Psychiatric Bulletin - Letter: Psychiatry for medical students: need for a more holistic approach to teaching?

From: Psychiatric Bulletin -

http://pb.rcpsych.org/content/38/3/138.2.full

Kristina Rodney and Laura Wilkinson

Kristina Rodney and Laura Wilkinson are both ST4 medical students, Newcastle University, Newcastle, UK, email:k.rodney AT newcastle.ac.uk.

We are two medical students who wish to offer a perspective on undergraduate education and psychiatry.

During our student placement, we attended the old age psychiatry module at the Northern Deanery MRCPsych programme focusing on dementia and ethics. This was aimed at trainees and not specifically medical students but we were surprised to find that this was not above our level of knowledge. This prompted discussion of undergraduate psychiatry training more broadly, which we felt focused too heavily on the diagnosis of mental illness and less so on the holistic approach to the patient and their presentation as covered by the MRCPsych course. From our experience of undergraduate psychiatry we feel that the assessment by means of a logbook of conditions encourages students to find patients with a certain diagnosis, and in doing so overlooks the true essence of psychiatry. To our mind this incorporates the ability to consider all aspects of a patient’s life and formulating these, while demonstrating compassion for another person at a time of most need.

Through choosing a 6-week placement in old age psychiatry we have been able to explore the specialty more thoroughly and broadly than facilitated within the standard undergraduate programme, and we have realised how little of psychiatry we have been exposed to as undergraduates. We have become more aware of the importance of considering the patient’s personal and social circumstances alongside their diagnosis, and how these can influence each other. Specifically, the importance of a sound ethical approach to practice has been highlighted through the higher-level teaching we experienced, where the Mental Capacity Act was discussed in detail.

We believe that it would benefit undergraduates to experience a more realistic and rounded placement in psychiatry and truly consider the social implications of mental illness. As it currently stands, undergraduate education in psychiatry is oversimplified to focus on diagnosis and does not acknowledge the capabilities of medical students to adopt a holistic approach. An opportunity to consider all aspects of a psychiatrist’s role may encourage more students to consider a career in this field.

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I have contacted the authors of this letter to inform them of Hodges' model and its scope in assuring holistic and integrated care. The model could also facilitate curriculum development. The authors of the letter are not endorsing Hodges' model, I am seeking to highlight the need for such a resource.

Thanks to:

Lucy Alexander
Rights and Permissions Manager
Royal College of Psychiatrists

A *prospective* journal issue devoted to the "Health Career - Care Domains - Model"

Last month I was contacted regards the possibility of acting as associate editor for a journal issue devoted to Hodges' model, or a related theme.

At present with part-time studies having started in January and a residential week to following at the end of March I have rather got my hands full. I hope to post in the near future on how these studies are helping to shape my ideas.

One clear 'result' is the prompt to engage with residential and nursing homes in preparation for a 'small research study' I have to complete this northern Spring. I've two meetings organised thus far with home managers.

A journal issue is a great prospect however, a giant step in fact - for the conceptual framework and myself (I'd also contribute an editorial). Perhaps I could share this project with someone similarly minded regards the potential of Hodges' model in health and social care and without in education and informatics? It seems that this invitation will stand even if I can only pick it up in the future, end of 2015-2016...

In the sidebar, below the bibliography I've listed a publications to-do list that could be extended:

• Hodges' model, structure, content and applications 
• taking the 'career' out of Hodges' model and putting it back;
• curriculum development;
• reflective practice;
• case formulation;
• holistic care (and related perspectives, but in informatics, SOCIO-TECHNICAL);
• the theory - practice gap;
• threshold concepts;
• and conceptual spaces;
• integrated care; 
• Nursing theory: future history - why they still matter;
• quality assurance and care values;
• multidisciplinary care and interprofessional education;
• diagrams that care;
• student contribution;
• patient, service user contribution;
• .... ?

The distance learning Technology Enhanced Learning course is stimulating many other insights. The learning is very collaborative and a great demonstrator in so many ways. The recent trip to London and meeting at London South Bank University also stressed the need for publishing in the 'popular' nursing press. Recent writing (recovery, recovery model) and studies also points to not being tied to original purposes of Hodges' model - but going beyond this ... far beyond: global health integration, health literacy, self-care, methodological approaches to critique and investigate Hodges' model. ...

'Intellectual brutalisation' and the saving grace and power of poetry

BBC Radio 4 Today: An eminent cardiologist has organised and funded a poetry competition for his medical students to stop them becoming, in his words, intellectually brutalised.
Gabrielle Gascoigne, pictured, is a previous winner.
The BBC’s Jane Dreaper discovers more.

Listen to ‘Poetry competition for 'intellectually brutalised' medics’ on Audioboo

PBS: For these medical students, poetry nurtures the soul

Here's (source: http://www.bbc.co.uk/programmes/b03s6mdp/live ) the full version of Mastectomy - For His Wife, by Gabrielle Ruth Gascoigne:

It will be an honour
to bathe the scars.
Don’t think my tears imply
an ounce of sorrow -
only joy
could fill my eyes.

It will be a pleasure
to hold you close.
Know this – your precious flesh
calls the bluff on gold
and silver -
makes me a king.

It will be a delight
to talk with you
into the night we thought
stolen, clean away -
until day
renews our hope.

It would be too heartless
if all this love,
these sinner’s prayers and more
should fall to nothing
more than rain
on empty streets.

INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL

individual

subjectivity insight, rapport, empathy emotional control, detachment, engagement risk of burnout	objectivity anatomy, physiology          physicality, processes, mechanistic intellectual brutalisation
humanistic communication, relationships (medic) poetry	funding, crowded curricula hidden curriculum

group - population

Student engagement survey UK pilot – Year 2: HEA

Forwarded from the HEA

The National Survey of Student Engagement (NSSE) was designed to measure students’ participation in activities and practices that are known to relate to improvements in learning. It asks about the amount and quality of effort that students invest in their studies, as well as the extent to which their courses and institutions are supportive and encouraging. It was developed and first used in North America in 2000, and has now been adapted and implemented in Australia, New Zealand, South Africa and Ireland.

In early 2013, nine UK institutions piloted a range of survey questions derived from NSSE. The questions were focused on four key areas:

• Critical thinking. Four questions asked students about the emphasis their coursework placed on a range of mental activities such as evaluating and applying information.

• Course challenge. Three questions focused on how their courses have encouraged them to work hard.

• Collaborative learning. Three questions asked students how often they had interacted with other students in a range of ways.

• Academic integration. Five questions explored students’ interaction with academic staff, participation in class and discussions with others outside class.

8500 students responded, and the report of the first year of the pilot will be published on 6 November 2013 and will be available at www.heacademy.ac.uk/surveys. The report contains analysis of the results, as well as findings from interviews with students about the questions used.

In order to allow more institutions to take part in this project, and to collect more data for research purposes, the project will run again in spring/summer 2014.

Participation in this project allows institutions to ask students about the extent to which they are investing effort in their studies, to identify areas where more encouragement and opportunities to engage may be required. Institutions will be able to benchmark their own results against the aggregate UK results, both at institutional and subject level, to better understand their students’ engagement.

For full information on the pilot and how to be involved, along with all related documentation please see our website at http://www.heacademy.ac.uk/resources/detail/engagement_survey/pilot_call_2014

Kind Regards

Celia

Dr Celia R Brigg

Academic Lead (Business Development)

 celia.brigg at heacademy.ac.uk

The Higher Education Academy, Innovation Way, York Science Park, Heslington, York, YO10 5BR

www.heacademy.ac.uk – Twitter @HEAcademy

Part II: Pensioners, 'Health students' and Children

For decades the reactive health care system has been founded, loved and sustained through the primary care - secondary care hospital system, together with its complex range of referral systems and processes.

Now demographic trends and economic pressures have seen the emergence and ongoing development of the virtual hospital. Call centers and teams that deliver nursing and medical care in the home to prevent admission and facilitating early discharge are still basically reactive.

What is needed is a cognitive hospital.

A form of hospital that acknowledges the health care system but can finally progress the preventive agenda on an individual, educational basis, fostering self-efficacy, health literacy and if necessary self-care.

'Holistic reform of education' in Jordan (an eastern dose of serendipity)

View from The Citadel, Amman 23 April 2013

Yesterday morning I arrived back safe and sound from Amman in Jordan, via Istanbul through to Manchester and full of new experiences and learning. I say 'safe and sound' because travel to the region is clearly not a matter of routine given ongoing events. Checking governmental advice in the UK it becomes a question of personal evaluation as was the unexpected trip to Colombia in 2011. Once the non-trivial decision is out of the way ... Jordan's nursing and educational communities provide a truly remarkable welcome and experience. Not only that, but the kingdom of Jordan and the people have so much to offer in their culture, history, hospitality and engagement.

Returning on Thursday from a full day's trip to Petra - amazing! - I asked for an English language paper to read at the hotel before leaving for the airport. I was provided with a copy of The Jordan Times to accompany a cappuccino^*. On page nine Mona Smadi,^# Asst. Professor, Al Balqa Applied University) wrote an opinion piece on Holistic reform of education. The opening sentence enabled my brain to reconnect with my legs (although I would have gladly walked back through the valley):

A holistic perception of reality means having a vision of the context of the constituent fragments and thereby gaining a clearer perception of the reality in its totality.

Prof. Smadi's focus is children's education and curriculum reform. The overlap between children's education, the professor's concerns and nursing is not limited to how curricula are designed and who owns them. Is, for example, the curriculum centered on the student as an individual nurse, or child? If nurses are to be able to integrate their learning and effectively negotiate the emotional and ethical spaces they find themselves in then when is this deeper thinking to start?

Petra 25 April 2013

Not surprisingly there was a lot of talk about this at the JNC conference. The theory - practice gap is not just alive and kicking there is an echo off the seemingly disparate walls. Given too the debate in the UK about student nurses spending time as a health care assistant before starting their formal nurse education. The word applied in the title of Prof. Smadi's university's is interesting. We are accustomed to applied mathematics, ethics, energy and of course applied nursing research and many other examples?

What of applied nursing - does that make sense? Or is there a circularity of sorts in nursing applied? I will check my notes as this point was raised in conference regards to evidence based care and evidence based practice.

Prof. Smadi's referring to a 'clearer perception' can also be extended to recognition of patterns, contexts and situations that are 'hot' in how they relate to values.

(There are a couple of points to add here which I will get too).


There was another serving of serendipity to add to that at Le Meridien, soon after rejoining the land of the virtual I came across the UK Department of Education's Preparing for Adulthood initiative on twitter. If you read the brief article by Prof. Smadi you will see how the two are closely related. Do lifestyles and family life today for many compromise the ability of families to teach moral values to children? As noted in the text this then becomes a critical role for education. In westernized cultures is this one of the qualities referred to in the saying of 'spending quality time' with the family? An acknowledgement of a deficit?

Source: http://www.preparingforadulthood.org.uk/

Vital and complex work in two senses. On the one hand cultures try to understand themselves; and on the other, they seek to understand the other others out there: now not so far away. The patterns that are realised be they mosaic, prayers, celtic knot, tartan, languages, landscapes - rock cut architecture - sculpture; these patterns work, that is 'make a difference' by virtue of both the detail and the whole.

"Petra is half-built, half-carved into the rock ..." UNESCO.

^#If I have not used the proper name and title I will edit this accordingly asap upon advice.
 
^*Why not an Arabic coffee? Well I had one the day before. What can I say... It was different in the preparation, being an observation as in so many cultural patterns (tea). I would like to think I will have another one day. The key thing is I did not necessarily want to have the capability to run to the airport at 11pm, or back to Petra for that matter.

Inaugural Symposium on Person-centredness in the Curriculum May 2nd - 3rd

Dates
Thursday 2 May and Friday 3 May 2013
(starting at lunch time on 2 May with a full day on 3 May)

Venue
Loughview Suite, Jordanstown campus, University of Ulster, Northern Ireland

The School of Nursing at Ulster has a strong tradition of national and international leadership in the field of person-centred practice. The Institute of Nursing and Health Research at Ulster incorporates the Person-centred Practice Research Centre directed by Professor Brendan McCormack. Against this backdrop the School has been developing a programme of work with a focus on person-centredness in nursing education. It is our contention that in order to achieve maximum effect in practice, person-centredness should be embedded within and across all programmes of education for health care professionals.

This year the School of Nursing at Ulster will host its Inaugural International Symposium on Person-Centredness in Nursing Education. The one and a half day symposium will include presentations and workshops that will appeal to those involved in nursing education in academic and practice settings.

Symposium themes 
The three key themes of the symposium are:

• To explore ways of infusing a culture of person-centredness through effective, contemporary higher education
• To share innovative approaches to the facilitation of person-centredness in practice learning
• To reflect upon how the experiences of teaching teams and service users and to consider how these can shape educational approaches and teaching strategies

Target audience
The symposium will be of interest to colleagues who have an interest in promoting person-centred practice through education in practice or academic settings.

Fee
£70 (includes car parking, lunch and refreshments on both days)

To reserve a place or for further information please contact:
Julie Cummins at the Institute of Nursing and Health Research
Email: j.cummins1 AT ulster.ac.uk Telephone: +44 (0) 28 7012 4094
Web: www.science.ulster.ac.uk/nursing/international-symposium/

-----

I plan to attend this event on a topic central to h2cm.

h2cm in the presence of -alities

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

morality     personality   mentality   individuality   spirituality intentionality   transcendentality  rationality	dimensionality   causality  functionality logicality   locality   physicality artificiality  materiality  finicality
hospitality   geniality   quality informality     sociability      conjugality practicality  plurality	nationality    feudality  principality   equality  formality  confidentiality brutality  officiality   criminality

Child to adult:

"Yes, but where does reality, aboriginality, universality, proportionality, abnormality, mortality go?"

:Adult to child

Threshold Concepts: Undergraduate Teaching, Postgraduate Training and Professional Development A short introduction and bibliography

From:
Threshold Concepts: Undergraduate Teaching, Postgraduate Training and Professional Development
A short introduction and bibliography

The Meyer and Land Threshold Concept

	“The idea of threshold concepts emerged from a UK national research project into the possible characteristics of strong teaching and learning environments in the disciplines for undergraduate education (Enhancing Teaching-Learning Environments in Undergraduate Courses). In pursuing this research in the field of economics, it became clear to Erik Meyer and Ray Land [1-8, 9-16], that certain concepts were held by economists to be central to the mastery of their subject. These concepts, Meyer and Land argued, could be described as ‘threshold’ ones because they have certain features in common.”
	Glynis Cousin, An introduction to threshold concepts

As the calendar slipped across from 2011 to 2012 the discovery of threshold concepts is very timely and quite central to my own studies. Wish I'd been in time for the call for papers!

Threshold Concepts Conference

As one year ends it helps to have a gateway to new vistas and to make sure that my review of the literature is systematic.

Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs. Some health care institutions are gearing up for the challenge.

• In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
  

• In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.
  

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care. Such efforts are already under way at a number of institutions.

• Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
  

• In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
  

• The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
  

• In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditorium and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.
  

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at
www.rwjf.org/goto/cnf.

My source: Matt Freeman (PRS)