Cefn Coed Hospital

Forensic mental health, custodial and community forensic services provide care and treatment to individuals with complex histories and needs including the presence of trauma. With increased attention being paid to delivering trauma informed care, this paper presents a framework for supporting safe and effective service delivery. It details ways in which trauma informed organizational consultation and trauma informed staff supervision and reflective practice should be embedded within criminal justice and forensic mental health service delivery. Together these support reflection, learning, decision making and intentional action, helping to meet an organization’s duty of care to both staff and clients. Trauma informed organizational consultation and trauma informed forensic staff supervision and reflective practice provide ways to anticipate and address possible iatrogenic impacts on staff (e.g. burnout, presenteeism and sickness) and on clients (e.g. dropping out of treatment). Together these can enable services to provide and sustain authentic approaches to delivering safe and effective care.

Abstract Introduction Differential Attainment (DA) refers to divergent achievements when related to protected traits. Annual Review of Competency Progression (ARCP) panels play a key role which compositions should reflect, yet no guidance exists on panel profile related to protected traits. This study aimed to evaluate the influence of panel profile on DA. Methods Anonymised ARCPs numbering 1090 in a UK Statutory Education Body (SEB) were examined and primary effect measure was ARCP Outcome (ARCPO) with satisfactory ARCPO classified as 1, 2 or 6, and unsatisfactory as 3 or 4. Results Satisfactory ARCPOs numbered 1005 and unsatisfactory 85. Median panel number was 7 (range 1-15, p<0.001). Median female percentage consultant representation was 18.2% (0% (Urology, Plastic & Paediatric Surgery) to 40% (Core Surgery) and median ethnicity (BME) consultant representation 14.3% (0% (Vascular & Neurosurgery) to 80% (Cardiothoracic Surgery). Multivariable analysis revealed: Trainee seniority (OR 0.800, p<0.001), SAC Liaison Member gender (OR 0.720, p=0.013) and Panel gender balance (N ARCP panel females, OR 10.695, p=0.003) to be independently associated with adverse ARCPO. Discussion Important two to five-fold variance in ARCP panels were found related to gender and ethnicity profile respectively with apparent significant impact on DA.

Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1–5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3–5), P < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5–5], P = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1–3], P < 0.001, P = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

Abstract Aims Drivers at Work (DW) and Learning Styles (LS) refer to a range of contentious theories that aim to account for differences in career progression, yet seldom feature in training assessment. This study aimed to quantify the influence of Core Surgical Trainees’ (CST) DW and LS on career progression. Methods Kolb LS inventories were distributed to 168 CSTs during five consecutive induction boot camps in a single Statutory Education Body. Primary outcome measures were MRCS and National Training Number (NTN) success. Results Of 108 responses received (response rate 64.3%), 64.8% were male and 35.2% female (p = 0.003). The spectrum of DW was: Please People (25%), Be Perfect (21.3%), Hurry Up (18.5%), Be Strong (13.9%), and Try Hard (0%, p &amp;lt; 0.001). DW was either unequivocal or not provided by 23 CSTs (21.3%). The spectrum of LS was: Converging (34.3%), Accommodating (28.7%), Diverging (23.1%), and Assimilating (13.9%, p = 0.021). MRCS success was not associated with DW (p = 0.703) or LS (p = 0.598). Men were more likely to have Converging LS (29/70, 41.4%), and women Diverging LS (15/38, 39.5%, p = 0.018) and to have team-based LS (Accommodating / Diverging, 26/38 vs. 30/70, p = 0.010). NTN success was associated with LS (p = 0.038) with Convergers achieving most NTNs (65.4%). Conclusions LS are associated with important differences in career progression with Converging LS three-fold more likely to achieve NTNs than Diverging LS.

Effective manual-handling strategies will not only help prevent vulnerable skin from becoming exposed to pressure, shear and friction, but also safeguard nurses from injury. Despite this, manual handling advisers and tissue viability nurses generally have very little contact with each other. This supplement describes how such a collaboration in a NHS trust improved pressure-care outcomes

Screening for potential child abuse is an essential component of work in many child and family services. The Child Abuse Potential inventory (CAP; Milner 1986) is one measure developed to help in this task. The primary aim of this review is to critically evaluate studies reporting psychometric information of the CAP. A previous paper by Milner (Clinical Psychology Review 14(6): 547–583 1994) reviewed studies evaluating the psychometric properties of the measure up to 1994. Since then over 100 articles have been published that consider the measurement properties of this tool. This review considers 27 papers published since Milner’s (Clinical Psychology Review 14(6): 547–583 1994) review that clarify previous findings in relation to specific psychometric properties of the CAP. In particular, this review focuses on studies that provide information on the cross-cultural validity of the CAP, on the internal consistency of the CAP measure as a whole and its subscales, or on sensitivity and specificity classification rates. Studies providing information on the differential validity of the CAP (using at least two differentiated sample groups) or the efficacy of the CAP to identify change are also considered. Published evidence suggests that the CAP can help assess for a range of difficulties associated with increased risk for physical child abuse. The CAP scales have shown good internal consistency estimates across sample groups and cultures, with similar underlying themes for CAP factors reported for the different cultures studied. The differential validity of the CAP has also been shown, although sensitivity and specificity classification rates have varied. The CAP appears able to indicate some degree of pre—to post-intervention change, although further investigation is required to clarify what changes in CAP scores actually reflect. Further investigation of this measure in other countries is also required.

Evidence suggests a complex relationship between substance misuse, mental health, and violence in forensic populations, however, the majority of existing research and interventions focus on these factors individually. This paper reports an evaluation of the first module of an integrated poly-substance misuse group delivered within a medium secure mental health hospital, which was designed to address these factors collectively. Qualitative and quantitative approaches were used to assess participant's subjective views of the program and to gather pre and post quantitative measurement of change. The concordance between self report and observer reports was explored. Recommendations for the development of the treatment and for further evaluation and research are discussed.

It was the monthly meeting between clinicians and management. It had been going on for three quarters of an hour. The discussion was disjointed and downbeat. Colleagues were sad and disappointed by the effects of the latest round of NHS reorganisation on clinical services. Since 1974 the psychiatric services for Neath, Port Talbot, and Swansea had been integrated. This …

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