The workshop was valuable in contributing to the development of the Child in Mind Project training programme. The content and process of the programme were explored and several issues emerged that will need serious consideration by the Child in Mind project team. These include the strongly expressed need for a change in culture within the health care system that will embrace child-centred mental health care. The magnitude of change required is uncertain but may well be extensive given evidence that a study based in general practice in The Netherlands reported that the inclusion of the child in all phases of the consultation was "limited" with parents frequently speaking for the child, the child not questioning the parent, and the GP supporting this behaviour by minimal exploration of meta-communicative behaviours. The authors described this process resulting in a dyadic emphasis as being "institutionally co-constructed" [24
Ways to change the health care culture in the United Kingdom were not explicitly identified. However, the project teams' desire to implement the training programme in a few centres that were already enthusiastic suggests that creating centres of best practice is inherent in their approach for change. This supports theoretical approaches for effective institutional change [25
]. That is, implementation commences in sites receptive to change before introducing change on a wider scale having already demonstrated positive outcomes. One outcome of the workshop was the identification of individuals willing to trial the new programme with their trainees. These individuals work in centres with different structures and functions in the health care system so will prove valuable in evaluating how deliverable the programme is in different types of settings.
The inter-professional nature of the workshop was beneficial in exchanging views from different perspectives. This supports the findings of the few studies in medical curriculum development that reports this approach [27
]. Most participants acknowledged the importance of continuing the consultation process although there was no attempt to agree on format. The importance of regular consultation with the principal users of the training programme – the senior house officers – will be essential to ensure that the programme is deliverable within the diverse settings in which they learn and work.
Although consultation with other stakeholders (children, adolescents and their families) was not identified by this group, it is important that they are also included in the development and evaluation of the training programme. Community participation – especially of key stakeholders, is often lacking in all phases of professional education (development, implementation and evaluation). In order that the training can best meet the needs of its intended targets their voices should be considered. The medical education literature strongly supports inclusion of patient voices in all aspects of curricula development [28
The importance of training the trainers of the programme was identified as key to success of implementation. Although agreement was not sought, there was a powerful sentiment that trainers should be inter-professional. This notion may also address cultural barriers that relate to doctors' lack of understanding of other health care professional roles by exposing them to trainers who have mental health assessment and/or communication skills expertise. The nature of support provided to trainers may vary reflecting the diverse settings in which the training programme will eventually be implemented.
There appeared to be agreement that the workshop was not an appropriate forum for identifying the details of content and process of the training programme. Rather core issues were identified in psychosocial assessment, mental health and communication. Effective approaches to learning patient-centred communication skills are labour-intensive (videotaped interviews with feedback) [31
] so maximising the benefits of such activities will be essential. The literature reports examples of communication skills programmes for trainee paediatricians [19
] as well as other doctors and health care professionals who work with children [20
] that address diverse issues. Common to many of these programmes is the use of simulated patients and parents incorporating critiquing of videotapes. This may provide valuable guidance in selecting educational methods that are effective and can be delivered in different settings. Ensuring that the training programme incorporates principles of work-based and other adult-learning approaches are essential [34
The purpose of eliciting participants' reasons for attending and their expectations of the workshop is to help make sense of their satisfaction afterwards. Although the invitation outlined the purpose of the workshop, participants came with varied views that to some extent reflected their level of experience, their unique professional perspective and their interpretation of the information provided in the invitation. However, there was an overarching expectation that each would contribute to the development of a training programme. It is important to reflect on the reasons that only 28.6% of the participants reported that their expectations were completely met.
The suggestions given for improvements offer insight into why more participants did not meet their expectations. Restating the project team's aims at the commencement of the workshop may have been helpful. Although some participants felt able to express their views others were unable to do so because of the structure of sessions, the way in which they were facilitated and the settings in which the discussions took place. Providing a more open forum for discussion may have generated different ideas. The breadth and depth of the "culture change" some participants consider essential for implementation of the training programme is extensive and is likely to have influenced their judgement as to what could be realistically achieved both in the workshop and the training programme.
The physical limitations of the workshop impeded discussion in some groups.
Although group sizes were thought appropriate, providing spaces in which they could work will need to be considered in future workshops.
Limitations of the evaluation
There are several limitations with this evaluation project some of which were beyond the control of the evaluator (DN).
• Higher response rates may have improved the quality of the evaluation. It is possible that respondents differed to non-respondents which may influence the results in someway although it is difficult speculate how.
• Scheduling the evaluation forms as part of the workshop may have increased response rates and may also help participants to focus on their expectations immediately before the meeting and then afterwards in considering what they achieved.
• The low response rate in relation to the final plenary session may be explained by the request to complete the forms immediately after the workshop. It is possible that some participants wanted more time to reflect on their experiences. It may have been more helpful to contact participants after the workshop.
• Further, the responses may not represent the diversity of opinions expressed during the workshop nor were the professional groups equally represented in the evaluation forms. For example, no nurses completed the pre workshop evaluation form. It is unclear why this was the case as all respondents were equally encouraged to complete the forms.
Future evaluations of workshops attended by disparate groups may consider:
• Scheduling the completion of evaluation forms into the workshop timetable
• Using identifiers to link pre and post workshop evaluation forms
• Following-up participants some time after the workshop to elicit their considered views
Despite these methodological weaknesses, the evaluation offers useful insights to the management of an inter-professional workshop for curricula development.