Evaluating a Process for Offering Psychiatry Inpatients a Novel Onsite Sexual and Reproductive Health Clinic

Aims 1.For all eligible general adult psychiatry and substance misuse inpatients at the Royal Edinburgh Hospital (REH) to be offered appointments at a pilot onsite sexual and reproductive health (SRH) clinic. 2.To evaluate the need for this novel service using eligibility rates and attendance levels. Methods Eligibility of all inpatients on a substance misuse ward considered at admission, and a space in the clinic offered if appropriate. Reminder added to the clerking proforma. Eligibility of general adult psychiatry (GAP) inpatients considered by their multidisciplinary team (MDT) weekly. Team 1 to trial this at ward round, and team 2 to trial it at rapid rundown. A patient leaflet was created to explain the clinic. Results General adult psychiatry: In team 1, 82% (120/147) of patients were considered by the MDT over 20 weeks, and in team 2, 65% (53/82) over 10 weeks. Of all GAP patients considered, 48% (83/173) were deemed eligible. Of those, 70% (61/83) were asked if they wished to attend, usually by the junior doctor leading the QI project. Thirty-six percent (22/61) of those booked into the clinic, of which 82% attended. Substance misuse ward: Over 15 weeks, 85% (82/97) of patients admitted to the substance misuse ward were considered, deemed eligible and offered a space in the clinic at admission, of whom 15 accepted and 4 attended. Conclusion Nearly half of GAP inpatients were eligible to attend, with the total likely to be higher over time, as mental state improved. A high level of demand was demonstrated for SRH services in this population, where research also suggests a higher level of need and lower levels of access. During weeks when the QI leads were absent, it was not recorded that any patients were considered at ward rounds or rapid rundowns. It was difficult to implement a process for this whilst the clinic was still at the pilot stage. The incorporation of a reminder into the ward round template would ensure that this is always considered. A very high proportion of substance misuse patients were eligible for this clinic, highlighting higher levels of capacity. The main challenges for attendance were a high discharge rate, presence of withdrawal symptoms, and extensive passes off the ward

Peer observation of student-led teaching

The use of near-peer teaching in medical schools is increasing internationally. Peer observation of teaching (POT) is a useful and effective method for enhancing teaching experiences and quality, but its use among student peer teachers is not well documented. The aim of the study was to explore medical student perceptions on the value and limitations of POT. Ten medical students were trained as observers. Using a previously developed model, they observed 27 teaching sessions led by other students (observees), with a pre- and post-observation meeting. Observers and observees completed a survey and group interview to explore their experiences. Descriptive analysis of survey data and thematic analysis of qualitative data were conducted. Observees found feedback valuable in learning about, reflecting on, and increasing confidence in teaching practice. They felt comfortable receiving feedback and reported positively about the observers in terms of: expertise, relatability, non-intimidating presence, and awareness of the target audience. Observers reported learning more about good teaching practice. While most observers found it enjoyable, several found some aspects of giving feedback uncomfortable. Most found it difficult to establish a satisfactory dynamic, citing lack of credibility and difficulty in eliminating hierarchies. Pre-existing friendships were reported by observers as both helping and hindering the dynamic. Both observers and observees gained from the experience of POT. However, observers lacked confidence in their credibility. Further work should address how best to implement POT into the curriculum to improve teaching practice in medical students. Further training or coaching could be considered to overcome observers’ concerns. Practice pointsConsider coaching observers to address concerns of credibility.Consider collaborating with experienced staff to ensure evaluation is robust.To support sustainability, consider facilitation of experienced observers training those more junior in POT.Following initial training, observers could be given the chance to shadow an observer, do an observation and debrief with a trainer. Practice points Consider coaching observers to address concerns of credibility. Consider collaborating with experienced staff to ensure evaluation is robust. To support sustainability, consider facilitation of experienced observers training those more junior in POT. Following initial training, observers could be given the chance to shadow an observer, do an observation and debrief with a trainer.</p