.

OBJECTIVE: During psychiatric rotation, clerkship students must learn the clinical skill of recording an accurate Mental Status Examination (MSE). The authors built a video e-library consisting of 23 authentic patient videos that were accessible on a secure website during the rotation period, aimed at assisting students' acquisition of MSE skills. METHODS: The authors conducted a prospective case comparison study investigating the impact of the video e-library as "add-on" intervention, on acquisition of MSE skills, as measured by a test consisting of three videos with adjoining forced choice questionnaires. Eighty-five clerkship students had instructions and access to the video e-library whereas 82 did not. A group of clinicians, unfamiliar with the video e-library, was also subjected to the new MSE skills test and they served as a reference group. Outcome was defined as scores of MSE skills measured by the purpose made MSE skills test and entailed evaluation questions on the students' use of the e-library. RESULTS: The MSE skill test score differed between the three groups, and the clinicians scored higher than both student groups (clinicians mean score (M) 12.6; p < 0.001). However, the students with video access scored higher compared to students without access (M 10.7 versus M 9.9, p = 0.04). The e-library was appreciated by the students as helpful (83.6%) and they used it not only for practicing the MSE but also for observation of interviewing techniques. CONCLUSION: The e-library with video vignettes of authentic patients strengthens MSE skills as "add-on" to the psychiatric rotation, and evaluations by the students were positive.

Steps to construct educational interventions on sexual dysfunction for healthcare professionals and patients. Experiences from the SECRET research study-group.

Objectives: To design an educational intervention on sexual dysfunction for patients suffering from schizophrenia and diabetes based on patients' and other relevant stakeholders' preferences, and to offer transparency into the basic decision-making process behind a final design. Methods: We conducted a three-part investigation to explore theory, preferences, and feasibility based on literature searches and interviews with patients, healthcare professionals, heads of Assertive Community Treatment Centres and experts. Based on a content analysis of this material, a draft of the intervention was developed. The draft was quality-checked by involvement of stakeholder representatives and refined to its final design. Results: The intervention evolved into having two components: One intervention for patients and one for healthcare professionals. In patient education, meeting peers and predictability were important factors. For healthcare professionals, daily clinical activities were prioritised. Conclusions: We present a framework for an educational intervention about sexual dysfunction, schizophrenia and diabetes targeting both patients and healthcare professionals. Innovation: The transparency of the design process underlying the interventions allows for reproduction and eases further refinement, extension, and adjustment if implemented in other contexts.

[Constructive learning theories and clinical apprenticeship]. / Et læringsteoretisk perspektiv på klinisk mesterlære

The article introduces how constructive learning theories as Constructive Alignment, Situated Learning and Cognitive Apprenticeship can explain learning during medical students' clinical placements and points out why Cognitive Apprenticeship can be particularly applicable in clinical psychiatry. This results in a discussion of the time frame, the organization of the placement in psychiatry at University of Copenhagen.