Transitioning from being a medical student to a junior doctor is stressful. Junior doctors must find ways to cope with unfamiliar clinical work in rapidly changing environments. Hospital-based placements can also expose junior doctors to vicarious trauma which cumulatively and disproportionately impacts the less experienced.ObjectivesPsychological debriefing continues to be implemented and advocated as a reactive approach to limit the effects of vicarious trauma. However, the literature strongly suggests this approach does not reduce the risk of developing post-traumatic stress disorder and may worsen symptoms. To identify alternatives to supporting junior doctors, a narrative literature search was conducted across multiple databases to identify relevant information. Alternatives to psychological debriefing included resilience training, mindfulness-based intervention, Schwartz rounds and somatic experiencing. While these novel interventions are promising, caution must be exercised, the evidence base is limited.ConclusionsExposure to distressing events may be unavoidable for junior doctors. As hospitals look for better ways to address vicarious trauma, caution must be exercised to follow the evidence rather than implement a solution-focused ideology that may be harmful. Our findings suggest the need to focus on proactive rather than reactive approaches. Further research is needed.

Medical EducationVolume 56, Issue 2 p. 230-231 LETTERS TO THE EDITOR Psychological debriefing: First do no harm Andrew Teodorczuk, Corresponding Author Andrew Teodorczuk a.teodorczuk@uq.edu.au orcid.org/0000-0003-0802-718X Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia The Prince Charles Hospital, Metro North Mental Health, Brisbane, Queensland, Australia School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia Correspondence Andrew Teodorczuk, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Email: a.teodorczuk@uq.edu.auSearch for more papers by this authorBrian Kelly, Brian Kelly School of Medicine and Public Health, University of Newcastle (UoN), Callaghan, NSW, Australia Cumming School of Medicine, University of Calgary, Calgary, CanadaSearch for more papers by this authorStuart Carney, Stuart Carney Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this author Andrew Teodorczuk, Corresponding Author Andrew Teodorczuk a.teodorczuk@uq.edu.au orcid.org/0000-0003-0802-718X Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia The Prince Charles Hospital, Metro North Mental Health, Brisbane, Queensland, Australia School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia Correspondence Andrew Teodorczuk, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Email: a.teodorczuk@uq.edu.auSearch for more papers by this authorBrian Kelly, Brian Kelly School of Medicine and Public Health, University of Newcastle (UoN), Callaghan, NSW, Australia Cumming School of Medicine, University of Calgary, Calgary, CanadaSearch for more papers by this authorStuart Carney, Stuart Carney Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this author First published: 19 September 2021 https://doi.org/10.1111/medu.14622Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue2February 2022Pages 230-231 RelatedInformation

Critically analyzing the term ‘psychological debriefing’ and its evidence base yields caution against widespread adoption in medical education practice

Medical Journal of AustraliaVolume 211, Issue 4 p. 169-169 Editorials Should medical students act as interpreters? Stuart Carney, Corresponding Author med.medicaldean@uq.edu.au University of Queensland, Brisbane, QLDSearch for more papers by this author Stuart Carney, Corresponding Author med.medicaldean@uq.edu.au University of Queensland, Brisbane, QLDSearch for more papers by this author First published: 18 July 2019 https://doi.org/10.5694/mja2.50282Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume211, Issue4August 2019Pages 169-169 RelatedInformation

BackgroundRecent training and education changes have raised important issues in delivery of psychiatric education at all levels. In this article, the authors describe the current status of mental health education in the training of all doctors and postgraduate training and education in psychiatry in the U.K.MethodsThe authors explore and describe some of the initiatives that are being used in order to increase exposure to mental health placements in the Foundation Program, and they then describe the existing specific mental health opportunities within general practice and other specialist training programs.DescriptionAfter graduation from medical school, a two-year Foundation training program is a must, and, at the end of the first year, trainees become eligible for full registration with the “regulator,” the General Medical Council; after finishing the second year, they become eligible to undertake specialist training. Psychiatry training takes up to 6 years, and six specialties are recognized as leading to certificates for completion of training before independent practice. These six specialties are 1) general and community; 2) child and adolescent; 3) medical psychotherapy; 4) forensic psychiatry; 5) psychiatry of old age; and 6) psychiatry of learning disability. Also, three subspecialties-liaison psychiatry, addictions, and rehabilitation-form a part of the training in general and community psychiatry.ConclusionsThe authors discuss advantages and disadvantages of such an approach and raise key issues related to ongoing work to improve recruitment, progression, and retention of trainee psychiatrists.

Aims and methodThis study analyses whether there is a relationship between a psychiatry placement during the UK Foundation Programme and appointment to psychiatry training. A survey was distributed to all foundation year 2 doctors in the UK to determine how many have exposure to psychiatry before specialty applications and whether such exposure correlates with choosing psychiatry as a career.ResultsThe study showed that 14.6% of foundation doctors had exposure to psychiatry prior to specialty applications. Of these, 14.9% chose psychiatry as a career in contrast to only 1.8% of those who did not have psychiatry exposure (χ2P = 0.0008; risk ratio 8.19).Clinical implicationsThis study adds weight to calls to increase the proportion of psychiatry posts in the Foundation Programme as part of a broader strategy to improve recruitment. To answer this question categorically, we suggest a prospective cohort study looking at how attitudes and career preferences change with exposure to psychiatry posts.

Aims and methodPsychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.ResultsWe identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.Clinical implicationsThe results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.

This paper sets out the rationale, process for development and the content of the new evidence-based practice syllabus, which is examined as part of the Membership of the Royal College of Psychiatrists' Paper 3. The syllabus was developed by the Critical Review Paper Panel of the Royal College of Psychiatrists. Suggestions for learning and teaching evidence-based practice are also put forward.

Evidence-based medicine (EBM) was introduced to meet the increasing need of clinicians to keep up-to-date with the research evidence. EBM integrates advances in information technology with those in clinical epidemiology (the study of the distribution and determinants of disease) to provide a coherent strategy for the timely acquisition of the best available evidence on which to base clinical practice. A fundamental component of EBM has been the development of the methodology of research synthesis. Although the main driver of the development of EBM has been to get existing research into practice, the same approach can be used to inform the development of treatments.

Psychiatry has lagged behind other specialties in developing diagnostic laboratory tests for the purpose of confirming or ruling out a diagnosis. Biological research into the pathophysiology of psychiatric disorders has, however, yielded some highly replicable abnormalities that have the potential for development into clinically useful diagnostic tests. To achieve this goal, a process for systematic translation must be developed and implemented. Building on our previous work, we review a proposed process using four clearly defined steps. We conclude that biological parameters currently face challenges in their pathways to becoming diagnostic tests because of both the premature release and premature abandonment of tests. Attention to a systematic translation process aided by these principles may help to avoid these problems.

(the difference in risk) is estimated to be 19.6% with a 95% CI of 5.7% to 33.6%. The P value of 0.006 means that an ARR of 19.6% or more would occur only in 6 in 1000 trials if streptomycin was equally as effective as bed rest. Since the P value is less than 0.05, the results are statistically significant (i.e., it is unlikely that streptomycin is ineffective in preventing death). The 95% CI suggests that the likely true benefit of streptomycin could be as small as 5.7% or as large as 33.6%, but is very unlikely to be 0% or less. Our best estimate for the ARR is 19.6% and hence the NNT is 6 (95% CI 3 to 18). This means that we might have to treat as many as 18 people with streptomycin or as few as 3 to prevent 1 additional person dying of tuberculosis. Figure 1. Clinical significance and statistical significance. Conventionally, a P value < 0.05 is taken to indicate statistical significance. This 5% level is, however, an arbitrary minimum and P values should be much smaller, as in the above study (P = 0.006), before they can be considered to provide strong evidence against the null hypothesis. Hence, reporting the exact P value (e.g., P = 0.027) is more helpful than simply stating that the result is significant at the 5% level (or 1% level, as above). If an effect is statistically significant, does this mean it is clinically significant? A statistically significant difference is not necessarily one that is clinically significant. In the above example, the statistically significant effect (P = 0.006) is also clinically significant as even a modest improvement in survival is important. For many effects, however, the benefit needs to be somewhat greater than zero for it to be of clinical significance (i.e., sufficiently beneficial to be worth the effort of treatment). In Figure 1, while both studies (a) and (c) show a statistically significant result, with the CIs not overlapping the " no difference " value, only (a) has a result that is consistent (in terms of the CI) with at least a minimum clinically important difference. Studies (b) and (d) are not statistically significant, as their CIs overlap the values of no difference. Minimum clinically important difference No difference (a) (b) I n t r o d u c t i o n What is statistical uncertainty? …