Teaching mental health skills to general practitioners and medical officers.
David Goldberg opened by describing the research that had led up to the present WPA teaching package. Early research had demonstrated that many psychological illnesses were not detected in primary care settings (Goldberg & Huxley 1980; ibid 1992), and these findings have been replicated in 14 centres round the world, with broadly similar results (Ustun & Sartorius 1995). We have found that in the UK the problem is not defects in factual knowledge, but not having clinical skills to assist in the management of mental disorders in general medical settings. The clinical skills needed in primary care are seldom taught in medical schools, and cannot be learned by listening to a lecture: it is necessary to practice them after they have been demonstrated. To do this it is convenient to break complex clinical skills down into their components: these are called "micro-skills", and we will deal later with the way in which these are taught. The most powerful method for improving mental health skills in this setting is to provide doctors with feedback--either video or audio--of their interview with real patients. The emphasis of such teaching must be on the interview techniques used by the doctor, rather than the clinical problems displayed by the particular patient being interviewed (Gask et al 1991). The problem with this is that video-feedback teaching of the necessary type is not always available, so we have developed videotapes that we can send out to distant locations, and which focus the attention of both local tutor and postgraduates on what should be learned. Because it is essential that most of the teaching is done by the live teacher rather than the videotape, there are always several "discussion points" so that postgraduates can ask questions, or describe their own way of dealing with particular situations. The videotapes are supplied together with teaching notes for the tutor, power points slides which can be adapted to suit local conditions, "role plays" to allow postgraduates to practice each skill they wish to learn, and other support materials. There is also a paper written by ourselves in association with Norman Sartorius, who has encouraged us to prepare the teaching package under the auspices of the WPA. Linda Gask described the process of teaching specific 'microskills', by working through how the skills necessary for the management of people who present in primary and general medical settings have been described and taught in the UK (see box 1). A model of the strategies and skills to be [figure: see text] taught was first developed utilizing the experience professionals and teachers from both primary care and mental health. A videotape was produced in which the skills to be acquired were demonstrated by real primary care doctors in role-played interviews with the addition of subtitles to label particular skills. The videotape is then utilised in a group teaching session to model the specific component skills of the model or 'microskills' to the participants in order to demonstrate exactly how the strategies of the model are applied in a real consultation. Watching the videotape will not however change behaviour. To do this, it is necessary to role-play brief scenarios so that the professional is able to practice the actual words he or she would use. This role-play work may be carried out in pairs, with one doctor playing the professional and the other playing the patient, or in threes, with the addition of an observer who ensures that the participants keep to the task. At the end of the role-play all participants provide feedback. These methods are described in much more detail in Gask (1999). Finally, there is also the possibility of videotaping one of these role-played interviews and teaching on this tape with the group as a whole. The specific skills and methods required to do this are described in much more detail along with the research evidence for these methods in Gask (1998). Our approach to facilitating the group in the exercise of videofeedback teaching is summarised in box 2.
Goldberg
David
D
Institute of Psychiatry, King's College, London, UK.
Gask
Linda
L
D005194:Family Practice / Q000193:education*; D030141:Feedback, Psychological; D011570:Psychiatry / Q000193:education*; D013663:Teaching / Q000379:methods; D014743:Videotape Recording