mrcpsych course 2018 2020 - nw school of psychiatry · underpinning specialist training in...
TRANSCRIPT
Trainee Handbook
MRCPsych Course
2018 – 2020
School of Psychiatry, Health Education England North West
Dr Latha Hackett
MRCPsych Course Director
Dr Gareth Thomas
MRCPsych Deputy Course Director
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Handbook updated June 2018. Thanks to Dr Hannah Slevin, Year 3 core trainee, for her helpful
suggestions.
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Contents
Background ............................................................................................................................................... 3
Aims of the Course .................................................................................................................................... 4
The Overall Course Structure .................................................................................................................... 5
Educational Supervision ............................................................................................................................ 5
Local Academic Programme Training ....................................................................................................... 5
Structure of LAP Sessions (Broadly) .......................................................................................................... 6
Case Presentations .......................................................................................................................... 6
Journal Club ..................................................................................................................................... 7
555 Presentations ........................................................................................................................... 7
Expert Led Sessions ......................................................................................................................... 7
Flexible Session ............................................................................................................................... 7
Regional Academic Course ........................................................................................................................ 8
Attendance ................................................................................................................................................ 8
Psychotherapy........................................................................................................................................... 8
Exam Preparation ...................................................................................................................................... 8
Assignments to Evidence Learning ........................................................................................................... 9
Evaluation of the MRCPsych Course ......................................................................................................... 9
Appendix 1 – Guidance for Journal Club Presenttion & Critical Appraisal ............................................. 10
Appendix 2 - Guidelines for Case Conference Presentation ………………………………………………………………23
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Background
This Course Handbook has been written along with members of the course development group for
trainees, module leads, course facilitators, administrative staff, trainees and Educational Supervisors. In
this handbook we describe the course, its special features, overall purpose, basic structure, how it will
be run and the educational principles and philosophy on which it is based.
We strongly recommend that you read this in conjunction with other important documents relating to
the course, particularly:
The curriculum for Core Specialty Training, published by the Royal College of Psychiatrists:
https://www.rcpsych.ac.uk/traininpsychiatry/curriculaandguidance.aspx
The College syllabus on which the MRCPsych examination is based:
https://www.rcpsych.ac.uk/pdf/Core_Psychiatry_Curriculum_April_2018.pdf
The module handbooks which will be given to you on day one of the course. These handbooks
have been provided with extensive and interesting references and reading material. It is hoped
that it will encourage trainees to enjoy the subject and learn more.
An important aim of the course is to enable you to pass the MRCPsych exam, which is a crucial stepping
stone in your progression through specialty training. This is how the course is arranged to deal with
that. Firstly, the topics that are presented in the modules have been ‘mapped’ against the College
curriculum and exam syllabus:
(https://www.rcpsych.ac.uk/pdf/Core_Psychiatry_Curriculum_April_2018.pdf)
Not all of the syllabus will be covered on the course which means that you will have to learn this
through your own private study. This handbook will explain the topics that will not be covered.
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Aims of the Course
The HEE(NW) School of Psychiatry MRCPsych course has several purposes that will enable you to
practise psychiatry at the highest possible standard, safely and at a level appropriate to your year of
training. It will also prepare you for further specialist training in the future. We also aim to link together
various elements of your training, such as:
Clinical practice
Meetings with your Educational Supervisor
Psychotherapy training
Site based education programmes
Academic training with the School of Psychiatry
Exam preparation in your placement
Personal study
Revision for the MRCPsych examination.
The following diagram shows how all aspects of your training contribute to the MRCPsych course, and
how they are integrated into your training. The course covers the College curriculum and examination
syllabus and should prepare you for all of the membership exams.
The aim is to integrate all aspects of your training, making your postgraduate education a rewarding,
fulfilling and enjoyable experience. We believe that this will help you to develop as a better clinician, as
you integrate the various (otherwise separate) strands of your working life. The course has been devised
on sound educational principles.
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We are able to provide you with educational opportunities to help you to learn effectively, so you
develop into a competent core trainee, who is ready to undertake further higher specialist training, but
you have to do your own learning too. You should read through this handbook to understand the
course, the curriculum and exam syllabus. You are the vital part of the process of teaching and learning.
Psychiatry, like all clinical specialties, is changing rapidly. New treatment options are becoming
available. Alternative medications, some of them increasingly powerful, are being developed. Service
configurations are also being altered - some in the face of financial constraints, others for social and
humanistic reasons and some because the research evidence points in a particular direction.
We do recognise that the world of psychiatry you will be working in will be very different from that of
your Educational Supervisors and the things you learn now might soon be outdated too. Psychiatric
practice will be changing around you as you continue through your career. This course is designed not
just for you to learn a lot about psychiatry, to pass exams and to achieve the core curriculum
competencies, but also to develop your capacity to go on learning and developing your practice for the
rest of your career. In short, we want to support you in becoming a life-long learner.
For all these reasons, the overriding educational model on which this new course is based requires that
you research and enquire critically your own emerging clinical practice. We aim to support you in
becoming a self-directed, reflective practitioner and to understand that when you become senior
clinicians you will be the one from whom other colleagues will seek advice. You will need to develop the
ability for continued professional development, keep abreast of what is happening in psychiatry and
become lifelong learners.
The Overall Course Structure
The course is developed with the premise that you learn most of your practice in the workplace under
supervision from your Clinical Supervisor. This will be supported by the Local Academic Programme
(LAP), as well as Psychotherapy training in the locality. Additionally, there are centrally-organised
regional academic training days. Examination practice will be provided by your Clinical/Educational
Supervisor in your placement and also during Local Academic Programme training days. The regional
academic training days run by the School of Psychiatry are for 6 full days every 6 months for two years.
We have annual clinical and written progress tests.
Educational Supervision
It is mandatory that you have weekly one-hour supervision sessions with your Clinical/Educational
Supervisor. During supervision, a range of discussions should take place where you have the opportunity
to discuss clinical, educational, pastoral and career development matters. You should prepare for your
supervision sessions so that you have an agenda that meets your educational needs. In your placement
there should be ample opportunities to undertake workplace-based assessments, portfolio reviews and
to obtain CASC practice; weekly supervision is just one of these opportunities. Use every opportunity
you have to prepare yourself for your CASC examination.
Local Academic Programme Training
All Local Academic Programmes are expected to provide 15 half-day training sessions, every 6 months,
for core trainees in psychiatry. These training sessions are mandatory. The sessions will include case
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presentations, journal clubs, expert-led sessions and 555 presentations. There will also be time to
complete multiple choice questions and reflection on the learning of the day at the end of the session.
The programme is based on the syllabic curriculum, which covers areas of Core Medical Knowledge
Underpinning Specialist Training in Psychiatry (Royal College of Psychiatrists UK), with 24 months’
modular training.
Every 6 months, the following areas of psychiatry will be covered:
General Adult (6 sessions)
Old Age (2 sessions)
Child and Adolescent (2 sessions)
Intellectual Disability (1 session)
Forensic (1 session)
Substance Misuse (1 session)
Psychotherapy (1 session)
and a session on a specific disorder across age groups e.g. psychosis across the life span. The
‘across the ages’ session aims to look at areas of psychiatry (e.g. psychosis, depression, liaison,
the burden of mental illness in the family) and to compare and contrast these across childhood,
adulthood and into old age.
You will be expected to present at case presentations, journal clubs, 555 sessions and also to participate
in some of the expert-led sessions. You will be asked to do some background reading before you attend
these sessions, including reading each week’s journal club article. This will ensure you get the most out
of the education sessions. You may be asked to present more than once per semester; please see this as
a positive learning opportunity, giving you additional exam preparation and more evidence for your
learning portfolio.
Local Academic Programmes will also have around 7 weeks per 6 months to cover other topics such as
Audit/Communication Skills etc. Overall responsibility for delivery of the LAP programme lies with the
Clinical Tutor/Local Educational Leads on each site, so if you do experience any difficulties, feed this
back to them when possible. Completing the feedback forms each week will enable continued review
and improvement of the course.
Structure of LAP Sessions (Broadly)
Case Presentations
This is based on the traditional model of case presentations. It is expected to be trainee-led, but it is
also expected that some Consultants and Clinical/Educational Supervisors attend these conferences and
help facilitate rigorous discussions. It is expected that the Clinical/Educational Supervisor of the trainee
who presents the case should discuss it during supervision and make arrangements to attend the
presentation as far as possible. It is expected that the case will demonstrate many (but perhaps not all)
of the clinical features, aetiological factors, aspects of treatment, socio-cultural and ethical issues of the
theme of the week. We would encourage you to inform your Clinical/Educational supervisor about your
case presentation. They can support you in gaining access to relevant clinical cases, preparing your
presentations and support you on the day. This can be used as an opportunity to gain feedback and
evidence in your e-portfolio.
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Guidance for trainees presenting a case presentation will be provided in the appendices of this
handbook.
Journal Club
Knowledge and understanding of research is essential for trainees. This is not just for basic training but
also for passing the MRCPsych exams. It is expected that this would be trainee-led, but Consultants and
especially Clinical/Educational Supervisors are expected to take an active interest in journal clubs. It is
expected that the Clinical/Educational Supervisor of the trainee who presents the journal should discuss
it during supervision and make arrangements to attend the presentation as far as possible. Each locality
could be flexible in the methods of conducting this session but the aim should be to cover the Royal
College syllabus component of critical review.
The journal club has traditionally focussed particularly on acquiring critical appraisal skills. The intention
is to expand this to also focus on the educational content appropriate to the day’s theme.
Guidance for trainees presenting journal clubs is provided in the appendices of this handbook.
555 Presentations
The aim of this session is to give the trainee practice in summarising complex concepts and being able to
communicate this succinctly. This is analogous to clinical work, particularly when communicating with
patients and how CASC would expect trainees to present. This model consists of a concise and focused
presentation by trainees: 5 slides (excluding title slide); 5 bullet points on each slide; 5 minutes to
present. There will be some additional time for discussion after the presentation. These presentations
should include ‘key points’ or summaries of important topics, which can be explored further in your
independent learning.
Typically, there is 1x 555 presentation in each LAP half-day training session. For the General Adult
themed LAPs, however, there will be 2x 555 presentations. One of these will be related to the theme of
the LAP day. The other will be linked to the journal club presentation, and will give you some theoretical
teaching about an area of critical appraisal.
Expert Led Sessions
An ‘expert’, for the purpose of this course, is a Consultant Psychiatrist or ST4-6 trainee. However, as trainees particularly value consultant-led sessions it is hoped that this will be the norm.
The aim of this session is to have an interactive discussion and debate, combined with a ‘teaching’
component whereby both the trainees and the expert participate actively. The trainees are expected to
read about the topic beforehand. The expert’s ‘function’ is not to merely facilitate discussion but to lead
and actively participate in it, to ask questions, to generate curiosity to learn more and to provide some
teaching or guidance if required. The expert may wish to bring some form of presentation but the
session should not be purely didactic.
Flexible Session
The flexible session can be used by individual Local Educational Providers to fit their needs and
purposes. It could be used, for example, for MCQ/EMI practice, communication skills training though
videos brought by trainees, reflective practice, audit presentation etc. This time may also be used to
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review any training issues or particular clinical scenarios that have arisen out of hours. Alternatively, this
time could be used to review and reflect upon what the trainees have learned and what further reading
they will need to undertake to meet the relevant learning objectives.
Reflective Learning
At the end of each LAP session, it is recommended that you complete a piece of independent reflective
practice that should be uploaded onto your learning portfolio. This will be looked at by Supervisors.
Regional Academic Course
This will occur on 12 full days a year (Thursdays) in the Medical Education Department at North
Manchester General Hospital. There will normally be 6 face-to-face teaching days between September
and January and 6 days between March and July, throughout your first and second year of core
psychiatry training. Once again, the course will run using adult learning principles with different types of
teaching methods, such as problem-based learning, workshops and didactic teaching. You may be
expected to do some personal studying in preparation for the days’ learning. Reading material will be
sent to you in advance.
Attendance
An attendance of 70% is mandatory at both local and regional academic teaching sessions, and this
should be evidenced in your portfolio. Attendance will be monitored by the School of Psychiatry, who
will provide attendance figures for you and your Training Programme Director. We appreciate that there
are times when you may be on call/leave etc. – though this should be an infrequent occurrence.
Psychotherapy
Please refer to the psychotherapy training guidance provided:
https://nwpgmd.nhs.uk/Specialty_Schools/Psychiatry/psychotherapy-information
Exam Preparation
You must organise with your Educational Supervisor to have CASC practice, at least 2-4 sessions in your
six month placement. This could be in the form of a workplace based assessment, such as Mini-ACE and
CbD sessions.
At the end of every Local Academic Programme (LAP) session you will be given 15-20 minutes to do
some multiple choice questions and EMIs as part of the exam practice. There will be similar exam
practice during the regional academic training days.
Annually, there is an OSCE-style School Progress Test (usually end of May/early June), which all core
trainees are expected to participate in and for which you should prepare and treat as a formal
examination. You will receive detailed feedback (including mark sheets) regarding your performance.
In addition to the above exam, there is an online MCQ question bank, with mock examination papers,
which can be accessed via the Virtual Learning Environment: http://manchesterpsychiatry.net/
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Assignments to Evidence Learning
You can evidence your learning in your e-portfolio is the following way:
70% attendance record for your LAP and for the regional academic training days
Educational supervision records
On call records
Presentation handouts
Reflective learning log of the day
You must upload your attendance records prior to your TPD reviews around Dec & May; please request
these from your LAP administrator. You will be provided with your Regional Academic Programme
attendance by the School.
Evaluation of the MRCPsych Course
You will be sent feedback forms to complete after each training session. It is important that you
complete and return these to the School of Psychiatry immediately following each session.
Copies of all resources will be available on the School website www.schoolofpsychiatry.net
Dr Latha Hackett
MRCPsych, Course Director
June 2018
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Appendix 1 - Guidance for Journal Club Presentation & Critical Appraisal
Introduction
Critical appraisal skills have now become essential, both for membership exams as well as for daily
evidence-based clinical practice. The journal club is essentially a group activity and can be as interesting
and stimulating or as boring as the group wants it to be. It is a very rewarding habit if one regularly
looks at research papers to guide practice. One does not need to be a statistician to be able to do so.
The following is an introduction to journal clubs and critical appraisal. The intention is to help you
navigate through the various aspects of it. It is not meant to be a comprehensive book about critical
appraisal.
What is expected in a Journal Club Presentation
The usual way of doing journal clubs is that one person presents a paper, which is followed by a group
discussion. Although one person takes the lead, the success of the journal club depends on everyone
else making themselves familiar with the paper before the journal club meeting.
Please identify a paper to present well in advance and circulate it to everyone. This is crucially important
because discussions are very limited if nobody has a chance to read the paper. Equally, please do read
the paper circulated by your colleagues beforehand.
The presenter should make a PowerPoint/Keynote/Prezi presentation (as opposed to just using the
paper printout). One suggested method is to present it in the following sections:
Introduction (about 15 minutes)
The title of paper, the journal, authors.
The context of the paper (i.e. Why is this paper being presented,
what is its place in context of the literature on the subject)
What is the research question? (This is not always explicitly stated, in
which case one needs to think about it and try to articulate it in the
presentation).
The contents of the paper (Background, Sample, Method,
Conclusions, Limitations, Recommendations)
Relevant discussion about the statistics used
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Questions /clarifications about the paper
Critical appraisal & Discussion (this should take up major proportion of the time and involve the whole
group)
Why have the authors done this piece of research in the first place?
(What is its value?)
Does it add to the existing knowledge?
Why have the researchers chosen this particular method?
Is there other research that refutes or supports the conclusions?
Systematic step-by-step (critical) appraisal using standardized
questions /checklists (see Appendices).
[The presenter should circulate the checklist along with the paper, beforehand. The presenter should
take lead in starting the discussion first and then present his/ her own views on the particular question].
Take home points / conclusion
How are the results helpful in clinical practice?
The gist of the authors’ conclusions
Your conclusions about the paper
References / Further reading
Obtaining Feedback
The usual practice is to identify an assessor (Consultant or Higher trainee) beforehand and giving
him/her the Work Place Based Assessment form beforehand. You could also distribute some feedback
forms amongst the group.
Study Designs
Broadly speaking, study designs can be divided into quantitative and qualitative (Figure 1). The type of
study design is determined by the kind of research question that the researchers want to address (Table
1).
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Study Designs
Quantitative
Qualitative
Ecological Case-control Cohort Cross-sectional, 2 group
Analytical
Observational
Descriptive
Case reports Case series Cross-sectional Longitudinal
Experimental /
intervention
GOLD standard for drug treatments
Randomised control trials Cross-over trial N of 1 trial
Economic studies
Cost-minimisation Cost-effectiveness Cost-utility Cost-benefit
Meta-analysis & Systemic Reviews
For ‘what, how and why’ questions rather than ‘how much or how many’ type of questions.
Table 1: Study designs and research questions
Study design Research question and example of study
1 RCT
Is Agomelatin effective in treatment of sleep disturbance and depressed mood? Example: A randomized double-blind placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo for sleep disturbance and depressed mood (Serfaty et al., 2010).
2 Meta-analysis
How do second generation antipsychotics compare with each other for efficacy of treatment of Schizophrenia? Example: A meta-analysis of the efficacy of second-generation antipsychotics (Davis et al., 2003).
3 Systematic review
What is the evidence for long-term Lithium therapy for bipolar disorder? Example: Long-term Lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials (Geddes et al., 2004).
4 Qualitative study
How do patients perceive the quality of care for depression in general practice? Example: Qualitative study of patients' perceptions of the quality of care for depression in general practice (Gask et al., 2003).
5 Economic study
What is the cost effectiveness of Clozapine compared to other second-generation antipsychotics in people with Schizophrenia? Example: A Randomized controlled trial of the cost-utility of second-generation antipsychotics in people with psychosis and eligible for clozapine (Davies et al., 2009).
6 Case series Are there known cases of Cotard syndrome described in the literature? Example: Cotard's syndrome: analysis of 100 cases (Berrios & Luque, 1995).
7 Cross-over trial What is the effect of treatment with Modafinil on healthy volunteers? Example: A randomized, double-blind, crossover trial of Modafinil on mood (Taneja et al., 2007).
8 Case-control study Is environmental tobacco smoke associated with lung cancer? Example: Multicenter case–control study of exposure to environmental tobacco smoke and Lung cancer in Europe (Bofetta et al., 1998).
9 Cohort study
Is Cannabis a risk factor for Schizophrenia? Example: Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study (Zammit et al., 2002).
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A little bit of Statistics
The key is not to be afraid of it! The rest is not too difficult!
The BMJ has a fantastic series of short articles (Statistical Notes) on different statistical concepts which
are written with great lucidity (http://www.jerrydallal.com/LHSP/bmj.htm). It also has an easy-to-
navigate online version of the book – Statistics at Square One (http://www.bmj.com/about-
bmj/resources-readers/publications/statistics-square-one).
Impact Factor
The impact factor is one of three standardized measures created by the Institute of Scientific
Information (ISI) which can be used to measure the way a journal receives citations to its articles over
time (Amin & Mable, 2000). Higher the impact factor, the more the relative importance of the journal.
For example in Psychiatry; the Archives of General Psychiatry, the British Journal of Psychiatry and the
Acta Psychiatrica Scandinavica have impact factors of 12.2, 6.6, 4.2, respectively.
Peer Reviewing
In order to improve the quality of research, studies are evaluated by peers (other researchers in the
same field) before they get published. This is peer reviewing.
Conflict of Interest
Check if the study of a drug is sponsored by the pharmaceutical company that makes the drug or if the
authors work for that company or have affiliations with it. It would be easy for potential bias to creep in
such studies. Authors must clearly state any conflict of interest in the publication. It is worth reading the
recent article by Kendall (2011) about how the pharmaceutical industries have influenced antipsychotic
prescribing practices of doctors.
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Glossary
Some useful statistical concepts are explained in the glossary. The books from which these were derived
are referenced in the reading list. It is hoped that you would be motivated to read more.
Bias - Anything which erroneously influences the conclusions about groups and distorts comparisons is
bias (Rose & Barker, 1994). Bias can enter at various stages of the study (e.g. selection bias, performance
bias, exclusion bias, detection bias, publication bias) and there are methods of reducing bias.
Blinding - The process by which researchers ensure that the person/s providing the treatment or
assessing the outcome and the person/s receiving the treatment do not know which drug /intervention
(or placebo) is being experimented in which arm of the study. Studies can be single, double or triple
blind.
Confidence interval (95%) - If one repeats the experiment 100 times, the true value of p would lie within
the given range on 95 of the occasions. The smaller the confidence interval, the more accurate an
estimate.
Confounding - Confounding factor is a factor that is an alternate explanation for apparent associations
between exposures and outcomes (it alters the likelihood of an outcome and is associated with both
exposure and outcome but is not on the causal pathway).
Correlation, regression - Correlation is the relationship between variables where one depends on the
other, usually indicated by a constant / coefficient (e.g. Pearson’s ‘r’).
Regression is a mathematical tool for calculation of the exact nature of the correlation, which allows one
variable (dependent) to be predicted from another variable/s (independent). [Remember the equation:
y=a +bx !]. It could be linear, multiple linear or logistic.
Grounded theory - It is a method used in qualitative studies to compare and contrast the data (e.g.
transcripts) by coding (open coding, secondary coding, and theoretical coding) in order to find common
themes in the data from which a theory may emerge. Some studies use thematic analysis instead.
Heteregeneity In meta-analysis and systematic reviews, one needs to be confident that the studies
being compared are not very different from each other (i.e. they should not be heterogenous), except
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by chance alone. This can be inspected visually (by Forrest plots) or calculated statistically (by “chi-
square statistic”).
NNT (Number Needed to Treat) - It is the number of people who would need to be treated in order to
prevent one extra person being ill. (e.g. Lithium is effective in the treatment of moderate to severe
mania with a NNT of 6 (Taylor et al., 2009). As a clinician, one would be interested in NNTs when
considering treatment options (in addition to other things e.g. side effect profile, etc.).
Null hypothesis, p values, confidence intervals, errors - It is the number of people who would need to
be treated in order to prevent one extra person being ill. (e.g. Lithium is effective in the treatment of
moderate to severe mania with a NNT of 6 (Taylor et al., 2009). As a clinician, one would be interested in
NNTs when considering treatment options (in addition to other things e.g. side effect profile, etc.).
These are best explained with an example:
Null hypothesis: Drug X is not better than Drug Y for treatment of severe depression.
p = probability that the null hypothesis is true.
If p < 0.05 (this is an arbitrary cut-off by convention) → evidence is strong against null hypothesis for it
to be rejected → evidence favours Drug X or Y.
If p > 0.05 → null hypothesis cannot be rejected → evidence does not favour either drug.
P values should always be stated with Confidence intervals, usually stated as 95% confidence interval.
Odds - It is a way of expressing the effect of a treatment (given as a ratio). For example, continuing
treatment with antidepressants reduces the odds of depressive relapse by about two-thirds (Taylor et
al., 2009).
Power [OR (1-β)] = size of the sample - Researchers should present a power calculation which indicates
the likelihood that the sample is large enough to avoid false positive errors (but you will find this rarely
in papers).
Primary and secondary outcomes - Researchers need to define what outcomes they have measured /
assessed to show that the particular intervention / treatment is better (e.g. efficacy, side-effects, quality
of life, costs, length of admission, etc.). This is particularly tricky in psychiatry.
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Randomization - It is the method of assignment of subjects (patients) to different arms of the
experiment so as to make comparisons. There are various methods with different degrees of rigour to
do this (e.g. from flipping a coin to stratified block randomization).
Sampling - Sampling strategy could be probabilistic (e.g. simple random, systematic, stratified,
multistage and cluster) or non-probabilistic (purposive, snowballing, theoretical sampling, quota,
opportunistic); the former is used in quantitative studies and the later in qualitative studies.
As a clinician, one would be interested in knowing if a study sample has patients similar to his/her own
patient population, in which case the study recommendations might be applicable and worth trying.
Sensitivity and specificity - These concepts are used in diagnostic tests.
Sensitivity is a measure of how good a test is at identifying disease (i.e. if one has the condition/illness
what is the probability that the test would be positive for it).
Specificity is a measure of how good a test is at identifying normality (i.e. if one does not have the
condition, what is the probability that the test would be negative for it).
Example: The NASBA assay (for paediatric HIV testing) has sensitivity of 95% at 42-93 days of life and
specificity of 99%.
Type I error (OR ‘false positive’ OR ‘α’) = null hypothesis was rejected as false when in fact it was true
(i.e. Drug X was thought to be more effective when in fact it is no better than Drug Y).
Common reasons for Type I error: 1). Biased sample, 2). Too small a sample, 3). Multiple testing.
Type II error (OR ‘false negative’ OR ‘β’) = null hypothesis should have been rejected but was not (i.e.
neither drug was thought to be better but in fact one of them was actually better).
Common reasons for Type II error: low Power of study.
Literature Search
Using Boolean search strategies (using AND, OR, NOT operators) would be good way to begin a
systematic literature search
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(http://learntech.physiol.ox.ac.uk/librarytutorials/pubmed_medline_turorial_d0e68.php).
Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) has over 21 million citations!
Google Scholar is also quite a good resource for quick searches
(http://scholar.google.co.uk/).
Cochrane has its own journal club system which has online material, clinical vignettes, podcasts,
PowerPoint’s and monthly publication (Cochrane Journal Club). And it is free!
(http:/www.cochranejournalclub.com/).
Ask your local librarians- they can be really very helpful.
Get your NHS Athens password (https://register.athensams.net/nhs/nhseng/).
Referencing Systems
The two most commonly used referencing systems in the literature are:
1. Harvard system
(http://www.library.manchester.ac.uk/academicsupport/referencing/_files/JRUL-Harvard-
referencing-guide.pdf)
2. Vancouver system
(http://www.southampton.ac.uk/library/resources/documents/vancouverreferencing.pdf).
Note: Harvard system has been used in this document (except for website links).
Bibliography
Ajetunmobi, O. 2002. Making sense of critical appraisal. Arnold Publishers. London.
Bowers, D., House, A., Owens, D. 2001. Understanding clinical papers. Wiley. West Sussex.
Freeman, C., Tyrer, P. (Eds.) 2006. Research methods in psychiatry. Gaskell. The Royal College of
Psychiatrist, London.
Greenhalge, T. 2001. How to read a paper-the basics of evidence based medicine. 2nd Ed. BMJ Books.
London.
References
Amin, M., Mabe, M. October 2000. Impact factors: use and abuse. Perspectives in publishing, No. 1
[PDF] Elsevier. Available at:
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https://info.aiaa.org/SC/PC/Private%20Documents/Journals%20Subcommittee%20Materials/IFUseandA
buse.pdf [Accessed on 12/8/12].
Berrios, G.E., Luque, R. 1995. Cotard's syndrome: analysis of 100 cases. Acta Psychiatrica Scandinavica,
91(3), p. 185-188.
Bofetta, P., Agudo, A., Ahrens,W., et al. 1998. Multicenter case–control study of exposure to
environmental tobacco smoke and Lung cancer in Europe. Journal of the National Cancer Institute, 90
(19), p. 1440-1450.
Davies, L.M., Barnes, T., Jones, P., Lewis, S., Gaughran, F., Hayhurst, K., Markwick, A., Lloyd, H.2009. A
Randomized controlled trial of the cost-utility of second-generation antipsychotics in people with
psychosis and eligible for clozapine. Value in Health, 11 (4), p. 549-562.
Davis, J.M., Chen, N., Glick, I.D. 2003. A meta-analysis of the efficacy of second-generation
antipsychotics. Arch Gen Psychiatry, 60(6), p. 553-564.
Gask, L., Rogers, A., Oliver, D., May, C., Roland, M. 2003. Qualitative study of patients' perceptions of the
quality of care for depression in general practice. Br J Gen Pract., 53(489), p. 278–283.
Geddes, J., Burgess, S., Hawton, K., Jamison, K., Goodwin, G. 2004. Long-term Lithium therapy for bipolar
disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry, 161, p.
217-222.
Kendall, T. 2011. The rise and fall of atypical antipsychotics. BJPsych, 199, p.266-268.
Rose, G., Barker, D.J.P. 1994. Epidemiology for the uninitiated, 3rd Ed. BMJ Publications, London.
Serfaty, A., Osborne, D., Buszewicz, M. J., Blizard, R, Raven, P. W. 2010. A randomized double-blind
placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo
for sleep disturbance and depressed mood. International Clinical Psychopharmacology, 25(3), p.132-142.
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Taneja, I., Haman, K., Shelton, R., Robertson, D. 2007. A randomized, double-blind, crossover trial of
Modafinil on mood. Journal of Clinical Psychopharmacology, 27(1), p. 76-79.
Taylor, D., Paton, C., Kapur, S. 2009. The Maudsley Prescribing guidelines. 10th Ed. Informa Healthcare.
London.
Zammit, S., Allebeck, P., Andreasson, S., Lundberg, I., Lewis. G. 2002. Self reported cannabis use as a risk
factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ, 325 (23), p. 1195-
1212.
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Appendix 2 – Guidelines for Case conference Presentation
The objectives of case conference are:
1) Provide a forum to discuss complex/interesting cases in a supportive learning atmosphere 2) Develop your ability to present cases in a concise and logical manner 3) Develop your presentation skills
Guidelines for presenters:
1. Please use PowerPoint or similar program for the presentation.
2. You have to present a case that is relevant to the topic of the day (handbook) on which you are presenting. 3. Please meet with your educational/clinical supervisor at least 4-6 weeks prior to the presentation to identify an appropriate case to present. You may have to approach other teams/consultants to identify a case, if needed. 4. Cases can be chosen for their atypical presentation, diagnosis, complexity or for exploring management options. 5. It would be helpful if you can identify specific clinical questions that would you would like to be discussed/answered at the end of the presentation
6. We would recommend the following structure for the presentation: - Introduction (include reasons for choosing the case) - Circumstances leading to admission (if appropriate) - History of presenting complaint - Past Psychiatric history - Medical History/ current medication - Personal/family History - Alcohol/Illicit drugs history - Forensic history - Premorbid personality - Social circumstances - Mental state examination - Investigations - Progress since admission (if appropriate) - A slide with questions that you would you like to be discussed
Note that trainees should use the ICD10 criteria and be able to justify the differential diagnoses based
on this.
7. The structure of the presentation can vary as long it is logical and concise. Please build into the
presentation some natural points to stop and discuss the case, eg: after mental state examination to
take questions from audience on the history
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8. Important: Please ask a senior medical member of your team who knows the case to attend when you
are presenting. Other relevant professionals are welcome too.
Dos and Don’ts
Do
1. Be creative
2. Engage with the audience
3. Create a narrative of the case
4. Encourage debate and discussion
5. Encourage reflective practice
6. Prepare well – discuss with your CS/ES beforehand and inform the WPBA assessor in
advance.
Don’t
1. Present without any agenda or context
2. Be vague about why you are presenting
3. Give needless information
4. Cram the slides
5. Just read the slides out
6. Carry on regardless of the time
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Bibliography
1. Gelder, M., Andreason, N., Lopez-Ibor, J., Geddes, J. (Eds.) 2012. New Oxford textbook of
Psychiatry. Oxford University Press.
2. Stein, G. & Wilkinson, G. (Eds.) 2007. Seminars in General Adult Psychiatry (2nd Ed). The Royal
College of Psychiatrists. Gaskell, London.
3. Semple, D. & Smyth, R. (Eds.) 2013. Oxford Handbook of Psychiatry. Oxford University Press.
4. Brown, T. & Wilkinson, D.(Eds.) 2005. Critical Reviews in Psychiatry (3nd Ed). The Royal College of
Psychiatrists. Gaskell, London.
5. Puri, B.K.,Ho, R.C.M., Treasaden,I.H. 2011. Revision MCQs and EMIs for the MRCPsych. Hodder
Arnold, London.
Papers and Articles
Some classic papers
1. Edwards, G., Gross, M.M. (1976) Alcohol dependence: provisional description of a clinical
syndrome. British Medical Journal, 1, p.1058-61.
2. Lewis, A.J. (1938). States of depression: their clinical and aetiological differentiation. BMJ, 2,
p.875-878.
3. Coppen, A., Noguera. R., Bailey, J., Burns, B.H., Swani, M.S., Hare, E.H., Gardner, R., Maggs, R.
(1971) Prophylactic Lithium in affective disorders. Lancet, ii, p. 275-279.
4. Barrachough, B., Bunch, J., Nelson, B., Sainsbury, P. (1974) A hundred cases of suicide: clinical
aspects. BJPsych, 125, p. 355- 373.
5. Elkin,I., Shea, I., Watkins, J.T. et al (1968) National Institute of Mental Health treatment of
depression collaborative research programme: general effectiveness of treatments. Archives of General
Psychiatry, 46, p. 971-982.
6. Kessel, N. (1965) Self-poisoning. BMJ, ii, 1265-70 and 1336-40.
7. Slater, E. (1965) Diagnosis of hysteria. BMJ, I, p. 1395-1399.
8. Pollitt, J. (1957) BMJ, I, p. 194-198.
9. Andreasen, N.J.C. (1982) Negative versus positive schizophrenia: definition and validation.
Archives of General Psychiatry, 36, p. 1325-1330.
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10. Brown, G.W. & Birley, J.L.T. (1968) Crises and life changes and the onset of acute schizophrenia:
clinical aspects. Journal of Health & Social Behavior, 9, p.203-214.
11. Johnstone, E.C., Crow, T.J., Frith, C.D., et al (1976) Cerebral ventricular size and cognitive
impairment in chronic schizophrenia. Lancet, p.924-926.
12. Leff, J.P., Wing, J.K. (1971) Trial of maintenance therapy in schizophrenia. BMJ, 3, p.599-604.
13. Vaughan, C.E. & Leff, J.P. (1981) The role of maintenance therapy and relatives expressed
emotion on relapse of schizophrenia- a two-year follow-up study. BMJ, 139, p.102-104.
14. Wing, J.K. & Brown, G.W. (1961) Social treatment of chronic schizophrenia: a comparative
survey of three mental hospitals. Journal of Mental Science, p.847-861.
15. Shepherd, M. (1961) Morbid jealousy: some clinical and social aspects of a psychiatric symptom.
Journal of Mental Science, 107,p.687-704.
16. Murray Parkes, C. (1965) Bereavement and mental illness. British Journal of Mental Psychology,
38, p.1-12 and 13-26.
17. Brown, G.W., Harris, T.O., Peto, J. (1965) Life events and psychiatric disorders: nature of the
causal link. Psychological Medicine, 3, p.159-176.
18. Popper, K.R. Science: conjectures and refutations. Chapter 1, p.33-39 and p.42-59.
Papers on Gender identity disorders
Eden, K., Wylie, K., Watson, E. (2012) Gender dysphoria: recognition and treatment. Advances in
Psychiatric treatment, 18, p.2-11.
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RCPsych CPD Online
Driving and Mental disorders
Morbid jealousy
Safe Lithium Prescribing: initiation and monitoring
First episode psychosis: Part 1 -assessment, diagnosis and rationale
First episode psychosis: Part 2 -treatment approaches and service delivery
Prescription of ECT
Psychotropic medication in breastfeeding
The pharmacological management of mania
The Mental Health Act 1983: criteria for detention
Post-traumatic stress disorder
Supervised community treatment
Gender dysphoria
Alcohol and the brain
Assessment and management of obsessive compulsive disorder- 1
Assessment and management of obsessive compulsive disorder- 2
Introducing eating disorders
Managing challenging behaviour in mental health in-patient units
Risk assessment and management of violence in general adult psychiatry
The assessment of personality
Competence, capacity and decision-making ability in mental disorder
The assessment of adult bulimia
Antidepressants and psychosexual dysfunction: Part 1 – diagnosis
Antidepressants and psychosexual dysfunction: Part 2 – treatment
Mental capacity Act 2005: Part 1
Mental Capacity Act 2005: Part 2
The bedside assessment of cognition
The pharmacological management of anxiety disorders