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BackgroundFunctional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for its efficacy and lack of understanding of the predictors and components of recovery.MethodsWe report clinical outcome data for an inpatient cohort with severe FND. Clinical Global Impression Improvement with treatment is the primary outcome measure. Admission and discharge measures (Euroqol quality of life measures, Beck Depression Inventory, Spielberger Trait Anxiety Inventory, Cambridge Depersonalisation Scale, Illness Perception Questionnaire (Revised) and Functional Mobility Scale) are reported as secondary outcomes.ResultsWe describe an FND cohort (n=52) with chronic illness (mean symptom duration 9.7 years). At admission, there were clinically relevant levels of depression, anxiety and depersonalisation derealisation. At the time of discharge, most (43/52) patients’ global condition had improved. Measures of mobility, depression and quality of life also significantly improved while at discharge, symptoms were experienced as more understandable and less distressing than at admission. An admission measure of patient confidence in treatment was predictive of eventual clinical outcome.ConclusionsThe most frequent outcome of inpatient rehabilitation is global improvement, even when symptoms are chronic and severe, reflected in measurable changes in both physical and psychological functioning. Significant levels of depersonalisation derealisation seen in this patient group suggest that routine enquiry into such experiences could help personalise FND treatment approaches. Patient confidence in treatment is key in determining clinical outcomes.

AimsFunctional somatic symptoms (FSS) is an umbrella term for symptoms inadequately explained by structural disease or damage. FSS show complex causality, and fall between the gaps in mainstream medical epistemology and/or mind-body dualism. Lack of explanations for FSS exacerbates uncertainty, anxiety and stigma for patients, and contributes to fragmented care and inappropriate management. We aimed to develop an open access health-educational resource that provides an acceptable, relevant, and usable explanatory model of FSS to internet users.MethodsWe carried out a participatory design study to develop the website bodysymptoms.org. Explanatory concepts were developed through iterative stages of dialogue between individuals with lived experience of multi-system FSS (n = 7), researchers, healthcare professionals and designers/developers. Initial explanatory components were collected from currently existing patient education about FSS, a review of the literature, and participants’ illness narratives. Principles were developed to filter, and organize these explanatory components into a coherent model. The model was translated into 5 European languages and through iterative rounds of feedback incorporated a diverse range of perspectives.ResultsWe describe the explanatory model that developed through the bodysymptoms project, and considerations that arose through the dialogic process. The model is based on the body as a complex adaptive system with causal interactions operating across bio-psycho-socio-ecological levels. Mechanistic processes that can maintain persistent symptoms were chosen as the main nodes (or topics) of the model, and minor topics were structured to demonstrate interactions between mechanisms. Considerations that arose during the process included coherence across philosophic, scientific and clinical levels of explanation; a therapeutic model of agency, within which explanations empowered without blame; the need to introduce notions of biological time, like body rhythms and body memory; and the role of multi-media, embodied metaphors and lived experience narratives in communication of the explanatory model. Personalisation of the model was achieved through embedding the structure of the model into the graphical and navigational structure of the website, which allows website visitors to explore the model in a non-linear manner, tailored by relevance, acceptability, and prefered level of information.ConclusionWe present results from a research in action study to develop a novel resource for understanding functional somatic symptoms. bodysymptoms.org is based on the model of the body as a complex system that adapts in personal ways. To explain FSS there is a need for new ways to understand the body and how we become unwell. Bringing diverse perspectives into dialogue generated new forms of knowledge and allowed the power of scholarship to be harnessed for immediate shared value.

Psychiatric diagnoses are increasingly seen as viable categories around which self and social identities might be drawn. This introduces a new pressure on the “boundary problem” for psychiatry: when members of the public request diagnoses to affirm their self-identities how should we draw the line between mental disorder and normality? If psychiatrists have the authority to recognize and diagnose mental disorder, how can roles as diagnosers and gate-keepers be balanced in a post-stigma era of mental health care? Focusing on the disorder identified would-be patient who would not attract the diagnosis they seek were they not to seek it, this essay explores what it means to have an identity bound to a psychiatric diagnosis and considers a framework for psychiatrists to negotiate clinical encounters that involve the seeking of identity affirming diagnoses.

AimsTo develop a responsive and sustainable template for long-term course evaluation for PsychED UpTo obtain rich, meaningful and specific feedback across multiple domains which can be translated into course improvementsTo work collaboratively with students interested in medical education having previously participated in the courseTo empower current students with the knowledge that their input is valuableBackgroundPsychED Up is an innovative extra-curricular course for 3rd year medical students at King's College London delivered by psychiatry trainees, senior students and actors. It is in its second year of running and focuses on the hidden curriculum in medicine, exploration of holistic care and communication skills at the mind-body interface. Input from people with lived experience is used to shape teaching.MethodEmbedded evaluation in course development sessions thus engaging the entire faculty in evaluation processes at the start of the new termDecided evaluation focusFace-to-face discussionsSurvey for faculty to determine what specific feedback content would be most usefulFinalised the questionnaireCollaborative design and refinement of questions, confirmed sub-sections and scope of questionnaireResultRevised questionnaire:Included rationale at the startTailored questions so faculty have more useful responsesGreater quantity of prompted questionsSpecific questions for large group presentation, small group teaching, actors’ performances and students’ reflectionsThoughtful combination of quantitative ratings and open-space questionsReduced time between course sessions and obtainment of feedbackQuality and quantity of feedbackHigh response rates: 32/30 (2 duplicates) mid-term, 29/30 end-of-termHigh-quality filling of open-space feedback allowed consolidation of themes to improve the courseConclusionCo-designing the feedback form with previous students from the course and faculty brought focus to the questions. They were more specific and were organised into sub-sections for different domains. This led to responses that were relevant, enriched with depth and breadth and provided faculty with richer, more personalised responses. More detailed reflections in feedback were thought to be due to better student understanding of the rationale for questions, and knowledge that their input would help improve the course. We have set up a robust system for collecting long-term feedback for PsychED Up. We will continue to make iterative amendments, and supplement questionnaire feedback with focus groups.

AimsAn extracurricular clinical communication course called PsychED Up, with a focus on Psychiatry, met with challenges during the COVID-19 pandemic and the associated social distancing requirements. The course is usually delivered face-to-face by a small team of doctors, medical students, actors and lived-experience practitioners, and consists of large-group teaching on a weekly topic, followed by small group simulations. A small-scale study was performed to evaluate whether conducting clinical communication teaching and simulation online was acceptable, effective and feasible.MethodsTwelve students and ten faculty members participated in the online session, performing live clinical scenarios with simulated patients, over a two-hour period. Pre-and post-course questionnaires were designed with quantitative measures of confidence and qualitative questions about participants’ experience. Eight students completed both questionnaires. Questionnaire answers were analysed using a mixed-methods approach, with themes identified from the qualitative long answers, and statistical analysis of quantitative answers was also performed.ResultsStudents found the session beneficial, with all indicating that they would sign up for a full online course. Based on answers to the quantitative questions, 50% of students felt more prepared for their clinical examinations. (p = 0.046). However, all participants noted a reduction in their ability to read non-verbal cues and body language. Returning students found they were less attentive during the session compared with the original face-to-face teaching (p = 0.05). Actors and faculty members found that the online course was feasible, acceptable and effective. However, most agreed that it was not preferable to teaching clinical communication skills face to face. Technological issues were minimal.ConclusionThe majority of students and faculty found the session both beneficial and enjoyable, but felt face to face sessions would be more helpful in teaching clinical communication. Student attentiveness and awareness of non-verbal cues were highlighted as concerns. However, students generally responded positively to the online course, particularly the quality and diversity of peer feedback. Teaching clinical communication virtually has the potential to be successful, and has implications for future undergraduate medical teaching.

The National Institute for Civil Discourse, a non-partisan organization focused on promoting civil political debates based out of the University of Arizona, found in a study that more than eight out of 10 adult Americans view the “lack of civil or respectful discourse in our political system” as a “somewhat serious” or “very serious problem.” Many topics discussed online or in person, especially regarding politics, are sensitive points of discussion. Just this past month, in...