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

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Presentation on theme: "Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences A community service-learning approach to destigmatise student perceptions about psychiatric."— Presentation transcript:

1 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences A community service-learning approach to destigmatise student perceptions about psychiatric patients Stefanus Snyman, Martie van Heusden

2 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Context of study Positioned in context of curriculum design Specific application in Health Sciences Education (HSE) Purpose of HSE: To prepare students to address the health needs of patients and communities effectively (Kern et al, 2009) Programme: MBChB (6 years)Course: Psychiatry Module: Middle Clinical Rotation (Years 4/5)

3 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The challenge: Students are not crazy about Psychiatry Negative and stigmatising attitudes of medical students towards psychiatric patients (Gelder, 1998) Attitude usually improve while rotating through Psychiatry, but not for long (Sinclair, 1997) WHO estimates: 500 million people suffer from psychiatric disorders (WHO, 2011)

4 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The challenge: The Psychiatry curriculum Not aligned Overemphasis of cognitive (proposional knowledge) with progression to psychomotor skills during clinical rotations Students struggle to contextualise (epistemic knowledge) and to develop personal skills through reflection on reflection in action (Wensing et al, 2010; Lucket, 2009) Negative evaluation of Middle clinical rotation

5 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The intervention Step 1: What are we suppose to do? Determine outcomes for Psychiatry: International core curricula World Psychiatric Association World Federation for Medical Education Leading universities South African Legislation Stellenbosch University’s Community interaction policy and Pedagogy of Hope Faculty of Health Sciences vision - Leader in Africa

6 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The intervention Step 2: What was done already? We analysed the exposure to mental health and psychiatry in medical curriculum MBChB I Developmental Psychology MBChB II Introduction to Clinical Medicine MBChB III Psychiatry theory Middle Clinical RotationLate Clinical Rotation

7 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Step 3: Determine outcomes for Middle Clinical Rotation Continuity between 3 rd year theory and Late Clinical Rotation Formulate clear outcomes: Clinical exposure and skills regarding Psychiatry Integrated theoretical component Graduate Attributes Service-learning approach

8 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The Intervention Step 4: Clinical and community exposure Thorough orientation Clinical exposure and skills Contextualising theory Continuous assessment

9 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The Intervention Step 5: Graduate Attributes Communication Counselling Role in a team Reflective practitioner Bio-psycho-social-spiritual approach Social responsiveness Ethics Human Rights

10 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The Intervention: Step 7: Community Engagement (service-learning) Focus from “our” perspective: Impact of psychiatric disorders on community Outside ivory tower of hardcore “super-specialised” psychiatry Psychosocial rehabilitation Prevention and mental health promotion University’s CE policy Collaboration with 7 NGO’s (12 placements)

11 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The Intervention Community Engagement (Service-learning) (S-L) S-L model used: Combination of discipline-specific, capstone and pure S-L: S-L framework for logistics and administration

12 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences The question What difference did a community service-learning approach make to destigmatise student perceptions about psychiatric patients?

13 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Method Interpretive paradigm with a qualitative inductive approach Focus group interviews were conducted with 32 students: Immediately after the completion A year later, to determine if non-stigmatising changes in perceptions, if any, were sustained. Interviews were also conducted to determine if students, who previously followed the traditional Psychiatry course, have in accordance with international trends, stigmatising perceptions about psychiatric patients. Student reflections analysed

14 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group who followed previous curriculum Questioning role of Psychiatry in medicine I don’t think it [Psychiatry] is a medical subject I don’t know where it fits in Nie deel van my verwysingsraamwerk nie

15 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group who followed previous curriculum Fear I’m still afraid of psychiatric patients Confused My fear was just replaced by confusion Ek kan honestly nie … kop of stert uitmaak nie Unorganised

16 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Role of Psychiatry acknowledged as brain pathology Fear for Psychiatric patients overcome Knowledge integration due to community engagement and clinical experience at Lentegeur hospital The correlation between textbook and what you saw there [community] was very evident … it was astronomical, like our benefits....got most of my basic knowledge that I need to know [at Lentegeur]. I probably will use most of that knowledge … [as] general practitioner.

17 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Acceptance of psychiatric patients … one thing I really learnt … behind all of that there is a person… I need to start treating psychiatric patients … as a real condition and not just some crazy person …

18 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Better clinical experience … for the first time you do actually feel like a medical student. You are tired the whole time, you are working a lot, and I think maybe it gave us a little bit of an idea what it would be like to be SIs, and as tough as it was, I think it was important. A very valuable skill … psychiatric interview I spoke to … final years … we were actually better off because we got a chance to at least see patients … Learning outside tertiary complex … I felt that I learnt a lot more there … The doctors there were way more prepared.

19 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Graduate attributes cultivated: Counselling Better communication Interprofessionality Role of community and community organisations Bio-psycho-social-spiritual approach Teamwork “multi-tasking”

20 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Social responsiveness Die gemeenskapsprojek … vir ons dokters wat in Suid-Afrika opgelei word … gewys ons kan hier iets beteken.. … I have realised … my life [is revolving] around Stellenbosch University … thinking that that is the end of the world … we do need to get out of these gates, there is a whole new world out there that we do need to experience. (5 th year) the community project linked with reflection … is important and everybody learns a lot from it, but …

21 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Personal growth … I have always been told throughout my course is that we need to detach ourselves from our patients … something that I have been struggling with, but … on psychiatry I actually realised that there is no way that you can actually detach emotionally from them… I actually realised that it’s not necessary … it just makes me more human … helps me to give better care to my patients… (5 th year) … I have never seen that in any other rotation… that kind of relationship ever… the amount of attention and the amount of empathy that they gave to this patient … that is the kind of attention that I need to give to my patients…

22 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: Group immediately after revised curriculum Logistic and administration “Die bes georganiseerde blok ooit…”

23 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: A year later – the positives “Middle rotation totally took away stigmatisation” Now… I see the benefit of … [S-L] project and the reflections... I got angry... With the perceptions of those doctors [stigmatising patients] “The community project stood out for me and it’s something I’ll take with me for the rest of my live” “it definitely changed my perception... broadened my scope...” Nice to see psychiatric conditions... in... ordinary people... Interact with [psychiatric] people with their normal sort of daily... psychiatric conditions...

24 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: A year later – the positives The impact society has on mental illness The impact mental illness has on society … Impact on families and how they adapted their entire lifestyle…

25 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: A year later – the challenges Programme too busy Not uniform approach to patients Within Psychiatry What is taught in other disciplines

26 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Results: A year later – the challenges Community project Convincing all stakeholders that “non-hardcore Psychiatry” is also department’s role Selecting the right community partners to reach outcomes Improve design of structured reflections Be careful that community projects don’t overwhelm students Better coaching of students

27 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Conclusion Sustained non-stigmatising perceptions about psychiatric patients were found in students who participated in CSL activities, compared to stigmatising perceptions in those who previously completed the traditional course in Psychiatry. These perceptions were still present a year after the rotation

28 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Take home message Medical faculties worldwide can take note that a CSL approach contributes to ensure sustained, non-stigmatising perceptions among medical students about psychiatric patients.

29 Fakulteit Gesondheidswetenskappe  Faculty of Health Sciences Thank you Students Tygerberg- en Lentegeur lecturers Dr Antoinette Smith-Tolken Dr Alwyn Louw Prof Dana Niehaus Jacob du Plessis FINLO


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