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Biomedical subjects

L Gask

Publications and source records attributed to L Gask.

49 records · Page 3Linked to original sources

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners.

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.

Clinical Competence↗

Training general practitioners to teach psychiatric interviewing skills: an evaluation of group training.

Group teaching in problem-based interviewing based on video and audiotape feedback of the doctor's own consultations significantly improved the ability of experienced general practitioners to teach psychiatric skills to their trainees. When the GPs were randomly allocated to one of three further training experiences--video feedback of their tutorial sessions, discussion about how to teach and no further teaching, there were very few differences between the groups. The greatest impact on improving teaching skills was brought about by watching their own consultations in a group feedback setting.

Clinical Competence↗

The treatment of somatization: teaching techniques of reattribution.

Patients commonly present to general practitioners with somatic symptoms for which no adequate physical cause can be found, which are accompanied by the symptoms of an anxiety state or a depressive illness. These illnesses pose a major public health problem, but little is known about optimal management. A three stage model is proposed to encourage patients to reattribute these symptoms, and relate them to psychosocial problems. These stages are; feeling understood; changing the agenda; and making the link. A videotaped learning package is described suitable for use with vocational trainees in general practice, consisting of demonstrations of component parts of the model followed by micro-teaching, as a preliminary to video-feedback of actual interviews with such patients.

Education, Medical, Continuing↗

The treatment of somatization: evaluation of a teaching package with general practice trainees.

A teaching package is described which aims to improve the management of somatization by general practice trainees. The package comprises a training videotape in which a model (described in the preceding paper) is demonstrated, together with material for paired role-play of new skills and small group videofeedback of consultations. Evaluation of the teaching package reveals that the skills can be effectively learned.

Education, Medical, Continuing↗

Psychotherapy and general practice.

The authors review the development of liaison psychotherapy in general practice, and argue that a 'skill-sharing' approach, where the general practitioner retains the treatment role, is a more efficient model than a 'consultation' approach. Skill-sharing models are reviewed, and the need for psychiatrists and psychotherapists to be more directly involved in teaching basic psychotherapeutic skills to general practitioners is emphasised.

Family Practice↗

Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course.

Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.

Clinical Competence↗

Improving the psychiatric skills of established general practitioners: evaluation of group teaching.

Ten established general practitioners, eight of whom were also trainers, took part in a course designed to improve their psychiatric interviewing skills. Participants were instructed in the problem-based model with audiotape and videotape feedback of real consultations in a group setting. Although those attending were experienced practitioners with a particular interest in the management of psychological problems, evaluation demonstrated a significant improvement in their skills after training. It is suggested that trainers could be trained to provide a similar teaching experience for their own trainees.

Attitude of Health Personnel↗

What happens when psychiatric out-patients are seen once only?

The outcome of 30 new psychiatric outpatient consultations at which the psychiatrist decided to see the patient once only was examined after 3 months. Patients were referred from general practice, and evaluation was primarily from the viewpoint of practitioners; the majority were satisfied with a single consultation. However, only about half the patients were seen again by their GPs within the 3-month period, and most of the treatments recommended by the psychiatrists were not carried out by the GPs. Suggestions are offered to ameliorate this disturbing state of affairs.

Adolescent↗

Teaching front-line health and voluntary workers to assess and manage suicidal patients.

BACKGROUND: To devise and evaluate the retention of a new brief training package for non-psychiatrically trained multidisciplinary staff to assess suicide risk and manage suicidal patients, including referral of patients at significant risk to psychiatric staff. METHOD: 8 h of interview skills training, using role play with modelling and video feedback, was taught to 33 health and voluntary workers. Evaluation used a controlled before and after training design. Performance of the interview skills was assessed blindly by raters using predetermined criteria from videotaped role played interviews with actors. Self-rated questionnaires (SIRI-2 and visual analogue scales) were used to assess the clinical skills and confidence respectively of the front-line workers. RESULTS: Suicide risk assessment and management skills such as problem solving, future coping and provision of immediate support were significantly improved at 1 month after training. Training did not significantly improve general interview skills, combating hopelessness nor the removal of lethal weapons. Performance on the SIRI-2 and confidence significantly improved after training. The assessment procedure itself did not improve clinical skills nor confidence. LIMITATIONS: Performance among individual health disciplines was not assessed. Design was not a randomised controlled trial with short follow up and no patient outcome data. CONCLUSIONS: A brief training package is available which is effective in teaching suicide risk assessment and clinical management skills.

Adult↗