Zaza Lyons

Attitudes of Medical Students Toward Psychiatry and Psychiatry as a Career: A Systematic Review

ObjectiveThe discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades. There is a large amount of literature on attitudes of students and the factors that attract them to and detract from psychiatry. The aim of this article is to systematically review this literature from 1990 to the present time.MethodsThe author undertook a systematic review searching a number of electronic databases using the following key words: medical students, attitudes, psychiatry, career. Studies were included in the review if they had been published in an English-language, peer-reviewed journal. Data extracted included year of publication, country where the study was conducted, study design and aim, sample size and response rate, year of study that students were in when they participated in the research, and main results.ResultsA total of 32 papers from 22 different countries were selected for inclusion; 12,144 students from 74 medical schools were surveyed. A mix of positive and negative attitudes toward psychiatry were identified, and, overall, attitudes were found to be positive. However, psychiatry as a career choice was rated poorly and found to be unpopular for many students.ConclusionsThe studies undertaken to-date have identified and raised awareness of a wide range of negative and positive factors toward psychiatry. In order to encourage more students to consider psychiatry as a career, attention needs to focus more closely on the psychiatry curriculum and the development of innovative teaching strategies. This may overcome the negativity that students express toward psychiatry, improve recruitment rates to training programs, and put psychiatry on a more positive foundation for the future.

Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice

BackgroundMental illnesses are a major public health problem around the world and the prevalence and burden of common mental disorders is growing. Psychiatry is an unpopular career choice for many medical students and this impacts negatively on the supply of psychiatrists to the workforce. The psychiatry clerkship can play an important role in influencing students’ attitudes towards psychiatry, either positively or negatively. However, stigma towards mental illness detracts students from considering a career in psychiatry. The aim of this study was to assess the impact of an eight week psychiatry clerkship on i) student knowledge and interest in psychiatry; ii) psychiatry as a career choice; iii) attitudes towards psychiatry; and iv) perceptions of stigma towards mental illness.MethodYear 4 medical students at the University of Western Australia completed two questionnaires, the Balon Attitudes Towards Psychiatry and the Mental Illness Clinicians Attitudes (MICA), at the beginning and end of the psychiatry clerkship. Interest in, knowledge of, and consideration of psychiatry as a career were also assessed. Non-parametric tests were used to compare baseline and follow-up differences on the Balon and MICA. Unpaired t-tests compared mean differences for interest, knowledge and psychiatry as a career.ResultsAttitudes towards psychiatry were positive at the beginning of the clerkship. Overall, there was a significant decrease in negative and stigmatising views towards mental illness post clerkship measured by the MICA, but the follow-up mean score remained close to the neutral value with views in some areas becoming more negative. There was no significant improvement in students’ interest in psychiatry post clerkship, however, knowledge of psychiatry improved significantly. Numbers of students ‘definitely considering’ psychiatry as a career increased significantly from 7 (4.6%) students at baseline to 17 (10.5%) at follow-up.ConclusionThe clerkship made a modest impact on students’ attitudes to psychiatry, stigma and consideration of psychiatry as a career. Integration of strategies to overcome stigma towards mental illness and the mental health profession into pre-clinical teaching may provide students with skills to prepare them for the clerkship. This may assist in improving attitudes towards psychiatry and encourage more students towards a psychiatry career.

Evaluation of the Claassen Institute of Psychiatry for Medical Students

Objective: Psychiatric educators need to develop innovative strategies to attract more medical students to psychiatry. In 2008, the University of Western Australia held the inaugural Claassen Institute of Psychiatry for Medical Students. This novel program aimed to increase students’ level of interest in psychiatry as a career opportunity. Method: Students completed baseline and follow-up questionnaires. Questions were rated on a scale of 1 to 10. Results: Thirty students participated. The average age was 25.5 years and 11 were male. The mean interest and knowledge in psychiatry from baseline to follow-up increased from 7.8 to 8.9 and 5.8 to 7.3, respectively. Mean interest and knowledge in neurosciences increased from 6.9 to 7.7 and 4.3 to 6.2, respectively. Paired t sample tests were significant (p<0.001). Students ‘definitely considering’ a career in psychiatry increased by 20% overall from baseline to follow-up. Enjoyment and organization of the week were rated highly. Conclusions: The Institute is an innovative teaching strategy targeted towards medical students. The program increased the level of interest shown by students in psychiatry as a career. The Institute may positively contribute to recruitment of students to psychiatry training programs and it is planned to run it annually.

Here and Now Aboriginal Assessment: background, development and preliminary evaluation of a culturally appropriate screening tool

Objective: Assessment of Aboriginal social and emotional wellbeing (SEWB) is a complex and challenging task, in part due to a lack of suitable assessment tools. This paper reports the development and evaluation of a culturally appropriate screening tool called the Here and Now Aboriginal Assessment (HANAA). Method: The initial phase included development of a glossary of Aboriginal terms and concepts relating to SEWB. The glossary was used to identify 10 key HANAA domains, which included physical health, sleep, mood, suicide risk and self harm, substance use, memory, unusual experiences, functioning, life stressors and resilience. Evaluation of the HANAA included exploration of its cultural applicability, feasibility, reliability and validity. Results: The HANAA was well accepted by study participants and easily implemented by assessors. Reliability was good, with inter-rater agreements between Aboriginal and non-Aboriginal assessors measured by Kappa statistics ranging from 0.5 to 1.0. There was also a good agreement between assessors and treating clinicians in identifying the main presenting problem and recommended course of action. Conclusion: The HANAA is a culturally appropriate and useful tool for the screening of SEWB among Aboriginal adults. It can also be used for teaching and training purposes of mental health and other professionals working with Aboriginal people.

Stigma towards mental illness among medical students in Australia and Ghana.

ObjectiveStigma towards mental illness has been found to impact adversely on medical students’ attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia.MethodA 28-item “Attitudes and stigma towards mental health” questionnaire was distributed to final year students at both universities.ResultsThere was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students.ConclusionStigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students’ attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students’ attitudes towards psychiatry as a discipline and mental illness in general.

The University of Western Australia Institute of Psychiatry for Medical Students: an Australian first

Objective: Recruitment of medical graduates into psychiatry has become a growing issue over the last few decades. This paper describes the implementation of an innovative program, based on a Canadian concept, that aimed to promote psychiatry as a career choice to medical students, to immerse them in the ‘world of psychiatry’, and introduce them to potential mentors. The University of Western Australia Institute of Psychiatry for Medical Students was a week-long program that provided medical students with an opportunity to participate in a diverse agenda of interactive seminars on a range of psychiatric subspecialties and the neurosciences. Students were also able to attend elective sessions and meet registrars and psychiatrists on an informal basis. Lunches and social events were also provided. Conclusion: Twenty-one students attended the inaugural Institute. Twenty-seven speakers contributed to the morning seminars and there were 17 clinical elective site visits. Feedback from students was positive and the week was rated highly, both in terms of its organization and from an academic perspective. It is planned to run the Institute annually and, in time, it is hoped that it will increase the numbers of students who choose psychiatry as a career option.

Psychiatry Enrichment Initiatives: A Review of Current Programs, Summer Schools, and Institutes

Psychiatry is an integral component of undergraduate and graduate medical courses around the world. Preclinical teaching can serve as a valuable learning experience and introduction to psychiatry that can be positively predictive of students choosing psychiatry as a career [1]. Clinical clerkships in the later years of medical training provide students with experience of working with patients in clinical settings, and for most will be the only exposure they have to the clinical psychiatry at the time of graduation. However, with clerkships becoming shorter, between 4 and 6 weeks in most medical schools [2], designing curriculum that adequately covers the core knowledge and skills required by all medical graduates is a challenging process. For a diverse speciality such as psychiatry this inevitably results in difficult choices regarding what teaching content can be included in the time available [3]. This places a greater onus on academic departments to offer students who are interested in psychiatry additional opportunities to extend their knowledge and interest beyond the teaching curriculum [4]. In an attempt to improve recruitment to psychiatry and the image of psychiatry more generally, in the last 10 years or so there has been a growing interest in the development of enrichment programs, activities, and initiatives specifically designed to attract more medical students towards a career in psychiatry [5, 6]. Some of these are more formally implemented at a departmental and/or faculty level, for example, the integration of psychiatry electives in to the existing curriculum, and some involve the establishment of extracurricular psychiatry institutes and summer schools. Other activities are student organized and led such as psychiatry student societies (PsychSocs), mental health interest groups, and coffee clubs [7]. Enrichment programs that target students who are interested in psychiatry and considering it as a career have potential to address the recruitment and image problems that have plagued psychiatry for so long. In this review, an enrichment program is defined as any extra curricula program that is targeted specifically towards medical students who have an interest in learning more about psychiatry as a discipline, and as a potential career pathway. Programs can be designed as an elective to complement or supplement the content of an existing psychiatry curriculum, or implemented as a summer school or institute either during the vacation break or in semester time. Programs can also be implemented as a weekend workshop. The aim of this paper is to review, describe, and summarise results of existing enrichment programs in psychiatry.

Future-proofing the psychiatry workforce in Australia: evaluation of an innovative enrichment programme for medical students

Objective: The Claassen Institute of Psychiatry for Medical Students (the Institute) is an innovative enrichment programme aimed at attracting medical students to psychiatry. This paper reports on the effectiveness of the Institute as a strategy to increase interest in psychiatry as a career, and the career pathways of students who have attended since 2008. Method: Students completed a baseline questionnaire on day 1 and the final day of the Institute. A follow-up survey was administered electronically to ex-Institute students to determine their career pathways and current level of interest in psychiatry. Results: Since 2008, 117 students have attended the Institute. There was a significant increase in those ‘definitely’ considering a career in psychiatry from 57% at baseline to 77% at the end of the week. Eighty-nine ex-Institute students were invited to participate in the follow-up survey, and of these 21% were currently psychiatry trainees. Conclusion: The Institute has been successful in encouraging medical students to pursue a career in psychiatry. Enrichment programmes are emerging as an effective recruitment strategy and will assist in future-proofing the psychiatric workforce in decades to come.

Indigenous Children in Australia: Health, Education and Optimism for the Future:

In Australia, Indigenous children are disproportionately affected by poor health. The combined consequences of illness and social factors in this population have an adverse affect on educational outcomes for Indigenous children, resulting in lower levels of achievement and attainment compared with non-Indigenous children. From early childhood, infectious diseases are significantly more common among these children compared to their non-Indigenous counterparts and there are a number of risk factors that contribute to this burden of disease. Health and education are inextricably linked but, for the most part, the two sectors operate independently of each other in the provision of health and educational services. This article will discuss the health and educational status of Indigenous children and describe a range of programs and initiatives from both sectors that aim to improve outcomes for this population.

Use of mental-health services by Australian medical students: a cross-sectional survey

Objective: Medical students have higher rates of mental illness compared to the general population. Little is known about services accessed by medical students for mental-health problems. This study aimed to assess the use of mental-health services by Australian medical students and to identify barriers that may prevent students from using mental-health services. Method: A cross-sectional online survey was designed and administered to medical students at the University of Western Australia. Questions focused on self-reported psychological well-being, use of mental-health services, the perceived usefulness of services and barriers to the use of services. Results: The response rate was 41% (n=286). Sixty-two per cent self-reported experiencing mental-health problems, and of these, 75% had used at least one service. General practitioners and psychiatrists were rated as the most effective service type. The main barriers to seeking help were not enough time, affordability and concerns regarding stigma, including disclosure and peer judgement. Conclusion: A high proportion of students with self-reported mental-health problems had accessed services. However, barriers were also identified. Access to mental-health services needs to be improved, and strategies aimed at reducing stigma and raising awareness of mental-health issues should be encouraged by medical faculties.