Developing a Primary Care Mental Health Personal

Development Plan (PDP) Dr David Harniess

MBChB MRCGP DCH DRCOG

Learning Objectives

• Understanding experiential and reflective learning

• Understanding what portfolio learning is and its importance

• Identifying your learning needs and how to achieve them

• Developing a Mental Health Personal Development Plan (PDP)

Why is this type of learning important?

• Makes learning practical and applied

• Improves your clinical performance

• Improves patient care and outcomes

• Skills for lifelong learning – learning never stops!

• Self directed and relevant

to you

How did you learn how to do your job?

Experiential Learning Cycle

Kolb DA. 'Experiential Learning experience as a source of learning and development', New Jersey: Prentice Hall 1984

The wise man reflects!

Reflective Learning

Levels of Reflection• “Knowing that” – or textbook knowledge for example the

ICD-9 symptoms and signs of depression• “Knowing -in- action” - or the integration of skills and

knowledge to do the job – looking, listening and testing the patient for a diagnosis of depression

• “Reflection - in –action” – or when in the midst of tasks we examine what is happening – the history suggested depression but the affect of the patient didn’t fit - what is going on? Do I need to re-think?

• “Reflection – on – action” – after the event so was the decision to start the patient on antidepressants right?

Portfolio based learningIs a collection of evidence that demonstrates learning. Examples could include:

• Diary of reflections on patient cases• Reflections on discussion with colleagues regarding patients• Reflections from educational meetings e.g. lectures, courses, in

house education• Reflections from reading a book/journal article• PUNs and DENs• Audit• SEA• E learning modules• Peer review (feedback from colleagues)• Small group discussion• Review of any patient complaints

Portfolio based learningBenefits of a portfolio based approach – unmasking the

unknowns

Recording your learning

• Keeping a diary/ learning log

• Internet tools – appraisal toolkit/ RCGP new appraisal

• Recording reflections from lectures/ courses

• PUNs and DENs……

Date of learning event

23.1.2011

Learning event activity

Seminar on importance of physical examination in mental health

What did you learn?

Should examine patients presenting with mental health presentations

Patients with schizophrenia have worse health than the general population

What will you do differently in the future? How can I apply what I learnt in practice?

Perform a general examination in all patients presenting with depression, anxiety or psychoses

What further learning needs have you indentified?

None

Example 1 – Descriptive learning log entry

Date of learning event

23.1.2011

Learning event activity

Seminar on importance of physical examination in mental health

What did you learn?

Tailoring neurological examination to check for Parkinson’s disease in older person presenting with anxiety and tremor

Increased rates of obesity, ischaemic heart disease and diabetes in schizophrenic patients related to poor lifestyle and long term atypical antipsychotics

What will you do differently in the future? How could I apply what I have learnt in practice?

If someone presents with an acute psychotic episode I need to rule out physical causes first as historically many people have been admitted to psychiatric hospitals with underlying organic disorder

Consider the SOAP acronym as a format to document my findings in the medical notes

Need to develop a general practice protocol for an annual health check with patients suffering with severe mental illness

What further learning needs have you indentified?

Need to read mhGAP intervention guide to consider minimum investigations for new onset depression

Example 2 – Reflective learning log entry

PUNs and DENs1

• Patient Unmet Needs – in many of our consultations there is a patient unmet need and may be due to doctor’s lack of knowledge or skill

• Doctor’s Educational Need – define identified lack of knowledge or skill

• Method of recording these experiences and prioritising what we need to learn

1 Eve, R. PUNs and DENs: Discovering Learning Needs in General Practice Radcliffe Medical Press 1994 

Example of PUN and DEN

Date PUN DEN Action to achieve DEN

241/2011

I have patients who present to me withnew onset of delusions and I normallyrefer these patients directly to thepsychiatrist at this point - is thereanything else I could do to help thepatient with their delusions whilst theyare waiting to see the psychiatrist?

What do expert psychiatrists dowith someone who is

experiencingdelusions in their conversationwith patients

Attended lecture of Psychiatrist DrPalazidou on assessing forpsychoses - important to ask thepatient why they believe thedelusion, what evidence do theyhave to confirm their delusion andthen gently offer the patient analternative explanation for theirdelusion e.g. crack on the wallrather than listening device theybelieve it is

Audit Cycle

What possible audits could you consider in mental health

Possible audits in mental health

Annual health check with all patients with severe chronic mental health e.g. bipolar affective disorder and schizophrenia – have we done a health check in the last year on these patients? Minimum standard 90%

Has depression been correctly diagnosed in all our patients with a label of depression? Audit patient notes against ICD-9 criteria (minimum standard 90%)

Coverage of primary care mental health in Libya – what mental health services are available? In which geographical areas do we need to develop services?

Significant Event Analysis

Group meeting to discuss mistake/near misses or something done well

Ground rules – honest and non-judgemental

The process covers four basic stages:• Select the event you want to analyse• Gather the data needed• Hold a meeting to analysis the event and agree

on action• Implement action and review the effects

Significant Event Analysis

What possible SEAs could you consider for mental health situations

Possible SEAs in mental health

Review of cases of any completed or attempted suicides

Harm caused to others by patient with mental health problems – could we have identified this? Could we have prevented it?

Prescribing errors or adverse drug reactions

How do you identify your learning needs?

Identifying your learning needs

Possible tools:Self awareness of needSignificant events in practiceFeedback from colleagues or patientsReferral analysis and feedback from consultant lettersObjective tests e.g. MCQAnalysis of patient contactsReading – journals/medical booksSelf rating scale

How do you achieve your identified learning needs?

How do you achieve your identified learning needs?

Learning from colleagues – peer discussion

Asking an expert

E learning modules – eGP, BMJ

Internet searches – cochrane, Medline, guidelines

Medical Books

Internet resources

Specific mental health resources

World Health Organisation www.who.int/topics/mental_health - (new mhGAP guidelines available)

WONCA guidelines www.woncaeurope.org / www.wwpomh.ning.com(download of talks)

NICE guidelines www.nice.org.uk – (depression in adults, schizophrenia, antenatal and postnatal mental health…)

BMJ articles – Clinical Review articles and 10 minute consultation www.bmj.com

MIND charity organisation for patients and carers www.mind.org.uk

Patient information and leaflets (some in arabic) www.patient.co.uk

Davies, T. & Craig, TKJ. ABC of Mental Health BMJ Books 1998 (Introductory text in mental health)

Making a plan to achieve your identified learning needs

Educational NeedReason for inclusion in

development planLearning objectives Activities to be used What evidence will you keep?

Learn how to managepsychosis

Significant event: I had a patient with new onset psychosis who required emergency admission to hospital. However we had failed to recognise the condition so I would like to improve my knowledge and skills in its management

1. Know how to recognise acute psychoses

Read medical text, BMJ

Clinical Review articleand review mhGAPIntervention guidet

Summarise key points fromreading

   2. Know to whom to refer the patient to

DiscussWith colleagues

Keep records of case discussion of patient’s with acute pscyhosis and outcomes

   

3. Consider which isbest first line antipsychotic depending on associated psychiatricpresentation

 Produce practice formulary on antipsychotics and monitoring

Learning Objectives

• Understanding experiential and reflective learning

• Understanding what portfolio learning is

• Identifying your learning needs and how to achieve them

• Developing a mental health Personal Development Plan (PDP)

Time for Reflection

Self rating on RCGP framework

Developing a Personal Development Plan using the table provided