Recruiting medical students into psychiatric residency programs has received much attention. In the 1980s and 1990s, North American psychiatric residency programs experienced numerous barriers to recruiting high-quality medical students (1–5). This remains a problem around the world. The literature suggests that experiences during medical school, personalities of applicants, and beliefs about the practice of psychiatry are all strongly associated with the decision to enter a psychiatric residency. Recruitment strategies have been widely recommended to bolster positive psychiatry-related experiences and to alter negative perceptions (6–9). In the mid-1990s, only about 4% of U.S. and 6% of Canadian medical school graduates chose psychiatry (10, 11).
More recent studies focused on perceptions and attitudes of medical students about psychiatry careers (12–17). While initial interest is still the most influential factor, positive experiences during psychiatry clerkships and electives have been described as “modifiable programmatic factors that could enhance recruitment to psychiatry” (17).
The Psychiatry Institute for Medical Students at the University of Toronto in Ontario was initiated in 1994 as a novel recruitment strategy (18). To our knowledge, similar programs have not been reported.
As an indication of how much the recruitment situation has changed in Toronto, the 2008 Canadian Resident Matching Service match was successful in filling all 28 postgraduate year 1 (PGY-1) psychiatric residency positions at the University of Toronto as well as two international medical graduate positions—a total of 30 spots, up from 24 spots 2 years ago (19). As of July 2007, the University of Toronto has 138 psychiatric residents from PGY-1 to PGY-5.
In 1993, the University of Toronto’s Department of Psychiatry created a recruitment committee to formalize attempts to attract medical students to psychiatry. At that time there was concern that residency positions might not be filled, with the changing political landscape of the application process to postgraduate training. Various activities were planned, including journal clubs, career-night dinners, and psychiatry interest groups. A booklet called “The Many Faces of Psychiatry,” which illustrates the breadth and scope of psychiatry and features interviews with faculty and contact information, was created and distributed at medical student events.
The idea of highlighting psychiatry in a more experiential way gave rise to the Psychiatry Institute for Medical Students in 1994, a week-long summer program to introduce medical students to positive role models, mentors, and potential elective supervisors.
The Institute has now existed for 14 years, with 13 sessions completed and 1 year missed due to Severe Acute Respiratory Syndrome (SARS) in Toronto. In 2006, the Institute received the American College of Psychiatrists’ Award for Creativity in Psychiatric Education. The program has had international impact as well. The Romanian Psychiatric Association struggles with broader recruitment challenges in Eastern Europe, and the Institute was proposed as a model to consider in this regard (J Lofchy, personal communication, Sept 7, 2006), and in 2008, Western Australia launched its first Institute of Psychiatry for Medical Students, modeled after the Toronto program (JN Claassen, personal communication, Feb 28, 2008).
The recruitment committee is organized as a subcommittee of undergraduate education in the department of psychiatry at the University of Toronto and consists of two co-chairs (LA, CD), who are faculty psychiatrists, three other staff psychiatrists, eight residents, two medical students, and an administrative assistant. The last author of this article (JL) was the founder of the recruitment committee and the Institute and the director of undergraduate education for the department of psychiatry.
The recruitment committee aims to encourage medical students to consider a career in psychiatry, to communicate the satisfaction of such a career, to recruit students into the University of Toronto’s psychiatric residency program, and to promote psychiatry as a valued specialty. The committee meets monthly to plan and to evaluate various recruitment events.
Organization of the Institute
An annual budget is allocated for the Institute from the undergraduate committee for the program’s weeklong events, including food and local transportation. Students are responsible for their own travel and accommodation expenses but can stay at an affordable university residence. Participating speakers and elective supervisors do not receive honoraria, but many have university appointments that include remuneration for academic activities. In addition to thank-you cards, faculty members receive evaluations to include in their teaching dossier. In contrast to earlier years, no funds are obtained from pharmaceutical companies, in keeping with department policy.
Attendance in the Institute was initially 15 first- and second-year students from the five medical schools in Ontario; for many years this increased to 20 attendants. Attendance further increased to 25 students from medical schools across Canada to make the Institute more available to a growing pool of applicants, to parallel the size of Toronto’s psychiatric residency class, and to give more students a chance to experience psychiatry at the University of Toronto, where approximately 25% of psychiatrists in Canada are trained. In 2007, 16 of 25 students from Ontario schools and nine of 25 from the rest of Canada were accepted to the Institute (10 first-year and 15 second-year students) (Table 1).
The Institute is held for a week in June, after most classes and final exams are finished, but with more than 17 medical schools to consider, not all are able to attend at this time. Posters advertising the Institute are distributed to all medical schools in Canada and throughout the Toronto hospitals (a sample is available from the authors upon request). Advertising also occurs via student e-mail lists and the recruitment committee’s web site (20).
Selection is based on a resume and the strength of a letter of interest describing the desire to attend the program. Criteria have evolved over the years to reflect changes in the number of applicants to the residency program and to the Institute. As the residency has become more competitive, so has the Institute. Where preference used to be given to undecided students, Toronto students, and second-time applicants, emphasis is now on recruiting the best students.
The Institute is based primarily at the Centre for Addiction and Mental Health (CAMH), the hub of many departmental activities. Each day has a thematic focus (schedule details available upon request). Mornings are spent in informal lectures and seminars, and afternoons consist of clinical electives at teaching hospitals across the city linked to the theme of the day. Students also can observe ECT. One to three students attend each elective placement. Supervisors are chosen for their ability to provide an individualized clinical experience and are encouraged to discuss their career choices.
A patient panel is held in which a senior faculty member invites three patients to share their life stories and illness experiences in a nonclinical setting so that students hear about psychiatric treatment from the patient’s point of view and can learn about stigma and how mental illness affects family life, education, and employment. On alternate years, panelists have been health care providers with mental illness.
Social activities are an important component. The week begins with a barbecue at the home of the director of undergraduate education. The students receive individualized packages containing an overview of the week, elective placements, and selected readings. Breakfasts and lunches from Toronto’s multicultural cuisine are provided, with lunches being a time for attendees to meet psychiatric residents and talk freely without other staff around.
Two hundred twenty-two students have completed the program. Students complete pre- and postprogram questionnaires and detailed evaluations on all aspects of the week.
From 2000 to 2007, 11/110 students (10%) were initially undecided about a career in psychiatry. This decreased significantly to 4/114 (3.5%) after the Institute (z=−1.94, one-tailed p=0.026). In addition, 98/110 students (89%) were interested in a career in psychiatry before the Institute, which increased to 108/114 (95%) afterward (z=1.55, one-tailed p=0.061).
In 2006 and 2007, selection criteria shifted to include the most interested students, rather than the undecided, and we found no difference between those interested in a career in psychiatry before or after the Institute (39/43). Only three students were undecided before and after the Institute.
Students viewed the Institute as enjoyable, well organized, and relevant to their interests and level of training (Table 2).
From 1994 to 2005, 76 of 178 Institute participants (43%) matched to psychiatric residency programs. Ninety-four of 178 participants (53%) applied to the University of Toronto psychiatric residency program, and 60 (64%) matched there; 16 of 178 participants (9%) matched elsewhere. Overall, 76 of 94 participants (81%) applying to the University of Toronto matched into psychiatry. Students from 2006 and 2007 had not made their residency choices at the time of this writing but will be included in future analyses.
The Psychiatry Institute for Medical Students is a unique educational experience for preclerkship medical students. It continues to develop according to the needs of the program and yearly feedback. Although some unmatched positions remain for psychiatric residency programs in Canada, the University of Toronto program has become more competitive, with all positions being filled. Similarly, Institute applications have become more competitive, with the number of applicants exceeding the number of positions. The selection process for the Institute has been modified to reflect the above changes, with less consideration for ambivalent students. Since 2006, selection has focused on students expressing interest in psychiatry. As a result, it is not surprising that there was no difference between pre/post measures of interest in a career in psychiatry with the Institute.
Since the Institute has increased from 15 to 25 students, there has been some concern that small group cohesion would be compromised; however, this does not appear to be the case. In fact, the Institute size reflects the growing size of the PGY-1 class and gives students a chance to meet their future colleagues in psychiatric residency training in a realistic setting. Students have many opportunities to engage with one another academically and socially and to meet residents and faculty, who can become future supervisors and mentors.
Some of the challenges with expanding the Institute nationwide include a greater need for administrative coordination and the importance of reviewing timetables across the country to find a week in June suitable to the majority of schools.
The Institute could be adapted for other settings and sites, including smaller training programs. Its main goal, to provide medical students with a broad exposure to psychiatry as early as possible in medical training, is replicable, even with limited resources.
Universities outside North America have considered adapting the Psychiatry Institute model to address their recruitment challenges, and other schools have created versions of the Psychiatry Institute based on the Toronto model, such as Perth, West Australia (JN Claassen, personal communication, Feb 28, 2008). Such a program has many potential applications, depending on recruitment needs and departmental resources.
The Psychiatry Institute for Medical Students continues to be an effective part of a departmental recruitment strategy. Encouraging the best students from their earliest years of medical training to pursue careers in psychiatry has been a very worthwhile endeavor.
We would like to thank the members of the recruitment committee for their ongoing contributions, as well as Jennifer Holland, Alicia Barker, and Kelly Killip for their administrative assistance over the last several years.
At the time of submission, the authors reported no competing interests.