The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness

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.

Reducing stigma and increasing competence working with mental illness: Adaptation of a contact-based program for osteopathic medical students to a virtual, active learning format

PURPOSE

Contact-based education, offering meaningful contact with individuals living in recovery with mental illness, reduces stigma. This study evaluated the effectiveness of the National Alliance on Mental Illness Provider Education Program (NAMI PEP) when implemented as a curricular requirement across two cohorts of third-year osteopathic medical students, comparing traditional, passive learning and active, online delivery formats.

MATERIALS AND METHODS

Participants were two cohorts of third-year medical students (Cohort 1 n = 186; Cohort 2 n = 139; overall N = 325) who completed questionnaires measuring affect, beliefs, and behaviors toward patients with mental illness at pre-program, 1-week follow-up, and 6-month follow-up. For Cohort 1, the existing community-based NAMI PEP was implemented. For Cohort 2, the program was adapted to an online, active learning format tailored to medical students, and an additional 3-month follow-up assessment was added to better identify intermediate-term effects.

RESULTS

The NAMI PEP was associated with longitudinal improvements in target outcomes, with enhanced effects with the adapted curriculum in Cohort 2. At 6-month follow-up, students reported less stigma, fewer stereotyping negative attitudes, and lower anxiety treating patients with mental illness. They also reported increased confidence integrating psychiatry into routine care and increased competence in principles of collaborative mental health treatment.

CONCLUSIONS

This study demonstrates the longitudinal effectiveness of the NAMI PEP across two cohorts of medical students, with strengthened effects observed when the program is tailored to contemporary medical education.

Anti-Indigenous bias of medical school applicants: a cross-sectional study

BACKGROUND

Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias.

METHODS

All applicants to a single university in the 2020-2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating 'cold/unfavourable' to 100, indicating 'warm/favourable') and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students.

RESULTS

There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80-100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37-55), and had mild implicit preference for European faces (- 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful.

CONCLUSIONS

Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.

Medical Student Attitudes and Perceptions on the Relevance of Neuroscience to Psychiatry: a Mixed Methods Study

OBJECTIVE

Many psychiatry residency programs are actively incorporating neuroscience training into their curricula; however, relatively little scholarship exploring neuroscience and psychiatry integration in undergraduate medical education has been conducted. This study investigated second-year, pre-clerkship medical students' perceptions on the relationship between neuroscience and psychiatry following foundational neuroscience and behavior instruction to identify their views before they enter clerkships.

METHODS

A mixed methods design combined qualitative analysis of medical students' essays in response to the prompt: "What is the relationship between neuroscience and psychiatry?" with quantitative analysis of survey responses on a 7-point scale.

RESULTS

Ninety-three percent of the class participated in the study (n = 77). Learners rated neuroscience as important for understanding and treating psychiatric disorders, albeit less important for psychiatric compared to neurological disorders. Using applied thematic analysis, the authors identified qualitative themes. Specifically, participants recognized neuroscience as a foundational science for psychiatry, but some emphasized that factors other than neuroscience are needed to explain psychiatric disorders. Some students perceived neuroscience and psychiatry as complementary approaches to understanding the brain and behavior. Others identified a role for neuroscience in reducing the stigma of psychiatric disorders and thereby improving access to psychiatric care.

CONCLUSIONS

The quantitative and qualitative findings reinforced each other and provided novel insight to pre-clerkship medical students' views on the relevance of neuroscience for psychiatry. Educating all medical students, not just psychiatry residents, on the neuroscience of psychiatric disorders may better equip the next generation of physicians, regardless of specialty, to care for their patients with psychiatric conditions.

Public stigma profile toward mental disorders across different university degrees in the University of Valencia (Spain)

BACKGROUND

A large proportion of studies carried out in recent years in different populations have shown that stigma toward mental disorders is highly prevalent. In the present study we conducted a comprehensive assessment of stigma to describe and compare stigma toward mental disorders in students enrolled in five different university degrees.

METHODS

Three hundred and twenty-five students from the University of Valencia (Spain), attending the second term of their first-degree courses in the faculties of medicine, psychology, teaching, economics, and data science participated in this cross-sectional study. Stigma was measured using: the Reported and Intended Behavior Scale (RIBS), the Scale of Community Attitudes toward Mental Illness (CAMI), the Attribution Questionnaire (AQ-27), and the Knowledge about Mental Illness test (KMI).

RESULTS

We found different patterns of stigma according to gender, the fact of knowing or living with a person with mental disorders and the university degree studied. Overall, women show fewer stigmatizing attitudes than men but similar stereotypes and prejudice toward people with mental disorders. However, the pattern of results across degrees is more complex. Overall, students of medicine, psychology and teaching showed fewer stigmatizing attitudes than students of economics and data science but differences between degrees were more subtle in stereotypes and prejudice toward people with mental disorders.

CONCLUSION

Our study suggests the existence of different profiles of stigma in relation to mental disorders in university students. These profiles varied in relation with the degree being studied, gender and already knowing or living with a person with mental disorders.

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.