PSYCHIATRY AND ETHICS UNIT (TEACHING)
ANNUAL REPORT
JULY 2012
Contents
Introduction
Report on Central Teaching
Examinations in 2011-12
Ethics
Annual Report for Gloucester Academy
Annual Report for AWP NHS Partnership Trust
Annual Report for Somerset Academy
Student Feedback 2011-2012
Final Site by Site Totals, Units 1-3, 2011/12
Site Teaching Timetables for 2011-12
Introduction
When I look back to my presentation to all the year 3 students in September last year, my aim was to inspire and encourage the wisest and most thoughtful to consider Psychiatry; not just as a Unit to tick off but as the most holistic of medical sciences that we are all privileged to practice. Since that time there have been many personal and systemic peaks and troughs. Progress is being made, but inevitably in these austere times, there are many challenges, but we must not lose sight of the importance of encouraging and motivating the best of the next generation to consider psychiatry and perhaps more importantly to ensure that ALL our students are encouraged to think and practice in an integrated way that never neglects the human and emotional journey that we are all on. And so to a summary of the year. The major innovation in 2011/12 was the introduction of the new Direct Observation of Clinical Skills (DOCS) exam, in response to GMC and external examiner feedback. This necessitated a change in some aspects of the teaching with a focus on the rehearsal and development of clinical skills, as well as preparation of new style vignettes. On the whole and with hard work from all those involved, the change has been relatively seamless, and the new exam is seen as a major improvement on our previous assessment. There is still work to be done to optimise further, but we can all feel pleased with what has been achieved so far. The challenge will be to develop this further whilst being mindful that our aim is not to prepare Psychiatrists, but foundation year doctors. As a result of the nature of secondary care (and its funding and focus on SMI) we have perhaps moved to far away from the common and “milder” mental disorders; a major aim for the next year will be to ensure that we focus more on these, and this will necessitate optimum collaboration with our Trust teaching deliverers, at a time when there is much uncertainty in their structure, functioning and leadership. Within this we must ensure that students see patients and learn from them as Osler said: - “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” On that note I should also add that the “retro” step that we took last year of giving the students a textbook (PRN Psychiatry) has been an unqualified success and other Schools are likely to follow suit!
Dr John Potokar, Teaching/Unit Lead
Report on Central Teaching
This consists of one day of teaching, usually on the 2nd Friday of the attachment. It was comprehensively changed this year, to give students the opportunity to have an overview of the therapies available in psychiatry, delivered by specialists in these areas. Psychotherapeutic (AM) and pharmacological (PM) treatments are covered, as well as Dr Evans’ highly respected mind/body lecture bridging the two parts of the day.
Some tweaks have been made following early feedback from the students to both parts of the day with feedback improving. Thus, quantitatively, the last two were as follows (the marks for the 3rd unit are the key ones for pharmacology, as this is the lecturer who will continue delivering these for 2012-2013).
Psychological Treatments 1 / Psychological Treatments 2 / Mind & Brain / Pharmacological Treatments 1 / Pharmacological Treatments 2Unit 3: 3.9 / 3.8 / 4.3 / 4.4 / 4.3
Unit 4: 3.7 / 3.5 / 4.1 / 2.7 / 2.8
Qualitative feedback was generally good with no specific themes, apart from a wish to move the Day away from Friday, particularly the afternoon lectures. Logistically, this has not proven possible for a variety of reasons.
Therefore, there will be little change for the 2012/2013 talks. There will be a group of speakers, led by Dr Andrew Clark, to provide the morning talks and role play on Psychological Therapies, with Dr Evans bridging to the afternoon with his mind/brain talk, followed by Dr Melichar in the afternoon covering Psychopharmacology.
Dr Jan K Melichar, Central Teaching Lead
Examinations in 2011-12
The examinations for psychiatry and ethics in 2011-12 ran smoothly, predominately because of the significant amount of work by the clinical lecturers and the administration staff.
There were some changes to the exams for this year, particularly in the clinical assessments and the feedback to students.
Overall unit assessment scheme
The overall assessment consists of two parts; component A (clinical assessment) and component B (written assessment).
Component A – the clinical assessment has one part: Direct Observation of Clinical Skills (DOCS) Examination
Component B-the written assessment has three constituent parts:
Written Examination (EMQ/MCQ)(50% of component mark)
Internal Psychiatry SSC(33% of component mark)
Ethics Written Case(17% of component mark)
Candidates must pass component A (40% of the total Unit mark) and component B (60% of the total Unit mark) to pass the Unit. To pass component A students must receive a mark of at least 50%. To pass component B students must receive a mark of at least 45% in each of the three constituent parts and a mark of at least 50% for the component overall.
Clinical assessment (Component A)
The clinical exams have used the viva format for many years. It was decided to change the format this year for a number of reasons. Firstly the psychiatry exam committee had been concerned for a number of years that some students, who were not weak candidates, failed the exam and that some borderline students, who might have passed in other units, failed psychiatry. Secondly, the GMC had indicated that vivas were not the most appropriate method of examining students and that more standardized methods should be introduced. Thirdly, the external examiner suggested that the clinical examinations should assess clinical skills as well as knowledge. Fourthly, other medical schools are changing their examinations. Given this background DOCS were introduced.
DOCS (Direct Observation of Clinical Skills) are similar to an OSCE (Objective Structured Clinical Examination) but have fewer stations. The DOCS in psychiatry consisted of three stations with each station having a stimulated patient (ie an actor with a standardized history of a mental disorder).
Each station lasted 15 minutes which included 1 minute for the candidate to read the instructions, 12 minutes to perform the allotted task and 2 minutes to transfer to the next station (and for the examiner to decide the marks). The candidate moved directly from one station to the next and completed three stations in total. Thus the whole assessment took 45 minutes for each candidate. There was a single examiner at each station, and so each candidate was assessed by three different examiners.
The candidate was marked across three domains, by the examiner, at each station and there was also a mark from the actor. The domains were approach to the patient, knowledge (asking the correct questions) and approach to the task (final summary) patient. Each domain was 30% of the mark for the station with the final 10% being the actor’s mark. Each of the three stations contributed a third of the overall mark.
Given that this was a new examination, there was concern about the whole process, particularly the marking. In the event, all the exam days went well and the feedback from the students and examiners was positive. The marks were very similar with the previous year’s viva and there were no major differences between the units.
Summary statistics of DOCS mark distribution for Psychiatry DOCS 2011-12 (and unit 4 viva 2011)
Unit 4 –May 12 / Unit 3-Mar 12 / Unit 2-Jan 12 / Unit 1-Nov 11 / Viva (Jun11)Number of students / 62 / 62 / 64 / 60 / 62
Mean mark (SD) / 64.4 (4.8) / 65.2 (5.5) / 65.2 (4.8) / 63.1 (4.6) / 64.2 (8.5)
Median / 64.4 / 65.4 / 65.1 / 62.7 / 64.5
Range / 51.8-73.9 / 51.6-78.3 / 51.3-78.0 / 51.7-75.1 / 50-86
The main area of concern was that there were no fails in the clinical assessments (compared to 6 in 2010/11, 7 in 2009/10 and 8 in 2008/09). On this point there was reassurance from the external examiner who reported that the assessments, in her view, were probably too difficult.
Written assessment (Component B)
Changes to the written assessment were less that those to the clinical assessment. The main change to the end of year written examination was the use of the Angoff method as a form of criterion referencing. This had been piloted last year. The clinical academics continued to have some concern about criterion referencing in general with somewhatlimited evidence that it was any more reliable that norm referencing. However, given that the university and the GMC have indicated that criterion referencing should be used, it was used this year. The result was that every candidate passed the end of year written exam (norm referencing would have resulted in one candidate, who was more than 4 standard deviations below the mean, failing the examination).
Given the change to the clinical assessments, in particular the loss of the long case, the iSSC was altered slightly so that the presentation started with a brief description of a case from which the main topic came. This was reflected in a minor adjustment to the marking scheme.
There were no significant changes to the ethics assessment.
Marks to the students
Bristol University has fared badly in recent years in the students’ survey and one area of concern has been feedback. The Year 3 committee therefore decided that marks should be given to the students as soon as was possible after each exam. For psychiatry, marks are now available for each student individually after each DOCS exam. The available marks are the total for each station and the overall total for the clinical exam. For the written exam, the marks are available for the combined MCQ/EMQ, the iSSC and ethics.
Changes for next year
Changes for the coming academic year will be limited due to the significant changes this year. There will be some minor alterations of how the different parts of the exams are combined. There will also be some modifications of the DOCS. The setting of the MCQ/EMQ paper should be easier as the University joins with other universities in producing a large bank of questions which participating universities can use.
Thanks to the clinical lecturers, the administrative staff, the examiners and the actors for a successful year which was very satisfactory given the significant changes made to the assessments.
Dr Tim Amos, Examinations Lead
Ethics
Owing to maternity leave for Dr AinsleyNewson, Dr Natasha Hammond-Browning took over as Ethics element Lead in January 2012. Kerry Gutridge will be replacing Natasha from September 2012 to January 2013, it is expected that there will be a new person in a permanent role from January 2013 onwards.
General Assessment: The Ethics Element continues to run smoothly. The standard of ethics case reports by students continues to be good and some were outstanding, we had a high number of distinctions this year. Feedback on case reports continues to be made available to students on an ‘opt-in’ basis, drawn to students’ attention in the handbook. However, we are looking at changing this to an automatic system of informing the student of their feedback as the current system is time consuming to the administrator and not all students ask for feedback, including the weaker students who may need this. In future, all students will be sent their feedback once it becomes available, without their mark. Any students who have failed will be contacted and offered a face to face meeting to discuss the feedback. A record will be kept of those students who do/not take up this option. Grades will no longer be released by the Centre for Ethics in Medicine.
Academy teaching has run smoothly and I would like to take this opportunity to formally thank all the academy ethics element co-ordinators and tutors for making the 2011/12 iteration of the course a success.
Note on changes since last APR report: None that I am aware of.
Points of Note: Fortunately I was able to hold an informal Away Day with the majority of the academy ethics tutors in April 2012. This was a very informative session where the tutors discussed teaching methods and suggested alterations to the content of the tutorials. This has been taken on board and will be largely incorporated into the new updated teaching materials.
Unfortunately it was not possible to hold the 2012 ‘Training the Trainer’ Ethics Away Day due to time tabling/work constraints of both the ethics element lead and academy ethics element co-ordinators. The running of this event will be attempted again for 2012/2013 although it is envisaged that similar problems will be encountered. However, the ethics element lead remains available to offer advice and support for academy tutors and leads.
2 students failed Ethics this year and are resitting.
Looking ahead to 2012/13
Continuing good relations with ethics tutors is foreseen and support provided through regular contact and advice.
Dr Natasha Hammond-Browning, Locum Ethics Lead, June 2012
Annual Report for Gloucester Academy
We had 45 students this year and the following are the highlights from 2011/12:
Changes in Personnel
Dr Attila Sipos left 2Gether NHS Foundation Trust for the sunnier climes of Basel, Switzerland in March 2012. We also lost Dr Ian Parnell, a dedicated and well respected education supervisor & internal iSSC examiner, who retired this year. We would like to extend our thanks for a job well done as well as our best wishes on their future endeavours. I was appointed to the task of filling Dr Sipos’ considerable shoes and took on the unit coordinator role in February 2012.
Introductory Lecture Week and Weekly Tutorials
The introductory week of lectures was generally successful and well received. The students found the sessions informative and many said it helped prepare them for their psychiatric block. A few complained about the length of the day as they had to sit through up to 5 different sessions in a day. A couple of students also complained about the intensity of the week and stated their preference for the lectures to be spread out across the attachment. However, most students preferred the introductory week to remain.
The single 2½ hour MSE role-play session introduced 2 years ago was expanded to 2 consecutive sessions per attachment this year. These sessions aim to develop students’ interview skills with a focus on eliciting relevant psychopathology and information to perform a risk assessment. In each session, the students were divided into 2 groups; each with a facilitator (consultant psychiatrist or higher trainee) and a professional actor who played various patient roles. The expansion allowed every student the opportunity to be in the “hot seat” at least once. Feedback has been excellent with students wanting more of the same as well as having an additional session at the end of the attachment for exam practice.
Clinical Placements
We have continued to run a clinical placement system, which allocates students to individual Educational Supervisors across the three localities in our county. Students were allocated to specific teams (either inpatient or community) and were swapped round halfway through their attachment. Sessions with the Old Age & Learning Disability teams were timetabled into their schedule. Students were encouraged to explore other psychiatric sub-specialities and contact numbers/e-mail addresses were given in their welcome packs.
SIFT money was used to pay for a PT nurse, based with the Hospital Liaison Team. In return, our students were allocated to spend a day with the team. The student starts his/her day with a 1 to 1 session with either the consultant or team manager who goes through a 45 minute tutorial on Deliberate Self Harm and Risk Assessment. The student then shadows a member of the team on the rounds through A&E and the general hospitals. Feedback has been excellent and the Director of Medical Education has reassured me he will continue to support this.
Junior Doctor Mentoring Scheme
This scheme assigns each medical student to a junior doctor in their locality, who is able to offer additional support during their placement. The scheme is generally well received though unfortunately, it did not happen for students in Unit 3. The main reasons include the departure of the junior doctor coordinating this, as well as a significant change in junior doctors during the change over period.