Can online distance learning improve access to learning in conflict zones? The Oxford Psychiatry in Iraq (OxPIQ) experience

Psychiatry trainees in Iraq face many challenges that limit their immediate access to training opportunities. These include limited opportunities to attend international conferences due to visa restrictions, reduced access to evidence-based practice and guidelines and less experience in conducting quality improvement projects and audits. There are also issues related to their training programmes, including lack of regular meetings with supervisors and fewer opportunities for case-based discussions. Clinical Psychiatry is thus a potential key affected clinical domain due to the above factors. Technological advances in the field of e-learning created concepts such as Technology-enhanced or Web-based learning (TEL or WBL). These developments enabled the formation of “virtual teams” using an online platform. These teams overcome logistical geographical and other barriers to enable professionals to connect and learn from each other. This paper includes an appraisal of the TEL, looking at its advantages and challenges in meeting the needs of learners and educators. Also, we describe how we incorporated evidence-based and good practice guidelines on TEL use in these circumstances to the design, delivery and early evaluation of the distance learning programme. In our conclusion, we add to these and draw attention to the use of established online platforms (Medicine Africa in this case) and the importance of involving Iraqi Training leads, trainees and institutions in identifying trainee learning needs and supporting existing training provisions

Impact of mhGAP-IG training on primary care physicians’ knowledge of mental, neurological and substance use disorders in Iraq

To address the growing need for good-quality mental health service provision to patients in Iraq, mhGAP-IG 2.0 training in mental, neurological and substance use (MNS) disorders was delivered for primary care physicians in May–June 2022 by the Royal College of Psychiatrists (RCPsych) volunteers scheme. An innovative hybrid model was used to deliver this training to improve engagement compared with virtual training alone. Pre- and post-training assessment tools showed a significant improvement in participants knowledge of MNS disorders. Follow-up fortnightly supervision sessions by RCPsych volunteers were planned to help participants consolidate their learning in managing MNS disorders

Reliability and validity of the FORUM-P and FORUM-C: two novel instruments for outcome measurement in forensic mental health

We conducted a series of tests on the FORensic oUtcome Measure (FORUM), a novel tool for measuring outcomes in forensic mental health services, which consists of complementary patient-reported (FORUM-P) and clinician-reported instruments (FORUM-C). Inpatients and outpatients at a UK forensic psychiatric regional service completed the FORUM-P and members of their clinical teams completed the FORUM-C. Patients and clinicians also provided qualitative feedback on the instruments. We assessed test-retest and inter-rater reliability in standard ways. Sixty-two patients participated with a mean age of 41.0 years (standard deviation 11.3). Thirty-five clinicians provided information about these patients. For internal consistency, Cronbach’s alpha for FORUM-P was 0.87 (95% confidence interval 0.80–0.93) and for FORUM-C was 0.93 (95% confidence interval 0.91–0.96). For test-retest reliability, weighted kappa for FORUM-P was 0.44 (95% confidence interval 0.24–0.63) and for FORUM-C was 0.78 (95% confidence interval 0.73–0.85). For inter-rater reliability, Spearman correlation coefficient for overall FORUM-C score between the first rating by clinician 1 and clinician 2 was 0.47 (95% confidence interval 0.18–0.69). For comprehensiveness, comprehensibility, and relevance FORUM-P and FORUM-C were both rated as good. FORUM-P and FORUM-C provide a novel, robust set of complementary instruments with promising psychometric properties for monitoring outcomes in forensic mental health

Neuropsychological assessment of aggressive offenders: a Delphi consensus study

ObjectiveThis study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression.MethodsAn international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability.ResultsThe panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed.ConclusionsThis research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify