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Qualitative study of medical students' experiences of a psychiatric attachment

  • Claire Archdall (a1), Tanya Atapattu (a1) and Elizabeth Anderson (a2)
Abstract
Aims and method

This study utilised qualitative methods to explore medical students' experiences of a clinical attachment in psychiatry and examine the impact of these on career intentions. Fifteen 4th-year students from the University of Bristol were interviewed and their responses analysed.

Results

Four key themes of role models, difference, stigma and career choice emerged from the analysis. Role models could be more influential than the specialty when choosing career options. Many students experienced psychiatry as being different to other specialties. For some this was a reason not to pursue psychiatry as a career but for others it was a positive aspect of the specialty. Stigma arose from a variety of sources, notably from medical students themselves.

Clinical implications

These findings are relevant given the current recruitment problems in psychiatry and need to be considered in the planning and delivery of undergraduate medical education.

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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
Claire Archdall (clairearchdall@hotmail.com)
Footnotes
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This is one of a series of papers on recruitment in psychiatry. See also pp. 25–29 and pp. 30–32, this issue. Additional papers on this topic are due for publication in the February issue.

Declaration of interest

None.

Footnotes
References
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1 Wigney, T, Parker, G. Factors encouraging medical students to a career in psychiatry: qualitative analysis. Aust N Z J Psychiatry 2008; 42: 520–5.
2 Glynn, S, Reilly, M, Avalos, G, Mannion, L, Carney, PA. Attitudinal change toward psychiatry during undergraduate medical training in Ireland. Ir J Psychol Med 2006; 23: 131–3.
3 McParland, M, Noble, I, Livingstone, G, McManus, C. The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career. Med Educ 2003; 37: 447–54.
4 Singh, SP, Baxter, H, Standen, P, Duggan, C. Changing the attitudes of tomorrow's doctors towards mental illness and psychiatry: a comparison of two teaching methods. Med Educ 1998; 32: 115–20.
5 Baxter, H, Singh, SP, Standen, P, Duggan, C. The attitudes of tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year. Med Educ 2001; 35: 381–3.
6 Wright, S, Wong, A, Newill, C. The impact of role models on medical students. Gen Intern Med 1997; 12: 53–6.
7 Curtis-Barton, MT, Eagles, JM. Factors that discourage medical students from pursuing a career in psychiatry. Psychiatrist 2011; 35: 425–9.
8 Braun, V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77101.
9 Smith, M. Stigma. Adv Psychiatr Treat 2002; 8: 317–23.
10 Hafferty, FW. Cadaver stories and the emotional socialization of medical students. J Health Soc Behav 1988; 29: 344–56.
11 Monrouxe, LV. Negotiating professional identities: dominant and contesting narratives in medical students' longitudinal audio diaries. Current Narratives 2009; 1: 4159.
12 Monrouxe, LV. Identity, identification and medical education: why should we care? Med Educ 2010; 44: 40–9.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Qualitative study of medical students' experiences of a psychiatric attachment

  • Claire Archdall (a1), Tanya Atapattu (a1) and Elizabeth Anderson (a2)
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eLetters

Towards a solution

Peter Carter, Consultant Psychiatrist, NELFT
04 April 2013

There is more that can be done to improve the undergraduate experience. This can be through curriculum design, preparation before the placement and what is done during the placement.

The curriculum is mostly designed in a way that means psychiatry is only encountered in the 4th year with very little prior. Although this mayensure that students' confidence and communication skills are more developed, it also means that the possibility of psychiatry as a career has been considered quite late on in the undergraduate career.

More could be done to better prepare students for their psychiatry placement. All too often this is only by way of theory and basic science and communication skills, rather than preparation for the realities and potentially difficult nature of the patient interactions.

During placements, it is important students spend time with several sub-specialties such as perinatal or liaison psychiatry. This helps to make the link with the medical specialties and makes psychiatry seem less alien to other specialties.

We feel that the attitude of a team towards students can be as important as specific role models. When students have an identified role in a team or with patients, this helps them feel involved, builds theirconfidence and maintains interest.

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Conflict of interest: None declared

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Psychiatrists are not Surgeons

Eleanor J. Hogarth, ST4 in Forensic Psychiatry
12 February 2013

Reading the article by Archdall et al1 took us right back to our student days, where we both remember our emerging interest in psychiatry often being lambasted by those around us. Not so reassuring to see that some things never change.

What was most striking then, and it appears still now, are the beliefs that 'you can't cure anyone if you do psychiatry', 'you can't helppeople'. Whilst we admit it has been a few years since either of us have worked in acute medicine or primary care, unless there have been some radical developments, we weren't aware that conditions such as asthma, diabetes, arthritis or coronary artery disease could be easily cured either. Yet chronic physical illness is what the majority of medical students will end up managing in some form or another.

This research made us wonder if we as psychiatrists paint a rather grave, dare it be said hopeless, picture of what our speciality involves when students spend time with us. Because surely the reality is that psychiatry has no lower a 'help' rate than other specialties that deal with both acute and chronic illness?

We did not go into medicine solely to cure people; we went into medicine to help ease suffering, in whatever small way that may be. And yes that may be a listening ear instead of a scalpel or a pill, but no less is the satisfaction for us or relief for the patient.

So what is the answer to this? How do we help students see psychiatryfor what it is, rather than this hopeless and helpless version that keeps being quoted back to us? We suggest addressing this stigma head on, acknowledging that we are seen as separate and different, and take students to see the good that we do.

1 Archdall C, Atapattu T, Anderson E. Qualitative study of medical students' experiences of a psychiatric attachment. Psychiatrist 2013; 37: 21-24

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Conflict of interest: None declared

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Experiences of psychiatric attachments

Jiyan L. Darabi, 4th year medical student from Newcastle University
11 February 2013

As medical students, we were interested in psychiatry because we felt that our input was important and relevant to the patient's assessment and treatment. We enjoyed the degree of independence and freedom afforded. However, as our experience has developed we have increasingly seen psychiatry and other medical faculties as very separate, with stigma surrounding psychiatry. Stigma arises from other clinicians and students, but it also seems that psychiatrists themselves perpetuate the problem. They seem to be constantly trying to justify the importance of their profession to medical students; and this can often put them off the subject rather than entice them to it.Another problem is the consultants seem to be out of touch with medicine, leaving the junior doctors to manage medical problems. This gives the impression that the majority of the skills and knowledge attained in medical school would be rendered futile if a career in psychiatry were chosen.Finally, we feel there may be an underlying inherent reason why few medical students choose a career in psychiatry. Candidates are selected for medical school who perform highly in scientific subjects yet; psychiatry still feels more like an art and not a science.Individuals who enjoy working with concepts and not facts are often selected out even before they reach medical school meaning medical school does not tend to select individuals who naturally feel at home in psychiatry.

References1.Archdall C, Atapattu T, Anderson E. Qualitative study of medical students' experiences of a psychiatric attachment. The Psychiatrist 2013; 37: 21-24
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Conflict of interest: None declared

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