Evaluation by undergraduate medical students of a role-playing training program on the management of acute states of agitation

Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation

BACKGROUND

Agitation is a common reason for psychiatric consultation in the general hospital. The consultation-liaison (CL) psychiatrist is often tasked with teaching the medical team how to manage agitation.

OBJECTIVE

The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation.

METHODS

Following current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), Cumulated Index to Nursing and Allied Health Literature (CINAHL) (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full-text review according to which patient population a curriculum was designed for.

RESULTS

The search yielded a total of 3250 articles. After removing duplicates and reviewing procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based on their target patient population, specifically the acute psychiatric patient (n = 10), the general medical patient (n = 9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (n = 32). Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use.

CONCLUSIONS

Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with major neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting, as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and nonpsychiatric providers. It calls into question whether the lack of educational programs makes the implementation of management interventions more difficult and less effective, even with the assistance of the CL psychiatrist.

Facilitators and Barriers to Student Learning and Impact of an Undergraduate Clinical Posting in Psychiatry: A Thematic Analysis

BACKGROUND

There is an absence of information on empirical evaluation of undergraduate psychiatry training programs in India. We aimed to evaluate a clinical posting in psychiatry for undergraduate medical students.

METHODS

We employed levels one and two of Kirkpatrick's four-level program evaluation model. The qualitative study used written feedback that was collected using a semistructured questionnaire. For quantitative metrics, we used end-of-posting assessment scores and frequencies of standard comments provided by examiners on case-based discussions with students to evaluate their clinical skills.

RESULTS

We obtained written feedback from 40 female and 19 male fifth-semester students. We identified facilitators (patient interaction, outpatient department observation and teaching, demonstration of signs, case presentation and discussion, evening posting, observation of clinical work, use of anecdotes while teaching, and lectures by senior faculty) and barriers (organizational issues related to evening posting and disinterest in didactic teaching) to the students learning psychiatry, and the perceived impact of the posting for the students (changed attitudes, knowledge, self-efficacy, and skills acquired). The mean total score on case-based discussion, assigned to 22 groups of students, was 3.86 out of 5.

CONCLUSION

We described the impact of the posting and identified unique facilitators and barriers to students' learning in psychiatry. These findings will inform the choice of teaching-learning methods in the context of the new Competency-Based undergraduate Medical Education (CBME) curriculum.