Rob Selzer

Alignment: a conceptual shift from adherence

Developing a treatment plan with a patient is one of the cornerstones of clinical medicine. The current concept of adherence, a conceptual shift away from the notion of compliance, connotes an agreement to and implementation of a plan. There are, however, myriad causes that can impinge on whether or not a treatment plan is followed through. The current clinical usage of the word ‘adherence’ tends to focus on the ultimate behaviour of the patient, and as such the factors acting on the behaviour may escape attention. We propose the concept of treatment ‘alignment’. The term ‘alignment’ conveys an image of the patient and clinician in the context of a range of factors that must ‘line up’ to maximise the chances of a treatment plan being successfully implemented.

The effects of utilizing a near-patient e-learning tool on medical student learning

Abstract Context: This study aimed to develop a near-patient, e-learning tool and explore student views on how utilization of such a tool influenced their learning. Methods: Third year medical students from Monash University in Melbourne, Australia were invited to trial a novel, near-patient, e-learning tool in two separate pilots within the ward environment. All participating students were invited to contribute to focus groups which were audio-recorded, transcribed verbatim and thematically analyzed. Results: Four focus groups were conducted with a total of 17 participants. The emerging themes revealed influences on the students’ learning both prior to and during a clinical encounter, as well as following completion of an e-learning module. The unifying concept which linked all six themes and formed the central feature of the experience was patient-centered learning. This occurred through the acquisition of contextualized knowledge and the facilitation of workplace integration. Conclusions: Utilization of a near-patient e-learning tool influences medical student learning in a number of complex, inter-related ways. Clinical e-learning tools are poised to become more commonplace and provide many potential benefits to student learning. However, incorporation of technology into clinical encounters requires specific skills which should form an integral part of primary medical training.

Understanding and reducing work-related psychological distress in interns: a systematic review.

The aim of this study was to collate and evaluate studies investigating either the factors influencing work‐related psychological distress in postgraduate year one (PGY1) doctors or the strategies designed to reduce it. This is a systematic review conducted in May 2014. The data sources were key databases (MEDLINE, PsycINFO and Embase) and manual searches of reference lists for relevant studies published in the last 15 years. This study is an empirical research designed either to elucidate the factors influencing work‐related psychological distress in PGY1 doctors, or examine the effects of an intervention designed to reduce it. Key information was extracted into an electronic data extraction form, which incorporated elements of Murphys model of work stress factors. A total of 21 studies was included in the review; 16 studies had examined the factors influencing work‐related psychological distress, four studies had investigated strategies to reduce it, and a single study addressed both. Analysis of the findings of each individual study through the conceptual framework provided by Murphys model revealed a discrepancy between the factors influencing work‐related psychological distress and the focus of strategies designed to reduce it. Factors such as career progression and a PGY1 doctors role within the organisation were not addressed in the interventions identified. Significant sources of psychological distress in PGY1 doctors remain overlooked by current interventions. Strategies designed to prevent or reduce psychological distress should be broad‐based and grounded in both the literature exploring salient factors and existing theories of work‐related stress.

Formulation for beginners

Objective: Developing a formulation is an important method of understanding the people we treat. Writing a formulation need not be seen as burdensome or difficult. Our objective is to provide a framework for the formulation process to make it more accessible for beginners. Conclusion: We describe a method that beginners can adopt easily and then build upon as their experience and knowledge broadens.

Twelve Tools for Teaching Medical Students

Objective: The aim of this paper is to outline strategies for teaching psychiatry to medical students. The background is that todays medical students are tomorrows doctors. Undergraduate psychiatry teaching provides us a unique opportunity to instil positive attitudes, knowledge and skills in the medical workforce of the future. Moreover, teaching has many positives for the individual clinician, their service and the community. Conclusions: We outline 12 strategies that we find makes teaching not only enjoyable for us, but engaging, memorable and relevant for students.

What do GPs want from a psychiatrist's letter?

Objective: The aim of this study was to investigate the preferences of general practitioners (GPs) in reply letters for patients referred for a one-off psychiatric assessment. Method: A sample of GPs referring to a primary mental health team service were mailed a questionnaire inquiring into the usefulness of 21 different letter items. Results: The response rate was 51%. Many of the items in our routine reply letters were rated highly, but others such as developmental history, supplementary information and a comprehensive report were not. Sending a copy of the letter to the patient was rated as useful by only 42.5%. Conclusions: The Royal Australian and New Zealand College of Psychiatrists’ guidelines for reply letters are endorsed. There are, however, some additional items that GPs may find useful.

Designing a referral form.

The results highlighted the need for a comprehensive and thorough orientation program with eight (57%) participants identifying a strong theme of inadequate information. Suggestions on improving orientation included staggering orientation, a cross-cultural focus, explanation of case management, overview of the Australian legal system, introductions to senior staff, restricting driving requirements and debriefing after the commencement of clinical work.

Twelve tips for performing well in vivas

Abstract The viva examination is a common method of assessment in medical education. It is, in essence a performance given by candidates to examiners, and as such, candidates would be well advised to optimize their performance. Knowledge and skills are essential to passing the viva, but they alone are not sufficient. The process of the performance is also important, but it is not often made explicit in feedback during viva practice. Moreover, there are many aspects to the performance process that can be worked on to improve candidates’ chances of passing. Here we present 12 tips focused on performance processes, for use by supervisors and their trainees.

Supporting the front line: the development of a consultation liaison psychiatry model in primary health care.

In light of the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners Through the Medicare Benefits Schedule by the Australian Government in late 2006, information obtained by the Inner South East Primary Mental Health and Early Intervention Team (PMHT) in Victoria regarding the types of mental illness commonly seen by the service, may be of interest to mental health workers. PMHTs were established in Victoria in 2002 to develop a more inclusive mental health service and to strengthen the partnership between specialist services and primary care providers (for a recent review of collaborative models see Craven and Bland).

Reflections of a CEQ Examiner

The Critical Essay Question (CEQ) tests some of the key skills necessary for the practice of psychiatry. Many candidates find the CEQ a challenge but there are some basic rules of writing which can help.