Thinking together: a pilot scheme linking paediatric and CAMHS trainees to improve collaboration and address training gaps

Background: Mental health presentations are an increasing part of the paediatric caseload and there is growing evidence that paediatric trainees feel ill-equipped to manage these patients. Only 33% of trainees we surveyed felt that their current training programme enabled them to achieve their curriculum requirements in paediatrics or mental health respectively. CAMHS services are increasingly stretched, raising referral thresholds and making the need for closer working together across disciplines paramount. Aim: A working group of paediatric and psychiatry trainees developed the concept of Thinking Together, to tackle this training gap. The scheme involves pairing paediatric and CAMHS trainees to share in each other’s clinical encounters to foster a joint way of learning and working together, while fulfilling curriculum competencies that are otherwise difficult to achieve. Method: A pilot was launched in March 2016 where trainees from both specialties were paired for a period of 6 months, attending at least two clinical encounters in each setting. Curriculum competencies for both specialties were outlined in a resource pack. Trainees were encouraged to explore a variety of learning possibilities, including clinics, referral meetings and signposting their partner to other relevant clinical opportunities. Results: 30 trainees were surveyed and 16 of these completed pre and post pilot evaluation. Prior to participating in Thinking Together, 70% stated they had no experience of working in a jointly delivered paediatric/mental health clinic. 93% of participants felt that their patients benefitted from access to the jointly delivered paediatric and mental health clinics. Confidence in achieving curriculum competencies in paediatrics and mental health respectively, increased to 93% following involvement in the project. Conclusion: Our results highlighted that trainees felt they had achieved curriculum competencies in their linked specialty, while improving their capabilities in collaborative, patient-centred practice. Trainees felt the scheme benefited both their patients and themselves, thinking together through cases and developing a greater appreciation of different professionals’ roles and responsibilities. As the burden of mental health grows, with it’s irrefutable link to physical well being, we feel schemes such as ours will improve understanding for future trainees between the cross over of mind and body

Psychological aspects of child health: Workshops for paediatric trainees

Aims Paediatricians often see children and young people with emotional difficulties manifesting as physical illness, sometimes called medically unexplained symptoms. Mental health training for general paediatricians is often lacking which can result in over-medicalisation of the problem. Recent political and media attention has been focused on the need to improve mental health provision for child and young people. Given the demands on Child and Adolescent Mental Health Services, attempts at improving the skills of paediatricians in assessing and treating children with medically unexplained symptoms could help ease pressure and improve care. Methods We evaluated the impact on paediatric trainees’ confidence of a series of workshops about medically unexplained symptoms. Five workshops were facilitated by a Consultant Child and Adolescent Psychotherapist and took the form of case discussions. The primary outcome measure was trainees’ self-reported confidence in assessing and managing child and young people with medically unexplained symptoms. Results Thirteen trainees participated in the workshops. Self-reported confidence in assessing children and young people with medically unexplained symptoms was higher after the workshops (difference in confidence +0.88, 95% CI 0.21–1.56, p = 0.023). Trainees’ confidence in formulating and discussing a management plan was also increased (difference in confidence +1.00, 95% CI 0.57–1.43, p = 0.004). Participants identified that the workshops had increased their awareness of the psychological aspects of illness with one describing having a “better idea of the myriad of ways that psychological distress may manifest in children and young people”. Trainees also described an increasing willingness to reflect on their own response to children, young people and families with medically unexplained symptoms. Conclusion Reflective workshops for paediatric trainees improve their confidence in assessing and managing children and young people with medically unexplained symptoms. Given that this is a common presentation to general paediatricians and that they often feel unconfident managing mental health problems, we believe such workshops could be usefully incorporated into postgraduate paediatric training. Further studies will evaluate the impact on clinical outcomes and the feasibility of multi-professional training

Thinking Together: A collaboration of pediatricians and psychiatrists to improve patient care at the mental-physical interface for children and young people

Only 33 percent of London trainees surveyed felt that their current training program enabled them to achieve curriculum requirements in pediatrics or child and adolescent mental health. Child and adolescent mental health services (CAMHS) are increasingly stretched, raising referral thresholds, and making the need for working closer together across disciplines paramount. A working group of pediatric and psychiatry trainees developed the concept of Thinking Together to tackle this training gap. The scheme involves pairing pediatric and CAMHS trainees to share in each other's clinical encounters to foster a joint way of learning and working together, while fulfilling curriculum competencies that are otherwise difficult to achieve