How to win friends and influence students: The role of student Psychiatry Societies in remedying recruitment problems

Neel Halder, Consultant Psychiatrist, Alpha Hospital, Buller Street, Bury, BL8 2BS. Senior Honorary Lecturer, School of Medicine, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.
Judith Harrison, FY2, Royal Surrey Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK.

Improving recruitment numbers into psychiatry in the UK is recognised as an important issue in the field. One recent way of tackling the problem has been to set up Psychiatry societies for undergraduates within medical schools. Very little has been published about this ever-growing phenomenon. This article provides personal perspectives from undergraduate and postgraduate levels, taking into account ideas trialled in areas of the UK. It provides practical suggestions that can be easily incorporated into other Psychiatric Societies and shares examples of events that have been successfully trialled.

Introduction

Psychiatry tends to be an unpopular career choice. Problems recruiting psychiatrists were first encountered when the numbers of consultant posts were increased in the 1970’s [1]. Psychiatry is one of the largest specialties in the UK; around a tenth of all medical doctors are psychiatrists. Despite the employment of huge numbers of psychiatrists from overseas, 12% of consultant posts remained unfilled in 2002 [2]. A critical juncture was reached in 2008, with the news that only 6% of candidates passing the MRCPsych Part 1 Examination were UK graduates causing widespread consternation. The situation had not improved by 2009, when it was found that just 1 in 8 of those passing the MRCPsych Clinical Assessment of Skills and Competencies (CASC) Examination had qualified in the UK [3].

Why is psychiatry such an undersubscribed specialty in the UK? It is unequivocal that it appears unattractive to medical students. Studies of undergraduates’ attitudes towards psychiatry make disheartening reading; some students consider psychiatry to be ‘boring’, ‘unscientific’, ‘depressing’, ‘stressful’ and ‘frustrating’ [4]. Researchers have suggested that a low perceived status of psychiatry compared to other specialties and negative attitudes among other medical professionals may deter students [1]. Others have posited that a lack of clarity about the role of the psychiatrist in the modern National Health Service could be discouraging [5]. Exposure to psychiatry in undergraduate training tends to be limited. There is evidence that a negative experience during the psychiatry clinical attachment greatly reduces the likelihood that a student will consider it as a career [6].

Previous research using focus groups found that some medical students were misinformed about what actual clinical practice in specialities such as psychiatry was like. For factors that influenced medical students’ decision-making in career choice, themes included lifestyle, controllable hours, intellectual challenge, and role models [7]. Psychiatrists should therefore do their utmost to reduce misinformation and stigma, and promote the factors listed above and the many more benefits a career in psychiatry entails. This should occur not just in the limited few weeks of the psychiatry attachment, but throughout the undergraduate years.

Views from a recent graduate

Personally, I (JH) have never quite understood why everyone doesn’t want to be a psychiatrist. I see it as applied science, where interacting with people is key. The burden of disease is massive; mental illness causes as much suffering as all physical conditions combined [8]. Our understanding of the brain is poor when compared to our knowledge of other organs, and there is so much yet to be discovered. The enormity of the challenges gives greater scope to make a difference.

As a third year student, I attended the Royal College of Psychiatrists annual meeting as part of a group of students who were as interested and enthusiastic about psychiatry as I was. I heard about the pioneering activities of the Psychiatry Society at King’s College London (KCL), which was set up in 2005. Its stated aims are “to promote psychiatry as a career to medical students, support those students who wished to pursue psychiatry as a career and raise the profile of mental health issues amongst all student health professionals”. They organise lectures, psychiatry career events and elective information sessions. In addition, they collaborate closely with the medical school to facilitate special study modules in psychiatry and to run exam revision workshops. Most of their events are open to all; students from the other London medical schools are also invited. The Department of Psychological Medicine and Psychiatry at the Institute of Psychiatry provides the society with funding and with administrative support.

The ‘Psych Soc’ allows those who are interested in psychiatry to learn more about it, and keen students can find psychiatrists to become their mentors. Moreover, assuming roles of responsibility within the interest group allows students to develop key leadership and organisational skills, in addition to adding interest to their CV’s.

When my colleagues and I were considering setting up a similar interest group at the University of Dundee, we had to think about what the main issues were for us as medical students. It seems that student concerns can be divided into three broad categories: our finances, our futures and having fun.

We are all in a considerable amount of debt. Tuition fees for medicine in 2010/2011 were £3,290; they are set to increase now that the cap of tuition fees has been raised to £9000 per annum. This compounds the pressure to perform academically. Failing to complete the course presents the prospect of leaving university with no means of paying off the money we owe.

Changes to postgraduate medical training require us to specialise sooner than our predecessors; we have to consider our career options at a much earlier stage. A senior postgraduate friend of mine said: “Things are so different for students these days; the pressure’s on for you to start building your CV’s much sooner”.

Most students make time to enjoy the recreational aspects of the undergraduate experience. In addition to the informal opportunities to socialise, there are numerous clubs, sports teams, bands and choirs. At Dundee University there are more than 70 registered Societies catering for a diverse range of hobbies and interests, from sky diving to overseas volunteering. These provide plenty of opportunity for students to ‘let their hair down.’

Ideas for events run by psychiatry societies

There is already information available on the Royal College of Psychiatrists’ website about how medical schools can set up a Psychiatry Society [9]. This section will therefore concentrate on what can be successfully implemented by them once set up. A summary of the events are presented in Box 1.

Dundee and Manchester Psychiatry Societies (the logo for the Dundee society is shown in figure 1) run events that appeal to all students, not only those who want to be psychiatrists. It is important that these societies receive senior support, as their members are potential future psychiatrists. Most of the following are ideas that have been successfully trialled in Dundee and Manchester. They provide areas where psychiatry trainees and consultants can get involved.

Fig 1: Logo of the Dundee Psychiatry Society

Speed-dating

The format for the evening was modelled on the highly successful ‘Speed dating for Psychiatry careers’ event run by Cambridge Psychiatry Society [10].

This can take place in any room, but in Dundee, it worked well when one of the more reputable bars was hired and wine and nibbles were laid on. Consultants and trainees from each sub-specialty sat around tables and small groups of students rotated around them at ten minute intervals; this avoided the potential pitfall of keen students ‘hogging’ the psychiatrists from their favourite sub-specialty, although some did have to be reminded more than once that their time was up. The atmosphere was relaxed; students and psychiatrists met on an equal footing, free from the hierarchies of the hospital environment. It gave students the chance to ask all the questions they wanted about careers and training. Students could also identify potential supervisors for special study modules and research projects, and the psychiatrists shared the enthusiasm they have for their fields.

OSCE revision sessions

OSCE revision sessions in both Dundee and Manchester gave tips on getting through the psychiatry exam questions and were massively oversubscribed. This is one of the times where students other than those already interested in psychiatry will attend. This gives an opportunity to promote the psychiatry society and give careers advice to a broader audience. In Manchester, the session usually takes the form of a two-hour lecture delivered by a psychiatrist, followed by a one-hour practice OSCEs using student volunteers as patients. The lecture is about communication skills and contains a brief recap on symptoms and management of common mental illnesses. It helps if someone who has experience as an OSCE examiner delivers this. It also allows for some ‘pre-traumatic counselling’ as many students do not handle failing well.

Film nights

These nights work well as an alternative way of raising awareness of mental health issues and give an opportunity to teach. They are held in the evenings, usually in lecture theatres that already have access to projectors and screens. Those that attend can have a free meal (funding may be made available from deaneries), and everyone gets a certificate of attendance. Prior to showing the film, the psychiatrist gives a brief introduction giving students specific issues to think about during the viewing. Following the film, the psychiatrist can facilitate a discussion about how mental illness is portrayed in the media, and debate its accuracy, giving an opportunity to discuss symptoms, treatment (e.g. ECT) and management as shown in the film compared to reality. Examples of films and possible discussion points that can be used are given in Box 2.

Career guidance

In Manchester’s first medical careers’ fair in 2010 (for all specialities), 64 out of 700 medical students (throughout years 1 to 5) who confirmed their attendance said they would come to the psychiatry ‘stall’. This represented a healthy 9.1% of the population expressing a serious interest. This compares well with other studies showing psychiatry to be the students’ choice in only 3% (n=300) and at the bottom of the list of clinical specialities chosen by students as a career they would like to pursue [3].
Box 3 shares ideas from the Manchester careers’ fair for next year based on student feedback and what went well.

Debates

This is in some ways harder to set up as it requires more manpower, but can be a good way of generating a lively discussion. Ideas for debates can be found on the Institute of Psychiatry Maudsley debate website (www.iop.kcl.ac.uk/podcast/rss/Maudsley_Debates.xml) which is complete with podcasts. Two debate topics that were tried successfully in Manchester were: ‘This house believes that depression is a medical illness’, and ‘this house believes that psychiatrists are real doctors’.

Setting up an annual essay prize

The Psychiatric societies can help in promoting prizes such as these throughout the medical school. I (NH) set this up last year with minimal effort (it required a brief email to the Head of the Medical School for approval). Essentially I asked students to write up to maximum of 2500 words on a mental health related topic chosen by me, from a choice of 3 titles. I encouraged writing using a similar style to that adopted by scientific journals (and gave guidance on referencing style etc). The 2011 prize was presented by myself to Christiana Hadjidemetriou (figure 2).

Fig 2: Dr Neel Halder presenting the winning certificate for the annual essay prize to medical student Christiana Hadjidemetriou in 2011

What’s in it for them? All entries receive certificates for their portfolios. They all receive structured feedback on their essays (in a similar way to peer-reviewed manuscripts), which will help them with future publications. These are marked, with students’ names anonymised to minimise bias. Students will have a chance to win a monetary prize, spread over the first five essays as judged by myself. Initial feedback indicates that some students would not have entered if there was not a chance of winning money, and that more students would enter if the monetary prize was spread over more places. Interestingly, some students stated that despite initially entering “just for the money”, they are now considering psychiatry as a career option, having now focussed on an area that they would have otherwise overlooked. Although I am providing the prize money from my own pocket, the Deanery or medical school may be able to help, once I collate more evidence to demonstrate its success.

So what do I get out of it? Focussing minds of students to psychiatry when so little time is devoted formally to the speciality at an undergraduate level; the knowledge that some students are turning to psychiatry when they would not have done so; the pleasure of reading some high quality work and offering feedback to improve scientific writing (for many students this would be the first time writing like this). Also I can learn from the students themselves. Essay topics include: (i) How do we attract more students into psychiatry? (ii) New ways of teaching students in Psychiatry: Explore and discuss; (iii) How are negative attitudes toward mental illness shaped and overcome? What better way to learn than from the students themselves.

Summer school

The Institute Of Psychiatry (IoP), London ran a summer school in 2010. This generated a lot of interest and other medical schools are looking to set up something similar. The IoP advertisement is given in Box 4. Students were expected to submit a 200-word statement on why they should be selected.

Conclusions

Many of the suggestions above have been trialled successfully in Manchester and Dundee, and the Manchester and Dundee Psychiatric Societies are currently among the largest Psychiatric Societies in the UK. As these are still in their early stages there is as yet no published evidence as far as we are aware that the interventions suggested have influenced recruitment. Future research would need to concentrate on this. This could be done perhaps by looking at recruitment rates for several years before and after a Psychiatry Society being created, or perhaps looking at rates where Psychiatry Societies exist and comparing them to geographical locations where they do not. Another option for research is to ask doctors who have chosen Psychiatry to rate how much influence the Societies had on their decision. The Psychiatry Society is a way for us to mark our interest in the specialty; by its very existence it refutes the misconception that nobody wants to be a psychiatrist. We actively attempt to contradict the myths that persist around the specialty and seek to promote a more positive view of the profession among our student colleagues. We hope that this will help to reverse recent trends in psychiatry recruitment, and that more medical students will consider a career in what we hold to be a fascinating specialty.

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