HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS British Journal of Psychiatry Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit an eLetter View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in PB Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Eagles, J. M. Articles by Brown, T. Search for Related Content PubMed Articles by Eagles, J. M. Articles by Brown, T.

What impact do undergraduate experiences have upon recruitment into psychiatry?

Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH, email: john.eagles{at}gpct.grampian.Scot.nhs.uk

Sam Wilson, Clinical Teaching Fellow

Medical Education Unit, University of Aberdeen

Jane M. Murdoch, Lecturer in Old Age Psychiatry

University of Aberdeen

Tom Brown, Consultant Liaison Psychiatrist

Western Infirmary, Glasgow

Declaration of interest

None.

	Introduction

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
The Scottish Division of the Royal College of Psychiatrists conducted a survey of members and fellows in 2003 on recruitment and retention within psychiatry. Responses relating to retirement intentions of consultants have been published previously (Eagles et al, 2005). Respondents were asked to give views about improving recruitment, and by far the most common suggestion was that this could be achieved by enhancing undergraduate teaching in psychiatry. This paper will discuss the ways in which undergraduate experiences may have an impact upon recruitment.

	Recruitment issues

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
The distribution of consultant vacancies in psychiatry across the UK is variable (Storer, 2002), but overall 12% of consultant posts were unfilled at the time of the College’s last national census (Royal College of Psychiatrists, 2002). Based on calculations in 1999, Brockington & Mumford (2002) suggested that 250–300 new consultants are required per annum in the UK for replacements and new posts. Factors which may affect this complex equation include the recent increase in numbers of medical students, the current debate about the level of unemployment among senior house officers, retention rates of junior psychiatrists and early consultant retirement. These issues are outside the scope of this paper. Our discussion will proceed on the basis that our recruitment problems are likely to persist and, even if they ease, that ‘it should be seen as the responsibility of the whole profession to attract the brightest and best’ (Pidd, 2003).

	How do doctors choose their careers?

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
The processes which influence doctors in the choice of their careers are subtle and complex. McManus (1997) espouses the views that medical careers ‘can only really make proper sense to a chaos theorist’ and that ‘doctors mostly still find out about medical careers in the same way as adolescents used to find out about sex – through the mistaken, confused ideas of their peers in the playground’. In this context, the lack of career advice and support to medical students and newly graduated doctors has been criticised (McManus, 1997; Lambert & Goldacre, 2002; Mahoney et al, 2004).

When young people are at the stage of considering a medical career, they deem many specialties (including psychiatry) to be very attractive options (Maidment et al, 2003). Over the next 10–15 years, a complex set of ‘push-and-pull’ factors influence career choice. Lifestyle factors seem to be of growing general importance (Tolhurst & Stewart, 2004). Against all the positive factors which may attract people into a particular specialty, it is necessary to balance repelling factors such as the impact of ‘bad-mouthing’ by specialists in other fields (Hunt et al, 1996). It is helpful to bear in mind that attracting future psychiatrists takes place against this complex backdrop.

	Medical student selection

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
Recruitment of good psychiatrists must depend to some degree on the selection of appropriate medical students. Petrides & McManus (2004) found that doctors entering psychiatry and general practice were more likely to have an ‘artistic’ approach to medicine, ‘seeing, interpreting and responding imaginatively to a range of medical, social, ethical and other problems’. In the USA, Sierles et al (2004) found that before entry into medical school psychiatrists scored higher than other doctors in measures of verbal ability and general information. Brockington & Mumford (2002) noted that entry requirements for medical schools favour passes in science subjects, thus making it less likely that students will possess these qualities. However, the increasing proportion of female medical students may yield more graduates with a natural aptitude for psychiatry (Wilson & Eagles, 2006).

Inclinations before entry to medical school were deemed to have a large influence on career choice in only 15% of the graduates surveyed by Goldacre et al (2004), being significantly outweighed by factors during their undergraduate experience. Thus, although psychiatrists should encourage selection of appropriate students, with respect to recruitment into our specialty it should be accorded less attention than our interactions with medical undergraduates.

	When do psychiatrists choose their specialty?

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
It is perhaps surprising that preferences before entry to medical school do not appear to greatly influence ultimate career choice (Goldacre et al, 2004). In Canada, Cameron & Persad (1984) found that 14% of psychiatrists had decided to enter the specialty before starting medical school.

One year after graduation, 78% of male doctors and 72% of female doctors state that they have made a definite or probable choice of specialty (Goldacre et al, 2004), but in reality career intentions are likely to change in the early postgraduate years (Goldacre & Lambert, 2000). For psychiatry, it is encouraging that significantly more young doctors select than deselect a psychiatric career during the first three postgraduate years (Goldacre & Lambert, 2000; Goldacre et al, 2005). Cameron & Persad (1984) reported that 58% of Canadian psychiatrists selected the specialty after graduation, having observed the frequency of psychosocial problems in other areas of medicine and the effectiveness of psychiatric therapies. It is hoped that the advent of Modernising Medical Careers, which will result in doctors making an earlier choice of speciality, does not reduce exposure to such experiences, with adverse effects on psychiatric recruitment.

	Undergraduate influences on career choice

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
In their survey of sixth-formers contemplating a medical career, Maidment et al (2003) found that 49% of respondents considered psychiatry a ‘very attractive’ career choice and among students expressing a ‘definite intention’ psychiatry was the fourth most popular specialty. Something seems to change during the undergraduate years. Rajagopal et al (2004) found that only 3% of students at a London medical school rated psychiatry as a career they would wish to pursue. Exposure to clinical psychiatry tends to promote positive attitudes, so it seems that this negativity must derive from non-psychiatric sources.

Overemphasis on acute hospital-based medicine during undergraduate training acts as a powerful disincentive for recruitment into primary care (Whitcomb & Cohen, 2004) and the same may apply for psychiatry. As Gray (1999) states: ‘sometimes the whole ethos of a medical school can become dominated by high technology medicine with a specialist focus’. It does seem that the more exposure students have (to either community or hospital medicine), the keener they become upon careers in those areas (Howe & Ives, 2001). Early clinical experience, which is uncommon in psychiatry, may exert particular influences on career choice (Littlewood et al, 2005). Others feel that influences are less subtle, with direct negative effects on attitudes to psychiatry occurring during medical and surgical training (Creed & Goldberg, 1987). Psychiatrists have to work very hard at ‘neutralizing antipsychiatric socialization experiences in medical school’ (Weintraub et al, 1982). In our survey of Scottish psychiatrists, the low status of psychiatry among other medical professionals was considered to be the single factor which most adversely affected recruitment.

Turning to positive influences, Sierles & Taylor (1995) stated that ‘most authors believe the psychiatry clerkship is the most important medical school influence on recruitment’. Several studies have investigated changes in attitudes of students towards psychiatry and/or to a possible psychiatric career following psychiatric clinical attachments, and none has found that attitudes became more negative. Two found no significant change (Galletly et al, 1995; Calvert et al, 1999), whereas more studies found that attitudes became increasingly positive (Shelley & Webb, 1986; Sivakumar et al, 1986; Creed & Goldberg, 1987; Alexander & Eagles, 1990; Singh et al, 1998; McParland et al, 2003). Studies investigating specific aspects of clinical attachments which might give rise to attitudinal changes have been less common. Attitude changes were similar whether students were taught with problem-based learning or with a more traditional curriculum (Singh et al, 1998; McParland et al, 2004), although problem-based learning may give rise to better results in psychiatric examinations (McParland et al, 2004). Positive attitudinal changes were found to be related to direct involvement in patient care, seeing patients improve with treatment and receiving encouragement from consultants (McParland et al, 2003). Being kept busy and experiencing few boring meetings may also help to improve attitudes (Sierles & Taylor, 1995). The perceived lack of a scientific foundation to psychiatric practice (Malhi et al, 2002) and concerns about over-identifying with patients (Field & Lennox, 1996) can exert negative influences on the likelihood of pursuing a career in psychiatry.

Across the various medical specialties, several undergraduate factors influence career choice. In their survey of over 5000 new graduates, Goldacre et al (2004) found that career choices were greatly influenced for 45% of graduates by experience of the chosen subject as a student and by a particular teacher or department for 27%. The importance of a good role model has been emphasised by others (Watts et al, 1998; Park et al, 2005). Not surprisingly, doctors tend to pick subjects in which they feel that they have an aptitude as students, and this seems clearly to be the case for psychiatrists (Goldacre et al, 2005). Students seem to place increasing emphasis on the importance of lifestyle factors in their career selection (Tolhurst & Stuart, 2004) and ‘selling the merits of flexible, family-friendly working practices’ (Pidd, 2003) within psychiatry should enhance the attractiveness of our specialty.

	Conclusions

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
Many doctors make career choices in the early postgraduate years and perhaps the main goal of teachers should be to promote sufficiently positive attitudes among students for them to graduate still considering the possibility of becoming a psychiatrist. It is likely that recruitment of the best graduates may be enhanced by: encouraging early undergraduate exposure to psychiatry; identifying students with an aptitude for psychiatry and offering them encouragement and career advice; ensuring that students have busy clinical attachments in which they see patients who respond well to treatment; emphasising the growing evidence base underlying psychiatric practice; engaging proactively with students; and pointing out the potential lifestyle benefits of a psychiatric career.

	Acknowledgments

 
Many of the points covered in this paper have been discussed within the Royal College of Psychiatrists’ Scottish Division Undergraduate Student Teaching and Recruitment Group (S–DUSTARG), and we are grateful to other members of this group. We thank Lana Hadden for secretarial work.

	References

Top Introduction Recruitment issues How do doctors choose... Medical student selection When do psychiatrists choose... Undergraduate influences on... Conclusions References

 
ALEXANDER, D. A. & EAGLES, J. M. (1990) Changes in attitudes towards psychiatry among medical students: correlation of attitude shift with academic performance. Medical Education, 24, 452 –460.[Medline]

BROCKINGTON, I. F. & MUMFORD, D. B. (2002) Recruitment into psychiatry. British Journal of Psychiatry, 180, 307 –312.[Abstract/Free Full Text]

CALVERT, S., SHARPE, M., POWER, M., et al (1999) Does undergraduate education have an effect on Edinburgh medical students’attitudes to psychiatry and psychiatric patients? Journal of Nervous and Mental Disease, 187, 757 –761.[CrossRef][Medline]

CAMERON, P. & PERSAD, E. (1984) Recruitment into psychiatry: a study of the timing and process of choosing psychiatry as a career. Canadian Journal of Psychiatry, 29, 676 –680.[Medline]

CREED, F. & GOLDBERG, D. (1987) Students’attitudes towards psychiatry. Medical Education, 21, 227 –234.[Medline]

EAGLES, J. M., ADDIE, K. & BROWN, T. (2005) Retirement intentions of consultant psychiatrists. Psychiatric Bulletin, 29, 374 –376.[Abstract/Free Full Text]

FIELD, D. & LENNOX, A. (1996) Gender in medicine: the views of first and fifth year medical students. Medical Education, 30, 246 –252.[Medline]

GALLETLY, C. A., SCHRADER, G. D., CHESTERMAN, H. M., et al (1995) Medical student attitudes to psychiatry: lack of effect of psychiatric hospital experience. Medical Education, 29, 449 –451.[Medline]

GOLDACRE, M. J. & LAMBERT, T. W. (2000) Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993. Medical Education, 34, 700 –707.[CrossRef][Medline]

GOLDACRE, M. J., TURNER, G. & LAMBERT, T. W. (2004) Variation by medical school in career choices of UK graduates of 1999 and 2000. Medical Education, 38, 249 –258.[CrossRef][Medline]

GOLDACRE, M. J., TURNER, G., FAZEL, S., et al (2005) Career choices for psychiatry: national surveys of graduates of 1974–2000 from UK medical schools. British Journal of Psychiatry, 186, 158 –164.[Abstract/Free Full Text]

GRAY, D. P. (1999) Fit for the future – are medical schools going to produce the doctors the Health Service needs? Medical Education, 33, 872 –873.[CrossRef][Medline]

HOWE, A. & IVES, G. (2001) Does community-based experience alter career preference? New evidence from a prospective longitudinal cohort study of undergraduate medical students. Medical Education, 35, 391 –397.[CrossRef][Medline]

HUNT, D. D., SCOTT, C., ZHONG, S., et al (1996) Frequency and effect of negative comments (‘badmouthing’) on medical students’career choices. Academic Medicine, 71, 665 –669.[Medline]

LAMBERT, T. W. & GOLDACRE, M. J. (2002) Career destinations and views in 1998 of the doctors who qualified in the United Kingdom in 1993. Medical Education, 36, 193 –198.[CrossRef][Medline]

LITTLEWOOD, S., YPINAZAR, V., MARGOLIS, S. A., et al (2005) Early practical experience and the social responsiveness of clinical education: systematic review. BMJ, 331, 387 –391.[Abstract/Free Full Text]

MAHONEY, R., KATONA, C., McPARLAND, M., et al (2004) Shortage specialties: changes incareer intentions frommedical student to newly qualified doctor. Medical Teacher, 26, 650 –654.[CrossRef][Medline]

MAIDMENT, R., LIVINGSTON, G., KATONA, M., et al (2003) Carry on shrinking: career intentions and attitudes to psychiatry of prospective medical students. Psychiatric Bulletin, 27, 30 –32.[Abstract/Free Full Text]

MALHI, G. S., PARKER, G. B., PARKER, K., et al (2002) Shrinking away from psychiatry? A survey of Australian medical students’ interest in psychiatry. Australian and New Zealand Journal of Psychiatry, 36, 416 –423.[CrossRef][Medline]

McMANUS, C. (1997) Medical careers: stories of a life. Medical Education, 31, 31 –35.

McPARLAND, M., NOBLE, L. M., LIVINGSTON, G., et al (2003) The effect of a psychiatric attachment on students’attitudes to and intention to pursue psychiatry as a career. Medical Education, 37, 447 –454.[CrossRef][Medline]

McPARLAND, M., NOBLE, L. M. & LIVINGSTON, G. (2004) The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Medical Education, 38, 859 –867.[CrossRef][Medline]

PARK, J., MINOR, S., TAYLOR, R. A., et al (2005) Why are women deterred from general surgery training? American Journal of Surgery, 190, 141 –146.[CrossRef][Medline]

PETRIDES, K. V. & McMANUS, I. C. (2004) Mapping medical careers: questionnaire assessment of career preferences in medical school applicants and final-year students. BMC Medical Education, 4, 18 –27.

PIDD, S. A. (2003) Recruiting and retaining psychiatrists. Advances in Psychiatric Treatment, 9, 405 –411.[Abstract/Free Full Text]

RAJAGOPAL, S., REHILL, K. S. & GODFREY, E. (2004) Psychiatry as a career choice compared with other specialties: a survey of medical students. Psychiatric Bulletin, 28, 444 –446.[Abstract/Free Full Text]

ROYAL COLLEGE OF PSYCHIATRISTS (2002) Annual Census of Psychiatric Staffing 2001 (Occasional Paper OP54). Royal College of Psychiatrists.

SHELLEY, R. K. & WEBB, M. G. (1986) Does clinical clerkship alter students’ attitudes to a career choice of psychiatry? Medical Education, 20, 330 –334.[Medline]

SIERLES, F. S., & TAYLOR, M. A. (1995) Decline of U.S. medical student career choice of psychiatry and what to do about it. American Journal of Psychiatry, 152, 1416 –1426.[Abstract/Free Full Text]

SIERLES, F. S., VERGARE, M. J., HOJAT, M., et al (2004) Academic performance of psychiatrists compared to other specialists before, during, and after medical school. American Journal of Psychiatry, 161, 1477 –1482.[Abstract/Free Full Text]

SINGH, S. P., BAXTER, H., STANDEN, P., et al (1998) Changing the attitudes of ‘tomorrow’s doctors’towards mental illness and psychiatry: a comparison of two teaching methods. Medical Education, 32, 115 –120.[CrossRef][Medline]

SIVAKUMAR, K., WILKINSON, G., TOONE, B. K., et al (1986) Attitudes to psychiatry in doctors at the end of their first post-graduate year: two-year follow-up of a cohort of medical students. Psychological Medicine, 16, 457 –460.[Medline]

STORER, D. (2002) Recruiting and retaining psychiatrists. British Journal of Psychiatry, 180, 296 –297.[Free Full Text]

TOLHURST, H. M. & STEWART, S. M. (2004) Balancing work, family and other lifestyle aspects: a qualitative study of Australian medical students’ attitudes. Medical Journal of Australia, 181, 361 –364.[Medline]

WATTS, R. W., MARLEY, J. & WORLEY, P. (1998) Undergraduate education in anaesthesia: the influence of role models on skills learnt and career choice. Anaesthesia and Intensive Care, 26, 201 –203.[Medline]

WEINTRAUB, W., BALIS, G. U. & DONNER, L. (1982) Tracking: an answer to psychiatry’s recruitment problem? American Journal of Psychiatry, 139, 1036 –1039.[Abstract/Free Full Text]

WHITCOMB, M. E. & COHEN, J. J. (2004) The future of primary care medicine. New England Journal of Medicine, 351, 710 –712.[Free Full Text]

WILSON, S. & EAGLES, J. M. (2006) The feminisation of psychiatry: changing gender balance in the psychiatric workforce. Psychiatric Bulletin, 30, 321 –323.[Free Full Text]

Related articles in PB:

Opportunity for sub-specialty recruitment

Charles Dixon
PB 2007 31: 234. [Full Text]  

This article has been cited by other articles:

				B. F. P. Broekman, R. Kumar, A. Y. P. Toh, and K. E. Heok Recruiting psychiatrists - the Singapore experience Psychiatr. Bull., July 1, 2008; 32(7): 275 - 275. [Full Text] [PDF]

				B. Adams Dark side of the moon: a course in mental health and the arts Psychiatr. Bull., June 1, 2008; 32(6): 227 - 229. [Full Text] [PDF]

				T. M. Brown, K. Addie, and J. M. Eagles Recruitment into psychiatry: views of consultants in Scotland Psychiatr. Bull., November 1, 2007; 31(11): 411 - 413. [Abstract] [Full Text] [PDF]

eLetters:

This Article Full Text (PDF) Submit an eLetter View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in PB Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Eagles, J. M. Articles by Brown, T. Search for Related Content PubMed Articles by Eagles, J. M. Articles by Brown, T.