AimsOver the last decade, there have been significant developments in the use of simulation for undergraduate medical education. Despite simulation's diverse applications across the medical school curriculum, it has thus far been underutilised within psychiatry teaching. Psychiatric simulation can support students to develop strategies to elicit psychopathology, de-escalate an aggressive patient or perform a risk assessment. Such experiences can be difficult to encounter during clinical placements and may expose a student or patient to an unacceptable level of risk. We have therefore developed an immersive simulation course that aims to enhance undergraduate psychiatry training.MethodOur course was developed by medical education faculty and psychiatry staff. The course handbook includes storyboards, patient scripts and debrief guidelines. Clinical scenarios are mapped to university intended learning outcomes and include; conducting a risk assessment for a patient with emotionally unstable personality disorder and comorbid depression, managing a manic patient in the Emergency Department and assessing a patient with obsessive-compulsive disorder who has developed skin damage due to hand washing.The one-day course is delivered to groups of 4-8 students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. The course takes place in a simulation suite and is facilitated by psychiatrists and medical education faculty. Students each take the lead role during a clinical scenario in which they will encounter a simulated patient. Live video from the simulation is broadcast to other candidates. Scenarios last 10-15 minutes with a 20-30 minute group debrief immediately afterwards. The debrief utilises the PEARLS framework (Promoting Excellence and Reflective Learning in Simulation) and provides the opportunity for peer and facilitator feedback, as well as discussions regarding mental state examination, diagnosis and management.ResultQualitative and quantitative feedback has been collected via an anonymous electronic post-course questionnaire. To date, the course has received universally positive feedback. 93% of candidates rated the overall quality of the course as a learning experience as ‘excellent’. Students reported that the course helped them develop communication skills which they could apply to future clinical situations. In addition, candidates felt participation had increased their confidence in taking a psychiatric history and performing a risk assessment.ConclusionImmersive simulation is an underutilised tool in psychiatry education. Our course complements the existing educational programme of lectures and ward-based teaching and has been positively received. It provides the opportunity for students to develop interview techniques and communication skills in a safe, controlled environment.

It is commonly held that a normal electrocardiography (ECG) rules out heart failure (HF). In older populations with HF, 98% of patients have been reported to have major ECG abnormalities. Anecdotally, young patients with HF have been noted to have ECGs without major abnormalities. The aim of this study was to determine the proportion of patients aged under 65 years with HF lacking major ECG abnormalities. Data were collected for 100 consecutive admissions with HF (aged ,65 years) with echocardiogram and ECG available. ECGs were independently assessed by two cardiologists; disagreements were resolved by a third. Ejection fraction was quantified using the biplane Simpson's. Majorly abnormal ECGs contained !1 of Q waves, left ventricular hypertrophy, bundle branch block or atrial fibrillation. Minor abnormalities of ECG also recorded; these included atrial enlargement, bradycardia, tachycardia, broadening of QRS complex, poor R wave progression, left/right axis deviation, first-degree atrioventricular block and non-specific ST-T wave changes. The mean age was 50.0 years. Seventy-six had major abnormalities on ECG, 22 had minor abnormalities and two showed no abnormalities. Ejection fractions were similar across all groups (28.6 + 2.8%, 28.4 + 3.4% and 25.5 + 6.9%, respectively). Twenty-four percent of patients with HF (aged ,65 years) do not have major ECG abnormalities. Patients aged ,65 years with a clinical suspicion of HF but without major ECG abnormalities should undergo further investigation.

AimsIncreased clinical contact during undergraduate psychiatry placements has been shown to both increase the likelihood of students considering a career in psychiatry and reduce mental-health related stigma. It can be challenging to provide medical students with a valuable clinical experience, a problem which has been further exacerbated by the coronavirus pandemic. We aimed to develop a junior doctor mentoring scheme to increase clinical exposure and teaching for students.MethodsWithin NHS Lanarkshire, groups of 4–6 University of Glasgow medical students are accommodated for their five-week clinical psychiatry blocks, during which they have a varied structured timetable, providing an overview of different psychiatric specialties. As such, students meet a wide range of clinicians, which can unfortunately mean there is little continuity in their training throughout the block.We developed a mentoring scheme to help address this issue. Enthusiastic trainee doctors – including foundation year two doctors, GP trainees and psychiatry core trainees – were invited to participate. Medical students are paired with a mentor for the duration of their block, during which they meet informally on a weekly basis. Mentors provide students with ward shadowing opportunities and bedside teaching, as well as completing work-place based assessments (WPBAs), discussing case reports and providing an additional perspective for end-of-block reports.ResultsThe mentoring scheme has been running successfully for every five-week student placement since October 2020. Student feedback has been collected via an anonymous electronic questionnaire. Students were asked what they enjoyed the most about their placement, with students frequently highlighting the support from their mentor.Examples from free-text comments included, “having an assigned mentor was really useful as someone to touch base with and go through clinical cases” and, “having a mentor was invaluable – it is crucial to have a friendly face on the wards and a contact to complete WPBAs”.Informal feedback from mentors has also been positive with trainees enjoying the opportunity to develop their teaching skills and support student training. Mentors also highlighted the role's benefit for their portfolios and specialty applications.ConclusionThis simple and cost-free intervention has had resoundingly positive feedback from medical students and trainees. Medical students enjoy having consistent informal teaching, support and feedback. Our mentoring scheme will continue for all medical students in NHS Lanarkshire and we would encourage other areas to consider a similar project. By increasing clinical exposure we hope to further reduce mental health stigma amongst students and inspire the psychiatrists of tomorrow.

AimsStress and burnout is increasingly recognised as an issue for doctors in training. The 2022 General Medical Council (GMC) National Training Survey revealed that 39% of respondents were suffering from burnout to a ‘high’ or ‘very high’ degree. 51% felt their work is emotionally exhausting. There are multiple sources of stress for psychiatry trainees, including clinical demands, adverse events, the impact of emotional labour and moral injury. The Royal College of Psychiatrists recognises the importance of supporting trainees’ well-being; this has been reflected with the inclusion of personal well-being-focussed key capabilities in the new Core Psychiatry Training curriculum.MethodsTo meet these needs, we developed and delivered two interactive face-to-face workshops for Year 1 Core Psychiatry Trainees (CT1s) in the West of Scotland. Training is embedded within the CT1 educational programme and facilitated by higher trainees. The sessions cover key aspects of well-being, including the physiology of stress, risk factors for burnout and the evidence base for developing resilience. We explore the impact of errors on doctors and the health service, relevant clinical governance systems and regulatory policies, focussing on psychiatry training issues. Feedback was obtained immediately after each session via anonymous questionnaire with a mixture of Likert scale and free text responses.ResultsThere were 27 responses for workshop one and 21 for workshop two. 14 respondents felt the teaching should be mandatory for core training. There was mixed opinion regarding the overall benefit and optimum timing of the sessions within the training year. Overall, CT1s valued group discussions and wanted more time for this with less focus on GMC policy. There was also split opinion on the value of discussing institutional responses to errors, including significant adverse event reviews and Datix reporting.ConclusionOur feedback showed differing opinions on which topics should be covered during the training and their level of detail. Overall, the opportunity for group discussion – in order to share experiences with peers – appeared to be valued most. We feel the sessions provide new CT1s with an opportunity to explore problems they may encounter in a safe and supportive environment.We aim to provide trainees with a ‘toolkit’ to support their personal well-being within the workplace, as well as demystifying clinical governance systems. We plan to further develop our course materials based on our feedback, and deliver the workshops again in 2023.

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