Raed Hawa

Interprofessional education for delirium care: a systematic review

Abstract Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick’s evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. Studies reporting changes in patient outcomes following the delirium education intervention used an interprofessional practice (IPP) intervention in combination with interprofessional education (IPE). Our review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care. More systematic studies of the effectiveness of interprofessional delirium education interventions are needed.

Preparing International Medical Graduates for Psychiatry Residency: A Multi-Site Needs Assessment

ObjectiveDespite the growing number of international medical graduates (IMGs) training in medicine in Canada and the United States, IMG-specific challenges early in psychiatry residency have not been fully explored. Therefore, the authors conducted a needs-assessment survey to determine the needs of IMGs transitioning into psychiatry residency.MethodUsing a 15-item online questionnaire, authors conducted a needs-assessment of IMG residents in five Canadian psychiatry residency programs. The survey examined IMGs’ perceived difficulties with the transition into psychiatry residency, educational needs, and demographic data. Data were analyzed with descriptive statistics and Mann-Whitney tests.ResultsIMGs identified the following difficulties with their transition into residency: understanding the healthcare system, medical documentation, and evidence-based medicine/mental health. Language barriers and social isolation were significant factors affecting the transition into residency for residents who did not speak English as their first language. Residents who lived in Canada 12 months or less had greater perceived difficulties in psychotherapy knowledge and adapting to the Canadian healthcare system; 88% of IMGs reported having little- or- no IMG-specific preparation for psychiatry residency from their psychiatry program; however, 69% reported that they would use IMG resources if offered; 63% felt that faculty in their program should undergo training to assist with IMG transition.ConclusionSeveral perceived challenges, needs, and gaps in training were reported by IMGs in Canadian psychiatry residency programs. The results of this survey will be used to inform future curriculum development to facilitate IMG transition into psychiatry postgraduate training programs. We thank the survey working group, and, especially, Drs. N. Roberts, M. Hasnain, H. Haensel, T. Callanan and K. Skakum, J. Parent, and the postgraduate office administrative staff for each program for their assistance with survey dissemination. We also thank the Canadian Psychiatric Association Membership Affairs Committee and Members-in-Training Committee for their input in this project. We appreciate the time and effort of the participating international medical graduates from the five psychiatry residency programs.

A framework for understanding international medical graduate challenges during transition into fellowship programs.

Background: Previous studies have highlighted unique needs of international medical graduates (IMG) during their transition into medical training programs; however, limited data exist on IMG needs specific to fellowship training. Purposes: We conducted the following mixed-method study to determine IMG fellow training needs during the transition into fellowship training programs in psychiatry and surgery. Methods: The authors conducted a mixed-methods study consisting of an online survey of IMG fellows and their supervisors in psychiatry or surgery fellowship training programs and individual interviews of IMG fellows. The survey assessed (a) fellows’ and supervisors’ perceptions on IMG challenges in clinical communication, health systems, and education domains and (b) past orientation initiatives. In the second phase of the study, IMG fellows were interviewed during the latter half of their fellowship training, and perceptions regarding orientation and adaptation to fellowship in Canada were assessed. Survey data were analyzed using descriptive and Mann–Whitney U statistics. Qualitative interviews were analyzed using grounded theory methodology. Results: The survey response rate was 76% (35/46) and 69% (35/51) for IMG fellows and supervisors, respectively. Fellows reported the greatest difficulty with adapting to the hospital system, medical documentation, and balancing ones professional and personal life. Supervisors believed that fellows had the greatest difficulty with managing language and slang in Canada, the healthcare system, and an interprofessional team. In Phase 2, fellows generated themes of disorientation, disconnection, interprofessional team challenges, a need for IMG fellow resources, and a benefit from training in a multicultural setting. Conclusions: Our study results highlight the need for IMG specific orientation resources for fellows and supervisors. Maslows Hierarchy of Needs may be a useful framework for understanding IMG training needs.

Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale: Evaluating A New Clinical Assessment Tool for Bariatric Surgery Candidates.

BACKGROUND Patients who are referred for possible bariatric surgery (BS) intervention undergo a series of assessments conducted by an interdisciplinary health care team to determine suitability for surgery. Herein, we report the initial validation and reliability studies of the Bariatric Interprofessional Psychosocial Assessment Suitability Scale (BIPASS) and its relationship to interdisciplinary psychosocial assessment practices for BS. METHODS This study was conducted at the Toronto Western Hospital, a Level 1A BS center of excellence accredited by the American College of Surgeons. Phase I: a total of 4 blinded raters applied the BIPASS to 31 randomly selected BS cases referred to our program to establish interrater reliability. Phase II: in all, 3 raters with clinical experience in bariatric psychosocial care applied the BIPASS to 54 randomly selected BS cases. RESULTS In total, 46 of 54 (85.1%) patients were women. The median age of all patient cases was 49 years (range: 21-74). Raters׳ BIPASS scores ranged from 4-52 (median = 19.24, standard deviation =10.38). BIPASS scores were highly predictive of the BS psychosocial outcome (area under curve = 0.915; 95% CI: 0.844-0.985; p < 0.001). A BIPASS score of ≥16 was chosen as the cutoff score for further clinical assessment before proceeding with surgical evaluation based on a receiver operating characteristic curve analysis (sensitivity = 0.839; specificity = 0.783). The instrument has very good interrater reliability (Pearson correlation coefficient = 0.847) even among novice raters. CONCLUSION The findings show that the BIPASS is a comprehensive screening tool in the psychosocial assessment of BS candidates, which standardizes the evaluation process and systematically identify at-risk patients for negative outcomes after BS.

Attachment Style in Bariatric Surgery Care: A Case Study

In this chapter, we will summarize an approach to using attachment-informed care in the Toronto Western Hospital (TWH) Bariatric Surgery Program as an illustrative case example of how attachment style can be integrated into the clinical care of patients in medical settings. We begin with an overview of the impact of attachment style on obesity and bariatric surgery care, followed by details on the integration and application of attachment theory on bariatric surgery patients.

A Transition to Residency Curriculum for International Medical Graduate Psychiatry Trainees

The impact of these challenges can be quite profound as they may not only affect the quality of life of these new trainees but possibly also affect their overall learning experience and the quality of patient care delivered. The existing general orientation and transition to residency programs are often brief, largely didactic, and limited to teaching knowledge and skills specific to addressing the Accreditation Council of Graduate Medical Knowledge competency or addressing the Medical Expert CanMEDs role for a given specialty [5]. We created, and have subsequently implemented, an orientation program to address the special needs of IMG trainees withinthedisciplineofPsychiatryattheUniversityofToronto to facilitate their transition into their new training environment. Herein, we report the results of an educational case study, which was designed to prospectively assess the effectiveness of a psychiatry IMG transition to residency (TTR) orientation program in improving the transition into residency training for new IMG trainees.

A Case of an RLS Mimic Treated with an Antipsychotic

This case reports on a restless leg syndrome mimic that has responded to antipsychotic medication.

Psychopharmacological Management of Restless Legs Syndrome and Periodic Limb Movements in Sleep

Psychological (e.g., stress), physiological (e.g., pregnancy), pharmacological (e.g., caffeine and SSRIs) and pathological (e.g., renal failure and Parkinson’s disease) factors all play a role in RLS and PLMD. Sleep specialists debate whether continuous long-term treatment for an undulating (but at times very disruptive condition) is merited. In “quiet” times, there may be the unnecessary ingestion of regularly prescribed medication. However, the disruption of sleep is unpredictable for most patients and an overall improvement of symptoms and quality of life may be achieved with continuous treatment. We generally favor the latter approach but have observed (especially with patients on Seligiline) that there may be several months of symptom free respite after inadvertently stopping the medication. This implies that some patients may be well on published regimens.