View
218
Download
0
Category
Tags:
Preview:
Citation preview
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
A community service-learning approach to
destigmatise student perceptions about
psychiatric patients
Stefanus Snyman, Martie van Heusden
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Context of study
• Positioned in context of curriculum design
• Specific application in Health Sciences Education (HSE)
• Purpose of HSE: To prepare students to address the health needs of patients and communities effectively (Kern et al, 2009)
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The challenge: Students are not crazy about Psychiatry
• Negative and stigmatising attitudes of medical students towards psychiatric patients (Gelder, 1998)
• Attitude usually improve while rotating through Psychiatry, but not for long (Sinclair, 1997)
• WHO estimates: 500 million people suffer from psychiatric disorders (WHO, 2011)
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The challenge: The Psychiatry curriculum
• Not aligned
• Overemphasis of cognitive (proposional knowledge) with progression to psychomotor skills during clinical rotations
• Students struggle to contextualise (epistemic knowledge) and to develop personalskills through reflection on reflection in action (Wensing et al, 2010;Lucket, 2009)
• Negative evaluation of Middle clinical rotation
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The interventionStep 1: What are we suppose to do?
• Determine outcomes for Psychiatry:
• International core curricula
• World Psychiatric Association
• World Federation for Medical Education
• Leading universities
• South African Legislation
• Stellenbosch University’s Community interaction policy and Pedagogy of Hope
• Faculty of Health Sciences vision - Leader in Africa
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The intervention Step 2: What was done already?
• We analysed the exposure to mental health and psychiatry in medical curriculum
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Step 3: Determine outcomes for Middle Clinical Rotation
• Continuity between 3rd year theory and Late Clinical Rotation
• Formulate clear outcomes:
• Clinical exposure and skills regarding Psychiatry
• Integrated theoretical component
• Graduate Attributes
• Service-learning approach
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The InterventionStep 4: Clinical and community exposure
• Thorough orientation
• Clinical exposure and skills
• Contextualising theory
• Continuous assessment
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The Intervention Step 5: Graduate Attributes
• Communication
• Counselling
• Role in a team
• Reflective practitioner
• Bio-psycho-social-spiritual approach
• Social responsiveness
• Ethics
• Human Rights
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The Intervention: Step 7: Community Engagement (service-learning)
• Focus from “our” perspective:
• Impact of psychiatric disorders on community• Outside ivory tower of hardcore “super-
specialised” psychiatry• Psychosocial rehabilitation • Prevention and mental health promotion• University’s CE policy
• Collaboration with 7 NGO’s (12 placements)
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
The question
What difference did a community service-learning approachmake to destigmatisestudent perceptions about psychiatric patients?
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Method
• Interpretive paradigm with a qualitative inductive approach
• Focus group interviews were conducted with 32 students:
• Immediately after the completion
• A year later, to determine if non-stigmatising changes in perceptions, if any, were sustained.
• Interviews were also conducted to determine if students, who previously followed the traditional Psychiatry course, have in accordance with international trends, stigmatising perceptions about psychiatric patients.
• Student reflections analysed
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group who followed previous curriculum
• Questioning role of Psychiatryin medicine
I don’t think it [Psychiatry] is a medical subject
I don’t know where it fits in
Nie deel van my verwysingsraamwerknie
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group who followed previous curriculum
• Fear
I’m still afraid of psychiatric patients
• Confused
My fear was just replaced by confusion
Ek kan honestly nie … kop of stert uitmaak nie
• Unorganised
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Role of Psychiatry acknowledged as brain pathology
• Fear for Psychiatric patients overcome
• Knowledge integration due to community engagement and clinical experience at Lentegeur hospital
• The correlation between textbook and what you saw there [community] was very evident … it was astronomical, like our benefits.
• .. .got most of my basic knowledge that I need to know [at Lentegeur]. I probably will use most of that knowledge … [as] general practitioner.
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Acceptance of psychiatric patients
• … one thing I really learnt … behind all of that there is a person…
• I need to start treating psychiatric patients … as a real condition and not just some crazy person …
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Better clinical experience
… for the first time you do actually feel like a medical student. You are tired the whole time, you are working a lot, and I think maybe it gave us a little bit of an idea what it would be like to be SIs, and as tough as it was, I think it was important.
A very valuable skill … psychiatric interview
I spoke to … final years … we were actually better off because we got a chance to at least see patients …
• Learning outside tertiary complex
… I felt that I learnt a lot more there … The doctors there were way more prepared.
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Graduate attributes cultivated:
• Counselling
• Better communication
• Interprofessionality
• Role of community and community organisations
• Bio-psycho-social-spiritual approach
• Teamwork
• “multi-tasking”
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Social responsiveness
Die gemeenskapsprojek … vir ons dokters wat in Suid-Afrika opgelei word … gewys ons kan hier iets beteken..
… I have realised … my life [is revolving] around Stellenbosch University … thinking that that is the end of the world … we do need to get out of these gates, there is a whole new world out there that we do need to experience. (5th year)
the community project linked with reflection … is important and everybody learns a lot from it, but …
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Personal growth
… I have always been told throughout my course is that we need to detach ourselves from our patients … something that I have been struggling with, but … on psychiatry I actually realised that there is no way that you can actually detach emotionally from them… I actually realised that it’s not necessary … it just makes me more human … helps me to give better care to my patients… (5th year)
… I have never seen that in any other rotation… that kind of relationship ever… the amount of attention and the amount of empathy that they gave to this patient … that is the kind of attention that I need to give to my patients…
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: Group immediately after revised curriculum
• Logistic and administration
“Die bes georganiseerde blok ooit…”
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: A year later – the positives
• “Middle rotation totally took away stigmatisation”
• Now… I see the benefit of … [S-L] project and the reflections
• ... I got angry ... With the perceptions of those doctors [stigmatising patients]
• “The community project stood out for me and it’s something I’ll take with me for the rest of my live”
• “it definitely changed my perception... broadened my scope...”
• Nice to see psychiatric conditions ... in ... ordinary people ...
• Interact with [psychiatric] people with their normal sort of daily ... psychiatric conditions ...
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: A year later – the positives
• The impact society has on mental illness
• The impact mental illness has on society
• … Impact on families and how they adapted their entire lifestyle…
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: A year later – the challenges
• Programme too busy
• Not uniform approach to patients
• Within Psychiatry
• What is taught in other disciplines
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Results: A year later – the challenges
• Community project
• Convincing all stakeholders that “non-hardcore Psychiatry” is also department’s role
• Selecting the right community partners to reach outcomes
• Improve design of structured reflections
• Be careful that community projects don’t overwhelm students
• Better coaching of students
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Conclusion
• Sustained non-stigmatising perceptions about psychiatric patients were found in students who participated in CSL activities, compared to stigmatising perceptions in those who previously completed the traditional course in Psychiatry.
• These perceptions were still present a year after the rotation
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Take home message
• Medical faculties worldwide can take note that a CSL approach contributes to ensure sustained, non-stigmatising perceptions among medical students about psychiatric patients.
Fakulteit Gesondheidswetenskappe Faculty of Health Sciences
Thank you
• Students
• Tygerberg- en Lentegeur lecturers
• Dr Antoinette Smith-Tolken
• Dr Alwyn Louw
• Prof Dana Niehaus
• Jacob du Plessis
• FINLO
Recommended