A small percentage of newly qualified physicians intend to choose psychiatry as a future career (1). Many studies have pointed out that exposure to psychiatric services is likely to promote a positive attitude toward psychiatry (2). Existing literature also suggests that the quality of the psychiatry clerkship during medical school may be the most important modifiable influence on recruitment into psychiatry (3). However, psychiatry clerkships in Western and Arabic medical schools vary considerably with respect to setting, content, expectations, duration, and teaching strategies.
Most mental health services in the Saudi Kingdom are offered by the Ministry of Health and to a lesser extent by other agencies, such as the military, the national guard, and university hospitals. About 498 psychiatrists are in the country, with a disproportionate number of expatriates. There are only 78 Saudi psychiatrists; furthermore, only 19 of them are women who are mostly involved in academic teaching.
Relatively few studies have addressed medical students’ attitudes about the clerkship experience in the Saudi culture, with its unique characteristics such as Islamic heritage, historic role as an ancient trade center, and Bedouin traditions. The religious and cultural heritage attributes the etiology of mental illness to supernatural forces, and traditional medicine is still practiced in nomadic and rural areas. Faith healers usually classify and treat mental disorders from the spiritual perspective. Only about 2% of medical students choose psychiatry as their specialty. The objective of this study was to gain an understanding of the changes in the attitudes toward psychiatry among Saudi medical students during an academic year after their psychiatry rotation.
During the 2007–2008 academic year, all 56 of the fifth-year male students of the Al-Hassa College of Medicine, King Faisal University, were invited to participate in this study. Up to this time, only male students joined this college, so there is no gender variable. The response rate was 96.4% (N=54). The students’ mean age was 23.11±0.57 years old.
Medical students at Al-Hassa are exposed to behavioral sciences in the third year. In the fourth year, they learn more about the interplay between physical and psychological components of illnesses through problem-based modules. In the fifth year clerkship, students spend 5 days a week for 6 weeks training in psychiatry at Al-Hassa psychiatric hospital, mainly in inpatient sections.
Teaching methods include small-group tutorials, group discussion, lectures, and hospital rotations. The psychiatry course consists of 205 contact hours (25 hours of theoretical lessons and 180 hours of practice rotation), which correspond to 6 credit hours.
Balon et al.’s (4) questionnaire, consisting of 29 items to examine the attitudes of medical students toward psychiatry in six main domains, was used. Item 19 was deleted because of the absence of international graduates in the college. The instrument was self-administered by students in its original English because English is the medium for teaching. The same questionnaire was completed before and after completion of the psychiatric rotation.
Students gave oral consent to participate in the study. The study was approved by the College of Medicine authority because there is no research ethics committee.
The statistical analysis was performed using SPSS version 11. The descriptive analyses of the items concerning attitudes were converted into percentages. The data obtained before and after training in psychiatry were compared using the McNemar test. Significance was set at p≤0.05.
Table 1 shows favorable changes in the attitudes following clerkship in most of the domains studied. In the merits domain, the number of students who considered that psychiatry is expanding at the frontiers of medicine doubled after the rotation. Significant favorable changes after training were observed in the three items of the efficacy domain.
Students’ opinions concerning the role definition and functioning of psychiatrists also changed. A more favorable attitude after rotating in psychiatry was reported in the career domain, and there were changes in students’ attitudes in the medical school domain.
Attitudes toward psychiatry and mental illness among medical undergraduates seem to be key factors in determining their choice of psychiatry as a career and willingness to treat psychiatric disorders in clinical practice (5).
This study showed a favorable attitude expressed by students after they had some experience in the discipline. The findings revealed significant improvement among participants in the common myths about psychiatry. They perceived psychiatrists as logical thinkers who earn money like most other doctors and have the most authority and influence among mental health professions, which agreed with previous studies in Arab regions (5). Students changed their negative attitudes, and their knowledge of psychiatry increased. Therefore, as they came to know the field better (both theoretically and practically), students showed a reduced bias (either positive or negative) (6).
The students were undecided after the rotation about whether psychiatry is unscientific and imprecise. They lacked family support in their choice of psychiatry as a career, a finding that could be based on the cultural perspective. First, traditional beliefs attribute mental illness to supernatural forces. Second, behavior in the Arab culture is determined more by group needs and thinking rather than those of the individual (7). Finally, traditional beliefs tend to be deeply imprinted and are therefore not easily erased by modern education (8).
The teaching of psychiatry in Saudi Arabia is hospital-based, concentrating on patients with severe mental disorders. Consequently, communications with patients and psychiatric diagnostic skills for less severely affected patients are not addressed in medical training. Furthermore, the biomedical approach that is favored in Arab medical training focuses on physical-organic causes of illness and minimizes the important role of emotional distress in the health of patients (9).
To overcome the problems of recruiting more graduates to specialize in psychiatry, programs should focus on promoting positive contact between medical students and people with mental disorders, improving the teaching methods of psychiatry, and approaching students with positive attitudes toward psychiatry individually during their clerkship.
At the time of submission, the authors reported no competing interests.