title: 'Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school'.
abstract: BACKGROUND
  The use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure.
  
  
  METHODS
  Zimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4-5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback.
  
  
  RESULTS
  Post-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was "helpful", "enjoyable" and "boosted confidence".
  
  
  CONCLUSIONS
  In Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. aepiette@doctors.org.uk.
authors.forename: Angharad
authors.initials: A
authors.lastname: Piette
authors.affiliation: Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. fchikwanha@gmail.com.
authors.forename: Florence
authors.initials: F
authors.lastname: Muchirahondo
authors.affiliation: Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. wmangezi@yahoo.co.uk.
authors.forename: Walter
authors.initials: W
authors.lastname: Mangezi
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. amy.iversen@kcl.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Iversen
authors.affiliation: Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. f.cowan@ucl.ac.uk.|University College London, London, UK. f.cowan@ucl.ac.uk.
authors.forename: Frances
authors.initials: F
authors.lastname: Cowan
authors.affiliation: Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. mmukonoweshuro@gmail.com.
authors.forename: Michelle
authors.initials: M
authors.lastname: Dube
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. hughgp@gmail.com.
authors.forename: Hugh Grant-
authors.initials: HG
authors.lastname: Peterkin
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. Ricardo.Araya@lshtm.ac.uk.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. melanie.abas@kcl.ac.uk.|Department of Psychiatry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. melanie.abas@kcl.ac.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Abas
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004504:Education, Medical, Undergraduate; D005240:Feasibility Studies; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D016544:Patient Simulation; D018794:Problem-Based Learning / Q000458:organization & administration*; D011570:Psychiatry / Q000193:education*; D020377:Self Efficacy; D055815:Young Adult; D015030:Zimbabwe