Background In the 2017 Mental Health of Children and Young People in England Report, 15.4% of children presented to a physical health specialist such as a paediatrician or GP regarding their mental health. An Australian survey found that over a 7-year period, childhood mental health presentations to Emergency Departments increased three times faster than physical health presentations (Hisock et al, 2018). However, GPs and paediatricians receive little formal training on the assessment and management of common mental health presentations. Despite the clinical and educational advantages of simulation, mental health simulation is less commonly utilised (Attoe et al, 2016). Consequently, little is known about the use of simulation to train paediatric and GP trainees in assessment and management of children and adolescents presenting with mental health concerns.
Aim To increase junior doctor confidence in managing common acute paediatric mental health presentations through the development of a paediatric mental health simulation programme.
Method Low-technology, high-fidelity simulation scenarios on self-harm and eating disorders were developed and incorporated into the weekly in-situ simulation programme for paediatric and GP junior doctors trust-wide over 6 months. Confidence in history-taking, psychosocial assessment and management of the adolescents was assessed by self-report before and after the simulation. Each simulation was subsequently debriefed, including discussions on risk assessment and management, signposting to resources and sharing learning points.
Results Following the simulations there was increased clinician-reported confidence in history taking (33.4% vs. 82.6%), psychosocial assessment (30.4% vs. 62.5%) and management (33.3% vs. 58.4%) of adolescents with self-harm. Thematic analysis of qualitative feedback highlighted the desire for further training as well as the benefits of simulation.
Conclusion As the mental health needs of children and adolescents continue to rise, it is clear there remains an urgent and unmet need for mental health training for clinicians. This data suggests that low-technology high-fidelity simulation is a feasible method of improving clinician confidence in the assessment and management of adolescents with mental health presentations. It is hoped that by developing such programmes, clinicians will be encouraged to cultivate the necessary skills to appropriately assess and manage patients presenting with mental health concerns.
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