Using entrustable professional activities to guide curriculum development in psychiatry training.

BACKGROUND: Clinical activities that trainees can be trusted to perform with minimal or no supervision have been labelled as Entrustable Professional Activities (EPAs). We sought to examine what activities could be entrusted to psychiatry trainees in their first year of specialist training. METHODS: We conducted an online survey of Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). RESULTS: The majority of respondents considered initiating patients with the common medications, discharging patient suffering from schizophrenia, bipolar disorder or following a crisis admission, conducting risk assessments and managing psychiatric emergencies were activities that trainees could be entrusted with by the end of the first stage of training. CONCLUSIONS: Four activities were identified that trainees should be entrusted with by the end of their first year of training. Each of these activities comprises a set of competencies in each of the CanMEDS roles. When a trainee is unable to satisfactorily perform an EPA, deficits in the underpinning competencies can be a focus for remediation. Further EPAs are being identified in areas of more specialised practice for use within more advanced training.

Expanding psychiatry training: Australian specialists' and trainees' perceived gaps in experiences and settings.

Objective: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is working together with the Australian Federal Government to expand the range of training experiences and settings with the object of producing better equipped and better distributed psychiatrists to address the rising prevalence of mental disorder. To assist in this process, the College sought the views of its Fellows (psychiatrists) and trainees concerning important gaps in clinical experience and the settings best suited to filling them. Method: An electronic survey was sent to all Australian RANZCP psychiatrists and trainees in June 2008. Results: Only 15% of psychiatrists and 28% of trainees responded to the survey. There was striking concordance, however, that psychological therapies required much greater emphasis and that this experience would best be acquired in the private healthcare system. Conclusions: These findings support the recommendations of the Medical Specialist Training Steering Committee's report on expanded settings, suggesting that RANZCP members are likely to engage enthusiastically in the expanded specialist training program. It will be important to ensure that trainees are well supervised in their treatment of anxiety, affective and substance abuse disorders.

Expanding Australian psychiatry training settings beyond metropolitan public hospitals: background and issues.

OBJECTIVE: The aim of this paper is to provide an overview of the rationale behind the expansion of specialist psychiatry training positions outside of major public teaching hospitals, as expounded by the Australian Federal Government's Expanded Settings for Specialist Training (ESST) Program. CONCLUSION: Alternative training settings are required to help address the anticipated growth in numbers of medical graduates and to meet the need of psychiatry trainees for greater experience in treating high prevalence mental disorders. To progress the expansion of training settings within psychiatry, it is essential that comprehensive consultation be undertaken to understand the implications of this program for trainees, existing training facilities and expanded setting providers to ensure that all stakeholders, including patients and carers, derive benefit.

Collaborative action learning: a professional development model for educational innovation in nursing.

The paper describes the processes and outcomes of a major curriculum innovation which was conducted by a collaborative multi-disciplinary team (nurse academics, educational developers and software developers). The paper argues that collaborative professional development in pedagogical innovation in nursing can be successfully supported by action learning as a framework for practice. In presenting this argument the paper draws on the experience of the School of Nursing and Midwifery (SNM) at the University of Tasmania in integrating high-fidelity simulation-based learning into an existing undergraduate case-based learning curriculum in the three year Bachelor of Nursing (BN).

The perceptions of undergraduate student nurses of high-fidelity simulation-based learning: a case report from the University of Tasmania.

This paper reports a qualitatively informed curriculum research project in the three-year Bachelor of Nursing (BN) at the School of Nursing and Midwifery (SNM) at the University of Tasmania. The project investigated the perceptions of second year undergraduate nurses and their academic teachers of their experiences of high-fidelity simulation using the Laerdal Vital Sim Nursing Kelly and Nursing Anne technology(2) as part of their preparation for clinical practice. An associated curriculum benchmarking audit was also undertaken. A voluntary purposeful sample of students enrolled in a clinically-based practise unit(3) participated in the research, along with a small cohort of academic teachers. The results indicated that undergraduate nursing students value the opportunity to practice nursing activities in a safe environment prior to clinical placement. Students believed that simulation is an innovative strategy that promotes active learning and has great potential for developing clinical competence and increasing confidence prior to practise. The academic staff reported a similar belief about the potential of high-fidelity simulation in a case-based curriculum. The associated curriculum benchmarking audit provided evidence to support further integration of high-fidelity simulation in the undergraduate nursing program.

Reflective critique and collaborative practice in evaluation: promoting change in medical education.

The School of Medicine at the University of Tasmania has recently begun to implement a process of curriculum evaluation,which aims to reflect contemporary best practice in evaluation in tertiary pedagogy and medical education. Best practice must accommodate a broadening interest in cooperative and collaborative evaluation strategies among stakeholders, advances in applied qualitative educational research and recognition that critical reflection on practice is the cornerstone of professional education. This paper reports a recent evaluation strategy in a specific year-long unit in the second year of a six-year undergraduate medical degree. The paper begins by presenting the context; it then discusses and rationalises the evaluation strategy and presents findings. The paper concludes by arguing that curriculum evaluation as best practice must be reflective, informed by the scholarship of medical education, and internalized as a dynamic process that can promote sustainable change and improvement in medical curricula. Such an approach will contribute to an undergraduate medical curriculum that prepares students for the demands and complexities of medical practice.