Millennials in Psychiatry: Exploring Career Choice Factors in Generation Y Psychiatry Interns

Exploring Career Choice Among Black Psychiatry Interns: an Exploratory Qualitative Study

OBJECTIVE

Relative to the Black American population size, there is an underrepresentation of Black psychiatrists in the USA. In order to address this issue, it is important to explore factors that contribute to Black medical students' decision to pursue a career in psychiatry.

METHODS

First-year psychiatry residents who identify as Black (N = 7) were interviewed. Career Construction Theory provided a structured framework for the interview process. For qualitative analysis of data, codes were assigned to reflect concepts and develop themes.

RESULTS

All participants mentioned the impact of being a Black psychiatrist in the Black community, the influence of strong female role models on their life, and the importance of the fit between their personality and the work done within psychiatry. The majority of interviewees identified macro-level and cultural events that had influenced them and discussed a desire for advocacy and the influence of Black role models, perseverance, and the importance of work-life balance.

CONCLUSION

This qualitative study identified many influential factors that were deemed important to Black interns in their decision to pursue a residency in psychiatry. With the information learned from these interviews, educators within psychiatry can bolster their support of Black medical students, encourage pursuit of a career in psychiatry, and ultimately, work toward reducing disparities in psychiatric care. Future research should examine additional collective notions of career decision-making.

Parallel Application to U.S. Psychiatry Residency Programs: Trends in Frequency and Differences by Applicant Group, 2009-2021

OBJECTIVE

The present study examines trends of percent of applicants, number of specialties, and specialty combinations for psychiatry residency applicants applying to multiple specialties (parallel application).

METHODS

The authors conducted a retrospective analysis of data captured by the Association of American Medical Colleges Electronic Residency Application System for applicants to psychiatry residency between 2009 and 2021. The percent parallel-applying, the mean number of specialties, mean application counts, and frequency of specialty combinations with psychiatry residency were determined.

RESULTS

The dataset described 67,261 applicants. The percentage parallel-applying decreased from 73.7% in 2009 to 60.0% in 2021. International Medical Graduates and U.S. International Medical Graduate parallel-applied at the greatest rate in each year. Applicants who were parallel-applying submitted larger numbers of applications compared to those who were single-specialty applying.

CONCLUSIONS

Parallel application to psychiatry residency appears to be a common practice, but has decreased in frequency. However, the mean numbers of applications submitted to each specialty in parallel application combination and among single-specialty applicants have increased. This practice appears to have a disproportionate impact on international and osteopathic applicants. Additional efforts are needed to develop evidence-based advising tools to reduce the number of residency applications submitted to psychiatry programs.

Digital Group-Based Intervention for Physical Activity Promotion Among Thai Adults During the COVID-19 Lockdown: Randomized Controlled Trial

BACKGROUND

The COVID-19 pandemic significantly diminished the physical activity (PA) level of Thai adults belonging to Generation Y (Gen Y). As a response to the global crisis, many individuals worldwide have turned to social community platforms, recognizing their potential in promoting PA during the pandemic. Gen Y, in particular, demonstrates exceptional proficiency in using social media platforms, showcasing a remarkable aptitude for swiftly accessing new information and knowledge. However, their proclivity for reckless behavior exposes them to various health risks, potentially leading to enduring adverse health consequences. Consequently, there arises a pressing need to develop a comprehensive model aimed at elevating the PA levels among individuals belonging to Gen Y.

OBJECTIVE

This research aimed to examine the effectiveness of a digital group-based activity in promoting PA among Gen Y in Thailand.

METHODS

This was a parallel 2-arm randomized controlled trial with single-blind allocation to experimental and control groups and pre- and posttest measurements. Measurements were administered on the web and were designed for respondents to complete by themselves. The sample comprised 100 Gen Y individuals who met the inclusion criteria. Both groups were matched for background characteristics. The two 8-week intervention activities were (1) two weeks of education and (2) six weeks of motivation by target groups that set goals for PA together (using the Zoom meeting application), with a time limit and group consensus as to when the goal was to be achieved. The intervention activities were implemented one by one at specified intervals and delivered daily through health apps and the official LINE account.

RESULTS

The intervention starts from August 22 to October 16, 2021. Of the 100 participants, 20 (20%) left the study, and the remaining 80 (80%) participated in the study (40 individuals each in the experimental and control groups). After participating in the experiment, a statistically significant difference in PA was found between the 2 groups (moderate to vigorous PA; 25/40, 63%; P=.03). Participants in the intervention group collected a higher cumulative minute of moderate to vigorous PA weekly (283 minutes) than those in the control group (164 minutes), and this was statistically significant (P=.03). For the transition to the fourth stage of behavior (ie, action), the improvement in the experimental group, after participating in the trial, was statistically significant compared to that of the control group (P=.01).

CONCLUSIONS

Digital group-based activity showed its effectiveness in improving the PA of Gen Y individuals in the intervention group. It created a process-based intervention activity that corresponds to the stages of behavior changes, from contemplation to action. The digital community can also connect individuals to comparable groups locally and globally.

TRIAL REGISTRATION

Thai Clinical Trials Registry TCTR20211101005; https://www.thaiclinicaltrials.org/show/TCTR20211101005.

Comparison of medical students' considerations in choosing a specialty: 2020 vs. 2009/10

BACKGROUND

Workforce shortage in healthcare and particularly in physicians poses a threat to healthcare delivery and its quality. In comparison to other OECD countries, Israel currently has a small number of medical graduates relative to its number of physicians, naturally emphasizing the importance of ensuring that this population chooses to remain in medicine. Understanding what is most important to medical students can help improve working conditions in residency. Such information is particularly needed to facilitate policy planning that will encourage the next generation of physicians to specialize in medical fields that are experiencing shortages. We hypothesized that between 2009/2010 and 2020, there were significant changes in medical students' preferences regarding their considerations for choosing a medical specialty.

METHODS

We compared cross-sectional data from questionnaire-based surveys of 5th year medical students performed in 2009-2010 and 2020 at two Israeli universities.

RESULTS

Of the 335 medical students who responded (237 and 98 in 2009/2010 and 2020, respectively) those in 2020 were 2.26 less likely vs. those in 2009/2010, to choose a residency for its high-paying potential (P < 0.05), and had significantly more interest in residencies with greater teaching opportunity (98.8% vs 82.9%, P < 0.05), increased responsibility and chances to make clinical decisions on their own (67.9% vs 51.6%, P < 0.05). Criteria important to both the 2009/2010 and 2020 students were choosing a bedside specialty (70.2%vs 67.9%, NS), and an interesting and challenging specialty (95.2%v s 91.3%, NS).

CONCLUSIONS

These results partially supported our hypothesis that medical students' preferences have changed over the years, though there are fundamental factors that apparently reflect medical students' nature that do not change over time.

Neuroscience-based nomenclature as a teaching tool, introduction and pilot study

Neuroscience-based nomenclature (NbN) is a pharmacologically-driven nomenclature aiming to replace the current disease-based nomenclature of psychotropics, focusing on pharmacology and mode-of-action to encourage scientifically-minded prescribing. NbN might also be used as a teaching tool as it presents the depth and richness of the neuroscience of psychotropics. This study examines the effect of using NbN in student curriculum. Fifty-six medical students during clerkship in psychiatry, divided into a control group ( n  = 20), taught standard psychopharmacology, and an intervention group ( n  = 36) introduced with NbN. Both groups filled out identical questionnaires at the beginning and end of the clerkship, including questions of knowledge on psychopharmacology, views on current terminology and interest in psychiatric residency. Comparing the average change in scorings (delta post-pre) for each item in intervention vs. control questionnaires, the intervention group showed a significantly larger positive delta in 6 out of 10 items than the control group. Mean scores did not differ significantly between the two groups in the pre-questionnaires, while significantly higher scores were shown for the intervention group in within- and between-group comparisons. Introduction of NbN was associated with a better educational experience, a deeper understanding of psychotropics and increased interest in psychiatric residency.

Unpopular medical specialties: exploring the concept that "the customer knows best"

BACKGROUND

Healthcare systems often face shortages of certain medical specialists due to lack of interest among medical students. We questioned a common "one solution fits all" approach to this problem which involves monetary incentives to lure students to these specialties. Instead, we used the marketing principle the "consumer knows best" to explore ways of elucidating the reasons and proposing solutions for such shortages.

METHODS

A convenience sample of Israeli 6th-year medical students and interns completed questionnaires to determine why they thought three specialties (geriatrics, anesthesiology, emergency medicine) were unpopular and their ideas on increasing their appeal.

RESULTS

119 6th-year students and 84 interns completed questionnaires. Geriatrics was reported having a problematic patient population; not being interesting and challenging; and not considered prestigious by colleagues and the populace. This contrasts with emergency medicine which, although considered prestigious, has difficult working conditions both during and after residency accompanied by much pressure at work. Although, improvements in lifestyle and remuneration were thought by students and interns as possibly making these specialties more attractive, reducing the pressure at work and decreasing on-call obligations were designated by the students/interns as ways to increase emergency medicine's and anesthesiology's appeal. Half the students replied that anesthesiology would be more appealing if work was in shifts (< 16 h), while 60% replied so for emergency medicine and only 18% for geriatrics. 90% of students reported that control over lifestyle would make emergency medicine more attractive while 55% and 48% replied positively for anesthesiology and geriatrics, respectively.

CONCLUSIONS

Using the concept "consumer knows best" provided additional insight into the specialty selection process. Students/interns have specialty-specific opinions as to why some specialties are unpopular. Their ideas about attracting more students to these specialties were also specialty-dependent, i.e. "one solution does not fit all". These observations render problematic a single solution aimed at ameliorating the workforce shortages of multiple specialties. Instead, these results advocate a differential approach wherein the lack of appeal of each unpopular specialty is analyzed individually and the students'/interns' (the "consumers") ideas sought resulting in solutions tailored to address each specialty's lack of attractiveness.

TRIAL REGISTRATION

None.

Supporting Clinician-Scientist Development in Child Psychiatry: A Four-Domain Model for Individual or Programmatic Self-Reflection

Background: The Albert J. Solnit Integrated Training Program (AJSP) is a novel educational initiative designed to prepare physician-scientists for independent careers in the investigation and treatment of childhood psychiatric disorders. Methods: We conducted a qualitative study to explore the impact and active components of the AJSP through hour-long individual interviews of its enrollees and graduates. We were specifically interested in identifying individual or programmatic traits for success that could be replicated elsewhere. As components of our theoretical framework, we used sources on Strength, Weakness, Opportunity, and Threat (SWOT) Analysis as applied to healthcare, and on mentorship and career development as pertaining to child and adolescent psychiatry (CAP). Results: Thirty-four individuals matriculated into the AJSP between 2004 and 2020, 33 (97%) of whom participated. Through iterative thematic analysis, we developed a model consisting of quadrants resulting from the intersection of a developmental perspective (spanning professional or personal spheres) and a reflective direction (with outward- or inward-facing vantage points). The model can be of practical utility through putative questions that trainees/program leaders could ask themselves by using the four domains as points of departure: (I) Individual: "Is becoming a clinician-scientist right for me?"/"What traits are we looking for in prospective applicants?"; (II) Program: "Is this the right program for me?"/"What is the right balance between structure and freedom for trainees to thrive in?"; (III) Mentorship: "What is the right number and constellation of mentors for me?"/"How can we optimize our experience and backgrounds toward the benefit of our trainees?"; and (IV) Charting Course: "Who do I want to become?"/"How can we help our charges embrace, find, or reconnect with their true vocation?" Conclusion: Our analytic approach can help identify, refine, and replicate programs that are urgently needed to increase the workforce of clinician-scientists dedicated to improving the well-being and mental health of children and families. The model we describe can be fruitfully applied to the self-reflection by individuals or program leaders. Although based on a single program with very specific goals, the model could also be applied to other training initiatives within psychiatry-and beyond.