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Trainee Handbook MRCPsych Course 2018 – 2020 School of Psychiatry, Health Education England North West Dr Latha Hackett MRCPsych Course Director Dr Gareth Thomas MRCPsych Deputy Course Director
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Page 1: MRCPsych Course 2018 2020 - NW School of Psychiatry · Underpinning Specialist Training in Psychiatry (Royal College of Psychiatrists UK), with 24 months [ modular training. Every

Trainee Handbook

MRCPsych Course

2018 – 2020

School of Psychiatry, Health Education England North West

Dr Latha Hackett

MRCPsych Course Director

Dr Gareth Thomas

MRCPsych Deputy Course Director

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Handbook updated June 2018. Thanks to Dr Hannah Slevin, Year 3 core trainee, for her helpful

suggestions.

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Contents

Background ............................................................................................................................................... 3

Aims of the Course .................................................................................................................................... 4

The Overall Course Structure .................................................................................................................... 5

Educational Supervision ............................................................................................................................ 5

Local Academic Programme Training ....................................................................................................... 5

Structure of LAP Sessions (Broadly) .......................................................................................................... 6

Case Presentations .......................................................................................................................... 6

Journal Club ..................................................................................................................................... 7

555 Presentations ........................................................................................................................... 7

Expert Led Sessions ......................................................................................................................... 7

Flexible Session ............................................................................................................................... 7

Regional Academic Course ........................................................................................................................ 8

Attendance ................................................................................................................................................ 8

Psychotherapy........................................................................................................................................... 8

Exam Preparation ...................................................................................................................................... 8

Assignments to Evidence Learning ........................................................................................................... 9

Evaluation of the MRCPsych Course ......................................................................................................... 9

Appendix 1 – Guidance for Journal Club Presenttion & Critical Appraisal ............................................. 10

Appendix 2 - Guidelines for Case Conference Presentation ………………………………………………………………23

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Background

This Course Handbook has been written along with members of the course development group for

trainees, module leads, course facilitators, administrative staff, trainees and Educational Supervisors. In

this handbook we describe the course, its special features, overall purpose, basic structure, how it will

be run and the educational principles and philosophy on which it is based.

We strongly recommend that you read this in conjunction with other important documents relating to

the course, particularly:

The curriculum for Core Specialty Training, published by the Royal College of Psychiatrists:

https://www.rcpsych.ac.uk/traininpsychiatry/curriculaandguidance.aspx

The College syllabus on which the MRCPsych examination is based:

https://www.rcpsych.ac.uk/pdf/Core_Psychiatry_Curriculum_April_2018.pdf

The module handbooks which will be given to you on day one of the course. These handbooks

have been provided with extensive and interesting references and reading material. It is hoped

that it will encourage trainees to enjoy the subject and learn more.

An important aim of the course is to enable you to pass the MRCPsych exam, which is a crucial stepping

stone in your progression through specialty training. This is how the course is arranged to deal with

that. Firstly, the topics that are presented in the modules have been ‘mapped’ against the College

curriculum and exam syllabus:

(https://www.rcpsych.ac.uk/pdf/Core_Psychiatry_Curriculum_April_2018.pdf)

Not all of the syllabus will be covered on the course which means that you will have to learn this

through your own private study. This handbook will explain the topics that will not be covered.

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Aims of the Course

The HEE(NW) School of Psychiatry MRCPsych course has several purposes that will enable you to

practise psychiatry at the highest possible standard, safely and at a level appropriate to your year of

training. It will also prepare you for further specialist training in the future. We also aim to link together

various elements of your training, such as:

Clinical practice

Meetings with your Educational Supervisor

Psychotherapy training

Site based education programmes

Academic training with the School of Psychiatry

Exam preparation in your placement

Personal study

Revision for the MRCPsych examination.

The following diagram shows how all aspects of your training contribute to the MRCPsych course, and

how they are integrated into your training. The course covers the College curriculum and examination

syllabus and should prepare you for all of the membership exams.

The aim is to integrate all aspects of your training, making your postgraduate education a rewarding,

fulfilling and enjoyable experience. We believe that this will help you to develop as a better clinician, as

you integrate the various (otherwise separate) strands of your working life. The course has been devised

on sound educational principles.

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We are able to provide you with educational opportunities to help you to learn effectively, so you

develop into a competent core trainee, who is ready to undertake further higher specialist training, but

you have to do your own learning too. You should read through this handbook to understand the

course, the curriculum and exam syllabus. You are the vital part of the process of teaching and learning.

Psychiatry, like all clinical specialties, is changing rapidly. New treatment options are becoming

available. Alternative medications, some of them increasingly powerful, are being developed. Service

configurations are also being altered - some in the face of financial constraints, others for social and

humanistic reasons and some because the research evidence points in a particular direction.

We do recognise that the world of psychiatry you will be working in will be very different from that of

your Educational Supervisors and the things you learn now might soon be outdated too. Psychiatric

practice will be changing around you as you continue through your career. This course is designed not

just for you to learn a lot about psychiatry, to pass exams and to achieve the core curriculum

competencies, but also to develop your capacity to go on learning and developing your practice for the

rest of your career. In short, we want to support you in becoming a life-long learner.

For all these reasons, the overriding educational model on which this new course is based requires that

you research and enquire critically your own emerging clinical practice. We aim to support you in

becoming a self-directed, reflective practitioner and to understand that when you become senior

clinicians you will be the one from whom other colleagues will seek advice. You will need to develop the

ability for continued professional development, keep abreast of what is happening in psychiatry and

become lifelong learners.

The Overall Course Structure

The course is developed with the premise that you learn most of your practice in the workplace under

supervision from your Clinical Supervisor. This will be supported by the Local Academic Programme

(LAP), as well as Psychotherapy training in the locality. Additionally, there are centrally-organised

regional academic training days. Examination practice will be provided by your Clinical/Educational

Supervisor in your placement and also during Local Academic Programme training days. The regional

academic training days run by the School of Psychiatry are for 6 full days every 6 months for two years.

We have annual clinical and written progress tests.

Educational Supervision

It is mandatory that you have weekly one-hour supervision sessions with your Clinical/Educational

Supervisor. During supervision, a range of discussions should take place where you have the opportunity

to discuss clinical, educational, pastoral and career development matters. You should prepare for your

supervision sessions so that you have an agenda that meets your educational needs. In your placement

there should be ample opportunities to undertake workplace-based assessments, portfolio reviews and

to obtain CASC practice; weekly supervision is just one of these opportunities. Use every opportunity

you have to prepare yourself for your CASC examination.

Local Academic Programme Training

All Local Academic Programmes are expected to provide 15 half-day training sessions, every 6 months,

for core trainees in psychiatry. These training sessions are mandatory. The sessions will include case

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presentations, journal clubs, expert-led sessions and 555 presentations. There will also be time to

complete multiple choice questions and reflection on the learning of the day at the end of the session.

The programme is based on the syllabic curriculum, which covers areas of Core Medical Knowledge

Underpinning Specialist Training in Psychiatry (Royal College of Psychiatrists UK), with 24 months’

modular training.

Every 6 months, the following areas of psychiatry will be covered:

General Adult (6 sessions)

Old Age (2 sessions)

Child and Adolescent (2 sessions)

Intellectual Disability (1 session)

Forensic (1 session)

Substance Misuse (1 session)

Psychotherapy (1 session)

and a session on a specific disorder across age groups e.g. psychosis across the life span. The

‘across the ages’ session aims to look at areas of psychiatry (e.g. psychosis, depression, liaison,

the burden of mental illness in the family) and to compare and contrast these across childhood,

adulthood and into old age.

You will be expected to present at case presentations, journal clubs, 555 sessions and also to participate

in some of the expert-led sessions. You will be asked to do some background reading before you attend

these sessions, including reading each week’s journal club article. This will ensure you get the most out

of the education sessions. You may be asked to present more than once per semester; please see this as

a positive learning opportunity, giving you additional exam preparation and more evidence for your

learning portfolio.

Local Academic Programmes will also have around 7 weeks per 6 months to cover other topics such as

Audit/Communication Skills etc. Overall responsibility for delivery of the LAP programme lies with the

Clinical Tutor/Local Educational Leads on each site, so if you do experience any difficulties, feed this

back to them when possible. Completing the feedback forms each week will enable continued review

and improvement of the course.

Structure of LAP Sessions (Broadly)

Case Presentations

This is based on the traditional model of case presentations. It is expected to be trainee-led, but it is

also expected that some Consultants and Clinical/Educational Supervisors attend these conferences and

help facilitate rigorous discussions. It is expected that the Clinical/Educational Supervisor of the trainee

who presents the case should discuss it during supervision and make arrangements to attend the

presentation as far as possible. It is expected that the case will demonstrate many (but perhaps not all)

of the clinical features, aetiological factors, aspects of treatment, socio-cultural and ethical issues of the

theme of the week. We would encourage you to inform your Clinical/Educational supervisor about your

case presentation. They can support you in gaining access to relevant clinical cases, preparing your

presentations and support you on the day. This can be used as an opportunity to gain feedback and

evidence in your e-portfolio.

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Guidance for trainees presenting a case presentation will be provided in the appendices of this

handbook.

Journal Club

Knowledge and understanding of research is essential for trainees. This is not just for basic training but

also for passing the MRCPsych exams. It is expected that this would be trainee-led, but Consultants and

especially Clinical/Educational Supervisors are expected to take an active interest in journal clubs. It is

expected that the Clinical/Educational Supervisor of the trainee who presents the journal should discuss

it during supervision and make arrangements to attend the presentation as far as possible. Each locality

could be flexible in the methods of conducting this session but the aim should be to cover the Royal

College syllabus component of critical review.

The journal club has traditionally focussed particularly on acquiring critical appraisal skills. The intention

is to expand this to also focus on the educational content appropriate to the day’s theme.

Guidance for trainees presenting journal clubs is provided in the appendices of this handbook.

555 Presentations

The aim of this session is to give the trainee practice in summarising complex concepts and being able to

communicate this succinctly. This is analogous to clinical work, particularly when communicating with

patients and how CASC would expect trainees to present. This model consists of a concise and focused

presentation by trainees: 5 slides (excluding title slide); 5 bullet points on each slide; 5 minutes to

present. There will be some additional time for discussion after the presentation. These presentations

should include ‘key points’ or summaries of important topics, which can be explored further in your

independent learning.

Typically, there is 1x 555 presentation in each LAP half-day training session. For the General Adult

themed LAPs, however, there will be 2x 555 presentations. One of these will be related to the theme of

the LAP day. The other will be linked to the journal club presentation, and will give you some theoretical

teaching about an area of critical appraisal.

Expert Led Sessions

An ‘expert’, for the purpose of this course, is a Consultant Psychiatrist or ST4-6 trainee. However, as trainees particularly value consultant-led sessions it is hoped that this will be the norm.

The aim of this session is to have an interactive discussion and debate, combined with a ‘teaching’

component whereby both the trainees and the expert participate actively. The trainees are expected to

read about the topic beforehand. The expert’s ‘function’ is not to merely facilitate discussion but to lead

and actively participate in it, to ask questions, to generate curiosity to learn more and to provide some

teaching or guidance if required. The expert may wish to bring some form of presentation but the

session should not be purely didactic.

Flexible Session

The flexible session can be used by individual Local Educational Providers to fit their needs and

purposes. It could be used, for example, for MCQ/EMI practice, communication skills training though

videos brought by trainees, reflective practice, audit presentation etc. This time may also be used to

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review any training issues or particular clinical scenarios that have arisen out of hours. Alternatively, this

time could be used to review and reflect upon what the trainees have learned and what further reading

they will need to undertake to meet the relevant learning objectives.

Reflective Learning

At the end of each LAP session, it is recommended that you complete a piece of independent reflective

practice that should be uploaded onto your learning portfolio. This will be looked at by Supervisors.

Regional Academic Course

This will occur on 12 full days a year (Thursdays) in the Medical Education Department at North

Manchester General Hospital. There will normally be 6 face-to-face teaching days between September

and January and 6 days between March and July, throughout your first and second year of core

psychiatry training. Once again, the course will run using adult learning principles with different types of

teaching methods, such as problem-based learning, workshops and didactic teaching. You may be

expected to do some personal studying in preparation for the days’ learning. Reading material will be

sent to you in advance.

Attendance

An attendance of 70% is mandatory at both local and regional academic teaching sessions, and this

should be evidenced in your portfolio. Attendance will be monitored by the School of Psychiatry, who

will provide attendance figures for you and your Training Programme Director. We appreciate that there

are times when you may be on call/leave etc. – though this should be an infrequent occurrence.

Psychotherapy

Please refer to the psychotherapy training guidance provided:

https://nwpgmd.nhs.uk/Specialty_Schools/Psychiatry/psychotherapy-information

Exam Preparation

You must organise with your Educational Supervisor to have CASC practice, at least 2-4 sessions in your

six month placement. This could be in the form of a workplace based assessment, such as Mini-ACE and

CbD sessions.

At the end of every Local Academic Programme (LAP) session you will be given 15-20 minutes to do

some multiple choice questions and EMIs as part of the exam practice. There will be similar exam

practice during the regional academic training days.

Annually, there is an OSCE-style School Progress Test (usually end of May/early June), which all core

trainees are expected to participate in and for which you should prepare and treat as a formal

examination. You will receive detailed feedback (including mark sheets) regarding your performance.

In addition to the above exam, there is an online MCQ question bank, with mock examination papers,

which can be accessed via the Virtual Learning Environment: http://manchesterpsychiatry.net/

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Assignments to Evidence Learning

You can evidence your learning in your e-portfolio is the following way:

70% attendance record for your LAP and for the regional academic training days

Educational supervision records

On call records

Presentation handouts

Reflective learning log of the day

You must upload your attendance records prior to your TPD reviews around Dec & May; please request

these from your LAP administrator. You will be provided with your Regional Academic Programme

attendance by the School.

Evaluation of the MRCPsych Course

You will be sent feedback forms to complete after each training session. It is important that you

complete and return these to the School of Psychiatry immediately following each session.

Copies of all resources will be available on the School website www.schoolofpsychiatry.net

Dr Latha Hackett

MRCPsych, Course Director

June 2018

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Appendix 1 - Guidance for Journal Club Presentation & Critical Appraisal

Introduction

Critical appraisal skills have now become essential, both for membership exams as well as for daily

evidence-based clinical practice. The journal club is essentially a group activity and can be as interesting

and stimulating or as boring as the group wants it to be. It is a very rewarding habit if one regularly

looks at research papers to guide practice. One does not need to be a statistician to be able to do so.

The following is an introduction to journal clubs and critical appraisal. The intention is to help you

navigate through the various aspects of it. It is not meant to be a comprehensive book about critical

appraisal.

What is expected in a Journal Club Presentation

The usual way of doing journal clubs is that one person presents a paper, which is followed by a group

discussion. Although one person takes the lead, the success of the journal club depends on everyone

else making themselves familiar with the paper before the journal club meeting.

Please identify a paper to present well in advance and circulate it to everyone. This is crucially important

because discussions are very limited if nobody has a chance to read the paper. Equally, please do read

the paper circulated by your colleagues beforehand.

The presenter should make a PowerPoint/Keynote/Prezi presentation (as opposed to just using the

paper printout). One suggested method is to present it in the following sections:

Introduction (about 15 minutes)

The title of paper, the journal, authors.

The context of the paper (i.e. Why is this paper being presented,

what is its place in context of the literature on the subject)

What is the research question? (This is not always explicitly stated, in

which case one needs to think about it and try to articulate it in the

presentation).

The contents of the paper (Background, Sample, Method,

Conclusions, Limitations, Recommendations)

Relevant discussion about the statistics used

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Questions /clarifications about the paper

Critical appraisal & Discussion (this should take up major proportion of the time and involve the whole

group)

Why have the authors done this piece of research in the first place?

(What is its value?)

Does it add to the existing knowledge?

Why have the researchers chosen this particular method?

Is there other research that refutes or supports the conclusions?

Systematic step-by-step (critical) appraisal using standardized

questions /checklists (see Appendices).

[The presenter should circulate the checklist along with the paper, beforehand. The presenter should

take lead in starting the discussion first and then present his/ her own views on the particular question].

Take home points / conclusion

How are the results helpful in clinical practice?

The gist of the authors’ conclusions

Your conclusions about the paper

References / Further reading

Obtaining Feedback

The usual practice is to identify an assessor (Consultant or Higher trainee) beforehand and giving

him/her the Work Place Based Assessment form beforehand. You could also distribute some feedback

forms amongst the group.

Study Designs

Broadly speaking, study designs can be divided into quantitative and qualitative (Figure 1). The type of

study design is determined by the kind of research question that the researchers want to address (Table

1).

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Study Designs

Quantitative

Qualitative

Ecological Case-control Cohort Cross-sectional, 2 group

Analytical

Observational

Descriptive

Case reports Case series Cross-sectional Longitudinal

Experimental /

intervention

GOLD standard for drug treatments

Randomised control trials Cross-over trial N of 1 trial

Economic studies

Cost-minimisation Cost-effectiveness Cost-utility Cost-benefit

Meta-analysis & Systemic Reviews

For ‘what, how and why’ questions rather than ‘how much or how many’ type of questions.

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Table 1: Study designs and research questions

Study design Research question and example of study

1 RCT

Is Agomelatin effective in treatment of sleep disturbance and depressed mood? Example: A randomized double-blind placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo for sleep disturbance and depressed mood (Serfaty et al., 2010).

2 Meta-analysis

How do second generation antipsychotics compare with each other for efficacy of treatment of Schizophrenia? Example: A meta-analysis of the efficacy of second-generation antipsychotics (Davis et al., 2003).

3 Systematic review

What is the evidence for long-term Lithium therapy for bipolar disorder? Example: Long-term Lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials (Geddes et al., 2004).

4 Qualitative study

How do patients perceive the quality of care for depression in general practice? Example: Qualitative study of patients' perceptions of the quality of care for depression in general practice (Gask et al., 2003).

5 Economic study

What is the cost effectiveness of Clozapine compared to other second-generation antipsychotics in people with Schizophrenia? Example: A Randomized controlled trial of the cost-utility of second-generation antipsychotics in people with psychosis and eligible for clozapine (Davies et al., 2009).

6 Case series Are there known cases of Cotard syndrome described in the literature? Example: Cotard's syndrome: analysis of 100 cases (Berrios & Luque, 1995).

7 Cross-over trial What is the effect of treatment with Modafinil on healthy volunteers? Example: A randomized, double-blind, crossover trial of Modafinil on mood (Taneja et al., 2007).

8 Case-control study Is environmental tobacco smoke associated with lung cancer? Example: Multicenter case–control study of exposure to environmental tobacco smoke and Lung cancer in Europe (Bofetta et al., 1998).

9 Cohort study

Is Cannabis a risk factor for Schizophrenia? Example: Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study (Zammit et al., 2002).

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A little bit of Statistics

The key is not to be afraid of it! The rest is not too difficult!

The BMJ has a fantastic series of short articles (Statistical Notes) on different statistical concepts which

are written with great lucidity (http://www.jerrydallal.com/LHSP/bmj.htm). It also has an easy-to-

navigate online version of the book – Statistics at Square One (http://www.bmj.com/about-

bmj/resources-readers/publications/statistics-square-one).

Impact Factor

The impact factor is one of three standardized measures created by the Institute of Scientific

Information (ISI) which can be used to measure the way a journal receives citations to its articles over

time (Amin & Mable, 2000). Higher the impact factor, the more the relative importance of the journal.

For example in Psychiatry; the Archives of General Psychiatry, the British Journal of Psychiatry and the

Acta Psychiatrica Scandinavica have impact factors of 12.2, 6.6, 4.2, respectively.

Peer Reviewing

In order to improve the quality of research, studies are evaluated by peers (other researchers in the

same field) before they get published. This is peer reviewing.

Conflict of Interest

Check if the study of a drug is sponsored by the pharmaceutical company that makes the drug or if the

authors work for that company or have affiliations with it. It would be easy for potential bias to creep in

such studies. Authors must clearly state any conflict of interest in the publication. It is worth reading the

recent article by Kendall (2011) about how the pharmaceutical industries have influenced antipsychotic

prescribing practices of doctors.

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Glossary

Some useful statistical concepts are explained in the glossary. The books from which these were derived

are referenced in the reading list. It is hoped that you would be motivated to read more.

Bias - Anything which erroneously influences the conclusions about groups and distorts comparisons is

bias (Rose & Barker, 1994). Bias can enter at various stages of the study (e.g. selection bias, performance

bias, exclusion bias, detection bias, publication bias) and there are methods of reducing bias.

Blinding - The process by which researchers ensure that the person/s providing the treatment or

assessing the outcome and the person/s receiving the treatment do not know which drug /intervention

(or placebo) is being experimented in which arm of the study. Studies can be single, double or triple

blind.

Confidence interval (95%) - If one repeats the experiment 100 times, the true value of p would lie within

the given range on 95 of the occasions. The smaller the confidence interval, the more accurate an

estimate.

Confounding - Confounding factor is a factor that is an alternate explanation for apparent associations

between exposures and outcomes (it alters the likelihood of an outcome and is associated with both

exposure and outcome but is not on the causal pathway).

Correlation, regression - Correlation is the relationship between variables where one depends on the

other, usually indicated by a constant / coefficient (e.g. Pearson’s ‘r’).

Regression is a mathematical tool for calculation of the exact nature of the correlation, which allows one

variable (dependent) to be predicted from another variable/s (independent). [Remember the equation:

y=a +bx !]. It could be linear, multiple linear or logistic.

Grounded theory - It is a method used in qualitative studies to compare and contrast the data (e.g.

transcripts) by coding (open coding, secondary coding, and theoretical coding) in order to find common

themes in the data from which a theory may emerge. Some studies use thematic analysis instead.

Heteregeneity In meta-analysis and systematic reviews, one needs to be confident that the studies

being compared are not very different from each other (i.e. they should not be heterogenous), except

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by chance alone. This can be inspected visually (by Forrest plots) or calculated statistically (by “chi-

square statistic”).

NNT (Number Needed to Treat) - It is the number of people who would need to be treated in order to

prevent one extra person being ill. (e.g. Lithium is effective in the treatment of moderate to severe

mania with a NNT of 6 (Taylor et al., 2009). As a clinician, one would be interested in NNTs when

considering treatment options (in addition to other things e.g. side effect profile, etc.).

Null hypothesis, p values, confidence intervals, errors - It is the number of people who would need to

be treated in order to prevent one extra person being ill. (e.g. Lithium is effective in the treatment of

moderate to severe mania with a NNT of 6 (Taylor et al., 2009). As a clinician, one would be interested in

NNTs when considering treatment options (in addition to other things e.g. side effect profile, etc.).

These are best explained with an example:

Null hypothesis: Drug X is not better than Drug Y for treatment of severe depression.

p = probability that the null hypothesis is true.

If p < 0.05 (this is an arbitrary cut-off by convention) → evidence is strong against null hypothesis for it

to be rejected → evidence favours Drug X or Y.

If p > 0.05 → null hypothesis cannot be rejected → evidence does not favour either drug.

P values should always be stated with Confidence intervals, usually stated as 95% confidence interval.

Odds - It is a way of expressing the effect of a treatment (given as a ratio). For example, continuing

treatment with antidepressants reduces the odds of depressive relapse by about two-thirds (Taylor et

al., 2009).

Power [OR (1-β)] = size of the sample - Researchers should present a power calculation which indicates

the likelihood that the sample is large enough to avoid false positive errors (but you will find this rarely

in papers).

Primary and secondary outcomes - Researchers need to define what outcomes they have measured /

assessed to show that the particular intervention / treatment is better (e.g. efficacy, side-effects, quality

of life, costs, length of admission, etc.). This is particularly tricky in psychiatry.

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Randomization - It is the method of assignment of subjects (patients) to different arms of the

experiment so as to make comparisons. There are various methods with different degrees of rigour to

do this (e.g. from flipping a coin to stratified block randomization).

Sampling - Sampling strategy could be probabilistic (e.g. simple random, systematic, stratified,

multistage and cluster) or non-probabilistic (purposive, snowballing, theoretical sampling, quota,

opportunistic); the former is used in quantitative studies and the later in qualitative studies.

As a clinician, one would be interested in knowing if a study sample has patients similar to his/her own

patient population, in which case the study recommendations might be applicable and worth trying.

Sensitivity and specificity - These concepts are used in diagnostic tests.

Sensitivity is a measure of how good a test is at identifying disease (i.e. if one has the condition/illness

what is the probability that the test would be positive for it).

Specificity is a measure of how good a test is at identifying normality (i.e. if one does not have the

condition, what is the probability that the test would be negative for it).

Example: The NASBA assay (for paediatric HIV testing) has sensitivity of 95% at 42-93 days of life and

specificity of 99%.

Type I error (OR ‘false positive’ OR ‘α’) = null hypothesis was rejected as false when in fact it was true

(i.e. Drug X was thought to be more effective when in fact it is no better than Drug Y).

Common reasons for Type I error: 1). Biased sample, 2). Too small a sample, 3). Multiple testing.

Type II error (OR ‘false negative’ OR ‘β’) = null hypothesis should have been rejected but was not (i.e.

neither drug was thought to be better but in fact one of them was actually better).

Common reasons for Type II error: low Power of study.

Literature Search

Using Boolean search strategies (using AND, OR, NOT operators) would be good way to begin a

systematic literature search

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(http://learntech.physiol.ox.ac.uk/librarytutorials/pubmed_medline_turorial_d0e68.php).

Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/) has over 21 million citations!

Google Scholar is also quite a good resource for quick searches

(http://scholar.google.co.uk/).

Cochrane has its own journal club system which has online material, clinical vignettes, podcasts,

PowerPoint’s and monthly publication (Cochrane Journal Club). And it is free!

(http:/www.cochranejournalclub.com/).

Ask your local librarians- they can be really very helpful.

Get your NHS Athens password (https://register.athensams.net/nhs/nhseng/).

Referencing Systems

The two most commonly used referencing systems in the literature are:

1. Harvard system

(http://www.library.manchester.ac.uk/academicsupport/referencing/_files/JRUL-Harvard-

referencing-guide.pdf)

2. Vancouver system

(http://www.southampton.ac.uk/library/resources/documents/vancouverreferencing.pdf).

Note: Harvard system has been used in this document (except for website links).

Bibliography

Ajetunmobi, O. 2002. Making sense of critical appraisal. Arnold Publishers. London.

Bowers, D., House, A., Owens, D. 2001. Understanding clinical papers. Wiley. West Sussex.

Freeman, C., Tyrer, P. (Eds.) 2006. Research methods in psychiatry. Gaskell. The Royal College of

Psychiatrist, London.

Greenhalge, T. 2001. How to read a paper-the basics of evidence based medicine. 2nd Ed. BMJ Books.

London.

References

Amin, M., Mabe, M. October 2000. Impact factors: use and abuse. Perspectives in publishing, No. 1

[PDF] Elsevier. Available at:

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https://info.aiaa.org/SC/PC/Private%20Documents/Journals%20Subcommittee%20Materials/IFUseandA

buse.pdf [Accessed on 12/8/12].

Berrios, G.E., Luque, R. 1995. Cotard's syndrome: analysis of 100 cases. Acta Psychiatrica Scandinavica,

91(3), p. 185-188.

Bofetta, P., Agudo, A., Ahrens,W., et al. 1998. Multicenter case–control study of exposure to

environmental tobacco smoke and Lung cancer in Europe. Journal of the National Cancer Institute, 90

(19), p. 1440-1450.

Davies, L.M., Barnes, T., Jones, P., Lewis, S., Gaughran, F., Hayhurst, K., Markwick, A., Lloyd, H.2009. A

Randomized controlled trial of the cost-utility of second-generation antipsychotics in people with

psychosis and eligible for clozapine. Value in Health, 11 (4), p. 549-562.

Davis, J.M., Chen, N., Glick, I.D. 2003. A meta-analysis of the efficacy of second-generation

antipsychotics. Arch Gen Psychiatry, 60(6), p. 553-564.

Gask, L., Rogers, A., Oliver, D., May, C., Roland, M. 2003. Qualitative study of patients' perceptions of the

quality of care for depression in general practice. Br J Gen Pract., 53(489), p. 278–283.

Geddes, J., Burgess, S., Hawton, K., Jamison, K., Goodwin, G. 2004. Long-term Lithium therapy for bipolar

disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry, 161, p.

217-222.

Kendall, T. 2011. The rise and fall of atypical antipsychotics. BJPsych, 199, p.266-268.

Rose, G., Barker, D.J.P. 1994. Epidemiology for the uninitiated, 3rd Ed. BMJ Publications, London.

Serfaty, A., Osborne, D., Buszewicz, M. J., Blizard, R, Raven, P. W. 2010. A randomized double-blind

placebo-controlled trial of treatment as usual plus exogenous slow-release melatonin (6 mg) or placebo

for sleep disturbance and depressed mood. International Clinical Psychopharmacology, 25(3), p.132-142.

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Taneja, I., Haman, K., Shelton, R., Robertson, D. 2007. A randomized, double-blind, crossover trial of

Modafinil on mood. Journal of Clinical Psychopharmacology, 27(1), p. 76-79.

Taylor, D., Paton, C., Kapur, S. 2009. The Maudsley Prescribing guidelines. 10th Ed. Informa Healthcare.

London.

Zammit, S., Allebeck, P., Andreasson, S., Lundberg, I., Lewis. G. 2002. Self reported cannabis use as a risk

factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ, 325 (23), p. 1195-

1212.

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Appendix 2 – Guidelines for Case conference Presentation

The objectives of case conference are:

1) Provide a forum to discuss complex/interesting cases in a supportive learning atmosphere 2) Develop your ability to present cases in a concise and logical manner 3) Develop your presentation skills

Guidelines for presenters:

1. Please use PowerPoint or similar program for the presentation.

2. You have to present a case that is relevant to the topic of the day (handbook) on which you are presenting. 3. Please meet with your educational/clinical supervisor at least 4-6 weeks prior to the presentation to identify an appropriate case to present. You may have to approach other teams/consultants to identify a case, if needed. 4. Cases can be chosen for their atypical presentation, diagnosis, complexity or for exploring management options. 5. It would be helpful if you can identify specific clinical questions that would you would like to be discussed/answered at the end of the presentation

6. We would recommend the following structure for the presentation: - Introduction (include reasons for choosing the case) - Circumstances leading to admission (if appropriate) - History of presenting complaint - Past Psychiatric history - Medical History/ current medication - Personal/family History - Alcohol/Illicit drugs history - Forensic history - Premorbid personality - Social circumstances - Mental state examination - Investigations - Progress since admission (if appropriate) - A slide with questions that you would you like to be discussed

Note that trainees should use the ICD10 criteria and be able to justify the differential diagnoses based

on this.

7. The structure of the presentation can vary as long it is logical and concise. Please build into the

presentation some natural points to stop and discuss the case, eg: after mental state examination to

take questions from audience on the history

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8. Important: Please ask a senior medical member of your team who knows the case to attend when you

are presenting. Other relevant professionals are welcome too.

Dos and Don’ts

Do

1. Be creative

2. Engage with the audience

3. Create a narrative of the case

4. Encourage debate and discussion

5. Encourage reflective practice

6. Prepare well – discuss with your CS/ES beforehand and inform the WPBA assessor in

advance.

Don’t

1. Present without any agenda or context

2. Be vague about why you are presenting

3. Give needless information

4. Cram the slides

5. Just read the slides out

6. Carry on regardless of the time

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Bibliography

1. Gelder, M., Andreason, N., Lopez-Ibor, J., Geddes, J. (Eds.) 2012. New Oxford textbook of

Psychiatry. Oxford University Press.

2. Stein, G. & Wilkinson, G. (Eds.) 2007. Seminars in General Adult Psychiatry (2nd Ed). The Royal

College of Psychiatrists. Gaskell, London.

3. Semple, D. & Smyth, R. (Eds.) 2013. Oxford Handbook of Psychiatry. Oxford University Press.

4. Brown, T. & Wilkinson, D.(Eds.) 2005. Critical Reviews in Psychiatry (3nd Ed). The Royal College of

Psychiatrists. Gaskell, London.

5. Puri, B.K.,Ho, R.C.M., Treasaden,I.H. 2011. Revision MCQs and EMIs for the MRCPsych. Hodder

Arnold, London.

Papers and Articles

Some classic papers

1. Edwards, G., Gross, M.M. (1976) Alcohol dependence: provisional description of a clinical

syndrome. British Medical Journal, 1, p.1058-61.

2. Lewis, A.J. (1938). States of depression: their clinical and aetiological differentiation. BMJ, 2,

p.875-878.

3. Coppen, A., Noguera. R., Bailey, J., Burns, B.H., Swani, M.S., Hare, E.H., Gardner, R., Maggs, R.

(1971) Prophylactic Lithium in affective disorders. Lancet, ii, p. 275-279.

4. Barrachough, B., Bunch, J., Nelson, B., Sainsbury, P. (1974) A hundred cases of suicide: clinical

aspects. BJPsych, 125, p. 355- 373.

5. Elkin,I., Shea, I., Watkins, J.T. et al (1968) National Institute of Mental Health treatment of

depression collaborative research programme: general effectiveness of treatments. Archives of General

Psychiatry, 46, p. 971-982.

6. Kessel, N. (1965) Self-poisoning. BMJ, ii, 1265-70 and 1336-40.

7. Slater, E. (1965) Diagnosis of hysteria. BMJ, I, p. 1395-1399.

8. Pollitt, J. (1957) BMJ, I, p. 194-198.

9. Andreasen, N.J.C. (1982) Negative versus positive schizophrenia: definition and validation.

Archives of General Psychiatry, 36, p. 1325-1330.

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10. Brown, G.W. & Birley, J.L.T. (1968) Crises and life changes and the onset of acute schizophrenia:

clinical aspects. Journal of Health & Social Behavior, 9, p.203-214.

11. Johnstone, E.C., Crow, T.J., Frith, C.D., et al (1976) Cerebral ventricular size and cognitive

impairment in chronic schizophrenia. Lancet, p.924-926.

12. Leff, J.P., Wing, J.K. (1971) Trial of maintenance therapy in schizophrenia. BMJ, 3, p.599-604.

13. Vaughan, C.E. & Leff, J.P. (1981) The role of maintenance therapy and relatives expressed

emotion on relapse of schizophrenia- a two-year follow-up study. BMJ, 139, p.102-104.

14. Wing, J.K. & Brown, G.W. (1961) Social treatment of chronic schizophrenia: a comparative

survey of three mental hospitals. Journal of Mental Science, p.847-861.

15. Shepherd, M. (1961) Morbid jealousy: some clinical and social aspects of a psychiatric symptom.

Journal of Mental Science, 107,p.687-704.

16. Murray Parkes, C. (1965) Bereavement and mental illness. British Journal of Mental Psychology,

38, p.1-12 and 13-26.

17. Brown, G.W., Harris, T.O., Peto, J. (1965) Life events and psychiatric disorders: nature of the

causal link. Psychological Medicine, 3, p.159-176.

18. Popper, K.R. Science: conjectures and refutations. Chapter 1, p.33-39 and p.42-59.

Papers on Gender identity disorders

Eden, K., Wylie, K., Watson, E. (2012) Gender dysphoria: recognition and treatment. Advances in

Psychiatric treatment, 18, p.2-11.

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RCPsych CPD Online

Driving and Mental disorders

Morbid jealousy

Safe Lithium Prescribing: initiation and monitoring

First episode psychosis: Part 1 -assessment, diagnosis and rationale

First episode psychosis: Part 2 -treatment approaches and service delivery

Prescription of ECT

Psychotropic medication in breastfeeding

The pharmacological management of mania

The Mental Health Act 1983: criteria for detention

Post-traumatic stress disorder

Supervised community treatment

Gender dysphoria

Alcohol and the brain

Assessment and management of obsessive compulsive disorder- 1

Assessment and management of obsessive compulsive disorder- 2

Introducing eating disorders

Managing challenging behaviour in mental health in-patient units

Risk assessment and management of violence in general adult psychiatry

The assessment of personality

Competence, capacity and decision-making ability in mental disorder

The assessment of adult bulimia

Antidepressants and psychosexual dysfunction: Part 1 – diagnosis

Antidepressants and psychosexual dysfunction: Part 2 – treatment

Mental capacity Act 2005: Part 1

Mental Capacity Act 2005: Part 2

The bedside assessment of cognition

The pharmacological management of anxiety disorders


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