Academic Psychiatry 23:151-156, September 1999
© 1999 Academic Psychiatry
The Psychiatry Institute for Medical Students
A Novel Recruitment Strategy
Jodi Lofchy, M.D., F.R.C.P.C.,
Aileen Brunet, M.D. and
Ivan Silver, M.D., F.R.C.P.C.
Dr. Lofchy and Dr. Brunet are at the Centre for Addiction & Mental Health—Clarke Site, Toronto, Ontario; and Dr. Silver is at Sunnybrook Health Sciences Centre, Toronto, Ontario. Address correspondence and reprint requests to Dr. Lofchy, Centre for Addiction & Mental Health—Clarke Site, 250 College Street, Toronto, Ontario, Canada M5T 1R8; e-mail: jodi.lofchy{at}utoronto.ca
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ABSTRACT
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In response to decreasing numbers of applicants to the authors' psychiatry residency program, the University of Toronto initiated a novel recruitment strategy in 1994: The Psychiatry Institute for Medical Students. The institute is a weeklong summer program for 15 first- or second-year medical students. The institute provides exposure to a wide variety of subspecialties in psychiatry organized into theme days and an active social program. Evaluations by the attendees have been uniformly positive. In the past 3 years, 50% of the attendees have entered a psychiatric residency program.
Key Words: Psychiatry Institute • Recruitment • New Idea
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INTRODUCTION
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In the past several years, American psychiatry residency programs have been faced with numerous barriers in their efforts to recruit high-quality medical students (1–5). The literature suggests that experiences during medical school, personality qualities of applicants, and beliefs about the practice of psychiatry are all strongly associated with consideration of a psychiatric residency. Recruitment strategies are widely recommended to bolster positive psychiatry-related experiences and to alter those experiences or perceptions viewed as negative (6–9).
Unlike the United States, statistics on the number of individuals entering Canadian psychiatric residency programs were not documented at a national level until 1993. Prior to the institution of a new application process, the Canadian Residency Matching Service (CaRMS) has maintained a database on all applicants to Canadian residency programs. Data from CaRMS reveal that about 6% of Canadian medical students chose psychiatry in the graduation years 1993–1997 (10). Although this percentage is higher than the about 4% of American medical school graduates choosing psychiatry (11), a proportion of Canadian postgraduate year (PGY)-1 positions consistently remain unfilled.
This situation is of concern to psychiatric educators, particularly in light of numerous changes to the residency training and application process that appear to disadvantage psychiatric residency programs. Until 1993, available positions in psychiatric residency programs could be filled by any combination of graduating Canadian medical students, physicians in practice who wished to pursue subspecialty training, residents switching from other training programs, and foreign medical graduates. National changes in the structure of postgraduate training programs and routes to licensure instituted in 1993 have effectively blocked the enrollment of candidates other than those who are applying immediately upon graduation from a Canadian medical school. Therefore, foreign graduates, reentry physicians, and residents who wish to change training programs are essentially unable to gain entry to residency training.
Psychiatry appears to be uniquely disadvantaged by this postgraduate training system. A prior study revealed that 58.1% of residents at the University of Toronto decided to enter psychiatry after spending at least 1 year in another form of postgraduate training or practice (12). This type of entry into psychiatry is no longer possible within the current system of postgraduate training. Therefore, this pool of applicants, many of whom were mature individuals who may have practiced as physicians for some time prior to developing an interest in psychiatry, may become unavailable as potential recruits unless an interest in psychiatry can be fostered in medical school.
In the context of these changes, the Recruitment Committee of the University of Toronto's Department of Psychiatry was created in 1993, which formalized the attempts of a group of faculty and residents to design programs to attract medical students to psychiatry. In addition to other recruitment strategies, such as journal clubs and career-night dinner programs, the committee planned a weeklong program for first- and second-year medical students to be called "The Psychiatry Institute for Medical Students."
The goals of such a week were to introduce students to positive role models, mentors, and potential elective supervisors. We hoped to demystify the often misunderstood persona of the psychiatrist as it is frequently portrayed in the media—often students' only exposure at an early stage of training. We endeavored to create a small-group experience that was an intensive and enjoyable immersion into the psychiatrist's world. As well as attracting the best and the brightest students to psychiatry, we wanted to target the undecided—those students who had an interest in psychiatry but were also considering other career options. We anticipated that unsure or ambivalent students might be "hooked" by taking part in such an experience and might later pursue further psychiatry-related activities. Overall, we hoped to increase recruitment of medical students to the University of Toronto's program.
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ORGANIZATION
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A subcommittee consisting of a coordinating psychiatrist, two faculty psychiatrists, four residents, and an administrative assistant planned the program. A budget of $4,000 was raised from a combination of pharmaceutical company donations and a university departmental contribution.
Attendance was limited to 15 first- and second-year medical students. The number was restricted to maintain a small, cohesive group atmosphere. These students are still early in their training and often undecided about their specialty choice. To encourage both the University of Toronto students and students from Ontario's four other medical schools, 10 students from the University of Toronto and 5 from the other schools were chosen.
The institute was held in June after classes finished. Posters advertising the institute were distributed to all medical schools in Ontario. Advertising was also done over the Internet and on student e-mail listservs. Students from outside Toronto were housed at a University residence nearby. Students were asked to submit a letter of interest in addition to a copy of their curriculum vitae. They were selected on the strength of their expressed desire to attend the program and their curriculum vitae. Preference was given to second-year students, as they have no further summer breaks in their undergraduate training.
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STRUCTURE OF THE WEEK
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The week was based at the Clarke Institute of Psychiatry, a psychiatric hospital and research institute that is the hub of many university departmental activities. Each day had a thematic focus (Table 1). Mornings were spent at Clarke, with the students partaking in informal seminars. Each afternoon consisted of a clinical elective at various sites across the city, consistent with the theme of the day. One to two students attended each elective placement. Elective supervisors were chosen for their ability to provide an individualized clinical experience. The students were not competing with any other housestaff for the supervisor's attention. Supervisors were approached directly, initially by telephone and then in writing, with a suggested format for the afternoon. They were encouraged to discuss their career choices with the students in addition to providing the clinical elective.
Monday was "Psychosis/Forensics Day." In addition to a seminar on schizophrenia and a chance to interview a patient with a psychotic disorder, the students toured the positron emission tomography (PET) scanner and learned about recent advances in neuroimaging. The forensics seminar included patients with paraphilic disorders and videos highlighting the complexity of legal psychiatry. The afternoon was spent attending electives in psychiatric emergency rooms, hospital-based schizophrenia clinics, chronic rehabilitation community clinics, sexual offender programs, and forensic assessment units.
Tuesday was "Psychosomatic/Geriatric Day." After feedback about the elective placements from the day before, the morning started with an overview of medical psychiatry. Three psychiatrists with expertise in transplantation psychiatry, AIDS psychiatry, and psychooncology led case discussions. The rest of the morning was spent with geriatric psychiatrists. The afternoon electives included placements in general hospitals on the consultation-liaison teams and in specialized settings such as the Intensive Care Unit and Eating Disorder programs. Geriatric placements featured neuropsychiatry, community outreach teams, and consultation in a geriatric hospital.
Wednesday was "Mood/Substance Abuse Day." Half of the students observed electroconvulsive therapy (ECT), and then all had lectures on depression, suicide, and bipolar disorder (the remaining students attended ECT on Friday morning). The substance abuse seminar involved introducing the group to the drug lexicon of the streets and demonstrating assorted paraphernalia used by the drug-taking population. The afternoon was spent in mood disorder clinics, emergency room settings, and at a dual-disorder program in a general hospital.
Thursday was "Child and Adolescent Day," based at the Hospital for Sick Children. The child psychiatrists and residents organized a full day featuring different themes each year (infant psychiatry, fire setting). Afternoon placements were numerous and included private office practices and specialized hospital placements for children with psychosis, anxiety disorders, disabilities, and eating disorders.
Friday was "Psychotherapy Day." The afternoon was used for evaluation and feedback as well as a final cinematic closing event entitled "Psychiatry in the Movies." The morning consisted of simulated psychotherapy with a standardized patient and panel discussions focusing on the experience of psychotherapy.
Social activities were an important component of the week. The week began with a welcoming barbeque at the home of the chairman of the Department of Psychiatry. All staff and resident participants in the week's activities were invited to meet the students. The directors of undergraduate and postgraduate education also attended. The students were given individualized packages containing an overview of the week, their elective placements, and selected readings, such as newspaper articles pertaining to mental health issues and academic articles related to the morning presentations. The guest speakers were asked to submit articles. Lunches were provided daily; residents accompanied the students to lunch on two of the days to talk freely without the presence of staff.
Tuesday evening there was a dinner program entitled "Living with Mental Illness." One staff member invited three of his patients to discuss with the students, in an informal setting, the experience of having a mental illness, being on medication, and seeing a psychiatrist. This was an opportunity for the students to meet patients who were articulate, educated, and eloquent about their conditions.
Thursday night was a social event at a downtown club. For the participants from out of town, this was another opportunity to see more of Toronto. Finally, there was a closing lunch on Friday, at which all those involved in the week's activities were invited.
All staff psychiatrists participating in the week did so freely, as there are no honoraria offered to speakers or clinicians. Many staff have university appointments that include remuneration for academic activities. An administrative assistant was responsible for all communications with the students and faculty as well as organizing room bookings, student packages, and catering for the BBQ and final lunch.
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INSTITUTE EVALUATION
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Over the past 4 years, 57 students have attended the Psychiatry Institute. Two groups (1995,1996) were surveyed before the week began (n=30), and 53 students completed postinstitute feedback forms. Faculty participants have not been formally surveyed about the week, but informal feedback has been positive. The majority of faculty have been with the institute since its inception.
With respect to the students completing preinstitute surveys, paired t-tests showed a significant shift within that group in terms of future interest in psychiatry (df=13,13, P<0.01). Four out of 30 (13%) students were initially undecided about a future as a psychiatrist. After the institute, none were undecided; all were either somewhat or very interested in a future as a psychiatrist.
The evaluation of the week's experience has been very positive (Table 2). Independent of future career plans, it was clear the students had an enjoyable week learning more about psychiatry. They felt the week was well organized and attempted to address their needs. The question they struggled with was the one questioning their decision to specialize in psychiatry. As these students were in their preclinical years, they had not yet been exposed to many other specialty areas. They did not want to describe themselves as "definitely interested in being a psychiatrist." However, many students created a novel category on the Likert scale midway between being "somewhat" and "definitely" interested in becoming a psychiatrist.
Students were also asked to provide written feedback about the program's strengths and weaknesses. Strengths noted included the enthusiasm, diversity, availability, and friendliness of staff and residents; the exposure to a wide variety of experiences, including ECT and the PET center; the tailoring of the afternoon electives to the specific interests of the students; and the meals and social events. Responses to the question about the program's weaknesses have diminished over time as a result of ongoing modifications. Initially, there were a number of elective placements that were poorly received. Either the supervisor was not prepared for the students, was unfamiliar with their needs, or patients were not available for residents to interview and/or discuss. Unpopular electives have been removed from the curriculum. The days were noted to be long and tiring, especially with early ECT sessions and evening activities. Recently, coffee breaks have been added to the morning program.
In answer to specific questions about interest in future psychiatry-related activities, all students commented that they would like to pursue psychiatry electives. Many of the psychiatrists encountered during the week were mentioned as possible future elective supervisors and desirable mentors. The students described changes in their views of psychiatric patients, psychiatrists, the residency program, and mental illness. Many students stated they had an increased awareness of the breadth of psychiatric illness and a heightened empathy toward psychiatric patients. They appreciated how mental illness spans age, gender, and culture and felt more positive about treatment for mental illness after the week's program. The students from other universities admitted they would now seriously consider the University of Toronto program, whereas prior to the institute they had no desire to train in a large program. They noted that the residents seemed happy and the training was comprehensive and student-centered. One comment reflected the view of an uncommitted student: "even if I never practice psychiatry, I have had a wonderful experience and gained respect for what psychiatrists do."
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FOLLOW-UP
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Of the 57 institute graduates, 40 have completed medical school. This number includes students from the institutes of 1994, 1995, and 1996. Information on which residency programs these students have been matched to as PGY-1 trainees was obtained through CaRMS. The number of students who were matched to psychiatry at the University of Toronto or any other North American residency program is shown in Table 3. Also, the number of students who did not match to psychiatry is indicated. As Table 3 shows, 10/16 (62.5%) of the students from other Ontario universities were selected for psychiatric residencies, and 4/16 (25%) of the students from the other universities matched to the University of Toronto. Also, 10/24 (42%) of the institute's students from the University of Toronto ultimately matched into a psychiatry residency program—the majority to the Toronto program. There has been no significant change in the number of University of Toronto medical students entering Toronto's psychiatry program since the creation of the institute.
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DISCUSSION
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The Psychiatry Institute for Medical Students was well received. The students had an intensive immersion into the world of psychiatry that was educational and enjoyable. They met staff and residents who became role models and mentors. Many have returned to pursue electives in psychiatry. We believe that recruitment activities such as the institute have positively influenced Toronto's residency program. The institute's graduates have had a broader exposure to psychiatry than their peers in the residency program. Presumably, they have made a more informed decision about their career based on their experience within the institute and subsequent electives and are less likely to switch to alternate residency programs. In this era of limited resources for postgraduate medical education, it is important that trainees remain satisfied and comfortable with their career choice.
There remains some uncertainty as to how to best attract ambivalent and undecided students to the institute. Students may be discouraged from indicating their ambivalence when they compose their letter of interest. They do not want to portray themselves as being unsure about psychiatry, for fear they will not be accepted into the program. On the other hand, many students already have an impressive curriculum vitae with graduate degrees and numerous publications in psychiatry-related areas. These students are quite clear about wanting to specialize in psychiatry. It seems unfair to penalize them for their interest by rejecting them in preference for someone less certain. However, if our finances remain limited, our resources may best be spent on those students less certain of their futures. This tension has not yet been resolved.
The institute has been successful with a small group size. Although a large number of applications are received each year, we believe the small group cohesion would be threatened if the group were increased to greater than 15 participants. Also, the small number of students keeps the budget within a reasonable range.
We plan to create a database capable of tracking institute "graduates," which would be useful in following all medical students who have indicated an interest or curiosity about psychiatry, whether through attending programs such as the institute or taking an elective or attending a dinner talk. A centralized psychiatry student registry of this kind could provide much-needed information on the effectiveness of various recruitment strategies.
We have demonstrated that it is possible to create an intensive immersion into the field of psychiatry for medical students by using local staff resources and a limited budget. The Psychiatry Institute for Medical Students was created to allow students to experience the breadth and depth of one of the largest psychiatric residency programs in North America. However, it is possible that the institute could be equally successful in a smaller setting, if the goals of the week are to introduce junior medical students to the world of psychiatry through exposure to psychiatrists, residents, and patients. A program such as the Psychiatry Institute for Medical Students can be an effective tool as part of an overall departmental recruitment strategy.
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REFERENCES
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Lee EK, Kaltreider N, Crouch J: A pilot study of current factors influencing the choice of psychiatry as a specialty. Am J Psychiatry 1995; 152:1066–1069
-
Zimny GH, Sata LS: Influence of factors before and during medical school on choice of psychiatry as a specialty. Am J Psychiatry 1986; 143:77–80[Abstract/Free Full Text]
-
Mowbray RM, Davies BM, Biddle N: Psychiatry as a career choice. Aust N Z J Psychiatry 1990; 24:57–64[Medline]
-
Perry S, Cella DF, Klar H, et al: Medical students selecting psychiatric careers—a distinct breed. Journal of Psychiatric Education 1988;12:171–181
-
Jurvetson KT: Characteristics of medical students and residents who select psychiatry. Academic Psychiatry 1995; 19:125–131[Abstract]
-
Sondheimer A: The literature and medicine seminar for medical students—a potential recruitment tool. Academic Psychiatry 1994; 18:38–44[Abstract]
-
Kay J, Bienenfeld D: The role of the residency training director in psychiatric recruitment. Academic Psychiatry 1992; 16:127–133[Abstract]
-
Weissman SH: Recommendations from the May 1992 Conference to Enhance Recruitment of U.S. Medical Graduates into Psychiatry. Academic Psychiatry 1993; 17:180–185[Abstract]
-
Kaltrieder NB, Lu FG, Thompson TL: Student education and recruitment into psychiatry—a synergistic proposal. Academic Psychiatry 1994; 18:154–161[Abstract]
-
Canadian Residency Matching Service Match Results: Canadian Residency Matching Service, Ottawa, Ontario, Canada, 1997
-
Sierles FS, Taylor MA: Decline of U.S. medical student career choice of psychiatry and what to do about it. Am J Psychiatry 1995; 152:1416–1426
-
Cameron P, Persad E: Recruitment into psychiatry: a study of the timing and process of choosing psychiatry as a career. Can J Psychiatry 1984; 29:676–680[Medline]
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ABSTRACT
INTRODUCTION
