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Harniess 04


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Harniess 04

  1. 1. Developing a Primary Care Mental Health Personal Development Plan (PDP) Dr David Harniess MBChB MRCGP DCH DRCOG
  2. 2. Learning Objectives <ul><li>Understanding experiential and reflective learning </li></ul><ul><li>Understanding what portfolio learning is and its importance </li></ul><ul><li>Identifying your learning needs and how to achieve them </li></ul><ul><li>Developing a Mental Health Personal Development Plan (PDP) </li></ul>
  3. 3. Why is this type of learning important? <ul><li>Makes learning practical and applied </li></ul><ul><li>Improves your clinical performance </li></ul><ul><li>Improves patient care and outcomes </li></ul><ul><li>Skills for lifelong learning – learning never stops! </li></ul><ul><li>Self directed and relevant </li></ul><ul><li>to you </li></ul>
  4. 4. How did you learn how to do your job?
  5. 5. Experiential Learning Cycle Kolb DA. 'Experiential Learning experience as a source of learning and development', New Jersey: Prentice Hall 1984
  6. 6. The wise man reflects!
  7. 7. Reflective Learning <ul><li>Levels of Reflection </li></ul><ul><li>“ Knowing that” – or textbook knowledge for example the ICD-9 symptoms and signs of depression </li></ul><ul><li>“ Knowing -in- action” - or the integration of skills and knowledge to do the job – looking, listening and testing the patient for a diagnosis of depression </li></ul><ul><li>“ Reflection - in –action” – or when in the midst of tasks we examine what is happening – the history suggested depression but the affect of the patient didn’t fit - what is going on? Do I need to re-think? </li></ul><ul><li>“ Reflection – on – action” – after the event so was the decision to start the patient on antidepressants right? </li></ul>
  8. 8. Portfolio based learning <ul><li>Is a collection of evidence that demonstrates learning. </li></ul><ul><li>Examples could include: </li></ul><ul><li>Diary of reflections on patient cases </li></ul><ul><li>Reflections on discussion with colleagues regarding patients </li></ul><ul><li>Reflections from educational meetings e.g. lectures, courses, in house education </li></ul><ul><li>Reflections from reading a book/journal article </li></ul><ul><li>PUNs and DENs </li></ul><ul><li>Audit </li></ul><ul><li>SEA </li></ul><ul><li>E learning modules </li></ul><ul><li>Peer review (feedback from colleagues) </li></ul><ul><li>Small group discussion </li></ul><ul><li>Review of any patient complaints </li></ul>
  9. 9. Portfolio based learning <ul><li>Benefits of a portfolio based approach – unmasking the unknowns </li></ul>
  10. 11. Recording your learning <ul><li>Keeping a diary/ learning log </li></ul><ul><li>Internet tools – appraisal toolkit/ RCGP new appraisal </li></ul><ul><li>Recording reflections from lectures/ courses </li></ul><ul><li>PUNs and DENs…… </li></ul>
  11. 12. Example 1 – Descriptive learning log entry None What further learning needs have you indentified? Perform a general examination in all patients presenting with depression, anxiety or psychoses What will you do differently in the future? How can I apply what I learnt in practice? Should examine patients presenting with mental health presentations Patients with schizophrenia have worse health than the general population What did you learn? Seminar on importance of physical examination in mental health Learning event activity 23.1.2011 Date of learning event
  12. 13. Example 2 – Reflective learning log entry Need to read mhGAP intervention guide to consider minimum investigations for new onset depression What further learning needs have you indentified? If someone presents with an acute psychotic episode I need to rule out physical causes first as historically many people have been admitted to psychiatric hospitals with underlying organic disorder Consider the SOAP acronym as a format to document my findings in the medical notes Need to develop a general practice protocol for an annual health check with patients suffering with severe mental illness What will you do differently in the future? How could I apply what I have learnt in practice? Tailoring neurological examination to check for Parkinson’s disease in older person presenting with anxiety and tremor Increased rates of obesity, ischaemic heart disease and diabetes in schizophrenic patients related to poor lifestyle and long term atypical antipsychotics What did you learn? Seminar on importance of physical examination in mental health Learning event activity 23.1.2011 Date of learning event
  13. 14. PUNs and DENs 1 <ul><li>Patient Unmet Needs – in many of our consultations there is a patient unmet need and may be due to doctor’s lack of knowledge or skill </li></ul><ul><li>Doctor’s Educational Need – define identified lack of knowledge or skill </li></ul><ul><li>Method of recording these experiences and prioritising what we need to learn </li></ul>1 Eve, R. PUNs and DENs: Discovering Learning Needs in General Practice Radcliffe Medical Press 1994 
  14. 15. Example of PUN and DEN Attended lecture of Psychiatrist Dr Palazidou on assessing for psychoses - important to ask the patient why they believe the delusion, what evidence do they have to confirm their delusion and then gently offer the patient an alternative explanation for their delusion e.g. crack on the wall rather than listening device they believe it is What do expert psychiatrists do with someone who is experiencing delusions in their conversation with patients I have patients who present to me with new onset of delusions and I normally refer these patients directly to the psychiatrist at this point - is there anything else I could do to help the patient with their delusions whilst they are waiting to see the psychiatrist? 241/2011 Action to achieve DEN DEN PUN Date
  15. 16. Audit Cycle
  16. 17. What possible audits could you consider in mental health
  17. 18. Possible audits in mental health <ul><li>Annual health check with all patients with severe chronic mental health e.g. bipolar affective disorder and schizophrenia – have we done a health check in the last year on these patients? Minimum standard 90% </li></ul><ul><li>Has depression been correctly diagnosed in all our patients with a label of depression? Audit patient notes against ICD-9 criteria (minimum standard 90%) </li></ul><ul><li>Coverage of primary care mental health in Libya – what mental health services are available? In which geographical areas do we need to develop services? </li></ul>
  18. 19. Significant Event Analysis <ul><li>Group meeting to discuss mistake/near misses or something done well </li></ul><ul><li>Ground rules – honest and non-judgemental </li></ul><ul><li>The process covers four basic stages: </li></ul><ul><li>Select the event you want to analyse </li></ul><ul><li>Gather the data needed </li></ul><ul><li>Hold a meeting to analysis the event and agree on action </li></ul><ul><li>Implement action and review the effects </li></ul>
  19. 20. Significant Event Analysis
  20. 21. What possible SEAs could you consider for mental health situations
  21. 22. Possible SEAs in mental health <ul><li>Review of cases of any completed or attempted suicides </li></ul><ul><li>Harm caused to others by patient with mental health problems – could we have identified this? Could we have prevented it? </li></ul><ul><li>Prescribing errors or adverse drug reactions </li></ul>
  22. 23. How do you identify your learning needs?
  23. 24. Identifying your learning needs <ul><li>Possible tools: </li></ul><ul><li>Self awareness of need </li></ul><ul><li>Significant events in practice </li></ul><ul><li>Feedback from colleagues or patients </li></ul><ul><li>Referral analysis and feedback from consultant letters </li></ul><ul><li>Objective tests e.g. MCQ </li></ul><ul><li>Analysis of patient contacts </li></ul><ul><li>Reading – journals/medical books </li></ul><ul><li>Self rating scale </li></ul>
  24. 27. How do you achieve your identified learning needs?
  25. 28. How do you achieve your identified learning needs? <ul><li>Learning from colleagues – peer discussion </li></ul><ul><li>Asking an expert </li></ul><ul><li>E learning modules – eGP, BMJ </li></ul><ul><li>Internet searches – cochrane, Medline, guidelines </li></ul><ul><li>Medical Books </li></ul><ul><li>Internet resources </li></ul>
  26. 29. Specific mental health resources <ul><li>World Health Organisation - </li></ul><ul><li>(new mhGAP guidelines available) </li></ul><ul><li>WONCA guidelines / </li></ul><ul><li>(download of talks) </li></ul><ul><li>NICE guidelines – (depression in adults, schizophrenia, antenatal and postnatal mental health…) </li></ul><ul><li>BMJ articles – Clinical Review articles and 10 minute consultation </li></ul><ul><li>MIND charity organisation for patients and carers </li></ul><ul><li>Patient information and leaflets (some in arabic) </li></ul><ul><li>Davies, T. & Craig, TKJ. ABC of Mental Health BMJ Books 1998 (Introductory text in mental health) </li></ul>
  27. 30. Making a plan to achieve your identified learning needs Produce practice formulary on antipsychotics and monitoring   3. Consider which is best first line antipsychotic depending on associated psychiatric presentation     Keep records of case discussion of patient’s with acute pscyhosis and outcomes Discuss With colleagues 2. Know to whom to refer the patient to     Summarise key points from reading Read medical text, BMJ Clinical Review article and review mhGAP Intervention guidet 1. Know how to recognise acute psychoses Significant event: I had a patient with new onset psychosis who required emergency admission to hospital. However we had failed to recognise the condition so I would like to improve my knowledge and skills in its management Learn how to manage psychosis What evidence will you keep? Activities to be used Learning objectives Reason for inclusion in development plan Educational Need
  28. 31. Learning Objectives <ul><li>Understanding experiential and reflective learning </li></ul><ul><li>Understanding what portfolio learning is </li></ul><ul><li>Identifying your learning needs and how to achieve them </li></ul><ul><li>Developing a mental health Personal Development Plan (PDP) </li></ul>
  29. 32. Time for Reflection <ul><li>Self rating on RCGP framework </li></ul><ul><li>Developing a Personal Development Plan using the table provided </li></ul>