Guest blog: Dr. Frank McKenna - A Year in Time: Reflection on a year as Clinical Tutor

This week I am delighted to welcome yet another graduate of the University of Limerick Medical School as a guest blogger. Dr. Frank McKenna has just completed a year as Clinical Tutor in Psychiatry with UL. During that year, Frank has become immersed in the worlds of medical education and research and his students have been lucky to have had such a talented, wise and dedicated teacher and guide. Frank has provided a very modest biography (see below) so, along with his wide range of accomplishments in his first few years in psychiatry, I must add that he is not just 'a writer of fiction' but an award winning author. For artistic accompaniment this week, Frank has suggested two of his favourites - Limerick artist Annemarie Bourke and Gibraltarian artist Christian Hook.

Frank's biography: 

Frank McKenna completed psychiatry BST in 2019 and will commence HST this July. He has spent the intervening time as a Clinical Tutor in Psychiatry with the University of Limerick (UL). A former Business and Information Systems graduate who worked in both IT and retail management, he completed Graduate Entry Medicine in UL in 2015. He has varied interests within psychiatry including Sports Psychiatry and Narrative Psychiatry. He is a writer of fiction, and avails of any opportunity to speak to a crowd. 

Evening on the Shannon (Annemarie Bourke)

George's Head, Kilkee (Annemarie Bourke)

A Year in Time: Reflection on a year as Clinical Tutor

Affect. I described it routinely. Congruent and resonant, appropriate and reactive, perhaps incongruent and blunted, or inappropriate and flattened, or some other combination of a limited collection of descriptors.

The lecture notes I inherited likened affect to the weather, in contrast to mood being the climate. The same simile was on the same slides when I went through my psychiatry rotation at the University of Limerick (UL) in 2015. I wasn’t sure about it then and I’m not sure about it now. But the night before I would first deliver this particular lecture – MSE: Mood, Affect and Risk – after a little thought, I came to enough clarity to think “I’ll run with it.”

 

Foxes Bow, Limerick (Annemarie Bourke)

From Clare to Here (Annemarie Bourke)

Climate and mood pervade in the background. They influence the likelihood of what will be visibly evident at any given time: the weather, or the affect.

By 11am the following morning weather and climate were out the window, where they bloody well ought to be. Eventually inevitable, this reaction was catalysed by the twenty-eight gazes that materialised incremental layers of glaze with each of my attempts to clarify what was becoming increasingly abstract in my own head.

There is a lot of focus in medical education theory on the value of feedback. I found that the best feedback is not sought, but evident in the students’ engagement and in the looks on their faces. This was my principal guiding force: Are they engaged?

I resorted to being less clever than my predecessors.

We ask two questions about affect:

(1)   How reactive (or resonant) is it?

(2)   How congruent is it with the patient’s mood?

The twenty-eight pleasant nods I received allowed me to think this had done the trick. The students’ first written case presentations at the midway point of their 6-week psychiatry rotation illustrated that the trick certainly had not been done. Patients’ affects were all manner of verbs and adjectives: “happy”, “crying”, “tense”, “laughing”. Some were even “good” or “bad.”

I had a few tries at this. In UL we teach the same course 5 times in the academic year as students rotate through the psychiatry placement. In the end I think I had it down, and this came with realising that, in the Mental State Exam, we are not asking “what is the patient’s affect?” The question we ask is “how good is their affect?” That is, how well does their affect represent their mood? Towards the end of the year, reactive and congruent affects began to stream in, and all was right in the academic world.

Shodo Series 2019 (Christian Hook)

The Ambush (Christian Hook)

In July I will start my first post as a Senior Registrar (SR), but for the last (almost) eleven months I have been outside of clinical training, working fulltime for UL, teaching psychiatry to medical students.

I applied for this job for many reasons, but mainly I wanted more teaching experience and I wanted to get a research boost prior to starting HST.

Teaching hours were not as many as I expected – guest lecturers deliver about half, leaving the other half to share between Kevin (my fellow tutor) and myself. Initially this was a tad disappointing. I was chomping at the bit to strut my stuff, impart knowledge to, and open the minds of, roomfuls of focused final years. I had notions. It did not take long to realise the teaching hours I had were plenty, even ideal; easily enough to maximise teaching skills, time to prepare well, time to ponder how best to get the content across and afterwards to reflect on to how to do better.

That is not to say that time is there to be spent staring out the window, thinking the long thoughts of youth (not quite applicable in my case anyway, I’m afraid). The tutors are there to ensure the course runs well. Kevin and I had the advantage of having both gone through the course as students. The problem-based philosophy in particular came naturally to us, but still, time fills up. Scheduling lectures, liaising with lecturers (mainly consultants and SRs), filling in at teaching when things crop up unexpectedly, takes a chunk every now and then. Assessment of students is a continual process – monitoring engagement, assessing written assignments, delivering feedback, identifying the rare struggler, preparing end of year exams, and not infrequently addressing students personal or interpersonal issues.

This year coughed up the particular challenge of creating a new online assessment to replace the clinical exam. The aim was, in some way, to confirm that this year’s graduates understand the subtleties of a psychiatric interview – but there is much more on that in my colleague’s previous posts:

https://psychiatry7trainingtips.blogspot.com/2020/06/guest-blog-part-2-of-dr-kevin-lally.html

https://psychiatry7trainingtips.blogspot.com/2020/06/guest-blog-part-3-of-dr-kevin-lally.html

A year free of clinical responsibilities is a huge opportunity, not just to boost research output but also to improve research skills. The former, for me, despite a lot of work, has been hindered by Covid-19, but I am hoping foundations are laid to produce results in the months ahead. My research skills, on the other hand, have vastly developed. Planning projects, proposing to supervisors, reviewing literature, discussing aims and methodologies, collecting data, analysing data, writing papers – there is probably no substitute for going through these processes, and this year I was able to supplement this work by availing of relevant and useful tutorials and short courses available to University staff. I am a latent powerhouse of research.

More than anything else, I have enjoyed the year. Whatever about its place on my CV, it has allowed me to develop as a teacher, into having a clue and having an opinion when it comes to research. It has made me continually question my knowledge, and thus has deepened and broadened my understanding of psychiatry. It also removed me from the blinkered path from intern to consultant and broadened the scope of where I think my career could go.

HST is waiting. I have not seen a patient in a year so in the first days there may be some toe dipping. Soon enough I will be sailing again, and a year as UL Clinical Tutor in Psychiatry has given me a greater understanding of the vastness of the ocean ahead.

Origins (Christian Hook)

La Nostalgia de Londres (Christian Hook)