WPA Position Statement on Recruitment in Psychiatry

Are efforts to recruit to psychiatry closing the stable door after the horse has bolted? Knowledge and attitudes towards a career in psychiatry amongst secondary (high) school students: a UK-based cross-sectional survey

BACKGROUND

Internationally there is a shortage of psychiatrists, whilst clinical psychology training is generally oversubscribed. School students interested in psychological health may not be aware of the possibility of studying medicine before specialising in psychiatry. This has implications for the mental health workforce.

AIMS

To evaluate the knowledge and attitudes relating to a potential career in psychiatry amongst secondary (high) school students.

METHOD

A cross-sectional survey evaluated attitudes and knowledge relating to psychiatry and clinical psychology, targeting students from five schools who were studying chemistry, biology and/or psychology at an advanced level.

RESULTS

186 students completed the survey (response rate 41%). Knowledge was generally poor with only 57% of respondents knowing that psychiatrists had medical degrees, and most participants substantially underestimating the salaries of consultant psychiatrists. Attitudinal response patterns were explained by two underlying factors, relating to generally negative attitudes towards psychiatry and positive attitudes towards the effectiveness of psychiatric treatments. Females and those studying psychology reported more positive attitudes towards psychiatry. Those studying chemistry reported more negative attitudes towards the effectiveness of mental health treatment.

CONCLUSIONS

Studying psychology predicted positive attitudes towards psychiatry. Such students could be targeted by recruitment campaigns, which emphasise factual information about the specialty.

Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry

BACKGROUND

The goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients.

METHODS

As part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students' summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews.

RESULTS

41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons.

CONCLUSION

The results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.

Screening for emotional problems: Diagnostic accuracy of the Strength and Difficulties Questionnaire Indonesian version

PURPOSE

Screening and intervention of emotional problems in Indonesia can be quite challenging given the large gap between available resources in Indonesia. Strength and Difficulties Questionnaire (SDQ) emotional problem subscale is a simple screening tool often used to detect mental health issues in adolescents. This study examined the accuracy of the SDQ emotional problem subscale Indonesian version.

METHODS

Accuracy has been examined by comparing the SDQ with diagnostic interviews based on DSM-5 as a gold standard. A double-blind study has been utilized with the assistance of the research team. Interviews have been conducted with 40 adolescents acquired from high schools located in Jakarta. Data has been analyzed with crosstabs and Receiver Operating Characteristic (ROC).

RESULTS

SDQ emotional problem subscale has a sensitivity of 94.4% and specificity of 86.4%. ROC plot shows that the cutoff score of 6 is ideal to identify adolescents with emotional problems.

CONCLUSIONS

The Indonesian version of the SDQ emotional problem subscale showed high diagnostic accuracy for emotional problem screening based on the DSM-5, therefore it is an accurate tool to screen for emotional problems in adolescents.

Prevalence of Anxiety and Depression among Psychiatric Healthcare Workers during the COVID-19 Pandemic: A Malaysian Perspective

The psychological distress reported among frontline healthcare workers (HCWs) is concerning. Little is known about the mental health of non-frontline, psychiatric HCWs, who play a central role in handling the mental health crisis during the COVID-19 pandemic. This study aimed to examine the prevalence of anxiety and depression among psychiatric HCWs and evaluate its association with socio-demographic, socio-economic, work-related factors and coping strategies. The authors proposed a cross-sectional study design using the Hospital Anxiety and Depressive Scale (HADS) and Brief-COPE scale. This study found that the prevalence of anxiety and depression were 22.0% and 16.8%, respectively. A multivariate analysis revealed that married psychiatric HCWs had a lower level of anxiety with OR = 0.31 (95% CI: 0.11-0.83). Psychiatric HCWs who were experiencing financial hardships, were unvaccinated and those who had a shorter duration of service in the psychiatric department had a higher level of depressive symptoms with OR = 0.31 (CI: 1.19-11.27), 3.21 (CI: 0.97-10.52), and 1.01 (CI: 1.00-1.02), respectively. For every increase of one unit of avoidant coping score among respondents, the odds of having anxiety and depression increased by 1.25 times (CI: 1.15-1.37) and 1.20 times (CI: 1.09-1.32), respectively, whereas for every increase of one unit of religious coping score among respondents, the odds of having anxiety reduced by 1.42 times (CI: 1.10-1.84). The authors highlight that psychosocial measures addressing the relatively high levels of anxiety and depression among psychiatric HCWs should be a key priority to ensure the sustainment of mental health services in the face of this prolonged pandemic.

The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients-A Cross-Sectional Online Survey

The aim of the study was the assessment of the level of stigmatisation of psychiatric patients and psychiatry as a field of study by students at medical schools in Poland and the comparison of students’ attitudes over the years. The study was conducted based on a proprietary questionnaire assessing the stage of tertiary education, sociodemographic status, and MICA-2 psychometric tool that is used for assessing both the attitudes of students at medical schools towards psychiatry as a field of study and patients with mental health disorders. According to the MICA score, those who have higher scores have more negative attitudes towards psychiatry. The survey consisted of two rounds at an interval of 3 years. Results. The first-round survey, conducted in 2017, involved 480 students. The second-round survey, conducted in 2020, involved 573 students. In both cases, women constituted the vast majority of respondents. Women, as well as medical major students, achieved significantly lower scores than men p < 0.001. The said relationship was also observed for individual experience with mental illness. There was no correlation between the MICA-2 total score and the psychiatry course completion—p = 0.105. However, the levels of stigmatisation are still high. The implementation of educational methods to improve the perception of psychiatric patients by students at medical schools should be taken into consideration. An increase in direct student–patient contact, for example, by means of intensive elective classes, could be beneficial.

Career choice and influential factors among medical students majoring in psychiatry in China

BACKGROUND

The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors.

METHOD

This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career.

RESULTS

44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career.

CONCLUSION

More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.

Attitudes of Medical Students in Malta Toward Psychiatry and Mental Illness

OBJECTIVE

The study aimed to explore the attitudes of medical students in Malta toward psychiatry and mental illness. It looked at the effect of sex, clinical exposure, and experience with mental illness on students' attitudes.

METHODS

A questionnaire containing the ATP 30 and MICA-2 scales was distributed to all medical students in Malta in a cross-sectional study. Factor analysis was followed by reliability testing using Cronbach Alpha. Factor scores were achieved using the regression method. The independent sample t test and the Mann-Whitney U test were used to check for relationships between factor scores and variable of interest. Following this, the means and medians of factor scores for each group were calculated and compared.

RESULTS

Three hundred ninety-six students (51%) answered the questionnaire. Males had more positive attitudes toward psychiatry as a career choice (p = 0.01) and more positive attitudes toward the importance of psychiatry (p = 0.00). Those with clinical exposure to psychiatry had more negative attitudes toward the efficacy of psychiatry and psychiatrists (p = 0.00). Having experience with mental illness in some form was associated with decreased appeal in psychiatry as a career (p = 0.01 for personal experience, p = 0.01 for relatives, p = 0.00 for friends).

CONCLUSIONS

The factor structures obtained using ATP 30 and MICA-2 scales in this study are different from those found in the original literature. Having undergone psychiatry rotations had no significant impact on the attitudes toward psychiatry as a career choice but led to more negative attitudes toward the efficacy of psychiatry and psychiatrists.

Psychiatric education in North America

In North America, the psychiatric workforce while relatively large, remains insufficient for the population needs. Specialist training opportunities in psychiatry continues to grow, reflected in both increased recruitment and competitiveness. Furthermore, the iterative process of curriculum development and standardisation of training encourages greater educational consistency. There is an ongoing growth in subspecialty training opportunities, however access varies across centres and curriculum gaps remain. The diverse demographic characteristics and requirements of populations also play a role in educational needs, such as youth mental health, tele-psychiatry, cultural, rural and addictions psychiatry. Advances in science such as genetics, and the use of technologies and digital media also invite innovative approaches to knowledge acquisition. Overall, training needs to be matched by sufficient numbers of experienced and skilful trainers, mentorship and leadership in psychiatry with awareness of physician wellbeing and the risks of burnout. In the USA and Canada, the growing prospect of fellowships in leadership and administration lay important foundations for the growth of psychiatry, driven by high quality education for the mental health professionals and leaders of tomorrow.

A worldwide survey on training provisions for psychiatric trainees in WPA member associations

This World Psychiatric Association (WPA) global survey of its WPA member society presidents using an online self-administered 15-item questionnaire successfully recruited 47 WPA member countries or regions (response rate = 39.8%) to provide responses about training provisions of psychiatric education at undergraduate, postgraduate, and post-qualified levels in their respective countries. There were significantly fewer responses from the low and middle income countries (LMIC) than the high income countries (HIC). At undergraduate level, the median duration of psychiatric education during medical school education was 4.0%. However, the current allocated time for psychiatric education was only around one-third to one-half of the time considered as optimal by the member countries or regions (optimal mean = 8.9%; optimal median = 10%). At the postgraduate level, the duration of training varied widely from 12-72 months, with a mean duration of 48 months. In 31% of the respondent countries, psychiatrists only required 36 or fewer months of post-graduate training. The number of months of training required for training a psychiatrist was significantly fewer in the LMIC than HIC. At post-qualified continuing medical education level, all respondents reported providing post-qualified continuing medical education. With the advent of internet technology, many respondents prefer having online training.

Remote Telepsychiatry Workforce: a Solution to Psychiatry's Workforce Issues

PURPOSE OF REVIEW

The purpose of this paper is to demonstrate how a remote workforce may increase access to care while reducing physician burnout. We review workforce issues and organizational and individual obstacles for implementing a telepsychiatry workforce including administrative, logistical, and clinical considerations and offer resources for how to overcome barriers that may arise in implementing a remote workforce.

RECENT FINDINGS

There is an increasingly unmet demand for mental health services and a shortage in psychiatrists. Burnout may be a key factor contributing to psychiatrists working less, pursuing less acute cases, and leading to worsened outcomes for patients and the psychiatrists themselves. Telepsychiatry provides comparable patient and provider satisfaction and equal outcomes when compared with face-to-face encounters. We provided 3 case examples to demonstrate psychiatrists demonstrating successful delivery of care in a range of clinic settings and workplace configurations while optimizing their quality of life and reducing their risk of burnout.

Postgraduate training in psychiatry in Asia

PURPOSE OF REVIEW

To understand the current situation, needs and challenges in the area of postgraduate training in psychiatry in Asia and identify implementable solutions.Leaders in psychiatric education from nine Asia Pacific countries prepared country reports, based on a suggested list of items and met for a day to discuss and identify implementable solutions to improve the current unsatisfactory status of postgraduate training in psychiatry.

RECENT FINDINGS

Except Japan, all the other countries have a very low number of psychiatrists per 100 000 population - far lower than the global target of 10 psychiatrist per 100 000 population. The undergraduate teaching in psychiatry in majority of the countries is restricted to 20 h of lectures given during the 4-6 semester and 2-3 weeks of clinical ward placements. The duration as well as the overall quality of postgraduate training and methods of assessment and accreditation varies widely across and within countries.

SUMMARY

Numerous gaps that need to be addressed to enhance the quality of psychiatrists trained in Asia were identified. There is a need to have uniform minimum standards of training and mechanisms of mutual support, for not only training but also academics and research activities in Asia.