Lost in Documentation: A Study of Case-Formulation Documentation in Letters After Outpatient Assessment

Abbas, Mohammed; Premkumar, Lekshmi; Goodarzi, Amin; Walton, Ruth

doi:10.1176/appi.ap.12060114

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…There was diversity among the papers about the purpose of formulation, with only Korner et al and Abbas et al recommending that formulation be considered primarily for its role in engaging the patient. 8,26,36…”

Section: Resultsmentioning

confidence: 99%

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

Bagster

Myles

2021

Australas Psychiatry

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Objective: To examine the peer-reviewed literature on psychiatric formulation. Methods: The term (formula*) was used to systematically search Australasian Psychiatry, Australian and New Zealand Journal of Psychiatry, British Journal of Psychiatry, BJPsych Bulletin, American Journal of Psychiatry and Academic Psychiatry. The resulting papers were reviewed. Results: Of the 42 papers located, 22 (52%) were published between 2002 and 2019; 90% papers were published in Australasian Psychiatry (15), Academic Psychiatry (12) or BJPsych Bulletin (10), journals that focus on training and clinical practice. The papers varied in their aims and recommendations and not all justified the need for formulation. Formulation was recommended as a necessity for training, a communication tool and a guide to treatment. No article provided evidence for the superiority of any type of formulation, and the role of consumers in formulation was conspicuously lacking. Conclusion: There are many ways to structure formulation. However, the existing literature does not support any particular approach. More consideration needs to be given to the needs of consumers in conceptualising and practicing formulation.

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Section: Resultsmentioning

confidence: 99%

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

Bagster

Myles

2021

Australas Psychiatry

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“…The results of a study in the UK showed that the documentation status of 150 referral letters for new patients to psychiatric clinics was low and majority of the patient records (94%) had documentation defect in general conclusions. [ 7 ] The documentation evaluation status of 52 patients with cognitive disorders showed that 17% of the reviewed medical records had documentation defects. [ 6 ] Lotfnezhad et al .…”

Section: Discussionmentioning

confidence: 99%

A quantitative study on completeness rate of documentation in psychiatric medical records

Ebnehoseini

Khorasani

Moharari

et al. 2022

Indian Journal of Psychiatry

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Background: Mental disorders are one of the leading causes of illness and disability worldwide. According to the World Health Organization (WHO), one in four people in the world will be affected by mental or neurological disorders during their lifetime. Regular evaluation of mental health outcomes plays an important role in making decisions about timely treatment of the patient. Studies show that a medical record does not provide enough information about the diagnosis, current symptoms, psychiatric medications, and side effects of current medications and treatments for ongoing health care. In this study, the completeness of paper-based psychiatric records was investigated. Aim: The current study aimed to explore the completeness rate of paper-based psychiatric medical records (PMRs) and to investigate the factors effective on documentation status. Setting: The study was conducted in Ebnesina and Dr. Hejazi Psychiatric Hospital and Education Center. The case hospital is a psychiatric teaching hospital, which has 900 beds. Materials and Methods: The completeness rate of PMRs was determined using descriptive statistics. Fleiss’ Kappa agreement and effective factors on PMRs’ documentation status were assessed. Results: In total, 83.65% ( n = 312) of the PMRs had at least one documentation defect. A significantly higher level of documentation completeness rate between different psychiatric wards was observed. Conclusion: Based on our results, it is suggested to conduct regular evaluation and provide feedback to the health-care providers, and conduct training courses.

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“…Trainee cohorts have recognised their own deficiencies and underscored the necessity for enhanced formal instruction in formulation (Crockford et al, 2004). The near total lack of compliance among trainees in documenting formulations within admission reports in a UK institution suggest shortcomings may have lasting clinical implications (Abbas et al, 2013).…”

Section:  Educational Shortcomingsmentioning

confidence: 99%

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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Lost in Documentation: A Study of Case-Formulation Documentation in Letters After Outpatient Assessment

Abstract: Although case-formulation is considered an important skill by various training bodies, it seems that this is rarely translated into daily clinical practice. The authors discuss the possible reasons for this deficiency and discuss potential solutions.

Cited by 5 publications

References 5 publications

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

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

A quantitative study on completeness rate of documentation in psychiatric medical records

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

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