The international burnout syndrome study (BoSS) examined burnout in psychiatry trainees and associated factors. Long working hours were significantly associated with burnout.

A high rate of severe burnout in UK psychiatric trainees (38%) was found in the BoSS study. This paper looks at the working hours of UK trainees.

Data collected during the BoSS study included information related to working hours, looking in particular at the working time directive rules. A total of 3964 UK psychiatric trainees were invited to take part, of which 1187 (30%) responded, and 811 (20%) provided complete responses for working hours questions.

The mean age was 33 years, with 49.1% males and equal gender distribution of participants and non-participants. The mean hours of contracted work per week were 42.7 (42.2–43.2) for men, versus 41.1 (40.4–42.0) for women. Actual hours worked were significantly higher at 46.2 (45.0–47.4) for men and 46.0 (44.9–47.1) for women. Forty-six percent of trainees breached one or more working time directive (WTD) safety limits.

Actual hours worked among psychiatric trainees in the United Kingdom are about 10% higher than contracted hours. Female trainees also work more uncontracted hours than male trainees. This is significant when considering the association between hours of work and burnout, and also adds to the perception that women have to work harder for the same recognition as men. Forty-six percent of trainees breached WTD limits.

The authors have not supplied their declaration of competing interest.

Previous studies reported high burnout rates and indicated significant factors associated with burnout syndrome among psychiatric trainees, such as hard working conditions, lack of supervision and not opting for psychiatry as a first career choice.

A substantial amount of variance was reported in psychiatry training across countries. However, there is not sufficient national data regarding the rates and risk factors of burnout syndrome among psychiatric trainees in Turkey.

To determine the burnout syndrome rates and the risk factors associated with burnout syndrome among psychiatric trainees.

A questionnaire of occupational, educational and personal factors and Maslach burnout inventory (MBI) were answered by 180 of 450 psychiatric trainees in Turkey. The data was collected from 167 (56% females) trainees who completed the survey material. Converting the scores of three subscales by using MBI manual, a dichotomous variable (severe/non-severe burnout) was obtained for each participant and the data was analyzed using descriptive statistics and regression models.

Mean age was 28.85 ± 2.99-year-old and mean duration of residency was 2.61 ± 1.31 years. Severe burnout was found in 38.3% of the trainees. Logistic regression confirmed that older age (P = 0.02) and pressure from superiors (P = 0.04) are predictive factors associated with severe burnout. The high number of patient visits (P = 0.001), violation of employee personal rights (P = 0.04) and pressure from superiors (P = 0.01) were significantly associated with the “wish working in another institution”.

Pressure from superiors and older age can be described as risk factors associated with burnout syndrome among psychiatric trainees in Turkey.

The authors have not supplied their declaration of competing interest.

A morbidity and mortality (M&M) conference is a time-honored educational format in surgery and medicine to review bad patient outcomes and learn from mistakes made. However, despite the value of learning together as peers from difficult cases with unexpected outcomes, most psychiatric departments in the United States do not have an M&M conference. Several years ago, the department of psychiatry at Massachusetts's general hospital in Boston began a monthly M&M conference.

Describe our department's experience with the M&M format as an educational vehicle to teach patient safety and improve care in an increasingly complex care environment.

Introduce the M&M format that we have developed at our department and obstacles encountered.

We reviewed the content of our four years of M&M conferences; the feedback received from participants after each conference; and changes introduced to improve the conference.

Our department has successfully implemented and sustained a monthly psychiatric M&M conference that is well attended and valued. A critical decision was mandatory involvement of residents to prepare cases in conjunction with a dedicated faculty member. A structured presentation using a root cause analysis framework to guide the discussion in order to harness the wisdom of the group allows for a more comprehensive understanding of factors leading to bad outcomes, including systems-based problems.

A psychiatric M&M conference can teach individual clinicians about patient safety. Developing a departmental mechanism to apply lessons learned in the conference to improve hospital systems is the next task.

The authors have not supplied their declaration of competing interest.

A doctor–patient encounter is a dyadic interaction between two people, one needing help and the other providing it. However, the encounter between an interprofessional team and a patient is changing this picture.

To measure how patient satisfaction changes when patients are treated by an interprofessional team.

Ecological momentary assessment (EMA) directly evaluates patient satisfaction when patients interact with interprofessional teams. This research is a before-and-after study of undergraduate health care students undergoing interprofessional education. Answers to questions on a 5-point Likert scale (from “Totally satisfied” to “Totally unsatisfied”) were uploaded online on a survey platform linked to a dedicated app.

Twenty-nine undergraduate students before, and eight after, interprofessional training reported their evaluation of patient satisfaction with interprofessional teams. Meta-analysis used Tau2, Cochrane's Q and I2.

Meta-analysis showed a homogeneity in the answers before and after IPE training (P = 0.4) and variability of only I2 = 39%, with t2 = .006, and Q (4 df) = 4.0. To a certain degree, the study showed a drop before and after in students who report their patients being “moderately satisfied” (from 20.7% to 0%), with C.I. 95% = 4.702 (0.238–92.713) (Fig. 1).

This study requires further inquiry on why a moderate level of patient satisfaction declines when patients are treated by an interprofessional team.

The authors have not supplied their declaration of competing interest.

Learning to work in an interprofessional team entails satisfaction in working with others.

Contextual assessment of the degree of satisfaction of undergraduate healthcare students (doctors, nurses, occupational therapists and physiotherapists) during interprofessional education (IPE).

Meta-analysis of degree of satisfaction contextually assessed during major interprofessional learning moments.

Thirty-six undergraduate health care students (medical students, nursing students, occupational therapy students) answered questions on a 5-point Likert scale (from “Very satisfied” to “Very dissatisfied”). A meta-analysis with Tau2 (t2), Cochrane's Q, and I2 analyzed IPE activities: self-reflection after daily training, interactions with teachers, discussion of clinical cases during ward rounds and patient care as a team.

Meta-analysis reported significant heterogeneity in the degrees of satisfaction (Fig. 1): 47.2% being “satisfied” with reflection after IPE, {t2 = .011; Q (5df) = 30.03; I2 = 83%, P < .0001}; 45% being “satisfied” during interactions with their teachers {t2 = .01; Q (5df) = 25.74; I2 = 80%, P < .001}; 31.4% being “satisfied” about the discussion of a clinical case during ward rounds {t2 = .009; Q (5df) = 22.61; I2 = 77.89%, P < .001}; and 44.4% being “satisfied” about patient care with the interprofessional team {t2 = .009; Q (5df) = 22.99; I2 = 78.25%, P < .001}.

Undergraduate students show satisfaction with IPE activities. This helps improve the quality of care and teamwork in the busiest wards.

The authors have not supplied their declaration of competing interest.

Mental health services in many European countries are undergoing to changes: it is important that early career psychiatrists (ECPs) have opportunities to broaden their professional horizons and better understand the international context of the upcoming changes: then, they can become aware protagonists of these changes and the future of the mental health system in their countries and in Europe. The gaining experience programme (GEP), offering ECPs observership placements in various psychiatric institutions across the Europe, can boost it.

We aim to consider how the EPA GEP can provide a unique professional and cultural understanding of the mental health services across the Europe and positively affect the ECPs’ career.

Starting from an experience of the GEP in 2016, we will discuss how it represents a great chance to observe the clinical work of multidisciplinary teams and an opportunity to visit different countries. Many aspects were significant, starting from the different organization of the mental health services, as well as the influence of different cultures on the mental health care system and the patient's expectations.

Attending EPA GEP is an important chance for ECPs to improve their professional and organizational skills as well as a great skill-building opportunity and personal growth experience. The GEP is at his third edition this year and it has having a growing success among young psychiatrists. It gives them a chance to improve mentoring and professional networks among experts and ECPs and to get more involved in the EPA activities.

The authors have not supplied their declaration of competing interest.

Transparency and due process are inseparable principles that should underpin any educational and administrative decision made within an organization.

It is considered best practice for organizations to place the processes and structures surrounding reviews of decisions made by their organization at arm's length to the committee or group that made the original decision. This ensures there is and that due process is followed.

An independent appeal process is an integral part of any fair system of assessment and decision making.

The Royal Australian and New Zealand College of psychiatrists has undertaken several reviews of its current processes to examine its practices as both substantive and procedural issues arise in decisions with regard to the provision of psychiatric training. The reconsideration and appeal policy was developed to set out a clear and fair process for applicants to request decisions of the RANZCP to be reconsidered and appealed. This ensures that an applicant has a fair and reasonable opportunity to challenge the original decision whilst receiving support from the RANZCP to minimize any stress that may be experienced during this process.

The RANZCP has observed that the three phase process has enabled matters to be resolved at an earlier stage of the appeal cycle and do not require progression to a formal appeal.

This presentation will identify best practice methods in educational decision-making and conducting appeals.

The author has not supplied his/her declaration of competing interest.

Assessment of suicide risk is of paramount importance for proper prevention.

To examine the association between gatekeeper training and suicide-related knowledge among a diverse set of health care workers (psychiatrists, nurses, psychologists, and educators) and students enrolled in medical and psychological schools who took part in the world suicide prevention day 2015 conference.

Among 223 participants who completed the assessment, 204 provided complete data for analyses. Participants were administered the applied suicide intervention skills training (ASIST), a 13-item survey questionnaire to assess participants’ knowledge about suicidal behavior and comfort dealing with suicidal clients. There were 62 psychiatrists; 23 nurses, 51 psychologists, 11 educators, and 57 university students.

Among participants, 57.1% of the sample had experiences of suicide a patient (students were excluded from these analyses). Those who reported a suicide among patients (compared with others) less frequently answered that suicide risk is more alarming in older adults than youths. They also less frequently disagreed with questions asking if they had the training to deal with suicidal patients. Students more frequently answered correctly on the association between depression and suicide risk, and less frequently chose the correct answer on the seriousness of suicide intent in borderline personality disorder. Students also more frequently disagreed with questions asking on their suicide assessment skill.

Our study highlights that differences exist when it comes to knowledge and skills related to suicide risk assessment both among health professionals and students. Our results also indicate that suicide awareness among these groups should be promoted.

The authors have not supplied their declaration of competing interest.

Global trends in the nature of working conditions pose significant threats to the training of medical professionals, as a result of cuts in educational grants and the salaries of professionals in training. Psychiatric trainees are not exempt from these changes.

To determine the current working conditions of psychiatric trainees and how they impact on their experience of training.

A semi-structured survey was distributed to all members of the European forum of psychiatric trainees. Responses were collected online from 34 participating countries. The respondents were representatives of national trainee associations. Data collection was completed between May and July 2016.

Respondents reported that the most important issues affecting postgraduate training were firstly working conditions, then salary, psychotherapy training and supervision, respectively. The average official mandatory working hours for a trainee, including on call duty was reported to be on average 40.16 (± 10.14 hours per week). In reality, the time that trainees report working is more than 20% higher than official working hours (on average 49.08 ± 15 per week). There is an officially recognized minimum vacation period of 20 days in almost all countries, ranging up to a maximum of 40 days (mean: 26.93 ± 4.97, per year). Salaries demonstrate an even greater variation, ranging from 100 Euros (as in the case of Moldova), up to over 5000 Euros (as in the case of Germany or Switzerland) per month.

Psychiatric trainees often work longer than the officially recognized hours and their income varies considerably between countries, which have been identified as the two biggest challenges trainees face.

The authors have not supplied their declaration of competing interest.

Working effectively with colleagues using a multidisciplinary and interprofessional approach is vital in healthcare, particularly mental health, where the interface between physical and mental health is often missed due to involvement with different specialties. Collaborative clinical practice is essential to provide the best clinical care to people experiencing mental and physical health comorbidities. Simulation training encourages experiential learning for human factors (or non-technical) skills, such as teamwork and interprofessional collaboration. This study explored the differences in learning outcomes between team and non-team training for physical and mental health comorbidities.

This project aimed to establish differences in human factors learning, confidence and knowledge, following training for teams that work together versus interprofessional groups from various teams. The project hoped to continue improving mental health simulation training and promote and enhance human factor skills that are basic pillars of multi-disciplinary and interprofessional care.

The human factors skills for healthcare instrument (HFSHI), alongside confidence and knowledge measures were administered to all participants pre and post simulation training on interacting mental and physical health. A post-course evaluation survey with open questions was used to collect qualitative feedback on the impact of the training course.

With data collection ongoing, preliminary results indicate differences between team and non-team simulation training, with particularly interesting qualitative findings.

Learning outcomes may differ for team versus non-team simulation training, evidencing the different value of these two training set-ups.

The authors have not supplied their declaration of competing interest.

Simulation training has the potential to develop communication and teamwork skills, as well as technical knowledge and competency. Mental health simulation training aims to promote awareness of mental health conditions and to enhance human factors (or non-technical) skills that will enable professionals that work in mental and physical healthcare settings to improve their collaborative and patient-centered clinical practice. This study explored the differences in learning outcomes after a mental health simulation course between different professionals–nursing staff, medical staff, and allied health professionals.

Aims and objectives This project examined the different learning outcomes of human factors, confidence and knowledge, for nursing, medical and allied health professionals following mental health simulation training.

Course-specific measures of confidence and knowledge were administered pre- and post-training to all participants, in addition to The Human Factors Skills for Healthcare Instrument (HFSHI). A post-course evaluation for with free-text responses to open questions regarding the impact of the training was utilised to collect qualitative data.

With data collection ongoing, preliminary results indicate differences in learning outcome depending on professional background, both in terms of quantitative measures and qualitative findings.

Learning outcomes may differ for different professionals despite receiving the same simulation training focusing on mental and physical health, evidencing the importance of sharing individual learning experiences in simulation using a debrief model.

The authors have not supplied their declaration of competing interest.

Like elsewhere, studies from developing countries suggest that parents of children with attention deficit hyperactivity disorder (ADHD) report significant stress. Besides symptoms, parental stress stems from experiences in interpersonal, schooling and societal domains, which may in turn be influenced by socio-cultural factors. This is a highly under-studied area.

Exploring experiences in familial, schooling and societal areas amongst Indian parents and understanding these in a cultural context using experiential qualitative research methodology.

In-depth semi-structured interviews were conducted with consenting parents of 27 children diagnosed with ADHD (17 mothers; 10 fathers).

All parents reported experiencing moderate to high degree of stress, feeling worried and frustrated due to child's problems. 19 parents reported being “short-tempered”, while 1 mother expressed feeling “lost”. Majority reported strained relations with spouse and extended family. Mothers reported higher stress, more difficulties in family life, faced criticism from immediate family and community regarding handling of child, felt more embarrassment, guilt and sense of failure as a mother. Half of the parents avoided attending social gatherings. Other than 2 parents, all had negative experiences with schooling. Experiential descriptions included those of teachers being highly critical of child and parents, punitive, dismissive and discriminatory. Teacher had advised seeking treatment in only 6 children. Themes of blame, discrimination and rejection were identified.

We conclude that cultural factors such as stigma, blaming of parent (especially mother) and lack of knowledge regarding ADHD amongst teachers and society may be responsible for these experiences and needs further investigation.

The authors have not supplied their declaration of competing interest.

Cultural factors have an important role in causal model of symptoms, threshold for treatment seeking and acceptability of professional help in ADHD.

To explore causal explanations and treatment seeking amongst parents of children with ADHD and understand these in context of a largely collectivistic culture as in India.

In-depth semi-structured interviews were conducted with 27 consenting parents; data interpreted using process theory.

Initial reaction to psychiatric referral revealed themes of disbelief/surprise, feeling confused/offended and lag of 6–36 months to consultation. Parents most commonly attributed causality to psychosocial reasons (lack of motivation/volitional, inadequate disciplining), while few gave one or more biomedical explanations (epilepsy, brain damage, low birth weight, nutritional deficiency, maternal ill health, low intelligence) alone or with a psychosocial reason. Despite the initial reaction, all but 1 parent was relieved with medical explanation, accepted diagnosis, and perceived need for treatment. Most parents were willing to start/continue medication if doctor suggested so as “he/she would know the best”. All parents expressed that counseling was needed.

Initial reactions and delay in treatment seeking is understood in light of cultural attitudes towards mental illnesses and psychiatric consultation in developing nations. More importantly, despite initial reluctance, most parents accepted biomedical explanation and treatment. The doctor patient relationship modeled on a guru-chela relation of complete trust in authority can explain this process change. We conclude that cultural attitudes not only influence causal models and initial treatment seeking, but also modify process of help seeking.

The authors have not supplied their declaration of competing interest.

Before initiating the intervention all children presented severe difficulties in communication, social interaction, lack of language, and gestures of communication, auto– and hetero-aggressive behaviors. After 6 months, children showed significant changes in mean scores for emotional functioning, communication, and daily living skills and diminution of aggressive behaviors. The present results provide strong support for the effectiveness of a developmental-based intervention, specifically in the domains of social skills behavior, social responsiveness, in a group of children with severe autism. These results highlight the positive effects of a rehabilitative approach that works in harmony with the family, school and professional team.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Many studies have focused on the strong link between impulsivity and addictive behaviors, such as alcohol use disorders.

Our study aimed to investigate the links between alcohol use and impulsivity in a sample of Tunisian pupils.

This was a cross-sectional study conducted in May and June 2016. It enrolled 317 pupils from four colleges and schools in Sfax (Tunisia). The participants were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence. The Barratt Impulsiveness Scale (BIS), in its 11th version, was used to assess impulsivity trait. Its three second-order factors were attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness.

The mean age was 16 years with a sex-ratio of 1.07. The school children reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. According to BIS, impulsivity prevalence (IP) in the whole sample was 27.8% while it was 40% among the alcoholic participants versus 24.9% in non-alcoholic participants. The average BIS score was more important in the alcoholic participants (69.25 versus 65.53; P = 0.011). Alcohol consumption was correlated to attentional impulsiveness (P = 0.01) and motor impulsiveness (P = 0.008). Alcohol dependence was correlated to motor impulsiveness (P = 0.018).

These results show the importance of clinically evaluating and intervening on impulsive personality traits to better prevent addictive behavior such as alcoholism among adolescents.

The authors have not supplied their declaration of competing interest.

It is widely recognized that parents and peers play a critical role in the adolescent's introduction to alcohol.

The aim of the study was to examine the relationship of parental and peers drinking to adolescent drinking behavior.

A cross-sectional study was carried out in four colleges and schools in Sfax in Tunisia, in May and June 2016. The sample consisted of 317 pupils, and was determined through a simple randomized sampling. These adolescents were asked to answer a self-administered questionnaire, after their consent. Alcohol use disorders identification test (AUDIT) was used to evaluate alcohol dependence.

The mean age was 16 years, with a sex-ratio of 1.07. The participants reported having drunk alcohol at least once in 18.9% of cases and 41.66% of them still consume. According to AUDIT, 1.6% of alcohol users presented an alcohol misuse and 21.6% presented dependence. They reported that parents’ attitude toward their alcohol use was favorable in 27.11% of cases. Among dependent adolescents, the prevalence of fathers’ alcohol consumption was 20% while that of friends was 70%. Adolescent drinking was significantly correlated to fathers, mothers and peers drinking (P < 0.001, P = 0.004, P < 0.001 respectively), mothers and peers smoking (P = 0.05, P < 0.001 respectively), fathers and peer's cannabis use (P < 0.001, P < 0.001 respectively).

Findings suggest that negative family and peers influence increased risk of alcohol consumption in adolescents. Understanding the influences on parents’ beliefs about their children's drinking and the functions of social networks in preventing alcohol consumption may be necessary to address adolescent risky drinking.

The authors have not supplied their declaration of competing interest.

The associations between genetic variants of drug metabolizing enzyme and transporter (DMET) genes and steady-state plasma concentrations of risperidone, 9-hydroxyrisperidone, total active-moiety, and metabolic ratio remain unclear.

The objective of the present study was to present the results of the association between genetic variants of DMET gene and steady-state plasma concentration risperidone and its metabolite using Affymetrix DMET Plus genotyping microarray.

Subjects eligible for this study included male and female adolescents with ASD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and being treated with risperidone for at least 4 weeks prior to the blood sample collection. Blood samples were drawn prior to the next dose of risperidone intake to determine the steady-state plasma trough concentrations of risperidone and 9-hydroxyrisperidone. Genotyping profile was obtained using the microarray. Steady-state plasma risperidone and 9-hydroxyrisperidone were measured using liquid chromatography/tandem mass spectrometry (LC-MS/MS) assay.

The polymorphisms of UGT2B4, CYP2D6 were highly associated with metabolic ratio. Of all the DMET analysis, ABCB11 (3084A > G, 420A > G, 368G > A, and 236G > A) and ADH7 (690G > A and –5360G > A) were found to be associated with plasma concentrations of risperidone (P < 0.01). In addition, 6 genetic variations among the SLC transporter family were associated with the plasma concentration of 9-hydroxyrisperidone.

This study provides a pharmacogenomic approach to investigate further among the DMET genetic variants which influence plasma concentration of risperidone. The treatment of ASD should be based on genetic factors making the challenge of psychopharmacological treatment more efficacious with lesser adverse events.

The author has not supplied his/her declaration of competing interest.

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by abnormalities in 3 domains; social interaction, communication/language, and restricted and repetitive behavior. The study of ASD prevalence in Thailand showed that it is approximately 9.9 children per 10,000 population for children 1–5 years old. ASD has a strong genetic basis, although the genetics of autism are complex and it is unclear. The objective of this study was to identify the genetic markers of Thai ASD.

Exome sequencing was performed with twelve unrelated ASD affected individuals from twelve families. Each sample was sequenced on SOLiD 5500xl genetic analyzer, and the resulting data was processed and analyzed on LifeScope Genomic Analysis software. Exome sequencing with two additional samples was performed Ion Proton System and the data was processed on Ion Reporter server. Tertiary data analysis with all fourteen exome sequencing data were performed by using Golden Helix software. In filtering process, data were annotated to various databases including UCSC KnownGenes for non-coding and synonymous variants filter, 1000 Genomes Project for high frequency variants filter, and dbNSFP for functional prediction.

The genetic markers were identified for Thai ASD associated variants (c.2014G > A in EIF2AK3, c.2951G > A in FGD6, and c.6119A > G in CHD8).

these genetic markers were the most possible of causing variants Thai. We also demonstrated a potential of exome sequencing and bioinformatics pipeline to identify the possible causative variants of ASD, which could by applied in the case that unable to identified variants by other technique.

The author has not supplied his/her declaration of competing interest.