Factors affecting recruitment into psychiatry: a canadian experience

Factors that influence psychiatric trainees' choice of higher training specialty: mixed-methods study

AIMS AND METHOD

Factors influencing trainees' decisions about choosing and remaining in higher training subspecialties have not been widely researched. We administered telephone questionnaires to higher specialist trainees in the north-east of England to ascertain what influences these decisions. Thematic analysis was employed to develop overall constructs.

RESULTS

Twenty-seven trainees were interviewed, resulting in six overall constructs. These were: supervisory experiences; perceived work-life balance; career prospects; training and working environments; interest in the chosen subspecialty; and previous experience within the chosen subspecialty. Most trainees interviewed felt they had made the right specialty choice.

CLINICAL IMPLICATIONS

This study demonstrates the particular importance of exposure to a specialty and perceptions of the supervisory experience in determining trainees' choices of, and decisions to remain in, a particular psychiatric specialty. Factors highlighted in this study must inform training, recruitment and workforce planning in order to bolster the recruitment and retention of trainees into higher specialty training.

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.

Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study

BACKGROUND

Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission.

METHODS

We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission.

RESULTS

A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission.

CONCLUSION

A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.

The future of psychiatric education

Mental health disorders cause a large burden on global public health, with many patients living years with the disability. However, many doctors are ill-equipped to treat mental health disorders given inadequate training during their undergraduate years. In some countries, psychiatry is even considered an elective course rather than a core module. There is, therefore, a pressing need to improve the training of medical students in managing mental health disorders. Measures need to be implemented to attract students to choose psychiatry as their career. Given the developments in the fields and the challenges currently faced by trainees and early career psychiatrists, changes may also be made to the training programme in the postgraduate stage to unify the variations across the world in terms of the training duration and format. This paper will describe the ways that undergraduate and postgraduate psychiatry training may be ameliorated to improve the delivery of mental healthcare around the world and to equip doctors to face challenges in the future.

Factors influencing medical students and psychiatry residents in Ghana to consider psychiatry as a career option - a qualitative study

BACKGROUND

Currently, Ghana has 14 actively practicing psychiatrists and about 26 psychiatric residents for a population of over 28 million people. Previous research suggests a lack of interest by Ghanaian medical students and medical graduates in considering psychiatry as a career option.

OBJECTIVES

To examine the perception of medical students and psychiatry residents in Ghana about the barriers which hinder Ghanaian medical graduates from choosing careers in psychiatry and how these barriers could be overcome.

METHODS

This was a cross-sectional qualitative study with data gathered using focus group discussion. Twenty clinical year medical students were selected through block randomization from the four public medical schools in Ghana and invited to participate in one of two focus group discussions. Also, four psychiatric residents were invited to participate in the focus group discussions.

RESULTS

The main barriers identified by participants could be grouped under four main themes, namely: (a) myths and stigma surrounding mental health and patients, (b) negative perceptions of psychiatrists, (c) infrastructure and funding issues, (d) lack of exposure and education. To address the barriers presented, participants discussed potential solutions that could be categorized into five main themes, namely: (a) stigma reduction, (b) educating professionals, (c) addressing deficient infrastructure, (d) risk management, and (e) incentivizing the pursuit of psychiatry among students.

CONCLUSION

Health policy planners and medical training institutions could consider implementing proposed solutions to identify barriers as part of efforts to improve the psychiatrist to patient ratio in Ghana.

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.

Psychiatry as a specialization: influential factors and gender differences among medical students in a low- to middle-income country

OBJECTIVES

To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions.

METHODS

This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20.

RESULTS

Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided.

CONCLUSION

Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.

Why psychiatry as a career: Effect of factors on medical students' motivation

Context

The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3].

Aims

To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty.

Subjects and Methods

Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice.

Statistical Analysis Used

Statistical analysis was done using Statistical Package for Social Sciences (SPSS)^® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant.

Results

It was noted that 85% did not choose psychiatry, with the most important deterrent being "Family member is psychologically ill" and "Available job position" being the most common motivator for choosing a specialty.

Conclusion

In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice.

Why did you choose psychiatry? a qualitative study of psychiatry trainees investigating the impact of psychiatry teaching at medical school on career choice

BACKGROUND

There is no consensus regarding the optimal content of the undergraduate psychiatry curriculum as well as factors contributing to young doctors choosing a career in psychiatry. Our aim was to explore factors which had influenced psychiatry trainees' attitudes towards mental health and career choice.

METHOD

Qualitative in-depth interviews with 21 purposively sampled London psychiatry trainees analysed using the Framework method.

RESULTS

Early exposure and sufficient time in undergraduate psychiatry placements were important in influencing psychiatry as a career choice and positive role models were often very influential. Integration of psychiatry with teaching about physical health was viewed positively, although concerns were raised about the potential dilution of psychiatry teaching. Foundation posts in psychiatry were very valuable in positively impacting career choice. Other suggestions included raising awareness at secondary school level, challenging negative attitudes amongst all medical educators, and promoting integration within medical specialties.

CONCLUSIONS

Improvements in teaching psychiatry could improve medical attitudes and promote recruitment into psychiatry.

Medical School Factors Associated with Higher Rates of Recruitment into Psychiatry

OBJECTIVE

The medical school a student attends appears to be a factor in whether students eventually match into psychiatry. Knowledge of which factors are associated with medical schools with higher recruitment rates into psychiatry may assist in developing strategies to increase recruitment.

METHODS

Psychiatry leaders in medical student education in the 25 highest and lowest recruiting US allopathic schools were surveyed concerning various factors that could be important such as curriculum, educational leadership, and presence of anti-psychiatry stigma. The relationship between the survey results of high recruiting schools versus those of low recruiting schools was evaluated using Mann-Whitney U tests.

RESULTS

Factors significantly associated (p < .05) with higher recruiting schools included better reputation of the psychiatry department and residents, perceived higher respect for psychiatry among non-psychiatry faculty, less perception that students dissuaded other students from pursuing psychiatry, and longer clerkship length.

CONCLUSIONS

Educational culture and climate factors may have a significant impact on psychiatry recruitment rates. Clerkship length was associated with higher recruiting schools, but several previous studies with more complete samples have not shown this.

Doctoring Undercover: updating the educational tradition of shadowing

BACKGROUND

Premedical students are educated in basic biological and health sciences. As a complement to traditional premedical coursework, medical school applicants are encouraged to shadow practitioners, with the hope that observation will introduce students to the culture and practice of healthcare. Yet the shadowing experience varies widely across practitioners and institutions; resources that guide students' critical reflection and structure the experience are scarce.

DEVELOPMENT

A pilot experiential learning course, Doctoring Undercover: Shadowing and the Culture of Medicine, was developed to fill this gap. The course consisted of three parts: an introduction to medical culture through the disciplines of medical sociology, history, anthropology, and bioethics; a site placement in which students applied these fields' analytical techniques to the study of medical culture and practice; and the development of an online activity guide that other premedical students may adapt to their shadowing circumstances.

IMPLEMENTATION

Students reported that they were exposed to new disciplinary perspectives and interprofessional environments that they would not traditionally encounter. Students' contributions to the shadowing guide encouraged active learning and reflection on the dynamics of effective patient-provider relationships and shadowing experiences.

FUTURE DIRECTIONS

Locally, the class may be scaled for a larger group of premedical students and incorporated into a formal pathway program for premedical students; the content will also be integrated into the clinical medicine course for first-year medical students. Online, the guide will be promoted for use by other institutions and by individuals planning extracurricular shadowing experiences; feedback will be solicited. Tools for evaluating the short- and long-term impact of the course and guide will be developed and validated. Observational and experimental studies of the course's impact should be conducted.

ABBREVIATIONS

ICM: Introduction to Clinical Medicine; SCE: Selective Clinical Experiences.