Examination of Medical Students’ Expectations of Psychiatry Prior to Placement: A Qualitative Study

Abstract

Aims

There is limited literature regarding medical students’ expectations of psychiatry placements, although studies focussing on nursing students reveal fear and anticipation of aggression and violence to be prominent factors. Anecdotally, authors have been aware of medical students having reported impressions of psychiatric wards which were at odds with the reality. This study aims to explore what medical students specifically imagine and expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used as a specific focus to highlight the full extent of their preconceptions.

Methods

Students undertaking their psychiatry attachment between July and December 2021 were invited to complete a semi-structured questionnaire, deemed to be more preferable to interviews as it was thought that anonymity would encourage more students to participate, provide open and honest responses, thereby exposing the full scope of presumptions. Question content was designed by 2 psychiatrists, with modifications after consultation with 2 student advisors. Questions explored student emotions regarding their visits to psychiatric wards and psychiatric intensive care, as well as expectations of the ward atmosphere, layout, activities, where patients would be, what they would be doing and how they would be managed. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Two authors read and coded all text independently, before discussing any discrepancies and then defining and refining themes with involvement from all authors, in a process of several reviews.

Results

Five themes emerged from the data: 1) Mixed feelings about the placement (with anxiety being prominent), 2) Mixed views about patient behaviour with many assumed to be violent, 3) Caring and holistic-minded staff, 4) A restrictive and locked environment, 5) Assumed similarities to acute general hospital care. Some of the expectations of students were markedly different to the realities of psychiatric inpatient and intensive settings, with students reporting ideas of patients in locked rooms, physically restrained, sedated and attached to ventilators.

Conclusion

This study offers a unique insight into what medical students expect from their psychiatry placement, a key issue of which all educators and clinicians who supervise students should be aware. Results can inform better student preparation and placement supervision, leading to more meaningful learning and improved well-being.