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UK crisis in recruitment into psychiatric training

  • Kamaleeka Mukherjee (a1), Michael Maier (a1) (a2) and Simon Wessely (a3)
Summary

Psychiatry recruitment in the UK is in crisis. In this paper we review reasons and solutions for the current predicament, focusing on the UK situation. We assert that there are specific national issues over and above more general and well-established ones, such as stigma and bad-mouthing, which need to be considered. These include factors that are an unintended consequence of recent changes in postgraduate training, as well as the organisation of the National Health Service. We conclude with some suggestions for psychiatrists, whether trainee or consultant, to help address the situation.

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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
Kamaleeka Mukherjee (kamaleeka.mukherjee@gosh.nhs.uk)
Footnotes
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This is one of a series of papers on recruitment in psychiatry. See also Archdall et al (pp. 21–24), Oakley et al (pp. 25–29) and Kelley et al (pp. 30–32) published in January, Greening et al (pp. 65–71) published in February and Qureshi et al (pp.104–110) published in March.

Declaration of interest

None.

Footnotes
References
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11 Curtis-Barton, MT, Eagles, JM. Factors that discourage medical students from pursuing a career in psychiatry. Psychiatrist 2011; 35: 425–9.
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13 Furnham, A. Medical students' beliefs about 9 specialities. BMJ 1986; 293: 1607–10.
14 Department of Health. Modernising Medical Careers: The Next Steps. Department of Health, 2004.
15 Lowe, J, Rands, G. Current position of psychiatry in UK foundation schools. Psychiatrist 2012; 36: 65–8.
16 Boyle, AM, Chaloner, DA, Millward, T, Rao, V, Messer, C. Recruitment from foundation 2 posts into specialty training: a potential success story. Psychiatr Bull 2009; 33: 306–8.
17 Shah, P, Brown, T, Eagles, J. Choosing psychiatry: factors influencing career choice among foundation doctors in Scotland. In Teaching Psychiatry to Undergraduates (eds Brown, T, Eagles, J): 255–63. RCPsych Publications, 2011.
18 Bhugra, D. Foundation for what? Commentary on … Current position of psychiatry in UK foundation schools. Psychiatrist 2012; 36: 6970.
19 Royal College of Psychiatrists and National Institute for Mental Health in England. New Ways of Working for Psychiatrists: Enhancing Effective, Person-centred Services through New Ways of Working in Multidisciplinary and Multi-agency Contexts. Final Report ‘But Not the End of the Story’. Department of Health, 2005.
20 Craddock, N, Antebi, D, Attenburrow, M-J, Bailey, A, Carson, A, Cowen, P, et al. Wake-up call for British psychiatry. Br J Psychiatry 2008; 193: 69.
21 Barras, C, Harris, J. Psychiatry recruited you, but will it retain you? Survey of trainees' opinions. Psychiatrist 2012; 36: 71–7.
22 Mynors-Wallis, L. College Position Statement: Work Experience in Psychiatry. Royal College of Psychiatrists, 2012.
23 Royal College of Psychiatrists. Pathfinder Fellowships. Royal College of Psychiatrists, no date (http://www.rcpsych.ac.uk/pathfinderfellowships).
24 Yakeley, J, Shoenberg, P, Heady, A. Who wants to do psychiatry? The influence of a student psychotherapy scheme – a 10-year retrospective study. Psychiatr Bull 2004; 28: 208–12.
25 Royal College of Psychiatrists. Setting up a student group in psychiatry. Royal College of Psychiatrists, 2011 (http://www.rcpsych.ac.uk/discoverpsychiatry/studentassociates/resources/psychiatrystudentsocieties/settingupastudentsociety.aspx).
26 Royal College of Psychiatrists. Affiliate your medical school psychiatry society with the Royal College of Psychiatrists. Royal College of Psychiatrists, 2012 (http://www.rcpsych.ac.uk/training/studentassociates/resources/psychiatrysocietyaffiliation.aspx).
27 Royal College of Psychiatrists. Student Associates: Career information for Medical Students and Foundation Doctors. Royal College of Psychiatrists, no date (http://www.rcpsych.ac.uk/discoverpsychiatry/studentassociates.aspx).
28 Academy of Medical Sciences. Strengthening Academic Psychiatry in the UK. Academy of Medical Sciences, 2013.
29 Brown, T. Recruitment Strategy 2011–2016 (updated February 2012). Royal College of Psychiatrists, 2012 (http://www.rcpsych.ac.uk/pdf/Recruitment%20Strategy%20(RCPsych,2012)).
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UK crisis in recruitment into psychiatric training

  • Kamaleeka Mukherjee (a1), Michael Maier (a1) (a2) and Simon Wessely (a3)
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eLetters

Recruitment into Psychiatric Training

Wendy K Burn, Dean
26 June 2013

We welcome Mukherjee, Maier and Wessely's article on recruitment into psychiatric training (1) which contains a thoughtful analysis of the reasons for recruitment problems and suggests some helpful solutions.

We are happy to report that the most recent recruitment figures show a great improvement. For 2013 we achieved a 95% fill rate of CT1 (first year of core training) in England with a 19% increase in actual numbers oftrainees. There are also reports from those involved in recruitment of higher quality applicants. 70% of those appointed are British graduates.

We believe this change is due to the success of the College recruitment campaign which has included initiatives to engage medical students, an increase in Foundation posts, summer schools and taster sessions. It is essential that we continue with these activities to attract trainees to our specialty.

Yours sincerely

Wendy Burn, Dean, Royal College of Psychiatrists

Sue Bailey, President, Royal College of Psychiatrists

Tom Brown, Associate Registrar for Recruitment, Royal College of Psychiatrists

... More

Conflict of interest: None declared References 1. Mukherjee K, Maier M, Wessely S. UK crisis in recruitment into psychiatric training. The Psychiatrist (2013) 37:210-214.

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Response to the article "UK crisis in recruitment into psychiatric training"

Christopher W. Rusius, Consultant in Old Age Psychiatry and Regional Advisor
17 June 2013

I read with interest the article entitled "UK crisis in recruitment into psychiatric training" (1). Whilst helpful, the article concentrates mainly on interventions in medical training, but it is also important to bear in mind that medical students are and always have been members of the public and are thus constantly exposed to public perceptions and media portrayals of psychiatry over many years. The poor public perception of psychiatry is perhaps a more fundamental reason for poor recruitment.

Surveys indicate psychiatrists are perceived as having low status compared to other doctors, with psychiatry being seen as relatively non-scientific, non-medical and ineffective. Relatively few people know the difference between psychiatry, psychology, psychotherapy, psychoanalysis and general counselling, and relatively few know that psychiatrists are doctors. A survey indicated that 70% of people view ECT as harmful and only 7% view it as potentially helpful; many have a highly negative view of any psychotropic medication, and have an over-expectation of talking therapies compared to the evidence base (2). As a member of the public, watching television and listening to the radio, I can understand these views.

An enormous amount of work has been done by the college in public education and attempting to boost the perception of psychiatry but the results are disappointing; more detail on the reasons for areas ofsuccess and failure in this area is required. One approach may be to emphasise what psychiatry specifically is, what it does and doesn't do andreduce the contradiction, confusion and negative views in the media portrayal of psychiatry. Given the enormous challenge of this, it is likely that more help from professional experts in political spin and advertising with influence within the media will be required to achieve this. Any improvement in the public perception could well have thebiggest impact on recruitment.

References:

1. Mukherjee K, Maier M, Wessely S. UK crisis in recruitment into psychiatric training. The Psychiatrist (2013) 37:210-214. 2.Sartorius N. et al. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry (2010) 9: 131-144.

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Conflict of interest: None declared

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Why psychiatry isn't sexy...

Nicky Jecks, 5th year medical student
17 June 2013

I read the piece by Mukherjee et al. (1) with interest, as I am two weeks into my psychiatry placement, and have been forced to ask myself some uncomfortable questions. I, and many of my fellow students, began with a negative view of psychiatry based almost entirely on our formal (and more importantly, informal) medical training. Although I am increasingly aware of the many compelling arguments which challenge our prejudices, unfortunately the rot sets in before we have even stepped ontoa ward.

It is hard to establish exactly when this happens. Mental illness isstigmatised my friends! It makes us feel uncomfortable. We don't understand it. The mechanisms underlying many mental illnesses seem so vague as to fall into the realms of pseudoscience. Medical schools selectscientists. We want to know how, and why, and what will cure. Psychiatrydances at the edge of such parameters. We are taught by academics that the drugs don't work, well, they do, but they have intolerable side-effects. ECT works, but we don't know how, and anyway, seizures are generally a bad thing.

Archdall et. al. (2) emphasised the importance placed on role models. It is a well-known fact amongst medical students that psychiatrists are crazy. This is unfair. Lots of GPs are crazy too. Surgeons must be crazy to endure the training they actively choose. This view may prevail because, whilst roaming around the hospital we come into contact with many more generic surgeons and medics than we do psychiatrists. Psychiatric wards and units are 'other'. We rarely (never) see psychiatrists at the medical grand round.

For the inexperienced, psychiatric patients are scary! It's humiliating enough when the cantankerous gentleman on the respiratory wardtells you to, ahem, go away. Infinitely worse when there is the slim possibility that the psychotic patient "could kill you, ha-ha...!". Our communication skills session came halfway through the psychiatric placement. This lack of preparation seems to be a common feature of UK medical education, and compounds the unease.

Most medical students see themselves graduating to wander around wards swinging stethoscopes and healing the sick; delivering babies; curing cancer in theatre; entering academia and naming a transcription factor after themselves; or at worst, serving a broad range of ailments inthe community and thereby having a life. We need more exposure to this diverse branch of medicine to challenge our idea of what 'doctor' means.

The psychiatry ward round was a revelation to me. High profile, successful psychiatrists would provide us with role models that challenge our misconceptions. In the last two weeks I have encountered some dedicated and inspiring clinicians, I have met some fascinating patients with interesting and complex conditions, and I have had my eyes opened to the over-looked yet vitally important value that psychiatry brings to the clinical care of a whole range of people. Popular opinion might dictate that psychiatry isn't sexy, but it's on my list.

1. Mukherjee K, Maier M, Wessely S. UK crisis in recruitment into psychiatric trainingThe Psychiatrist (2013) 37:210-214.

2. Archdall C, Atapattu T, Anderson E. Quality study of medical students experience in psychiatric attachments. The Psychiatrist (2013) 37:21-24.

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Conflict of interest: None declared

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Blame the "Blame Culture"

Keith E Dudleston, Retired Consultant Psychiatrist
17 June 2013

Mukherjee et al identify several important factors which discourage young doctors from choosing to train as psychiatrists. Stigma, low qualityundergraduate training and a perception that the specialty is unscientific probably all play a part.

However I contend that these factors are likely to have been influencing these doctors for many years. Why a recruitment crisis now? />
I disagree that the recent reduction in the number of training posts in academic psychiatry is an important influence on most doctors' career choice. However I agree that the lack of psychiatry F2 posts and the introduction of Modernising Medical Careers have probably been influential.

Sadly the most important influence is the paucity of consultant psychiatrists who act as good role models. Medical students and junior doctors notice the absence of enthusiastic senior colleagues. I agree that"New Ways of Working" has undermined consultant morale, probably to a significant extent, but the most important issue is the stress caused by the culture of repeated enquiries, which follow untoward incidents.

Most other medical specialties are not subject to the same intensive "blame culture". The recruitment crisis will continue until this issue is addressed.

... More

Conflict of interest: None declared

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