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Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees

  • Ania Korszun (a1), Nishan Dharmaindra (a1), Valsraj Koravangattu (a2) and Kamaldeep Bhui (a1)
Abstract
Aims and method

An online survey was used to examine the attitudes of clinical, academic and trainee psychiatrists on the delivery of undergraduate education and why students are not choosing psychiatry as a career. This paper explores whether attitudes to teaching psychiatry to medical students is a factor in poor recruitment to the specialty.

Results

Overall, 390 psychiatrists completed the survey. All groups were highly committed to psychiatry education, but there were significant differences in attitudes that may have an impact on the delivery of medical student teaching, which in turn may influence recruitment. Five major themes emerged from the survey, the most dominant being stigmatisation of psychiatric patients and professionals by the medical profession. These divergent attitudes to teaching and stigma may be contributing to low levels of recruitment into psychiatry.

Clinical implications

Education of the next generation of psychiatrists is a high priority and active measures are needed to increase commitment and enthusiasm in undergraduate 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
Ania Korszun (a.korszun@qmul.ac.uk)
Footnotes
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Declaration of interests

None.

Footnotes
References
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1 Howard, R. Tackling psychiatry's recruitment crisis head on. Royal College of Psychiatrists eNewsletter 2008; Nov (http://www.rcpsych.ac.uk/members/rcpsychnews/november2008.aspx).
2 Maidment, R, Livingston, G, Katona, C, McParland, M, Noble, L. Change in attitudes to psychiatry and intention to pursue psychiatry as a career in newly qualified doctors: a follow-up of two cohorts of medical students. Med Teach 2004; 26: 565–9.
3 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.
4 Karim, K, Edwards, R, Dogra, N, Anderson, I, Davies, T, Lindsay, J. A survey of the teaching and assessment of undergraduate psychiatry in the medical schools of the United Kingdom and Ireland. Med Teach 2009; 31: 1024–9.
5 Dogra, N, Edwards, R, Karim, K, Cavendish, S. Current issues in undergraduate psychiatry education: the findings of a qualitative study. Adv Health Sci Educ Theory Pract 2008; 13: 309–23.
6 Aronson, JK. How to attract, retain and nurture young academic clinicians. J R Soc Med 2011; 104: 614.
7 Rahman, A. Teaching students – whose job is it anyway? BMJ 2005; 330: 153.
8 General Medical Council. Tomorrow's Doctors. GMC, 2009.
9 Thompson, C, Dogra, N, McKinley, R. A survey of general practitioners' opinions and perceived competencies in teaching undergraduate psychiatry. Educ Prim Care 2010; 21: 20–4.
10 Thornicroft, G, Brohan, E, Kassam, A, Lewis-Holmes, E. Reducing stigma and discrimination: candidate interventions. Int J Ment Health Syst 2008; 2: 3.
11 Mathers, CD, Loncar, D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3: e442.
12 Schulze, B. Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry 2007; 19: 137–55.
13 Craddock, N, Antebi, D, Attenburrow, MJ, Bailey, A, Carson, A, Cowen, P, et al. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 69.
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Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees

  • Ania Korszun (a1), Nishan Dharmaindra (a1), Valsraj Koravangattu (a2) and Kamaldeep Bhui (a1)
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eLetters

Recruitment in Psychaitry: A complex and mutifactorial problem

Rajesh Sekhri, ST5, Old Age Psychiatry
11 January 2012

We read with interest this paper that explores the attitudes of thosedelivering undergraduate teaching in psychiatry as a factor in poor recruitment (1). Whilst we appreciate that a positive attitude to teachingstudents is vital in the delivery of education and in creating appropriaterole-models, we believe that these attitudes play a relatively minor role in this problem. The reason for poor recruitment in psychiatry is multifactorial.

In recent years we have seen competition for psychiatry posts gradually decline (2,3). One major factor that has contributed to this arethe changes to visas for doctors trained outside the UK. International doctors have traditionally contributed significant numbers to British psychiatry, but current restrictions make it near impossible for international graduates to secure training positions.

Psychiatry as a specialty has always been considered somewhat separate from other hospital-based medical specialties, but we have to consider whether geographical and structural changes to mental health services are further reinforcing this idea and contributing to poor recruitment. Whilst we have come a long way from the asylum culture, many psychiatric hospitals remain geographically separate from the main hospital, giving medical students the impression of a 'Cinderella branch' of medicine. Similarly, a streamlining of services has often led to a reduced presence of Liason psychiatry within main hospitals, giving an image of an isolated and understaffed specialty.

In years gone by, junior doctors enjoyed a flexibility in training that allowed them to experience a wide variety of placements and specialties before choosing a career path. Changes to training has meant that doctors are now under pressure to choose a specialty early in their careers, often without the luxury of having been able to explore all available options. As a result, the 'less obvious' options, such as psychiatry, may be overlooked. Early exposure to psychiatry through foundation year one posts has been suggested (4), but caution should be exercised as we cannot underestimate the general medical experience and decision making involved in an often community-based or 'off-site' placement such as psychiatry. It would not serve the specialty well to discourage potential applicants through asking too much of an inexperienced junior doctor.

This lack of exposure to the specialty may extend back to undergraduate training, where psychiatry is a comparatively small component of the syllabus and often not experienced until the later years of medical school. As a specialty that is often subject to out-dated mythsor jokes, the junior doctors and students who are relatively naive to the reality of psychiatry are at risk of adopting such untruths, thus influencing their opinions, and in turn recruitment rates.

Exploring the factors affecting recruitment is complex. For this reason it is useful for studies such as that by Korszun et al(1) to consider an individual factor. Much of the literature has concentrated on teaching and the opinions of medical students (5). These writers believe that there is a need for further evidence on the opinions of foundation trainees, in particular whether the negative opinions suggested by studiessuch as this are widespread and affecting recruitment. A study to explore this factor has therefore been undertaken and we aim to release the results to add to the evidence to be used in tackling declining recruitment rates in the UK.

Psychiatry is one of the most exiting branches of medicine. Because of its very nature and complexity, innovation in psychiatry has been slow relative to other specialties. As a result, we now stand at the door of a major revolution in this branch of medicine. We are now, where other medical specialties were half a century ago. We now know that one in threeof us will suffer from a mental illness in our lifetime and with a vast amount of research ongoing, this remains a very exciting medical branch tobe part of.

There is no doubt that we are guilty of underselling psychiatry. The time has come for us to excite the next generation of doctors and open their eyes to a fascinating specialty that will offer a challenging and fulfilling career. To secure the future of psychiatry we need to ensure that we attract the best candidates for training posts, and as such, studies into recruitment will need to continue.

References

(1) Korszun A, Dharmaindra N, Koravangattu V, Bhui K. Teaching Medical Students and Recruitment to Psychiatry: Attitudes of Psychiatric Clinicians, Academics and Trainees. The Psychiatrist 2011; 35: 350-353.

(2)The Royal College of Psychiatrists. Psychiatry National Recruitment 2011: CT1 Outcomes

(http://www.rcpsych.ac.uk/pdf/CT1%20recruitment%200utcomes-03.08.2011.pdf)

(3)Scottish Medical Training. Competition Ratios 2009-2010 (http://www.scotmt.scot.nhs.uk/media/27625/smt%20website%20competition%20ratios%202009_2010.pdf)

(4)Welch J, Bridge C, Firth D, Forrest A. Improving psychiatry training in the Foundation Programme. The Psychiatrist 2011; 35: 389-393

(5)Brockington I, Mumford D. Recruitment into Psychiatry. British Journal of Psychiatry 2002; 180: 307-312

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Conflict of interest: Rajesh Sekhri and Ruth Sibbett are employed by NHS Greater Glasgow and Clyde as trainees in Psychiatry

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Learning from medical students

Selim Ahmed, CT3
11 October 2011

I think this study was an excellent insight into ways in which to further evaluate teaching of psychiatry. I am a core trainee and eagerly teach medical students when opportunities arise and would equally jump to be involved in the teaching of foundation doctors as I have also done so with Physician Assistants in the west midlands.

In my experience I find a major obstruction in junior trainees getting involved in teaching foundation doctors is not lack of time or lack of inability to incorporate teaching into learning objectives, but often it is due to lack of awareness of events at which foundation doctorsattend for teaching sessions.

At the main hospital affiliated to our pychiatry in-patient unit there is a liaison psychitary team who attend the grand-round at the main hospital where specialists in other medical fields present cases in turn. Due to the attendence of a psychiatry team there, the psychiatric team gets a chance to also present psychiatry admist all the other rostered presentations including cardiology, endocrinology, neurology, vascular surgery, and so on.

This "grand round" is a meeting place for foundation year doctors as well as core trainees of various specialities and unfortunately my impression is that almost all, if not all medical specialties attend it excepting psychiatrists. If pyschiatrists could also be actively involved I think foundation year doctors would get more of a flavour of what psychiatry is about - not only to inform them if they want to pursue the specialty but also to guide them in doing their own initial psychiatric assessments before suitably referring patients on. The educational opportunity would be valuable to all medics of all grades.

When I was a foundation doctor myself I recall presentations from different medical and surgical specialties except psychiatry. This also highlights how seperate psychiatrists tend to be from the rest of the medics akin to how medical students tend to be from the corpus of the other uni students in general!

So why don't psychiatrists attend grand-round at main hospitals? I wonder if reasons include not being invited, not actively seeking it out and perhaps majorly, in most hospitals the mental health trust is seperatefrom the main hospital trust, thus enforcing a divide where each side loses contact with the other.

The benefit in attending works both ways, when I attended the grand-round whilst part of the liaison psychiatry team I also kept updated on general medical conditions and management which informed my own aseesment of physical conditions in psychiatric in-patients.

I think one way forward in educating foundation year doctors is to find out where they attend for post graduate development and get involved there.

... More

Conflict of interest: None declared

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Teach medical students - but don't forget about the foundation doctors

Adam Moreton, FY2 Doctor
14 September 2011

I commend Korszun(1) et at for raising some very valid points in their efforts to uncover why medical students aren't becoming psychiatry trainees. But don't forget about those in the 16 months between graduation and choosing a speciality.

Every day foundation year (FY) doctors work alongside juniors from core medicine/surgery, acute common stem, and GP training schemes; they observe what their colleagues' jobs entail and can decide if they can see themselves in that role. At grand rounds they talk with trainees from obstetrics and gynaecology, radiology and paediatrics - once again they have the chance to discover what it's like to train in a speciality removedfrom their own.

But when do most FY doctors get chance to speak with core psychiatry trainees? Hardly ever.

Korszun et al showed, disappointingly, that almost a quarter of psychiatry trainees "do not have time to teach medical students". If there isn't time to teach students then one would imagine it would be evenharder to coordinate a psychiatry trainee's rota with the already hectic timetable of a FY doctor. So, where are the relatable role models for these newly qualified doctors? Career inspiration can emanate from one's peers, after all, who understands the dilemmas faced in committing to a speciality better than someone who did that themselves only a couple of years ago?

The study showed that juniors overwhelmingly want to teach - so that'snot the problem. The problem is getting people to listen and giving the teachers time to do it. It becomes a self perpetuating cycle: psychiatry trainees have no time to teach, therefore, students and FY doctors never discover what it is like to be a core trainee in psychiatry, they don't apply to become psychiatrists and posts remain unfilled, leaving those whoare recruited to psychiatry training to maintain the service with no time to teach and inspire.

How do we get more doctors into core psychiatry training? Medical student teaching is crucial, but don't forget the FY doctors - most have little or no contact with psychiatrists as part of their day-to-day job. Psychiatrists need to find other ways in - more FY psychiatry posts that are genuinely educational and not just for service provision, a greater availability of 'taster days' for FY2 doctors that can be taken as study leave, and more psychiatry teaching delivered by psychiatry trainees.

Psychiatry has a lot going for it in addition to being a great job: weekly consultant supervision sessions, Balint groups, opportunities to undertake a masters degree - it's a shame hardly anyone knows about them. Like most prejudice, ignorance is at its heart - its time to do some educating!

(1) Korszun A, Dharmaindra N, Koravangattu V, Bhui K. Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees. The Psychiatrist 2011; 35: 350-353.

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Conflict of interest: None declared

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