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EMERGENCY HELP IN THE PSYCHIATRIC PRACTICE OF INTERN DOCTORS
Rusina S.,
Candidate of Medical Sciences, Associate Professor of the Department of Nervous Diseases, Psychiatry and Medical Psychology. of S.M. Savenko Higher educational institution of Ukraine "Bukovynian State Medical University", Chernivtsi, Ukraine Nikoryak R.
Aspirant of the National Medical Academy of Postgraduate Education of Shupyk,
Kyiv, Ukraine DOI: 10.5281/zenodo.7049708
ABSTRACT
In the period of training in the internship of the first and, especially, the second year of training, close attention should be paid, along with theoretical knowledge, to practical skills and abilities in preparing doctors for professional professional work with mentally ill patients. It is important in this direction to provide qualified and timely emergency care to the patient, on which the life and health of both him and the people around him depend.
Keywords: interns, mental patients, emergency care.
Formulation of the problem.
The modern information society and the growing prevalence of diseases, in particular, mental diseases, make high demands on the professional training of future specialists in the field of psychiatry. The development of a strategy to improve the mental health of Ukrainians, especially during times of war, is an integral part of the work of higher educational medical institutions of Ukraine to train medical personnel aimed at a positive shift in the timely diagnosis, treatment and prevention of psychopathological disorders.
Analysis of recent research and publications.
Serious challenges of society, provoked by various socio-political (threat of the third world), epidemiological (COVID) and medical-psychological (military operations) reasons, encourage the reform of higher education in Ukraine with the aim of improving the training of professional medical workers. Socially stressful
factors have led to the fact that mental disorders have become the most common today. Therefore, it is important to introduce emergency care standards into the educational process, which ensure early diagnosis of mental disorders, sometimes in combination with physical ones, and timely provision of emergency care in order to preserve the health of the nation (5).
In medical practice, psychopathological conditions that require immediate medical intervention with suddenly occurring aggressive, auto-aggressive, destructive and other dangerous actions of the patient are quite often observed. Medical intervention, including for these patients, is understood as a complex of organizational, pharmacotherapeutic, psychotherapeutic and legal measures of a medical nature (1).
Such exacerbations are most often manifested by psychomotor agitation, which is accompanied by de-
structive, aggressive tendencies or, on the contrary, stupor. Both the first and second psychotic states are dangerous both for those around them and for the patients themselves, which requires the doctor to diagnose these disorders in a timely manner and provide emergency assistance as soon as possible in order to prevent illegal acts, ensuring the safety of the patient and the people around him (2) .
Life in modern society, in particular Ukrainian, has been full of unpredictable socio-economic and military events for many years. Starting from the solution of everyday problems and ending with the loss of lives among the civilian population with the destruction of future prospects(3) People live in a state of stress on their adaptive resources, which are closely related to psychological and physiological well-being. However, the possibilities of adaptation (psychological, physiological, social) to such conditions sooner or later are exhausted, which contributes to the increase in the number of stress (psychogenic) disorders, which make up 25% of mental disorders. Therefore, it is important to draw attention to mental disorders in this area of psychiatry - psychogenic (4).
The purpose of the article is to improve the professional skills of interns by practicing practical skills and abilities in providing emergency care for mental (non-psychotic and psychotic) and behavioral disorders.
Presenting main material. Considering the fact that Ukrainian society has been under the influence of socially stressful events for a long time (economic, political, migration, emigration and military, etc.), important attention is paid to the practical direction in the study of psychiatry, and this for intern doctors is the provision of emergency care to patients who they need it here and now.
According to the working curriculum for postgraduate education for interns in the discipline "Psychiatry", the study of the organization of psychiatric care, classification of mental illnesses, research methods, general psychopathology, special (nosological) psychiatry with methods of treatment and emergency care is provided. Some urgent conditions in psychiatry require temporary isolation of the mentally ill, namely, hospi-talization in a psychiatric hospital. The experience of teaching psychiatry to 4th-year students and intern doctors determines that the greatest attention should be paid to the practical training of future medical workers when studying the subject. Therefore, on the course of psychiatry and medical psychology during the training in the eye cycle, preference should be given to the practical activities of the doctor.
The main emphasis at the postgraduate level is on making a clinical diagnosis, taking into account the clinical manifestations of a mental disorder (syndromal level), on correctly conducted differential diagnosis with similar conditions, followed by the appointment of adequate treatment and emergency care.
Important attention is paid to patients who are in psychomotor agitation, namely - in states of confused consciousness (delirious, oneiroid, amentive, chore-atic); in states of narrowing of the field of consciousness (twilight, fugiform excitation and physiological
and pathological affects), in excited states with partial loss of consciousness, as well as in neurotic (stressful) states, namely, in excitatory neurotic reactions, psychopathic, hysterical and panic attacks.
Stupor states that require urgent help are also significant, such as asthenic, alcoholic, hallucinatory, epileptic, manic, depressive, catatonic, psychogenic.
In the practical training, interns master the provision of emergency care for acute psychotic conditions observed in narcological practice, including acute intoxication, delirium, hallucinosis, paranoia, and pathological intoxication. These conditions require urgent help, because such patients can die from untimely detoxification, as well as be dangerous for themselves and others, can commit murder due to the presence of commanding voices.
Taking into account the fact that there are not always thematic patients in practical psychiatry classes, and taking into account the online mode of teaching psychiatry for a long time (the last 3 years), the course teachers successfully implement a simulation approach to teaching the subject. This approach is proposed when studying mental disorders in order to practice practical skills, namely: the teacher, when studying a certain psy-chopathological condition in a practical session, presents a clinical situation close to reality and asks any intern doctor to diagnose this condition and provide first aid. All interns are involved in the discussion, since the wrong answer of the previous respondent connects the next one. Thus, in a lively discussion, interns try to correctly diagnose the presented condition and, most importantly, consolidate the clinical skill of providing emergency care. Therefore, this approach will help students to improve their knowledge not only in the diagnosis of mental disorder, but also in the practical application of drug therapy in order to eliminate one or another psychotic state, which will positively contribute to them when preparing the certification (semi-annual, annual and final). At each certification, the commission of teachers evaluates theoretical knowledge on 5 questions, namely: on the organization of psychiatric and drug addiction care; pathology of one of the forms of consciousness (cognitive or active); definition of psy-chopathological syndrome; clinical manifestations of this or that disease; the use of drug treatment in psychiatry, namely, neuroleptics, antidepressants, tranquilizers, antiepileptics, sedatives, vascular, nootropic drugs, normotimitics, etc.). An important component of evaluating the knowledge of intern doctors during the attestation process is solving a situational problem with answers to 3 questions, namely, defining a psychopatho-logical syndrome, making a clinical diagnosis, prescribing treatment and, in acute conditions, providing emergency care. Assessment for a practical skill (solving a situational problem) takes priority, i.e. in case of a conflicting assessment, preference is given to the practical skill. Therefore, at each practical session, collective curation of one thematic patient is carried out, or microcuration of the patient is carried out by each intern separately. This approach to training helps doctors practice clinical thinking, which is the basis of their professional activity.
Oral surveys and testing of educational achievements of each intern are considered an effective mechanism for theoretical knowledge assessment. At each practical session, a test is conducted, which accelerates the survey. In accordance with each practical lesson, methodical instructions are drawn up, which contain tests and clinical tasks of 1 and 2 levels of complexity, which every doctor, using the "Mudl" system, can work on at home. Therefore, using distance learning, interns can better prepare for practical classes. The "Mudl" program also includes a working program; topics of lectures; practical and seminar classes; topics of independent work, the questions of which are included in the control questions of the survey in the practical session.
At the Bukovyna State Medical University, on the course of psychiatry and medical psychology, interns of the first and second years of study are involved in scientific work. At the end of the first year of internship, doctors present their scientific achievements at the university scientific and practical conference of interns. At this conference, doctors make presentations of their scientific research, which they conducted under the guidance of teachers of the department.
Thus, a practical-oriented approach to medical education is currently an effective and efficient method of teaching at clinical departments, in particular, psychiatry courses.
An important condition for ensuring the quality of professional training of future medical specialists, and, therefore, increasing the effectiveness of the educational process in a higher educational institution, is the systematic acquisition of objective information about the results of students' activities. It is believed that everyday control and rating assessment remain an important and necessary motivational component of the educational process, especially for intern doctors who earn their professional authority in this way.
Conclusion.
Emphasis on the study and mastery of emergency care, aimed at satisfying the necessary - important basics of psychiatry, which will serve interns in their professional activities in the future.
This approach is useful both for interns and, of course, for patients of psychiatric clinics. Training at the postgraduate level is carried out in full compliance with the work program of medical institutions of education of III - IV levels of accreditation for intern doctors who specialize in psychiatry, taking into account the presentation of modern theoretical knowledge, practical skills, which emphasizes their practical importance, taking into account the deontologically important in communication with clinical terminology patients. Emergency care is a marker of professional skill, which is what we focus on when training competitive specialists in psychiatry.
Thus, the system of training medical specialists at the Bukovyna State Medical University allows for daily control and clear identification of knowledge on mastering theory and practical skills and abilities in order to successfully form interns their professional skills, which is a priority in clinical medicine.
References
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3. Psychiatry and narcology: textbook/ edited by O.K. Napreyenko//. - K.: VSV "Medicine", 2011. -528p.
4. Psychiatry/ed. V.M. Kozidubova, V.M. Kuznetsov with the author - Kharkiv: Oberig, 2013. -1164 p.
5. Chaban O.S., Khaustova E.A., Omelyanovych V.Yu. Emergency care in psychiatry and narcology -Kyiv, 2019. -172p.
