Search

An unintended consequence of the COVID-19 pandemic has been the exponential growth of telemedicine, with automation of healthcare becoming more common. Face-to-face meetings and training events have been replaced relatively seamlessly with online versions, taking clinical or academic expertise to distant parts of the world and making them more accessible and affordable. The wide reach of digital platforms offering remote healthcare offers the opportunity of democratising access to high-quality healthcare, However, certain challenges remain: (a) clinical guidance developed in one geographical area may need adaptation for use in others; (b) regulatory mechanisms from one jurisdiction need to offer patient safety across other jurisdictions; (c) barriers created by disparity in technology infrastructure and the variation in pay for services across different economies, leading to brain drain and an inequitable workforce. The World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel could offer the preliminary framework on which solutions to these challenges could be built.

Sexual harassment and gender discrimination overlap affecting people (including children) of all genders, however data shows an overwhelmingly high prevalence of violence or harassment experienced by women in areas of conflict, professional life and in their homes as well as in the healthcare workplace. It is pervasive, persistent and all too common. Workplace sexual harassment an discrimination although illegal, is particularly is more common in women who are young, early in their careers, in temporary employment, from under-represented or marginalised groups based on ethnicity, immigrant status, gender non-conformity or disability. Majority of perpetrators are men, who are older and enjoy the privilege of disproportionate power and in certain toxic male-dominated healthcare environments. Two recent stories of sexual harassment in healthcare prompted many women to follow suit and share similar stories referring to flashbacks, post-traumatic stress, damage to careers, pressure to leave their job, self-harm and suicidal thoughts, brought about by their experiences. Yet there are examples of women as role models breaking down historical barriers such as Hilary and Chandi in their polar adventures. Tackling such structural inequality requires remedies that go beyond incremental approaches focussed on individuals and include transformation of the organisational and societal climate by interventions, affirmative policies and courageous, compassionate leadership. Workplace sexual harassment and discrimination is unacceptable, not inevitable and needs to be eradicated.

Differential attainment exists in all professions and is a manifestation of systemic factors creating an unequal environment where individual careers and aspirations may be thwarted. Although this inequality which affects some groups of students unfairly, has been recognised over the last 2 decades, it remains a significant issue. This scoping review explores the causes and contributors in relation to undergraduate medical education. Using thematic analysis, the authors present the case for tackling the disparity in education and training. There are evidence-based solutions for individuals, organisations and at a societal level. The recommendations from this review will be discussed and debated in the series of workshops, as part of the ‘Bridging the Gap’ series from the Alliance for Tackling Inequalities in Health, chaired by the British Association of Physicians of Indian origin. The output of the consensus-building workshops and thematic synthesis with the accompanying qualitative research will be presented in the final report due in 2021.

SummaryIn mental health services, recovery constitutes a guiding principle that is endorsed in professional medical guidelines and has become central to mental health policies across the world. However, for many clinicians, it can be a challenge to effectively embed recovery concepts into professionally directed treatment of disease without distortion, and ostensibly away from what matters to those who use the services. We discuss the evolving and multifaceted concept of ‘recovery’, including illness narratives to frame our discussion. We demonstrate how integration between a person-directed management of illness and a professionally directed treatment of disease can converge, resulting in positive outcomes for people with mental illness.

AimsDifferential attainment (DA) amongst Black and Minority Ethnic (BAME) medical students and postgraduate trainees including Psychiatry trainees has been extensively documented in medical education, with non-white medical students being 2.5 times more likely to fail high-stake examinations compared to their White counterparts. The Equality Act 2010 places a responsibility on public bodies such as Royal Colleges to address discrimination in training and assessment. Understanding DA in undergraduate medical education can help understand DA in the postgraduate setting. Consequently, this systematic review aims to detect the processes that enable and impede DA in UK undergraduate medical education.MethodSeven online databases including PubMed, Scopus, PyschInfo, and ERIC were searched. A formal grey literature search was also conducted. Inclusion criteria comprised studies dated from January 1995 to present and included UK undergraduate medical students. We present the preliminary findings from 13 papers, analysed to create a conceptual framework for a further mixed methods analysis. The studies were critically appraised for methodological quality.ResultFive key themes emerged from the preliminary analysis of 13 papers. BAME students experienced:Being ‘divergent’: Not feeling part of the current organisational learning milieuLack of social capital: Difficulty in being absorbed into existing ‘networks’ of relationships in a manner that is ‘approachable’ and not ‘intimidating’Continuum of discrimination: ‘Indirect’ impact of subtle communication processes in the learning environment undermining individual ‘belief’ in own performanceInstitutional discriminatory factors: Culture, rules, norms, and behavioural routines of educators that lead to differential outcomes for learnersLack of external support: Relative lack of interventions tackling DA.ConclusionThe key finding of this review is that British BAME undergraduate medical students experience discriminatory behaviours early in medical schools that impact on personal, educational, and professional outcomes. These factors may need to be borne in mind by postgraduate training organisations such as the Royal College of Psychiatrists as they commence the challenging task of addressing DA.

BackgroundThere is a gap between the supply of trained cognitive – behavioural therapists to treat depression and demand for care in the community. There is interest in the potential of self-help interventions, which require less input from a therapist. However, the design of effective self-help interventions is complex. Qualitative research can help to explore some of this complexity Aims The study aimed to identify qualitative studies of patient experience of depression management in primary care, synthesise these studies to develop an explanatory framework, and then apply this framework to the development of a guided self-help intervention for depression.MethodA meta-synthesis was conducted of published qualitative research.ResultsThe synthesis revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions.ConclusionsThis meta-synthesis of qualitative studies provided a useful explanatory framework for the development of effective and acceptable guided self-help interventions for depression.

Background The role of primary care for young people with psychosis, and transitions between specialist mental health services and primary care, are underexplored areas, both clinically and in research terms. Aim To explore service users9 perspectives of early intervention services and primary care, in-depth and over time. Design and setting Longitudinal qualitative methodology in five geographically diverse sites across England. Method Semi-structured interviews with 21 young people with first-episode psychosis at two time points. Results Early intervention services are highly prized by service users; however, the ‘gold standard’ nature of the care is difficult to replicate in other services and may lead to unrealistic expectations. Flexibility in terms of the timing of discharge does appear to be happening in practice, but continuity is not always well established before discharge. Primary care seems to be under-utilised, both as a location of care during time with the early intervention service and as a skill set, particularly for physical health problems. Service users expected GPs to advocate for and navigate the health system, particularly at times of crisis or relapse. Conclusion Early intervention services should focus on actively establishing relationships between service users and either the community mental health team or the GP in the months leading up to discharge, and ensuring that service users9 expectations about access and availability of care are ‘realistic’. Primary care could be better utilised, even when service users are actively engaged with early intervention services, to help ensure physical health needs are met from the start of treatment.

This study described the views over time of young people referred to early intervention services (EIS), particularly as they relate to the importance of relationships.A cohort of people aged 14 to 35 enrolled in a large multisite study of EIS for psychosis in the United Kingdom were recruited for a qualitative, longitudinal study in which they were interviewed within six months of admission to EIS and 12 months later. Transcripts of the interviews were analyzed using Charmaz's constructivist grounded-theory methodology.A total of 63 individuals were interviewed during the six months after their first service contact, and 36 (57%) were interviewed 12 months later. Service users generally viewed IES key workers as supportive and youth sensitive, but up to one-third felt that the three years of sustained engagement expected was too intensive. Family support was highly valued by service users, and key workers and families worked well together to support the young people as they recovered. A significant minority of service users, however, reported feeling the emergence of a new self-identity, often associated with a sense of loss of the person they had felt themselves to be before becoming ill.EIS for young people should provide not only the right type of engagement but also the right amount, recognize the very important role of families in giving both practical and emotional support and in liaising with key workers, and take into account the relatively rapid change in perceptions of personal identity that accompany illness.