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SMARTGPSYCHT.docx

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SMART GOALS

Course Reflection

Before this clinical rotation, I anticipated a transition from a passive role to a more active role in psychiatric practice. From previous courses in psychiatric management and psychopharmacology, I knew this rotation would be an opportunity to put theory into practice. I also expected an increased involvement in group psychotherapy given the emphasis of the course on group dynamics and communication. This was based on my previous clinical rotations, where I was more closely monitored with a more limited role. I knew I had to become more independent, while ensuring patient safety.

My five SMART goals at the start of the term reflected my areas of need and the course learning objectives. These included psychiatric assessment, group psychotherapy, motivational interviewing, treatment planning, and interprofessional collaboration. These are essential competencies for the PMHNP role and skills that I had not performed competently or consistently. In particular, my experience with psychiatric assessments was mainly with patients who had depressive or anxiety conditions. This process allowed me to identify areas for growth and ensure that each goal was specific, measurable and achievable in the time frame of the rotation.

Throughout the term, I demonstrated improvement in psychiatric assessment and diagnosis. Initially, I relied on my preceptor for guidance in patient assessments and differential diagnosis. As I practiced this over time with feedback and reviewed my course notes, I felt more comfortable conducting thorough assessments, including history and mental status exams. I could provide diagnostic impressions that were often consistent with my preceptor's final diagnoses. This allowed me to apply my assessment skills to inform treatment decisions and showed my improvement in the course focus of prioritizing treatment for psychiatric disorders.

I improved my skills in group psychotherapy and therapeutic communication. At first, I observed group psychotherapy sessions and recorded the therapist's interventions. Over time, I became more active. I encouraged discussion, reminded patients of their expectations and used basic cognitive behavioral strategies. I also applied motivational interviewing techniques when working with patients individually, which helped me to engage and motivate patients. This helped me to understand group dynamics, and improved my communication skills, which are important in psychiatry.

I also developed my treatment planning and decision-making skills. I participated in case discussions and created treatment plans that connected diagnosis with history and symptoms. I made an effort to incorporate clinical practice guidelines and research findings to justify my decision making. I became better at justifying my plans and considering psychotherapies and medications. At first, my plans needed to be modified. Then my plans were more evidence-based. This shows the development of clinical reasoning skills and readiness for advanced practice.

I also learnt from my interactions with other health professionals. I engaged in discussion and presented patient cases, including assessment, risk assessment and management plans. This improved my confidence in sharing clinical information, and the importance of teamwork in psychiatric care. I also saw the importance of various professionals in the care of patients, which improved my knowledge of multidisciplinary care. I also became more comfortable receiving feedback and incorporating it into my clinical practice.

Another valuable learning opportunity was caring for patients from different socioeconomic backgrounds, including those with limited access to mental health services. I observed the effects of limited financial and transport resources and stigma on treatment adherence. This increased my awareness of social determinants of health and the need for cultural competence. It also helped me to communicate better with patients as I began to recognize barriers and context.

The most valuable part of this rotation was the opportunity to go from observing to actively participating in patient care. This allowed me to apply my learning and to develop clinical reasoning skills, based on my own experience and patient feedback. I noticed my clinical reasoning skills improve in my practice, as I became more confident in interviewing patients, organizing clinical information, and using therapeutic communication skills. The classwork reinforced the importance of personalizing each treatment to a patient. As a result, the experience also helped me learn how to tailor my communication and treatment approached based on each patient personal circumstances.

Overall, this experience facilitated the course objectives by improving my skills in providing individual and group therapies, using assessment findings to guide treatment, and working with an interprofessional team. I was able to show early competency in these skills and areas for further development. The SMART goal setting process was useful to monitor progress and accountability during the rotation. This experience has prepared me for my career in advanced practice and the need for continuous learning.