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A community service-learning approach to destigmatise student perceptions about psychiatric patients

A community service-learning approach to destigmatise student perceptions about psychiatric patients. Stefanus Snyman , Martie van Heusden. Context of study. Positioned in context of curriculum design Specific application in Health Sciences Education (HSE)

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A community service-learning approach to destigmatise student perceptions about psychiatric patients

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  1. A community service-learning approach to destigmatise student perceptions about psychiatric patients Stefanus Snyman, Martie van Heusden

  2. 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)

  3. 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. 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 personalskills through reflection on reflection in action (Wensing et al, 2010;Lucket, 2009) • Negative evaluation of Middle clinical rotation

  5. The interventionStep 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. The intervention Step 2: What was done already? • We analysed the exposure to mental health and psychiatry in medical curriculum

  7. Step 3: Determine outcomes for Middle Clinical Rotation • Continuity between 3rd year theory and Late Clinical Rotation • Formulate clear outcomes: • Clinical exposure and skills regarding Psychiatry • Integrated theoretical component • Graduate Attributes • Service-learning approach

  8. The InterventionStep 4: Clinical and community exposure • Thorough orientation • Clinical exposure and skills • Contextualising theory • Continuous assessment

  9. 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. 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. The question What difference did a community service-learning approachmake to destigmatisestudent perceptions about psychiatric patients?

  12. 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

  13. Results: Group who followed previous curriculum • Questioning role of Psychiatryin medicine I don’t think it [Psychiatry] is a medical subjectI don’t know where it fits in Niedeel van my verwysingsraamwerknie

  14. 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

  15. 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.

  16. 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 …

  17. 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.

  18. 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”

  19. 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. (5th year) the community project linked with reflection … is important and everybody learns a lot from it, but …

  20. 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… (5th 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…

  21. Results: Group immediately after revised curriculum • Logistic and administration “Die bes georganiseerde blok ooit…”

  22. 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 ...

  23. 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…

  24. Results: A year later – the challenges • Programme too busy • Not uniform approach to patients • Within Psychiatry • What is taught in other disciplines

  25. 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

  26. 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

  27. 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.

  28. 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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