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

Pharmacy student attitudes to mental illness and the provision of mental health care: a repeated cross-sectional survey

BACKGROUND

Attitudes to mental illness are an important factor in the willingness of professionals to engage in mental health care.

AIM

The aim of this study was to understand attitudes of undergraduate pharmacy students in Ireland to severe mental illness and the provision of medicines optimisation services as well as the variation in these attitudes throughout the undergraduate course.

METHOD

A survey instrument was compiled using existing published research and validated questionnaires. The survey was distributed to students in their first, third and Master of Pharmacy years annually between 2014 and 2019. Although designed as a longitudinal study, following the matching process there were a limited number of students who completed more than one survey and therefore data were treated as independent samples.

RESULTS

The overall average response rate was 25% per survey (n = 191 participants) Notwithstanding generally positive attitudes, a sizeable proportion of students felt people with severe depression and schizophrenia were hard to talk to (n = 48, 25.3%; n = 54, 29.2%) Less than half of MPharm students expressed confidence and competence in caring for people with more severe mental illnesses such as bipolar disorder and schizophrenia and 29% (n = 60) of students would feel awkward asking someone about their antipsychotic medication. Almost two thirds (n = 120, 63.8%) expressed an interest in a career in mental health.

CONCLUSION

Irish pharmacy students have generally positive attitudes towards people with severe mental illness and provision of medicines optimisation services. There is an opportunity to improve pharmacy graduates perceived competence and confidence to provide mental health services.

Inter-relationships between perception of educational environment and learning processes within medical undergraduate psychiatry teaching: a mediational analysis

Amongst medical undergraduates, the perception of educational environment (EE) has been associated with academic achievement and positive attitude toward the course. Nonetheless, there are sparse data on how it influences various learning processes and outcomes especially within psychiatry training. Consistent with situativity and self-determination learning theories, we hypothesized that a positive perception of the EE within psychiatry postings will be beneficial for the learning process, specifically pertaining to greater motivation to learn, better engagement, allowing them to feel more equipped, and greater appreciation of the subject. The DREEM (Dundee Ready Education Environment Measure) was administered to fourth-year medical undergraduate students from the Yong Loo Lin School of Medicine, Singapore, undergoing psychiatry rotations from 2015 to 2019. The students also completed five additional items evaluating the specific learning processes (motivation to learn, engagement, equipping, and appreciation of the subject) and overall rating of the posting. We examined the relationship between DREEM domains and learning processes using correlation analysis. We explored learning processes as mediators of the relationship between total DREEM scores and overall rating of the posting. Altogether, 1343 (response rate 89.5%) medical undergraduates participated in the study. The overall DREEM score was 157.01 ± 15.86. Overall DREEM and subdomain scores were significantly correlated with several learning processes (r = 0.354 to 0.558, all p < .001). Motivation and engagement were significant mediators of the relationship between total DREEM scores and overall rating of the psychiatry posting. Our results highlighted that a positive perception of EE was associated with the specific learning processes that mediated the overall rating of the posting. In the context of relevant learning theories and our study findings, improvement of the EE within undergraduate psychiatry training can potentially enhance overall learning experience through better motivation and engagement of our learners.

Medical students' experiences in learning the Mental State Examination with standardized patients

INTRODUCTION

Standardized patients are widely used in psychiatry teaching and examinations, but their effectiveness in teaching psychopathology and the Mental State Examination in particular has not been established. A mixed-methods study was undertaken amongst fourth year medical students during a psychiatry rotation to explore the usefulness of learning the Mental State Examination with standardized patients compared with real patients.

METHODS

Qualitative semistructured interviews (N = 10) were done to explore learning experiences with standardized patients. The Experience with Standardized Patients Scale was used (N = 200) for the quantitative assessment in relation to examination performance and learning experience.

RESULTS

In qualitative interviews, the common themes were that the experience with standardized patients was not natural and made it difficult to suspend disbelief, but students recognized the usefulness of standardized patients for practicing their skills. While there was no significant relationship between overall student experiences with standardized patients and their examination performance in the end-of-rotation Observed Standardized Clinical Examination (P = .40), the exception was with those who perceived they learnt more communication skills with standardized patients (P = .002). Students' experience with standardized patients role-playing psychotic disorders was poorest compared with standardized patients role-playing depressive and neurotic disorders. There were statistically significant differences in experiences between the three diagnostic groups.

DISCUSSION

Standardized patients are useful in psychiatry for students to practice and improve their skills in eliciting psychopathology. However, attention to the training and selection of these individuals for psychiatric roles are crucial.

Evaluating the educational environment in a residency programme in Singapore: can we help reduce burnout rates?

INTRODUCTION

The educational environment (EE) reflects the quality of a residency programme and has an association with burnout. Studying the EE allows for interventions to target specific weaknesses. We aimed to measure the EE of an internal medicine residency programme in Singapore, compare the perceptions between genders, residency grades and levels of work experience, and identify specific areas of weaknesses for intervention in hopes of reducing residency burnout rates in Singapore.

METHODS

This study took place between October and December 2017. We adopted a mixed methods approach, quantitatively using the Postgraduate Hospital Educational Environment Measure (PHEEM), and qualitative exploration using semi-structured focus group discussion.

RESULTS

A total of 136 (88.9%) out of 153 residents responded. Our total PHEEM scores (112.23 ± 16.71), along with the scores for all three subscales, were higher than those of institutions in previous studies. There were no differences in overall PHEEM and subscale scores between genders, residency grades or levels of work experience. However, there were differences for individual questions, which were explored in the focus group discussion. Senior residents juggling heavier workloads, responsibilities and examinations appeared to be most prone to burnout. We identified three recurring themes that contributed to a poor EE in our programme: excessive workload, poor faculty relationships and differing unmet needs.

CONCLUSION

Although our programme had a good EE, there were also areas of weaknesses revealed by specific questions, possibly contributing to burnout. We hope to implement interventions to these areas and subsequently assess for longitudinal changes in EE and burnout rates.

Can curriculum design influence medical students' attitudes to psychiatry? A comparison of two different approaches

Medical students with poor attitudes toward psychiatry are unlikely to choose it as a career, and current psychiatry recruitment is inadequate for future NHS needs. Amending medical school curricula has been suggested as one solution. We performed a unique naturalistic mixed-methods cross-sectional survey of two sequential cohorts in a UK medical school, before and after the restructuring of the entire MBChB curriculum. As well as increasing integration with other specialties, the emphasis placed on psychiatry increased throughout the course, but the final psychiatry block reduced from 8 to 6 weeks. Students experiencing the refreshed curriculum had better attitudes to psychiatry and psychiatric patients and were more positive about psychiatry as a career for themselves and others, compared to students on the old curriculum. This was demonstrated both quantitatively using validated rating scales (12/30 questions ATP-30 and 1/6 questions PEAK-6) and qualitatively using free-text responses. Restructuring undergraduate medical curricula to enhance integration may yield added value, including the potential to improve attitudes to specialties previously learned in silos, such as psychiatry. This may improve recruitment and the understanding of mental health for all future doctors.

Learning environment, stress and coping in psychiatry residents within a national training program: a longitudinal study

INTRODUCTION

Perception of one's learning environment is associated with academic performance and well-being of medical students. Yet, few studies have explored learners' perceptions and their correlates within a postgraduate environment. This study examined longitudinal changes in learning environment perception, perceived stress and coping for psychiatry residents in junior and senior years of training. Based on extant social learning theories, we hypothesized that learning environment perceptions will improve with seniority, and be accompanied by lower stress levels and better coping.

METHODS

Eighty-two out of 101 psychiatry residents (81.2%) from our National Psychiatry Residency Program rated their perception of learning environment, perceived stress, and coping strategies from June 2016 to June 2018. Correlations between these variables, and changes across five timepoints were examined.

RESULTS

Senior-year residents reported better perception of learning environment over time, together with increased use of problem-focused coping and lowered perceived stress levels. Junior-year residents reported no changes in learning environment perception and coping strategies, despite rating greater perceived stress levels over time. Perception of learning environment negatively correlated with perceived stress levels and specific coping strategies.

DISCUSSION

Based on these findings, we suggest specific strategies with the emphasis on context, participation, and social interaction within a community of practice to better support residents in training, which are applicable to other similar training programs.

Impact of Experience-Based, Longitudinal Psychiatry Training on Family Medicine Residents' Attitudes Toward Depression and Psychiatry in Singapore: a Prospective Study

OBJECTIVES

The primary aim of this study was to evaluate the impact of an experience-based, longitudinal psychiatry training program in a Family Medicine residency on residents' attitudes toward depression and psychiatry. The secondary aim was to identify background predictor variables of changes in attitudes.

METHODS

Pre- and post-training surveys were prospectively conducted on attitudes toward depression and psychiatry on Family Medicine residents undergoing an experience-based, longitudinal psychiatry training program. The primary outcome measures were pre- and post-training Depression Attitude Questionnaire (DAQ) and Modified Attitudes to Psychiatry Scale (mAPS) scores. Regression analysis was carried out to determine background variables predictive of improvement in DAQ and/or mAPS scores post-training.

RESULTS

Sixty-three Family Medicine residents (100% response rate) responded to the pre-training surveys. All 63 subjects completed the post-training surveys (100% retention rate). There was significant improvement in DAQ and mAPS scores post-training, indicating better attitudes toward depression and psychiatry. Significant improvement was observed in 8 out of 13 DAQ items and 3 out of 4 mAPS domains. Regression models showed having a previous 3-month elective psychiatry inpatient posting was a predictor of less improvement in mAPS scores.

CONCLUSIONS

Our experience-based, longitudinal psychiatry training program significantly improved Family Medicine residents' attitudes toward depression and psychiatry. Experiential and situated learning in communities of practice, as well as educational continuity with longitudinal supervision, coaching, and modeling may have contributed to this improvement.

Adoption and correlates of the Dundee Ready Educational Environment Measure (DREEM) in the evaluation of undergraduate learning environments - a systematic review

BACKGROUND

The Dundee Ready Educational Environment Measure (DREEM) was specifically designed to measure the undergraduate medical educational environment. This study seeks to review the adoption of DREEM internationally, and its association with different learning contexts and learner factors in order to better support our learners and facilitate future applications and research.

METHOD

A systematic literature review was conducted on all articles that adopted and reported data using the DREEM from 1997 to April 2017.

RESULTS

Overall, the majority of 106 included studies from over 30 countries were conducted in Asia and Europe (76.4% of studies) within medical, dental, and nursing programs (86.8% of studies). Seventy-nine out of 98 studies (80.6%) which reported DREEM scores observed a mean total DREEM score within the range of "more positive than negative" (101-150 out of maximum 200 points). Higher DREEM scores were associated with better past academic achievement, quality of life, resilience, positive attitudes towards course, mindfulness, preparedness for practice, less psychological distress, and greater peer support.

CONCLUSIONS

Future studies may want to examine other correlates of DREEM such as coping styles, personality profiles, burnout level, and DREEM scores can be incorporated into reviews of learning environments to ascertain longitudinal changes following educational interventions.

Interventions Designed to Improve the Learning Environment in the Health Professions: A Scoping Review

This article was migrated. The article was marked as recommended. Purpose: To identify and describe interventions designed to affect the learning environment (LE) in health professions education, summarize factors that influence the LE, and determine gaps that require additional research. The LE can be thought of as a dynamic and complex construct co-created by people in a particular setting. A positive LE represents a welcoming climate for learning, which enhances satisfaction, well-being, academic performance and collaboration, while a negative LE restricts participation and learning, leading to emotional exhaustion, depersonalization and burnout. Method: A six-step scoping review methodology was followed to identify and report on literature that describes interventions affecting the LE in the health professions education: 1. Identify the research question, 2. Identify relevant studies, 3. Select studies to be included, 4. Chart the data, 5. Collate, summarize and report results, and 6. Consult with stakeholders. Results: 2,201 unique citations were identified and reviewed using titles and abstracts. 240 full-text articles were retained for detailed review, resulting in the inclusion of 68 articles. Study results are reported in relation to essential components of the LE: personal, social, organizational, physical and virtual spaces. Results of four different types to the studies of the LE are described: specific interventionsimpacting the LE, comparisonsof perceptions of the LE by two or more different groups, associations with other variable such as well-being with the LE, and descriptivestudies of the LE. Major influences included accreditation regulations, curricular interventions, faculty/staff development grading practices, instructional interventions, placements, physical and virtual spaces, and support services; and are reported along with specific interventions. Conclusion: These results reflect the complexity of the LE and the need for conceptual clarity. Since the quality of the evidence was not evaluated, the identified influences should be viewed as potential opportunities to improve the LE.

Relationships between optimism, educational environment, career adaptability and career motivation in nursing undergraduates: A cross-sectional study

BACKGROUND

For solving the problem of the abandonment of the career in nursing undergraduates, it is important to understand their motivation to choose nursing as a career and its associated personal and situational factors.

OBJECTIVES

To examine the relationships between optimism, educational environment, career adaptability, and career motivation in nursing undergraduates using the career construction model of adaptation.

DESIGN

This study adopted a cross-sectional design.

PARTICIPANTS AND METHODS

A convenience sample of 1060 nursing undergraduates from three universities completed questionnaires for measuring optimism, educational environment, career adaptability, and career motivation. Confirmatory factor analyses, descriptive analyses, comparison analyses, correlation analyses, and mediation analyses were performed accordingly.

RESULTS

Nursing undergraduates' career motivation was positively correlated with their career adaptability (r = 0.41, P < 0.01), the educational environment (r = 0.60, P < 0.01), and optimism (r = 0.26, P < 0.01). In addition, the effects of optimism and educational environment on career motivation were partially mediated by career adaptability in nursing undergraduates.

CONCLUSIONS

In nursing undergraduates, the educational environment had a relatively strong positive association with career motivation, while optimism had a weak one. Career adaptability played a mediating role in the relationships. Targeted interventions may improve nursing undergraduates' career motivation.

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

OBJECTIVES

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

DESIGN

Cross-sectional online study.

PARTICIPANTS

502 medical students from two public medical institutions in Singapore.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Stigmatization towards the mentally ill: Perceptions of psychiatrists, pre-clinical and post-clinical rotation medical students

BACKGROUND

Stigma towards the mentally ill is a well-known phenomenon and it is not restricted to certain communities or countries. Stigma, be it self-stigma or public stigma, has a major influence in mental health care.

AIM

The aim of this study was to determine whether stigmatizing attitudes towards the mentally ill differ according to the level of knowledge about psychiatric illnesses and whether the level of exposure towards the mentally ill plays a role in stigmatizing attitudes.

METHOD

This study was carried out by assessing psychiatrists ( n = 68), pre-clinical ( n = 194) and post-clinical ( n = 354) medical students' attitudes towards the mentally ill using the Mental Illness: Clinicians' Attitudes (MICA) scale. The scale is scored on a Likert scale with higher scores indicating higher levels of stigmatization.

RESULTS

Participants in the three groups had statistical significant different levels of stigma with a decline in scores as you are more exposed to psychiatry. Familiarity with mental illness was associated with less stigma. Participants who had friends or family members who suffered from mental illness or they themselves suffered from a mental illness had less stigma.

CONCLUSION

More exposure to mental health-related issues are needed not only in communities but also in medical schools. Medical students need to be targeted for educational intervention because they are the future doctors who might pursue psychiatry as their field of choice. Stigma against psychiatry as a medical profession should also be addressed. If psychiatry is to be respected as a medical profession, mental illness-related stigma interventions need to be put in place to raise awareness about the negative impact of stigma.

Building Beautiful Minds: Teaching Through Movies to Tackle Stigma in Psychology Students in the UAE

OBJECTIVE

The use of movie-based educational interventions has been used widely and is considered an effective method aiming at changing the stigmatizing attitudes of future mental health professionals. The purpose of this study was to examine the effectiveness of a 10-week intervention that combined movies and related discussions in a sample of 26 psychology students in the United Arab Emirates, where the opportunities for real contact with patients with mental illness are limited.

METHODS

By means of mixed methods approach, students were assessed at two time points by the Opening Minds Stigma Scale for Health Care Providers [OMS-HC] (T1-T2) and by qualitative questions only at the end of the intervention (T2).

RESULTS

The results corroborated changes to some of the students' attitudes, namely agency, compassion, and proximity, but did not prove a general attitudinal change. Additionally, students acknowledged the benefit obtained by their participation with regard to their learning experience, pointing out the importance of combining theory with practical examples of mental illness for spreading awareness and tackling stigma.

CONCLUSION

The results are discussed in the light of their importance for the United Arab Emirates educational context.

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

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