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Case Study: Clinical Placements in Psychiatry

In the first days, the biggest challenge we had was fear… I was afraid of the patients

 Participant in psychiatry clinical placement 2013

King’s volunteers have taught an annual two-week course in psychiatry to final year medical students since 2008. This was the only course in psychiatry that the students received during medical school, and they were in desperate need of further training and exposure to patients with mental illnesses. Participants reported that prior to working with King’s volunteers, they had had no contact at all with psychiatric patients, and they were apprehensive about spending time on the wards.

In November 2013, the then KSP Mental Health Lead Dr Lauren Gavaghan travelled on an extended trip to Somaliland to further integrate psychiatry into the undergraduate curriculum at KSP’s partner medical schools. This trip ultimately led to the establishment of the first ever undergraduate clinical placements on psychiatric wards in Somaliland.

The major obstacle to providing more clinical teaching in psychiatry was the lack of experienced faculty members and clinicians who could provide supervision. During her trip, Dr Gavaghan had several meetings with the Deans of the medical schools and the KSP Mental Health Group - a group of junior doctors in Somaliland who are supported by KSP to pursue their interest in psychiatry - to see if there was a way to find local doctors who could provide support to the students.

It was agreed that, after completing the psychiatry course, small groups would do six-week placements on the psychiatry ward one or two days per week. This is organised and supervised by members of the Mental Health Group, who receive regular online supervision from King’s volunteer psychiatrists to help them manage this additional workload.

By spending more time on the wards, course participants learn how to manage real cases, and begin to feel more comfortable and confident treating patients with mental illness:

 Before I thought that all psychiatric patients were difficult to manage, but I learned to talk to them like the other patients, and most can be dealt with.

Participant in psychiatry clinical placement 2013

 

To provide additional supervision for the students, there are also weekly case discussion classes on MedicineAfrica, which students are required to attend in order to complete their placement. Students gain additional knowledge about the conditions and cases that they see on the wards, and are encouraged to develop their approach to taking histories from psychiatric patients, and to use that information to make a diagnosis:

 On MedicineAfrica my cases were discussed, corrected, and then I could use that knowledge again. [On the ward] I did not get an equal chance to learn, as no-one listened and corrected our histories.

Participant in psychiatry clinical placement 2013

 

Although the majority of course participants will not go on to have careers in psychiatry, they recognise the importance of this training. In their everyday work as junior doctors, they regularly come into contact with patients in need of psychiatric care. The junior doctors who participated in this review reported that, due to their training from KSP, they are now able to identify patients most in need, and seek help for them.

 

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