Fakulteit Gesondheidswetenskappe Faculty of Health Sciences A community service-learning approach to destigmatise student perceptions about psychiatric

Fakulteit Gesondheidswetenskappe Faculty of Health Sciences

A community service-learning approach to

destigmatise student perceptions about

psychiatric patients

Stefanus Snyman, Martie van Heusden


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)


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)


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


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


The intervention Step 2: What was done already?

• We analysed the exposure to mental health and psychiatry in medical curriculum


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


The InterventionStep 4: Clinical and community exposure

• Thorough orientation

• Clinical exposure and skills

• Contextualising theory

• Continuous assessment


The Intervention Step 5: Graduate Attributes

• Communication

• Counselling

• Role in a team

• Reflective practitioner

• Bio-psycho-social-spiritual approach

• Social responsiveness

• Ethics

• Human Rights


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)


The question

What difference did a community service-learning approachmake to destigmatisestudent perceptions about psychiatric patients?


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


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


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


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.



• 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 …



• 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.



• Graduate attributes cultivated:

• Counselling

• Better communication

• Interprofessionality

• Role of community and community organisations

• Bio-psycho-social-spiritual approach

• Teamwork

• “multi-tasking”



• 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 …



• 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…



• Logistic and administration

“Die bes georganiseerde blok ooit…”


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 ...


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…


Results: A year later – the challenges

• Programme too busy

• Not uniform approach to patients

• Within Psychiatry

• What is taught in other disciplines


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


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


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.


Thank you

• Students

• Tygerberg- en Lentegeur lecturers

• Dr Antoinette Smith-Tolken

• Dr Alwyn Louw

• Prof Dana Niehaus

• Jacob du Plessis

• FINLO

Documents

Fakulteit Gesondheidswetenskappe Faculty of Health Sciences A community service-learning approach to destigmatise student perceptions about psychiatric