Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice

Changes in attitudes toward persons with mental disorders after attendance of a psychiatric curriculum among medical students in Vietnam: A cross-sectional study

This study aimed to determine the influence of psychiatric training and hands-on learning with individuals with mental illness on increasing medical students' benevolent attitudes towards psychiatry and psychiatric patients. The cross-sectional study compares medical students' attitudes before and after a compulsory psychiatry curriculum and psychiatric bedside training at Hanoi Medical University with those of non-medical students who have yet to undergo similar training. Two validated scales regarding the attitudes toward psychiatry and psychiatric patients were evaluated. Analysis of the Medical Conditions Regard Scale[1] revealed a significant difference, indicating that medical students displayed more accepting and benevolent attitudes towards psychiatry and psychiatric patients after completing the curriculum and bedside training than medical students before participation. Most stigmatising and rejecting attitudes were found among non-medical students. This study is the first to examine medical students' attitudes toward psychiatry and psychiatric patients compared to non-medical students in Vietnam. It can guide the development of the medical curriculum to increase benevolence towards psychiatric patients and interest in the psychiatric field of work in Vietnam and Southeast Asia, aiming to improve the mental health care sector.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Mental illness attitudes, service provision interest and further training preferences of clinical associates

BACKGROUND

 Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training.

METHODS

 A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians' Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score.

RESULTS

 The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health.

CONCLUSION

 The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates' attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.

Impact of Psychiatry Clerkship Rotation in Attitudes Towards Mental Illness and Psychiatry as a Career Among Medical Students

Background

Stigma associated with mental illness (MI) permeates many professions, including healthcare. Recognizing and correcting bias is critical in delivering impartial and beneficial healthcare for all patients. Early educational interventions providing exposure to individuals with MI have shown to be effective at reducing MI stigma. The primary aim of our study was to assess the impact of a psychiatry clerkship on attitudes to MI. A secondary aim was to determine if the psychiatry clerkship influenced medical students' perceptions of psychiatry as a career.

Methods

A cohort of third-year medical students in Florida was invited to complete an online survey before and after participating in their first 4-week-long psychiatry clerkship during the 2021-2022 academic year. The voluntary, anonymous survey consisted of the Attitudes to Mental Illness Questionnaire (AMIQ) and a 3-item questionnaire on interest and knowledge in psychiatry. The Wilcoxon Sign-Rank test was used to determine statistical significance (P < .05) for pre- and post-clerkship values.

Results

Among 39 invited students, 22 participated before (56.4%), and 23 participated after their psychiatry rotation (59.0%). Overall, there was a statistically significant increase in the perceived level of general interest in psychiatry (P = .027), psychiatry knowledge (P < .001), and career interest in psychiatry (P = .040). There was also a significant decrease in the stigmatized attitude score for depression and self-harm after their psychiatry rotation (P = .042). Finally, the participants initially showed the highest stigmatized attitude score for intravenous drug abuse among the 4 mental illnesses presented, which also included depression and suicidal ideation, alcohol use disorder, and schizophrenia.

Conclusion

The findings suggest that a psychiatry clerkship provided a positive exposure to the field, enhanced medical students' overall interest in psychiatry, and positively impacted medical students' attitudes towards MI.

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.

Stigmatizing attitudes towards mental illness: A cross-sectional survey of Australian medical students

OBJECTIVES

We aimed to assess the degree of stigmatizing attitudes and psychological distress amongst Australian medical students in order to better understand factors that may impact help-seeking behaviours of students. We hypothesize that sociodemographic factors will not significantly predict stigmatizing attitudes, and increasing levels of psychological distress will be associated with increasing stigma.

METHODS

A cross-sectional online survey was distributed to medical students at Western Australian universities and members of the Australian Medical Students' Association. Stigma was scored using the Mental Illness Clinicians' Attitudes (MICA-2) scale. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS). Participants provided information about gender, age, spirituality, financial hardship, treatment for mental illness, and experience in psychiatry.

RESULTS

There were 598 responses. The mean (Standard Deviation) MICA-2 score was 36.8 (7.5) out of a maximum of 96, and the mean (SD) HADS depression score was 4.7 (3.7). The mean (SD) HADS anxiety score was 9.3 (4.4). Past or current treatment for a mental illness was associated with lower MICA-2 scores. There was no association between MICA-2 and HADS scores, or sociodemographic factors.

CONCLUSIONS

Our results demonstrate relatively low MICA-2 scores and high HADS-A scores overall, with no association between HADS scores and stigma.

Evaluation of US Medical Student Bias Toward Mental Health Before and After First-Year Pre-clinical Psychiatry Education

OBJECTIVE

Much of mental health care is provided by non-psychiatric providers, and unfortunately, bias toward patients with mental health conditions leads to worsened outcomes. The authors endeavored to determine if pre-clinical medical student psychiatry education had an impact on these perceptions.

METHODS

All 366 first-year medical students at Indiana University were invited to participate in a survey that consisted of the Mental Illness: Clinician's Attitudes version 2 (MICA-2) and six supplemental questions, pre- and post-course.

RESULTS

One hundred seventeen students completed both surveys. The pre- and post-course means were 36.6 and 33.6, a change of - 2.9 (paired t-test p-value < 0.001), indicating a reduction in bias.

CONCLUSIONS

These results suggest that pre-clinical education can lead to a measurable decrease in bias in medical students early in training. Unfortunately, individual question results and free responses continue to highlight significant bias in US medical students against mental illness and the field of psychiatry. Health care educators should be aware of these biases and their potential impact on patient outcomes so that these harmful perceptions can be targeted.

'They say': medical students' perceptions of General Practice, experiences informing these perceptions, and their impact on career intention-a qualitative study among medical students in England

OBJECTIVES

The number of UK graduates choosing General Practice training remains significantly lower than the current numbers required to meet the demands of the service. This work aims to explore medical students' perceptions of General Practice, experiences which lead to the development of these perceptions, and the ultimate impact of these on career intention.

DESIGN

This mixed-methods, qualitative study used focus groups, semistructured interviews, longitudinal audio diary data and debrief interviews to explore and capture the experiences and perceptions of students in their first and penultimate years of university.

SETTING

Three English medical schools.

PARTICIPANTS

Twenty students were recruited to focus groups from first and fourth/fifth year of study. All students in these years of study were invited to attend. Six students were recruited into the longitudinal diary study to further explore their experiences.

RESULTS

This work identified that external factors, internal driving force and the 'they say' phenomenon were all influential on the development of perceptions and ultimately career intention. External factors may be split into human or non-human influences, for example, aspirational/inspirational seniors, family, peers (human), placements and 'the push' of GP promotion (non-human). Driving force refers to internal factors, to which the student compares their experiences in an ongoing process of reflection, to understand if they feel General Practice is a career they wish to pursue. The 'they say' phenomenon refers to a passive and pervasive perception, without a known source, whereby usually negative perceptions circulate around the undergraduate community.

CONCLUSION

Future strategies to recruit graduates to General Practice need to consider factors at an undergraduate level. Positive placement experiences should be maximised, while avoiding overtly 'pushing' GP onto students.

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.

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.

Subjective achievement from psychiatry rotation in the Japanese postgraduate residency system: a longitudinal questionnaire study

BACKGROUND

Psychiatry rotation has been mandatory in the Japanese postgraduate residency system since 2020. Some psychiatry-related competency items are stipulated as mandatory for residents. The current study aimed to clarify whether psychiatry rotation affected residents' subjective achievement of these competency items.

METHODS

This longitudinal study was conducted among postgraduate residents who completed a rotation in the psychiatry department at Nagasaki University Hospital across two academic years (2020-2021). The survey was administered at the start and at the end of the psychiatry rotation. Residents evaluated their subjective understanding and confidence regarding initiating treatment for these competency items using a six-point Likert scale. The average scores for each item were compared between pre-rotation and post-rotation.

RESULTS

In total, 99 residents (91.7%) responded to this survey. Residents had significantly higher scores at post-rotation compared with pre-rotation in all psychiatry-related competency items in both subjective understanding and confidence in initiating treatment. Additionally, strong effect sizes were found for many items.

CONCLUSION

Residents improved learning about psychiatry-related competency items through psychiatry rotation. This finding suggests that it is reasonable for psychiatry rotation to be mandatory in the current Japanese postgraduate residency system. The importance of psychiatry is likely to increase in both undergraduate and postgraduate medical education in the future. It is necessary to continuously update educational strategies to meet changing social needs over time. As this study was conducted at a single institution, a multi-center study is needed to expand the current findings.

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.

The effectiveness of mental health disorder stigma-reducing interventions in the healthcare setting: An integrative review

Individuals with mental health disorders frequently seek medical treatment in health care settings other than a mental health facility. However, mental health disorder stigmatization is prevalent in the healthcare setting across the globe. Stigmatizing attitudes remain widespread among healthcare professionals who are responsible for delivering patient-centered, quality care. Stigma in the healthcare setting can undermine effective diagnosis, therapy, and optimum health outcomes. Addressing stigma is critical to delivering quality health care in both developed and developing countries. Therefore, it is important to deliver successful anti-stigma education, along with practical strategies, to reduce the stigma of mental health disorders among healthcare professionals. An integrative review was conducted to identify the effectiveness of various interventions used in 10 different countries globally to reduce the stigma of mental health disorders in the healthcare setting.

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.

Psychiatry curriculum: How does it affect medical students' attitude toward psychiatry?

The purpose of this study was to identify the attitude of South Korean medical school students towards psychiatry and to analyze how lectures and clinical clerkship in psychiatry effect changes in students' attitudes. A total of 100 medical school students were recruited as subjects in the study, 86 of whom completed psychiatry lectures and underwent psychiatry clerkship from March 2015 to August 2018. The participating students completed a survey, which included demographic data, specialty choice, and attitude towards psychiatry. Subjects who completed lectures and clinical clerkship in psychiatry showed positive changes in attitude towards psychiatry in the following items: "Among mental health professionals, psychiatrists have the most authority and influence" (p = 0.002), "Psychiatrists frequently abuse their legal power to hospitalize patients against their will" (p < 0.001), and "Many people who could not obtain a residency position in other specialties eventually enter psychiatry" (p = 0.028). However, negative changes in attitude towards psychiatry were shown in the following item: "On average, psychiatrists make as much money as most other doctors" (p = 0.008). Also, specific medical school factors scored positively overall. Although it was not statistically significant, the questionnaire item "During my psychiatry rotation, psychiatry residents were good role models" was more positively observed by students after completion of psychiatry lectures and clerkship. After each curriculum, certain attitudes toward psychiatry were positively changed, but others either remained unchanged or were negatively changed. By using these study results to revise the current curriculum, medical school students' attitude towards psychiatry can be improved.

Effects of the psychiatric nursing course on students' beliefs toward mental illness and psychiatric nursing perceptions in Turkey

PURPOSE

To investigate the effects of the psychiatric nursing course on students' beliefs toward mental illness and psychiatric nursing perceptions.

DESIGN AND METHODS

This experimental study was carried out with 80 students enrolled for the psychiatric nursing course.

FINDINGS

The mean score of the Beliefs toward Mental Illness Scale decreased, and the mean score of the Psychiatric Nursing Perception Scale increased after the course. The difference between the measurements was statistically significant (p < 0.05).

PRACTICE IMPLICATIONS

This study shows that psychiatric nursing course is effective in decreasing students' negative beliefs toward mental illness and increasing positive psychiatric nursing perceptions. Students' attitudes about mental illness and psychiatric nursing should be determined from the very first year of their education, and their negative beliefs should be intervened with.

Evaluating the Effects of Experiencing Virtual Reality Simulation of Psychosis on Mental Illness Stigma, Empathy, and Knowledge in Medical Students

OBJECTIVES

Applying technologies such as virtual reality (VR) in education has gained popularity especially in comprehending abstract and subjective phenomena. Previous studies have shown that applying a virtual reality simulation of psychosis (VRSP) is useful in increasing knowledge and empathy toward patients. Here, the efficacy of using VRSP in altering stigma, empathy and knowledge as well as side effects have been assessed in medical students in comparison with the routine education (visiting the patients).

METHOD

After attending one session of lecture about positive psychotic symptoms, medical students were allocated to two groups: experiencing one session of VRSP or visiting patients under supervision as routine practice in the ward. Before and after the first session and after the second one, questionnaires of knowledge, empathy and stigma were filled by students. Finally, the results were compared in two groups.

RESULTS

Both interventions were effective in reducing stigma as well as increasing knowledge and empathy toward patients with psychotic experiences. VRSP could significantly reduce stigma and increase knowledge and empathy compared with the traditional visiting patients under supervision. The side effects were minimal and ameliorated right after the experience.

CONCLUSION

VRSP is an effective tool in decreasing stigma and increasing empathy and knowledge of the students and can be incorporated in psychiatric education with minimal side effects.

Stigma Towards Mental Illness at an Academic Tertiary Care Center in Lebanon

OBJECTIVE

Individuals with mental illness may fall victim to stigma. In this cross-sectional study, the authors aimed to explore correlates of stigma towards mental health in a Lebanese private university and its associated tertiary medical center.

METHODS

The authors surveyed students, staff, and faculty at the American University of Beirut and its associated medical center. They assessed stigmatizing behaviors via the Reported and Intended Behavior Scale (RIBS), perceived stigma via the Perceived Devaluation and Discrimination Scale (PDDS), and attitudes towards collaborating with mental health professionals via the Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH).

RESULTS

A total of 270 participants (response rate of 18%) provided their responses. The mean scores on the RIBS and PDDS were 15.26 ± 4.75 and 32.25 ± 2.70, respectively. Participants who had higher scores on RIBS were more likely to be younger than 25 years of age (OR=1.869; p=0.026), to have a history of mental illness (OR=2.657; p=0.003), and to interact with individuals with a psychiatric disorder (OR=2.287; p=0.028).

CONCLUSIONS

Results show a mixed pattern of stigmatizing behaviors and perceptions towards mental illness. This highlights the need for mental health awareness campaigns and interventions in the country.

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 of Medical Students Towards Psychiatry in Venezuela: a 6-Year Longitudinal Study

OBJECTIVE

The authors evaluated changes in attitude towards psychiatry of medical students in one medical school in Venezuela.

METHODS

Balon's modified questionnaire was administered to first and sixth-year medical students to analyze their attitude towards psychiatry. The answers were compared with McNemar's test.

RESULTS

The students' negative perception of psychiatry increased by the end of medical school with 45% of sixth-year students reportedly feeling uncomfortable when working with patients with psychiatric illness compared to only 8.3% of first-year medical students. Interest in specializing in psychiatry decreased from 2.6% in first-year medical students to 0% in sixth-year medical students (p=0.001).

CONCLUSION

Different factors may lead to the loss of interest in psychiatry of medical students in Venezuela, such as little time spent with patients, being in contact only with patients with psychosis, stigma about psychiatry among medical doctors and friends, feeling more comfortable with other specialties, and other specialties having a higher perceived status and being better paid.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review

BACKGROUND

Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.

RESULTS

A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.

CONCLUSIONS

The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

Student’s confidence in mental health practice before and after psychiatry rotation: a follow up study

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of “Preparation for Hospital Practice Questionnaire” (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: “Diagnosis elaboration and basic care” (F1), “Crisis management and prevention” (F2), “External sickness determinants” (F3) and “Personal distress with clinics” (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

Mediating effects of stigma on the relationship between contact and willingness to care for people with mental illness among nursing students

BACKGROUND

Previous studies have demonstrated that contact positively impacts nursing students' willingness to care for people with mental illness. However, studies that have explored the mechanism of such a relationship between contact and willingness remain few.

OBJECTIVES

To examine the direct relationship between contact and nursing students' willingness to care for people with mental illness and to explore the potential mediating roles of stigma.

DESIGN

This was a cross-sectional study design.

SETTINGS

The study was conducted in a nursing school in Nanjing city, China.

PARTICIPANTS

A total of 839 nursing students were recruited in the study through convenience sampling.

METHODS

Nursing students' stigma, contact, and willingness to care for people with mental illness were measured online through the Stigma toward People with Mental Illness Scale (SPMI), the Level of Contact Report, and one item of "which degree indicates your willingness to provide care for people with mental illness," respectively. The structural equation model was applied to explore the potential mediating roles of stigma.

RESULTS

Contact with people suffering from mental illness directly affected nursing students' willingness to care for them (β = 0.076, p < 0.05). Meanwhile, stigma partly mediated the effect of students' contact on willingness to care for people with mental illness (β = 0.048, p < 0.05).

CONCLUSIONS

High level of contact can improve nursing students' willingness to care and the relationship is partly mediated by stigma. Measures to improve the level of contact and reduce stigmatizing attitudes of nursing students are accordingly essential in influencing them to have more willingness to care for people with mental illness.

[Quality of health worker-patient communication: What are the benefits of integrating mental health into front-line services in Guinea?]

BACKGROUND

Patient-centred care presupposes communication based on empathy, active listening and dialogue. Our study examines the effects of integrating mental health in multi-purpose health centres on health workers' communication with patients who consult for problems unrelated to mental health. The objective is to compare the quality of communication in health centres where staff have received specific training in the management of mental disorders (SM+) compared to those without such training (SM-).

METHODS

The study was conducted among 18 health workers in charge of primary curative consultations in 12 non-governmental health centers in Guinea: 7 health workers in 4 SM+ health centers and 11 health workers in 8 SM- health centres. The study is based on mixed methods: observation, semi-structured and group interviews. The Global Consultation Rating Scale (GCRS) was applied to assess patient-centered communication.

RESULTS

The SM+ GCRS scores obtained by SM+s during observations are generally higher than the SM- scores. The odds of having a "good quality" consultation are almost 3 times higher in SM+ than in SM- for some steps in the consultation process. The SM+ discourse is more patient-centered, and differs from the more biomedical discourse of SM-. SM- health workers do not consider all of the stages of a patient-centred consultation to be applicable and recommend "leapfrogging". On the contrary, SM+ health workers consider all stages to be important and are convinced that the integration of mental health has improved their communication through the training they have received and the practice of caring for persons with mental disorders.

CONCLUSION

The integration of mental health into primary care provision represents an opportunity to improve the quality of care in its "patient-centred care" dimension. That said, optimal development of patient-centred care presupposes favorable structural conditions.

["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.

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

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

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.

Stigma and attitudes towards restrictive practices in psychiatry among psychology students: a network and path analysis study in an Italian sample

Background: People suffering from mental disorders are affected by public stigma in many areas of daily life, including mental health services. Stigma among mental health professionals needs to be addressed.Aims: This study explores the path leading to attitudes toward seclusion and restraint practices among future mental health professionals, considering the complex interplay among demographic variables, personality, stigma, and experience in psychiatric services.Method: Network analysis and Structural Equation Modeling were used to explore 1512 Psychology students. The survey instrument included a form for demographic and academic variables, the Attribution Questionnaire-9, the Ten Items Personality Inventory, and few questions exploring attitudes toward open-door and restraint-free policies in Psychiatry.Results: The personality trait of Openness and previous experience with psychiatric patients resulted to play a positive effect on stigma. Openness was also associated with a better disposition towards restraint-free policies. Conversely, higher levels of stigma predicted a negative attitude toward no restraint, decreasing the positive effect of Openness.Conclusions: In conclusion, some personality traits may be associated with lower levels of stigma and a more open view about treatment policies in Psychiatry. Direct educational or professional experience with patients suffering from mental disorders may be a crucial factor in reducing the risk of stigmatizing attitudes in future professionals.

Stigma Levels Toward Psychiatric Patients Among Medical Students-A Worldwide Online Survey Across 65 Countries

Background: According to epidemiological data, over 450 million people worldwide suffer from mental disorders, presenting one of the major challenges of modern medicine. In their everyday lives, patients, in addition to fighting the disease itself, often struggle with stigmatization. This phenomenon negatively affects both the diagnostic and therapeutic processes, as well as the patients' everyday functioning. This study aimed to assess stigma attitudes toward psychiatry and psychiatric patients among undergraduate medical students. Methods: This study used a Computer-Assisted Web Interview (CAWI), which included the standardized items from the Mental Illness: Clinicians' Attitudes (MICA-2) scale to evaluate stigma. The study was disseminated via the internet to students from medical universities from 65 countries worldwide. Participation was voluntary and anonymous. The study involved 1,216 students from these 65 countries. Most of the sample were women, and most were medical faculty students and students living in cities with more than 500,000 residents. Taking into consideration Gross Domestic Product (GDP) per capita and Human Development Index (HDI) variables, it can be seen that there was a prevalence of medical students from highly developed countries. Results: For the whole sample, the mean MICA-2 score was 40.5 points. Women and medical and nursing students showed more positive attitudes toward psychiatric patients. Students from countries with the highest economic development levels also achieved statistically lower MICA-2 scores. Lower score means a more positive attitude. Conclusion: Stigma toward both psychiatry and psychiatric patients is common among undergraduate medical students. Female students and respondents with a history of mental disorders in countries with high HDI and GDP per capita indices show more favorable attitudes than other medical students. There is a need to further our understanding of the problem of stigmatization, both among the general population and among medical personnel, and to implement and maintain appropriate measures to reduce stigma toward psychiatry.

Medical Students' Career Choice and Attitudes Toward Psychiatry: Case of the Czech Republic

OBJECTIVE

A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry.

METHODS

A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools' internal communication systems in the form of an anonymous online questionnaire.

RESULTS

Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness.

CONCLUSIONS

Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

Australian Junior Doctors' Perspectives on Psychiatry Teaching in Medical School

OBJECTIVE

This research aimed to investigate the perspectives of junior doctors regarding the psychiatry teaching they received in medical school and to ascertain which areas of psychiatry are relevant to practicing junior doctors.

METHODS

In 2017 an online survey was sent to junior doctors affiliated with an Australian public health service. Respondents were asked to rate the degree of preparation their medical school education had provided, in regard to the application of psychiatry knowledge/skills in their practice. Respondents were also asked to specify which psychiatry knowledge/skills were relevant to their practice and how psychiatry teaching in medical school could be improved. Authors generated descriptive statistics for the quantitative data and reviewed the open-ended question data to form themes, guided by the general inductive approach.

RESULTS

The responses of 82 junior doctors were included in the analysis. Over half of the respondents believed that their psychiatry teaching in medical school had prepared them well for their current clinical practice. Responses to open-ended questions noted the following areas of psychiatry as most relevant to practice: delirium, mood disorders, risk assessment, and de-escalation. Respondents emphasized the importance of teaching psychiatry knowledge/skills relevant to the management of patients seen outside of psychiatric units.

CONCLUSIONS

Psychiatry teaching in medical school appears to be providing adequate preparation for most junior doctors. However, there is still significant room for improvement. Changes to the curriculum should be considered, with a greater emphasis on clinically relevant psychiatry knowledge/skills, increased active learning sessions, and a broader range of clinical placements.

Effect of Contact-Based Education on Medical Student Barriers to Treating Severe Mental Illness: a Non-randomized, Controlled Trial

OBJECTIVE

Emerging evidence suggests that contact-based education-learning via structured social interactions designed around intergroup contact theory-could be an important educational adjunct in improving attitudes, beliefs, and behaviors of medical students toward patients with severe mental illness (SMI). However, existing literature in the area lacks structured curriculum, control group designs, or longitudinal analyses. The authors conducted a longitudinal, non-randomized, controlled trial of the National Alliance on Mental Illness (NAMI) Provider Education Program-a 15-h contact-based adjunctive curriculum-on the attitudes, beliefs, and behavior of third-year medical students (MS3) at a single institution.

METHODS

Two-hundred and thirty-one students were invited to participate. Forty-one students elected to complete the curriculum and eighty served as the control group (response rate = 52%). Participants in both conditions completed questionnaires assessing aspects of caring for patients with SMI at pre-test, 1-week post-curriculum, and at 3-month follow-up.

RESULTS

Results indicated that participants in the curriculum reported improved attitudes, beliefs, and behavior in working with SMI as compared with their cohort-matched peers. The majority of these outcomes were maintained at 3-months post-intervention, with effect sizes in the medium to large range. The largest improvement was in behavioral responses to a vignette describing an acute psychiatric emergency.

CONCLUSIONS

The present study provides evidence that a contact-based curriculum leads to improvements in the attitudes, beliefs, and behaviors of MS3 students when offered as an adjunctive program following their first year of clinical rotations.

Evaluation of a virtual agent to train medical students conducting psychiatric interviews for diagnosing major depressive disorders

BACKGROUND

A psychiatric diagnosis involves the physician's ability to create an empathic interaction with the patient in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) can be used to train these skills but need to be evaluated in terms of accuracy, and to be perceived positively by users.

METHODS

We recruited 35 medical students who interacted in a 35-min psychiatric interview with a VP simulating major depressive disorders. Semiology extraction, verbal and non-verbal empathy were measured objectively during the interaction. The students were then debriefed to collect their experience with the VP.

RESULTS

The VP was able to simulate the conduction of a psychiatric interview realistically, and was effective to discriminate students depending on their psychiatric knowledge. Results suggest that students managed to keep an emotional distance during the interview and show the added value of emotion recognition software to measure empathy in psychiatry training. Students provided positive feedback regarding pedagogic usefulness, realism and enjoyment in the interaction.

LIMITATIONS

Our sample was relatively small. As a first prototype, the measures taken by the VP would need improvement (subtler empathic questions, levels of difficulty). The face-tracking technique might induce errors in detecting non-verbal empathy.

CONCLUSION

This study is the first to simulate a realistic psychiatric interview and to measure both skills needed by future psychiatrists: semiology extraction and empathic communication. Results provide evidence that VPs are acceptable by medical students, and highlight their relevance to complement existing training and evaluation tools in the field of affective disorders.

Empathy, Experience and Cultural Beliefs Determine the Attitudes Towards Depression Among Pakistani Medical Students

The educated echelons of the Pakistani society as well as the medical fraternity have consistently reported poor knowledge of mental illnesses in past surveys. This poor knowledge further translates into poorer attitudes toward psychiatric patients in Pakistani hospitals. However, a paucity of data on predictors of attitude toward depression among Pakistani medical students, warrants further in depth investigations. This cross-sectional study was conducted in two medical colleges in the province of Punjab, Pakistan from January to July 2017. The data were collected conveniently, using a self-administered questionnaire comprising of five parts: (a) demographics, (b) a dichotomous (yes/no) scale exploring biological, psychosocial and religio-magical beliefs about causation of depression, (c) a dichotomous scale (yes/no) assessing knowledge regarding symptomatology of depression, (d) the revised depression attitude questionnaire, (e) Toronto empathy questionnaire. There were a total of 674 respondents. Students with an A-levels/high school diploma, urban background, and aspiration for a career in psychiatry, high empathy levels and endorsement of typical and atypical symptoms of psychiatry had more positive attitudes towards depression. Negative attitudes toward depression were associated with belief in religio-magical causes and false symptoms of depression. Attitude toward depression among Pakistani medical students are shaped by several modifiable and non-modifiable factors. Modifiable factors including exposure toward mentally ill patients and knowledge of depression can be mitigated by in-depth clerkship training in psychiatry.

Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

BACKGROUND

Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians' negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians' decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient.

METHODS

A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia).

RESULTS

A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p <  0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p <  0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians.

CONCLUSIONS

Additional background information on past medical history of schizophrenia increased physicians' mistakes in decision making. Patients' psychiatric backgrounds should not bias physicians' decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

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

OBJECTIVE

The purpose of this study was to assess if having completed a psychiatric clerkship or having increased exposure to mental illness in general was associated with reduced explicit and implicit stigmatizing attitudes towards mental illness in undergraduate medical students.

METHODS

A secondary analysis of data specific to medical students from McMaster University was completed. Data were obtained through a cross-sectional survey administered electronically. It consisted of a demographic questionnaire, the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, and an Implicit Association Test (IAT). The OMS-HC was used as a measure of explicit stigmatizing attitudes, whereas the IAT was used as a measure of implicit bias. All analyses were completed using Stata/IC 15 and were two-tailed with significance defined as p < 0.05.

RESULTS

Individuals that self-reported either having had a mental illness or diagnosis by a health care professional had significantly lower levels of explicit stigma. Final-year medical students had significantly lower levels of implicit stigmatizing attitudes than first-year medical students. Neither having completed a psychiatric clerkship nor having a close relationship with someone experiencing a mental illness was significantly associated with the explicit or implicit stigmatizing attitudes of medical students.

CONCLUSION

More years in medical school and self-identifying or receiving a diagnosis of mental illness are associated with reduced stigmatizing attitudes, whereas having completed the psychiatric clerkship and having a close relationship with an individual experiencing mental illness were not. This study suggests that the psychiatric clerkship may have limited impact on the stigmatizing attitudes of medical students.

Attitudes of participants of master degree in family medicine in Gezira University, Sudan towards Psychiatry: A vision to sustain continuous gain

Introduction:

Family medicine physicians are first contact of patients in the community and their role in treating mental health is highly recommended. The aim of the current study is to assess attitudes towards psychiatry among doctors enrolled in master degree in family medicine in Gezira University before and after training in psychiatry.

Methods:

This study was a quantitative cross-sectional study with two stages – pre- and post-psychiatry training. It has included one batch of master students of family medicine at Gezira University, Sudan. The whole master program lasts for 18 months, of which 3 weeks are dedicated to psychiatry training. All students in the batch were invited to participate in both stages – before and after psychiatric training.

Result:

31 students participated in the study, 35.5% of them were males (N = 11). Mean age was 39.4 (SD ± 5.34) and mean number of years after graduation was 13.3 (SD ± 4.96). 26 students (83.9%) earned Attitudes Toward Psychiatry (ATP) scores >90, which indicates a positive attitude. The ATP mean score for all participants was 104.26 (SD ± 12.56). The least score was 79 while the maximum was 130. Doctors’ attitudes toward psychiatry became more positive after psychiatric training and this difference was statistically significant (P value = 0.038) and this was found to be statistically significant only among participants below age of 40 years and those who have been graduated less than 15 years ago.

Conclusion:

Psychiatric training for family physicians in training was associated with significant improvement in attitudes towards psychiatry.

Um estudo longitudinal sobre a influência do internato em saúde mental na redução de atitudes negativas de estudantes de Medicina em relação a portadores de transtornos mentais

RESUMO Objetivo Avaliar o efeito do internato em saúde mental nas atitudes dos alunos de medicina quanto ao portador de transtorno mental (PTM). Métodos Atitudes foram avaliadas por questionário antes e depois do internato, por meio dos fatores: “aceitação social de PTM” (F1), “não acreditar em causas sobrenaturais para doença mental” (F2), “papéis sociais comuns para PTM” (F3), “acreditar em causas psicossociais para doença mental” (F4), “intimidade” (F5). Diferenças foram avaliadas por meio de testes t, fatores confundidores por ANOVA e correlações entre expectativa de melhora e fatores por Pearson. Resultados 74 de 85 alunos responderam ao questionário. Houve redução significativa em quatro fatores avaliados (F1, p < 0,001, F2, p = 0,002, F3, p = 0,04, F5, p < 0,001). Uma associação entre ter um amigo PTM e F3 foi identificada antes do curso (p = 0,04), porém não após (p = 0,13). Houve correlação positiva entre crenças de melhora e atitudes negativas com o F2 antes do curso (p = 0,01), mas não após. F5 esteve relacionado com a expectativa de melhora (p < 0,001) após o curso, indicando melhores atitudes quando melhor expectativa. Observou-se a melhora da expectativa quanto a resposta ao tratamento da esquizofrenia (p = 0,02), transtorno bipolar (p = 0,03) e transtorno de ansiedade (p = 0,03). Conclusões O internato esteve associado à redução de atitudes negativas com relação aos PTMs. O contato direto com o paciente parece ter influência direta nessa redução. Acreditamos que, mais importante do que possíveis efeitos de esclarecimento sobre causas do adoecimento, a desconstrução do mito sobre o louco violento é essencial para a melhora das atitudes. Estudos com populações de outras regiões do Brasil e voltadas para avaliação do medo de violência são necessários para a confirmação dessa hipótese e do efeito do internato sobre os alunos.

Impact of clinical posting in psychiatry on the attitudes towards psychiatry and mental illness in undergraduate medical students

Background

A major public health problem around the world today is mental illness. Although there are several studies on the topic, it is rarely conducted in the context like the current study.

Aims

This study aims to find out the attitudes of medical students towards psychiatry and mental illness as a clinical medicine major and evaluate the effects of clinical posting on their attitudes towards psychiatry and mental illness.

Methods

This is a longitudinal study of 6 months’ duration conducted with students in their fifth semester of medical college in Western India during the academic year of 2016–2017. The participants were assessed by pro forma containing demographic details, and the questionnaires—Attitude Towards Psychiatry-30 items (ATP-30) scale and Mental Illness Clinician’s Attitude (MICA) scale, which were presented to the students at the beginning and at the end of their psychiatry clinical posting. The statistical analysis was done with GraphPad, InStat V.3.06. A p value <0.05 was considered statistically significant.

Results

The students’ attitudes towards psychiatry were neutral at the beginning of the psychiatry clinical posting, and improved significantly at the end of the posting on both scales: ATP-30 (p=0.002) and MICA (p=0.048). The students became more positive towards the subject and mental illness in general, negative attitudes also reduced but the change was not statistically significant (p=0.058). We found significant improvement in students’ thinking towards being a psychiatrist in the future post-term (p=0.0002). The changes in attitude in terms of gender were equivocal, with an increase in positive attitude and reduction in negative attitude post-term in both sexes.

Conclusion

Psychiatry clinical posting aids in cultivating positive attitude towards psychiatry and mental illness and reduces the stigma associated with the students of this major and psychiatric patients.

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.

Stigma in health facilities: why it matters and how we can change it

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

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.

[Stigmatisation of mental illness by medical students in Conakry, Guinea]

INTRODUCTION

Stigmatisation of mental illness constitutes a major problem in the development of mental healthcare programs, especially when it originates from health professionals themselves. The aim of this research is to investigate possible attitudes of stigmatisation among first and final year medical students registered at the University of Conakry faculty of medicine in Guinea-Conakry (West Africa).

METHODS

Focus group discussions identified students' attitudes and perceptions in relation to mental illness, their explanatory models, their opinions concerning traditional and modern therapeutic practices with regard to mental illness, and their interest to possibly incorporate psychiatry in their future medical practice.

RESULTS

Many students explicitly regret the stigmatisation of mental health patients, but nevertheless share the general population's prevailing attitudes of discrimination. The dominant stereotype of mental illness is that of madness, although final year medical students describe a more diverse spectrum of mental health problems. There is strong adherence to secular occult explanations of mental illness and advocacy for traditional medicine in addressing these illnesses, including among final year medical students.

DISCUSSION

No student would opt for psychiatry as a specialisation, although some expressed interest in integrating psychiatry into their future medical practice. However, this research indicates that stigmatising attitudes are not cut in stone. Under the impetus of specific teaching programmes, attitudes can evolve to create room for tolerance and compassion.

The influence of clerkship on students' stigma towards mental illness: a meta-analysis

CONTEXT

In university programmes preparing students to work with patients with mental illness, clerkship is proposed as a component that may contribute to the battle against stigma, through bringing students into contact with the patients' reality. Yet, the precise contribution of clerkship remains unclear, perhaps because of the variety of university programmes, clerkship characteristics or types of stigma explored. This is the first systematic meta-analysis of available evidence determining the precise effect size of the influence of clerkship on stigma and the potential moderators.

METHODS

We carried out a systematic literature review in Eric, PsycINFO, Pubmed, Scopus, UMI and Proquest dissertations, aiming to identify all the studies exploring health care students' stigma of mental illness (measured as overall stigma or as attitudes, affect and behavioural intentions) before and after a clerkship from 2000 to 2017. Twenty-two studies were included in the meta-analysis, providing data from 22 independent samples. The total sample consisted of 3161 students. The effects of programme (medicine, nursing, occupational therapy, and their combination), study design (paired-unpaired samples), publication year, sex, age and clerkship context, and inclusion of theoretical training and duration, were examined as potential moderators.

RESULTS

Our analyses yielded a highly significant medium effect size for overall stigma (Hedge's g = 0.35; p < 0.001; 95% confidence interval [CI], 0.20, 0.42), attitudes (Hedge's g = 0.308; p = 0.003; 95% CI, 0.10, 0.51) and behavioural intentions (Hedge's g = 0.247; p < 0.001; 95% CI, 0.17, 0.33), indicating a considerable change, whereas there was no significant change in the students' affect. Moderator analyses provided evidence for the distinct nature of each stigma outcome, as they were influenced by different clerkship and student characteristics such as clerkship context, theoretical training, age and sex.

CONCLUSIONS

The robust effect of clerkship on students' stigma of mental illness established by the present meta-analysis highlights its role as a crucial curriculum component for experiential learning and as a necessary agent for the battle against stigma.