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There is little published literature on medical student exchanges in psychiatry.
Aims, objectives and methods
To use a two-week student exchange between Modena, Italy and Norwich, UK to highlight some of the meaningful differences in psychiatric practice between the centers.
White coats - English doctors in general and especially psychiatrists do not wear white coats; in Italy these are almost always worn. Psychiatric nurses in English hospitals likewise do not wear any uniform.
Locations of services - Italian acute psychiatric wards are sited in general hospitals; in England they are usually in a separate location.
Nursing role - Psychiatric nurses in English hospitals are required to play a significant role in decision making around patient care. For example, nurses make almost all decisions regarding admission to hospital. It is also common for nurses to challenge doctors on decisions regarding patient treatments. The role of nurses in Italy is often not a decision-making one, but rather following doctors' orders and providing information.
Wearing white coats can promote a sense of professionalism and help orient patients in a hospital environment, but without these the ward may look less like a hospital and be more comfortable for patients.
Locating psychiatric wards within general hospitals makes consultation between specialties straightforward and may help reduce stigma, but psychiatry-only hospitals may create opportunities for economic efficiencies and improved facilities.
Enhanced nursing roles may be perceived as a possible threat by psychiatrists, yet may strengthen mental health teams and enhance quality of care.
There has been an increased interest on the role of urban security and fear of crime on mental health of the general population, but there are not studies about this among patients with minor psychiatric disorders.
Assess patients’ fear of crime and perceived urban insecurity.
1) evaluate the association between perceived urban insecurity and crime, and minor psychiatric disorders;
2) identify subgroups of patients with high levels of perceived urban insecurity and fear of crime.
A sample of 24 patients with depressive or anxiety disorders attending outpatient services was collected. Patients consenting to the study underwent a battery of psychometric instruments. This study is part of a national multicentric study that enrolled 426 subjects.
The sample was mainly composed by females (83%), cohabiting (58%), employed (54%). Patients were more frequently diagnosed with dysthymia (54%) had an average GAF score of 73 (SD=8,44), an average GHQ-12 of 17.33 (SD =3,95). 41% reported high level of insecurity or fear and 58% stated that their worries were increased compared to 10 years earlier. Reported reasons for this were mostly ‘decrease of social security’ and ‘loss of values’. 12.5% of the sample reported of having been victim of a theft or vandalism.
The results of this study are not only useful to understand the role of fear of crime in the onset and relapses of minor psychiatric disorders, but they can also help to plan psychiatrists’ and Public Health's interventions in order to prevent them.
Studying the pathways followed by psychiatric patients is important to plan both mental health services organization and training programmes for doctors and psychiatrists.
Detecting the main pathways-to-care followed by patients.
Finding the reasons why patients look for psychiatric help and the main responses given to patients’ problems by psychiatric services. Evaluating the delays occurring along the pathways.
The study has been done on 420 Italian patients. In one month, patients with a new episode of disease have been included. Each of them has been administered a questionnaire collecting socio-demographical, medical infos and data concerning health workers, timing and delays along the pathways. Diagnosis done using ICD-10 and an Intervention Detection Schedule filled for each patient.
The Carpi’s sample consists of 43 patients. The 58% has seen the General Practitioner (GP) in the first place, the 19% the hospital doctor (HD), the 16% the psychiatric worker. Nation-widely, most patients have firstly referred to the psychiatrist (34%). In Carpi, the 44% has received a diagnosis of “Neurotic, stress-related and somatoform disorders”. The 93% has been treated with psychotropic medications. The longest pathway has occurred for behavioural syndromes associated with physiological disturbances and physical factors, the shortest for affective disorders.
GP, HD and direct access are the 3 main pathways followed by patients. The importance of the GP is confirmed, so as the necessity for training of sanitary workers within the psychiatric field. A greater cooperation between general practice and mental health services should be pursued
In a demographic survey in 2005, 13.6% of Italians admitted to have taken CAMs during the 3 years before. A study on hospitalized patients for psychiatric reasons highlighted that 63% of them used CAM in the previous year and 79% did not mention this to their psychiatrists.
To collect the opinions about the use of CAMs in psychiatry among a group of psychiatrists and nurses working in a Mental Health Centre.
To investigate knowledge, opinions and experiences on CAMs.
A mixed qualitative-quantitative method was used: 2 focus groups were conducted in June 2011, involving 12 professionals of one Mental Health Community Centre in Modena, Italy. The audio-recordings of the focus groups were analyzed by 2 researchers, who identified the main themes with an inductive method. The participants were finally asked to fill in a respondent validation questionnaire.
Four main themes were developed:
1) advantages, and
2) disadvantages in the use of CAMs,
3) patients’ and own experiences,
4) variety of therapies under the CAM acronym.
Among the pros, 75% of respondents agreed that CAMs allow a better global approach to the patient, 58% that CAMs may improve quality of life, 66% that conventional psychiatric therapies do not solve every situation. As to disadvantages, some professionals (medical doctors) expressed skepticism on CAMs.
Being realistic, open-minded and ready to listen and cooperate: this could be the best attitude towards patients who take CAMs.
There is a little of awareness about the existence of different methods for teaching undergraduate psychiatry in European countries.
Aims and objectives
To compare two methods of teaching psychiatry through a medical student's eyes during a student exchange.
Comparison of personal experience with traditional education at Modena (Modena University, Italy) and experience with Problem Based Learning (PBL) classes and didactic teaching in Norwich (UEA - Norwich,UK).
Group size- The traditional education system prefers lectures: one professor usually teaches more than 100 students. The PBL model assigns one tutor per group of 10 students. Intensity of work during the year - The traditional education system requires efforts to be concentrated on exams since clinical sessions and lessons can be attended passively. The PBL course requires that each student produce written work and teach this to the other group members weekly. Skill development- Facing comprehensive oral exams forces students in traditional education to focus learning sources and time. The PBL approach enhances debating abilities and improves skills in team working.
Professors' role- Traditional education professors are usually highly qualified in their subject. PBL professors do not necessarily have to be specialists in the subject because their role is mostly as supervisors of the peer-group learning process.
Although at the moment there is no evidence that interactive education methods are more effective in changing doctors' performance it is undeniable that PBL based courses offers more experience in teamwork and in working with a wide range of different colleagues.
INTERMED is a patient-centered method designed to assess bio-psycho-social case complexity in general health care. It consists in a structured interview leading to definition of 20 variables by focusing on past, present and future health needs and risks of patients. The total score supports professional decision and guides to patient-oriented care.
To describe the training process on INTERMED interview and to assess its effectiveness.
A training group of 4 doctors and 4 6th-year medical students attended two-hour meetings twice a month (December 2011– March 2012). After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the end of every session and compared statistically by means of Cohen’s kappa.
Agreement between individual and consensus scores was already considerable at the beginning of the training and improved during the course (Cohen’s kappa raised from 0.39 to 0.65). The participants were interested and motivated. They expressed satisfaction for the skills acquired during the training.
A five months 20-hour training period is a reasonable time not only for learning how to master the instrument, but also for gaining the basic skills required to build a structured interview. These skills would be useful in the whole participants’ career and allowed the implementation of INTERMED as a clinical and research tool in the Modena General Hospital.
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