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A recent Royal College of Physicians' study on assessment raises serious questions for workplace assessment. To address these, a system is recommended that bridges the gap from competence to performance and integrates supervised learning events (SLEs) that are formative in purpose with summative assessment of performance by entrustable professional activities (EPAs).
Relative to workforce numbers, the National Clinical Assessment Service (NCAS) has reported high rates of referrals for performance concerns in psychiatrists. Our aim was to see how these concerns would be distributed across good medical practice (GMP) domains. Such specification would help identify appropriate training and development interventions. Concerns were obtained from consecutive case reports (anonymised) of psychiatrists referred to NCAS between October 2004 and April 2006.
The proportion of psychiatrists with concerns in any domain was highest (just over 50%) in the domains of good clinical care and working with colleagues. Two-thirds had concerns across multiple domains.
Training and development needs of psychiatrists referred to NCAS are more complex and more prevalent in the GMP domain of good clinical care than previously reported.
The longer term prognosis of depressed patients treated with ECT is relatively unknown. We describe seven-year mortality and readmission risks for the Nottingham ECT series.
Cases were defined and subtyped using the Present State Examination (PSE). Follow-up was naturalistic. Death and readmission were ascertained using the Nottingham case register.
The risk of death was doubled (SMR=1.99, 95% CI = 1.34–2.84, P < 0.001). The seven-year cumulative probability of remaining without readmission was 0.27 (95% CI 0.19–0.35), being 0.79 (0.71–0.87) at 16 weeks (relapse) and 0.34 (0.24–0.44) thereafter (recurrence readmissions). Multiple regression analysis showed that delusions predicted relapse, while endogenous subtype, absence of psychomotor retardation, and previous history predicted recurrence readmissions.
Index ECT treatment predicted high longer-term mortality and readmission risks. PSE/CATEGO-based subtyping identified patients most vulnerable to relapse and recurrence.
This report describes the use of the needs for care assessment (NFCA) in measuring symptom and social function in patients with long-term mental Illness. The schedule recommends specific care interventions and these were implemented where appropriate. The problem status of the patients was reassessed using the needs for care schedule after the interventions had been offered and tried. The recommended care items were within the compass of our rehabilitation service, were rarely refused by the patients and there was an improvement in symptom and social function. These findings provide some validation for the concept of unmet need.