This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. Background:
Psychiatric hospitals have a doctor on-site 24 hours per day. Out of
hours – weekends and after 5pm Monday-Friday – the only on-site
doctor is the on-call junior doctor. It is possible that this doctor will have
had no previous experience of a psychiatry on-call.
Certain scenarios that junior doctors frequently deal with when on-call
are unlikely to have arisen during placements in other specialties. Initial
on-call shifts are therefore potentially daunting for new trainees.
The aim of our project was to expand available resources about on-
calls with the view of improving trainee confidence in approaching
common on-call situations.
Methods:
We first (in October 2015) issued questionnaires to first year psychiatry
trainees asking how prepared they had felt for on-call shifts. The level of
preparedness was measured using a 5-point Likert scale. We also asked
if trainees would have wanted more information about on-calls and, if so,
in what format.
Based on the questionnaire results we designed the following resources:
 A printed “pocket-guide” on common on-call scenarios
 A training video on common on-call scenarios
Before finalising the handout we gathered feedback from senior
colleagues with a special interest in education. We made some
modifications based on this feedback.
The handout was given to new trainees in February and August 2016.
The video was shown to new trainees in August 2016. Trainees
provided feedback on the resources through questionnaires utilising 5-
point Likert scales to measure how prepared they felt for on-calls.
Surviving
Psychiatry On-calls
“A project by trainees for trainees”
Clare Holt 1, Ross Mirvis 1, Sophie Butler 1, Andrew Howe
1, Penelope Lowe 1, Juliette Mullin 1, Damian Mirzadeh 1,
Rosemary Sedgwick 1, Tharun Zacharia 1
1 South London and the Maudsley NHS Foundation Trust
Fig. 1: Example content of printed handout: section on s136 assessments
Fig. 4. Chart showing trainee response to the statement “I found the section of the
video on [Section 5.2/Section 136/Rapid Tranquilisation/Seclusion useful”
To do
- Review patient, do full
psychiatric clerking
- Collateral history
- Drug chart e.g. PRN
- Consider physical,
bloods, ECG
Considerations
- Is seclusion required?
- Management plan
(admit/MHA/discharge)
s136 patient
arrival
To do
- Discuss patient
presentation
with police
- Review police
‘form 434 part B’
(has useful info)
Considerations
-Is A&E required
(e.g. overdose,
lacerations)?
Review of patient
with s136 team
Discuss with SPR who will
attend to review patient
DISCHARGE/ADMIT INFORMALLY
SPR will contact AMHP who will
attend to rescind s136
To do
- Admission: consider physical,
bloods & ECG
- Discharge: ensure discharge plan
in place
MHA ASSESSMENT REQUIRED
SPR will do 1st recommendation
and contact AMHP who will
attend with second s12 Dr to
assess for section of MHA
To do
- Consider physical, bloods, ECG
Extra tips for
learning
Try see patient
with SPR
Do a WBPA e.g.
CBD
Trainees also rated their confidence about the on-call scenarios in the
video on a 5-point Likert. This allowed us to calculate a pre and post
confidence score out of 20.
The video improved the confidence of trainees about on-call
situations by an average of 2.8 points – from a mean confidence
score of 13.0 to a mean confidence score of 15.8.
Conclusions:
We have been successful in our aim of expanding the resources
available to trainees about on-calls. In creating a printed hand-out we
responded to trainee feedback about preferred formats for resources.
Feedback on the printed handout showed a positive impact on trainee
confidence about on-calls.
Although not one of the favoured formats selected by trainees in the
initial questionnaires, trainees overwhelming found the video useful. It
also was effective in improving trainee confidence.
There is further scope for expanding the on-call resources to include
further topics (e.g. some trainees indicated that information on medical
emergencies would be useful) or formats (e.g. a phone app).
References: The Maudsley Prescribing guidelines 12th Edition
0
5
10
15
20
25
Stongly Agree Agree Neutral No response
Numberoftrainees
Response on 5-point Likert Scale
Section 5.2
Section 136
Rapid tranq
Seclusion
Results:
In October 2015, 24 trainees returned questionnaires. 15 (62.5%) were
“neutral” or “disagreed” that they had felt clinically prepared for on-calls.
All trainees thought that more information about on-calls would be useful.
The preferred format was either a paper handout or a phone download.
Results from the feedback questionnaires about the printed handout
were as follows:
• Pooling data from February and August 2016, 24 trainees (around
50%) returned questionnaires; 20/24 (83%) received the guide
• A higher proportion of trainees received the guide in August compared
to February 2016, showing improved distribution
• 100% of trainees found the guide useful; 18/20 (90%) said the guide
had improved their confidence in approaching on-call situations.
Pre and Post video questionnaires were returned by 36 trainees starting
the psychiatry training in August 2016.
Acknowledgements
Dr John Moriarty, Dr Mary Docherty, Dr Nicholas Hallet, Dr Catherine Murphy,
Charles Bowman, Corinne Jones
October
2015
• Questionnaire to CT1s "how
prepared are you for on-calls?"
February
2016
• Pocket guide handed out to new CT
starters
March
2016
• Feedback on the Pocket Guide
sought from CTs
April
2016
• Training video production begins
August
2016
• Training video shown and pocket
guide handed out to new CT starters
Fig. 3. Timeline of eventsFig. 2. Screenshots from the video
Scan this QR code
to watch the video
on YouTube