Psychiatry Training Activity

Prof. Fareed Aslam Minhas conducted the psychiatry training activity for the residents training 19th, May 2016 at CPSP Karachi in the local training units.

Psychiatry Training Activity

The following is the list of participants who attended the Psychiatry training activity at the Head Office of the College of Physicians and Surgeons Pakistan.

Proceedings of the activity:

The Psychiatry Training Activity started at precisely 1603 hrs. The dean opened the proceedings with a welcome to the trainees and asked them to introduce themselves formally. Forty-one trainees from Civil, JPMC LNH, AKUH, Abbasi, and Shifa Hospital were present at the occasion. The layout of the day’s activity was:

1. Long Case Presentation by Dr. Ilyas (JPMC )
2. Long Case Presentation by Dr. Amna (JPMC )
3. Short Case by Dr. Ajay (JPMC)
4. Short Case by Dr. Anoop (JPMC)
5. Objectives of the activity:
6. Focus on the current examination system.
7. Presentations by the trainees.
8. Feedback from within the trainees and Dean.

The Dean explained that he and his team have a responsibility to visit every center and meet the trainees, assign them their roles, make then understand the responsibilities of their respective training institutions as provided by the college (CPSP) guidelines and thus help the trainees to pass through the system smoothly. This was very nicely put by the Dean as ” To leave Mental Health of the country in safe hands.” His vision is to increase the number of supervisors from 40 to 60 initially and keep building it up.  Dean’s mission statement is to increase psychiatry trainees, to increase supervisors, more people pass exams with quality training, improve training, and bring it at par.

Training Activity 1

Long Case

Suggestions by the Dean: 

Long-case is presented for a remarkably interesting reason. You will see a patient for 45 mins, two examiners are watching you and they say nothing to you. At the end of those 45 minutes, examiners leave, and you get fifteen, mins to prepare your formulation for the next 30 mins to encounter two examiners. Art is that you should be able to present your history in 7-8 mins, so you need to organize your presentation in this way. In the last 22 mins, around 10 mins between each examiner, if you have prepared well then you can answer better.

The first examiner will ask about relevant investigations, Probable diagnosis, and MSE. The next examiner will ask about management, recent advances, and the prognosis of your case. “Remember, the long case is a typical representation of your ward round.” So, I am not telling you anything new, this is a clinical exam.

Pointers:

1. Diagnosis not clear, schizophrenia vs mood Disorder.
2. ICD Multi-axial Diagnostic criteria have utility in this case, for e.g.
   1.  Axis I: Primary Psychiatric Diagnosis, Medical Disorder.
   1. Axis II: Disability
   1. Axis III: Global Assessment of functioning.
3.  Relevance of life events and relapses.
4. They cannot guard the course of illness.
5. Presentation needs organization.
6. Mention Bio-psycho-social aspects in the management plan.
7. Recent advances.

The trainee was competent, and that overall, his style, knowledge, and content are good. The Dean praised the presentation style in terms of short-term and long-term courses. This is an effective way to break the monotony of the case. 

An especially important query from trainees was answered by the Dean here. When asked about the case presentation format, Dean explained that it is ok to use a formulation, summary, case, whichever system a trainee is comfortable in. The examiners can understand. If you cannot assimilate in 8-9 mins, they will stop you. However, if you can speak for 10 mins in a flow you are doing well. 

Training Activity 2

Long-Case by Dr. Ammara from Jinnah Postgraduate Medical Institute

Suggestions/comments by Dean: 

1- Mention the Differential of Depression.
2- Mention the differential of Phobic Anxiety Disorder.
3- Importance of childhood events.
4- Medical Differential Diagnosis like hypoglycemia, pheochromocytoma, not relevant.
5- This case can do better as an out-patient, with no need for admission.

In summary, according to the Dean, this was a good presentation. He had an excellent command over language; his presentation skills were up to the mark.

Short Case 1 and 2

Comments by Dean: 

Dean clarified the expectations of the trainees regarding short cases. There are not over thirty cases/ scenarios, therefore, it is quite easy for you to prepare. Common causes include:

• Drug history,
• OCD assessment,
• Suicidal risk assessment,
• Borderline personality assessment,
• Difference between Conversion and Epilepsy,
• Cranial nerve examination,
• Informational care plans,
• Assessing cognitive functions.

Each short case is 10 mins, 5 mins to intervention, and 5 mins to the examiner. You also know that you send to medicine and neurology for 3 months, respectively. How does this role get picked up? My idea is what you know, your supervisor knows. This Hierarchy has been effective. So, I take this task to myself and so this is the job of your supervisor to tell you about the short cases.

• Regarding the short cases, Dean said, you have 5 mins for the interview, take relevant points in the time.
• Stay focused on information collection.
• Keep interrupting your patient to stay focused.
• Candidates can themselves make a key they present later.
• Candidates MUST practice.
• Take twenty histories from twenty drug users and see how it enhances your skills.

The dean appreciated the Journal Club presentation by Dr. Sana (Agha Khan University Hospital). According to the Dean, trainees need to know the importance of reading a journal and the journals they need to read. The aims are to stay updated, improve clinical practice, and improve self-interest in research.

We must confine ourselves to some basic journals, BJP review articles every month is an effective way to stay abreast of all the information. So, in four years of training, 48-50 articles will be read, and the trainees will be aware.

Last lesson by the Dean: The ingredients of structured training is given in the college prospectus. This session was all about that. If you don't do it in your training, please ask your supervisor to follow these guidelines. My supervisors need to help me deliver it right. 

• The session adjourned at 2000 hrs.
• Minutes submitted by Dr. Sobia Haqqi.
• Chaired by: Dean of Psychiatry Prof. Fareed Minhas.
• Co-ordinators:
• Dr Sobia Haqqi, Dr Anil Wadhwani, Dr Jawed Akbar Dars