'Challenges in experiential learning during transition to clinical practice: A comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships'.

INTRODUCTION: This study explored the reflective writing (RW) of senior medical students across a co-ordinated reflection education programme in General Practice, Paediatrics and Psychiatry clerkships during their transition to clinical clerkships. The study compared RW themes from within and across three clerkships in order to understand the influence clerkships had on experiential learning and developing professional identity. METHODS: All medical students in their penultimate year were invited to participate in the study. 135 reflection assignments were analysed. A qualitative thematic analysis of students' RW was performed. An inductive approach was used and data saturation was achieved. RESULTS: Clerkship specific themes were the intimacy of the experience in General Practice, the powerlessness students felt and the challenge of delivering family centred care in Paediatrics and the sense of perceived risk in Psychiatry. Common themes across the three clerkships were of emotional struggles in developing a professional identity. CONCLUSION: There is an educational need for developmental space for students during General Practice, greater focus on preparing students for relationship building during Paediatrics and addressing stigma and personal safety issues in students during the Psychiatry clerkships. Across clerkships there is a need for better use of evidence based pedagogies to support emotional development.

Clozapine use - has practice changed?

BACKGROUND: One-third of individuals with schizophrenia have treatment-resistant illness. Of these, up to 60% will respond to clozapine treatment. AIMS: This study retrospectively examined clozapine prescribing patterns against National Institute for Health and Care Excellence (NICE) guidelines as treatment-resistant illness emerged in a first-episode psychosis cohort. METHODS: A total of 339 individuals with a first-episode psychosis were included in the study. Clozapine prescribing patterns were compared against the NICE guidelines and the impact of clozapine use on one index of service utilisation (hospitalisation) was assessed. RESULTS: A total of 32 individuals (9.4%) from the cohort were prescribed clozapine. The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17-6.25). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1-5). Following clozapine initiation, mean hospital admissions per year reduced from 2.3 to 0.3 (p=0.00). Mean hospital days pre- and post-clozapine also reduced (147 vs. 53; p=0.00). In total, 18 patients discontinued clozapine use during follow-up - 5 temporarily and 13 permanently. CONCLUSIONS: Patients are being prescribed clozapine earlier than previously demonstrated, though delays are still evident, and many patients discontinue treatment. More work needs to be undertaken to understand and address factors which lead to its discontinuation.

Smartphone and video game use and perceived effects in a community mental health service.

BACKGROUND: Gaming is a growing area and there are conflicting reports on its harms and benefits. There is also increasing interest in the use of gaming clinically. AIMS: This research aims to enhance our understanding of video and smartphone game use, and perceptions, among outpatients attending an Irish general adult mental health service. METHODS: An anonymised, opportunistic survey of outpatients attending an Irish general adult mental health service was completed. Respondents were self-selecting and self-administering of the survey. RESULTS: The response rate was 13% (n = 93). Younger patients were significantly more likely to own a smartphone (p = 0.00). Those who played videogames were significantly younger than those who did not (p = 0.00). Younger age groups were significantly more likely to have heard of (p = 0.00), and used (p = 0.01), Pokémon GO. Over 19% (n = 18) of respondents played video games. Nearly 24% (n = 16) of those with a smartphone played games on it daily. No respondents reported specifically using games for health reasons. The two individuals who found Pokémon GO usage increased their exercise levels, also reported mental health benefits from it. Individuals' gaming use and age did not significantly impact on whether they were positive or negative in their opinions towards video and smartphone games. CONCLUSIONS: There is an opportunity to deliver interventions to Irish mental health service outpatients through smartphone and video games. Our small study suggests this to be underutilised currently. As more frequent users, perhaps younger individuals would most benefit from gamification of interventions and the use of existing games that have possible physical and mental health benefits. This requires further research.