BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students.

Aims and method We used an online questionnaire to investigate medical students' perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments ('badmouthing' or 'bashing') against other specialists and whether this has had an effect on their career choice. Results In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine. Clinical implications Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.

The comparative hemodynamic efficacy of lower limb muscles using transcutaneous electrical stimulation.

BACKGROUND: Circulation in the limbs can be augmented using transcutaneous electrical stimulation devices. The optimum muscle stimulation sites for enhancement of vascular hemodynamic parameters have not been identified. METHODS: Seven suitable anatomic sites were identified within the right leg. Twelve healthy participants were recruited (mean age, 23.1 ± 3 years; body mass index, 23.1 ± 3 kg/m(2)). Muscles were stimulated by transcutaneous bipolar electrodes at a current twice their motor threshold, at 1 Hz, for 5 minutes. Hemodynamic ultrasound measurements were taken from the right femoral vein. Laser Doppler measurements from the feet of the stimulated and nonstimulated sides were obtained. Baseline measurements were compared with readings after 5 minutes of stimulation, with device active. Discomfort experienced for stimulation of each muscle was rated out of 100. RESULTS: Hemodynamic changes displayed large intersubject variation, with no muscle statistically superior to the others. All muscles increased peak velocity; contraction of medial gastrocnemius increased time-averaged maximum velocity and volume flow. All muscles increased foot fluximetry (P < .05). Discomfort correlated weakly with current applied. Tibialis anterior and vastus lateralis were most tenable. CONCLUSIONS: Transcutaneous stimulation increases hemodynamic parameters significantly, locally and systemically. No optimum stimulation site has been identified, and it is limited by comfort and variability in the subject's response. Gastrocnemius, tibialis anterior, and vastus lateralis all provoke large changes in hemodynamic parameters, but clinical efficacy in disease prevention and management has not been explored.

The PsychSimCentre: teaching out-of-hours psychiatry to non-psychiatrists.

BACKGROUND: Junior doctors have limited experience in psychiatry before starting their training placements. The out-of-hours setting offers specific challenges, and trainees are expected to cope despite being underprepared. We hyphothesised that simulation-based training would increase trainees' competence and confidence in approaching high-risk out-of-hours scenarios. METHODS: A pilot study focused upon the first cohort of psychiatry trainees joining the North East London NHS Foundation Trust in 2012. During their induction (and prior to any clinical duties) each trainee took part in five high-risk clinical scenarios, assessed by a senior psychiatrist and service-user representative. The trainees were required to complete a survey exploring their confidence across nine core psychiatric clinical domains, both before and after the simulation training. RESULTS: The simulation training increased trainee confidence in all nine clinical domains. Before the simulation training, over half of the nine trainees self-rated themselves as having 'no confidence' in six of the nine clinical competencies. After the training, confidence levels had significantly increased, with only two of the competencies scoring any 'no confidence' ratings. There were mixed feelings by trainees on the use of service-user representatives in the training of doctors. Junior doctors have limited experience in psychiatry before starting their training placements DISCUSSION: We found that high-fidelity simulation training is a useful tool to prepare junior trainees in psychiatry to familiarise themselves with some of the high-risk scenarios that they are likely to encounter during out-of-hour on-call duties. We showed that this intervention increased trainees' confidence across a range of core psychiatric skills. This has significant implications in the provision of safe and effective patient care.

Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The authors examined how specific OCD symptom dimensions were related to neuropsychological functions using multiple regression analyses. A total of 39 OCD patients and 40 controls completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994), which is a test of decision making, and the Wisconsin Card Sorting Test (R. K. Heaton, 1981), which is a test of set shifting. OCD patients and controls showed comparable decision making. However, patients with prominent hoarding symptoms showed impaired decision making on the IGT as well as reduced skin conductance responses. OCD patients had poorer set shifting abilities than controls, and symmetry/ordering symptoms were negatively associated with set shifting. These results help explain previous inconsistent findings in neuropsychological research in OCD and support recent neuroimaging data showing dissociable neural mechanisms involved in mediating the different OCD symptom dimensions.