In March 2020, COVID-19 and its associated restrictions forced a halt to in-person teaching and assessment. To try and mitigate this disruption, the psychiatry undergraduate teaching faculty developed a knowledge based remote curriculum. However, it became clear that our students sorely missed clinical and consultation experience. Prior to the pandemic we had delivered a mock Objective Structured Clinical Examination (OSCE) to those undertaking their psychiatry block. In Somerset Academy, we wanted to deliver a distanced alternative: the remote mock OSCE (ReMO). We hoped to demonstrate this would be a feasible and valuable learning experience.

In keeping with other OSCEs, ReMO had active stations (4) and a rest station. Four simultaneous Skype meetings were set up as clinical stations, each with an examiner and actor. To test the technology, students and facilitators were emailed links to each meeting in advance, and invited to sign in. Students were given individualised timings to rotate between stations. Stations involved history taking, risk assessment, and management discussions of common psychiatric presentations.

The students then rotated again, receiving personalised feedback about their performance, enabling immediate reflection and consideration of areas for development. This was followed up with written feedback, using examiner completed mark schemes.

After ReMO we invited feedback from medical students and facilitators. 7 out of the 8 medical students that participated completed a post-ReMO survey. 100% of students found ReMO “useful”, with 71% (5/7) rating it an “extremely valuable” experience and 29% (2/7) rating it “fairly valuable”. Students felt it was well organised, realistic, and increased their confidence in remote consultations and OSCE practice. 6 out of 8 facilitators completed feedback on ReMO. 100% felt that ReMO was reproducible and 83% (5/6) rated it as “fairly realistic” when compared to the face-to-face standard.

Firstly, ReMO was feasible. However, it was logistically difficult, requiring extensive organisation to ensure this relatively small group were in the right place at the right time. In future, we would consider alternative platforms such as Zoom, or specific consultation software, such as Attend Anywhere, to reduce the logistics burden and utilise features such as ‘breakout rooms’. We would recommend an allocated co-ordinator to troubleshoot any problems in real time via a group messaging service.

In conclusion, ReMO is achievable and a valuable student learning experience. Since the pilot it has become an integral part of our curriculum. We recommend that all undergraduate Psychiatry faculties consider adding it to their programme.

In response to medical students expressing concer at limited access to psychiatric placements, particularly on-the-ground teaching or witnessed patient cases, we established “Psych From The Couch” – an open-access, free, Zoom-based, interactive teaching programme. We sought to:

Explore new means of psychiatric education, assess needs of multiple “categories” of student – medical, nursing, or PA students, junior doctors, wider MDT – and meet those needs in a creative, yet virtually-limited format.

Assess disparities between students' self-declared learning deficits and objective knowledge gaps.

To explore the use and value of virtual programmes as a structured means for inclusive multi-disciplinary education of psychiatric practice.

We gathered information on students' self-declared learning needs and deficits, location, role, training level, and confidence at the outset of the programme, with data from ~180 “students”.

We experiemtned with learning styles and methods of online interaction, running a series of 10 sessions - recorded for those unable to attend - incorporating the bredth of psychiatric curricula:

Diagnostic Principles

“Organic” Psychiatry

Substance Misuse

Psychotic Disorders

Affective Disorders

Old Age Psychiatry

CAMHS

Emergencies & Legalities

Examinations in Psychiatry

Real World Psychiatry

We utilised initial sign-up forms and repeated feedback requests to assess wider student needs, establish overarching structure to our programme, and ensure learning objectives were appropriate and met.

We collated final feedback and scores at the close, assessing via examination questions and self-defined Likert scale, and incentivising feedback with a final portfolio certificate.

Demographics of open-access teaching varied broadly, from senior medical staff to access to medicine students; 92.9% were medical students. Students were diversely sourced from all years', with ~50% collectively in their penultimate or final years' of study.

Most common self-defined decficits reported were understandably anxiety regarding practical examinations or assessment given recent placement restrictions, however many reflected on anxieties regarding psychiatric emergencies, substance misuse, legal frameworks, personality disorders as a diagnostic category, and pharmacological management.

Our cohort responded warmly to our teaching style and techniques, with feedback and consequent improvements to teaching technique weekly. We were able to evidence improvements to global confidence, and confidence in key areas of prior learning anxiety.

Categorising self-defined deficits yielded fasctinating information on students' perception of their learning needs and deficits; these data may offer insight into potential deficits in the scope of nationwide psychiatric teaching.

We were able to separately identify international students' or professionals' self-defined needs as distinct from UK students and graduates, with further rich data on the potential needs of those entering the NHS workforce.

We also evidenced – with data regarding increased confidence, fewer self-defined learning deficits, significant Twitter social interaction, and in practical application of a virtual teaching methodology – proof of the concept of “Psych From The Couch”.

To highlight the presentation and treatment of catatonia in a patient with Schizophrenia.

Catatonia is a syndrome of altered motor behaviour accompanying many general and neurological disorders. It frequently goes unrecognized, leading to the erroneous conclusion that it is rare. Signs and symptoms of catatonia are commonly relieved by the intravenous (IV) administration of a barbiturate or benzodiazepine. If the patient does not fully respond to the sedative drug, ECT becomes the default.

A 61-year Caucasian male with a diagnosis of Paranoid Schizophrenia had been stable for 17 years on Clozapine. He was monitored by his GP. He resided in supported accommodation for 19 years and he was rehoused in a new borough. He was unable to obtain new prescription for Clozapine from his new GP and suffered a psychotic relapse following a period with no Clozapine and admitted under section 2 of the MHA. Clozapine was not restarted due to concerns of prolonged QTc and ectopics. Aripiprazol 15 mg and promethazine were prescribed. He was transferred to a medical ward three weeks later presenting as rigid with abnormal posturing on his bed, febrile, tachycardic and mute. He was confused, withdrawn and not responding to questions. In the medical ward he was bedbound, had high spiking temperatures, raised CK, ongoing fever.He was agitated , restless and confused with dystonic movements of arms and legs and echolalia. He developed an oral thrush, fecal impaction and was catheterised, had mittens put on due to pulling his iv cannulas. Clonazepam 2 mg QDS was prescribed, antipsychotic stopped and rehydrated. After two weeks in hospital clozapine was reintroduced and titrated accordingly. After 8 weeks Lorazepam was introduced as 1 mg QDS and he discharged to psychiatry unit on Lorazepam 1.5 mg QDS after 82 days in medical ward. He continued to be rigid and psychotic. Treatment continued with lorazepam increased up to 16 mg daily and 8 session of ECT were prescribed. Following ECT his mental state improved significantly and there was no rigidity or abnormal movements.

Catatonia is better regarded as a movement and behavioral syndrome with particular attributes and diverse antecedents. First line of treatment is high dose of Lorazepam and second line ECT. Catatonia is a diagnosable and treatable entity.More education is needed to reinforce this message for physicians, especially in emergency departments and psychiatric facilities.

The aim of this review is to systematically investigate simulation in psychiatry to enable the evidence based introduction of psychiatry simulation into the undergraduate curriculum at the University of Liverpool.

Transformations in the structure of psychiatric delivery and reductions in funding to mental health care have limited the availability of direct patient clinical experiences for medical students. Experiential learning through simulation can be utilised as a powerful pedagogical tool and provide exposure to a broad range of psychopathology.

Although psychiatric skills and knowledge are gained from the current University of Liverpool undergraduate curriculum, there is no specific well-designed psychiatry simulation.

The author searched MEDLINE, EMBASE and PsycINFO databases for studies that met the inclusion criteria. Search terms included ‘simulation (psychiatry or ‘mental health’). Studies were also searched using snowballing via citation tracking within the databases.

Inclusion criteria comprised studies of an educational intervention that involved simulation. The intervention had to be utilised within the field of psychiatric teaching.

The literature review illustrated the dearth of studies analysing role-playing (RP) and/or simulated patients (SP) in psychiatry with it typically encountered as part of the more general communication skills curriculum. Studies analysing SP and RPs demonstrate how they build on the social context of learning alongside drawing on a range of educational theories, including experiential learning. However, studies show that well-designed simulation training should encompass more facets of learning to be transformative, specifically reflecting upon ones experiences alongside understanding and interpreting this new knowledge, allowing it to guide future actions and change practice.

Studies analysing virtual-reality in psychiatry are limited but demonstrate significant improvements in students’ acquisition of key psychiatric skills and exposure to psychopathology. More studies are needed to evaluate the efficiency and cost-effectiveness of virtual-reality over more traditional methods.

Despite the increase in simulation teaching within psychiatry, and the expansion of innovative simulation approaches in other specialties, there was limited use of novel approaches found within the studies analysing psychiatric simulation. There were studies evaluating novel approaches to psychiatry simulation outside of the undergraduate curriculum.

Whilst there are barriers to overcome in simulation training, these are primarily logistical and are clearly outweighed by the educational gain demonstrated throughout this review. Simulation training in psychiatry has often remained limited to traditional communication-oriented scenarios using RP or SP. A greater emphasis on furthering the advancement and integration of more innovative approaches into psychiatric undergraduate teaching is needed.

The aim of this study was to conduct a literature search on long and short QTc and its implications on prescribing medications.

We also intended to assess the knowledge of psychiatry core trainees in the South Yorkshire region regarding QTc and its implications on prescribing for patients.

The majority of emphasis lies in ensuring the QTc interval is within range for our patients before initiation of psychotropic medication and as part of monitoring during the maintenance phase. The main dread for most psychiatrists is a prolonged QTc interval, however, a short QTc is equally important to identify and manage.

A literature search was performed using the key words “QTc, psychotropics, and ECG”. Results revealed extensive data on long QTc, but very few articles on prescribing psychotropics and short QTc. Most psychotropics are known to prolong QTc interval, which is what clinicians are worried about most when deciding to prescribe medications in mental health services. However, short QTc is also an equally important ECG finding which should not be ignored. We conducted a survey amongst core trainees in the South Yorkshire training scheme to gauge trainees’ knowledge of QTc and its implications when prescribing psychotropic medications. The survey was designed with SurveyMonkey and had seven questions to keep it user friendly.

The survey was distributed to 47 core trainees working in the South Yorkshire region with a response rate of 42.5%. CT1s comprised 30%, CT2s comprised 40% and CT3s comprised 30% of the total number of responders. 60% trainees reported performing and reviewing ECGs as an integral part of their jobs. 50% trainees believed both a short and long QTc interval were life threatening with 50% considering only long QTc as being fatal. 95% of the responders reported not knowing any medications causing QTc shortening; however 100% reported knowing medications causing QTc prolongation.

The results clearly show that we need to increase awareness regarding short QTc interval and its implications on patient health. Review of literature also highlights the challenges in treating patients with QTc abnormalities. In such situations, it's advised to seek advice from Cardiology colleagues to ensure safe and effective patient care. It would also be beneficial to arrange refresher workshops to help psychiatrists brush on their ECG skills.

To present a case of a near-miss, where an unexpected Pulmonary Embolism (PE) was identified in a patient with psychotic depression and catatonia, who almost had Electroconvulsive Therapy (ECT). Our aim is to highlight the importance of Venous-Thrombo Embolism (VTE) risk assessment in all psychiatric inpatients, particularly those with catatonia, and those about to undergo ECT.

A 53-year-old female admitted with her first presentation of psychotic depression, catatonia, poor oral intake, and significant weight loss in the community for months prior to admission. She was recommended for emergency ECT as the severity of her self-neglect was becoming life threatening. Her first ECT session was cancelled due to low potassium levels prior to ECT, which proved to be a fortunate event. She developed sudden onset chest pain the next day, and following further medical investigations; was diagnosed to have a bilateral PE, and subsequently treated with Apixaban. Due to the potential risk of ECT dislodging the clots, treatment was done by optimising medication alone; Venlafaxine 300 mg, Mirtazapine 45 mg, Haloperidol 6 mg. She made a slow but successful recovery, and was discharged home, with ongoing support from Early Intervention in Psychosis services.

We conducted a literature search, and it is well known that there is an increased risk of VTE in catatonic patients, as well as other psychiatric inpatients; due to anti-psychotic medication. Furthermore, cases have been reported where ECT was associated with increased risk of death in patients with known VTE/PE.

On retrospective review of the patient's risks of developing VTE in the community, it was clear, that she was at very high risk of developing VTE. It was also noted that she should have had a VTE risk assessment on admission, in accordance with NICE guidelines; where all acute psychiatric inpatients should have this assessed as soon as possible.

Through a process of assessment and treatment, VTE is often preventable. Identification of high-risk patients on admission to hospital is therefore crucial. It is thus, imperative that a comprehensive VTE risk assessment is completed on admission and regularly reviewed.

This case highlights the risk of missing VTE assessments in WAA Inpatients, particularly those with catatonia, about to undergo ECT, which could have been fatal. As such, VTE/PE risk assessment in such patients, about to undergo ECT, is particularly crucial.

Clinicians need to have a high index of suspicion of VTE/PE, particularly in patients with catatonia.

As a particular example of action research, to enquire into my use of Assessments of Clinical Expertise in my supervision of junior trainees, with the intention of further developing my own practice as an educator.

Work-Place Based Assessments (WPBAs) play an established role currently in the assessment of trainee doctors(tenCate, 2017). In psychiatry, supervised clinical assessments(ACE/mini-ACE) assess a trainee's proficiency in various areas. As part of my PGCert in Medical Education, I was inspired to examine how I conduct and utilise this form of assessment, and indeed the underpinning values and beliefs, about learning, and developing professional wisdom.

This enquiry was situated within the interpretivist tradition. I interrogated my views about the epistemology of knowledge, and how they had changed from pre-university. I made clear my influences from Coles (Fish & Coles, 1998) on professional practice. I investigated my values in performing an assessment, comparing them to those of the wider community. I examined the literature on the validity of this as a tool. I then performed an assessment of a junior, with a consultant observing, before interviewing them separately.

There has been a paradigm shift in how I view assessments, from pre-university in Singapore, to medical training in the UK. The history of WPBAs and the values espoused is intriguing. Consultants and experts may view assessments differently from trainees, but a core value of developing professional judgement is common.

In my interview with the consultant, there were themes around having a clear focus for an assessment, and provision of feedback; the rating scales and how they used them to stimulate feedback; and our shared values in performing an assessment. With the junior, the themes were around the delivery of feedback (including non-verbal), an appreciation of my encouraging self-reflection and understanding, and the observable values in my carrying out of the assessment, which could be compared to those of other assessors.

WPBAs have their merits, and shortfalls. I am aware of my values and beliefs when utilising them, and have identified a plan to further develop my own practice. This case study is particular, but possibly not unique, in how WPBAs are used in medical education.

The Royal College of Psychiatrists Neuroscience Project was established to promote greater integration of modern neuroscience into psychiatric training and practice. Regional “Neuronets” are being established to develop local learning opportunities. As the Southwest Neuronet, we sought to establish a high quality and sustainable regional educational event promoting modern neuroscience in psychiatry.

We developed and ran two events in collaboration with the Neuroscience Project, a whole day in-person event in September 2019 and a half day online event in January 2021. Attendees were invited from the Southwest with the latter event being shared more widely through other “Neuronets”. Both featured talks by leading experts in the neuroscience of psychiatry. The first was themed around “Neuroscience from the lab to the clinic”, building on basic research methodologies to their applications in clinical psychiatry. Our pandemic era online event, “Neuroscience of psychosis”, was structured around an evolving clinical case. Both featured interactive elements using audience polling technology to gather views and collate questions. Feedback was gathered through an online survey with individual session ratings and event ratings.

154 people attended the in-person event from across the South West Division. This included psychiatry trainees, consultants and a small number of other mental health professionals. 382 people signed up to our online event with 262 attending live and others watching recorded sessions. Feedback response rates were 42% and 33% respectively. Feedback on the practical arrangements was highly positive, particularly highlighting pre-event communication. Attendees valued the high calibre of speakers and particularly rated topics of psychiatric genetics, novel antidepressants, and autoimmune psychosis. Environmental sustainability was a prominent theme in our first event with support for our paperless approach but highlighted further potential to reduce waste associated with catering. Overall, attendees valued the opportunity to build on knowledge of basic research techniques but also wished to see greater focus on clinical applications of neuroscience, which we had responded to with the inclusion of a clinical case to frame our online event.

These events provide a prototype for low-cost regional neuroscience in psychiatry education events, in-person or online. Sustainability in terms of cost, human resources for organisation, and environmental impact are all important considerations for such events. We plan to continue to run these annually, forming part of the legacy of the Neuroscience Project. In line with feedback received, we seek to maximise the clinical relevance but also share novel research techniques encountered in the literature.

Post injection syndrome (PIS) is a serious complication that can occur after Olanzapine Long Acting Injection (LAI). It can occur without any derangement in physical observations. It is important that patients are monitored appropriately following administration of Olanzapine LAI to ensure that symptoms of PIS are appropriately identified and managed. This project aimed to evaluate the current level of knowledge about PIS in two staff groups within an Adult Forensic Service – in-patient nursing staff and junior doctors and advanced practitioners (APs) providing medical cover to inpatient wards.

Electronic surveys evaluating knowledge about the symptoms of PIS, monitoring requirements and management of possible PIS were circulated to inpatient nursing staff, junior doctors and APs working within an Adult Forensic Service in the North West of England.

1) Nursing staff knowledge – 26 nursing staff completed the survey. 4.5% of nurses correctly identified all symptoms of PIS and 72.7% believed that tachycardia or hypotension occur in PIS. 22.7% of nurses identified the correct management plan if a patient feels unwell following Olanzapine LAI. 40.9% would only request a medical review if physical observations were abnormal. 2) Junior doctor and AP knowledge – 6 doctors and 6 advanced practitioners completed the survey. 17% of doctors and APs correctly identified all symptoms of PIS. 50% believed hypotension or tachycardia were symptoms of PIS. 25% of doctors and APs identified correct management of PIS and 16.7% believed that the patient should be managed on the psychiatric ward unless physical observations became abnormal.

Levels of knowledge about the symptoms and management of PIS are low within this Adult Forensic Service. Knowledge of PIS and management of suspected PIS needs to be improved in nursing staff, junior doctors and advanced practitioners to ensure correct identification and safe management. In response to these findings, a care plan for monitoring of patients after Olanzapine LAI was developed. This included a structured monitoring proforma for completion post depot administration and instructions for managing suspected PIS. This care plan is kept in the front of the drug chart of all patients prescribed Olanzapine LAI. One-page educational summaries on PIS were written and circulated to nursing staff, junior doctors and APs. Information on Olanzapine LAI use and PIS were included in junior doctor induction materials and on-call handbook, to improve trainee awareness and knowledge.

Evidence shows that research-active trusts have better clinical patient outcomes. Psychiatric trainees are required to develop knowledge and skills in research techniques and critical appraisal to enable them to practice evidence-based medicine and be research-active clinicians. This project aimed to evaluate and improve the support for developing research competencies available to general adult psychiatry higher trainees (HT) in the North-West of England.

General Adult HT in the North–West of England completed a baseline survey in November 2019 to ascertain trainee's experience of research training provision. The following interventions were implemented to address this feedback:

A trainee research handbook was produced, containing exemplar activies for developing research competencies and available training opportunities, supervisors and active research studies.

The trainee research representative circulated research and training opportunities between November 2019 – August 2020.

Research representatives held a trainee Question and Answer session in September 2020.

All General Adult HT were asked to complete an electronic survey in November 2020 to evaluate the effect of these interventions.

18 General Adult HT completed the baseline survey in November 2019. 29.4% of trainees thought they received enough information on research competencies and 88.9% wanted more written guidance. 38.9% of trainees knew who to contact about research within their NHS Trust and 33.3% were aware of current research studies. Identified challenges for meeting research competencies included lack of time, difficulty identifying a mentor and topic and accessibility of projects.

20 General Adult HT completed the repeat survey in November 2020. 50% of trainees wanted to be actively involved in research and 35% wanted to develop evidence-based medicine skills. A minority of trainees aimed to complete only the minimum ARCP requirements. All trainees thought the handbook was a useful resource for meeting research competencies and would recommend it to other trainees. In trainees who received the handbook, 94.7% thought they had received adequate support on meeting research competencies and 94.7% knew who to contact about research in their trust. 68.4% of trainees would like further written guidance on meeting research competencies. Trainees highlighted ongoing practical difficulties with engaging with research and concern about lacking required skills for research.

Trainees are motivated to engage with research on various different levels, not purely for ARCP purposes. Simple interventions can help trainees feel adequately supported with meeting research competencies. Further work to support trainee involvement in research and improve trainee confidence in engaging with research is required.

To report on our progress and feedback running the Cambridge Mental Health Film Club. To share the recent development of a Standard Operating Protocol to help others organise Mental Health Film Screenings in order to foster discussion, engage the public, reduce stigma about mental health and build understanding.

Cinema lends itself to exploring social and mental health issues such as stigma in an enjoyable way within a limited time and budget. Viewing a film with those from different backgrounds and having a chance to discuss perspectives on meaning and significance is an effective way to promote a collaborative stance and expand perspectives. We have been running a Mental Health Film Club in Cambridge for the past 3 years and have recently celebrated our 10th screening.

We give details of our screenings and feedback. We also share our Standard Operating Protocol which covers important topics such as resources to find suitable films, obtaining copyright permission, finding suitable venues, supporting open discussions, use of social media and promoting inclusivity.

Our Mental Health Film club shows three films a year and over time has opened up to both professionals and members of the public who are interested in discussing mental health through movies and supporting recovery. We have screened many challenging and interesting films: from the impact of religious control on emergent adolescent sexuality (‘The Miseducation of Cameron Post’) to a classic film on Alcohol Dependency (‘Days of Wine and Roses’). We also support local festivals with a similar mental health theme (e.g. MEDFEST) and have recently run a very successful screening with the University of Cambridge Psychiatry Society which was introduced by a student offering subjective experience of growing up with a sibling with an Autism Spectrum Disorder (‘Life, Animated’). We promote screenings and publish all film discussions on our website (www.tinyurl.com/psychfilmclub) and Twitter in order to contribute to resources for educational use within Psychiatry training and to further involve the wider public. Feedback shows that our sessions are highly rated at helping audiences see mental health in a new way with post film discussion especially valued.

Our experience and practical advice can inspire others to start a Mental Health Film Club and promote cohesion, resilience and collaborative thinking within their locality. For future events we plan to expand into more public engagement via local Film Festivals. We welcome delegates ideas, experiences and film recommendations.

In Canada, there has been an increase in the rate of incarceration of individuals with mental health diagnoses. Overrepresentation of individuals with psychiatric diagnoses in correctional settings is well-established. Front-line officers play a central role in dealing with mental health struggles of inmates. Nonetheless, the training that officers receive is often considered inadequate. To address this gap, the goal of this study was to design, implement, and evaluate a mental health training for correctional officers at the Toronto South Detention Centre (TSDC) and Vanier Centre for Women (VCW) in Ontario, Canada.

A needs assessment was undertaken among officers at the TSDC. In response to needs identified, a one-day course was delivered to officers (n = 57) at the TSDC and VCW (n = 41). The curriculum included mental health awareness; assessment of risk; communicating with inmates in distress; and self-care. Live simulations provided the opportunity for participants to identify signs of mental illness, assess risk, and respond strategically to de-escalate situations. Participants’ knowledge and confidence in their ability to identify and assist individuals with these problems was established using pre and post measures. Participant satisfaction was also measured via a survey. A three-month follow-up administration was used to determine maintenance of gains. Focus groups at nine months were conducted to understand participants’ needs, learning, and impact of training.

The results were promising, with 92% and 88% of participants at TSDC and Vanier Centre for Women respectively expressing satisfaction and 62% and 68% at TSDC and Vanier Centre for Women respectively stating they intended to change practices. Analyses of change in knowledge and confidence scores pre to post-training showed statistically significant improvement in all areas measured. Three-month follow-up at TSDC showed 75% of respondents have applied what they learned from the training to a “moderate or great extent”. Focus group themes showed improved attitudes and ability to identify behaviours related to inmate mental health struggles and interest in further training to support officers’ mental health.

This study shows that training informed by officer learning needs can help them better meet the mental health needs of inmates. Training can improve attitudes toward inmates presenting with mental health issues. Training that is interactive and provides skills practice can have sustained impact on practice. Further training should integrate self-care to support officers' mental health.

As medical education becomes increasingly digital, there is a plethora of readily available video resources available to medical students, aimed at teaching a wide range of topics. Despite this abundance, students report a myriad of issues. These range from videos containing outdated material, being of a poor production quality, and not being entirely relevant to their learning objectives. The aim of this study is to explore student thoughts and perceptions of videos as a teaching and learning resource. As the Mental State Examination is a component of the Psychiatry curriculum that students often find difficult, we have written, filmed and produced a video series explaining and demonstrating it.

Following the production of the Mental State Examination videos at the University of Sheffield – which contained multiple doctor-patient consultations, interspersed with narration outlining the key learning points – three focus groups were undertaken. These were aimed at understanding student thoughts and perception on the new videos, and the use of videos in medical education in general. Taking a qualitative approach, thematic analysis was performed on the content of the focus groups.

There was universal positive feedback about the structure and content of the videos we had produced; students enjoyed observing the various doctor-patient consultations and felt the separate elements of the Mental State Examination was explained logically and concisely. Furthermore, students appreciated that the videos were produced at their own University, believing this added to their validity. With regards to videos as a teaching resource in general, focus groups revealed that students appreciated specific, relevant and novel video material. Most students felt that videos can play an important role in medical education. There was a unanimous belief however that videos used in medical education should be produced well and be factually correct.

Understanding how students feel about videos as a teaching and learning resource is crucial in the development of more in the future. This study suggests more video resources for many areas, both within Psychiatry, and within the greater sphere of medical education, would be welcomed. This ought to be accompanied with student evaluation.

The COVID pandemic has had both a massive impact on clinical service delivery and the way that training and education is provided. CNWL is a large NHS provider and has approximately 7000 staff working across 150 locations, providing mental health and community health services. In response to the need to share learning across the organisation, a trustwide “Safety Conversation Day” took place to spotlight the work being done to promote safety and to act as a platform to share ideas and learning across the trust. This was the first ever virtual conference organised by the trust.

The one-day conference included virtual posters and an all-day open access virtual conversation delivered via zoom. The day was divided into 6 safety themes: Safety tools; Safer Environments; Supporting and Involving Staff; Safer use of Medicines; See Think Act and Relational Security; and Prevention is Better than Cure. Frontline staff delivered 5-6 short presentations each hour highlighting new ways of working, quality improvement, local research etc.

Staff were also encouraged to submit posters for the event, with webinars held on how to write a poster held prior to the safety conversation to promote engagement. Prizes were awarded for best posters in the different categories.

A mentimeter survey was running throughout the day to get feedback from participants.

This was the largest event of this kind held by the trust. 430 unique viewers logged in during the day to watch the presentations.

Feedback was very positive on the mentimeter survey. 3 questions were asked on a likert scale of: Strongly Disagree – Strongly Agree (rated out of 5):

• – ‘I found the posters really useful': 4.5/5

• – ‘I found the presentations very useful': 4.6/5

• – ‘I will share what I've learnt about safety': 4.6/5

174 posters were presented with good representation from all services and staff groups across the trust (18 on safer use of medicines, 15 on co-production, 52 on quality improvement, 50 on COVID and non-COVID safety, 16 on use of technology, 23 on supporting and involving staff). These posters have since been downloaded 4062 times.

The first CNWL safety conference proved an excellent opportunity to celebrate achievements in patient safety in a very difficult year. It was very well-received and well-attended by staff, promoting maximal learning across the organisation.

The aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.

Collected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.

Reassessed and fedback to the trainees throughout.

Our baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.

We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.

From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.

• • Trainees must be central to the work in improving their training

• • Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan

• • Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses

• • Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes

• • Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central role

The aim of this audit was to look into patients on high dose antipsychotics who had developed complications of constipation in the PICU setting .

Antipsychotics are usually used in the treatment of Schizophrenia and other psychotic illnesses. Drug such as Clozapine mainly has a higher risk profile due to gastrointestinal hypo motility. It could present as constipation, fecal impaction or a bowel obstruction and could even lead to death.

During ward rounds enquired on bowel habits and diet.

Physical examination of patients complaining of abdominal pain.

Screened notes in past to see how many patients complained of constipation and interventions suggested and used.I65.

3 of the 10 patients on PICU were on high dose antipsychotics and 2 of them had reported constipation. Of which one required daily review and vigorous treatment with laxatives and dietary changes.

Recommendation

Bristol stool chart introduced as part of care plan for all patients.

Teaching presentation of constipation and its treatment management was given to the PICU team.

Involving medical team early on for assessment and prophylactic laxatives prescription.

Liaison with the pantry team to include more options of fruits and vegetables into daily meal plan for patients.

Data and material handed over to next trainee to Re-audit and complete audit cycle.

Appropriate prevention and early management of side effects can enhance the benefits of antipsychotics. Bowel function monitoring and the use of prophylactic laxatives for patient on high dose antipsychotics such as clozapine is advisable to prevent complications related to it.

To collate experiences of international medical graduates (trained psychiatrists) on the Medical Training Initiative (MTI) and equivalent programs (International Medical Fellowship (IMF)/CESR Fellowships) in the United Kingdom and to understand shared themes.

Three psychiatrists with the experience of being part of MTI/IMF program, for a minimum of 1 year, participated in theme guided, focussed discussions to understand common experiences. These discussion where limited to 3 broad headings. Opportunities to grow, what we wish the college knew and what we wished the trusts and supervisors knew. The experiential accounts were captured and circulated among a group of 20 MTI/IMF/CESR fellowship doctors and rated on a 5 point Likert scale varying between strongly agree to strongly disagree.

The findings suggest that the expectations and experiences of the psychiatrists on such programs share some common themes. Most of them had varied experiences under the theme ‘opportunities to grow’. The suggestions for what these doctors ‘wished the trusts, college and supervisors knew’ had a good concordance among the 20 doctors who reviewed the themes and suggestions. The details of the themes and commonalities will be discussed at the conference.

The expectations and experiences of the doctors on MTI/equivalent program share common themes. Bridging the gap between MTI experience to an excellent MTI experience would involve identifying such shared experiences, that could potentially guide development of processes, thereby making these training fellowships better tailored to each trainee.

This project aims to assess the experience of psychiatry core trainees who have undertaken core psychotherapy training (CPT), to identify what is experienced positively and potential areas of improvement.

Psychotherapy is an necessary part of core psychiatry training, requiring one short and one long case to complete core training.

An anonymous online survey was drafted, containing both qualitative and quantitative questions, to assess trainees experiences of CPT. It was circulated via Trust email (locally) and Twitter (nationally).

A total of 35 responses were received: 21 core trainees, 12 higher trainees, 1 consultant, and 1 staff grade doctor. 6 respondents had completed a short case only; 2 a long case only; 25 both; and 2 neither.

Confidence in psychotherapy knowledge was rated on a 1–5 scale (1: significantly below average to 5: significantly above average). Theoretical knowledge improved from a 2.57 average before CPT to 3.63 following, and clinical application improved from 2.43 before to 3.66 following.

Knowledge prior to delivering CPT was most commonly obtained from Balint group (71.4% of respondents) and MRCPsych courses (65.7%).

The main barriers to obtaining psychotherapy experience were: accessing supervision (60.0% of respondents); not enough patients (53.3%); and a lack of guidelines on accessing supervision and patients (43.3%). Additionally, getting time away from day jobs was identified as a concern, particularly among LTFT trainees.

Important learning points from CPT identified by trainees were: knowledge of psychoanalytic concepts, such as transference and counter-transference; differences between the theoretical models; an alternative approach to formulation; and how these skills can be useful in all clinical encounters, such as maintaining rapport, boundaries, and time-keeping. The useful role of supervision was also highlighted.

This project serves as an introductory look into how trainees view their experience of CPT, and potential areas for improvement.

Themes for improvement, arising from qualitative responses, are: clear reading list, including introductory materials; clear guidelines at induction, including supervisor contact details; improved access to supervision; patients to be allocated; protected time for psychotherapy, with extra support for LTFTs; shadowing; increased choice of modality; and more formal teaching on psychotherapy. These are key areas to be targeted to improve the trainee experience, particularly for those who risk delays in their training.

The main aim of the wellbeing day was to increase the sense of wellbeing amongst psychiatry higher trainees in the West Midlands. We first wanted to understand the wellbeing needs of the trainees and what they hoped to get out of an away day. We wanted then to evaluate whether the away day had met these needs.

The Psychiatry Trainees Committee (PTC) published a report ‘Supported and Valued? A trainee led review into morale and training within psychiatry’ in 2017. The importance of feeling valued and supported and the value trainees place upon the support of their peers, were highlighted in this report.

As higher trainees we are often geographically isolated from each other, and whilst the peer group meet once per month, this is mostly for academic lectures resulting in poor familiarity amongst trainees which can leave trainees feeling unknown and unsupported.

We decided to apply to HEE for funding for an away day. We surveyed the peer group, asking what they most wanted to get out of an away day. The results showed that ‘a morale boost’, ‘destress/relaxation’ and ‘opportunity to get to know other trainees’ were the trainee's priorities, followed by improving leadership, team working and negotiation skills.

With these priorities in mind, an away day programme was developed which included a talk from Dr Mike Blaber, a palliative care doctor with a special interest in doctors’ wellbeing, a ‘getting to know you’ art activity and a team building GPS treasure hunt funded by HEE. The day finished with a dinner in a local restaurant sponsored by Recordati. The rest of the day was paid for by the peer group.

28 higher trainees attended the away day which was held in Birmingham on 11/07/2019. Trainees gave feedback on the day using an online anonymous survey. 81% of attendees said the away day decreased their stress levels. 90% said that the day had increased their sense of wellbeing. 86% felt an increased sense of belonging and less isolated as a trainee.

Regular trainee away days may help tackle isolation and increase morale which is linked to better patient outcomes. Improving trainees’ sense of wellbeing leads to better job satisfaction, which may ultimately lead to higher rates of retention within psychiatry.

To encourage multidisciplinary team learning by introducing Child & Adolescent Mental Health (CAMHS) in-situ simulation training.

To provide focused Human Factors feedback through the expertise of senior airline pilots.

The integration of the WingFactors in-situ simulation programme to multiple departments at Whittington Health NHS Trust has transformed the education landscape. The programme has received unanimously positive feedback, and the potential benefits for not only physical, but also mental health training, have been quickly recognised. A total of 90 simulations have been performed. A number of CAMHS scenarios have been designed with the primary aims of encouraging multidisciplinary training and increasing the focus on Human Factors in Psychiatry.

Simulation scenarios were performed in real clinical environments with primed actors, thus enabling high-fidelity in-situ simulation. Immediate ‘hot’ debriefs were delivered by clinical faculty and uniformed airline pilots, with emphasis on psychological safety to encourage participation from all team members. The key learning points were then detailed in written documents and circulated to the wider team as a valuable learning resource.

The first CAMHS simulation involved the acute management of a collapsed patient in the Emergency Department toilet, with a ligature tied around her neck and accompanied by a distressed patient. Another scenario addressed de-escalation techniques when dealing with a patient presenting with an overdose, who was threatening to leave the ward and posing potential risk to herself.

The nature of these in-situ simulations enabled the multidisciplinary team to analyse practical considerations in the management of acute clinical situations. Scenarios were designed to focus on areas which had been identified as needing improvement for patient safety.

The observations provided by airline pilots increased the focus on Human Factors training. A number of key themes were identified, including the importance of effective team-briefing, distraction management and task allocation. This is of particular significance when managing a distressed patient and anxious relative, in a busy high-stress clinical environment.

In-situ simulation is a newly emerging concept in the field of Psychiatry, and the success of this programme has been highlighted through consistently positive feedback from participants, and nomination for the HSJ Award (Best Education Programme 2021). The involvement of airline pilots has promoted collaborative learning amongst the multidisciplinary team, and increased the focus on Human Factors in Psychiatry, clearly demonstrating the value of in-situ simulation training in this field.