To the Editor: Recruitment from medical school into child and adolescent psychiatry remains an ongoing challenge. General-psychiatry clerkship exposes students primarily to adult patients, and medical students often do not have exposure to child and adolescent psychiatry (CAP) until late in their decision-making process, making it difficult for them to choose this career path. Some medical students have reported that they are deterred from pursuing psychiatry because of negative comments made by residents and faculty in other fields, including the idea that psychiatrists are "not real doctors," and "everyone in psychiatry is crazy" (1). Early exposure to CAP may mitigate these stigmatizing experiences. Preclinical students have also indicated a desire for more meaningful interactions with patients, as opposed to the heavily lecture-based curriculum that has historically been common. Motivated by the desire to increase preclinical exposure of CAP to medical students, CAP faculty members developed a program at a large medical school, in partnership with a school-based mental health program, pairing medical-student mentors with school-aged children receiving mental health services.

Reports from the literature of similar mentoring programs involving undergraduate and graduate students have shown a positive impact both on the students and the children being mentored (2, 3). First-year medical students were recruited at the beginning of the academic year through an annual extracurricular-activities fair. Of the 118 first-year students, 13 expressed interest and 5 completed brief applications describing their interest in the non-credit program. Program orientation with the faculty adviser included a meeting to discuss the medical-student role, issues of confidentiality, and safety. A tour of the school and a meeting with the school-based therapist were then conducted. Medical students were paired with children receiving mental health services at the school. Parents signed permission forms describing the program and were introduced to the medical student. Students traveled to the school weekly-to-biweekly to meet with their "buddies" over the course of 10 months. They engaged in recreational activities with their buddies and observed elements of the children's clinical care. Activities included making art projects, playing basketball, playing board games, going on walks, and reading books.

Clinical experiences included observations of clinical encounters with the therapist. The medical-student participants met monthly for seminars coordinated by the faculty adviser in conjunction with a medical-student leader. Topics were drawn from the students' experiences with their buddies; these included anxiety disorders, aggression, negotiating boundaries, interacting with parents, and responding to problem behaviors. The medical students were also paired with CAP faculty members and encouraged to meet with them individually. Faculty mentors were instructed to arrange an initial meeting with their medical-student mentees, but were otherwise free to structure their sessions according to the needs and desires of both parties. The faculty adviser planned the seminars, monitored the experience of the medical students by communicating frequently with the school-based therapist and the students, coordinated the faculty—student pairs, and was available for questions as they arose. An IRB-approved pre- and post- survey was conducted with the five paired medical students. The survey consisted of 5-point Likert-type questions regarding their perceptions of psychiatry, factors that attract or detract them from CAP as a career, their future career interests, and their experience with the course. All five students reported that the program provided good basic understanding of issues in CAP, increased their interest in CAP, and said that they would recommend the program to a friend. Four of five students reported that the program would influence their future practice of medicine.

Three of the students chose to pursue summer research projects in psychiatry, and three of the students chose to continue with the program for an additional year. One student who had previously been unsure about a prospective specialty reported that they were now interested in CAP or general psychiatry, and another student who initially reported pediatrics and child-and-adolescent psychiatry as potential career options narrowed their preference to child-and-adolescent psychiatry. Medical students had the opportunity to witness the developmental trajectory of the children over the course of the year, receive education about how child psychiatry issues evolve over time and discuss de-stigmatizing child-psychiatry patients and their care. In the monthly discussion groups, students were able to learn about child psychiatric issues through the salient lens of the children with whom they worked. Informal feedback was also extremely positive. The school-based therapist reported, "from the perspective of the kids and their parents [the program] is a whopping success. The kids have all reported how much they like getting together with their buddies …"

Despite the successes, several challenges arose. One was ensuring an appropriate forum for students to fully discuss concerns between the medical student—child pairs. Some students were reluctant to share difficulties they were having with their buddies with their faculty members. A number of students benefitted from the group discussions, whereas others seemed less comfortable in the group setting. In the future, ongoing group opportunities, supplemented by more structured faculty interactions, will be integrated into the program, so that students with different learning styles can comfortably discuss their concerns. The program also highlighted the complex role-negotiation that medical students experience as they interact with patients throughout medical school. Although the program director made clear that the medical students were not doing "treatment" with the children, the medical students struggled with when to simply be a "friend," when to provide guidance and redirection, and when to act as an advocate between teachers and school administrators. A larger sample of students will be necessary in order to make definitive conclusions about the impact of the program on medical specialty choice and its capacity to de-stigmatize the field of child-and-adolescent psychiatry. Programs like this one, however, may be a promising way to engage preclinical students in child-and-adolescent psychiatry. The hope is that the program can be replicated at other schools, with the goal of increasing medical-student interest in this important field.

The development of this curriculum was sponsored by a grant funded by APA, called the "Innovative Medical Student Teaching Award." Continuation of this program will be sponsored by the Klingestein Third Generation Foundation. The author is indebted to these organizations for their support. There are no competing conflicts of interest.