General Block Info

General Advice

You may well feel de-skilled when it comes to taking a history and doing mental state examination – this is normal! If you feel apprehensive and unprepared at first when you talk to a patient, chat informally until you are more relaxed and have established good rapport. Ask them about what they have been doing on the ward, or join in with them whatever ward activity is going on. Some students prefer to start interviewing in pairs, with one concentrating on taking a thorough history whilst the other concentrates on assessing mental state. You can always swap over for the next person you see.

Ask nursing or medical staff which patients may be suitable/good/interesting and to whom you can talk. You will find that, in contrast to some placements, you do not feel that you are contributing much to things (there are not lots of bloods to do, antibiotics to give, X-rays to find, etc) – that’s okay, sometimes you are doing good just by giving patients some time and passing on any information that you think is important. You can get involved in more practical procedures at the Lithium, Clozapine and Depot clinics and can also gain much by shadowing the ward based doctors.

If you can’t find anything to do – just ask! There will always be something we can suggest.

Who to contact

Your timetable will help guide you as to some of the fixed things that happen during each week of the attachment. There is flexibility in this - sometimes things don't happen as planned, and other learning opportunities may arise. So long as you let you consultant know and get their agreement, it is fine to deviate from the timetable and attend other things, as long as you record this in your timetable.

Whilst GAP and OAP services are the largest in psychiatry, you can arrange to see other specialist services such as:

These services are generally based in Dundee or Perth and cover the whole region, and you are encouraged to contact one of the consultants running these services if you would like to arrange to shadow them. This again is best done at the start of the block as their time may be booked up already if you leave things until the very last minute! Dr Pell can provide further advice or contact details if you have a particular service you would like to attend.

During your placement, your consultant will invite you to attend ward rounds, team meetings, Mental Health Tribunals and outpatient clinics and you will be introduced to various other professionals in the multi – disciplinary team.

You should try to arrange to:

• Accompany a CPN (Community Psychiatric Nurse) or Case Worker on domiciliary visits.
• Meet with an MHO (Mental Health Officer), who is a specialist social worker, to find out more about their role, particularly in relation to the use of the Mental Health (Care and Treatment) (Scotland) Act 2003 and the Adults with Incapacity (Scotland) Act 2000.
• Meet the Occupational Therapists. Attend assessments/ home visits or Ward Activity Groups if possible
• Speak with our physiotherapists and learn about the role of exercise and health improvement for patients with mental illness.
• Attend a Mental Health Tribunal to see Scottish mental health legislation in action (Speak to your consultants to see when ones are timetabled in – although we sometimes only get a couple of days notice of these…).
• Take part with the Social Therapies group activities and use this as an opportunity to speak to patients more informally (see the weekly planner of activities on the inpatient wards).
• Shadow one of the junior doctors on a day on-call (or out of hours)
• Spend time with the Crisis Resolution and Home Treatment Team to see risk assessment and management, with intensive home treatment – based at Murray Royal Hospital and at Carseview Centre.
• Attend weekly postgraduate teaching sessions with senior medical staff and other students (Thursday mornings 10:00 – 12:00 from 6^th September onwards)
• Attend a session of ECT (electroconvulsive therapy), on Tuesdays and Fridays at 09:00. There are ECT clinics in all three areas – Stracathro (Dr Ashleigh Duthie / Lesley Alexander), Dundee (Dr Thomas Glen / Kirsty Spence) and Perth (Dr Gary Cousland / Elma Low). Please arrange early on in your placement to make sure that there is space for you on the day – book with the ECT nurses or consultant.

Remember: If you are ever at a loose end then there will always be patients on the in-patient wards that you can interview and practice mental state examination or cognitive testing with.

 Other Practicalities

Computer Access

Prior to starting your placement you should download and read through the Psychiatry Resources available on the rest of the PiP Psychiatry pages. Here you will find links to the Core Clinical Problems and the Block Study Guide. You should also arrange for your LDAP account to be activated (or reset the password if you have forgotten this) so that you can use the NHS computers on site, as you will need this to access the EMIS Web electronic health record system used for all documentation in Psychiatry in Tayside.

Learning Resources

There is Eduroam Wifi access in all of the 3 main hospital sites – Stracathro, Carseview and Murray Royal Hospital – and patient wifi in many of the clinical areas on site. You can also borrow O2 dongles from the medical school to ensure you have access to the internet in more rural locations – contact Dr Richard Day about this if you want to borrow one.

There is Internet access on the NHS computers in all three areas, and in the accommodation block at Stracathro if you are staying on the site. Again - these computers require LDAP passwords which you should organise before starting the block via the medical school. Please note that access to personal emails (Dmail, Gmail, Hotmail, etc)), streaming media and social networking sites are generally blocked by the NHS firewall system – unfortunately we cannot resolve this as it is a blanket NHS policy. If you are having any issues getting access to the computers then please contact the NHS IT Helpdesk on 70444 and they can offer advice or reset passwords, etc.

A range of textbooks and journals are available for reference use in the Susan Carnegie Centre (admin office area). There is a full Psychiatry Library on the first floor at Carseview Centre, and similarly Murray Royal also has a range of text books which can be found in the Stalker Library.

A DVD of ECT treatment is available in the consultation videos section of the medblogs website.  All students should have an Athens account which enables access to on-line books, journals and periodicals.

Your personal safety is your responsibility – although you are very well supported in the wards by the nursing team and the general environmental safety measures, you must always wear a Staff Alarm at all times when in the clinical areas of the hospital (available with instructions from nursing staff on the wards). It is sensible to check first with the nursing staff that the patient who you plan to speak with is well enough for your visit, and to let the nurses know where you will be interviewing them. If at any time during an interview you feel uncomfortable: follow your instincts, leave the room, return to the office and tell nursing staff. If a patient becomes more threatening or aggressive then you should activate your alarm to summon immediate nursing assistance.

Please wear your identification badges and alarms in clinical areas at all times.

At the end of the block, please:

• remember to hand back any swipe cards, keys or alarms that you have
• ensure you have submitted your written case discussion to your supervisor for marking
• fill out the feedback form for the block (it’s the only way we can know what works and what doesn’t and allows us to make changes for future students)
• think about joining the Dundee Psychiatry Society (PsychSoc)
• look over the Royal College of Psychiatrists Student pages and join up as a Student Associate
• consider choosing psychiatry as a career! #choosepsychiatry
• remind other specialties to #ban the bash!