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.

The Mental Health Act 1983 section 5(2): clinical application and predictors of outcome.

This study examined trends and influences of variables in the 100 most recent applications of Section 5(2) of the Mental Health Act 1983 in a major teaching hospital in England. Case notes, section-forms, log-books and computerised records were scrutinised. Sixty-four per cent of the cases were converted to Section 2(28%) or Section 3(36%), the remainder we rescinded or lapsed. No demographic, illness characteristic or grade of doctor significantly effected conversion or lapse rate of Section 5(2). The clinical implications of a high rate of non-conversion of Section (2) is clear. Non-psychotic patients may be less likely to be regarded for further Sections when detained under Section 5(4) before detention under Section 5(2), yet no ingle factor determines the outcome of emergency.