Bridging the gap from medical to psychological safety assessment: consensus study in a digital mental health context

Background: Digital Mental Health Interventions (DMHIs) that meet the definition of a medical device are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. The MHRA uses procedures that were originally developed for pharmaceuticals to assess the safety of DMHIs. There is recognition that this may not be ideal, as is evident by an ongoing consultation for reform led by the MHRA and the National Institute for Health and Care Excellence. Aims: The aim of this study was to generate an experts’ consensus on how the medical regulatory method used for assessing safety could best be adapted for DMHIs. Method: An online Delphi study containing three rounds was conducted with an international panel of 20 experts with experience/knowledge in the field of UK digital mental health. Results: Sixty-four items were generated, of which 41 achieved consensus (64%). Consensus emerged around ten recommendations, falling into five main themes: Enhancing the quality of adverse events data in DMHIs; Re-defining serious adverse events for DMHIs; Reassessing short-term symptom deterioration in psychological interventions as a therapeutic risk; Maximising the benefit of the Yellow Card Scheme; and Developing a harmonised approach for assessing the safety of psychological interventions in general. Conclusion: The implementation of the recommendations provided by this consensus could improve the assessment of safety of DMHIs, making them more effective in detecting and mitigating risk

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Stimulating Multiligualism in Kindergartens with Croatian as a Second or Foreign Language

U ovom završnom radu bit će pobliže objašnjen pojam materinskog jezika, pojam dvojezičnosti te nekoliko različitih vrsta usvajanja dvaju jezika kao što su dvojezičnost kao prvi jezik, dvojezično usvajanje prvoga jezika, dva prva jezika ili dvojezično usvajanje prvih jezika. Isto tako, rad donosi objašnjenje razlika između drugog i stranog jezika te pojam višejezičnosti, kao i njezine važnosti i dobrobiti za dječji razvoj. Bit će objašnjen način i redoslijed usvajanja drugog jezika u ranoj i predškolskoj dobi, objašnjena uloga dobi za ovladavanje jezikom te koji sve čimbenici utječu na ovladavanje prvim i drugim jezikom. Uz to, bit će predstavljeni jezik i jezične djelatnosti iz Kurikuluma ranog i predškolskoga odgoja i obrazovanja te važnost fleksibilnosti i obostrane komunikacije roditelja i odgajatelja za što uspješnije djetetovo savladavanje odgojno-obrazovnih programa. Središnji dio rada odnosi se na nacionalne manjine i manjinske jezike te organizaciju odgojno-obrazovnih aktivnosti/programa za djecu nacionalnih manjina. U ovom dijelu su navedeni primjeri dječjih vrtića u kojima se provode dvojezični programi za djecu pripadnike nacionalne manjine.In this final paper, the concept of mother tongue, the concept of bilingualism and several different types of acquisition of two languages such as bilingualism as a first language, bilingual acquisition of a first language, two first languages or bilingual acquisition of first languages will be explained in more detail. Likewise, the paper provides an explanation of the differences between a second and a foreign language and the concept of multilingualism, as well as its importance and benefits for children's development. The method and order of acquiring a second language in early and preschool age as well as the role of age in mastering a language will be clarified in detail. Different factors that affect the mastering of a first and second language will be mentioned and clarified. In addition, the language and language activities from the Curriculum of Early and Preschool Education will be presented, as well as the importance of flexibility and mutual communication between parents and educators for the child's mastery of educational programs as successfully as possible. The central part of the work refers to national minorities and minority languages and the organization of educational activities/programs for children of national minorities. This section lists examples of kindergartens where bilingual programs are implemented for children belonging to national minorities

Stimulating Multiligualism in Kindergartens with Croatian as a Second or Foreign Language

U ovom završnom radu bit će pobliže objašnjen pojam materinskog jezika, pojam dvojezičnosti te nekoliko različitih vrsta usvajanja dvaju jezika kao što su dvojezičnost kao prvi jezik, dvojezično usvajanje prvoga jezika, dva prva jezika ili dvojezično usvajanje prvih jezika. Isto tako, rad donosi objašnjenje razlika između drugog i stranog jezika te pojam višejezičnosti, kao i njezine važnosti i dobrobiti za dječji razvoj. Bit će objašnjen način i redoslijed usvajanja drugog jezika u ranoj i predškolskoj dobi, objašnjena uloga dobi za ovladavanje jezikom te koji sve čimbenici utječu na ovladavanje prvim i drugim jezikom. Uz to, bit će predstavljeni jezik i jezične djelatnosti iz Kurikuluma ranog i predškolskoga odgoja i obrazovanja te važnost fleksibilnosti i obostrane komunikacije roditelja i odgajatelja za što uspješnije djetetovo savladavanje odgojno-obrazovnih programa. Središnji dio rada odnosi se na nacionalne manjine i manjinske jezike te organizaciju odgojno-obrazovnih aktivnosti/programa za djecu nacionalnih manjina. U ovom dijelu su navedeni primjeri dječjih vrtića u kojima se provode dvojezični programi za djecu pripadnike nacionalne manjine.In this final paper, the concept of mother tongue, the concept of bilingualism and several different types of acquisition of two languages such as bilingualism as a first language, bilingual acquisition of a first language, two first languages or bilingual acquisition of first languages will be explained in more detail. Likewise, the paper provides an explanation of the differences between a second and a foreign language and the concept of multilingualism, as well as its importance and benefits for children's development. The method and order of acquiring a second language in early and preschool age as well as the role of age in mastering a language will be clarified in detail. Different factors that affect the mastering of a first and second language will be mentioned and clarified. In addition, the language and language activities from the Curriculum of Early and Preschool Education will be presented, as well as the importance of flexibility and mutual communication between parents and educators for the child's mastery of educational programs as successfully as possible. The central part of the work refers to national minorities and minority languages and the organization of educational activities/programs for children of national minorities. This section lists examples of kindergartens where bilingual programs are implemented for children belonging to national minorities

Stimulating Multiligualism in Kindergartens with Croatian as a Second or Foreign Language

U ovom završnom radu bit će pobliže objašnjen pojam materinskog jezika, pojam dvojezičnosti te nekoliko različitih vrsta usvajanja dvaju jezika kao što su dvojezičnost kao prvi jezik, dvojezično usvajanje prvoga jezika, dva prva jezika ili dvojezično usvajanje prvih jezika. Isto tako, rad donosi objašnjenje razlika između drugog i stranog jezika te pojam višejezičnosti, kao i njezine važnosti i dobrobiti za dječji razvoj. Bit će objašnjen način i redoslijed usvajanja drugog jezika u ranoj i predškolskoj dobi, objašnjena uloga dobi za ovladavanje jezikom te koji sve čimbenici utječu na ovladavanje prvim i drugim jezikom. Uz to, bit će predstavljeni jezik i jezične djelatnosti iz Kurikuluma ranog i predškolskoga odgoja i obrazovanja te važnost fleksibilnosti i obostrane komunikacije roditelja i odgajatelja za što uspješnije djetetovo savladavanje odgojno-obrazovnih programa. Središnji dio rada odnosi se na nacionalne manjine i manjinske jezike te organizaciju odgojno-obrazovnih aktivnosti/programa za djecu nacionalnih manjina. U ovom dijelu su navedeni primjeri dječjih vrtića u kojima se provode dvojezični programi za djecu pripadnike nacionalne manjine.In this final paper, the concept of mother tongue, the concept of bilingualism and several different types of acquisition of two languages such as bilingualism as a first language, bilingual acquisition of a first language, two first languages or bilingual acquisition of first languages will be explained in more detail. Likewise, the paper provides an explanation of the differences between a second and a foreign language and the concept of multilingualism, as well as its importance and benefits for children's development. The method and order of acquiring a second language in early and preschool age as well as the role of age in mastering a language will be clarified in detail. Different factors that affect the mastering of a first and second language will be mentioned and clarified. In addition, the language and language activities from the Curriculum of Early and Preschool Education will be presented, as well as the importance of flexibility and mutual communication between parents and educators for the child's mastery of educational programs as successfully as possible. The central part of the work refers to national minorities and minority languages and the organization of educational activities/programs for children of national minorities. This section lists examples of kindergartens where bilingual programs are implemented for children belonging to national minorities

What is the lived experience of being discharged from a psychiatric inpatient stay?

Psychiatric patients encounter many difficulties post-discharge reflected by quantitative data such as high suicide rates within the first 3 months. However, little is known about why discharge is so difficult. This article aimed to understand the lived experience of being discharged from a psychiatric unit. Eight participants were interviewed to explore their experiences of discharge. Interpretative phenomenological analysis was used to analyse data. Four superordinate themes emerged: leaving hospital; the outside world; the journey to health; and self-identity/beliefs. Clinical implications and suggestions for further research are discussed.<br/

Contact with mental health services- A video library of lived experience accounts- DClin Psychology

A video library of both patients and clinicians who have accessed Mental Health Services, and the experiences that they have had. These videos have been developed jointly by people with lived experience of mental ill-health, NHS clinicians and the University of Southampton. Participants have given permission for the videos to be used to support clinicians in training. We hope that this video library will enable you to remain steadfastly focused on the person you’re working with, and your therapeutic relationship with them, when you move into busy work settings that place considerable demands on you and your colleagues

Memory perspective and self-concept in social anxiety: an exploratory study

The mental representation of self and observer perspective images are important maintaining factors in cognitive models of social phobia (Clark &amp; Wells, 1995; Rapee &amp; Heimberg, 1997). This study investigates Libby and Eibach's (2002) hypothesis that the observer perspective is used to recall memories that are incongruent with current self-concept. A total of 60 participants (divided into high and low social anxiety groups) completed a questionnaire in which they described current self-concept, recalled four memories of social occasions (two congruent, two incongruent), and rated memory age and vividness. Congruence was defined as memories that "fit" with current self-descriptions. A qualitative analysis of self-concept showed that both groups used a similar range of themes. High socially anxious participants recalled more observer perspective memories in the second incongruent memory. Congruence did not influence vividness, but public self-consciousness did. The implications of the results are discussed and suggestions made for future research

Why are we not measuring what matters in mental health in the UK? The case for routine use of recovery outcome measures

Recovery is recognised nationally and internationally as key to service improvement in mental healthcare. This article highlights the need for routine use of patient reported outcome measures (PROMs) to ensure mental health services in the UK deliver recovery-based care