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

unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study

Background

It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions.

Methods

Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol.

Results

A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management.

Conclusion

These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

Factors influencing career preference in mental health among nursing students and intern nurses in Dar es Salaam, Tanzania

Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has been on the rise and remains a significant leading cause of disease burden. Sub-Saharan Africa (SSA) shares a fair burden of MNS with depressive disorders being the most prevalent in this region. A huge treatment gap for MNS exists, with lack of appropriate human resources and expertise for service delivery being one of the key barriers. Pre-service and in-service training plays a vital role in developing human resource for mental health. However, low or lack of career interests in mental health has been documented among students. A cross-sectional study was conducted between April and May 2021 to determine factors influencing career preference in mental health among nursing students and intern nurses at Muhimbili University of Health and Allied Sciences (MUHAS) and Muhimbili National Hospital (MNH) respectively in Dar es Salaam, Tanzania. Sixty-eight (68) nursing students at MUHAS who had covered the mental health nursing course and 83 intern nurses who had rotated at the MNH Psychiatry and Mental Health department participated in the study using consecutive sampling. A pre-tested structured self-administered questionnaire was used to collect data, followed by analysis with version 25 of the Statistical Package for the Social Sciences. The Chi-square test and logistic regression were performed to determine factors associated with career preference. One third (33.1%; n = 50) of participants had career preference in mental health nursing. Living with a person with mental illness (adjusted odds ratio [AOR]: 4.350; 95% CI: 1.958, 9.664; p <0.001), awareness of possible career advancement in mental health (AOR: 16.193; 95% CI: 2.022, 129.653; p = 0.009), awareness of possible income generation in mental health career (AOR: 6.783; 95% CI: 2.295, 20.047; p = 0.001), and satisfaction with psychiatric working environment (AOR: 6.753; 95% CI: 2.900, 15.726; p <0.001), were significantly associated with career preference in mental health. Low mental health career preference among university nursing students and intern nurses jeopardizes the future of the mental health nursing profession and may complicate the already existing shortage of human resource for mental health. The higher learning institutions, health facilities, and the Ministry of Health may need to take deliberate actions to ensure that interest to pursue a career in mental health is built among students and interns. Further research is needed to provide more insight into how the psychiatric working environment affects career preference in mental health.

Medical students' attitude towards psychiatry: a comparison of past and present

Attitude to psychiatry influences motivation for medical students to successfully achieve in studying psychiatry. With a new generation of students, it would be interesting to investigate how attitudes have changed. This study aimed to compare the attitude of fifth-year medical students toward psychiatry in recent and in the past 24 years. Two samples of fifth-year medical students at Chiang Mai University completed the 30-item attitude to psychiatry (ATP-30); 118 students completed it in 1996, whereas 242 medical students completed it in 2019. Rasch analysis was employed for examining the differences between the total score and individual item scores between the two groups. The total score of ATP in the 2019 group was significantly higher than that in the 1996 group. After misfitting individuals and biased items were removed, only 15 items were valid and useful for a comparison. Of 15 items, 11 were found highly significantly different between two groups (p < 0.001). Negatively worded items, e.g., no strong evidence indicating effectiveness, became easier to score items (increased positive attitude) whereas some positively worded items, e.g., I would like to be a psychiatrist. Nine items, became more difficult (less positive attitude) comparing between 1996 and 2019. In a comparison between the two methods using the traditional t-test and Rasch analysis, only 5 of 30 items (16.7%) agreed with each other. The overall attitude to psychiatry was significantly higher at the present compared with that in the past. Most items did not differ between the two times. Further studies regarding improving the attitude scale using item response theory such as Rasch should be encouraged.

Motivations and Limitations of Pursuing a Career in Psychiatry: A Cross-Sectional Study from the United Arab Emirates

Background. The global burden of mental disorders continues to grow with significant health, social, and economic consequences. Unfortunately, the gap between the need for mental healthcare and its provision remains wide all over the world. The recruitment and retention of psychiatrists is a long-standing concern in the United Arab Emirates, with social stigma playing a potential role. This study is aimed at investigating the factors that affect psychiatrists’ choice of psychiatry as an area of practice in the United Arab Emirates. Methods. This cross-sectional study was undertaken using an anonymized 30-item online questionnaire. Ethical approval was obtained from the United Arab Emirates University Social Sciences Research Ethics Committee prior to participant recruitment. We recruited qualified psychiatrists currently working in the United Arab Emirates. The structured questionnaire assessed the participants’ sociodemographic factors and reasons for choosing psychiatry. Statistical analysis, including Pearson correlations and chi-square tests, was performed using the statistical package for the social sciences (SPSS) version 26. Results. We found that the doctors trained in the United Arab Emirates were statistically more likely to face opposition to specializing in psychiatry ( $p$ value < 0.001). Participants with a family member or friend as a psychiatrist were more likely to choose psychiatry as a first-choice specialty ( $p$ value 0.01). Psychiatrists below the age of 35 were more statistically likely to face opposition to their decision to specialize in psychiatry ( $p$ value 0.006). Psychiatrists who regretted their decision to specialize in psychiatry were statistically more likely to feel this way in their first year of residency ( $p$ value < 0.001). Conclusions. Multiple sociodemographic factors influence responses to the decision to specialize in psychiatry in the United Arab Emirates. Younger people and people who studied in or were a citizen of the United Arab Emirates were more likely to face opposition to their decision to specialize in psychiatry, indicating why there are such high rates of psychiatrists from overseas in the United Arab Emirates and shortages in the profession.

Psychiatry Residents as Medical Student Educators: a Review of the Literature

OBJECTIVE

Professional organizations and medical schools need trainees as medical student educators. There are limited data describing the training of residents and fellows as educators. There are also limited data describing the impact of trainee educators on medical student performance and clerkship experience.

METHODS

A narrative literature search was done in PubMed, Embase, and PsychINFO from inception to January 1, 2021, to explore the approaches, methods, and outcomes (e.g., potential benefits) of psychiatric trainees as medical student educators. A total of 630 papers were screened using title and abstract, of which 20 met inclusion criteria. Studies were categorized into four quality tiers based on methodology.

RESULTS

Studies described how training programs utilized trainees as student educators, and various methods of teaching instruction. Residents and fellows valued being educators and reported these experiences increased teaching abilities. Medical students rated trainee educators well. Resident-led teaching initiatives were associated with increased exam scores in one study. Data were limited by low survey response rates, qualitative (i.e., subjective) inquiry, and heterogeneity in teaching and training modalities.

CONCLUSIONS

Due to a lack of high-quality studies, definitive conclusions cannot be drawn about the effectiveness of psychiatry trainees as medical educators nor about how to best train them as educators. Nevertheless, literature suggests that incorporating trainees as educators both augments resident and fellow training and enhances medical student experience and performance. Future research should assess needs and standardize methods, curricula, and outcome measures more systematically.

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.

Revisiting the ATP 30: the Factor Structure of a Scale Measuring Medical Students' Attitudes Towards Psychiatry

OBJECTIVE

Among the scales developed for assessing medical students' attitudes regarding psychiatry, "attitude towards psychiatry-30" (ATP-30) is probably the most widely used. Although this scale was originally deemed to form a unitary dimension without any meaningful subscales, the authors sought to re-examine its factor structure and the viability of subscales.

METHOD

Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were analyzed using exploratory factor analysis (EFA) with promax rotation and confirmatory factor analysis (CFA), to assess the underlying factor structure of ATP-30. Parallel analysis was used in determining the number of factors to retain. Items conceptually external to the emerging factors were discarded.

RESULTS

Three models based on literature (one-, five-, and eight-factor) were disproved by CFA. A six-factor solution encompassing 18 items was supported by EFA and CFA and was gender-invariant. These factors were, namely, the image of psychiatrists, psychiatric patients and mental illness, the efficacy of treatment, psychiatric teaching, career choice, and psychiatry as an evidence-based discipline. While "the image of psychiatrists" formed the most consistent subscale (ω = 0.71), the internal consistencies of the other subscales were modest (ω = 0.55-0.67). The overall 18-item scale showed good internal consistency (ω = 0.78).

CONCLUSION

The findings provide evidence of a multi-dimensional structure in medical students' attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific areas where students' attitudes are more stigmatized, to be intervened during undergraduate training.

Attitudes Towards Psychiatry in Lebanese Medical Students: What Are the Factors that Could Lead to a More Favorable Outlook?

OBJECTIVE

The authors aimed to assess the attitudes towards psychiatry of all Lebanese medical students, as well as the factors that could have led to these attitudes, whether favorable or not.

METHODS

In this cross-sectional study, the authors ran a questionnaire among a sample of Lebanese medical students from all medical faculties, regions in Lebanon, and years of medical school, using the ATP-30 scale and the WHO-5 well-being index. The answers from the 607 participants were statistically analyzed on SPSS version 23.0.

RESULTS

Among participants, 95.1% had a positive attitude towards psychiatry, reflecting a favorable outlook among Lebanese medical students overall. The average ATP-30 score in our sample was 111.95 out of 150 (SD = 12.55), which is in the range of countries of higher socio-economic level such as Germany and Switzerland. Also, 26.5% of participants reported that they consider psychiatry as a potential career choice. No demographic factor had any influence on the ATP-30 score. In the multivariate analysis, only two factors resulted in favorable attitudes: exposure to a patient with a diagnosed psychiatric illness in the student's surroundings and a lower WHO-5 well-being index.

CONCLUSION

This study's results do not fit into the traditional "developed vs. developing countries" paradigm. However, Lebanon still has a lot of challenges to face in order to provide quality mental healthcare.

["Psychiatry Takes its Time … " Why Does One Become a Psychiatrist? - A Qualitative Study]

Ziel Identifikation von intrinsischen Motivatoren, die bei der Berufswahl Psychiatrie eine Rolle spielen.

Methodik 14 leitfadengestützte Tiefeninterviews wurden mithilfe von Codierungsrahmen systematisch ausgewertet.

Ergebnisse Positive Aspekte waren der zwischenmenschliche Fokus und der ganzheitliche Ansatz. Negative Dimensionen waren das schlechte Image unter Kolleg*innen, Vorurteile und Stigma. Die Entstigmatisierung der Psychiatrie und die Gleichstellung psychiatrischer mit somatischen Aspekten in Fallberichten wurden als Möglichkeiten vorgeschlagen, das Interesse am Fach Psychiatrie zu erhöhen.

Schlussfolgerung Um die Beliebtheit der Psychiatrie bei Mediziner*innen zu steigern, bedarf es Maßnahmen zur Bekämpfung von mit Psychiatrie verbundenem Stigma im Gesundheitswesen. Im Rahmen der medizinischen Lehre müssen psychiatrische Störungen, welche durch ihre hohe Prävalenz alle medizinischen Disziplinen betreffen, entsprechende Gewichtung erhalten.

Child and Adolescent Psychiatry Perceptions and Career Preference: Participation in a National Medical Student Conference Improves Outcomes

Since 2002, the Klingenstein Third Generation Foundation (KTGF) has supported a network of medical schools across the country with the explicit aim of enhancing interest in, and eventual recruitment into, the field of child and adolescent psychiatry (CAP). An active component of the KTGF network has been its annual National Medical Student Conference (NMSC).

Factors associated with medical students' choice of psychiatry as future specialty: a cross-sectional study

BACKGROUND

Despite the fact that mental illnesses are highly prevalent, shortage of trained human resource, particularly psychiatrists, in the field is disproportionately low. This is especially challenging in developing countries. We report factors affecting medical students' choice of psychiatry specialty as a future career.

METHODS

A facility-based cross-sectional study design incorporating demographics, psychiatry specialty choice and a list of factors related to psychiatry was administered to fourth year medical students. Chi-squared test was used to identify factors associated with psychiatry choice. Multiple logistic regression analysis was done to identify the association between demographics and history of mental illness against psychiatry choice.

RESULTS

One hundred and sixty-five medical students participated in the study. The majority, 139 (84.2%), of the students were male. From the medical students, 34 (21%) reported that they will choose to specialize in psychiatry for their future career. A chi-squared test result indicated that there were many factors associated with psychiatry choice. Family history of mental illness was found to be significantly associated with the future career choice of the psychiatry discipline (AOR=2.76; CI: 1.05-7.25).

CONCLUSION

Family history of mental illness seemed to be a significant factor in medical students' psychiatry choice. Positive attitude to psychiatry, ‎the manner in which psychiatry is taught, satisfaction related to practical and theoretical psychiatry education, having direct involvement in psychiatric patient care and the like were factors that affect psychiatry choice. Therefore, paying due attention to modifiable factors negatively affecting psychiatry choice may increase the selection of the field by medical students as a specialty.

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.