Introduction
There is a worldwide increase in the demand for psychiatrists to fulfil the growing need for mental health services. In this review, we explore local and international approaches to promoting interest in psychiatry amongst medical trainees and other health professionals.
Despite the rising demand for mental health services, recruitment of medical students to psychiatry is a global problem. While most Western nations adhere to or exceed the one psychiatrist per 10,000 of the population recommended by the World Psychiatric Association (WPA) (Shields et al. Reference Shields, Ng, Ventriglio, Castaldelli-Maia, Torales and Bhugra2017); in developing nations, this statistic drastically lowers to 0.2 psychiatrists per 10,000 people. The corresponding figure in Ireland is 6 consultants per 100,000 which falls well below the EU average (Fianna Fáil, 2019). This is, in part, due to insufficient funding of mental health services (The Irish Times, 2018). The Irish mental health budget is now much lower than many other EU countries (Cullen et al. Reference Cullen, McDaid, Wynne, Matosevic and Park2017). It is also impacted by stigma towards psychiatry, lack of trained clinicians, poor work conditions, high work stress and unacceptable patient risk, amongst other factors (Andalo, Reference Andalo2019; Choudry & Farooq, Reference Choudry and Farooq2017; McNicholas et al. Reference Mcnicholas, Sharma, Oconnor and Barrett2020).
There have been many attempts internationally to stimulate interest in psychiatry amongst medical trainees. Clinical placements are a popular intervention strategy. Trainees noted that the ‘quality of their exposure to psychiatry at medical school’ (Appleton et al. Reference Appleton, Singh, Eady and Buszewicz2017) was crucial in affecting their attitudes towards mental illness. This included sufficient placement time, as practical experience greatly affected students’ attitudes towards working within the discipline (Appleton et al. Reference Appleton, Singh, Eady and Buszewicz2017; Farooq et al. Reference Farooq, Lydall, Malik, Ndetei and Bhugra2014). In addition, good role models during trainees’ educational period, as well as experience of team building exercises, were also useful.
Hor and colleagues (Hor et al. Reference Hor, Russell, Vasudevan and O’ Brien2020) explored changes in students’ attitudes towards psychiatry. They investigated changes in attitude and career preferences of year three medical students before an 8-week psychiatry rotation, after the rotation, and again in year 5. They found that attitudes towards psychiatry improved after their rotation. However, these preferences declined by year 5, falling below the level of preference pre-rotation. These findings suggest that clinical placement in psychiatry itself is not sufficient. The length of placement plays a role, while sustaining interest after placement poses a key challenge.
Several academic institutions and bodies worldwide have introduced summer schools for psychiatry to educate students and increase exposure to psychiatry as a profession, to senior role models, and to patients experiencing mental health difficulties. The University of Maryland was one of the first to hold such a programme, which began in 1970 and continues as the ‘Combined Accelerated Program in Psychiatry.’ Similar summer schools have been run at the University of Toronto and in Western Australia. Evaluations of these programmes show that contact with patients, seniors in the profession, other interested students and child and adolescent services, are valued. Exposure to specialist services, such as child and adolescent psychiatry, plays an important role in later career choices in international trainee reports (Barrett et al. Reference Barrett, Jacobs, Klasen, Herguner, Agnafors and Banjac2020). Additionally, social events, smaller teaching groups and diverse programmes, are also important (Andermann et al. Reference Andermann, De Souza and Lofchy2010; Weintraub et al. Reference Weintraub, Plaut and Weintraub1999).
In Ireland and the United Kingdom, similar programmes are underway. The Royal College of Psychiatrists, UK, runs a ‘Pathfinder’ programme to nurture early-stage medical students and doctors in pursuing a career in psychiatry. They also run the ‘Choose Psychiatry’ campaign, the primary aim of which is to bring attention to the patient’s story through interviews with doctors, as well as recitals of patients’ stories by actors. The campaign provides blogs, educational materials and interviews with clinicians on their site to educate students, medical professionals and the general public on psychiatry. The College of Psychiatrists of Ireland runs a short, free summer school, which is in its ninth year, aimed at those interested in a career in psychiatry. The programme includes interactive seminars with consultants and trainees in psychiatry, service users, carers and family members. It also includes tours of psychiatry facilities and a social event at the end of the programme. Initiatives such as the Spike Milligan Public Speaking Competition, aimed at fostering mental health awareness amongst medical students running since 1999, offer another example of looking for opportunities to both decrease stigma to psychiatry and increase interest in the field. Other brief enrichment opportunities outside of the academic sphere may also serve to increase student engagement and interest in topical issues on mental health. Programmes like Medfestaim bring important health issues to the fore through the use of film and media. This festival holds events throughout Ireland and the UK. Results of a survey of attendees of the festival revealed that 46% of students who attended the festival were more likely to consider psychiatry as a career path (Ahmed et al. Reference Ahmed, Bennett, Halder and Byrne2015).
The Child and Adolescent Psychiatry team at the University College Dublin (UCD) runs a nascent Summer Student Research scheme (SSRA), an 8-week summer placement with a strong emphasis on a research component hosted at the university. This is an optional, credit-bearing elective. Presently it comprises weekly tutorials on psychiatry mentoring and research, a clinical research project, and where possible observation periods in clinical services. The longevity of the programme aims to foster interest in psychiatry as a career. The Child and Adolescent Psychiatry group evaluated the efficacy of their SSRA programme through a survey approach, which found that one-third of students reported interest in pursuing a career in mental health following this programme. Several trainees are currently placed in intern years with psychiatry experience following the programme. Given the combination of clinical and academic components in the intervention, this multifaceted approach may serve to further engage participants with the field of mental health in multiple settings.
In summary, institutions and those interested in preserving psychiatry within the healthcare sector have been vigorously working to engage students who are interested in careers in psychiatry. Intervention programmes have included both educational and clinical components, and these have generally shown positive outcomes.
Acknowledgements
The authors would like to thank the participants of University College Dublin’s Summer Student Research scheme (SSRA) for their contributions to the programme and our further understanding of students’ interests in psychiatry.
Conflict of interest
The authors have no conflicts of interest to disclose.
Ethical standards
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that ethical approval for publication of this letter to the editor piece was not required by their local ethics committee.
Financial support
The contents of this letter received no specific grant from any funding agency, commercial or not-for-profit sectors.
