Research and Training Directorate

Introduction

The Research and Training Directorate (RTD) is responsible for all the academic and research activities which are conducted by the hospital and/or in the hospital. The Chief Academic and Research Director reports directly to the CED (CEO) of the hospital. There are three major categories of activities run by the RTD: one is academic and training activities, the other is research activities, and the third is community service and outreach activities.

The academic and training activities include long-term and short-term academic and in-service training activities. The long-term academic activities are related to training of psychiatry professionals which are conducted by the hospital in collaboration with distinguished universities of the country. A typical example of the long-term academic activity of the RTD is the masters’ degree program in Integrated Clinical and Community Mental Health (ICCMH) which has been conducted by the RTD in collaboration with the University of Gondar. Short-term trainings in the field of mental health are also conducted by the RTD; these include, but not confined to, in-service capacity building trainings in the field of psychiatry and mental health. The RTD provides short training for the duration of 2-4 weeks to nurses who wish to enhance their knowledge and skills in clinical psychiatry. The in-service training provided by the RTD includes the WHO’s mhGAP program for health professionals working in the primary health care setting. The RTD also prepares and provides need-based short in-service trainings in mental health and psychiatry when requested by partner organizations.

The research activities of the RTD are focused on the field of mental health; problem-based and applied research projects related to mental health and service delivery are the main focus areas. Several of the research works have been published on local and international reputable journals. The RTD will further work towards the implementation of research recommendations to improve mental health service and to inform policy decisions. The RTD also accepts several research proposals every year from academicians, graduate students, PhD candidates, etc and monitors their implementations. The RTD will make efforts to make collaborations with local and international institutions which have interest in mental health research.

The community service and outreach activities are concerned with supporting other health institutions with capacity and supplies so that they could gradually take over the delivery of mental health services by themselves. The RTD also works in support of healers and asylum shelters to deliver mental health services to those in need in the very place they are found. The RTD designs projects to work in partner with stakeholders to provide the mental health needs of the community.

ORGANOGRAM OF THE CHIEF ACADEMIC AND RESEARCH DIRECTORATE

PROTOCOL FOR CONDUCTING TEACHING ON PATIENTS AT ST AMANUEL MENTAL SPECIALIZED HOSPITAL

 PROTOCOL FOR CONDUCTING TEACHING ON PATIENTS AT ST AMANUEL MENTAL SPECIALIZED HOSPITAL January 1 2020
This protocol briefly describes and dictates the specific issues to be complied upon in the process of conducting teaching on patients.

Preface

   The Chief Academic and Research Directorate (CARD) of St Amanuel Mental Specialized Hospital has the responsibility to establish a system of managing academic, research and community services undertaken by the Hospital so that the listed functions of the CARD would proceed without causing compromise of clinical care delivery. In fact, those academic activities can be made to support and improve the quality of care delivered to patients (clients). This guideline is prepared to introduce a framework of managing academic activities in the Hospital. If the guideline is properly followed by all staff of the Hospital, a culture of structured and quality academic activities for the benefit of all students and trainees. The guideline also results in a culture of structured clinical care services. The outcome includes better patient care in the Hospital by introducing knowledge sharing, as well as implementation of evidence-based and regulated clinical practice. Clinical care and academic activities always go side by side, and one depends on the other for mutual benefits of students/trainees and patients/clients.

Sincerely,

Dr. Kibrom Haile (Chief Academic and Research Director)

Message from the Chief Executive Director (CED)

   Academic and clinical service activities go side-by-side. Quality academic activities benefit the clinical care, and the vice versa. The Hospital’s academic and clinical services can best be carried out integrated than parallel, so that beneficiaries can get the best of the services. In the absence of integrated management of the two services, both services suffer. In fact, poorly managed academic activities can happen to be a burden to the service, and vice versa. This guideline is expected to result in the smooth execution of academic activities within the Hospital, without affecting the clinical care. However, for this to happen all hospital staff are expected to be aware of the guideline and also participate in its implementation. The adoption of this guideline will significantly improve the quality of teaching-learning, and training activities of the Hospital. This will allow the contribution of the Hospital to enable decentralized mental health which is accessible to the people by producing well trained and qualified mental health task force.

Sincerely,

Edao Fejo (Chief Executive Director)

 

PROTOCOL FOR CONDUCTING TEACHING ON PATIENTS

Introduction

   In order to standardize the procedures and activities of teaching on patients, to ensure quality of teaching, as well as to safeguard the safety and comfort of patients this protocol has been prepared. All clinical staff in general, and case team leaders, coordinators and assigned supervisors should be familiar with this protocol and implement it accordingly.

Ward round and bedside student teaching procedures; addressing patients’ dignity and quality of care concerns

   The ward rounds and bedside student teaching should be done by the respective instructor, coaching clinician, or case team member in such a manner that ensures these activities are patient-centered. All providers (clinicians) should practice and provide care, conduct student teaching and research in a manner which maintains patents’ dignity, confidentiality and privacy, as well as, ensuring the quality and best clinical outcomes for patients.

In accordance with the guideline, and with the intention of maximal benefit both  for  patients and students/interns/residents, the following rules apply to clinical attachments in the hospital: students/interns/residents are encouraged to conduct ward rounds and bedsides to their levels and requirements by their respective programs, together with their instructor/supervisor, or case team members.

  • Interns, MSc students and residents are expected to clerk patients in wards and present their assessments during rounds;
  • BSc students are expected to clerk patients, take their own notes and present to their respective instructors/supervisors;
  • One instructor should have  a maximum of 15 students to supervise at any given time;
  • A patient (client) cannot be interviewed by more than one intern/MSc student/resident at any given moment. The intern/MSc student/resident should be continuously supervised by the respective instructor/supervisor, or by the appropriate case team member;
  • Interns, MSc students, and residents are allowed to write appropriately on patient charts about patient assessment and progress; however, they must write and sign with their name and position clearly written, and indicating that they are in the process of training;
  • If case of presence of students/interns/residents the responsible case team leader and coordinator must make sure that the ward does not become too crowded;
  • At times of massive student flow to the hospital, attendance of ward rounds by students must be by dividing the students in smaller groups and allowing them to attend the rounds turn by turn;
  • The instructors/supervisors are expected to inform patients (clients) that students are attending; instructor/supervisor must get consent from patient (client) for the attendance of students;
  • If patients (clients) refuse to consent to the presence of students, their wishes should be respected. The instructor also is expected to observe whether the scenario is conducive for teaching without compromising patient care;

   Bedside teachings are considered best for the purpose of teaching students. Bedsides allow for detailed discussions about a specific patient. The advantage of bedsides is that students are given selected patients to interview and they present their evaluation to their instructor and other students. Relatively bigger number of students can attend bedside teachings. For purposes of bedside teachings, lecture rooms are preferred venue instead of ward rooms. Bedside teaching is recommended to follow the following procedures:

  • Patients (clients) should give consent to be interviewed by the students;
  • The purpose of the interview must be clearly communicated to patient (client);
  • Patients’ (clients’) privacy and confidentiality issues must be carefully considered. Instructor/supervisor should discuss privacy and confidentiality issues with students.
  • With consent, patients (clients) may be interviewed in the presence of students during the bedside.
  • Bedside teachings and discussions are preferably conducted in lecture rooms, similar venues, in order to avoid overcrowding of wards and OPDs;
  • Patient charts are not to be examined by students at random; instead, information in charts may be referred by students assigned to interview patients for purpose of bedside teaching, and the case team coordinator must be notified by the instructor. The relevant CARD staff should make supervisions to make sure the above concerns are addressed by instructors and case team members.

Safeguarding confidentiality and dignity

As a matter of principle, and in accordance with the guideline, all concerned should note the following issues:

  • In addition to medical knowledge and skills, medical professionals should present psychosocial and humanistic qualities such as caring, empathy, humility and compassion, as well as, social responsibility and sensitivity to people’s culture and beliefs; 
  • Respecting the patient’s trust in the healthcare implies adherence to a set of values, which include acting in the patient’s interest, and being responsive to the health needs of the patient, while maintaining the highest standards of excellence in the practice of medicine (Professionalism);
  • Confidentiality and dignity are much influenced by the ward layout and available space;
  • All members of the ward round team should be aware of the immediate environment when conducting bedside teaching and ward rounds;
  • Instructors and case team staff should be exemplary to trainees, and should establish those standards during the teaching-learning process. The CARD staff should build the institutional culture to meet those standards.

Use of Skills Lab and Simulator Centers

   Skills labs and simulation centers are safe ways of teaching heath care students in general and medical and nursing students, in particular. These methods are designed to acquaint the student with clinical skills in such a way that they will acquire the skills prior to their application on actual patients. The use of skill labs and simulation centers must be applied as much as possible by all instructors. However, it must be noted that students must be given appropriate lectures before assigned for clinical attachment. In order to enable students to handle patient interviews, and to help students benefit most from the encounter, and to minimize patient discomfort, students must have video teachings, role plays, and demonstrations about how to interview psychiatric patients. New technologies such as live video conferences must be adopted when possible.

Ward rounds/bedside teaching and quality of care

Below are the recommended guidelines for ward rounds/bedside student teaching:

  • The number of students present during ward round should not exceed 5 at time;
  • The maximum time for bedside teaching and ward rounds in the presence of a given patient (client) should not exceed more than ONE hour;
  • Whenever teaching rounds are not conducted, regular rounds should be conducted DAILY for ALL inpatients by the ward specialist;  
  • Findings, change in treatments, complaints and any other relevant information during ward rounds and bedsides should be documented in the patients’ medical chart;
  • Mechanisms should be in place to ensure seniors’/consultants’ recommendations for treatment regimens during bedside teaching and rounds are implemented as detailed in the patients’ notes;
  • During duty times, assigned clinician should visit ALL inpatients for which he/she is responsible at least ONCE every shift;
  •  Critically ill patients should be routinely monitored by the on-duty clinician and should be seen by ward specialist at least ONCE in every shift, and more frequently whenever the need arises or patient’s condition changes; 
  •  Inpatient medications should ONLY be changed during duty hours only after consultation with ward specialist has been made and agreed, except when an emergency condition occurs and needs to be managed;
  • Emergencies should be attended immediately; critical situations should be managed, informed and discussed with the on duty physician wherever possible at the earliest. Priority should be given to stabilizing the patient;
  •  All referrals and consultations should be communicated to the on-duty specialist and documented on the patient’s medical chart;
  • All documentations should be accurate and legible.

Multidisciplinary Morning Meeting Sessions

   A multidisciplinary morning meeting session is a forum through which members of the multidisciplinary team ((MDT) (under/postgraduate students, interns, general practitioners, consultants, nurses, pharmacists, laboratory staff, anesthetists radiographers, etc) meet, usually in the morning for a short time to review patients’ cases. MDT morning sessions can be conducted first thing in the morning, before the commencement of the day’s routine activities, except on weekends and public holidays.  The meetings are meant for discussions of critical patient cases, and how they were managed during the past duty period. The MDT uses such meetings to discuss what going on well/not going well with critically ill patients. Such discussions are a mutual learning opportunities; however, the discussions will also result in the establishment of institutional culture of practice and patient care. The discussions could also result in recommendation for future management of patients, and as such, will benefit patients achieve better outcomes.  The duration for such morning sessions should not exceed 30 to 60 minutes.

The undertaking of every morning multidisciplinary briefings of patients’ issues within the case teams by involving the members of each case team are highly recommended.

STUDENT ORIENTATION GUIDELINE

STUDENT

ORIENTATION

GUIDELINE

Chief Academic and Research Directorate
Administrator
1/1/2020

This document pinpoints the important issues for providing orientation to students

Preface

   The Chief Academic and Research Directorate (CARD) of St Amanuel Mental Specialized Hospital has the responsibility to establish a system of managing academic, research and community services undertaken by the Hospital so that the listed functions of the CARD would proceed without causing compromise of clinical care delivery. In fact, those academic activities can be made to support and improve the quality of care delivered to patients (clients). This guideline is prepared to introduce a framework of managing academic activities in the Hospital. If the guideline is properly followed by all staff of the Hospital, a culture of structured and quality academic activities for the benefit of all students and trainees. The guideline also results in a culture of structured clinical care services. The outcome includes better patient care in the Hospital by introducing knowledge sharing, as well as implementation of evidence-based and regulated clinical practice. Clinical care and academic activities always go side by side, and one depends on the other for mutual benefits of students/trainees and patients/clients.

Sincerely,

Dr. Kibrom Haile (Chief Academic and Research Director)

Message from the Chief Executive Director (CED)

   Academic and clinical service activities go side-by-side. Quality academic activities benefit the clinical care, and the vice versa. The Hospital’s academic and clinical services can best be carried out integrated than parallel, so that beneficiaries can get the best of the services. In the absence of integrated management of the two services, both services suffer. In fact, poorly managed academic activities can happen to be a burden to the service, and vice versa. This guideline is expected to result in the smooth execution of academic activities within the Hospital, without affecting the clinical care. However, for this to happen all hospital staff are expected to be aware of the guideline and also participate in its implementation. The adoption of this guideline will significantly improve the quality of teaching-learning, and training activities of the Hospital. This will allow the contribution of the Hospital to enable decentralized mental health which is accessible to the people by producing well trained and qualified mental health task force.

Sincerely,

Edao Fejo (Chief Executive Director)

 SECTION 1: INTRODUCTION

   The guideline requires that students, interns, or residents should received orientation before they start their clinical attachment at the hospital. The guideline recommends that the orientation should include information about the hospital’s structures and accountability or reporting arrangements, policies and procedures. The orientation enables the new students/interns/residents to become familiar with the entire organization as well as their own attachment areas and departments. The orientation should include at least infection prevention and patent safety practices, patients’/clients’ information documentation and management, communication with patient and staff, teamwork, patient confidentiality and privacy, professional codes of conduct and other related knowledge and skills needed to perform activities. With this regard the Academic and Research Chief Directorate of Amanuel Mental Specialized Hospital gives the following orientation to all students/interns/residents at onset of their attachment in the hospital, including expectations from the student/intern/resident which should be respected by all concerned.

Attachment procedure

   For students/interns/residents who are sent by universities and colleges to the hospital for clinical attachment the concerned university or college is expected to write official letter about the attachment together with relevant details to the hospital at least one month ahead of the intended attachment date. The CARD will have to approve the request before the attachment is commenced; the CARD may inform the requesting university or college to reschedule the attachment time based on the student load and other issues of concern to the hospital. The hospital may decline to accept the request if it anticipates the acceptance of students seriously compromises hospital operations and patient care (sometimes the number of students in the hospital is visibly excessive and clients complain about it).

   The attachment schedule, assigned ward/OPD and supervisors must be prepared by the responsible personnel at the CARD in collaboration with case team leader or coordinator. The schedule and assignment must be communicated officially and in person to all concerned; a copy of the assignment and schedule should also be posted at a visible place in the ward or OPD for all concerned to view it at any time.

SECTION 2: CONTENTS OF THE ORIENTATION

   The orientation should include all the necessary contents. The contents of the orientation must be relevant, concise and to the point; the message to be conveyed during the orientation is summarized below. A copy of the orientation message may also be replicated in several copies and provided to students and their college teachers for them to read the details and comply with them.

Orientation message

1.  Information about structure of the hospital

Introduction: St Amanuel Mental Specialized Hospital is the only mental specialized hospital in Ethiopia, providing mental health services to clients coming from all over the country. Its main service domains are outpatient, inpatient and emergency services. The hospital also provides private wing and community pharmacy services. At outpatient level it receives more than 600 patients daily on average, about 11,000 per month and about 140,000 patients yearly. Its inpatient service has a capacity of 270 beds. The emergency visits are close to 2000 monthly.

Organizational structure: The hospital has a governing board responsible for the strategic leadership of the hospital. The hospital board has key roles including selecting the chief executive director (CED) of the hospital, approving the strategic and annual plans of the hospital, approving the hospital budget, controlling the hospital management structure by reviewing quarterly reports, among others. The CED is the head of the hospital and leads the directors for academic and research, clinical services, and administrative units. The CED is responsible to plan and execute the overall operations of the hospital with the help of the directors. The CED is also the chairperson of the hospital’s senior management committee.

     The hospital’s academic and research activities are mainly coordinated by the Chief Academic and Research Director (CARD). The chief Academic and Research Directorate has a research wing which is coordinated by the Research Director. The academic wing which is coordinated by the post-graduate and under-graduate programs team leader. The directorate also has short trainings program coordinated by short-trainings coordinator who is responsible for capacity building trainings including continued professional development (CPD). The other program of the directorate is community services and outreach collaborative program which is coordinated by the community services, outreach and collaborative programs coordinator.

   The hospital’s clinical activities are led by the chief clinical director (CCD), also called medical director. The main service domains of the clinical service, i.e outpatient, inpatient, and emergency are each led by outpatient, inpatient, and emergency director, respectively. The hospital’s clinical service functional units are the case teams. Each case team has both inpatient and outpatient service functions. The hospital has the following clinical case teams: eight adult psychiatry case teams, named case team 1, case team 2…through case team 8. There also are case teams for non-psychotic disorders, addiction psychiatry, geriatric psychiatry, forensic psychiatry, neuropsychiatry, medical, ECT, EEG, ART, MCH, etc.

2. Accountability, policies and procedures

     The accountability of any student/intern/resident during the clinical attachment is mainly to the Chief Academic and Research Directorate. But also has accountability to the case team leader or coordinator of the case team where the student is assigned for the attachment. All new students /interns/residents should receive an orientation on hospital policies and procedures prior to any clinical attachment. The case team where a student/intern/resident is assigned has the responsibility of coaching and supervising the student/intern/resident. The case team will communicate about the student/intern/resident with the relevant unit of the Chief Academic and Research Directorate as needed.

3. Infection prevention, patient safety practice and risk (hazards) protection

   During their attachment, students/interns/residents must address patients with respect and should respect dignity of patients as well as staff. The student/intern/resident will have to observe the rules and regulations of the hospital endorsed by the respective case team during the attachment. Every student/intern/resident should bear a badge which is provided by the Chief Academic and Research Directorate (CARD), or equivalent ID badge which is recognized and approved by the CARD. Any student/intern/resident must respect and observe hospital rules and regulations, and anyone who violates those rules and regulations will be subject to disciplinary measures according to existing disciplinary protocols.

4. Communication with patients (clients) and staff

   Communication is the cornerstone of provider-patient relationship. Good communication skills make the difference between average and excellent health care. The  purpose  of therapeutic relationships differs from  a social relationship in that it is  health-focused  and  patient(client)-centered with  defined  boundaries. Therapeutic relationship between the patient (client) and the health care provider should last throughout the spectrum of health, illness, healing and recovery. The following are key recommendations for the student/intern/resident to follow:

  • Choose language that sets the tone for partnership;
  • Common courtesy: ask the patient for permission and introduce teacher, learners and the proposed activity;
  • Physical examinations and procedures are performed and practiced with appropriate explanation to the patient (client);
  • Conversations are made in a way that the patient is included and understands.

5. Patient confidentiality and privacy

   Patient/attendant privacy, autonomy, and confidentiality are to be valued and respected by all students/interns/residents. Students/interns/residents should respect the confidentiality of all information relating to patients. Students/interns/residents should also observe privacy of their own personal space. Students/interns/residents are not supposed to take personal photo of a patient (client) except with the appropriately provided permission from the hospital officials together with permission of, the patient (client) when appropriate, or the legal guardian.

6. Professional code of conduct

Dignity: The student/intern/resident must observe the dignity of the patient (client) at all times. To that end, the following activities should be carried out:

  • Rights and freedoms of patients (clients) should be respected;
    • Patients (clients) should be given the appropriate personal space;
    • Privacy and modesty must be respected and observed at all times;
    • Respect for the culture of the patient (client) is mandatory;
    • Habits and values of the patient (client) should be well considered;
    • Patient’s (client’s) believes of self worth must be well considered and respected.

Respect: This can be intimately related to patient and/or staff. The following issues are important and must be observed:

  • Paying attention to clients and attendant’s concerns;                                                             
  • Avoiding damage, such as insulting and physically injuring them
  • Not interfering with or interrupting them when they talk;
  • Treating them with consideration;
  • Not offending in any way;
  • Treating clients with courtesy and kindness;
  • Respecting their rights;
  • Giving patients (clients) the freedom of choice;
  • Listening and taking into consideration what they say; 
  • Respecting their wishes and decisions, even if the student/intern/resident disagrees;
  • Being sensitive to clients’ needs and doing one’s best for them;
  • Involving  clients in decision making;
  • Respecting their individuality;
  • Allowing them to do what they can for themselves; and
  • Patients (clients) should be treated as human being not as cases.

   It must be noted that, the interaction with patients (clients) must be purely professional. No intimacy, or non-professional relations with patients (clients) and hospital staff are allowed. Any acts of sexual assault, including rape, of a patient (client) or hospital staff will have legal consequences.

7. Safety of the student/intern/resident

   Patients with mental illness generally are not more violent than the general population; instead, they are, in most instances, victims of violence. However, patients with mental illness can be aggressive. Some patients could become verbally, or physically aggressiveat the time of service delivery in the hospital. Keeping themselves safe from violence is the responsibility of each student/intern/resident. In order to decrease the possibility of aggression from patients (clients) the following measures are recommended:

  • Treating the patient (client) with respect at all times;
  • Not provoking the patient (client) as much as possible;
  • Not responding to minor acts by the patient (client) of apparent hostile gesture;
  • Not becoming confrontational with the patient (client) during encounter;
  • Trying to talk the patient (client) down until he/she gets calm, or until help arrives;
  • Making sure the patient (client) doesn’t carry any materials which can be used as weapon at any time;
  • Observing the patient (client) for emotional and bodily signs suggestive of impending violence and avoiding any encounter;
  • Not being alone with a patient (client) with history of aggression in a room or in a place where it is not possible to get help immediately in case of danger;
  • Not trying to give treatment by force in the absence of trained personnel who can effectively restrain the patient (client);
  • Recognizing the fact that physically restraining a patient (client) should be undertaken by personnel who are trained and assigned for such purpose;
  • Calling for help at times of perceived threat or impending danger;
  • Asking for an appropriate companion to be present may be appropriate in case violence is anticipated during interviewing of patient (client);
  • Asking for advice in similar issues from supervisors or other hospital staff when you have concerns;
  • Reporting any incidents to immediate supervisors or to relevant staff of the Academic and Research Directorate.

   It must be noted that any acts of violence by students/interns/residents on patients (clients) or hospital staff is not acceptable. If you have any issues, talk to your immediate supervisors or the appropriate staff of the Academic and Research Directorate.

8. Contact personnel at times of sickness or adversity    All students/interns/residents should contact the relevant official at the Academic and Research Directorate at times of sickness or any other adversity.

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