Acad Psychiatry 31:225-227, May-June 2007
doi: 10.1176/appi.ap.31.3.225
© 2007 Academic Psychiatry
Medical Students’ Interest in Child Psychiatry: A Clerkship Intervention
Vicki L. Martin, M.D.,
David S. Bennett, Ph.D. and
Maria Pitale, B.A.
Received March 20, 2006; revised July 5, 2006; accepted August 1, 2006. Drs. Martin and Bennett are affiliated with Drexel University College of Medicine, Philadelphia, Pennsylvania. Ms. Pitale is affiliated with Widener University, Wilmington, Delaware. Address correspondence to Dr. Martin, 801 Market Street, Philadelphia, PA 19107; vicki.martin{at}phila.gov (e-mail).
|
ABSTRACT
|
OBJECTIVE: The authors examine the efficacy of a brief presentation to enhance clerkship student interest in child and adolescent psychiatry as a career choice. METHOD: Attitudes of students attending a brief presentation on the positive aspects of child psychiatry were compared with those of non-attenders. RESULTS: Students who attended the presentation were more accurate in reporting salaries and acknowledging a shortage in the field. Their interest in child and adolescent psychiatry as a career choice, however, did not change. Student interest was related to having had prior contact with a psychiatrist, whereas decreased interest was related to having an adult-only experience during the clerkship. CONCLUSIONS: A brief presentation can be effective in changing certain factual perceptions about child and adolescent psychiatry but may be ineffective in enhancing medical students’ interest in it. However, exposure to child patients during the clerkship may prevent a decline in student interest in the field.
|
INTRODUCTION
|
Child and adolescent psychiatry is a medical specialty with a persistent shortage of practitioners (1), even though child and adolescent psychiatrists are generally very happy in their careers (2). Prior research has consistently found that medical students are relatively disinterested in psychiatry as a field of practice (3). Reasons for this lack of interest include concerns about low respect and salary and high job stress (4, 5). Little is known, however, about whether these same reasons apply to students’ interest in child and adolescent psychiatry.
Medical students perceive child and adolescent psychiatry to be a more respected area of medicine than general psychiatry, but many report that it would be emotionally stressful to practice (5). Student interest in child and adolescent psychiatry or any specialty as a career choice is complex and likely involves many factors in addition to the above. Cutler et al. (6), for example, found that few students who expressed interest in general psychiatry actually chose psychiatry residencies. The purpose of our study was to examine predictors of student interest in child psychiatry and the efficacy of a brief presentation given during the clerkship rotation on student interest toward child and adolescent psychiatry as a career choice.
|
Method
|
Third-year medical students (N=222) at the Drexel University College of Medicine served as subjects. Students (50% female) had a mean age of 26.5 (SD=2.9) years. Fifty-nine percent defined themselves as European American, 16% as Asian American, and 25% identified with another ethnic group. Students were asked to complete an anonymous questionnaire on the first and last day of their 6-week clerkship. Two hundred eighteen students (98%) completed the Time 1 questionnaire, and 177 (80%) completed the Time 2 questionnaire. The questionnaires included open-ended questions using a 7-point rating scale (the questionnaires can be obtained by contacting V.L.M.).
Students rotated at one of six different clerkship sites whose patient populations ranged from low socioeconomic to middle class status. Most patient contacts were with inpatients. Approximately 55% of students were assigned to a child and adolescent inpatient unit for 2 to 3 weeks as part of their clerkship. All students, regardless of site, received two or more formal lectures on clinical child and adolescent psychiatry. In addition, 49% who were assigned to a rotation site near the main clinical campus were required to attend a brief presentation during which they received a handout on the positive aspects of child and adolescent psychiatry. The presentation lasted 15 minutes and consisted of a PowerPoint slide show moderated by a board-certified child psychiatrist. The presentation addressed income potential, demand for services, job satisfaction, scientific basis for the field, and relatively low practice expenses; the handout consisted of PowerPoint slides covering these topics and the American Academy of Child and Adolescent Psychiatry Work Force Data Sheet.
|
Results
|
Students who attended the presentation reported higher and more accurate incomes for child psychiatrists at the end of the clerkship (mean=$173,543 [SD=$47,250] for presentation attenders, mean=$155,308 [SD=$43,734]; for nonattenders, t [160]=2.55, p=0.01). Presentation attenders were also more likely to report the presence of a shortage of child psychiatrists at the end of the clerkship (chi-square=9.56, p<0.01), increasing from 37% to 87%. Presentation attendance, however, was unrelated to student’s respect for and interest in child and adolescent psychiatry as a career choice at the end of the clerkship based on repeated measures of analysis of variance.
Student interest in child and adolescent psychiatry was positively related to having had personal contact (e.g., a family member or a friend who is a psychiatrist; r=0.23, p=0.01) or personal experience (e.g., through a family member or having seen a psychiatrist themselves; r=0.19, p<0.05) with psychiatrists, but only at Time 1. Age and gender were unrelated to interest at both Time 1 and 2. However, whereas students’ perceived income for child psychiatrists was unrelated to their interest in child psychiatry at Time 1, there was a trend for perceived income to be related to interest in this field at Time 2 (r=0.16, p<0.10).
Students who did not rotate on a child service (i.e., who were only exposed to adult patients) exhibited a trend for decreased interest in child and adolescent psychiatry from the beginning to the end of the clerkship (mean=3.7 [SD=1.4] at Time 1; mean=3.0 [SD=1.6] at Time 2; t[140]=1.80, p<0.10). In contrast, students who were on a child service showed no significant change in their interest in child psychiatry during the clerkship (Figure 1).
View larger version (48K):
[in this window]
[in a new window]
|
FIGURE 1. Student Interest in Child Psychiatry as a Function of Patient Exposure During Clerkship
*CAP=Child and adolescent psychiatry
|
Students’ respect ratings for child and adolescent psychiatry were also related to their interest in practicing it (r=0.17, p<0.05 at Time 1; r=0.33, p<0.001 at Time 2). Regardless of their interest in the field itself, students rated child psychiatry to be a more respected area of medicine than general psychiatry at both the beginning (for child, mean=4.1 [SD=1.2]; for general, mean=3.6 [1.2]; t[207]=7.85, p<0.001) and end of the clerkship (for child, mean=4.0 [SD=1.2]; for general, mean=3.6 [1.2]; t[174]=7.39, p<0.001).
|
Discussion
|
Students exposed to a presentation on the positive aspects of a career in child and adolescent psychiatry reported increased knowledge of the shortage of child and adolescent psychiatrists and more accurate incomes. Perceived income, however, was only weakly related to student interest in practicing, and only at Time 2. The presentation did not increase students’ interest in practicing child and adolescent psychiatry. Potential reasons are because the intervention was too brief or because a more experiential modality may be more effective. A prior study, for example, found that a weekly child/adolescent patient interview with attending discussion positively influenced student attitudes towards the field (7). Finally, the timing of the presentation may be more effective if delivered prior to the third year. It has been suggested that enhancing "hands on" exposure to psychiatry earlier in training may positively influence student interest in the field (8).
Student interest in child and adolescent psychiatry was related to having prior personal contact or experience with psychiatrists. Hence, students who had some personal knowledge of psychiatry were more interested in child psychiatry. Furthermore, a trend was found such that students who saw only adult patients (primarily inpatients in the present study), as opposed to child patients, during their clerkship showed less interest in child and adolescent psychiatry. This may stem, in part, from students perceiving change to be unlikely among some adult patient populations. Research has found that the most commonly perceived negative aspect of general psychiatry is the impression that adult patients are unresponsive to treatment (5). However, students who observed patients improving became more interested in general psychiatry (9). Thus, students who see only adult patients during the clerkship, especially if they perceive these patients as being unresponsive to treatment, may reject child and adolescent psychiatry because of the extensive adult training required prior to its residency. The existence of alternate pathways (e.g., through pediatrics) for entering into child and adolescent psychiatry residency programs may increase students’ interest. A study comparing the child psychiatry skills of child and adolescent psychiatry residents (10) found similar performance between residents who entered the program from a pediatric residency and those who came through the traditional pathway of general psychiatry.
Several limitations deserve mention. First, students were not randomly assigned either to the presentation or to a child subrotation. This may have created a sampling bias as a result of clerkship site assignment. Unfortunately, it was only feasible to provide the presentation to students whose sites were located within 30 minutes of the main clinical campus. Second, though we examined student exposure to a child subrotation, we did not control for the potential impact of other patient or clerkship site characteristics. Thus, we were unable to directly test whether students who had exposure to unresponsive patients had more negative perceptions of child and adolescent psychiatry than those exposed to more diverse populations. Finally, our findings may not generalize to clerkship students at programs that have greater exposure to outpatient populations.
Research is continuing to increase our understanding of medical student career choices. More studies are needed to develop and evaluate interventions for enhancing student interest in child and adolescent psychiatry. It has been suggested that offering mentorship by a child and adolescent psychiatrist, making child rotations more interactive and rigorous, increasing teaching by child psychiatrists in the basic science curriculum, and representing the field at career days may enhance student recruitment (11). Currently, there are no national requirements for a clinical child and adolescent psychiatry experience during medical school training. Given the continuing public health concerns raised by the shortage of psychiatrists in this area of expertise, a required child and adolescent psychiatry experience during medical school should be considered.
|
REFERENCES
|
- Kim JK: Child and adolescent psychiatry workforce: a critical shortage and national challenge. Acad Psychiatry 2003; 27:277–282[Abstract/Free Full Text]
- Stubbe DE, Thomas WJ: A survey of early-career child and adolescent psychiatrists: professional activities and perceptions. J Am Acad Child Adolesc Psychiatry 2002; 41:123–130[CrossRef][Medline]
- 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]
- Balon RB, Franchini GR, Freeman PS, et al: Medical students’ attitudes and views of psychiatry: 15 years later. Acad Psychiatry 1999; 23:30–36[Abstract/Free Full Text]
- Martin VM, Bennett DS, Pitale M: Medical students’ perceptions of child psychiatry: pre- and post-psychiatry clerkship. Acad Psychiatry 2005; 29:362–367[Abstract/Free Full Text]
- Cutler JL, Aspector SL, Harding KJ, et al: Medical students’ perceptions of psychiatry as a career choice. Acad Psychiatry 2006; 30:144–149[Abstract/Free Full Text]
- Szanjnberg NM: Medical students’ attitudes toward child psychiatry: the impact of a third-year required rotation. J Psychiatr Educ 1986; 10:5–14
- Claassen J, Kruger E: Beyond the chalkboard: the interacting domains in undergraduate psychiatric teaching. Australas Psychiatry 2005; 13:154–158[CrossRef][Medline]
- McParland M, Noble LM, Livingston G, et al: The effect of a psychiatric attachment on students’ attitudes to and intention to pursue psychiatry as a career. Med Educ 2003; 37:447–454[CrossRef][Medline]
- DeMaso DR, Mezzacappa E, Goldman SJ: Recruitment and training of child and adolescent psychiatry residents from pediatrics. J Am Acad Child Adolesc Psychiatry 1992; 31:1100–1104[Medline]
- AACAP: Report of the AACAP Task Force on Work Force Needs: Meeting the Mental Health Needs of Children and Adolescents: Addressing the Problems of Access to Care, 2001. http://www.aacap.org/training/wfn.pdf
This article has been cited by other articles:
|
|
|
|
 
R. Balon
Does a Clerkship in Psychiatry Affect Medical Students' Attitudes Toward Psychiatry?
Acad Psychiatry,
April 1, 2008;
32(2):
73 - 75.
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2007
Academic Psychiatry.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
TOP
ABSTRACT
INTRODUCTION
