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.

Variability between psychiatrists on domains of the mental status examination.

Background: The Mental Status Examination (MSE) is a core element of the psychiatric assessment. To investigate the current level of psychopathological knowledge, the reliability of the MSE can be used as a proxy as it is based on descriptive psychopathology.Methods: Three psychiatrists wrote their MSE based on 27 video recordings. The variability and inter-rater agreement were evaluated using an agreement scale from 1 to 5, made by several psychiatrists. The agreement was analysed by mean values, stratified mean values and Cronbach's alpha.Results: The total agreement had a Cronbach's alpha of 0.87 (p < 0.000). The grand mean of variability was 4.1 (SD = 0.8). The domains with the highest variability were Attitude (Est. = 3.5, SD = 0.9), Affect (Est. = 3.8, SD = 0.8) and Motor activity (3.7, SD = 0.9). The videos with the highest variability were #2 (Est.=3.3, SD = 1,1) and #21 (Est. = 3.6, SD = 1.1).Conclusions: The overall reliability of the MSE based on Cronbach's alpha was good and the mean variability was low. This indicates that the MSE performed by three psychiatrists is reliable. The main reason for variability was due to individual interpretation and discrepancies in literature. The literature-driven variability could possibly be reduced by approaching national tradition to international practise. The individual variability maybe reduced by increasing the opportunities for clinical group rating.

Hemodynamic responses to mental stress during salt loading.

PURPOSE: The purpose was to examine whether prolonged moderate stress associated with a student exam would increase the blood pressure response to a salt load in young healthy normotensive individuals. METHODS: Ten healthy young subjects were examined at two different occasions in random order (i) during preparation for a medical exam (prolonged stress) and (ii) outside the exam period (low stress). All subjects consumed a controlled diet for 3 days with low- or high-salt content in randomized order. The subjective stress was measured by Spielberger's State-Trait Anxiety Inventory-Scale, SCL Symptom Checklist for stress and the Visual Analogue Scale. On each level of stress, 24-h ambulatory blood pressure and cardiac output (CO) were measured. Furthermore, plasma norepinephrine (NE), epinephrine (E) and plasma renin activity (PRA) were measured. RESULTS: Twenty-four-hour ABP, 24-h heart rate, CO as well as plasma levels of NE, E and PRA remained unchanged by changes in stress level. Day-night reduction in SAP was significantly larger during moderate stress and high-salt intake; however, no significant difference was observed during daytime and night-time. Individual increase in mental stress correlated significantly with an individual decrease in PRA (SCL-17, r = -0·80, P<0·05, STAIr = -0·64 P<0·05) during high-salt intake. CONCLUSION: Moderate stress over a period of time in young healthy normotensive individuals does not lead to changes in 24-h ABP. However, the augmented reduction in day-to-night systolic blood pressure during high-salt intake and moderate stress may indicate that stress affects blood pressure regulation.