Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence

Bagster, Michelle; Myles, Hannah

doi:10.1177/1039856221992633

Cited by 3 publications

(4 citation statements)

References 46 publications

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“…No negative emotions towards formulation were found in this study, fostering a positive learning environment. Notably, ‘overwhelm’ and ‘daunt’ feelings hinder psychiatric trainees’ engagement (Bagster, 2021). This study’s outcomes suggest its methodology’s pedagogical mechanisms curbed adverse emotional responses.…”

Section: Discussionmentioning

confidence: 99%

“…Perceived difficulty has been identified as a potential major contributor to shortcomings; in a resident cohort from the USA, formulation was rated as the second most challenging skill, only behind psychotherapy (Sullivan et al, 2020). An Australian review posited that imprecision, subjectivity, and multifactorial vertical integration render formulation an intimidating task for residents (Bagster et al, 2021). Logically, the linear consequence of negative attitudes is evasion, inadequate skill attainment, insufficient skill mastery and subsequently a depletion of skilled educators perpetuating shortcomings.…”

Section:  Educational Shortcomingsmentioning

confidence: 99%

“…The predominantly favourable outcomes of these studies indicate that the complexity of skill acquisition might not inherently underlie educational deficiencies. Instead, attitudes and cultural factors could influence perceived difficulty, potentially resulting in task avoidance and degradation of skills over time (Bagster et al, 2021) (Smith, 2021). Consequently, it is reasonable to suggest fear and a fundamental lack of foundational comprehension regarding clinical benefits are significant barriers to education around formulation.…”

Section:  Educational Interventionsmentioning

confidence: 99%

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Perspectives on using a celebrity narrative to teach the psychiatric formulation to final year medical students

Hickey,

McFarland

2023

Preprint

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ObjectivesThe proficiency of an accomplished psychiatrist encompasses the development, adaptation, and refinement of a biopsychosocial formulation. A formulation aids clinical decision-making by organizing information and furnishes a documented rationale for decisions. Despite its significance, psychiatric trainees often perceive the formulation as arduous and time-intensive, leading to avoidance. Educational shortcomings are pervasive. Addressing this calls for low-cost, novel solutions. Undergraduate medical education possesses aspiring psychiatrists and provides a platform to develop a foundational understanding of formulation. This study aims to explore the viability of a novel, resource-efficient approach employing a celebrity case narrative to attain a fundamental understanding of the psychiatric formulation while concurrently elucidating activated pedagogical cognitions by using such methodology from the student’s perspective.MethodsA psychiatric formulation tutorial was conducted across five distinct final-year medical student cohorts during one academic year. A standardized tutorial structure was devised, incorporating interchangeable case studies. Following the tutorial, a post-tutorial survey was administered, followed by interviews that underwent qualitative analysis.ResultsSeventy-seven participants responded to the survey, expressing favourable views. Twenty students consented to interviews. They were distributed across five sessions with an average of four participants per group. Interviews yielded five key themes: Understanding of formulation, cognitive engagement, emotional salience and ethical considerations with twelve corresponding subthemes. The results suggested viability in using this methodology to teach formulation to foster a basic understanding and elicited a range of pedagogical phenomenon that may have contributed to this understanding.ConclusionThis study indicates that integrating a celebrity narrative into psychiatric formulation teaching intervention bears potential for enhancing engagement concurrently mitigating negative attitudes towards the formulation. The approach reveals latent learning outcomes suggesting a profound pedagogical impact. The range of pedagogical process elucidated lays a foundational research base for future instructional design and research.Declaration of interestNone

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Section: Discussionmentioning

confidence: 99%

Section:  Educational Shortcomingsmentioning

confidence: 99%

Section:  Educational Interventionsmentioning

confidence: 99%

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Perspectives on using a celebrity narrative to teach the psychiatric formulation to final year medical students

Hickey,

McFarland

2023

Preprint

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“…AustrAlAsiAn Psychiatry B agster et al's review 1 of formulation in selected psychiatry journals notes the collected wisdom that trainees can find it daunting. This wisdom has its own validity; acceptance of this underpins production of the RANZCP Formulation Guidelines cited in the review.…”

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confidence: 99%

Why is formulation daunting? A response to Bagster et al.’s ‘instructions’ for developing skills in formulation

Smith

2021

Australas Psychiatry

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Objective: To explore the theme identified by Bagster et al.1 in their selective psychiatric literature review that formulation can appear daunting. Conclusion: Formulation is understandably daunting, even though it occurs in all human encounters. The plural nature of mental symptoms is such that anxiety-provoking intuitive judgement is required at all points in both the process and explication of formulation, a type of instinctive guessing. There are no rules for this, because the laws of vertical integration of systems are not established. Guidelines are more appropriate than ‘instructions’. Much of the wider mental health and clinical reasoning literature addresses intuitive judgement, but the current psychiatric literature tends to focus on pattern recognition as a deliberative cognitive act of Type 2 processes. Arguably this reductionism adds to the dauntingness. Anxiety detected about the intuitive judgement involved can be addressed in supervision, taking into account the psychological mindedness of the trainee.

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Diagnosing mental disorders in diverse cultures

Thacore,

Dharwadkar

2024

Journal of Indira Gandhi Institute of Medical Sciences

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Our goal is to highlight challenges clinicians encounter in achieving valid psychiatric diagnoses in linguistically and culturally diverse patients. These challenges often arise from language barriers, misinterpretation of nuanced expressions of distress, and a lack of consideration for the patient’s unique experiences and perspectives regarding their illness, leading to potential misdiagnoses. In this context, we explore the strategies to address these diagnostic issues. To illustrate these challenges, clinical examples of culturally diverse patients are presented. These cases offer insights into the cultural nuances of expressing distress and attributing illness to the external factors such as cosmic influences and spiritual afflictions, often employed as a way to conceal underlying causes. To achieve culturally appropriate diagnoses, clinicians need to be mindful of their patients’ cultural and spiritual beliefs, establish trust and rapport, and approach patient narratives with empathy. This empathetic approach allows clinicians to gain a deeper understanding of the patient’s cultural expressions of distress and their perspectives on illness attribution, often tied to supernatural influences. Importantly, effective communication is a key to uncovering the concealed causes of the patient’s condition.

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Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence

Cited by 3 publications

References 46 publications

Perspectives on using a celebrity narrative to teach the psychiatric formulation to final year medical students

Perspectives on using a celebrity narrative to teach the psychiatric formulation to final year medical students

Why is formulation daunting? A response to Bagster et al.’s ‘instructions’ for developing skills in formulation

Diagnosing mental disorders in diverse cultures

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