Motivation through simulation


Classroom Simulation

This week Wendy has complained of headaches, problems sleeping and just not felt like doing much. She’s just about managing to breast feed her two-month old daughter, though she doesn’t feel like eating herself. It’s been like this for about a month she says and her family – currently waiting outside the consultation room – are so concerned that they’ve brought her to see a psychiatrist.

Wendy’s complaints though are fictitious. My girlfriend has no children and only arrived in Ghana a week ago. However, already she has met a number Ghanaian Medical Assistants (MAs) working in psychiatry as part of an exercise to assess their interviewing, diagnostic and management skills. While this method of professional assessment is somewhat novel to the MAs, what’s even more unlikely for them is that were Wendy’s family really concerned, then they would be in the room as well, providing much of her details themselves

As quaint and as obvious as that sounds in this deeply family-orientated society, Wendy’s simulation of post-natal depression has furthered my appreciation of the factors affecting mental health assessments in Ghana. It’s yet more to consider as I approach my third and final month here as a visiting volunteer psychiatrist. While my observing presence might explain some of their apparent inhibition, their markedly improved approach and consideration towards Wendy shows that there is ability, if not always application.

So why is that such awareness of the patient is not seemingly there in practice? While there are genuine issues with resources and infrastructure, is it really all due to being overworked and unappreciated? Is it missing in the additional training that these former psychiatric nurses underwent before becoming MAs? Are the patients at fault for just being accepting recipients of care that’s often being directed by their family through the MAs? Or is it something more prevalent that runs widely across Ghanaian society in that elusive but ubiquitous concept known as culture?

Certainly my own UK training through use of simulated patents and having my practice scrutinised has partly inspired this approach. However, what made this approach seem nigh-on essential was witnessing a number of MAs return to a free for all style of asking unbounded questions within a day of my presentation on how to perform methodical mental state examinations. While this scatter gun like method of psychiatric assessment might match the somewhat chaotic nature of the clinics they often work in, along with my other UK based teachers, we realised that further classroom work was required to develop methods that initially appeared to be understood but were not being followed in the field.

Next week Wendy will join me on the 9 hour journey to Ghana’s Kintampo Rural Health Training School where I earlier taught on the first ever specialist training course for Medical Assistants in Psychiatry (MAP). The course aims to train up scores of middle-grade specialists in the coming years to overcome a gap that is sorely lacking in a country that has less then one psychiatrist per two million people. We’ll develop Wendy’s story to incorporate a psychotic dimension and add a universal theme of persecution by her mother-in-law. Perhaps most importantly though by returning to the MAP course, we’ll show that by maintaining a personal interest in our fellow individuals, an ongoing motivation for concern about the human experience will be encouraged.


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