Harish Thampy

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems

BackgroundMental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting.MethodsA naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis.ResultsHealth professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients.ConclusionsEstablished divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

Residents as teachers: Near peer learning in clinical work settings: AMEE Guide No. 106

Abstract This AMEE Guide provides a framework to guide medical educators engaged in the design and implementation of “Resident as Teacher” programs. The suggested approaches are based on established models of program development: the Program Logic model to guide program design, the Dundee three-circle model to inform a systematic approach to planning educational content and the Kirkpatrick pyramid, which forms the backbone of program evaluation. The Guide provides an overview of Resident as Teacher curricula, their benefits and impact, from existing literature supplemented by insights from the authors’ own experiences, all of whom are engaged in teaching initiatives at their own institutions. A conceptual description of the Program Logic model is provided, a model that highlights an outcomes-based curricular design. Examples of activities under each step of this model are described, which would allow educational leaders to structure their own program based on the scope, context, institutional needs and resources available. Emphasis is placed on a modular curricular format to not only enhance the teaching skills of residents, but also enable development of future career educators, scholars and leaders. Application of the Dundee three-circle model is illustrated to allow for a flexible curricular design that can cater to varying levels of educational needs and interests. In addition, practical advice is provided on robust assessment of outcomes, both assessment of participants and program evaluation. Finally, the authors highlight the need for congruence between the formal and hidden curriculum through explicit recognition of the value of teaching by institutions, support for development of teaching programs, encouragement of evidence-based approach to education and rewards for all levels of teachers.

Clinical teaching: widening the definition

In all medical specialities, trainees are increasingly encouraged to develop teaching skills alongside their clinical professional development. However, there have been few empirical UK‐based studies that have examined trainees’ attitudes and understanding of their own engagement with educational activities. This study therefore aimed to explore this in the context of general practitioner (GP) training using a qualitative approach.

Peer-supported review of teaching: an evaluation.

Abstract Peer-supported review (also called peer observation) of teaching is a commonly implemented method of ascertaining teaching quality that supplements student feedback. A large variety of scheme formats with rather differing purposes are described in the literature. They range from purely formative, developmental formats that facilitate a tutor’s reflection of their own teaching to reaffirm strengths and identify potential areas for development through to faculty- or institution-driven summative quality assurance-based schemes. Much of the current literature in this field focuses within general higher education and on the development of rating scales, checklists or observation tools to help guide the process. This study reports findings from a qualitative evaluation of a purely formative peer-supported review of teaching scheme that was implemented for general practice clinical tutors at our medical school and describes tutors’ attitudes and perceived benefits and challenges when undergoing observation.

How To: Use audience response systems

The use of technology-enhanced learning within medical education is gaining increasing prominence as newer, cost-effective and user-friendly tools and devices become marketed.1 One such tool, audience response systems (ARS), is also commonly known as personal response systems (PRS) or ‘clickers’. The use of ARS has witnessed widespread success across both general higher education and medical education. They not only encourage greater interactivity with students, but also have been shown to enhance knowledge gain.2 There are multiple ARS products on the market aiming to provide a userfriendly, educationally valuable tool with increasing functionality and integration with presentation software. Yet, this rise in available products and options itself can be confusing and challenging. This article presents the many ways in which ARS can be used and examines potential challenges for medical educators to keep in mind when using these devices.

How to ⋯ Identify learning needs

Conceptualisation (concluding/learning from the experience) Active Experimentation (planning/trying out what you have learned) Re ective Observation (reviewing/re ecting on the experience) Figure 2 A four-stage cyclical model of reflective practice based on experiential learning. Thus reflective practice facilitates the multi-step process of the learning needs assessment described above. However, in order to close the ‘learning gap’ between the trainee’s current performance and expected competency, an action plan must subsequently be created to address this. This may be formalised through a personal development plan (PDP) whereby the trainee and their supervisor set out the required outcomes and strategies to achieve these. A widely used method of creating a wellstructured plan is to adopt a SMART approach:

Comment on ‘Continuing need for and provision of a service for non-standard implant removal’

We enjoyed reading the article by Pillai et al .1 on the subject of non-standard implant removals. The comments made in response by Bacon and Mahfoud2 regarding implants found in the ‘wrong’ …

Peer-assisted learning for Foundation doctors

Peer‐assisted learning (PAL) is a widely accepted learner‐led educational model encouraging cooperative active learning. Whereas attention has historically focussed on the use of PAL in undergraduate contexts, less is known about the benefits and challenges of using PAL for postgraduate clinical trainees. This study describes the implementation and evaluation of a PAL scheme for UK foundation‐year trainees (newly qualified doctors).

The role of mobile technology in clinical learning

The use of mobile technology is now a routine everyday activity for many individuals. Two thirds of people now own a smartphone and use their device on average for two hours a day.[1] The role of mobile technology within healthcare is gaining increasing prominence with ever rising numbers of tools available to help both healthcare professionals and patients alike. Mobile technology allows clinicians rapidly to access a wealth of clinical guidance and electronic decisions aids that can help with clinical reasoning and management.[2] Patients are now equally able to access a range of patient-facing medical information resources that can help promote patient education and patient involvement with shared decision making and condition management.[3] Attention is now also focusing on the use of mobile technology within medical education. There is a high use of mobile technology devices amongst medical students [4] and indeed some medical schools provide mobile devices to all their students.[5,6] Learners of all stages will therefore increasingly be using their mobile technology devices during placements as part of their clinical learning. GP tutors may be unfamiliar with the range and types of mobile technology resources available to learners and therefore may feel uncomfortable in encouraging learners to make best use of their device as part of their clinical learning. Furthermore, some tutors may even have negative views on learners’ use of mobile devices within the clinical environment and may question whether learners are actually using their device as an aid to learning rather than for entertainment purposes.[7] This Teaching exchange article, written primarily by medical students themselves, is therefore intended to provide practical advice and guidance for GP tutors on the many potential uses of mobile technology to enhance student learning and suggests methods for tutors of how to use mobile technology resources to enhance their own clinical instruction. What is mobile technology?

Sharing experiences of clinical teaching: an evaluation of contrasting workshops.

The literature is rich with studies describing faculty development programmes equipping clinicians with the skills and knowledge required to teach.[1] However less is known about how best to suppor...