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Factors that discourage medical students from pursuing a career in psychiatry

  • Marie T. Curtis-Barton (a1) and John M. Eagles (a2)
Abstract
Aims and method

This cross-sectional study investigated the evolution of intentions among medical students to pursue a career in psychiatry and the factors that might discourage them from becoming a psychiatrist. A questionnaire survey was sent to medical students in years 1–5 at Aberdeen University.

Results

From 918 students, 467 (51%) returned useable responses. Proportions of students across the 5-year groups who definitely or probably intended to become psychiatrists remained fairly stable at 4–7%. In their final year, psychiatry remained a possible career option for a further 17% of students. The most potent discouraging factor was the perception of poor prognoses among psychiatric patients. Perceptions of a lack of scientific/evidence base reduced enthusiasm for becoming a psychiatrist. Issues relating to the prestige of the specialty were also important.

Implications

If recruitment to the specialty is to improve, these negative perceptions among students should be addressed by their teachers and more widely within psychiatry.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
John M. Eagles (john.eagles@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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Factors that discourage medical students from pursuing a career in psychiatry

  • Marie T. Curtis-Barton (a1) and John M. Eagles (a2)
Submit a response

eLetters

Medical students and a career in psychiatry: A discussion

N Barry, FY2 Doctor in Psychiatry
07 December 2011

Sorting out the factors influencing medical students decisions about a career in psychiatry is clearly a difficult task.The importance of overcoming the negative perceptions of the speciality is a one vital aspect that needs to be addressed (1). A multitude of other issues need to be considered. Undergraduate medical training places great emphasisis on medicine and surgery. Psychiatry, in our opinion, is not viewed as medicine because it basically forces students to relinquish those skills which take years to develop and which are so heavily emphasized in assessments, for example practical procedures and physical examination. These skills equate with being a good doctor whereas the focus on psycho-social issues makes psychiatrists appear as less than real doctors.

Some medical schools ignore psychiatry until the later years, making it an add-on specialty rather than a core part of our thinking about what medicine really is. Some do all their psychiatry in six or eight weeks in the pre-final or final years. This is really like a drop in the ocean of the five to six year course. Some schools have incorporated the bio-psycho-social model into every area in a so-called spiral learning model; this may change students' attitudes.

Liaison psychiatry which is probably the psychiatric specialty with most overlaps and interacts with other specialties is noticeable by its absence in hospitals. The occasional patient with a psychiatric problem on the acute wards is often treated with little interest or enthusiasm by themedical or surgical teams. Referral is often made to psychiatry without any attempt to assess or manage the problem by the patient's team. This lack of enthusiasmdefinitely filters down to the students.

Comparing attitudes to psychiatry in different medical schools before and after the first year of exposure, as well as the length of psychiatricattachment might be useful. The latter is important because students' exposure to specialties is often too brief. A 4-week attachment is long enoughto observe a recovery from pneumonia, but not usually long enough for a depressive episode that has required hospital admission. Posting students in one psychiatric unit for the whole six to eight weeks may be better than one or two week postings to four or five different specialist teams. Students are often discouraged to be hands-on on psychiatric wards. This leads to less engagement than in say, an A&E post where they feel valued as a doctor-to-be.

Approach to diagnosis is important; students are often dismayed by the overlap of symptoms across psychiatric disorders and probably even more by psychiatrists appearing to not adhere to specific criteria when making diagnoses. Often, students are told that a patient has a particular diagnosis without explaining why.Trainers could easily remedy this.

Furthermore, psychiatrists are fairly vocal about psychiatric disorders being ultimately incurable. Even though,many physical disorders such as diabetes, hypertension, asthma and psoriasis are chronic and incurable, the physicians speak more about what they can improve than what they cannot. Focus on improving patient's quality of life and returning their ability to function is often not as obvious in psychiatry as in other specialties. While other specialists gain a sense of achievement from tangible results and high impact outcomes, psychiatrists deal with less clear cut multi-factorial aetiologyand less measurable outcomes.

An issue that students may feel uncomfortable with is that psychiatrists enforce treatments on patients against their will. This contradicts the notion of the caring profession. Having seen how appreciative patients are of the work of the other specialists, a specialty where patients hate you for acting in their best interests can be very unattractive. The Mental Health Act and the role of the review tribunals is often not adequately explained to students with tribunals seeming to treat psychiatrists as villains who incarcerate vulnerable patients.

Further, while most doctors are concerned about making patients better, psychiatrists seem over preoccupied with the issue of risk rather than the idea of actually making patients better.

It seems that they accept the blame when their attempts to treat patients fail whereas no other specialty seems to hold such unscientific beliefs or take responsibility for natural outcomes of illnesses they treat. Similarly in no other specialty are negative outcomes so widely publicised e.g. the 50 year old obese diabetic smoker who has a heart attack. The risk of adverse publicity discourages students from choosing psychiatry. It ismore appealing to be viewed as a saver.

Overall we might improve interest in and recruitment into psychiatry by posting medical students in psychiatry earlier in their training, offering longer postings, exposing them to specialties which interact mostwith medicine e.g. old-age psychiatry, giving them opportunity to see patients on acute hospital wards and in crisis e.g. A&E, Crisis Teams, andto follow-up patients into recovery.

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Conflict of interest: None declared

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