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Aims: The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in East London Foundation Trust (EL FT). We used large routinely collected DIALOG data to assess impact of treatment across different domains of life and whether the impact of treatment changed with Community Mental Health Transformation CMH (NHS Long Term Plan). We also carried out secondary disaggregation analysis of pooled data based on protected characteristics interrogating through an equity lens. Methods: EL FT had commissioned University of Plymouth for the review of CMH transformation. Anonymised pooled data set was obtained from the electronic patient records that were collected as a part of routine clinical practice. DIALOG (PROM and PREM) scores captured routinely from CMH services in ELFT over two time periods (2018–19 and 2021–22) were collected for this purpose. The anonymised and pooled data was linked with stages of treatment e.g. assessment, review and at discharge and protected characteristics (age, gender, ethnicity and a proxy of social deprivation). 14,813 DIALOG scores from 6,538 unique patients were identified. We analysed each domain of DIALOG separately and the numbers of return of scores on each domain varied depending on response rate. We compared domain based descriptive statistical analyses of mean pooled DIALOG scores looking at means across a range of variables for each domain and then conducted a series of multiple regressions for each of the DIALOG domains, to control for multiple variables together Results: Our results showed that service user satisfaction in each domain improved with treatment stage (from assessment to review to discharge) reaching statistical significance at each stage. There were minor differences between the two time periods (2018–19 and 2021–22) in a few domains. There was variation in outcomes across ethnicity, age and gender in a few domains. Conclusion: Large data sets of routinely collected DIALOG data offer valuable insight into the needs of the local population and impact of treatment. Assessment of the impact of the CMH service transformation was confounded by the pandemic. Disaggregated data on protected characteristics reveal interesting and useful information about experiences and outcomes of different population groups over time. Our study also validates DIALOG as a quality of life measure and patient experience measure scale that is sensitive to measure change. It affirms the value and depth that intelligence routine outcome data gathering can offer both to measure change as well as offering an assessment of population need.

Aims: International Medical Graduates (IMGs) make up more than half of new recruits in the NHS and recent data shows that there is an increased likelihood of IMGs being referred to the General Medical Council (GMC) for fitness to practice investigations. Analysis of these complaints highlighted communication skills as an area of concern. We wanted to support relatively new IMGs, who started practicing in the country within the last 2 years, by enhancing their communication skills. Methods: To deliver this initiative, medical education department, trust IMG tutor and two higher trainees (with recent lived experience as an IMG in the NHS) partnered with Talking Allowed (communication skills training company for healthcare professionals). 12 IMGs registered and were offered 5 half day online and 1 day face to face training using a mixed model of activities related to all aspects of communication – verbal, non-verbal and written. We ran role plays on: ‘Managing an upset relative’, ‘Breaking Bad News’, ‘Misunderstandings and Colloquialism’, ‘Dealing with disagreement/ conflict within the team’ and ‘Challenges to professional boundaries’. During role plays, prior to candidates’ attempt, a ‘how not to do it’ version was acted out by the higher trainees followed by the enrolled participants going next. Each role play was further followed by reflective feedback sessions facilitated by PM, LH & RB to identify and reflect on positive as well as areas for improvement. Through the course one session focused on written communication, with homework and best practice guidance provided prior to the session. At the last session, there was a didactic presentation and discussion on acculturation with opportunities to reflect. Feedback was gathered at every session from the attending IMGs. 7–8 trainees engaged through the process, 2 dropouts and 2 non-engagements. Results: 97.1% (n=35) rated the sessions as ‘highly engaging’ (on a scale of 1 to 4), 100% rated the sessions as ‘highly relevant’ (n=36); 91.4% (n=35) rated the course as ‘highly useful’. Compared with at the start of the course, subjective confidence in communication of participants improved by 2 points in a scale of 0 to 10. Initial score 6.8 and final score 8.8 (signifying 20% increase). Conclusion: Focused communication skills training involving a mixed method of role play using simulation principles, complemented by general reflective exercises on communication especially in a cultural and emotional context as well as some reflection on the personal experience and the known intelligence on immigration and acculturation can be an invaluable tool for IMGs.

Aims: More than half of new recruits in the NHS are International Medical Graduates (IMGs). It is recognised that IMG need additional support, however to offer this their supervisors need to be aware of the landscape and resources to effectively support them. We developed a training for supervisors of IMGs using a mix of didactic, group work and simulation training. Methods: The Faculty Development and IMG tutors surveyed and worked with several IMGs to identify topics for the training learning from their recent lived experiences. They also looked at guidance for IMG induction as published by General Medical Council (GMC) and British Medical Association (BMA). We identified that challenges of IMGs evolve through their journey and developed 3 simulation scenarios targeted at early, mid and later stages of the IMG pathway. The one day face-to-face course included: An introduction into current IMG landscape including the identified challenges. AS offered lived experience of IMG journey. This allowed for a discussion among the supervisors to reflect on their role. This was followed by the 3 SIM scenarios: An IMG doctor who had just moved to the UK and introduced to the supervisor the various practical hurdles that this entails around immigration and joining the NHS. An IMG had been living in the UK for a few months and was starting a training job, with the focus on fleshing out the differences in healthcare systems. Managing feedback about communication skills in an IMG who had significant clinical experience in their home country before moving to the UK a few years ago. We gathered quantitative and qualitative feedback from the participants. Results: 6 of the 7 candidates offered feedback which was unanimously positive. All found the content useful, most found the course extremely helpful to manage IMGs and an overall rating of excellent by 83% (5 out of 6). We received qualitative feedback as well, ‘It was amazing’ & ‘so grateful especially simulation rather than only theory’. Conclusion: As IMGs enter the workforce through different pathways and at different times, organising focused IMG induction can be challenging. Moreover the needs of IMGs evolve over time. In psychiatry we have a structure of regular supervision which offers an opportunity of ongoing support to IMGs through the supervisors. However we believe supervisors are not always up to date with the IMG landscape or resources and would benefit from upskilling and updating in this field.

A study of “Physical and Biological Evidences on Clothes amongst Autopsies” conducted at M.S. Ramaiah Medical College, Bangalore, between October 2011 to April 2013, for a period of 18 months with aims and objectives to ascertain the role of physical and biological evidences on clothing in opining the cause and manner of death and place of occurrence and the role of clothing in sexually related deaths. All cases with medico legally significant physical and biological evidence on the clothes were taken up in the study. The various evidences on the clothing were observed/noted/collected with clear description of the site, physical examination of stains and correlation of damage to clothing in relation to the injuries on the body. The findings were documented with a standard proforma and substantiated with clear photographs where ever necessary and data was analysed.A total of 102 cases were included in the study, the commonest types of cases studied were Road traffic accident 25 cases (24.5%), Assault 24 cases (23.52%), Railway deaths 22 cases (21.57%), Burns and electrocution 12 cases (11.7%), Fall from height 6 cases (5.88%).Tears/cuts, grease stains and mud/soil stains formed majority of the physical evidence observed. Blood stains were the most common biological evidence observed followed by salivary and seminal stains. In 31 out of 136 unidentified cases accounting for 22.79% positive identification was done by the relatives based on the clothes and pocket contents.Of the 102 cases included in the study, in 78 cases (76.47%) the physical and biological evidences aided in furnishing the cause and manner of death. The place of occurrence could be correlated with the evidences in 100% of cases of railway deaths, 66.66% of electrocution cases, 52% of road traffic deaths, 33.33% of fall from height cases and 25% of assault cases.