Medical students and psychiatry: an attitude change?

Patients' Attitudes Towards Medical Student Presence in Psychiatric Consultations

OBJECTIVES

Studies on patient-student relationships have to date largely focused on student attitudes. This study explores attitudes of patients with psychiatric illness in Ireland, towards medical students. Patients' experience of consent for student involvement is an area of concern in previous studies and is also quantified here.

METHODS

This was a mixed-methods cross-sectional survey of Irish adult psychiatric patients. Quantitative analysis was carried out using SPSS 22 (Statistical Product and Service Solutions, Version 22, IBM). Differences on Likert score between groups (male/female, hospital site, past experience with students/ no experience) were analysed using ordinal logistic regression with a p-value below 0.05 being significant. Qualitative data were analysed by thematic analysis using OpenCode 4.03.

RESULTS

A total of 340 patients completed the survey. The mean age (sd) was 44.8 (16.3). 52.8% were female, 75.2% were outpatients. 24.3% had never met a medical student. Most patients were comfortable seeing students, but preferred students being passive observers. Patients with previous student experience had higher comfort levels and more positive attitudes. Although most patients (63.7%) strongly agreed they had been asked for consent, only 49.3% felt they had been given sufficient information. Qualitative data revealed preference for adequate information and notice of involvement. Patients felt pressured by student presence in certain circumstances.

CONCLUSIONS

Psychiatric patients are comfortable with students but many feel inadequately informed. Patients recognise the benefits of interacting with students. More information is needed regarding circumstances in which patients give consent to involvement with students.

Attitudes and Confidence in the Integration of Psychiatry Scale

OBJECTIVE

The authors sought to measure attitudes and confidence in the integration of psychiatry into other fields of medicine.

METHODS

The Attitudes and Confidence in Integration of Psychiatry in Medicine (ACIP) scale was developed through discussion with content experts across disciplines and pilot testing of items and administered to third- and fourth-year medical students at University of Iowa, University of Michigan, Rush University for validation, focused on assessment of variability, internal consistency, factor structure, and test-retest reliability.

RESULTS

A total of 310 medical students completed the survey (35% participation rate). The scale had a high internal consistency (Cronbach's alpha = 0.88) and was without ceiling or floor effects. Students rated the integration of psychiatry into the practice of surgery and its subspecialties as less relevant than its integration into other specialties; however, scores were not biased by students' interest in procedural vs. non-procedural specialties. Test-retest reliability was high (Cronbach's alpha = 0.90).

CONCLUSIONS

The ACIP may serve a useful role in determining the outcome of educational efforts toward integrated care.

Psychiatry career in Brazil: regional disparities, differences and similarities in an international context

This review explores the literature related to career choice of psychiatry in Brazil through selection of scientific articles published in the period from 1999 to 2013 in the MEDLINE and SciELO databases. There are currently 145 medical schools in Brazil, the highest concentration being in the more developed areas. In 2005, there were 6,003 psychiatrists working in Brazil, a rate of 3.3 psychiatrists per 100,000 inhabitants, with unequal distribution across the geographical regions of the country: a rate of 4.5 psychiatrists/100,000 inhabitants in the southern region, and less than one psychiatrist per 100,000 inhabitants in the northern region. The south and south-east regions comprise 56% of the national population and 76% of the residency posts in psychiatry. In 2013, 27% of the residency posts in psychiatry were not filled, particularly in the north and north-east areas, where the shortage of professionals is more pronounced. The number of specialized doctors is far below what is needed to cover the burden attributed to neuropsychiatric disorders in the country. The main hypotheses to explain this imbalance in Brazil are the relatively low exposure to the speciality during undergraduate course work, the stigma attached to mental disorders, and the poor organization of mental healthcare services.