Medical education and recruitment in psychiatry

Recruitment into psychiatry

BACKGROUND

Despite improvements in psychiatric teaching, British medical schools have never produced enough graduands aiming for psychiatry.

AIMS

To inform the strategy for improving recruitment.

METHOD

A literature review.

RESULTS

The number of psychiatrists required depends on the role of psychiatry, which is constantly changing. The present requirement is about 250-300 per year, including replacements and new posts. The number of psychiatric trainees has always been higher than expected from the career plans of newly qualified doctors, but the number of British graduates passing the Royal College of Psychiatrists' Membership examination has still fallen short, requiring a supplement of foreign medical graduates. The recent 50% expansion in medical students may make this country self-sufficient.

CONCLUSIONS

To improve recruitment, the College should focus on influences before and after undergraduate training - the kind of student entering medical school and the factors favouring sustained psychiatric practice after graduation.

Psychiatric training in New Zealand

OBJECTIVE

The aims of this study were to develop a profile of current psychiatric trainees in New Zealand, to identify factors important in their recruitment to and retention in psychiatric training and to identify factors that predict failure to complete training.

METHOD

A survey was sent to all current psychiatric trainees in New Zealand and to all trainees who could be traced who had left psychiatric training in New Zealand In the last 5 years without completing the Fellowship of the Royal Australian and New Zealand College of Psychiatrists.

RESULTS

General characteristics of the two groups are presented, as well as information about recruitment, burnout, general health and experiences of work and training. The only significant difference in general characteristics between the two groups was that more of those who had left training prematurely had been born overseas. The levels of family and personal mental illness were high, but there was no difference in these rates between those who had stayed in training and those who had left permaturely. Most trainees had decided to pursue a psychiatric career during their house-officer years. The most important factors determining the choice of a career in psychiatry were philosophical interest and house-officer experience in psychiatry. With respect to retention, despite high rates of burnout and psychological morbidity, and dissatisfaction with various aspects of the work setting, 94% of current trainees indicated satisfaction with their decision to train in psychiatry and over 90% intended to practise in New Zealand in the future. Most trainees who left training prematurely did so during the first 2 years of training. Dissatisfaction with work conditions, and stress or burnout were the main reasons for leaving.

CONCLUSIONS

This study provides information on some of the complex determinants of psychiatric recruitment and retention in the New Zealand setting. Areas that could be addressed in order to improve recruitment, work satisfaction and retention in training are considered.

Medical students' attitudes toward psychiatry in Greece : an eight-year comparison

This study is a comparative investigation of the attitudes toward psychiatry of two medical student groups who did their undergraduate training in psychiatry in 1985 and 1993. Attitude assessments were carried out by using the Libertarian Mental Health Ideology Scale (LMHIS). The students completed the questionnaire twice, at the beginning and at the end of their clerkship. The LMHIS was also completed by the teaching staff. Both medical student groups showed a significant change in their attitudes toward psychiatry after the end of the training. The change consisted of a shift to a more medical orientation. However, the 1993 group manifested a significantly higher medical orientation both before and after their undergraduate training in psychiatry compared with the 1985 group. Furthermore, the former group's opinions at the end of their education were similar to those of their teaching staff, whereas the 1985 students continued to have a lower medical orientation compared with the teaching staff. These findings indicate that 1) psychiatric education during medical school may significantly mold students' attitudes toward psychiatry and 2) if these medical student groups represent the larger Greek society, then significant changes may be occurring in the Greek society about attitudes toward psychiatry.

Residency applicants in psychiatry : factors influencing program choice

With the continued decline in the number of U.S. medical graduates entering psychiatry residencies and the possibility of a decrease in the number of funded psychiatry training positions in the near future, this study aimed to update our understanding of why applicants choose a residency program. For 5 years (1989-1993), all applicants interviewed for postgraduate year-1 psychiatry positions at Long Island Jewish Medical Center/Hillside Hospital were asked to rank factors that influenced their program choice. The factors that were rated as most important, in declining order, were location (67.9%), reputation (46.2%), integration with a medical school (35.9%), resident satisfaction (33.2%), and quality of faculty (33.2%).

Medical students' attitude towards psychiatry

The attitudes of medical students are important as they influence recruitment to psychiatry. In order to better understand the attitudes of medical students towards psychiatry and the impact of psychiatric clerkship, the authors administered a questionnaire eliciting information regarding demographic data, attitudes and career choices to third year medical students of the University of Ottawa, at the beginning and end of their four week psychiatric clerkship. The data suggests that the students found their clerkship experience valuable and rewarding and expressed an interest in knowing more about psychiatry. The students' perception of the various aspects of their clinical practice of psychiatry became more positive after the clerkship. The authors have identified the positive and negative experiences the students had during their clerkship and postulate that the change in attitude is directly due to their clerkship experience.

The general hospital as a center of biopsychosocial training

Utilization of general hospitals as training sites for undergraduate and graduate medical education provides special opportunities for integration of biologic, psychologic, and social factors in health care. For medical students, the general hospital environment ideally facilitates learning a core of psychiatric knowledge and the biopsychosocial approach to all illness while attracting some students to psychiatric careers. By spending much of their internship year in the general hospital, psychiatric residents integrate psychiatry into the rest of medicine and develop collegial relations with nonpsychiatrists. Residency training in the general hospital perpetuates this integrative experience and allows in-depth training in consultation-liaison psychiatry. Despite the multiple advantages of general hospitals in training students and residents, limitations of this setting also exist.

Psychiatry in the medical curriculum

When medical students of three universities, house surgeons, general practitioners, psychiatrists, and surgeons were asked in what order would they rank the importance of various subjects in the medical school education of a general practitioner, there is remarkable agreement regarding the first three. In all, 1402 respondents rank medicine, then pediatrics, then psychiatry as most important. There are differences which reflect cultural and curriculum diversity among the student groups. The majority of respondents believe psychiatry should occupy 11% or more of the curriculum.