Impact of the psychiatry clerkship on medical student attitudes towards psychiatry and to psychiatry as a career

The effects of a psychiatric clerkship on stigmatizing attitudes toward mental disorders as held by German medical students

Background

According to the United Nations, access to medical care is a fundamental human right. However, there is widespread stigmatization of severe mental illnesses and this appears to seriously hamper the quality of healthcare in people with psychiatric co-morbidity. Thus, interventions that help reduce stigma among healthcare providers are urgently needed.

Purpose

The objective of the current study was to investigate the effects of a psychiatric clerkship on stigmatizing attitudes toward mental disorders held by medical students.

Methods

Between 2018 and 2019, a total of 256 third- and fourth-year students from Marburg University Medical School (Germany) completed two surveys-one before and one after a 2 week clerkship program that was designed to prioritize direct interaction with the patients. For measuring stigma, the questionnaires contained questions about students' attitudes toward psychiatry (ATP), including the Opening Minds Scale for Healthcare Providers (OMS-HC), Community Attitudes Toward the Mentally Ill (CAMI), and measurements according to the Stereotype-Content Model (SCM). We conducted pre-vs.-post comparisons using the Wilcoxon signed rank test with continuity correction or paired t-test and employed the Spearman method for correlational analysis. We considered p < 0.05 significant and adjusted all p-values reported here using the Benjamini-Hochberg procedure to account for family-wise error.

Results

After the clerkship, a significantly reduced stigma was found, as assessed with ATP (mean p < 0.001), OMS-HC (sum and subscale "attitudes" p < 0.001; subscale "disclosure" p = 0.002), and both SCM subscales (p < 0.001). Moreover, we observed significant associations between stigma expression (e.g., OMS-HC sum) and the willingness of students to choose psychiatric residency after finishing medical school (before clerkship: p < 0.001; ρ = -0.35; change after clerkship: p = 0.004; ρ = -0.2).

Conclusion

Our findings indicate that a psychiatric clerkship that involves students in direct interaction with patients may effectively reduce stigma. Therefore, we advocate the incorporation of components of direct interaction in medical education to combat stigma and unequal treatment, as this could improve outcomes in patients with severe mental illnesses.

Impact of clinical rotational posting on attitude toward psychiatry of undergraduate medical students in Malaysia

Background

Almost all over the world, psychiatry training of undergraduate medical students has been criticized to be deficient in imparting required knowledge and improving the perception of students towards psychiatry and psychiatric treatment. Considering the large mental health need gap in the community, it is essential to improve undergraduate students' attitude toward psychiatry.

Aim

Hence, this study was planned to study the impact of psychiatry clinical posting on attitude toward psychiatry of undergraduate medical students.

Materials and Methods

Undergraduate medical students undergoing psychiatry posting were assessed on the first and last day of clinical posting with the help of semi-structured proforma consisting of sociodemographic information, favored future career choice, the relevance of psychiatry to their future careers, the usefulness of particular knowledge and skills, the value of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry.

Results

After their clinical posting, students had a more positive attitude towards the usefulness of psychiatry knowledge in future general practice and the usefulness of psychiatry knowledge from undergraduate training in the future. Knowledge of alcohol withdrawal management, detection and management of delirium, and Mental Health Acts were perceived more essential in the future. Also, specialties such as deaddiction and child and adolescent psychiatry were felt more useful in future practice. After posting, students perceived that psychiatry can also be learned at medical and surgical wards as well as during home visits. However, despite some positive changes in attitude toward psychiatry, there was no significant change in choosing psychiatry as a career by the students after posting.

Conclusion

Undergraduate psychiatry training during clinical posting was able to make some positive changes in the knowledge and attitude of students. However, still, there were lacunae in some areas of concern. Preference of psychiatry as a branch of specialization was not increased after posting. This indicates the need for better reforms in psychiatry education at the undergraduate level to improve the perception of undergraduate students about psychiatry.

A cross-sectional study of opinion about mental illness among undergraduate medical students with and without exposure to the psychiatry clinical rotation/postings during their undergraduate training

Background

A positive attitude toward mental illness is a prerequisite for the provision of holistic care. Thus, a study was undertaken to know the opinion about mental illness among medical students with and without exposure to the psychiatry clinical rotation/postings during their undergraduate training.

Materials and Methods

This is a descriptive, cross-sectional study conducted at Adichunchanagiri Institute of Medical Sciences (AIMS), Karnataka. The sample comprised medical undergraduate students with and without exposure to psychiatry clinical postings, respectively. Self-administered socio-demographic and opinion about mental illness (OMI) questionnaires were used to collect the data.

Result

Medical undergraduates from 1st and 2nd years who were unexposed to psychiatry and students from 3rd and 4th years who had exposure to psychiatry constituted about 52.17% (n = 252) and 47.83% (n = 231) of the overall sample size. A positive opinion toward mental illness was seen across various subsections of OMI questionnaire, especially in students who had attended psychiatry clinical posting.

Conclusion

Opinions can change based on one's experiences. A positive opinion toward mental illness was seen across medical undergraduate students who had completed psychiatry clinical postings in our study. The study provides valuable insights across various domains or areas wherein a teacher can focus and adjust the teaching methodologies accordingly. In the long run, it might have a positive influence on medical students to understand mental disorders, diagnose them, and manage patients with mental illness.

[Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]

OBJECTIVES

The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation.

METHODS

A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests.

RESULTS

A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001).

CONCLUSIONS

GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.

A "patient as educator" intervention: Reducing stigmatizing attitudes toward mental illness among medical students

Introduction

This pre-post quasi-experimental pilot study aimed to assess the degree of stigma toward mental illness and whether a single, direct-contact "patient as educator" intervention with people with mental illness can reduce the degree of stigma among medical students.

Methods

All second-year medical students from the University of Valencia were invited to voluntarily complete the Community Attitudes Toward the Mentally Ill (CAMI), Reported and Intended Behavior Scale (RIBS), and Mental Health Knowledge Scale (MAKS) questionnaires before and after participating in the formal medical psychology course. A "patient as educator" workshop with expert patients was organized in the middle of the semester. A total of 127 students completed the survey; 20 students participated in the workshop (workshop group), and the remaining 107 students only took the formal educational course, forming the control group.

Results

At baseline, the groups were demographically matched and did not differ in the components of stigma or knowledge of mental illness. After the intervention, a greater reduction in the CAMI subscales of authoritarianism and social restriction was observed in the workshop group than in the control group. In the workshop group, scores for the benevolence subscale of the CAMI decreased more among women than men. In the control group, scores for the authoritarianism and benevolence subscales of the CAMI increased and decreased significantly more, respectively, in women than men. No significant changes were observed in scores for the RIBS at post-intervention in either group.

Discussion

The results of this pilot study suggest that a brief, direct-contact intervention in addition to formal medical education may further help reduce stigmatizing attitudes during the first years of medical school.

Professional values and educational needs in mental health professionals: survey results

BACKGROUND: Exploring the professional values and educational needs of future and practicing mental health specialists is required to develop effective measures aiming at improving their skills and interest in their work. AIM: Our aim was to explore professional values and educational needs of mental health specialists in Russia. METHODS: We conducted a survey that captured socio-demographic data, professional characteristics, professional values, and educational needs. Fisher's exact test, logistic regression, and the k-means cluster analysis were used in our statistical analysis. RESULTS: The survey included 133 participants, 71% of whom had completed their postgraduate education. The following items were mentioned as important professional values by the respondents: Job opportunities, Stimulation of intellectual activity, and Work-life balance. The most popular options for educational activities were English language (63.4%), the principles of evidence-based medicine (63.4%), and developing skills for conducting scientific research (59.4%). In comparison with practicing specialists, respondents who had not yet completed their postgraduate education were more interested in developing their curriculum vitae (39% vs. 60%, p=0.044) and communication skills (49% vs. 77%, p=0.0048). Compared to male respondents, female respondents were more interested in developing skills in conducting scientific research (47 vs. 70%, p=0.0165). A cluster analysis showed that specialists who attached more importance to almost all professional values, in comparison to those who did not, were more interested in activities aimed at developing their research skills (64% vs. 41%, p=0.0287), learning about the principles of evidence-based medicine (70% vs. 41%, p=0.0063), and participating in journal clubs (39% vs. 11%, p=0.0193). CONCLUSION: The present study suggests that job opportunities, intellectual stimulation, and work-life balance are the most important professional values for future and practicing mental health specialists. These findings might be used as a basis for developing educational activities for mental health specialists.

Estigma dirigido a pessoas com transtornos mentais: uma proposta para a formação médica do século XXI

Uma visão estigmatizada das pessoas com transtornos mentais está presente em parcelas significativas da sociedade, incluindo os profissionais de saúde, o que pode contribuir para uma baixa qualidade assistencial e dificuldade de acesso à saúde por parte dessa população. Diante desse problema, o artigo apresenta o relato de experiência curricular de uma escola médica privada, situada em uma capital do Sudeste brasileiro, de metodologia ativa, cujo cenário de prática ocorre inteiramente em uma Rede de Saúde Mental Comunitária do Sistema Único de Saúde – SUS. A avaliação dessa experiência concluiu que um modelo proposto contribuiu para a redução do estigma direcionada a portadores de transtornos mentais, além de ter sido avaliada positivamente pelos alunos. Para tanto, foi necessário a inclusão de estratégias educacionais que promovessem o convívio direto dos alunos com os portadores de transtornos mentais e o início do curso indicou ser um momento oportuno para oferecer esse tipo de atividade. A experiência também aponta que a colaboração eficaz entre a Universidade e o SUS pode promover mudanças positivas na formação em saúde mental de futuros médicos brasileiros.

A week long "pep" talk - initial and 2-3-year longitudinal data on the Ottawa Psychiatry Enrichment Program (OPEP)

BACKGROUND

Recruitment to psychiatry as a career has been challenging in Canada and abroad despite the known shortage and increasing burden of psychiatric issues globally. Deterrents to choosing psychiatry as a career include its negative stigma and paucity of knowledge about the field. The study goal was to evaluate the Ottawa Psychiatry Enrichment Program (OPEP), a one-week extracurricular program about psychiatry as a career for 1st and 2nd year medical students. We hypothesized OPEP would improve students' attitudes towards psychiatry, and positive changes would be sustained 2-3 years later following their residency match. We hypothesized there would be a high recruitment of OPEP attendees to psychiatry programs.

METHODS

1st and 2nd year medical students from Canada applied to OPEP. Attendees completed the Attitudes Towards Psychiatry Questionnaire (ATP-30) at three times: before OPEP (PreOPEP), after OPEP (PostOPEP) and after their Canadian Residency Matching Service (CaRMs) match 2-3 years later. OPEP ATP-30 scores were compared to third-year student ATP-30 scores before and after their psychiatry rotation. Data were analysed using Friedman non-parametric ANOVA and post hoc testing by either Wilcoxon rank sum test, Wilcoxon matched pairs signed rank test, or parametric Welch independent t-test as appropriate. Effect sizes of group mean differences were calculated using Cohen's "d".

RESULTS

Between 2017-2018, 29/53 Canadian applicants were selected for OPEP. 100%, 93.1% and 75.8% of OPEP students completed the PreOPEP, PostOPEP, and CaRMs ATP-30 surveys respectively. 43% of OPEP attendees matched to psychiatry. PostOPEP ATP-30 scores (mean = 133, median = 137, SD = 10.6) were significantly higher than PreOPEP ATP-30 (mean score = 121, median = 122, SD = 9.3, p < 0.001) and CaRMS ATP-30 (mean = 126, median = 127, SD = 12.3, p < 0.02) scores. OPEP effect size on ATP-30 scores was large (d = 1.2) but decreased 2-3 years later (p = 0.078, d = 0.44). 97/202 students completed the ATP-30 before and after their psychiatry rotation (clerkship). Clerkship effect size on improvement in ATP-30 was moderate (d = 0.39). There was a non-significant difference between OPEP CaRMS ATP-30 and post clerkship ATP-30 scores (median 127 vs 121, p = 0.056).

CONCLUSIONS

OPEP ameliorated attitudes toward Psychiatry, but improvement deteriorated longitudinally. Strategies for program design, and innovations to boost/retain improvements during clerkship years are discussed.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Attitudes of medical students toward psychiatry in Eastern Mediterranean Region: A systematic review

BACKGROUND

Psychiatry is facing one of the highest levels of shortages among medical specialties. Stigma toward psychiatry plays an influential role in medical students' decision to choose psychiatry as a career and has been reported to be prevalent in different parts of the world, particularly in low/middle-income countries.

OBJECTIVE

To systematically review the Eastern Mediterranean Region (EMR) medical students' attitudes toward psychiatry, to assess whether their attitudes are stigmatized or not, and the factors affecting their attitudes.

METHOD

PubMed, Scopus, Web of Science, and PsychInfo (PsycARTICLES) were searched using a combination of main terms "stigma," "psychiatry," "medical students," and the name of Eastern Mediterranean countries. Cross-sectional studies assessing the attitudes of EMR medical students toward psychiatry were included in this review.

RESULTS

Ten studies were eligible to be included in the result synthesis. These were from Pakistan (n = 3), Iran (n = 2), Saudi Arabia (n = 1), Lebanon (n = 1), Egypt (n = 1), Bahrain (n = 1), and Oman (n = 1). Most studies reported a combination of both positive and negative attitudes among medical students; however, the overall attitude was positive. Factors affecting medical students' attitude toward psychiatry included poor psychological well-being, having a friend with a psychiatric illness, involving in a romantic relationship with someone suffering from mental illness, young age, frequency of exposure to psychiatry clerkship/teaching, and quality of psychiatry clerkship. Nevertheless, the final positive or negative outcome of these factors on students' attitudes remained controversial.

CONCLUSION

Considering the lack of sufficient data from most EMR countries, we need to exercise caution in interpreting the results of this review. Nevertheless, our review indicates that psychiatry is not stigmatized among EMR medical students, and they have generally positive attitudes toward it. The findings of studies evaluating influencing factors are contradictory and demand further exploration.

Stigma in Psychiatry: Impact of a Virtual and Traditional Psychiatry Clerkship on Medical Student Attitudes

OBJECTIVE

The objective of the study was to assess the change in medical students' attitudes towards psychiatry following a virtual clerkship experience compared to a traditional clerkship experience.

METHOD

Ninety-seven medical students from the University of Ottawa were assessed pre- and post-clerkship on the ATP-30 (Attitudes Towards Psychiatry-30) measure. Cohorts of students were categorized as pre-COVID or during-COVID depending on when and how they experienced their clerkship (traditional or virtual). The total student response rate was approximately 48%. A quasi-experimental design was implemented, and non-parametric statistics were used to analyze the data.

RESULTS

Medical students' overall attitudes towards psychiatry improved from pre- to post-clerkship, with the type of clerkship experience (traditional or virtual) having no significant impact on the magnitude to which attitudes improved.

CONCLUSION

Implementation of a virtual clerkship in psychiatry did not deteriorate medical student attitudes towards psychiatry as a specialty, with both the traditional and virtual clerkship program enhancing students' attitudes towards psychiatry favorably.

Stigma, Empathy, and Attitude (SEA) educational module for medical students to improve the knowledge and attitude towards persons with mental illness

OBJECTIVE

The objective was to develop an educational module on stigma, empathy, and attitude towards mental illness and evaluate its effectiveness among undergraduate medical students.

METHODS

In phase I, the authors developed the Stigma, Empathy, and Attitude (SEA) module consisting of interactive teaching-learning components through an experts-based consensus (two rounds of Delphi). In phase II, the effectiveness of the module was evaluated. SEA module (one-hour interactive lecture and three hours' small group teaching) was delivered to the fifth-semester undergraduate medical students (N = 240) once during their psychiatry rotation. Students were assessed with the Mental Health Knowledge Schedule (MHKS), Mental Illness: Clinician's Attitudes (MICA) scale, Jefferson Scale for Empathy (JSE), and Social Distance scale (SDS), to measure mental health knowledge, attitude, empathy, and stigma, at baseline and after delivery of the module. Feedback on the module was obtained from the participating students and faculty.

RESULTS

Baseline data was obtained for 157 students, and post-intervention assessment was completed for 66 students. There was a significant increase in MHKS score (p < 0.001, Cohen's d = 0.59) and a significant reduction in the MICA score (p = 0.016, Cohen's d = 0.31) after the intervention. However, there was no change in empathy and social distance, as measured by JSE (p = 0.23) and SDS (p = 0.31). A majority of the faculty and students were satisfied with the module and felt it should be part of the psychiatry curriculum.

CONCLUSIONS

The SEA module was found to improve medical students' knowledge and attitude towards mental illness and could be integrated as part of the psychiatry curriculum. However, it was ineffective in changing empathy and stigma in the students.

Clerkship Experiences During Medical School: Influence on Specialty Decision

OBJECTIVE

Clinical rotations during medical school are the time when most students select their specialty. Limited or lack of exposure could deter students from certain sub-specialties, and thus, insight into the selection process is essential. This study assesses the role of limited clinical rotations and perception of students on specialty selection.

METHODS

All graduating medical students were surveyed at our US-based institution for 2 years. The survey included both open- and close-ended questions related to influence of clerkship experience and other factors on specialty choice and suggestions for improvement. The data were analyzed descriptively and thematically.

RESULTS

Majority of students (87%) had minimal exposure to their chosen residency specialty prior to the third-year clerkships. Role of a clerkship experience in selecting a specialty was significant for 70% students, especially interaction with attendings (92%) and residents (86.3%). The most influential reasons for specialty choice to change were clerkship experience (41%) and mentors (21%). Approximately 34% students chose a specialty that was not a part of third-year core clerkships, and the most significant factors influencing their choice were shadowing experience (21%) and lifestyle (18%). Further, thematic analysis suggested that earlier and more clinical exposure to various specialties and formal mentoring could make specialty selection process easier.

CONCLUSIONS

Along with specialty content, the relationship of learners and teachers in the clinical setting plays a significant role in selecting and/or rejecting certain specialty by medical students. The study provides broader baseline data for medical schools and educators in preparation of curriculum and future physician workforce composition.

Stigma about mental disease in Portuguese medical students: a cross-sectional study

BACKGROUND

The stigma about mental diseases is common in the population and also in medical students, where it may condition their future practice and the way they deal with these patients.

AIM

To evaluate and characterize the stigma on mental diseases in Portuguese sixth-year medical students, based on a clinical scenario of a classmate suffering from a mental disorder.

METHODS

Observational cross-sectional study, involving sixth-year students of all Portuguese medical schools. We applied an online self-response questionnaire, using the Portuguese version of the Attribution Questionnaire AQ-9, and a vignette of a classmate colleague, presenting mental illness symptoms. Stigma scores were calculated. We used logistic regression to estimate the effect of social determinants on stigma pattern, and we analysed the correlation between 9 variables evaluated by the AQ-9 and total stigma.

RESULTS

A total of 501 participants were included for analysis (69.5% females, median age of 24 years old). Medical students were available to help in the proposed clinical scenario (6.93/9.00; 95%CI:6.77-7.10), if necessary using coercion for treatment (3.85; 95%CI:3.63-4.07), because they felt pity (6.86; 95%CI:6.67-7.06) and they perceived some kind of dangerousness (4.06; 95%CI:3.84-4.28). Stigma was lower in students having a personal history of mental illness (OR:0.498; 95%CI:0.324-0.767; p = 0.002) and in those with positive familial history (OR: 0.691; 95%CI:0.485-0.986; p = 0.041).

CONCLUSION

Our results show the importance of implementing anti-stigma education, to improve medical students' attitudes towards peers living with mental diseases.

The Impact of Diaspora-Based Psychiatrists' Participation in Clinical Teaching in a Lower Middle-Income Country on Interest in Psychiatry Among Medical Students and the Choice of Psychiatry as a Career

OBJECTIVE

The authors assess the impact of Ghanaian diaspora-based psychiatrists' participation in clinical teaching in Ghana on the attitudes of medical students toward careers in psychiatry.

METHODS

This quantitative cross-sectional study involved fifth- and sixth-year medical students of the four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics.

RESULTS

About half (49.7%) of clinical year medical students in Ghana reported that diaspora-based Ghanaian psychiatrists participated in their teaching during their clinical psychiatry rotation. A significantly higher proportion of medical students who had diaspora-based psychiatrists participate in their clinical training expressed that the depth of clinical teaching (54.4% vs. 45.6%, p = 0.003) and the extent of experience gained during their psychiatric rotations (54.7% vs. 45.3%, p = 0.001) were adequate or somewhat adequate when compared with medical students who did not have diaspora psychiatrists participate in their clinical training. Medical students who had diaspora-based Ghanaian psychiatrists participate in their teaching were significantly more likely to consider careers in psychiatry after their clinical rotation (42.2% versus 25.6%, χ² = 16.2, p = 0.00).

CONCLUSIONS

In a low-resource country with few psychiatrists, the involvement of diaspora-based psychiatrists in the teaching of clinical year medical students has the potential to improve the global experience and attitude of the medical students toward psychiatry.

Inpatient Child and Adolescent Psychiatry as an Extracurricular Venue for Medical Student and Resident Education and Professional Development: Story Time and Teen Talk

OBJECTIVE

Comparatively little systematic data exists concerning medical student education from the inpatient child and adolescent psychiatry venue. Training in this venue is vulnerable to pressures including increasingly reduced lengths of stay and greater emphasis on clinical productivity. An extracurricular psychosocial opportunity during evening hours may be a productive means through which to provide meaningful patient exposure, training, and mentorship to trainees. We sought to evaluate the impact upon student beliefs and attitudes through participation in an initiative titled "Story Time and Teen Talk."

METHODS

Under the direct supervision of postgraduate resident physicians in psychiatry, students read fairy tales and children's literature to children and conducted group discussions with adolescents during weekly held evening hours. Students were invited to complete a 15-item questionnaire that surveyed the impact of their participation on their beliefs and attitudes concerning general medical education and patient care, the field of psychiatry, and training in child and adolescent psychiatry. A subset of students underwent a semi-structured interview which was evaluated via grounded theory analysis to determine qualitative themes related to impact of program participation.

RESULTS

Thirty students (N = 30) completed the survey and five students (N = 5) completed the interview. The majority of students reported strongly agreeing or agreeing that participation impacted their attitudes and beliefs about general medical education and patient care in twelve of the thirteen assayed items. Themes from qualitative analysis supported these findings.

CONCLUSIONS

Extracurricular opportunities may be a productive venue for graduate medical education and, specifically, child and adolescent psychiatry.

Attitudes to psychiatry and to mental illness among nursing students: Adaptation and use of two validated instruments in preclinical education

WHAT IS KNOWN ON THE SUBJECT

Stigma towards psychiatry and people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Internalized stigma among nurses can affect personal self-care and limit help-seeking behaviours. Stigma around mental health nursing can adversely affect recruitment into this already underserved field.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

This is the first report on the adaptation and use in a nursing student sample of two widely used stigma-related instruments that have been normed among medical students. The attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments proved sensitive to change and can be useful in tracking specific anti-stigma curricular interventions. Interactive and participatory student activities in courses such as ours (that include simulation with standardized patients, clinical placements and patient interaction) need to be complemented by exposure to individuals with lived experience with mental illness in order to address stigmatized views of SMI. Nursing educators and fellow nurses willing to share their own experiences with mental illness-including diagnosis, health-seeking, treatment and recovery-may prove especially powerful and germane during nursing school.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

Even a strong academic curriculum is not sufficient to change stigmatized perceptions about mental illness, psychiatric care and mental health nursing as a profession. Comparison and potential synergy between ATP-30, AMI and OMS-HC (Opening Minds Scale for Health Care Providers) could prove fruitful in identifying a more comprehensive approach to stigma assessment over time. The addition of validated instruments, such as the Self-Compassion Scale-Short Form (SCS-SF) and the Self-Stigma of Seeking Help (SSOSH), which tap into internalized stigma and into health-seeking behaviours and intervening barriers could prove particularly useful in evaluating innovative interventions for stigma-decreasing initiatives in nursing education. Interactive and participatory didactic offerings need to be complemented by exposure to individuals with lived experience with mental illness and ideally to nursing educators and practicing nurses willing to share their histories of diagnosis, help-seeking, treatment and recovery.

ABSTRACT

Introduction Stigma towards psychiatry and to people with serious mental illness (SMI) is prevalent among healthcare providers and can adversely affect patient care. Such stigmatized views can adversely affect recruitment into the already underserved field of mental health nursing. Aim/question We adapted two stigma-related instruments in a sample of nursing students and examined change in scores after participation in an eight-week preclinical psychiatry curriculum. Our goal was to identify stigma-malleable opportunities that would inform refinements in future iterations of a preclinical psychiatry curriculum in nursing. Method We made minor adaptations to the attitudes to psychiatry (ATP-30) and the attitudes to mental illness (AMI) instruments. We invited first-year nursing students to complete assessments at two time points: before and after completion of an eight-week core course in preclinical psychiatry. Results Seventy-one students completed the assessment at both time points. ATP-30 and three of its eight subscale scores improved by course's endpoint. By contrast, AMI scores did not change. Compared with medical student published norms, nursing students in our sample had higher (less stigmatized) average scores. Discussion The ATP-30 and the AMI can be easily adapted to a nursing student population and may prove useful in tracking specific anti-stigma educational interventions. Implications for practice A general psychiatry course during nursing school is, it and of itself, unlikely to change biased views about SMI and should be enhanced with exposure to, and interaction with individuals with lived experiences of mental illness, ideally by nurse educators and practicing nurses.

Prospective Physician Awareness of the Associations Between Social Media and Mental Health

OBJECTIVE

Recently, studies have cited negative, positive, and an absence of impact on mental health with social media use. However, there has been little studied regarding the level of awareness and training of clinicians in screening and identifying for these associations. For this reason, the authors designed a study to assess the awareness of prospective physicians, or current medical students, on the associations between mental health and social media.

METHODS

The study was in the form of a 12-question survey. The questions aimed at assessing the awareness through past experiences with social media, education of its use and potential impacts, and self-reported ability to screen, identify, and counsel patients on these associations. The survey was sent to a total of 634 medical students and included all classes from MS1-MS4. A total of 148 students completed this survey (23.3% response rate).

RESULTS

The majority of medical students reported first social media use between the ages of 13 and 18, with the most common occurrence of bullying identified in this age group as well. The majority percentage of students believed there could be both positive and negative effects of social media on mental health; however, only a small percentage of students reported being aware of specific patterns of social media use that are associated with mental health. Moreover, only a few students reported feeling adequate in their ability to screen, educate, and counsel patients on these associations.

CONCLUSIONS

Findings from this study suggest the need for educational resources to train future physicians in screening, identifying, and counseling patients on associations between social media and mental health. The small numbers in this study are a limiting factor for the validity of result interpretation.

Physician Self-disclosure of Lived Experience Improves Mental Health Attitudes Among Medical Students: A Randomized Study

INTRODUCTION

Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians.

METHODS

We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed.

RESULTS

Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 (P = .01) and AMI (P = .02) scores, as compared with the control group (n = 21).

CONCLUSION

Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students' mental health and their health-seeking behaviors.

Three-Year Longitudinal Follow-up of the Psychiatry Early Experience Program (PEEP): Gaining and Sustaining Positive Attitudes Towards Psychiatry in Students at a UK Medical School

OBJECTIVE

The Psychiatry Early Experience Programme (PEEP) is a novel enrichment activity at Kings College London medical school. Throughout their five-year degree, students shadow trainee psychiatry doctors. The study aimed to evaluate whether more regular early exposure affects attitudes towards psychiatry.

METHODS

Forty first-year medical students joined PEEP and completed a baseline survey, including questions on demographics, current top three choices of medical specialty and the 30-item Attitudes Towards Psychiatry questionnaire (ATP-30). Participants completed annual follow up surveys, incorporating free-text questions about what students had learned and whether their views about psychiatry had changed.

RESULTS

Over three years there was a sustained improvement in mean ATP-30 scores (8.27 points higher at three years than at baseline [95% CI 2.86-13.7, T=3.2, p=0.005]). There was no significant difference between baseline specialty choice and specialty choice at three-year follow-up. At three years there was a 55% response rate. There was no significant association between non-responders at three years and baseline ATP-30, specialty choice or demographic factors. Thematic analysis of qualitative data suggested that PEEP challenged preconceptions towards psychiatry and highlighted its relevance in medicine.

CONCLUSIONS

The results offer some support that exposure to clinical psychiatry through longitudinal shadowing experiences can sustain positive attitudes. Areas for development include using a control group and following-up participants to the point when they specialize. It remains unclear whether it is most effective to select participants based on established commitment to psychiatry or to try to influence students who are still undecided.

Evaluating the effectiveness of video cases to improve patient-centeredness in psychiatry: a quasi-experimental study

OBJECTIVES

To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry.

METHODS

This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training.

RESULTS

A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes.

CONCLUSIONS

Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.

Changing attitudes to psychiatry and interest in the specialty as a career choice during clinical undergraduate years at a medical school in Penang, Malaysia

BACKGROUND

Studies have suggested that the undergraduate clinical clerkship improves medical students' attitudes to psychiatry and career interest in the specialty, but few studies have explored the sustainability of these changes.

AIMS

To explore changes in students' attitudes to psychiatry and career preference for psychiatry during the course of their senior clinical years at RCSI & UCD Malaysia Campus (RUMC).

METHODS

All year 3 students (n = 111) at RUMC were invited to complete the Attitudes towards Psychiatry questionnaire (ATP-30) and a separate questionnaire seeking opinions on career preferences. The questionnaires were administered at 3 points in time: in year 3 before the 8-week psychiatry posting, following completion of the posting in year 4, and at the end of year 5. Quantitative data analysis was performed using SPSS version 18, and free-text responses were thematically analysed.

RESULTS

One hundred completed questionnaires (90.1%) were returned. There was a significant improvement in students' ATP scores after their psychiatry rotation and this was sustained into year 5. Psychiatry as a career choice had highest preference levels following completion of the clerkship but declined in year 5 to below pre-clerkship preference levels. Qualitative analysis of factors influencing a career in psychiatry revealed themes of job satisfaction, lifestyle factors, perceived image of psychiatry, and self-appraisal.

CONCLUSIONS

Our findings suggest that an enriched undergraduate clinical clerkship experience can help to sustain improved attitudes to psychiatry into the final medical year. However, declining interest in the specialty a career choice prior to graduation presents an enduring challenge.

The impact of a psychiatry clinical rotation on the attitude of South African final year medical students towards mental illness

BACKGROUND

Stigmatising attitudes of health care professionals towards mental illness can impede treatment provided for psychiatric patients. Many studies have reported undergraduate training to be a critical period for changing the attitudes of medical students, and one particularly valuable intervention strategy involves time spent in a clinical psychiatric rotation. In South Africa, medical students are exposed to a clinical rotation in psychiatry but there is no evidence to show whether this has an effect on attitudes toward mental illness.

METHODS

This prospective cohort study involved a convenience sample of 112 South African medical students in their 5th or 6th year of undergraduate training. This sample attended a 7-week psychiatry rotation. The Attitudes to Mental Illness Questionnaire (AMIQ) was used to assess students' attitudes toward mental illness before and after the clinical rotation which includes exposure to a number of psychiatric sub-divisions and limited didactic inputs.

RESULTS

There was a significant improvement (p < 0.01, t-test) in the students' attitude toward mental illness following the psychiatric rotation. Females displayed a more positive attitude towards mental illness at the end of the rotation compared to males. The participants' attitude significantly deteriorated for the non-psychiatric vignette describing diabetes (< 0.01, t-test).

CONCLUSIONS

Our findings suggest that clinical training and exposure to a psychiatric setting impacts positively on medical students' attitude towards mental illness, even when this training does not include any focused, didactic anti-stigma input.

Evaluating the Impact of an Innovative Public Speaking Competition to Promote Psychiatry as a Career Option for Ghanaian Medical Students

OBJECTIVE

The psychiatrist workforce has been identified as an area in need of development, especially in low- to middle-income countries. The purpose of this project is to assess the perceptions of Ghanaian medical students of a novel mental health inter-medical school speaking competition on career interest in psychiatry and mental health education and advocacy.

METHODS

The study employed quantitative and qualitative methods in a cross-sectional design. A paper-based survey was administered to medical students from four schools in Ghana, and focus groups were conducted.

RESULTS

A 52% response rate (545/1041 fifth- and sixth-year medical students from the four public medical schools in Ghana) was achieved. The competition was successful in stimulating interest in psychiatry as a subject (25%) and as a career (14%) and was viewed as serving an important public health and mental health advocacy function (65% and 66% respectively). The competition stimulated interest in students who were undecided or had previously ruled out psychiatry specialization, in both those who had and had not already completed a psychiatry clerkship (23% and 13% before and after completing a clinical rotation in psychiatry, respectively). Overall, 29% of respondents who participated in at least one competition-related activity reported that the competition stimulated their interest in psychiatry, compared to 4% who did not participate in any competition-related activity (Ӽ² = 80, p = 0.0). Analysis of focus group content echoed these themes and highlighted opportunities for improvement.

CONCLUSION

The innovative public speaking competition was successful in stimulating interest in psychiatry and furthering mental health education and advocacy. Implications are discussed.

There Is a Limit to Your Openness: Mental Illness Stigma Mediates Effects of Individual Traits on Preference for Psychiatry Specialty

Objective: The widening gap between the need for mental health professionals and the low percentages of medical students pursuing a psychiatric career urges an examination of how individual traits, stigma attitudes, and related intended behaviors interact to better explain the variance in preferences for psychiatry as a specialty choice. Methods: Participants were second-year, preclinical medical students at Bologna University, Italy. The study consisted in completion of an online questionnaire evaluating preferences for the psychiatry specialty (one single item and a scenario-based response), personality traits (the Big Five Questionnaire), attitudes (Mental Illness for Clinicians' Attitude scale), behaviors (Reported and Intended Behavior Scale), and fears toward mental illness (questionnaire created ad hoc). Sociodemographic data were also collected. Results: A total of 284 medical students [58.8% female, mean (SD) age 20.47 ± 1.90] completed the questionnaire. Preference for the psychiatry specialty was significantly and positively associated with openness to experience and negatively related with Mental Illness for Clinicians' Attitude scale and Reported and Intended Behavior Scale. The full-mediation model provided good indices explaining 18% of the variance. Mental illness stigma was strongly and negatively associated with both openness to experience and preference for psychiatry, and the mediation results evidenced a positive and significant effect. Conclusions: Mental illness stigma influences medical students' choice of psychiatry as a specialty, accounting for the effects of the openness to experience trait. Stigma awareness and reduction programs should be introduced as early as possible in medical education.

Psychiatry as a career choice among medical students: a cross-sectional study examining school-related and non-school factors

OBJECTIVES

Given the low recruitment to psychiatry worldwide, the current study aimed to examine how premedical and intramedical school factors, perception of career aspects, attitudes towards psychiatry, stigma towards mental illness and personality traits may affect the likelihood of psychiatry as a career choice.

DESIGN

Cross-sectional online study.

PARTICIPANTS

502 medical students from two public medical institutions in Singapore.

METHODS

We critically examined existing literature for factors identified to influence psychiatry as a career choice and explored their effects in a group of medical students in Singapore. To avoid overloading the regression model, this analysis only included variables shown to have significant association (p<0.05) with the outcome variable from the initial Χ² test and independent t-test analyses.

RESULTS

A considerable number of non-medical school factors such as preschool influence and interest, personality traits and importance of a high status specialty in medicine were found to affect students' choice of psychiatry as a career. Among medical school factors, attending a psychiatry/mental health club was the only influential factor. Negative attitudes towards psychiatry, but not stigma towards people with mental illness, significantly predicted the likelihood of not choosing psychiatry as a career.

CONCLUSIONS

Improving educational environment or teaching practice in psychiatric training may aid in future recruitment for psychiatrists. While the changing of premedical school influences or personality factors may be infeasible, medical schools and psychiatry institutes could play a more critical role by enhancing enrichment activities or clerkship experience to bring about a more positive attitudinal change towards psychiatry among students who did consider a career in psychiatry.

A Focused Addiction Curriculum and Its Impact on Student Knowledge, Attitudes, and Confidence in the Treatment of Patients with Substance Use

BACKGROUND

Assessment of attitudes towards addiction in medical students has largely gone unexplored. This study examines the impact of a supplemental substance use disorder curriculum in the psychiatry clerkship on medical student attitudes towards addiction.

METHODS

The curriculum was only administered to students at one clerkship site. Subsequently, medical students were surveyed across all sites regarding their attitudes towards addiction.

RESULTS

The survey response rate was 37.5% (N = 75/200), with 25 (33%) completing the supplemental addiction curriculum. In bivariate analysis, medical students receiving the curriculum were more likely to express confidence in managing patients with alcohol and opiate use disorders (T = 2.01, p = 0.05) and were more knowledgeable about Alcoholics Anonymous (AA) as a treatment option available to patients (T = 2.27, p = 0.03).

CONCLUSIONS

A supplemental addiction curriculum can improve medical student confidence in managing substance-using patients as well as improve knowledge of AA.

Predicting Medical Students' Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students' perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students' attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies.

Medical students' attitudes to mental illnesses and to psychiatry before and after the psychiatric clerkship: Training in a specialty and a general hospital

Medical students' attitudes to mental illnesses and psychiatry may be reshaped during the psychiatric training, with important implications in their future practice of the profession. Therefore, the present study set out to explore the impact of the psychiatric clerkship in students' attitudes, while taking into consideration the site of their practical training. To this end, a total of 678 final-year medical students were recruited. Students completed a self-reported questionnaire entailing the Attitudes to Psychiatry scale, the Attitudes to Mental Illness scale and the Greek Social Distance scale before and after their placement. Findings indicate that the psychiatric clerkship had a positive effect in reducing stigma towards both psychiatry and mental illnesses, with the effect being more pronounced in the general hospital with respect to the former, while in the specialty hospital was more marked regarding the latter. A further exploration of the determinants of change revealed that the improvement discerned in the general hospital was only among those without professional experience of mental illnesses. Therefore, the psychiatric clerkship may exert a substantial influence on shaping favourable attitudes towards mental illnesses and psychiatry; however, other elements should also be taken into consideration, if the clerkship is to tackle stigma in healthcare.

Medical Student Experiences on Consultation-Liaison Psychiatry Rotations: A Nationwide Survey

BACKGROUND

Consultation-liaison (C-L) psychiatry clerkship rotations may improve medical students' understanding of psychiatric principles relevant to the settings in which they will ultimately practice. This study aimed to characterize students' experiences on C-L rotations.

METHODS

This cross-sectional survey study, sponsored by the Academy of Psychosomatic Medicine Subcommittee on Medical Student Education, was conducted at 5 US medical schools between 2012 and 2016. After the C-L rotation, students completed a voluntary 17-item survey.

RESULTS

A total of 235 surveys were collected (mean response rate = 92%). The most frequently endorsed benefit of C-L was learning to manage psychiatric disorders in the context of medical illness (89%). The most frequently endorsed drawback was inconsistent/excessively variable workload (40%). Overall, 82% of respondents recommended C-L to other students; 80% reported that the ideal clerkship would include exposure to both C-L and inpatient psychiatry. Overall, 38% reported that their C-L experience increased their interest in psychiatry as a career. Effect of C-L on interest in psychiatry did not differ by study site, age, sex, clerkship length, or time spent on C-L. Respondents who noted more positive role-modeling on C-L compared to other clerkship rotations were more likely to report increased interest in a psychiatry career (odds ratio = 2.70).

CONCLUSIONS

Most medical students perceive C-L rotations favorably. Positive role modeling may increase their consideration of psychiatry specialization. The findings that C-L rotation length did not correlate with attitudes and that most students preferred exposure to both inpatient and C-L psychiatry suggest that C-L exposure can beneficially be integrated into core clerkships containing other elements.

[Impact of education program and clinical posting in psychiatry on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders]

OBJECTIVE

The aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders.

METHODS

Medical students from the University of Bordeaux were recruited during their 4-year course at the beginning of the academic education program in psychiatry. Medical students who were concomitantly in a clinical posting in wards of psychiatry or neurology were invited to participate in the study. The medical student version of the scale Mental Illness: Clinicians' Attitudes (MICA) was used to measure their attitudes towards psychiatry and persons with psychiatric disorder. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness, a higher score indicating more stigmatizing attitudes. Items exploring history of psychiatric disorders in close persons were added at the end of the MICA scale. The questionnaire was completed twice by each student, at the beginning and the end of the 11-week clinical posting. All questionnaires were strictly anonymized. Multivariate linear regression analyses were used to identify the variables independently associated with MICA total score.

RESULTS

At the beginning of the education program and clinical posting, 174 students completed the MICA scale: the mean MICA total score was equal to 46.4 (SD 6.9) in students in clinical posting in psychiatry (n=72) and 45.1 (SD 7.01) in those in neurology (n=102). At the end of the academic and clinical training, 138 students again completed the questionnaire, with mean MICA total scores equal to 41.4 (SD 8.1) in students in clinical posting in psychiatry (n=51) and 43.5 (SD 7.3) in those in neurology (n=87). Multivariate analyses showed that lower total MICA scores were independently associated with the time of assessment (lower scores at the end of education program and clinical posting) (b=-2.8; P=0.001), female gender (b=-1.8; P=0.03) and history of a psychiatric disorder in a close person (b=-1.92; P=0.02). Type of clinical posting (psychiatry vs. neurology) was not independently associated with MICA total scores (b=-0.02; P=0.98). A significant interaction was found between the variables "time of assessment" and "type of clinical posting" (P=0.05): stratified analyses showed that MICA total scores decreased significantly only when the clinical posting was in psychiatry (b=-4.66; P=0.001), with no significant change in medical students in neurology wards (b=-1.45; P=0.16).

CONCLUSION

Stigmatizing attitudes of medical students towards psychiatry and psychiatric disorders are reduced by an education program in psychiatry, with a positive impact more marked when the education program is concomitant to a clinical posting in psychiatry. As future health professionals in charge of persons with psychiatric disorders, medical students are key targets of actions aimed at reducing stigma towards mental health disorders. It is hence of great importance to promote clinical training in psychiatric wards during medical studies for all future practitioners, irrespective of their future specialty.

Attitudes of Students at a US Medical School Toward Mental Illness and Its Causes

OBJECTIVES

Stigma among health care providers toward people with mental illness is a worldwide problem. This study at a large US university examined medical student attitudes toward mental illness and its causes, and whether student attitudes change as they progress in their education.

METHODS

An electronic questionnaire focusing on attitudes toward people with mental illness, causes of mental illness, and treatment efficacy was used to survey medical students at all levels of training. Exploratory factor analysis was used to establish attitudinal factors, and analysis of variance was used to identify differences in student attitudes among these factors. Independent-samples t tests were used to assess attitudes toward efficacy of treatments for six common psychiatric and medical conditions.

RESULTS

The study response rate was 42.6 % (n = 289). Exploratory factor analysis identified three factors reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Stages of student education did not differ across these factors. Students who had completed the psychiatry clerkship were more likely to believe that anxiety disorders and diabetes could be treated effectively. Students reporting personal experiences with mental illness showed significantly more social acceptance, and people born outside the USA were more likely to endorse supernatural causes of mental illness.

CONCLUSIONS

Sociocultural influences and personal experience with mental illness have a greater effect than medical education on attitudes toward people with mental illness. Psychiatric education appears to have a small but significant effect on student attitudes regarding treatment efficacy.

Influencing Factors on Choosing Psychiatry as a Career: An Exploration in Chinese University Students

There is a consistent need of psychiatric professionals in the world including China, and a consistent challenge to recruit more medical students into the psychiatric careers. We aimed to look for factors which have an impact on career-choosing of psychiatry in Chinese university students. We invited 508 non-medical students (NM), 304 medical students without (MO) and 123 medical students with clinical internship experience (MW), to answer a matrix of 43 questions regarding factors influencing career-choosing of psychiatry. Answers to these questions were analyzed through exploratory and confirmatory factor analyses, once the latent factors were identified and structurally-validated, their mean scores in three groups of students were calculated. Five factors with five items each were identified, namely social status inferiority, career importance, practice reward, career preference, and practice stress. NM scored lower than MO and MW did on Social Status Inferiority; NM group scored higher than MO and MW groups did on Career Importance; MW scored lower than NM and MO did on Practice Reward and on Career Preference; Regarding Practice Stress, NM scored higher than MO did, who then in turn, scored higher than MW did. In addition, Practice Stress was positively correlated with advice of the medical educators; and Social Status Inferiority and Career Preference were positively correlated with the psychiatry teaching of the medical educators. Raising career rewards, improving social status, and reinforcing psychiatric education might help to recruit more medical students to specialize in psychiatry practicing.

A survey of how and why medical students and junior doctors choose a career in ENT surgery

Objective:

To ascertain determinants of an interest in a career in ENT surgery through a survey of medical students and junior doctors.

Methods:

A survey was administered, comprising Likert scales, forced response and single option questions, and free text responses, at five different courses or events for those interested in a career in ENT.

Results:

The survey had an 87 per cent response rate; respondents consisted of 43 applicants for national selection, 15 foundation doctors and 23 medical students. The most important factors that encourage ENT as a career included: the variety of operative procedures, work–life balance, inherent interest in this clinical area and inspirational senior role models. Exposure to ENT in undergraduate or post-graduate training is critical in deciding to pursue this specialty.

Conclusion:

It is important to promote those aspects of ENT surgery that attract people to it, and to argue for greater exposure to ENT during undergraduate and post-graduate training.

Attitude of interns towards mental illness and psychiatry: A study from two medical colleges in South India

OBJECTIVE

This study aims to assess the intern's beliefs about mental illness, their attitude towards psychiatry and psychiatry as a career choice.

METHODS

In a cross-sectional design, one hundred and seventy six interns from the two medical colleges completed the Belief about Mental illness scale and Attitudes Towards Psychiatry (ATP-29) scale.

RESULTS

Majority of the interns considered mentally ill patients as dangerous, unpredictable, cannot take up major responsibilities, cannot be a good parent, have poor interpersonal or social skills. The attitude towards psychiatry overall, functioning of a psychiatrist, efficacy of psychiatry treatment was found to be good in over 90% of the interns. The attitude towards career and reward aspect of psychiatry was not favorable in about 40%. About 13% considered psychiatry as a career choice.

CONCLUSIONS

Beliefs about mental illness continue to be negative. Though the attitude towards psychiatry, psychiatrist and treatment efficacy is good, the social and reward aspects of psychiatry are not encouraging. Steps for changes in undergraduate medical education policies are required.

Psychiatry training experiences: a narrative synthesis

OBJECTIVE

In Australia and internationally, psychiatry has struggled to fill training places to keep up with demand for service. The objective of this study was to review the components of psychiatry terms and placements that determine a positive experience and potentially influence interest in vocational training in psychiatry.

METHOD

A literature review and narrative synthesis was undertaken on 20 papers identified as meeting inclusion criteria.

RESULTS

The top themes contributing to positive experiences during the psychiatry term were: receiving high quality supervision; supported autonomy; and witnessing patient recovery. There was a paucity of Australian literature preventing investigation of the Australian context alone.

CONCLUSIONS

There is a need to better understand how the junior doctor and medical student psychiatry experience influences perceptions of psychiatry and intention to specialise, especially in the Australian context.

Factors Affecting the Choice of Psychiatry as a Specialty and Satisfaction among Turkish Psychiatry Residents

OBJECTIVE

This study aimed to investigate the factors affecting the choice of psychiatry among psychiatry residents, identify the fulfillment of expectations, and assess their satisfaction level.

METHODS

Anonymous questionnaires were administered to 98 psychiatry residents, and sociodemographic and professional data were collected.

RESULTS

Among the reasons for choosing psychiatry, the opportunity to cultivate interest in humanities, importance of social and relational issues, and intellectual challenge were most frequently selected. The opportunity for complete use of medical training, salary, and opportunity to practice psychotherapy were the expectations least met. The largest group of participants was satisfied to have chosen psychiatry (41.5%), decided on psychiatry training after medical school (35.4%), and attached importance to becoming a clinician (70.7%).

CONCLUSIONS

Although the satisfaction level was high in this study, addressing the areas in which expectations were not met may increase the satisfaction of psychiatry residents and the selection of psychiatry as a specialty.

Attitudes and Confidence in the Integration of Psychiatry Scale

OBJECTIVE

The authors sought to measure attitudes and confidence in the integration of psychiatry into other fields of medicine.

METHODS

The Attitudes and Confidence in Integration of Psychiatry in Medicine (ACIP) scale was developed through discussion with content experts across disciplines and pilot testing of items and administered to third- and fourth-year medical students at University of Iowa, University of Michigan, Rush University for validation, focused on assessment of variability, internal consistency, factor structure, and test-retest reliability.

RESULTS

A total of 310 medical students completed the survey (35% participation rate). The scale had a high internal consistency (Cronbach's alpha = 0.88) and was without ceiling or floor effects. Students rated the integration of psychiatry into the practice of surgery and its subspecialties as less relevant than its integration into other specialties; however, scores were not biased by students' interest in procedural vs. non-procedural specialties. Test-retest reliability was high (Cronbach's alpha = 0.90).

CONCLUSIONS

The ACIP may serve a useful role in determining the outcome of educational efforts toward integrated care.

Stigma towards mental illness among medical students in Australia and Ghana

OBJECTIVE

Stigma 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.

METHOD

A 28-item "Attitudes and stigma towards mental health" questionnaire was distributed to final year students at both universities.

RESULTS

There 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.

CONCLUSION

Stigmatization 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 impact of the educational environment on career choice and attitudes toward psychiatry

BACKGROUND

The educational environment may influence students' attitudes towards medical specialties, which in turn can affect specialty career choices. The present study sought to establish if perceptions of the educational environment in a psychiatry rotation influenced attitudinal changes towards psychiatry in medical students and impacts decisions about psychiatry as a career choice.

METHODS

The modified Attitudes to Psychiatry Scale, Dundee Ready Educational Environment Measure, and questions specific to career choice in psychiatry were administered to 100 undergraduates in a psychiatry rotation.

RESULTS

Significant improvements in attitudes toward psychiatry were highly correlated with the educational environment, particularly when it was perceived as providing inspiration and enabling students to recognize the merits of psychiatry and the effectiveness of treatment. However, there was a worsening trend in the stigma to psychiatry in the posting, and only the positive attitudinal change (but not educational environment) influenced a career choice in psychiatry.

CONCLUSIONS

While the educational environment contributes towards positive attitudinal changes in a specialty rotation, stigma of psychiatry continues to be a limiting factor, which is, unfortunately, not clearly addressed in the curriculum. The findings support the urgent need for interventions in this area.

Changing Medical Students' Attitudes to Psychiatry through Newer Teaching Techniques

The significance of mental health in the entire health scenario has increased. However, the representation of psychiatry in the current MBBS curriculum for undergraduate students in India still remains much less than desirable. Further, stigmatising attitudes lessen these future doctors’ ability to detect and manage patients with psychological problems despite adequate knowledge about psychiatry. Students believe that psychiatrically ill patients are unpredictable and can be dangerous to others. Some feel that psychiatry is unscientific, imprecise and treatment is not effective. Traditional teaching methods are directed more towards imparting knowledge than changing the attitudes of students. Newer teaching and assessment techniques should be used to bring about attitudinal changes and develop interest among medical students. Case based and problem based learning, small group teaching, simulated patients, using movies, multidisciplinary seminars, integrated teaching, attitude questionnaires, objective structured clinical examinations etc., could be introduced in the curriculum to achieve this objective.