| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| British Journal of Psychiatry | Advances in Psychiatric Treatment | All RCPsych Journals |
|
|
|
||||||||||
|
||||||||||||
Education & Training |
North London Forensic Services, Chase Farm Hospital, The Ridgeway, Enfield EN2 8JL, email: kalthomas{at}yahoo.co.uk
Department of Mental Health Sciences, University College London
West London Mental Health NHS Trust, The Claybrook Centre, London W6 8LN
 |
Abstract |
|---|
 Top Abstract IntroductionMethodResultsDiscussionConclusionsReferences |
|---|
To find out why consultant psychiatrists chose psychiatry as a career. A questionnaire was developed and posted to 87 consultant psychiatrists in substantive posts within a London psychiatric training scheme.
RESULTS
The survey had a response rate of 83% (72 out of 87).The majority of consultants (n=40) chose psychiatry as a career after leaving medical school. The most important reasons cited were empathy with the patient group (36.1%), the interface of psychiatry with the neurosciences (25%), the better working conditions expected in psychiatry (20.8%) and medical school teaching of the subject (19.4%).
CONCLUSIONS
The study highlights the need for recruitment efforts after medical school. The findings also reflect the lasting influence of medical school exposure to psychiatry. Interventions for improving recruitment in psychiatry are suggested. The under-recruitment of British medical graduates is masked by overseas recruitment into the specialty.
|
|
Introduction |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
Several studies have considered factors that lead to the choice of psychiatry as a specialty. These have been carried out among potential psychiatrists in their premedical years (Maidment et al, 2003), in medical school (Schumacher, 1964; Wilkinson et al, 1983; Maidment et al, 2003), during pre-registration house jobs (Creed & Goldberg, 1987), and among senior house officers (SHOs; Clarke-Smith & Tranter, 2002; Maidment et al, 2004). They have found that career plans change both during and after medical school. There has been a suggestion that the most specialty switching takes place in psychiatry (Held & Zimet, 1975). In addition there is a high rate of ‘attrition’ of SHOs in psychiatry, who do not progress to higher psychiatric training or to consultant grade posts (Cox, 2000).
A study among consultant psychiatrists would indicate the reasons why people become psychiatrists, and might suggest rational interventions for increasing recruitment and retention. To date there have been few studies of psychiatrists at this stage of their career (Prins, 1998). Our study of consultant psychiatrists aimed to explore their reasons for choosing the specialty and to help clarify the motivation of people who became psychiatrists, as opposed to those who intend to become psychiatrists and may change their mind.
|
|
Method |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
Analysis
Data were analysed using descriptive statistics and SPSS version 6 for
Windows. The three most important reasons for choosing psychiatry were grouped
together in order to have an adequate number of psychiatrists to compare
results between groups. Associations between demographic variables and the
reasons were assessed using the 
2 test. As this was an
exploratory study where associations between variables were considered, the
level of statistical significance was set at P=0.01 to avoid spurious
results.
|
|
Results |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
Stage of choosing psychiatry
The majority of the participants (n=40, 55.5%) chose psychiatry as
a specialty after leaving medical school; 30.5% (n=22) decided during
medical school and 8.3% (n=6) decided on a career in psychiatry
before medical school. Four participants did not respond to this question.
Country of primary medical qualification
There were 44 participants who qualified as doctors in the UK (61.1%) and
38.9% (n=28) who qualified overseas. Of the latter, 9 qualified in
South Asia, 7 in Western Europe, 6 in Africa, 4 in Australia and New Zealand,
and 2 in South America.
The ‘most important reasons’ for choosing psychiatry as a career
The ‘most important’ reasons for choosing psychiatry as a
career are shown in Table 1;
36.1% (n=26) chose psychiatry as a career because of their empathy
for those with a mental disorder; 25% (n=18) because of the interface
of psychiatry with the neurosciences; 20.8% (n=15) because of the
expectation of better working conditions in psychiatry; and 19.4%
(n=14) because of medical school teaching.
|
Participants were asked to indicate other reasons which influenced their choice of psychiatry. Other reasons cited were a holistic approach (n=3), an interest in people (n=10), psychodynamic and psychological reasons (n=3), an interest in the subject (n=8), the importance of team work (n=4) and alternative treatment modalities.
There were no significant differences in the importance of medical school teaching as a factor in recruitment among those who decided on the specialty before, during or after medical school. There were no differences in importance of ‘better working conditions’ among male and female psychiatrists. There were no differences based on the country of primary qualifications.
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
It is likely that these results can be generalised to the whole of England as the study population was representative of the consultant population in the UK in terms of gender and choice of sub-specialty (Royal College of Psychiatrists, 2005). However, a greater proportion of our study population qualified overseas (Goldacre et al, 2004).
Student attitudes to psychiatry improve after psychiatric attachments (McParland et al, 2003). These improvements then decay after graduation, but it is uncertain whether they remain higher than pre-attachment levels (Burra et al, 1982; Sivakumar et al, 1986; Baxter et al, 2001). The decay may be a result of the pull from other specialties, negative propaganda from other specialties (Clarke-Smith & Tranter, 2002) and narrow negative exposure to psychiatry after medical school. In the absence of exposure to psychiatry after medical school there is little to counteract these factors. After medical school, the narrow exposure of junior doctors to psychiatry may leave them with the impression that psychiatric patients are ‘difficult’ and ‘incurable’.
Cameron & Persad (1984) found that the rejection of other specialties, discovery of psychosocial problems in other specialties and discovering the effectiveness of psychiatric therapy influenced the choice of psychiatry. Participants in our study indicated that during their post-graduate years, they recognised that psychiatry offered the most holistic approach to patient care.
Reasons for choosing psychiatry
About a third of participants cited empathy for this patient group as an
important reason for choosing psychiatry as a career. Although there was no
difference on a humanitarian scale between medical students who showed a
preference for psychiatry and those choosing other specialties
(Eron, 1955), medical students
who did not show a preference for psychiatry found people with mental illness
anxiety-provoking and difficult; in contrast to psychiatrists’ who tend
to have more positive attitudes (Tucker
& Reinhardt, 1968).
Direct involvement in patient care is an important factor in improving medical students’ attitudes to psychiatry during their attachment (McParland et al, 2003). Longer attachments in psychiatry or more direct involvement in patient care might help to reduce the anxiety that medical students have of psychiatric patients and enable them to develop greater empathy for this group. Foundation year posts in psychiatry (Department of Health, 2002) may offer potential, but others have been more sceptical (Eagles, 2004). Increasing the numbers of general practitioner trainees might also improve recruitment in psychiatry.
The interface of psychiatry with the neurosciences was an important factor for 18 consultant psychiatrists in their choice of this specialty. This is consistent with previous work that suggested that the divorce of psychiatry from mainstream medicine had led to its relative unpopularity (Thompson & Sims, 1999). Galeazzi et al (2003) found that the perception of psychiatric care as evidence based and recognition of research opportunities in mental health were important factors that led to the choice of psychiatry as a career.
Working conditions experienced in psychiatry were an important factor for 15 of the participants. Following graduation, the choice of careers is influenced more by lifestyle than by specialty content (Sierles & Taylor, 1995). In our study around half of those who felt that working conditions were an important factor cited better on-call working patterns or work-home balance as important. Without exposure to psychiatry after medical school, doctors are unlikely to recognise the better work-home balance that is possible with a career in psychiatry.
Medical school teaching of psychiatry was an important factor in choice of specialty (19.4%). This was equally true of those who had decided on the specialty after medical school as for those who had decided earlier. Liaison psychiatry, student psychotherapy schemes and community psychiatric postings have been shown to improve recruitment into psychiatry (Clarke-Smith & Tranter, 2002; Yakeley et al, 2004). Enthusiastic teachers, encouragement from consultants, curability and direct patient involvement have all been cited as factors in medical school teaching which improved the attitudes of medical students (McParland et al, 2003).
Limitations
This study was carried out among consultant psychiatrists in one London
psychiatric training scheme. A retrospective survey of this kind may lead to
systematic recall bias. Direct questioning will not always reveal motivations
behind a career choice (Halford,
2003). Furthermore, consultant psychiatrists are unlikely to admit
that they made a mistake in their career choice.
|
|
Conclusions |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
|
|
Acknowledgments |
|---|
|
|
References |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionsReferences |
|---|
BURRA, P., KALIN, R., LEICHNER, S., et al (1982) The ATP-30: a scale for measuring medical students’ attitudes to psychiatry. Medical Education, 16, 31-38.[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]
CLARKE-SMITH, L. & TRANTER, R. (2002) Recruitment
and retention in psychiatry. British Journal of
Psychiatry, 181, 163
.
COX, J. (2000) Person-power: reflections on the mental
health National Service Framework for adults of working age.
Psychiatric Bulletin,
24, 201
-202.
CREED, F. & GOLDBERG, D. (1987) Doctors’ interest in psychiatry as a career. Medical Education, 21, 235 -243.[Medline]
DEPARTMENT OF HEALTH (2002) Unfinished Business: Proposals for Reform of the Senior House Officer Grade. Department of Health.
DEPARTMENT OF HEALTH (2003) Department of Health Vacancies Surveys, March 2003. http://www.dh.gov.uk/assetRoot/64/07/93/75/04079375.pdf
EAGLES, J. M. (2004) Modernising medicalcareers.
Psychiatric Bulletin,
28, 425.
ERON, L. D. (1955) Effect of medical education on medical students’ attitudes. Journal of Medical Education, 30, 559 -566.[Medline]
GALEAZZI, G. M., SECCHI, C. & CURCI, P. (2003)
Current factors affecting the choice of psychiatry as a career: an Italian
study. Academic Psychiatry,
27, 74-81.
GOLDACRE, J. M., DAVIDSON J. M. & LAMBERT, T. W.
(2004) Country of trainingand ethnic origin of UK doctors:
database and survey studies. BMJ,
329, 597.
HALFORD, J. (2003) Invited commentary on: recruiting
and retaining psychiatrists. Advances in Psychiatric
Treatment, 9, 411
-413.
HELD, M. L. & ZIMET, C. N. (1975) A retrospective view of medical speciality choice. Journal of Medical Education, 50, 2044 -2051.
McPARLAND, M., NOBLE, L. M., LIVINGSTON, G., et al (2003) The effect of a psychiatric attachment on students’ attitude to and intention to pursue psychiatry as a career. Medical Education, 37, 447 .[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.
MAIDMENT, R., LIVINGSTON, G., KATONA, M., et al (2004) Changes 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. Medical Teacher, 26, 565 -569.[CrossRef][Medline]
PRINS, H. (1998) Characteristics of consultant forensic psychiatrists (a modest survey). Journal of Forensic Psychiatry, 9, 139 -149.
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.
SCHUMACHER, C. F. (1964) Personal characteristics of students choosing different types of medical careers. Journal of Medical Education, 39, 278 -288.[Medline]
SIERLES, F. S. & TAYLOR, M. A. (1995) Decline of
US medical student career choice of psychiatry and what to do about it.
American Journal of Psychiatry,
152, 1416
-1426.
SIVAKUMAR, K., WILKINSON, G., TOONE, B. K., et al (1986) Attitudes to psychiatry in doctors at the end of their post-graduate year: two-year follow-up of a cohort of medical students. Psychological Medicine, 16, 457 -460.[Medline]
THOMPSON, D. J. & SIMS, A. C. P. (1999) Malaise in
psychiatric recruitment and its remedy. Psychiatric
Bulletin, 23, 227
-229.
TUCKER, G. J. & REINHARDT, R. F. (1968)
Psychiatric attitudes of young physicians: implications for teaching.
American Journal of Psychiatry,
124, 986
-991.
WILKINSON, D. G., TOONE, B. K. & GREER, S. (1983) Medical students’ attitudes to psychiatry at the end of the clinical curriculum. Psychological Medicine, 13, 655 -658.[Medline]
YAKELEY, J., SHOENBERG, P. & HEADY, A. (2004) Who
wants to do psychiatry? The influence of a student psychotherapy scheme - a
10-year retrospective study. Psychiatric Bulletin,
28, 208
-212.
Related articles in PB:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| British Journal of Psychiatry | Advances in Psychiatric Treatment | All RCPsych Journals |
