Hepatitis C virus monitoring in inpatient psychiatry: Doctors' practice.

OBJECTIVES: Current guidelines recommend routine Hepatitis C virus (HCV) monitoring in people with serious mental illness. We sought to determine the rates at which doctors practising in inpatient psychiatry units monitor the HCV exposure risk and HCV infection status of their patients. METHODS: Electronic medical records (EMRs) of 50 short stay and 50 long stay mental health inpatients of a regional NSW hospital were retrospectively audited to determine the rates at which doctors screened for HCV and associated risk factors. Chi-squared analysis and Fisher's exact test were performed to compare the two groups. RESULTS: Screening rates for HCV-associated risk factors varied according to the specific risk factor explored (prior incarceration 61%; intravenous drug use 55%; and tattoos/piercings 6%). Of 30 patients identified as having at least one HCV-associated risk factor, only 27% (n = 8) were tested for HCV during their admission, and the likelihood of testing was significantly higher in the long stay group. HCV infection status was documented for only one-third (34%) of patients. CONCLUSIONS: There is significant scope for improvement in assessing HCV status and exposure risk in this setting. Improved awareness among mental health professionals as to the higher incidence of HCV in this population could elicit more widespread monitoring.

The experience of psychiatry training in rural NSW.

OBJECTIVE: To examine the experience of psychiatry training in rural New South Wales. METHOD: All rural trainees in New South Wales and key psychiatrists involved in their training were invited to complete a survey in May-July 2013. RESULTS: Responses were received from 26 out of 44 rurally placed psychiatry trainees (57% response rate) and 37 out of 55 psychiatrists involved in training in a rural area (67% response rate). Positive and negative aspects of rural training were reported. In general, trainees reported positive experiences regarding supervision, consultant input and their Site Coordinator of training. Their experience of other aspects of training and education in rural areas was often negative with 52% of trainees feeling at a disadvantage due to fewer registrar peers and 60% feeling educationally isolated. Difficulty progressing through training, workforce shortages, difficulty accessing formal aspects of training and limited options for advanced training were reported. Metropolitan trainees on rotation to rural terms receive accommodation, travel and an increase in wage from the rural Local Health District. Rural trainees on rotation to the city for their mandatory subspecialty training receive no such support. CONCLUSIONS: There are many challenges for rural trainees. Support from the Royal Australian and New Zealand College of Psychiatrists and state and federal governments to enhance the rural training experience is vital.

Psychiatry trainees confidence as teachers, perceptions of supervisor support and opportunities for further training.

OBJECTIVE: To investigate psychiatry trainees' confidence in their role as teachers, their perceptions of support and preferences for a program to support this role. METHODS: Psychiatry trainees in New South Wales (NSW) (Australia) in the first three years of psychiatry training (N = 118) were invited to complete a survey which included demographic data, self-assessment of teaching confidence and perceptions of support for teaching. RESULTS: A total of 63% (N = 74) agreed to participate. Overall, 62% percent of participants regarded teaching as an important part of their role, 46% felt supported in the role by their training supervisors, but only 18% regularly discussed their teaching role in routine supervision. CONCLUSIONS: Psychiatry trainees viewed teaching as part of their role. They reported a low level of formal training in teaching skills and perceived a low level of support from supervisors. Registrar training needs to address trainees' competencies in a range of teaching skills along with supervisor support. Further research is required to assess the impact of a teaching program on teaching performance and learner outcomes.

The role of trainees as clinical teachers of medical students in psychiatry.

OBJECTIVE: To consider the role of specialty trainees as clinical teachers of medical students in psychiatry. METHOD: We discuss the role of specialty trainees as teachers and approaches to improving their skills and capacity, giving examples from the local and international literature and our own experience as psychiatry medical educators. RESULTS: Good clinical teaching is crucial for medical students' learning but sharp increases in numbers combined with economic and workforce pressures have stretched capacity. Specialty trainees do much of the medical student teaching during their clinical placements but infrequently receive instruction on how to teach. The two common approaches to increasing capacity are, first, establishing education rotations for individual trainees and, second, providing workshops to improve trainees' confidence and skill. Psychiatry trainees surveyed in New South Wales welcomed the role of teacher and the opportunity to improve their teaching capacity. Further support from supervisors, health services and medical schools is needed to assist trainees in their teaching role. CONCLUSION: The role that trainees play as clinical teachers should be acknowledged and supported. Further development of research and scholarship in medical education is needed to determine how best to teach trainees to teach.