The chronically mentally ill have the largest percentage of primary healthcare needs of any population of patients, but receive the worst treatment by providers. This is believed to be due to the oddity of their symptoms, which are difficult for healthcare providers to identify and empathize with, and the stigma associated with mental illness. The overall objective of this project was to create a virtual laboratory experience in chronic mental illness that my be used by students, housestaff and faculty in the healthcare field so they may:
- Better understand the devastating impact of chronic mental illness on the day-to-day functioning of individuals suffering from these disorders.
- Increase empathy, compassion and awareness toward the mentally ill.
- Enhance the general level of medical care provided to the chronically mentally ill.
Through the funds supplied by the CTE grant I have been able to:
- Purchase the curriculum, "Hearing Voices That Are Distressing: A Training and Simulated Experience." The curriculum is a complete training package in which participants use headphones to listen to specially designed audiotapes that simulate the experience of hallucinations. During the simulated experience, participants undertake a series of tasks including social interactions in the community, cognitive testing, and participation in a mock day treatment program.
- Purchase the audio equipment necessary to present the curriculum.
- Complete the training in "Hearing Voices That Are Distressing."
A basic underpinning of the project was that it would be set up with a research design using a standardized assessment to determine the impact of the experience on attitudes about the mentally ill.
A research design for the project has been developed. Prior to the simulation, students will complete a questionnaire about basic demographic information and "The Community Attitudes Toward the Mentally Ill (CAMI)." The CAMI is a structured, reliable, validated instrument that has been developed to measure beliefs about the mentally ill in six domains: authoritarianism, benevolence, social restrictiveness, community mental health ideology, genesis and primary care involvement. The students then participate in the simulation as described about. Afterwards, there is a group debriefing about the experience and the students complete the CAMI again. This proposal has been submitted to the VCU IRB for approval.
Phase I: Pre-IRB Approval:
The exercise has been tested with small groups of medical students to assess the proposed research design, determine its anticipated effectiveness and work out the logistics of the implimitation of the laboratory. Student reactions to the experience have been overwhelming. While listening to the simulated auditory hallucinations, they were unable to complete the simplest of cognitive and day-to-day tasks. Physically their movements were slower, they often touched tables and chairs to check on their sense of reality and turned to their classmates for reassurance. Most described a chronic sense of anxiety and, at times, fear of loss of their ability to reason. Many found themselves responding to the voices on the tape, although they clearly knew they were unreal. One task required that the students go outside of the building to ask for directions to a specific office. In the public, they found it difficult to differentiate the voices on the tape from those in reality leading to an increasing sense of anxiety, and at times mild confusion. Afterwards, students described themselves as exhausted, and with somatic complaints of tension including mild headaches and muscle strain. They were amazed at the impact of a simulated exercise in auditory hallucinations, could much more easily understand the devastating impact of psychosis on the personal lives of their patients and easily see how the mentally ill become totally disabled by these experiences that may go on for hours, days, weeks or years. The overwhelming majority of students said the experience had changed their entire perspective on mental illness and how in the future they will interact with and treat patients suffering from Psychiatric disorders. The entire group voiced the belief that all students should be required to complete the experience. Scores on the CAMI significantly (p<.05) improved after the simulation demonstrating an improved attitude about the mentally ill.
Phase II: IRB Approval:
A consent form and research proposal have been submitted to the VCU IRB for approval. Once this has been accomplished, each group of M3 students rotating through their Psychiatry Clerkship will be asked to participate in the exercise. There should be a sufficient number of students to obtain results on over 100 subjects. The data from this phase will be analyzed and submitted for publication in a refereed journal.
Phase III: Expanded Study and Request for External Funding:
Using the results from the Phase II study, external funding will be requested to allow the simulation to be conducted with primary care housestaff, faculty and as a CME exercise to be used with practicing physicians in the community. It will also be offered to non-MD practitioners including nursing students, staff and faculty, psychology and social work students, staff and faculty and groups in the community that work with the mentally ill.
Were the objectives of the project accomplished? The results from Phase I of the study clearly indicated that the project objectives are being met. The students have a much clearer understanding of the devastating impact of mental illness, have an increased sense of benevolence and empathy for this group of patients and voice that it will change their practice in working with patients suffering from Psychiatric disorders.
How many students, courses, or other faculty may be effected by the project? With the proposed use of the simulation in Phase II and Phase III, the project will effect all third year medical students, primary care housestaff and physicians practicing in the community plus other non-MD healthcare providers.
Has the project helped in my development as a faculty member? Most emphatically, yes. A major objective of my role as the Director of Undergraduate Medical Education in Psychiatry is to alter the attitudes of healthcare professionals in the treatment of the mentally ill. This is being fulfilled. The project is also enabling me to conduct research that is publishable and to be able to pursue extramural funding for expansion of the study.
Overall, the project thus far has been a tremendous success. I would never have been able to pursue this without the support of the CTE grant.
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