Educational supervision and the impact of workplace-based assessments: a survey of psychiatry trainees and their supervisors

<p>Abstract</p> <p>Background</p> <p>Educational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.</p> <p>Methods</p> <p>All junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before and after the introduction of WPBAs. Frequency and duration of ES were established, and structure, content and process were ascertained. Opinions on usefulness and responsibility were sought. The usage of ES for WPBAs was also assessed.</p> <p>Results</p> <p>The response rate of 70% showed general agreement between trainees and supervisors, but some significant discrepancies. Around 60% reported 1 hour of ES taking place weekly or 3 times per month. Most agreed that responsibility for ES should be shared equally between trainees and supervisors, and ES was largely seen as useful. Around 50% of trainees and supervisors used 25–50% of ES time for WPBAs, and this did not appear to affect the usefulness of ES or the range of issues covered.</p> <p>Conclusion</p> <p>ES continues to be an important component of psychiatric training. However, using ES for WPBAs introduces the potential for tension between trainees' education and their assessment by emphasising certain training issues at the expense of others. The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximised by remaining tailored to individual trainees' needs.</p

Cutaneous side effects in long term survivors on BRAF inhibitor based therapies for metastatic melanoma

1 page(s

Cutaneous adverse events in patients treated with BRAF inhibitor-based therapies for metastatic melanoma for longer than 52 weeks

Background: BRAF inhibitor-based therapies have been shown to induce cutaneous toxicities, with onset generally in the first 8–26 weeks of therapy. Objectives: To determine whether cutaneous toxicities persist in patients who have remained on BRAF inhibitor-based therapies for longer than 52 weeks, and therefore whether ongoing dermatology assessment is required. Methods: All patients treated with the BRAF inhibitors vemurafenib or dabrafenib or combination BRAF inhibitor and mitogen-activated protein kinase kinase (MEK) inhibitor therapy at Westmead Hospital, Sydney, Australia underwent regular dermatological assessments for the duration of therapy. All patients enrolled in a clinical trial, and 18% of patients in the compassionate access scheme underwent a baseline assessment prior to commencement of therapy and every 4–8 weeks thereafter. Patients' adverse events were recorded in a specific database. Results: Patients continued to develop cutaneous adverse events after 52 weeks of continuous therapy. Patients on single-agent BRAF inhibitor therapy suffered from Grover disease (45%), plantar hyperkeratosis (45%), verrucal keratosis (18%) and even cutaneous squamous cell carcinoma (16%). The most frequent adverse event seen in patients in the combination BRAF and MEK inhibitor group was an acneiform eruption (40%). Conclusions: Patients on BRAF inhibitor-based therapies need to continue to have regular dermatological follow-up independent of the duration of their therapy.5 page(s

Systemic retinoids for the chemoprevention of cutaneous squamous cell carcinoma and verrucal keratosis in a cohort of patients on BRAF inhibitors

Summary Background The treatment of metastatic melanoma has changed greatly with the development of inhibitors targeted at the mutated BRAF kinase present in up to 50% of metastatic melanoma cases. These agents, vemurafenib and dabrafenib, have been shown to increase median survival. Unfortunately, they have also been associated with the development of verrucal keratosis (VK) and cutaneous squamous cell carcinoma (cuSCC). These lesions require surgical excision, and when a large number of these lesions need to be treated, it can significantly affect the patient's quality of life. Objectives To determine if acitretin is suitable as a chemopreventative agent against the development of verrucal keratosis and cuSCC, in patients on BRAF inhibitors. Methods Patients treated with a BRAF inhibitor, vemurafenib or dabrafenib, for stage IV metastatic melanoma, who had undergone more than five surgical excisions to remove lesions suggestive of cuSCC, were offered the opportunity to commence acitretin as a chemopreventative agent. Patients were evaluated every 4 weeks. Clinical and histological data were collected. Results Eight patients, who had a total of 24 cuSCC removed, were included in the study. After commencement of acitretin, only five cuSCC were excised from two patients. The most significant reduction was in a patient who had developed 13 cuSCC over 10 months and only two cuSCC 3 months after commencing acitretin. No modifications in the dose of the BRAF inhibitor were made as a result of cuSCC in any of these patients. Conclusions Acitretin should be considered as a chemopreventative agent for VK and cuSCC in patients taking BRAF inhibitors, before considering dosage reductions. What's already known about the topic? The BRAF inhibitors vemurafenib and dabrafenib trigger the development of verrucal keratosis (VK) and cutaneous squamous cell carcinomas (cuSCC), requiring multiple surgical interventions and, in some cases, dose reduction. What does this study add? Acitretin may be a useful agent in the prevention of VK and cuSCC in patients on BRAF inhibitors. Acitretin may help avoid dose reduction due to the development of VK and cuSCC in patients on BRAF inhibitors. The patient's quality of life is improved as the number of surgical procedures required is reduced.4 page(s

Dermoscopy, reflectance confocal microscopy and histopathology of an amelanotic melanoma from an individual with the heterozygous MC1R variation 160W

Amelanotic melanoma is a rare form of melanoma. Its lack of pigment makes it diffi cult to detect clinically and assess dermoscopically. Individuals with melancortin-1-receptor (MC1R) red hair colour variants, such as 160W, D84E, R151C and D294H, have been found to have an increased risk of developing melanoma1 and their early melanomas have been reported to have reduced colours and structures in dermoscopy2. New imaging modalities such as reflectance confocal microscopy (RCM) can be used to help confirm the diagnosis of amelanotic melanoma prior to surgery. In this case study we present clinical, dermoscopic, RCM and histological features of a completely amelanotic melanoma found on a 26 year old female with brown hair, fair skin complexion and hazel eyes, who has a heterozygous MC1R variation 160W

Mentoring today - the students views: An investigative study of pre-registration nursing students' experiences of mentoring in one theory/practice module of the Common Foundation Programme on a Project 2000 course

The study reported in this paper investigated the mentoring experiences and perceptions of pre-registration nursing students in one organization, on a theory/practice nursing module. It considered the extent to which students' understanding and expectations matched their actual experiences. Interviews were conducted with 35 students on a Common Foundation Programme, and 15 allocated mentors, using a semi-structured interview guide. These were done within the clinical setting of the wards on which the students were placed as part of their requirements for completion of the module. A distortion of the actual meaning of mentoring appears to be present because of the lack of clarity provided, both internally by organizations and by the English National Board (ENB) who have provided loose guidelines. The implications of this distortion are discussed. The application of a mentoring role in practice needs to be re-examined, with the provision of a clear structured guide internally and externally, with regard to the needs of students and staff who are expected to act as mentors. The study was small scale and cannot be generalized. Mentoring, however, is now widely used within pre-registration nursing education, even though it is generally considered that its use may not be appropriate. Follow-up studies need to be undertaken on an ongoing basis, to examine what actually happens in practice, and to consider ways of ensuring that the benefits for staff and students are enhanced