Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.     

Medical student opinion of methods used to teach child and adolescent psychiatry

Medical student opinion of the various methods used to teach child and adolescent psychiatry at Westminster Medical School, London was determined with reference to four general teaching objectives. Their ratings and comments concerning the different methods were used to evaluate the various techniques and make suggestions concerning the planning of undergraduate teaching programmes in child and adolescent psychiatry.     

Teaching psychiatric ethics

In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved.     

Educational assessment of general practice experience for psychiatric trainees

Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitations of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.     

Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course

Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.     

Child and adolescent psychiatry in the undergraduate medical curriculum

The preliminary findings of a prospective controlled investigation to evaluate the effects of teaching child and adolescent psychiatry to medical students are presented. The results confirmed that the combined teaching of child and adolescent psychiatry, psychiatry and paediatrics led to significant changes as assessed using a multiple choice questionnaire and an attitude questionnaire. Students who had received the combined teaching acquired greater knowledge and more positive attitudes. Caution is warranted when interpreting the results, however, due to the multiplicity of factors affecting outcome: the absence of any measure of the acquisition of clinical skills; no attempt to determine separate or interactive effects of psychiatry and paediatric teaching; and no measure of stability of the changes over time.     

Students'' attitudes towards psychiatry

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.     

Postgraduate psychiatric training The Royal College of Psychiatrists survey of consultants in general psychiatry appointments in 1975–1978

Since 1966 all recently appointed consultants in general psychiatry in the United Kingdom have been asked to rate their training experiences. Four postal surveys have been made at three yearly intervals, of 574 consultants appointed in the period 1 October 1965—30 September 1978. This paper reports the findings from the responses of 162 consultants appointed 1975–1978.
Fifty per cent, or fewer, reported satisfactory training in special forms of psychotherapy, addiction, work in the community, mental handicap, forensic psychiatry, administration, research, psychogeriatrics, work with longstay patients, rehabilitation, medico-legal work, group psychotherapy, work in a therapeutic community, child psychiatry, epidemiology and postgraduate teaching. Those who had been at the Maudsley Hospital considered that they had experienced the best training, while those who had been at peripheral hospitals the worst. Progress has been made in the past 3 years, notably in the fields of individual psychotherapy, community work and forensic psychiatry.     

Married women doctors' training and re-employment schemes in the West Midlands Region, with particular reference to psychiatry

The response of one region to the Department of Health and Social Security recommendations on reemployment of women doctors contained in H.M. 69(6) is described. In many specialities there has been an encouraging return of married women doctors to medical practice within the hospital service. In the field of psychiatry the experience in a local subregional training scheme suggests that graduates of a high calibre can be attracted back to this speciality on a part-time basis for training; the training has been acceptable for full qualification and the exami- nation success rate is high; part-time appointments, including senior registrar and consultant posts, can be obtained; it would not appear that training need, in the first instance, be confined to those people working in a main teaching centre; the satisfactory resolution of any conflict between trainees' domestic and professional commitments is important, as is a flexible approach to the individual professional needs of the trainees. Such schemes appear to tap a valuable source of potential manpower which hitherto has not been fully utilized.     

Improving the psychiatric skills of established general practitioners: evaluation of group teaching

Ten established general practitioners, eight of whom were also trainers, took part in a course designed to improve their psychiatric interviewing skills. Participants were instructed in the problem-based model with audiotape and videotape feedback of real consultations in a group setting. Although those attending were experienced practitioners with a particular interest in the management of psychological problems, evaluation demonstrated a significant improvement in their skills after training. It is suggested that trainers could be trained to provide a similar teaching experience for their own trainees.     

Independent learning among general practice trainees: an initial survey

Self-directed learning is a natural way for adults to learn. Vocational training for general practice is a preparation for unsupervised clinical work that will be supported, in the main, by continuing medical education. This study uses the Self-Directed Learning Readiness Scale to investigate factors influencing readiness for such learning among a sample of general practice trainees. Three principal factors emerged from analysis: enjoyment and enthusiasm for learning; a positive self-concept as a learner and a factor suggesting the possibility of a 'reproducing' orientation to learning. These factors may reflect approaches to learning in general rather than these adopted for professional learning, but offer helpful pointers for the development of both vocational training and of continuing medical education.     

Training general practitioners to teach psychiatric interviewing skills: an evaluation of group training

Group teaching in problem-based interviewing based on video and audiotape feedback of the doctor's own consultations significantly improved the ability of experienced general practitioners to teach psychiatric skills to their trainees. When the GPs were randomly allocated to one of three further training experiences--video feedback of their tutorial sessions, discussion about how to teach and no further teaching, there were very few differences between the groups. The greatest impact on improving teaching skills was brought about by watching their own consultations in a group feedback setting.     

Objectives for the undergraduate teaching of psychiatry: survey of doctors and students

OBJECTIVES: The principal aim was to assess the psychiatric topics that doctors and students considered most important for undergraduate teaching. Differences between doctors and students, men and women, physicians/students with or without an interest in psychiatry were examined. DESIGN: A mailed questionnaire was used concerning the knowledge and skills of psychological/psychiatric medi- cine considered to be needed in medical practice. SETTING: The Medical School of the University of Geneva. SUBJECTS: Doctors and undergraduate medical students in their last 2 years of medical training. RESULTS: Both doctors and students agreed on most topics, even though the students tended to give all items a higher rating. Both groups agreed on the importance of the following main topics: the doctor-patient relationship, identification and management of the principal psychiatric disorders and their associated risks and problems of a psychosocial nature. Those doctors showing an interest in psychiatry tended to accentuate the importance attached to interpersonal skills. The male and female doctors and students expressed very similar opinions. The female doctors, however, tended to attach greater importance to relational-emotional aspects and to disorders affecting children and adolescents than did their male colleagues, which is probably a reflection of the specific role that women still play within our society. When asked to assess the current teaching they received in medical school, the students considered that certain important aspects of psychiatry were insufficiently taught. CONCLUSION: These results confirm the importance of teaching psychiatry with an emphasis on problems encountered in general practice.     

Public health medicine training

Summary. Training in public health medicine uses a ‘trainer-trainee’ model for learning similar to that used in general practice. In order to examine the quality of training in the South Western region of the UK, a questionnaire was devised to assess both adequacy and importance of various factors for training. The results of the survey identified key areas for further discussion and were used as the basis of an interactive study day. One interesting finding was the difference in perceptions of trainers and trainees, possibly illustrating the differences between trainees' ‘demands’ and trainers' perceptions of trainees' ‘needs’.     

Doctors'' interest in psychiatry as a career

Fifty pre-registration housemen were interviewed to elicit their attitudes towards a career in psychiatry. The doctors were all those in one academic year who were recommended for honours on the basis of their performance during the psychiatry clerkship. Those who gained honours in other subjects as well as psychiatry were unlikely to choose a career in psychiatry. The study indicates that further improvements in the psychiatry clerkship will not improve recruitment. Factors outside psychiatry--the pull to general practice and other specialties and the negative attitudes towards psychiatry expressed by other doctors--are among the major deterrents for young doctors considering a career in psychiatry. Collaborative teaching between psychiatrist, physicians and surgeons during the pre-registration year should encourage recruitment and gradually improve the widely held negative attitudes towards psychiatry.     

Capacity and Competence in Child and Adolescent Psychiatry

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa.     

A survey of threats and violent acts by patients against training physicians

OBJECTIVES: The primary purpose was to determine the prevalence of various types of threats or assaults by patients against training physicians and to determine the psychological impact of the most distressing incidents. Differences between specialty of training and gender were examined. DESIGN: An anonymous mailed questionnaire. SETTING: The Medical School of the University of Auckland, New Zealand. SUBJECTS: All 160 postgraduate trainees in psychiatry, general medicine, surgery, and obstetrics and gynaecology. A response rate of 84% (n=135) was obtained. RESULTS: The majority of trainees had been verbally threatened (n=91, 67%) or physically intimidated (n=73, 54%) at some time during specialty training, while another 41% (n=55) had witnessed Health Board property being damaged in their presence and 39% (n=53) had been physically assaulted. Psychiatry trainees were significantly more likely to experience the various types of threat or violence. Females (n=20, 38%) were significantly more likely than men (n=8, 10%) to report having been sexually harassed (chi2=14, d.f.=1, P < 0.001). The overall mean on the Impact of Event Scale for those who described the most distressing incident was 8. On only one occasion was a training director directly informed about a trainee's most distressing incident and most trainees (n=95, 70%) had not had training on protecting against assault or on managing violence. CONCLUSION: These findings underscore a priority for developing programmes which effectively reduce threats and violence against trainees and which lessen the psychological sequelae of these incidents.     

The need for medical statistics in the training of health personnel

Medical statistics is essential in the training of all categories of health workers and early involvement with the subject is advocated during the training of these health personnel. Four important areas for the application of statistical methods have been defined, namely, (1) the study of specific rates, (2) evaluation of clinical trial of drugs, (3) the assessment of factors affecting health or disease, and (4) the establishment of new avenues of medical research. Using examples from the training of the undergraduate medical student, the midwife and the family planning field health worker, different aspects of medical statistics should be emphasized at different levels of learning depending on the professional or academic needs of the trainee health worker.