We conducted a cross-sectional survey to examine how undergraduate psychiatry is taught and assessed across medical schools in the UK that have at least one cohort of graduated students.

In total, 27 medical schools completed the survey. Curriculum coverage of common mental disorders, assessment skills and mental health law was broadly consistent, although exposure to psychiatric subspecialties varied. Significant variation existed regarding the duration of psychiatry placements and availability of enrichment activities. Small-group teaching, lectures and e-learning were the most frequent teaching modalities and various professionals and lived experience educators (patient and/or carers) contributed to teaching. Objective structured clinical examinations and multiple-choice questions dominated assessments.

Medical schools should consider increasing students’ exposure to different psychiatric subspecialties and integrating physical and mental health training to address comorbidity and promote holistic care. Future research should explore whether specific undergraduate experiences promote greater career interest and skills in psychiatry.

Preparing for postgraduate examinations is stressful for many doctors, with psychological, financial, and social impacts. Ensuring that doctors feel supported with exam preparation is likely to improve their well-being and performance, whilst also potentially addressing workforce retention and differential attainment. This quality improvement project aimed to improve the confidence and preparedness of trainees taking the MRCPsych Paper A exam in the North West School of Psychiatry.

Six weekly online revision sessions were held for trainees preparing for the MRCPsych Paper A examination. One session was devoted to each major curriculum topic, whilst two covered neurosciences. The sessions were held over Microsoft Teams for 1 hour and chaired by senior trainees and Consultant Psychiatrists. The sessions incorporated a combination of PowerPoint slides, discussion about relevant theory, and interactive practice questions using Slido. A baseline survey was completed to ascertain trainees current levels of exam preparation and confidence. Questionnaires were administered at the end of each revision session to measure their impact and gather feedback. Trainees indicated the extent to which they felt confident with each curriculum topic and their responses were compared, at group level, before and after the revision sessions (1 = strongly disagree with feeling confident, 5 = strongly agree with feeling confident).

40 trainees completed pre-session feedback and 56 trainees completed post-session feedback. The mean confidence scores of trainees improved by between 25.4% to 51.5% after the revision sessions, with the lowest pre-session mean confidence score being observed for neuroscience and the greatest improvement being observed for psychopharmacology. 77.8% of trainees rated the revision sessions as ‘extremely useful’ and 22.2% perceived them as ‘useful’. All trainees agreed (43.4%) or strongly agreed (56.6%) that their knowledge improved after attending the sessions, and all trainees agreed (23.6%) or strongly agreed (76.4%) that they would recommend them to colleagues. Trainees favourite aspects of the revision sessions included completing multiple choice questions, combining Slido polling with PowerPoint slides, and the speakers explanations of difficult concepts. Suggestions for improvement included offering more frequent and longer revision sessions, concealing group voting choices on Slido until revealing the correct answers, and teaching more relevant theory alongside practice questions.

Online group revision sessions combining interactive polling and didactic teaching are popular and useful amongst trainees preparing for MRCPsych Paper A. These sessions appear to improve trainees' self-reported confidence with exam curricula content, although further evaluation is required to determine whether they improve examination pass rates.

The authors designed a simulation training programme for foundation doctors beginning psychiatry placements across a large mental health trust. The simulation training aimed to improve the confidence, competence, and well-being of foundation doctors through exposing them to realistic psychiatry scenarios and teaching clinical skills in a safe environment.

Four clinical scenarios were filmed with a 360-degree camera, professional actress, and doctors working in psychiatry. The scenarios depicted the journey of a patient being admitted onto a psychiatry ward from the community. Various clinical skills were embedded into the videos including psychiatric history taking, risk assessment, managing acute distress, managing comorbid physical and mental health problems, using the Mental Health Act, and teamwork with colleagues. All videos were delivered to learners using simulation with head-mounted-displays (HMDs). Each video lasted 6–8 minutes and was accompanied by pre-briefing and de-briefing with experienced psychiatrists for a further 15–20 minutes. Participants rated their confidence regarding several skills in psychiatry on Likert scales from 1 to 5 immediately before and after the session. Wilcoxon signed rank tests were conducted to detect statistically significant differences in learner's median confidence ratings before and after the training. Free-text questions explored trainee's most and least favourite aspects of the simulation. A survey also was distributed to learners 2-months after the training to assess how it had influenced their clinical practice.

20 foundation doctors completed the training and provided feedback. Following the simulation training, there were statistically significant improvements in foundation doctor's confidence in: completing psychiatric assessments (p < 0.01), managing physical health problems in psychiatry (p < 0.05), managing acute distress (p < 0.01), reporting information to senior colleagues (p < 0.05), and containing anxiety when communicating with patients (p < 0.05). Trainees highlighted the debriefing, group discussions, and “interactive” simulation videos as the most useful aspects of the training. Some trainees enjoyed viewing the 360-degree videos, whilst others found the HMDs difficult to use. Of the 8 trainees who completed feedback 2 months after the training, 7 (87.5%) felt that it had helped them in their current roles. All trainees agreed (37.5%) or strongly agreed (62.5%) that the simulation scenarios were closely aligned to real-life clinical encounters.

Simulation training in psychiatry using 360-degree videos and HMDs is generally well-received amongst foundation doctors. Embedding simulation training into placement induction can improve the confidence and skills of junior doctors starting psychiatry placements.

Osteoporosis is common amongst elderly patient populations and is associated with significant morbidity and mortality. We aimed to assess whether national clinical guidelines regarding the identification, assessment and management of osteoporosis and fragility fracture risk were being adhered to on a female later life psychiatry ward. We then aimed to improve the detection and treatment of osteoporosis amongst this patient cohort and subsequently conducted a re-audit of adherence to relevant clinical guidelines.

In July 2021, the electronic health records of the 20 most recently discharged patients from a female later life psychiatry ward were reviewed. The proportion of patients who appropriately received FRAX screening, DEXA scanning and pharmacological management of osteoporosis and fragility fracture risk was recorded. The results were compared to standards identified in national clinical guidelines from the National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Group (NOGG). In addition, the proportion of patients who had FRAX scores communicated to their general practitioners on discharge was recorded. Recommendations were made based on audit findings, and several changes to ward processes were implemented including incorporating fracture risk scoring in a structured ward round template and displaying information posters about osteoporosis in clinical areas. A re-audit was completed in February 2022 using the same methodology as baseline to re-assess adherence to the audit standards.

All included patients were female and aged >65 years, and therefore eligible for consideration of fragility fracture risk according to NICE guidelines. 88% (15/17 patients) of those without pre-existing osteoporosis had FRAX scores calculated during their admission on re-audit compared to 50% (8/16 patients) at baseline. 73% (11/15 patients) had FRAX scores communicated to their GP on discharge at completion of the audit cycle compared to 25% (2/8 patients) at baseline. At completion of the audit cycle 10% (1/10 patients) with intermediate fragility fracture risk received measurement of bone mineral density during admission while 30% (3/10) had this recommended to their GP on discharge. None of the high-risk patients (n = 4) were started on bisphosphonate therapy.

On completion of the audit cycle, we found excellent compliance with national guidelines regarding the identification of osteoporosis and fragility fracture risk, which demonstrates the feasibility of considering this aspect of physical health in the setting of a later-life psychiatry ward. Areas for improvement include the assessment and management of patients identified as having intermediate or high risk of osteoporosis and fragility fractures.

Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety.

To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm.

Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity.

Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is ‘manipulative’ or ‘attention-seeking’ were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff–prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care.

There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

The authors designed and delivered simulation training to improve the confidence and competence of junior doctors beginning work in psychiatry. Junior doctors completed various simulated psychiatry scenarios while receiving personalised feedback and teaching from their peers in online or socially distanced settings. Learners rated their confidence in psychiatry skills pre- and post-session, and Wilcoxon signed-rank tests were conducted to detect statistically significant differences. Qualitative feedback was analysed thematically.

Twenty-one junior doctors attended the training. There were statistically significant (P < 0.05) improvements in trainee confidence across all psychiatry skills tested. The most enjoyable aspects of the session included its ‘interactivity’, relevance to clinical practice, and ‘realistic’ and ‘interesting’ simulated scenarios.

Near-peer simulation teaching, delivered both in person and online, is effective at improving junior doctors’ confidence in psychiatry. Delivering this training during placement induction could help to ensure adequate preparation of, and support for, new doctors.