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MENTAL HEALTH
MARCH 2010 VERSION 1.1
NSW Institute of Medical Education and Training
NSW Hospital Skills Program
Mental Health Module Version 1.1
Sydney: NSW IMET 2010



This work is copyright. It may be reproduced in whole or in part for study or training purposes subject
to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale.
Reproduction for purposes other than those indicated requires written permission from NSW IMET.


© NSW IMET March 2010
ISBN 978-0-9806955-5-7


For further copies of this document, please contact IMET, or
download a digital copy from the IMET website: www.imet.health.nsw.gov.au



Acknowledgements

This document is a curriculum of capabilities required of doctors working in NSW Hospitals in the clinical area
of Mental Health. It will be a key supporting document for implementing the Hospital Skills Program which aims
to improve the safety, efficiency and quality of healthcare in NSW Hospitals.


This document is the version of the HSP Mental Health Module approved by the HSP State Training Council on 28 July
2009. It was prepared by the HSP Mental Health Module Development Working Group, facilitated by Dr Stephen Jurd.




Membership of the Module Development Working Group comprised:
      Dr Stephen Jurd     Psychiatry Network Director of Training, NSCCAHS
      Dr Tony Ryan        Career Medical Officer, HNEAHS
      Dr Alan Fostey      Career Medical Officer, SWAHS
      Dr Joe Garside      Career Medical Officer, SWAHS
      Mr Peter Davy       Curriculum Developer, NSW IMET
Hospital Skills Program

MENTAL HEALTH                            Background
                                         The Hospital Skills Program (HSP) Mental Health Curriculum
                                         is a framework which identifies the capabilities required of
P4    SECTION 1: Safe Patient Care
                                         doctors working in NSW hospitals with greater than two
P5    SECTION 2: Patient Assessment      years of postgraduate experience who are not participating
                                         in a specialist vocational training program.
P6    SECTION 3: Patient Management
                                         The HSP curriculum has been developed by IMET, on
P7    SECTION 4: Emergencies             behalf of NSW Health as part of the broader Hospital Skills
                                         Program for this group of doctors. The curriculum aims to
P8    SECTION 5: Skills and Procedures   guide doctors, their employers and educators with regard to
                                         training needs,workplace responsibilities and clinical tasks.
P10   SECTION 6: Common Mental           The HSP Mental Health Curriculum has drawn on existing
                   Health Conditions     work in this area (References: 1 – 3).


P11   SECTION 7: Communication           In particular the framework for the HSP curriculum was
                                         developed with reference to the Australian Curriculum
P14   SECTION 8: Professionalism         Framework for Junior Doctors (ACFJD), prepared by the
                                         Confederation of Postgraduate Medical Education Councils
                                         (1). The HSP curriculum framework also has a similar
                                         structure, comprising Clinical Management, Communication
                                         and Professionalism capabilities and identifying common
                                         illness problems and conditions which are likely to be dealt
                                         with by HSP participants
                                         and clinical skills and procedures to be achieved
                                         by HSP participants.

                                         This curriculum is one of several curricula that has been
                                         developed by IMET to support the HSP.




                                                                        MARCH 2010 VERSION 1.1 PAGE 3
The HSP Mental Health Module
This document is the version of the Mental Health             The approved curriculum comprises eight sections:
Curriculum approved by the HSP State Training Council on
28 July 2009. It was prepared by the HSP Mental Health           Section 1:     Safe Patient Care
Curriculum Working Group facilitated by Dr Stephen               Section 2:     Patient Assessment
Jurd. An initial draft was distributed for the purpose of        Section 3:     Patient Management
obtaining feedback on its accuracy and comprehensiveness         Section 4:     Emergencies
and responses were received from 10 individuals and              Section 5:     Skills and Procedures
organisations. This document has been prepared with regard       Section 6      Common Mental Health Conditions
to the feedback received. However it is expected as the HSP      Section 7:     Communication
is implemented there may be further curriculum revision and      Section 8:     Professionalism
development work required to ensure that the HSP fulfils its
goals in supporting the professional development needs of     Across all eight sections, each Mental Health Curriculum
non-specialist doctors in NSW.                                capability has been allocated an HSP level. The three
                                                              levels of the HSP (HSP 1, 2 and 3) reflect the developing
The document outlines the capabilities required of a non      knowledge and skills required of increasingly complex
specialist doctor to function efficiently and safely within    clinical management scenarios and increasing workrole
NSW hospitals. It is intended that future versions of the     responsibility and accountability. Each of the three levels
HSP Mental Health Curriculum will also include suggested      broadly distinguishes doctors in terms of proficiency,
teaching and learning activities/resources to support the     experience, and responsibility.
development of doctors’ capabilities, as well as suggested
assessment strategies and assessment tools to determine
HSP participants’ achievement of each capability. Where
possible suggested teaching and learning activities/
resources and assessment strategies/tools will be made
accessible via the IMET Online Learning Centre.




References
1. Australian Curriculum Framework for Junior Doctors, Version 2.1, Confederation of
   Postgraduate Medical Education Councils, www.cpmec.org.au/curriculum
2. Safety and Quality Council (2005) National Patient Safety Education Framework.
   The Australian Council for Safety and Quality in Healthcare, Commonwealth of Australia. www.patientsafety.org.au
3. A Hospital Skills Program for Staff Medical Officers (Non-Specialist
   Medical Staff) of NSW (Blueprint), IMET NSW Institute of Medical Education and Training




HSP: MENTAL HEALTH MODULE
The following is a summary of the criteria on which the HSP levels have been determined.

         HSP 1                                    HSP 2                                  HSP 3

     E   Has limited workplace experience in      Has moderate to large workplace        Has substantial workplace
         this discipline.                         experience in this discipline.         experience in this discipline.
   CP    Reliably recognises familiar             Recognises atypical presentations,     Has an intuitive grasp of a situation
         situations and key issues. Has a         recognises case specific nuances        as a means of linking his or her
         good working knowledge of the            and their relational significance,      understanding of a situation to
         management of these. Decision-           thus reliably identifies key issues     appropriate action. Able to provide
         making is largely bound by               and risks. Decision-making is          a large repertoire of management
         protocol. Demonstrates effective         increasingly intuitive. Fluent in      options. Has a comprehensive
         clinical decision making and clinical    most procedures and clinical           understanding of the hospital
         proficiency in defined situations.         management tasks.                      service, referral networks and the
                                                                                         links to community services.
     R   Uses and applies integrated              Autonomously able to manage            Works autonomously, consults
         management approach for all              simple and common presentations        as required for expert advice and
         cases; consults prior to disposition     and consults prior to disposition or   consults admitting team about
         or definitive management; and             definitive management for more          patients who require admission.
         arranges senior review of the            complex cases.
         patient in numerous instances,
         especially complex or uncommon
         cases.
    PS   Level 2                                  Level 2 – 3                            Level 3




                                                                                  KEY
It is assumed that doctors will practise medicine with the degree of              E       Level of Experience
autonomy that is consistent with their level of experience (E), clinical          CP      Clinical Proficiency
proficiency (CP) and responsibility (R) to ensure patients receive                 R       Responsibility
care which is appropriate, effective and safe. The levels are cross               PS      Patient Safety
referenced with levels described for Patient Safety (PS) competencies             SRMO    Senior Resident Medical Officer
in the National Patient Safety Education Framework.                               CMO     Career Medical Officer




                                                                                              MARCH 2010 VERSION 1.1 PAGE 5
Hospital Skills Program

MENTAL HEALTH                           SECTION 1: Safe Patient Care
                                        1.1 SYSTEMS
                                        1.1.1 Manage the complex mental healthcare environment
SECTION 1: Safe Patient Care
                                              to the advantage of a patient (HSP 2).
   1.1   Systems                        1.1.2 Make the appropriate use of mechanisms that
   1.2 Risk and Prevention                    minimise error e.g. protocols (HSP 1).
   1.3 Adverse Events and Near Misses   1.1.3 Actively participate in continuous quality
   1.4   Public Health                        improvement, e.g. clinical audit (HSP 1).

   1.5 Medication Safety                1.2 RISK AND PREVENTION
                                        1.2.1 Demonstrate an awareness of risk in the workplace
                                              (HSP 1).
                                        1.2.2 Identify how personal limitations contribute to risk
                                              and error (HSP 2).
                                        1.2.3 Identify and report potential risks to patients and
                                              staff (HSP 1).

                                        1.3 ADVERSE EVENTS AND NEAR MISSES
                                        1.3.1 Document and report adverse events in accordance
                                              with local incident reporting systems (HSP 1).
                                        1.3.2 Identify and manage adverse events and near misses
                                              (HSP 1).
                                        1.3.3 Evaluate and respond to the harm caused by errors
                                              and system failures (HSP 2).
                                        1.3.4 Coordinate staff in the event of an adverse incident
                                              (HSP 2).
                                        1.3.5 Debrief staff in the event of adverse incidents (e.g.
                                              death, suicide) (HSP 3).

                                        1.4 PUBLIC HEALTH
                                        1.4.1 Summarise key mental health issues in the
                                              community (HSP 1).
                                        1.4.2 Advocate on behalf of the community on mental
                                              health issues (HSP 3).
                                        1.4.3 Inform authorities of ‘notifiable diseases’, if these are
                                              detected (HSP 1).
                                        1.4.4 Demonstrate timely and appropriate management
                                              of a disease outbreak (HSP 2).

                                        1.5 MEDICATION SAFETY
                                        1.5.1 Describe and anticipate risks with particular medic-
                                              ations likely to cause psychiatric presentations (HSP 2).

HSP: MENTAL HEALTH MODULE
Hospital Skills Program

MENTAL HEALTH                      SECTION 2: Patient Assessment
                                   2.1 PATIENT IDENTIFICATION
                                   2.1.1 Utilise case notes and other information about the
SECTION 2: Patient Assessment
                                         patient to create a safe engagement (HSP 1).
   2.1   Patient Identification
                                   2.2 HISTORY AND EXAMINATION
   2.2 History and Examination
   2.3 Problem Formulation         2.2.1 Describe the modes of presentation of the listed
   2.4 Investigations                    problems and conditions (HSP 1).
                                   2.2.2 Elicit symptoms and signs within an empathic
   2.5 Referral and Consultation
                                         interview setting (HSP 1).
                                   2.2.3 Elicit key information regarding predisposing,
                                         precipitating and perpetuating factors (HSP 1).
                                   2.2.4 Elicit additional history from relevant family members
                                         (HSP 1)

                                   2.3 PROBLEM FORMULATION
                                   2.3.1 Demonstrate a biopsychosocial assessment (HSP 1).
                                   2.3.2 Document information gained from the
                                         biopsychosocial assessment (HSP 1).
                                   2.3.3 Regularly re-evaluate the formulation as part
                                         of clinical management (HSP 1).
                                   2.3.4 List differential diagnoses (HSP 1).

                                   2.4 INVESTIGATIONS
                                   2.4.1 Demonstrate sensible safe practice around
                                         investigations (HSP 1).
                                   2.4.2 Order and interpret investigations appropriately
                                         according to diagnosis and treatment (HSP 1).
                                   2.4.3 Seek specialist information (e.g. senior CMO or
                                         registrar) regarding investigation results as required
                                         (HSP 1).

                                   2.5 REFERRAL AND CONSULTATION
                                   2.5.1 Where appropriate, refer for consultation a medically
                                         ill psychiatric patient (HSP 1).
                                   2.5.2 Make appropriate use of the multidisciplinary team
                                         (HSP 2).
                                   2.5.3 Communicate effectively with consultants (HSP 1).
                                   2.5.4 Share information with general practitioners as
                                         required (HSP 1).




                                                                MARCH 2010 VERSION 1.1 PAGE 7
Hospital Skills Program

MENTAL HEALTH                                                   SECTION 3: Patient Management
                                                                3.1 MANAGEMENT OPTIONS
SECTION 3: Patient Management
                                                                3.1.1 Describe the management options for common
    3.1   Management Options                                          mental health conditions (listed in Section 6) (HSP 1).
    3.2 Treatments                                              3.1.2 Develop, implement and evaluate a plan of
                                                                      management relevant to a patient’s biopsychosocial
    3.3 Long Term Care
                                                                      assessment (HSP 2).
    3.4 Continuity of Care
                                                                3.1.3 Cooperatively create complex management plans to
                                                                      suit an individual patient and their situation (HSP 2).

                                                                3.2 TREATMENTS

                                                                3.2.1 Describe the actions, indications, contraindications
                                                                      and adverse effects of medications (HSP 1).
                                                                3.2.2 Describe the indications and contraindications of
                                                                      psychological treatments and their underpinning
                                                                      theories (HSP 1).
                                                                3.2.3 Describe the actions, indications, contraindications
                                                                      and adverse effects of electroconvulsive therapy
                                                                      (ECT) and other physical treatments (HSP 1).
                                                                3.2.4 Integrate the skills of all the professionals involved in
                                                                      the treatment plan (HSP 3).
                                                                3.2.5 Evaluate the outcomes of each of the components of
                                                                      the treatment plan (HSP 3).

3.3 LONG TERM CARE                                              3.4 CONTINUITY OF CARE

3.3.1 Evaluate the outcomes of long term psychiatric care       3.4.1 Implement the elements of effective discharge
      (HSP 2).                                                        planning (e.g. least restrictive care, safety, goal-
3.3.2 Describe the usefulness of the recovery model in long           setting, involving other health care providers in the
      term psychiatric illness (HSP 1).                               continuity of care) (HSP 1).
3.3.3 Adjust treatment plans allowing for the impacts of        3.4.2 Follow organisational guidelines to optimise
      resistance and disability in long term psychiatric              continuity of care (HSP 1).
      illness (HSP 2).                                          3.4.3 Demonstrate a capacity to use various levels of care
3.3.4 Identify patients suitable for aged care and                    and residential support (HSP 2).
      rehabilitation programs (HSP 1).
3.3.5 Describe the services available to patients outside of
      the inpatient setting (HSP 1).
3.3.6 Evaluate and individualise patient care using a variety
      of community agencies (HSP 1).
3.3.7 Involve family/carers in management (HSP 1).


HSP: MENTAL HEALTH MODULE
Hospital Skills Program

MENTAL HEALTH                   SECTION 4: Emergencies
                                4.1 ASSESSMENT
SECTION 4: Emergencies
                                4.1.1 Demonstrate the skills required to recognise
   4.1   Assessment                   psychiatric emergencies (HSP 2).
   4.2 Prioritisation           4.1.2 Demonstrate the skills required to manage psychiatric
                                      emergencies (HSP 2).
   4.3 Legal Issues
                                4.1.3 Recognise psychiatric manifestations of physical
   4.4 Acute Patient Transfer
                                      illness (HSP 2).

                                4.2 PRIORITISATION

                                4.2.1 Describe the principles of psychiatric triage (HSP 1).
                                4.2.2 Identify patients who require immediate attention
                                      (HSP 2).
                                4.2.3 Identify situations that require restraint (HSP 2).
                                4.2.4 Actively seek timely expert support as appropriate
                                      (HSP 1).
                                4.2.5 Justify decisions in order of psychiatric priority (HSP 2).

                                4.3 LEGAL ISSUES

                                4.3.1 Explain the concept of duty of care (HSP 1).
                                4.3.2 Implement the principles of the Mental Health Act in
                                      emergency situations (HSP 1).

                                4.4 ACUTE PATIENT TRANSFER

                                4.4.1 Identify the risks inherent in patient transfer (HSP 1).
                                4.4.2 Identify and manage factors that need to be
                                      addressed prior to transfer (HSP 2).
                                4.4.3 Describe and implement the factors determining the
                                      level of care required during transport (HSP 2).




                                                              MARCH 2010 VERSION 1.1 PAGE 9
Hospital Skills Program

MENTAL HEALTH                      SECTION 5: Skills and Procedures
                                   5.1 GENERAL MANAGEMENT
SECTION 5: Skills and Procedures   5.1.1 Perform blood pressure measurement (HSP 1).

   5.1   General Management        5.1.2 Perform pulse oximetry reading (HSP 1).

   5.2 General – Intravenous       5.1.3 Estimate blood sugar (HSP 1).

   5.3 General – Respiratory       5.2 GENERAL – INTRAVENOUS
   5.4 General – Therapeutics
                                   5.2.1 Perform a venepuncture (HSP 1).
   5.5 Assessment
                                   5.2.2 Demonstrate intravenous cannulation technique (HSP 1).
   5.6 Interventions
                                   5.2.3 Prepare an intravenous infusion (HSP 1).
   5.7 General
                                   5.2.4 Administer an intravenous drug (HSP 1).
                                   5.2.5 Conduct intravenous fluid and electrolyte therapy
                                         (HSP 1).

                                   5.3 GENERAL – RESPIRATORY
                                   5.3.1 Administer oxygen therapy (HSP 1).
                                   5.3.2 Administer nebuliser/inhaler therapy (HSP 1).

                                   5.4 GENERAL – THERAPEUTICS
                                   5.4.1 Monitor anticoagulant prescription (HSP 1).
                                   5.4.2 Monitor antibiotic prescription (HSP 1).
                                   5.4.3 Monitor insulin prescription (HSP 1).
                                   5.4.4 Monitor clozapine therapy (HSP 1).
                                   5.4.5 Monitor lithium and other mood stabiliser therapy
                                         (HSP 1).

                                   5.5 ASSESSMENT
                                   5.5.1 Conduct a cognitive examination (HSP 1).
                                   5.5.2 Conduct a Mental State Examination (HSP 1).
                                   5.5.3 Conduct a suicide risk assessment (HSP 1).
                                   5.5.4 Apply the alcohol withdrawal scale (HSP 1).
                                   5.5.5 Apply the Health of the Nation Outcome Scale
                                         (HoNOS) (HSP 1).




HSP: MENTAL HEALTH MODULE
5.6 INTERVENTIONS
5.6.1 Apply the Mental Health Act (HSP 1).
5.6.2 Apply the Guardianship Act (HSP 1).
5.6.3 Conduct psycho-education (HSP 2).
5.6.4 Conduct behaviour therapy (HSP 2).
5.6.5 Conduct psychodynamic therapy (HSP 2).
5.6.6 Conduct time limited therapy e.g. interpersonal
      psychotherapy (HSP 2).
5.6.7 Conduct cognitive therapy (HSP 2).
5.6.8 Conduct dialectical behavioural therapy (HSP 2).
5.6.9 Conduct group and family therapy (HSP 2).
5.6.10 Administer electroconvulsive therapy (HSP 2).
5.6.11 Manage aggression in patients (HSP 2).
5.6.12 Conduct acute situational crisis counselling as
       required (HSP 2).
5.6.13 Conduct conflict resolution as required (HSP 2).
5.6.14 Conduct violence interventions as required (HSP 2).
5.6.15 Debrief staff as required (HSP 2).

5.7 GENERAL
5.7.1 Comply with the NSW Health Code of Conduct in any
      interaction with the media (HSP 1).
5.7.2 Refer safely and transfer patients who require
      specialised care (HSP 2).




                                                             MARCH 2010 VERSION 1.1 PAGE 11
Hospital Skills Program

MENTAL HEALTH                                SECTION 6: Common Mental
                                             Health Conditions
SECTION 6: Common Mental Health Conditions
                                             6.1 ORGANIC DISORDERS
   6.1   Organic disorders
   6.2 Anxiety Disorders                     Including: brain injury, delirium and dementia
   6.3 Adjustment Disorders
                                             6.2 ANXIETY DISORDERS
   6.4 Substance use Disorder
   6.5 Psychotic Disorders                   Including: panic disorder, generalised anxiety disorder, post
   6.6 Mood Disorders                        traumatic stress disorder and obsessive compulsive disorder
   6.7 Personality Disorders
   6.8 Childhood Disorders                   6.3 ADJUSTMENT DISORDERS
   6.9 Other Disorders
                                             6.4 SUBSTANCE USE DISORDERS

                                             6.5 PSYCHOTIC DISORDERS

                                             Including: schizophrenia and brief psychotic disorders

                                             6.6 MOOD DISORDERS

                                             Including: bipolar disorder, dysthymia and major depression

                                             6.7 PERSONALITY DISORDERS

                                             Including: suicide and deliberate self harm

                                             6.8 CHILDHOOD DISORDERS

                                             Including: the difficult child, school refusal, encopresis and
                                             enuresis, attention deficit disorder and oppositional defiant
                                             disorder

                                             6.9 OTHER DISORDERS

                                             Including: sleep disorders, eating disorders, somatoform
                                             disorder, factitious disorder and relationship problems.




HSP: MENTAL HEALTH MODULE
Hospital Skills Program

MENTAL HEALTH                   SECTION 7: Communication
                                7.1 PATIENT INTERACTION
SECTION 7: Communication
                                Context
   7.1   Patient Interaction
   7.2   Managing Information   7.1.1 Use the environment to facilitate communication
                                      (e.g. privacy, location) (HSP 2).
   7.3   Working in Teams
                                7.1.2 Demonstrate the skills of effective communication
                                      (HSP 1).
                                7.1.3 Demonstrate effective communication with difficult
                                      or vulnerable patients (HSP 2).

                                Respect

                                7.1.4 Demonstrate courtesy and respect, displaying
                                      awareness and sensitivity for patients and families
                                      with diverse backgrounds (HSP 1).
                                7.1.5 Outline the principles of privacy and confidentiality
                                      (HSP 1).
                                7.1.6 Provide clear and honest information to patients,
                                      carers and families (HSP 2).
                                7.1.7 Involve patients (and carers and families, where
                                      appropriate) in treatment choices (HSP 2).

                                Providing Information

                                7.1.8 Display use of the principles of good communication
                                      (e.g. demonstrating active listening and avoiding
                                      information overload) (HSP 1).
                                7.1.9 Communicate with patients in a variety of ways
                                      (e.g. clear language, diagrams and images) (HSP 1).

                                Meetings with Families and/or Carers

                                7.1.10 Make positive use of family dynamics in effective
                                       communication with family members and carers
                                       (HSP 2).
                                7.1.11 Ensure that relevant family members/carers are
                                       included as appropriate in meetings, especially during
                                       decision-making (HSP 2).




                                                           MARCH 2010 VERSION 1.1 PAGE 13
Breaking Bad News

7.1.12 Show empathy and compassion (HSP 1).                         7.2.5 Demonstrate effective use of electronic resources
7.1.13 Outline the principles and the impact of grief, loss               in patient care (e.g. to obtain results, discharge
       and bereavement for patients, families and carers                  summaries, pharmacopoeia) (HSP 1).
       (HSP 1).                                                     7.2.6 Comply with policies regarding information technology
7.1.14 Demonstrate caring communication in breaking bad                   (e.g. passwords, email and internet) (HSP 1).
       news to patients, families and carers (HSP 1).
                                                                    Prescribing
Open Disclosure
                                                                    7.2.7 Accurately communicate prescriptions (HSP 1).
7.1.15 Outline and implement the principles of open                 7.2.8 Accurately record drug prescription and
       disclosure (HSP 1).                                                administration (HSP 1).
7.1.16 Outline and implement the principles of support and          7.2.9 Effectively use prescribing as an important form of
       care for patients, carers and staff after an adverse               communication within the healthcare team (HSP 1).
       event (HSP 1).
                                                                    Health Records
Complaints
                                                                    7.2.10 List the benefits of accurate documentation in
7.1.17 Identify the factors likely to lead to complaints (HSP 1).          constructing health records (HSP 1).
7.1.18 Identify the factors likely to minimise complaints           7.2.11 Comply with the legal and institutional requirements
       (HSP 1).                                                            for health records (HSP 1).
7.1.19 Demonstrate an appropriate response to complaints            7.2.12 Contribute and participate in the formation of the
       (HSP 1).                                                            health record to provide continuity of patient care
                                                                           (HSP 1).
                                                                    7.2.13 Review medical records for completeness, ensuring
7.2 MANAGING INFORMATION                                                   they are up to date (HSP 3).

Written                                                             Evidence-Based Practice

7.2.1 Comply with organisational policies regarding timely          7.2.14 Implement the principles of evidence-base practice
      and accurate documentation.                                          (HSP 1).
7.2.2 Demonstrate high quality written skills (e.g. legible,        7.2.15 Use best available evidence in clinical decision making
      concise and informative discharge summaries) (HSP 1).                (HSP 1).
7.2.3 Effectively write documents (e.g. referrals,                  7.2.16 Critically appraise evidence and information (HSP 1).
      investigation requests), using appropriate structure
      and content (HSP 1).                                          Handover

Electronic                                                          7.2.17 Summarise the importance of handover in terms of
                                                                           patient safety and continuity of care (HSP 1).
7.2.4 Contrast the uses and limitations of electronic patient       7.2.18 Describe the risks of ineffective handover (HSP 1).
      information and decision support systems (HSP 2).             7.2.19 Perform an effective handover (e.g. utilising ISBAR)
                                                                           to another healthcare team member (HSP 1).

HSP: MENTAL HEALTH MODULE
7.3 WORKING IN TEAMS

Team Structure

7.3.1 Identify different types and structure of healthcare
      teams (e.g. the medical team, the multidisciplinary
      team) suitable for the care of the patient (HSP 1).
7.3.2 Include patients and carers in the healthcare team
      where appropriate and if possible (HSP 1).
7.3.3 Provide appropriate leadership within a healthcare
      team (HSP 2).

Team Dynamics

7.3.4 Identify the characteristics of effective healthcare
      teams (HSP 1).
7.3.5 Work constructively with others in the healthcare
      team and resolve conflicts if they arise (HSP 1).
7.3.6 Within the healthcare team demonstrate flexibility
      and adaptability in responding to changes in the
      workplace (HSP 1).

Teams in Action

7.3.7 Participate fully in teams across healthcare settings,
      displaying respect for other team members (HSP 1).
7.3.8 Demonstrate support for the roles and responsibilities
      of healthcare team members (HSP 1).
7.3.9 Demonstrate the flexibility to adapt to a variety of
      roles within the healthcare team (HSP 2).

Case Presentation

7.3.10 Outline the elements and principles of an effective
       case presentation (HSP 1).
7.3.11 Perform an effective case presentation to members
       of the healthcare team, including senior medical staff
       (HSP 1).




                                                                MARCH 2010 VERSION 1.1 PAGE 15
Hospital Skills Program

MENTAL HEALTH                   SECTION 8: Professionalism
                                8.1 DOCTOR AND SOCIETY
SECTION 8: Professionalism
                                Access to Healthcare
   8.1   Doctor and Safety
   8.2 Professional Behaviour   8.1.1 Indicate how psychiatric disability can limit access
                                      to healthcare services (HSP 1).
   8.3 Teaching and Learning
                                8.1.2 Provide culturally appropriate healthcare (HSP 1).
                                8.1.3 Adopt an inclusive and non discriminatory approach
                                      to healthcare (HSP 1).

                                Culture, Society and Healthcare

                                8.1.4 Describe social, economic and political factors in
                                      patient illness (HSP 1).
                                8.1.5 Outline the impact of culture, ethnicity and
                                      spirituality on health (HSP 1).
                                8.1.6 Identify one’s own cultural values that can affect
                                      the role of being a doctor (HSP 1).

                                Indigenous Patients

                                8.1.7 Briefly describe the history and experiences of
                                      indigenous Australians and explain how these may
                                      affect indigenous patient illness presentation (HSP 1).
                                8.1.8 Demonstrate sensitivity to indigenous Australians’
                                      spirituality and relationship to the land (HSP 1).
                                8.1.9 Recognise the diversity of indigenous cultures,
                                      experiences and communities (HSP 1).

                                Medicine and the Law

                                8.1.10 Comply with the legal requirement in patient care
                                       (e.g. in implementing provisions of the NSW Mental
                                       Health Act) (HSP 1).
                                8.1.11 Complete medico-legal and forensic psychiatry
                                       documentation appropriately (HSP 1).
                                8.1.12 Liaise with and report to legal and statutory
                                       authorities as required (HSP 1).




HSP: MENTAL HEALTH MODULE
Health Promotion                                               Personal Well-being

8.1.13 Describe environmental and lifestyle risks to health    8.2.9 Identify the personal health risks of medical practice
       and advocate for healthy environmental and lifestyle           (e.g. fatigue, stress) (HSP 1).
       choices during encounters with patients (HSP 1).        8.2.10 Describe behaviours that will optimise personal
8.1.14 Demonstrate a non-judgemental approach to patients             health and well-being (HSP 1).
       and their lifestyle choices (HSP 1).                    8.2.11 Recognise the potential harm to others due to the
8.1.15 Contrast the positive and negative aspects of health           lack of personal well-being (HSP 1).
       screening and prevention (HSP 2).                       8.2.12 Describe unhealthy responses to work stress
                                                                      (e.g. substance abuse) (HSP 1).
Healthcare Resources
                                                               Ethical Practice
8.1.16 Deploy healthcare resources wisely to achieve the
       best outcomes (HSP 1).                                  8.2.13 Recognise the ethical complexity of medical practice
8.1.17 Demonstrate behaviour which acknowledges that                  (HSP 1).
       healthcare is a finite resource (HSP 1).                 8.2.14 Summarise professional and ethical codes relevant to
8.1.18 Describe the complexities and potential blocks of              medical practice (HSP 1).
       gaining healthcare access for psychiatric patients      8.2.15 Demonstrate ethical practice within and outside the
       (HSP 2).                                                       workplace (HSP 1).

                                                               Practitioner in Difficulty
8.2 PROFESSIONAL BEHAVIOUR
                                                               8.2.16 Describe the support services available to
Professional Responsibility                                           practitioners in difficulty (HSP 1).
                                                               8.2.17 Describe appropriate responses to a practitioner
8.2.1 Exercise professional responsibilities relevant to the          in difficulty (HSP 1).
      current work role (HSP 1).
8.2.2 Describe elements of reflective professional practice     Doctors as Leaders
      with regard to current personal capabilities (HSP 1).
8.2.3 Describe the parameters of individual professional       8.2.18 Describe the variety of leadership roles that may be
      skills (HSP 1).                                                 required as a doctor (HSP 2).
8.2.4 Demonstrate an awareness of boundary issues in           8.2.19 Describe and demonstrate the attributes of a good
      therapeutic relationships (HSP 1).                              leader (HSP 2).
                                                               8.2.20 Enact the roles of collaborator and leader in the
Time Management                                                       workplace (HSP 2).

8.2.5 Explain how time limits affect patient care and
      hospital function (HSP 2).
8.2.5 Prioritise daily workload and multiple demands on
      time and activities (HSP 2).
8.2.7 Demonstrate punctuality in the workplace (HSP 1).
8.2.8 Describe how working in multidisciplinary teams
      impacts on time management (HSP 2).

                                                                                          MARCH 2010 VERSION 1.1 PAGE 17
8.3 TEACHING AND LEARNING

Self-Directed Learning

8.3.1 Demonstrate a commitment to continuous learning in
      medicine (HSP 1).
8.3.2 Identify and address personal learning needs (HSP 1).
8.3.3 Describe and apply where relevant common research
      methodologies (HSP 1).
8.3.4 Summarise levels of evidence with regard to learning
      in medicine (HSP 2).

Teaching

8.3.5 Identify varied approaches appropriate to different
      settings of teaching and learning in medicine (HSP 2).
8.3.6 Incorporate teaching into professional practice as
      required (HSP 2).
8.3.7 Respond appropriately to feedback on teaching in
      professional practice (HSP 2).

Supervision

8.3.8 Describe the elements of effective supervision (HSP 1).
8.3.9 Participate in personal supervision and respond to
       feedback (HSP 1).
8.3.10 Provide supervision and feedback to other members
       of the health care team as required (HSP 2).
8.3.11 Participate in assessment and appraisal as required
       (HSP 1).
8.3.12 Demonstrate mentorship skills (HSP 3).

Career Development

8.3.13 Describe the career options as a medical practitioner
       working in the mental health context (HSP 2).
8.3.14 Identify pathways to alternative careers in medicine,
       if desired (HSP 2).




HSP: MENTAL HEALTH MODULE
NSW Institute of Medical Education and Training (IMET)
Building 12 Gladesville Hospital
GLADESVILLE NSW 2060
Tel: (02) 9844 6551
Fax: (02) 9844 6544
Email: info@imet.health.nsw.gov.au
Post: Locked Bag 5022, GLADESVILLE NSW 1675

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HSP Mental Health Module

  • 2. NSW Institute of Medical Education and Training NSW Hospital Skills Program Mental Health Module Version 1.1 Sydney: NSW IMET 2010 This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated requires written permission from NSW IMET. © NSW IMET March 2010 ISBN 978-0-9806955-5-7 For further copies of this document, please contact IMET, or download a digital copy from the IMET website: www.imet.health.nsw.gov.au Acknowledgements This document is a curriculum of capabilities required of doctors working in NSW Hospitals in the clinical area of Mental Health. It will be a key supporting document for implementing the Hospital Skills Program which aims to improve the safety, efficiency and quality of healthcare in NSW Hospitals. This document is the version of the HSP Mental Health Module approved by the HSP State Training Council on 28 July 2009. It was prepared by the HSP Mental Health Module Development Working Group, facilitated by Dr Stephen Jurd. Membership of the Module Development Working Group comprised: Dr Stephen Jurd Psychiatry Network Director of Training, NSCCAHS Dr Tony Ryan Career Medical Officer, HNEAHS Dr Alan Fostey Career Medical Officer, SWAHS Dr Joe Garside Career Medical Officer, SWAHS Mr Peter Davy Curriculum Developer, NSW IMET
  • 3. Hospital Skills Program MENTAL HEALTH Background The Hospital Skills Program (HSP) Mental Health Curriculum is a framework which identifies the capabilities required of P4 SECTION 1: Safe Patient Care doctors working in NSW hospitals with greater than two P5 SECTION 2: Patient Assessment years of postgraduate experience who are not participating in a specialist vocational training program. P6 SECTION 3: Patient Management The HSP curriculum has been developed by IMET, on P7 SECTION 4: Emergencies behalf of NSW Health as part of the broader Hospital Skills Program for this group of doctors. The curriculum aims to P8 SECTION 5: Skills and Procedures guide doctors, their employers and educators with regard to training needs,workplace responsibilities and clinical tasks. P10 SECTION 6: Common Mental The HSP Mental Health Curriculum has drawn on existing Health Conditions work in this area (References: 1 – 3). P11 SECTION 7: Communication In particular the framework for the HSP curriculum was developed with reference to the Australian Curriculum P14 SECTION 8: Professionalism Framework for Junior Doctors (ACFJD), prepared by the Confederation of Postgraduate Medical Education Councils (1). The HSP curriculum framework also has a similar structure, comprising Clinical Management, Communication and Professionalism capabilities and identifying common illness problems and conditions which are likely to be dealt with by HSP participants and clinical skills and procedures to be achieved by HSP participants. This curriculum is one of several curricula that has been developed by IMET to support the HSP. MARCH 2010 VERSION 1.1 PAGE 3
  • 4. The HSP Mental Health Module This document is the version of the Mental Health The approved curriculum comprises eight sections: Curriculum approved by the HSP State Training Council on 28 July 2009. It was prepared by the HSP Mental Health Section 1: Safe Patient Care Curriculum Working Group facilitated by Dr Stephen Section 2: Patient Assessment Jurd. An initial draft was distributed for the purpose of Section 3: Patient Management obtaining feedback on its accuracy and comprehensiveness Section 4: Emergencies and responses were received from 10 individuals and Section 5: Skills and Procedures organisations. This document has been prepared with regard Section 6 Common Mental Health Conditions to the feedback received. However it is expected as the HSP Section 7: Communication is implemented there may be further curriculum revision and Section 8: Professionalism development work required to ensure that the HSP fulfils its goals in supporting the professional development needs of Across all eight sections, each Mental Health Curriculum non-specialist doctors in NSW. capability has been allocated an HSP level. The three levels of the HSP (HSP 1, 2 and 3) reflect the developing The document outlines the capabilities required of a non knowledge and skills required of increasingly complex specialist doctor to function efficiently and safely within clinical management scenarios and increasing workrole NSW hospitals. It is intended that future versions of the responsibility and accountability. Each of the three levels HSP Mental Health Curriculum will also include suggested broadly distinguishes doctors in terms of proficiency, teaching and learning activities/resources to support the experience, and responsibility. development of doctors’ capabilities, as well as suggested assessment strategies and assessment tools to determine HSP participants’ achievement of each capability. Where possible suggested teaching and learning activities/ resources and assessment strategies/tools will be made accessible via the IMET Online Learning Centre. References 1. Australian Curriculum Framework for Junior Doctors, Version 2.1, Confederation of Postgraduate Medical Education Councils, www.cpmec.org.au/curriculum 2. Safety and Quality Council (2005) National Patient Safety Education Framework. The Australian Council for Safety and Quality in Healthcare, Commonwealth of Australia. www.patientsafety.org.au 3. A Hospital Skills Program for Staff Medical Officers (Non-Specialist Medical Staff) of NSW (Blueprint), IMET NSW Institute of Medical Education and Training HSP: MENTAL HEALTH MODULE
  • 5. The following is a summary of the criteria on which the HSP levels have been determined. HSP 1 HSP 2 HSP 3 E Has limited workplace experience in Has moderate to large workplace Has substantial workplace this discipline. experience in this discipline. experience in this discipline. CP Reliably recognises familiar Recognises atypical presentations, Has an intuitive grasp of a situation situations and key issues. Has a recognises case specific nuances as a means of linking his or her good working knowledge of the and their relational significance, understanding of a situation to management of these. Decision- thus reliably identifies key issues appropriate action. Able to provide making is largely bound by and risks. Decision-making is a large repertoire of management protocol. Demonstrates effective increasingly intuitive. Fluent in options. Has a comprehensive clinical decision making and clinical most procedures and clinical understanding of the hospital proficiency in defined situations. management tasks. service, referral networks and the links to community services. R Uses and applies integrated Autonomously able to manage Works autonomously, consults management approach for all simple and common presentations as required for expert advice and cases; consults prior to disposition and consults prior to disposition or consults admitting team about or definitive management; and definitive management for more patients who require admission. arranges senior review of the complex cases. patient in numerous instances, especially complex or uncommon cases. PS Level 2 Level 2 – 3 Level 3 KEY It is assumed that doctors will practise medicine with the degree of E Level of Experience autonomy that is consistent with their level of experience (E), clinical CP Clinical Proficiency proficiency (CP) and responsibility (R) to ensure patients receive R Responsibility care which is appropriate, effective and safe. The levels are cross PS Patient Safety referenced with levels described for Patient Safety (PS) competencies SRMO Senior Resident Medical Officer in the National Patient Safety Education Framework. CMO Career Medical Officer MARCH 2010 VERSION 1.1 PAGE 5
  • 6. Hospital Skills Program MENTAL HEALTH SECTION 1: Safe Patient Care 1.1 SYSTEMS 1.1.1 Manage the complex mental healthcare environment SECTION 1: Safe Patient Care to the advantage of a patient (HSP 2). 1.1 Systems 1.1.2 Make the appropriate use of mechanisms that 1.2 Risk and Prevention minimise error e.g. protocols (HSP 1). 1.3 Adverse Events and Near Misses 1.1.3 Actively participate in continuous quality 1.4 Public Health improvement, e.g. clinical audit (HSP 1). 1.5 Medication Safety 1.2 RISK AND PREVENTION 1.2.1 Demonstrate an awareness of risk in the workplace (HSP 1). 1.2.2 Identify how personal limitations contribute to risk and error (HSP 2). 1.2.3 Identify and report potential risks to patients and staff (HSP 1). 1.3 ADVERSE EVENTS AND NEAR MISSES 1.3.1 Document and report adverse events in accordance with local incident reporting systems (HSP 1). 1.3.2 Identify and manage adverse events and near misses (HSP 1). 1.3.3 Evaluate and respond to the harm caused by errors and system failures (HSP 2). 1.3.4 Coordinate staff in the event of an adverse incident (HSP 2). 1.3.5 Debrief staff in the event of adverse incidents (e.g. death, suicide) (HSP 3). 1.4 PUBLIC HEALTH 1.4.1 Summarise key mental health issues in the community (HSP 1). 1.4.2 Advocate on behalf of the community on mental health issues (HSP 3). 1.4.3 Inform authorities of ‘notifiable diseases’, if these are detected (HSP 1). 1.4.4 Demonstrate timely and appropriate management of a disease outbreak (HSP 2). 1.5 MEDICATION SAFETY 1.5.1 Describe and anticipate risks with particular medic- ations likely to cause psychiatric presentations (HSP 2). HSP: MENTAL HEALTH MODULE
  • 7. Hospital Skills Program MENTAL HEALTH SECTION 2: Patient Assessment 2.1 PATIENT IDENTIFICATION 2.1.1 Utilise case notes and other information about the SECTION 2: Patient Assessment patient to create a safe engagement (HSP 1). 2.1 Patient Identification 2.2 HISTORY AND EXAMINATION 2.2 History and Examination 2.3 Problem Formulation 2.2.1 Describe the modes of presentation of the listed 2.4 Investigations problems and conditions (HSP 1). 2.2.2 Elicit symptoms and signs within an empathic 2.5 Referral and Consultation interview setting (HSP 1). 2.2.3 Elicit key information regarding predisposing, precipitating and perpetuating factors (HSP 1). 2.2.4 Elicit additional history from relevant family members (HSP 1) 2.3 PROBLEM FORMULATION 2.3.1 Demonstrate a biopsychosocial assessment (HSP 1). 2.3.2 Document information gained from the biopsychosocial assessment (HSP 1). 2.3.3 Regularly re-evaluate the formulation as part of clinical management (HSP 1). 2.3.4 List differential diagnoses (HSP 1). 2.4 INVESTIGATIONS 2.4.1 Demonstrate sensible safe practice around investigations (HSP 1). 2.4.2 Order and interpret investigations appropriately according to diagnosis and treatment (HSP 1). 2.4.3 Seek specialist information (e.g. senior CMO or registrar) regarding investigation results as required (HSP 1). 2.5 REFERRAL AND CONSULTATION 2.5.1 Where appropriate, refer for consultation a medically ill psychiatric patient (HSP 1). 2.5.2 Make appropriate use of the multidisciplinary team (HSP 2). 2.5.3 Communicate effectively with consultants (HSP 1). 2.5.4 Share information with general practitioners as required (HSP 1). MARCH 2010 VERSION 1.1 PAGE 7
  • 8. Hospital Skills Program MENTAL HEALTH SECTION 3: Patient Management 3.1 MANAGEMENT OPTIONS SECTION 3: Patient Management 3.1.1 Describe the management options for common 3.1 Management Options mental health conditions (listed in Section 6) (HSP 1). 3.2 Treatments 3.1.2 Develop, implement and evaluate a plan of management relevant to a patient’s biopsychosocial 3.3 Long Term Care assessment (HSP 2). 3.4 Continuity of Care 3.1.3 Cooperatively create complex management plans to suit an individual patient and their situation (HSP 2). 3.2 TREATMENTS 3.2.1 Describe the actions, indications, contraindications and adverse effects of medications (HSP 1). 3.2.2 Describe the indications and contraindications of psychological treatments and their underpinning theories (HSP 1). 3.2.3 Describe the actions, indications, contraindications and adverse effects of electroconvulsive therapy (ECT) and other physical treatments (HSP 1). 3.2.4 Integrate the skills of all the professionals involved in the treatment plan (HSP 3). 3.2.5 Evaluate the outcomes of each of the components of the treatment plan (HSP 3). 3.3 LONG TERM CARE 3.4 CONTINUITY OF CARE 3.3.1 Evaluate the outcomes of long term psychiatric care 3.4.1 Implement the elements of effective discharge (HSP 2). planning (e.g. least restrictive care, safety, goal- 3.3.2 Describe the usefulness of the recovery model in long setting, involving other health care providers in the term psychiatric illness (HSP 1). continuity of care) (HSP 1). 3.3.3 Adjust treatment plans allowing for the impacts of 3.4.2 Follow organisational guidelines to optimise resistance and disability in long term psychiatric continuity of care (HSP 1). illness (HSP 2). 3.4.3 Demonstrate a capacity to use various levels of care 3.3.4 Identify patients suitable for aged care and and residential support (HSP 2). rehabilitation programs (HSP 1). 3.3.5 Describe the services available to patients outside of the inpatient setting (HSP 1). 3.3.6 Evaluate and individualise patient care using a variety of community agencies (HSP 1). 3.3.7 Involve family/carers in management (HSP 1). HSP: MENTAL HEALTH MODULE
  • 9. Hospital Skills Program MENTAL HEALTH SECTION 4: Emergencies 4.1 ASSESSMENT SECTION 4: Emergencies 4.1.1 Demonstrate the skills required to recognise 4.1 Assessment psychiatric emergencies (HSP 2). 4.2 Prioritisation 4.1.2 Demonstrate the skills required to manage psychiatric emergencies (HSP 2). 4.3 Legal Issues 4.1.3 Recognise psychiatric manifestations of physical 4.4 Acute Patient Transfer illness (HSP 2). 4.2 PRIORITISATION 4.2.1 Describe the principles of psychiatric triage (HSP 1). 4.2.2 Identify patients who require immediate attention (HSP 2). 4.2.3 Identify situations that require restraint (HSP 2). 4.2.4 Actively seek timely expert support as appropriate (HSP 1). 4.2.5 Justify decisions in order of psychiatric priority (HSP 2). 4.3 LEGAL ISSUES 4.3.1 Explain the concept of duty of care (HSP 1). 4.3.2 Implement the principles of the Mental Health Act in emergency situations (HSP 1). 4.4 ACUTE PATIENT TRANSFER 4.4.1 Identify the risks inherent in patient transfer (HSP 1). 4.4.2 Identify and manage factors that need to be addressed prior to transfer (HSP 2). 4.4.3 Describe and implement the factors determining the level of care required during transport (HSP 2). MARCH 2010 VERSION 1.1 PAGE 9
  • 10. Hospital Skills Program MENTAL HEALTH SECTION 5: Skills and Procedures 5.1 GENERAL MANAGEMENT SECTION 5: Skills and Procedures 5.1.1 Perform blood pressure measurement (HSP 1). 5.1 General Management 5.1.2 Perform pulse oximetry reading (HSP 1). 5.2 General – Intravenous 5.1.3 Estimate blood sugar (HSP 1). 5.3 General – Respiratory 5.2 GENERAL – INTRAVENOUS 5.4 General – Therapeutics 5.2.1 Perform a venepuncture (HSP 1). 5.5 Assessment 5.2.2 Demonstrate intravenous cannulation technique (HSP 1). 5.6 Interventions 5.2.3 Prepare an intravenous infusion (HSP 1). 5.7 General 5.2.4 Administer an intravenous drug (HSP 1). 5.2.5 Conduct intravenous fluid and electrolyte therapy (HSP 1). 5.3 GENERAL – RESPIRATORY 5.3.1 Administer oxygen therapy (HSP 1). 5.3.2 Administer nebuliser/inhaler therapy (HSP 1). 5.4 GENERAL – THERAPEUTICS 5.4.1 Monitor anticoagulant prescription (HSP 1). 5.4.2 Monitor antibiotic prescription (HSP 1). 5.4.3 Monitor insulin prescription (HSP 1). 5.4.4 Monitor clozapine therapy (HSP 1). 5.4.5 Monitor lithium and other mood stabiliser therapy (HSP 1). 5.5 ASSESSMENT 5.5.1 Conduct a cognitive examination (HSP 1). 5.5.2 Conduct a Mental State Examination (HSP 1). 5.5.3 Conduct a suicide risk assessment (HSP 1). 5.5.4 Apply the alcohol withdrawal scale (HSP 1). 5.5.5 Apply the Health of the Nation Outcome Scale (HoNOS) (HSP 1). HSP: MENTAL HEALTH MODULE
  • 11. 5.6 INTERVENTIONS 5.6.1 Apply the Mental Health Act (HSP 1). 5.6.2 Apply the Guardianship Act (HSP 1). 5.6.3 Conduct psycho-education (HSP 2). 5.6.4 Conduct behaviour therapy (HSP 2). 5.6.5 Conduct psychodynamic therapy (HSP 2). 5.6.6 Conduct time limited therapy e.g. interpersonal psychotherapy (HSP 2). 5.6.7 Conduct cognitive therapy (HSP 2). 5.6.8 Conduct dialectical behavioural therapy (HSP 2). 5.6.9 Conduct group and family therapy (HSP 2). 5.6.10 Administer electroconvulsive therapy (HSP 2). 5.6.11 Manage aggression in patients (HSP 2). 5.6.12 Conduct acute situational crisis counselling as required (HSP 2). 5.6.13 Conduct conflict resolution as required (HSP 2). 5.6.14 Conduct violence interventions as required (HSP 2). 5.6.15 Debrief staff as required (HSP 2). 5.7 GENERAL 5.7.1 Comply with the NSW Health Code of Conduct in any interaction with the media (HSP 1). 5.7.2 Refer safely and transfer patients who require specialised care (HSP 2). MARCH 2010 VERSION 1.1 PAGE 11
  • 12. Hospital Skills Program MENTAL HEALTH SECTION 6: Common Mental Health Conditions SECTION 6: Common Mental Health Conditions 6.1 ORGANIC DISORDERS 6.1 Organic disorders 6.2 Anxiety Disorders Including: brain injury, delirium and dementia 6.3 Adjustment Disorders 6.2 ANXIETY DISORDERS 6.4 Substance use Disorder 6.5 Psychotic Disorders Including: panic disorder, generalised anxiety disorder, post 6.6 Mood Disorders traumatic stress disorder and obsessive compulsive disorder 6.7 Personality Disorders 6.8 Childhood Disorders 6.3 ADJUSTMENT DISORDERS 6.9 Other Disorders 6.4 SUBSTANCE USE DISORDERS 6.5 PSYCHOTIC DISORDERS Including: schizophrenia and brief psychotic disorders 6.6 MOOD DISORDERS Including: bipolar disorder, dysthymia and major depression 6.7 PERSONALITY DISORDERS Including: suicide and deliberate self harm 6.8 CHILDHOOD DISORDERS Including: the difficult child, school refusal, encopresis and enuresis, attention deficit disorder and oppositional defiant disorder 6.9 OTHER DISORDERS Including: sleep disorders, eating disorders, somatoform disorder, factitious disorder and relationship problems. HSP: MENTAL HEALTH MODULE
  • 13. Hospital Skills Program MENTAL HEALTH SECTION 7: Communication 7.1 PATIENT INTERACTION SECTION 7: Communication Context 7.1 Patient Interaction 7.2 Managing Information 7.1.1 Use the environment to facilitate communication (e.g. privacy, location) (HSP 2). 7.3 Working in Teams 7.1.2 Demonstrate the skills of effective communication (HSP 1). 7.1.3 Demonstrate effective communication with difficult or vulnerable patients (HSP 2). Respect 7.1.4 Demonstrate courtesy and respect, displaying awareness and sensitivity for patients and families with diverse backgrounds (HSP 1). 7.1.5 Outline the principles of privacy and confidentiality (HSP 1). 7.1.6 Provide clear and honest information to patients, carers and families (HSP 2). 7.1.7 Involve patients (and carers and families, where appropriate) in treatment choices (HSP 2). Providing Information 7.1.8 Display use of the principles of good communication (e.g. demonstrating active listening and avoiding information overload) (HSP 1). 7.1.9 Communicate with patients in a variety of ways (e.g. clear language, diagrams and images) (HSP 1). Meetings with Families and/or Carers 7.1.10 Make positive use of family dynamics in effective communication with family members and carers (HSP 2). 7.1.11 Ensure that relevant family members/carers are included as appropriate in meetings, especially during decision-making (HSP 2). MARCH 2010 VERSION 1.1 PAGE 13
  • 14. Breaking Bad News 7.1.12 Show empathy and compassion (HSP 1). 7.2.5 Demonstrate effective use of electronic resources 7.1.13 Outline the principles and the impact of grief, loss in patient care (e.g. to obtain results, discharge and bereavement for patients, families and carers summaries, pharmacopoeia) (HSP 1). (HSP 1). 7.2.6 Comply with policies regarding information technology 7.1.14 Demonstrate caring communication in breaking bad (e.g. passwords, email and internet) (HSP 1). news to patients, families and carers (HSP 1). Prescribing Open Disclosure 7.2.7 Accurately communicate prescriptions (HSP 1). 7.1.15 Outline and implement the principles of open 7.2.8 Accurately record drug prescription and disclosure (HSP 1). administration (HSP 1). 7.1.16 Outline and implement the principles of support and 7.2.9 Effectively use prescribing as an important form of care for patients, carers and staff after an adverse communication within the healthcare team (HSP 1). event (HSP 1). Health Records Complaints 7.2.10 List the benefits of accurate documentation in 7.1.17 Identify the factors likely to lead to complaints (HSP 1). constructing health records (HSP 1). 7.1.18 Identify the factors likely to minimise complaints 7.2.11 Comply with the legal and institutional requirements (HSP 1). for health records (HSP 1). 7.1.19 Demonstrate an appropriate response to complaints 7.2.12 Contribute and participate in the formation of the (HSP 1). health record to provide continuity of patient care (HSP 1). 7.2.13 Review medical records for completeness, ensuring 7.2 MANAGING INFORMATION they are up to date (HSP 3). Written Evidence-Based Practice 7.2.1 Comply with organisational policies regarding timely 7.2.14 Implement the principles of evidence-base practice and accurate documentation. (HSP 1). 7.2.2 Demonstrate high quality written skills (e.g. legible, 7.2.15 Use best available evidence in clinical decision making concise and informative discharge summaries) (HSP 1). (HSP 1). 7.2.3 Effectively write documents (e.g. referrals, 7.2.16 Critically appraise evidence and information (HSP 1). investigation requests), using appropriate structure and content (HSP 1). Handover Electronic 7.2.17 Summarise the importance of handover in terms of patient safety and continuity of care (HSP 1). 7.2.4 Contrast the uses and limitations of electronic patient 7.2.18 Describe the risks of ineffective handover (HSP 1). information and decision support systems (HSP 2). 7.2.19 Perform an effective handover (e.g. utilising ISBAR) to another healthcare team member (HSP 1). HSP: MENTAL HEALTH MODULE
  • 15. 7.3 WORKING IN TEAMS Team Structure 7.3.1 Identify different types and structure of healthcare teams (e.g. the medical team, the multidisciplinary team) suitable for the care of the patient (HSP 1). 7.3.2 Include patients and carers in the healthcare team where appropriate and if possible (HSP 1). 7.3.3 Provide appropriate leadership within a healthcare team (HSP 2). Team Dynamics 7.3.4 Identify the characteristics of effective healthcare teams (HSP 1). 7.3.5 Work constructively with others in the healthcare team and resolve conflicts if they arise (HSP 1). 7.3.6 Within the healthcare team demonstrate flexibility and adaptability in responding to changes in the workplace (HSP 1). Teams in Action 7.3.7 Participate fully in teams across healthcare settings, displaying respect for other team members (HSP 1). 7.3.8 Demonstrate support for the roles and responsibilities of healthcare team members (HSP 1). 7.3.9 Demonstrate the flexibility to adapt to a variety of roles within the healthcare team (HSP 2). Case Presentation 7.3.10 Outline the elements and principles of an effective case presentation (HSP 1). 7.3.11 Perform an effective case presentation to members of the healthcare team, including senior medical staff (HSP 1). MARCH 2010 VERSION 1.1 PAGE 15
  • 16. Hospital Skills Program MENTAL HEALTH SECTION 8: Professionalism 8.1 DOCTOR AND SOCIETY SECTION 8: Professionalism Access to Healthcare 8.1 Doctor and Safety 8.2 Professional Behaviour 8.1.1 Indicate how psychiatric disability can limit access to healthcare services (HSP 1). 8.3 Teaching and Learning 8.1.2 Provide culturally appropriate healthcare (HSP 1). 8.1.3 Adopt an inclusive and non discriminatory approach to healthcare (HSP 1). Culture, Society and Healthcare 8.1.4 Describe social, economic and political factors in patient illness (HSP 1). 8.1.5 Outline the impact of culture, ethnicity and spirituality on health (HSP 1). 8.1.6 Identify one’s own cultural values that can affect the role of being a doctor (HSP 1). Indigenous Patients 8.1.7 Briefly describe the history and experiences of indigenous Australians and explain how these may affect indigenous patient illness presentation (HSP 1). 8.1.8 Demonstrate sensitivity to indigenous Australians’ spirituality and relationship to the land (HSP 1). 8.1.9 Recognise the diversity of indigenous cultures, experiences and communities (HSP 1). Medicine and the Law 8.1.10 Comply with the legal requirement in patient care (e.g. in implementing provisions of the NSW Mental Health Act) (HSP 1). 8.1.11 Complete medico-legal and forensic psychiatry documentation appropriately (HSP 1). 8.1.12 Liaise with and report to legal and statutory authorities as required (HSP 1). HSP: MENTAL HEALTH MODULE
  • 17. Health Promotion Personal Well-being 8.1.13 Describe environmental and lifestyle risks to health 8.2.9 Identify the personal health risks of medical practice and advocate for healthy environmental and lifestyle (e.g. fatigue, stress) (HSP 1). choices during encounters with patients (HSP 1). 8.2.10 Describe behaviours that will optimise personal 8.1.14 Demonstrate a non-judgemental approach to patients health and well-being (HSP 1). and their lifestyle choices (HSP 1). 8.2.11 Recognise the potential harm to others due to the 8.1.15 Contrast the positive and negative aspects of health lack of personal well-being (HSP 1). screening and prevention (HSP 2). 8.2.12 Describe unhealthy responses to work stress (e.g. substance abuse) (HSP 1). Healthcare Resources Ethical Practice 8.1.16 Deploy healthcare resources wisely to achieve the best outcomes (HSP 1). 8.2.13 Recognise the ethical complexity of medical practice 8.1.17 Demonstrate behaviour which acknowledges that (HSP 1). healthcare is a finite resource (HSP 1). 8.2.14 Summarise professional and ethical codes relevant to 8.1.18 Describe the complexities and potential blocks of medical practice (HSP 1). gaining healthcare access for psychiatric patients 8.2.15 Demonstrate ethical practice within and outside the (HSP 2). workplace (HSP 1). Practitioner in Difficulty 8.2 PROFESSIONAL BEHAVIOUR 8.2.16 Describe the support services available to Professional Responsibility practitioners in difficulty (HSP 1). 8.2.17 Describe appropriate responses to a practitioner 8.2.1 Exercise professional responsibilities relevant to the in difficulty (HSP 1). current work role (HSP 1). 8.2.2 Describe elements of reflective professional practice Doctors as Leaders with regard to current personal capabilities (HSP 1). 8.2.3 Describe the parameters of individual professional 8.2.18 Describe the variety of leadership roles that may be skills (HSP 1). required as a doctor (HSP 2). 8.2.4 Demonstrate an awareness of boundary issues in 8.2.19 Describe and demonstrate the attributes of a good therapeutic relationships (HSP 1). leader (HSP 2). 8.2.20 Enact the roles of collaborator and leader in the Time Management workplace (HSP 2). 8.2.5 Explain how time limits affect patient care and hospital function (HSP 2). 8.2.5 Prioritise daily workload and multiple demands on time and activities (HSP 2). 8.2.7 Demonstrate punctuality in the workplace (HSP 1). 8.2.8 Describe how working in multidisciplinary teams impacts on time management (HSP 2). MARCH 2010 VERSION 1.1 PAGE 17
  • 18. 8.3 TEACHING AND LEARNING Self-Directed Learning 8.3.1 Demonstrate a commitment to continuous learning in medicine (HSP 1). 8.3.2 Identify and address personal learning needs (HSP 1). 8.3.3 Describe and apply where relevant common research methodologies (HSP 1). 8.3.4 Summarise levels of evidence with regard to learning in medicine (HSP 2). Teaching 8.3.5 Identify varied approaches appropriate to different settings of teaching and learning in medicine (HSP 2). 8.3.6 Incorporate teaching into professional practice as required (HSP 2). 8.3.7 Respond appropriately to feedback on teaching in professional practice (HSP 2). Supervision 8.3.8 Describe the elements of effective supervision (HSP 1). 8.3.9 Participate in personal supervision and respond to feedback (HSP 1). 8.3.10 Provide supervision and feedback to other members of the health care team as required (HSP 2). 8.3.11 Participate in assessment and appraisal as required (HSP 1). 8.3.12 Demonstrate mentorship skills (HSP 3). Career Development 8.3.13 Describe the career options as a medical practitioner working in the mental health context (HSP 2). 8.3.14 Identify pathways to alternative careers in medicine, if desired (HSP 2). HSP: MENTAL HEALTH MODULE
  • 19. NSW Institute of Medical Education and Training (IMET) Building 12 Gladesville Hospital GLADESVILLE NSW 2060 Tel: (02) 9844 6551 Fax: (02) 9844 6544 Email: info@imet.health.nsw.gov.au Post: Locked Bag 5022, GLADESVILLE NSW 1675