Academic Psychiatry 29:92-95, March 2005
© 2005 Academic Psychiatry
The Attitudes of Israeli Medical Students Toward Residency in Psychiatry
Moshe Z. Abramowitz, M.D. and
Daphne Bentov-Gofrit, M.D.
Drs. Abramowitz and Bentov-Gofrit are with the Eitanim Mental Health Center in Israel. Address correspondence to Dr. Abramowitz, Eitanim Mental Health Center, Doar-Na Tzefon Yehuda 90972, Israel; mosheabramowitz{at}yahoo.com (E-mail).
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ABSTRACT
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OBJECTIVE: The authors analyze attitudes toward psychiatry residency of Israeli medical students in preclinical years, compared with similar U.S. data. METHODS: A 23-item questionnaire was administered anonymously to 181 Israeli medical students in their preclinical years and was completed by 70% of the students present. RESULTS: Psychiatry was ranked most attractive as far as intellectual challenge was considered and least attractive when the degree to which it draws upon all aspects of medical training was considered. Our study shows that 32.8% of the Israeli medical students in the preclinical years consider residency in psychiatry, compared to 7.7% in the U.S. and 15.9% in Australia, using the same questionnaire and methodology. CONCLUSIONS: The population of students interested in family medicine and neurology, as well as those interested in the humanities, should be the source of psychiatry residents, and their faith in the psychiatric paradigm should be strengthened.
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INTRODUCTION
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The recruitment of top medical students to the field of psychiatry is a growing concern in both the U.S. and abroad. According to recent data (1), there has been an increase in the number of American medical students matching with psychiatry, totaling slightly over 600 seniors (60.5% of filled positions). Still, there are 7.1% unfilled positions in the field, demonstrating that the demand is greater than the supply. In the U.K., overall consultant vacancies run at a steady 12% (2), causing more positive action devoted to attracting good candidates to residency in psychiatry.
In a recent study, Sierles et al. examined (3) the factors taken into consideration for a career choice in psychiatry, dividing them into intrinsic and extrinsic factors in relation to a specific medical school. According to Sierles et al., the intrinsic factors (e.g., quality of psychiatric education) were found to be the most important for recruitment, as opposed to the extrinsic factors (e.g., national trends, geographic region).
To get a better understanding of the factors affecting the attitudes of medical students during their studies, Feifel et al. (4) analyzed the attitudes of freshman medical students toward residency in the various specialties and characterized the demographic and personal profile of students interested in psychiatry. In Feifel’s study, which was conducted with 223 freshmen medical students in the U.S. (University of California–Irvine, University of California–San Diego, and University of Texas), only one student (0.5%) identified psychiatry as the career of choice, and only 16 (7.2%) considered it as a strong possibility.
We set out to gain a better understanding of the attitudes and career preferences among Israeli medical students and to compare the results with the U.S. findings. Finally, we aimed to gain insight into the learning process from the student’s perspective.
This information may assist in planning programs for increasing the interest of medical students in psychiatry and, optimistically, to direct more students toward psychiatry residency.
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METHOD
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Medical students from the Hebrew University who were attending the preclinical years in 2000–2002 were examined. Permission from Dr. Feifel was obtained to use his questionnaire, which consists of 23 questions that present relevant demographic data, inquire about the generic factors students consider important in their choice of a specialty, and examine students’ attitudes toward psychiatry and five other specialties.
The questionnaire was administered anonymously during routinely scheduled lectures and was completed by 70% of the students present. Students were blind to the specialty of the investigators and to the purpose of the study. The results were analyzed to find whether there was a significant statistical difference between students who considered psychiatry as a "chosen" or "strong possibility" for their career and those who did not. Chi-square test was used to identify potential differences. Ratings of attractiveness of each specialty, with regard to various aspects, were analyzed using a-parametric tests (Wilcoxon and Friedman).
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RESULTS
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One hundred eighty-one questionnaires were collected. Demographic analysis showed one difference between students who considered psychiatry residency and those who did not. Students who considered psychiatry were Jewish, although 7% of the responders were non-Jewish. The analysis showed that psychiatry is as attractive as gynecology and internal medicine, more attractive than family medicine, and less attractive than surgery and pediatrics. Seventeen students considered psychiatry as their "chosen career," and 40 students considered it a "strong possibility." Eighteen students excluded psychiatry completely. We compared the results of our survey with Feifel’s results (Figure 1).
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FIGURE 1. Comparison of the Popularity of a Psychiatric Residency Between Israeli and American Medical Students
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Table 1 shows the ratings of attractiveness regarding various career aspects of the five major specialties: internal medicine, surgery, pediatrics, gynecology, and psychiatry. Psychiatry was ranked the most attractive when intellectual challenge is considered and the least attractive when the degree to which it draws upon all aspects of medical training was considered. From a financial point of view, psychiatry was considered less appealing than surgery and gynecology but more appealing than pediatrics and internal medicine. Psychiatry, along with internal medicine and gynecology, was given the lowest score when prestige within the medical community was considered. Psychiatry was also given the lowest score in the following subjects: ability to benefit the patient, rapidly advancing comprehension, and the reliable scientific foundation.
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TABLE 1. Ratings of Attractiveness of Career Aspects of Five Medical Specialties by Medical Students (N=181) in Their Preclinical Years
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It was found that medical students considered controllable lifestyle (less time-consuming schedule, the option of private practice, etc.), the ability to assist patients, and challenge at work the most important aspects in selecting residency. Less important considerations were financial reward and prestige.
No difference in these parameters was found when students interested in psychiatry were compared to students uninterested in psychiatry.
When the students were asked to rank their interest in research, diagnosis and treatment, and communication with the patient, it was found that research was the least interesting subject. Again, no difference was found between students interested in psychiatry and the rest of the students.
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DISCUSSION
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What brings a medical student or physician to become a psychiatrist? In an editorial in The American Journal of Psychiatry, Andreasen states that "we are interested in what makes human beings tick" (5). In this study, we attempted to explore various factors influencing the decision to choose a particular specialty and whether there is a unique pattern with regard to the choice of psychiatry.
The students considered interesting/challenging work and the ability to help people as factors important in choosing a specialty. While the former item was rated the highest in psychiatry, the latter was given the lowest score. It would seem that although the modern practice of psychiatry has come a long way in the past decade, it still suffers from a poor image as reflected in students’ attitudes and beliefs. Fortunately, part of this problem can be remedied through changes in the medical school syllabus, encouraging participation in clinical research, mandatory clerkship in liaison psychiatry in a general hospital, and repeated exposure to the biopsychosocial paradigm during the preclinical years. Brockington (6) has suggested ways of improving recruitment by analyzing "nodal points" at different phases before and during undergraduate training to favor psychiatric practice after graduation. Likewise, using an approach based on old-fashioned role modeling by seasoned lecturers has been found to increase recruitment for psychiatry and, perhaps, all other specialties (3, 7).
Compared to studies using similar methodology in the U.S. and Australia, results of this study show that more students consider psychiatry as an option, and fewer students who dislike the field (4, 8). This study also shows that 32.8% of the Israeli medical students in the preclinical years considered residency in psychiatry, compared to 7.7% in the U.S. and 15.9% in Australia, using the same questionnaire. It is interesting to speculate as to the reasons behind these differences. Perhaps it has to do with the long tradition of psychiatry as a "Jewish" profession. There are some demographic differences between the Israeli population and the populations examined in U.S. and Australian studies; among them is a difference in the gender breakdown: 53%, 58%, and 47% are men, respectively. In the Australian survey (8), the only background variable that significantly distinguished between students who were interested or uninterested in psychiatry was gender, with many more women entertaining a possible career in the specialty. This is not true for our study.
It would also seem that many of the factors influencing a career decision are common to all three settings cited above. First, as reported by Dorsey et al. (9), there is an increasing preference of U.S. medical students for specialties with a "controllable lifestyle." In our study, this aspect was found to be less important than "interesting and challenging work" and "the ability to help people" but more important than prestige and financial reward. These results may be explained by the fact that we questioned students in their preclinical years, in contrast to Dorsey et al., who examined a population of senior students. Regarding financial reward, psychiatry is similar to the U.S. and Australia (8, 9) in Israel in that it is in the lower range of specialties in average income, far behind the surgical subspecialties.
We believe that the majority of students who do not dislike psychiatry, along with students interested in family medicine and neurology, should be the source of psychiatry residents, and their faith in the psychiatric paradigm should be strengthened.
In the past, the pool of potential psychiatrists came predominantly from a small subgroup of students with a background in the humanities (10). We believe, however, that there is increased likelihood of finding students with different backgrounds choosing psychiatry as a career due to recent developments in the field. In the present climate of managed mental health care, it is important that psychiatry should not lose its appeal to students of human behavior, and our study demonstrates this desire among the medical students. These changes may indeed be a throwback to the days of Freud, where a strong background in brain science was a good reason to choose a specialization in the human experience and its interface with medicine.
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REFERENCES
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- National Residents Matching Program Match Results, 1999–2003. Washington, DC, National Residency Matching Program
- Pidd SA: Recruiting and retaining psychiatrists. Advances in Psychiatric Treatment 2003; 9:405–413[Abstract/Free Full Text]
- Sierles FS, Dinwiddie SH, Patroi D, et al: Factors affecting medical student career choice of psychiatry from 1999 to 2001. Acad Psychiatry 2003; 27:260–268[Abstract/Free Full Text]
- Feifel D, Moutier CY, Swerdlow NR: Attitudes toward psychiatry as a prospective career among students entering medical school. Am J Psychiatry 1999; 156:1397–1402[Abstract/Free Full Text]
- Andreasen NC: Diversity in psychiatry: or, why did we become psychiatrists? (editorial). Am J Psychiatry 2001; 158:673–675[Free Full Text]
- Brockington I, Mumford D: Recruitment into psychiatry. Br J Psychiatry 2002; 180:307–312[Abstract/Free Full Text]
- Eagle PF, Marcos LR: Factors in medical students’ choice of psychiatry. Am J Psychiatry 1980; 137:423–427[Abstract/Free Full Text]
- Malhi GS, Parker GB, Parker K, et al: Shrinking away from psychiatry? A survey of Australian medical students’ interest in psychiatry. Aust N Z J Psychiatry 2002; 36:416–423[CrossRef][Medline]
- Dorsey ER, Jarjoura D, Rutecki G: Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA 2003; 290:1173–1178[Abstract/Free Full Text]
- 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]
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ABSTRACT
INTRODUCTION
