Teaching, assessment and best practice in undergraduate psychiatry education in the UK: cross-sectional survey.

AIMS AND METHOD: We conducted a cross-sectional survey to examine how undergraduate psychiatry is taught and assessed across medical schools in the UK that have at least one cohort of graduated students. RESULTS: In total, 27 medical schools completed the survey. Curriculum coverage of common mental disorders, assessment skills and mental health law was broadly consistent, although exposure to psychiatric subspecialties varied. Significant variation existed regarding the duration of psychiatry placements and availability of enrichment activities. Small-group teaching, lectures and e-learning were the most frequent teaching modalities and various professionals and lived experience educators (patient and/or carers) contributed to teaching. Objective structured clinical examinations and multiple-choice questions dominated assessments. CLINICAL IMPLICATIONS: Medical schools should consider increasing students' exposure to different psychiatric subspecialties and integrating physical and mental health training to address comorbidity and promote holistic care. Future research should explore whether specific undergraduate experiences promote greater career interest and skills in psychiatry.

Interventions for the detection, monitoring, and management of chronic non-communicable diseases in the prison population: an international systematic review.

BACKGROUND: High rates of health inequalities and chronic non-communicable diseases exist amongst the prison population. This places people in and/or released from prison at heightened risk of multimorbidity, premature mortality, and reduced quality of life. Ensuring appropriate healthcare for people in prison to improve their health outcomes is an important aspect of social justice. This review examines the global literature on healthcare interventions to detect, monitor and manage chronic non-communicable diseases amongst the prison population and people recently released from prison. METHODS: Systematic searches of EMBASE, MEDLINE, CINAHL, Web of Science, Scopus, and the Cochrane Library were conducted and supplemented by citation searching and review of the grey literature. The literature searches attempted to identify all articles describing any healthcare intervention for adults in prison, or released from prison in the past 1 year, to detect, monitor, or manage any chronic non-communicable illness. 19,061 articles were identified, of which 1058 articles were screened by abstract and 203 articles were reviewed by full text. RESULTS: Sixty-five studies were included in the review, involving 18,311 participants from multiple countries. Most studies were quasi-experimental and/or low to moderate in quality. Numerous healthcare interventions were described in the literature including chronic disease screening, telemedicine, health education, integrated care systems, implementing specialist equipment and staff roles to manage chronic diseases in prisons, and providing enhanced primary care contact and/or support from community health workers for people recently released from prison. These interventions were associated with improvement in various measures of clinical and cost effectiveness, although comparison between different care models was not possible due to high levels of clinical heterogeneity. CONCLUSIONS: It is currently unclear which interventions are most effective at monitoring and managing chronic non-communicable diseases in prison. More research is needed to determine the most effective interventions for improving chronic disease management in prisons and how these should be implemented to ensure optimal success. Future research should examine interventions for addressing multimorbidity within prisons, since most studies tested interventions for a singular non-communicable disease.

Using socially distanced and online simulation training to improve the confidence of junior doctors in psychiatry.

AIMS AND METHOD: The authors designed and delivered simulation training to improve the confidence and competence of junior doctors beginning work in psychiatry. Junior doctors completed various simulated psychiatry scenarios while receiving personalised feedback and teaching from their peers in online or socially distanced settings. Learners rated their confidence in psychiatry skills pre- and post-session, and Wilcoxon signed-rank tests were conducted to detect statistically significant differences. Qualitative feedback was analysed thematically. RESULTS: Twenty-one junior doctors attended the training. There were statistically significant (P < 0.05) improvements in trainee confidence across all psychiatry skills tested. The most enjoyable aspects of the session included its 'interactivity', relevance to clinical practice, and 'realistic' and 'interesting' simulated scenarios. CLINICAL IMPLICATIONS: Near-peer simulation teaching, delivered both in person and online, is effective at improving junior doctors' confidence in psychiatry. Delivering this training during placement induction could help to ensure adequate preparation of, and support for, new doctors.

A systematic review and mixed-methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm.

BACKGROUND: Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety. AIMS: To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm. METHOD: Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity. RESULTS: Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is 'manipulative' or 'attention-seeking' were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff-prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care. CONCLUSIONS: There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

The recording of mental health consultations by patients: clinical, ethical and legal considerations.

The topic of patients recording healthcare consultations has been previously debated in the literature, but little consideration has been given to the risks and benefits of such recordings in the context of mental health assessments and treatment. This issue is of growing importance given the increasing use of technology in healthcare and the recent increase in online healthcare services, largely accelerated by the COVID-19 pandemic. We discuss the clinical, ethical and legal considerations relevant to audio or visual recordings of mental health consultations by patients, with reference to existing UK guidance and the inclusion of a patient's perspective.

PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatry.

We describe the establishment and evaluation of a career-based mentoring scheme (PsychStart) for medical students interested in psychiatry. Medical students reported multiple benefits of mentoring, including enhanced personal and professional development, increased career and clinical knowledge, and broadened exposure to psychiatry. The mentoring scheme was also found to promote and sustain interest in the specialty. Further evaluation is required to determine the long-term effects of mentoring and how this may compare with other undergraduate enrichment activities. We conclude that mentoring in psychiatry could offer innovative solutions for improving recruitment and retention, and for supporting and valuing medical students who demonstrate an early interest in the specialty.

Remote consultations in prison mental healthcare in England: impacts of COVID-19.

Telemedicine has become increasingly used by prison mental health services throughout the COVID-19 pandemic. In this editorial, we explore the benefits and risks of the remote provision of forensic mental healthcare, with consideration of the clinical, financial, ethical and legal consequences.

The effects of COVID-19 on self-harm in UK prisons.

Self-harm is a major international public health concern and is especially prevalent among prisoners. In this editorial, we explore recent trends in prisoner self-harm during the coronavirus lockdown, and consider strategies for improving the prevention and management of self-harm in prisons as we emerge from the pandemic.

A Systematic Review and Meta-Analysis of Decision-Making in Offender Populations with Mental Disorder.

Decision-making has many different definitions and is measured in varied ways using neuropsychological tasks. Offenders with mental disorder habitually make disadvantageous decisions, but no study has systematically appraised the literature. This review aimed to clarify the field by bringing together different neuropsychological measures of decision-making, and using meta-analysis and systematic review to explore the performance of offenders with mental disorders on neuropsychological tasks of decision-making. A structured search of PubMed, Embase, PsycINFO, Medline, Cinahl was conducted with additional hand searching and grey literature consulted. Controlled studies of decision-making in offenders with evidence of any mental disorder, including a validated measure of decision-making were included. Total score on each relevant decision-making task was collated. Twenty-three studies met inclusion criteria (n = 1820), and 10 studies (with 15 experiments) were entered into the meta-analysis (n = 841). All studies included in the meta-analysis used the Iowa Gambling Task (IGT) to measure decision-making. Systematic review findings from individual studies showed violent offenders made poorer decisions than matched offender groups or controls. An omnibus meta-analysis was computed to examine performance on IGT in offenders with mental disorder compared with controls. Additionally, two sub-group meta-analyses were computed for studies involving offenders with personality disorder and psychopathy, and recidivists who were convicted of Driving While Intoxicated (DWI). Individual studies not included in the meta-analysis partially supported the view that offenders make poorer decisions. However, the meta-analyses showed no significant differences in performance on IGT between the offender groups and controls. Further research is required to ascertain whether offenders with mental disorder have difficulty in making advantageous decisions. An analysis of cause and effect and various directions for future work are recommended to help understand the underpinning of these findings. Trial Registration: CRD42018088402 .

Timing of onset of symptoms in people with idiopathic pulmonary fibrosis.

Little is known about when symptoms of idiopathic pulmonary fibrosis first develop. We identified incident cases of idiopathic pulmonary fibrosis-clinical syndrome (IPF-CS) from a UK primary care database and assessed the frequency of consultations for common symptoms in the 5 years prior to diagnosis. 1671 cases were identified with 5 years of data prior to diagnosis. Breathlessness was the most common symptom, followed by cough. Cases were significantly more likely than controls to experience these symptoms (p<0.001), even 4-5 years before diagnosis (OR for breathlessness for this period 2.79, 95% CI 2.13 to 3.65). This suggests that some patients with IPF may be symptomatic for more than 5 years before diagnosis.