The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year

AIMS: To compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final-year medical students' attitudes towards psychiatry and mental illness. METHOD: A 1-year follow-up questionnaire survey of two groups of medical students taught psychiatry in their fourth-year training by two different methods. One-year follow-up scores were compared with pre-attachment and post-attachment scores in the fourth year. RESULTS: 70 (68%) students completed both questionnaires at follow-up. The follow-up scores were significantly lower compared with both the fourth-year pre-attachment and post-attachment scores, suggesting that the positive change in attitudes following psychiatric training in the fourth year significantly decayed during the final year. The two teaching methods did not differ in the magnitude of this reduction. CONCLUSIONS: The positive change that occurs in medical students' attitude towards psychiatry, psychiatrists and mental illness after their fourth-year psychiatric training is transient and decays over the final year.     

Students'' attitudes towards psychiatry

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.     

Attitudes of Medical Students Towards Psychiatry

Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on “Attitudes Towards Psychiatry” (ATP-30). Results: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. Conclusion: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.     

Changes in attitudes towards psychiatry among medical students: correlation of attitude shift with academic performance

This study investigates the changes in attitudes to psychiatry and level of psychiatric knowledge among medical students before and after formal teaching on psychiatry. Teaching led to the development of more favourable attitudes (particularly among women) towards psychiatry, but doubt remained after teaching about the 'scientific' status of the discipline. Initial attitudes did not relate to academic performance but, those developed after teaching showed a significant positive correlation with it.     

Attitudes of men and women medical students to psychiatry

The attitudes of men and women medical students to psychiatry were compared using an attitude scale, before they began their psychiatry training. Major differences between the sexes were obtained, with the women students consistently displaying more positive attitudes to many aspects of psychiatry. The implications in terms of teaching and recruitment are considered.     

Medical students'' attitudes to psychiatry in Chile

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.     

Medical students' attitude towards psychiatry: a ten-year comparison†

Medical students' interest in and attitudes toward psychiatry, both as a field of education and as a medical specialty, have been explored by a number of investigators. The present study compares two series of investigations completed at the McGill University teaching hospitals over a ten year span and involving third year medical students in 1968–69 (n=59) and in 1978–79 (n=168). The findings of these two studies are evaluated in two parts: (1) comparison of attitudes toward psychiatry before and after clinical training in 1978–79. (2) comparison of the results obtained in 1969 with those in 1979. The results of the comparison showed that students currently put more emphasis on the clinical aspects of psychiatric training and less on the theoretical and research aspects of psychiatry. Thirty-two percent of students in 1979 found psychotherapy to be the most useful treatment modality as compared with only 10 percent in 1969. Findings reflecting the usefulness of organic therapies in psychiatry remained fairly consistent, but behaviour therapy was found to be less useful by students in 1979 than in 1969. In the 1969 survey, 2 per cent of the third year students indicated an interest in psychiatry as a future career as compared with 3.3 per cent in 1979. The implications of these findings are discussed in relation to the psychiatric training programmes in medical schools.     

Changing the attitudes of `tomorrow's doctors' towards mental illness and psychiatry: a comparison of two teaching methods

The General Medical Council's document ` Tomorrow ' s Doctors ' (1993, GMC, London) recommended major changes in the undergraduate curricula of UK medical schools. In Nottingham, the fourth-year psychiatric attachment became shorter in duration, and interactive, problem-oriented, workshop-based learning replaced lectures. We compared the efficacy of this new teaching style in changing medical students' attitudes towards psychiatry and mental illness with that of old-style, didactic, lecture-based teaching. On the first and last days of their psychiatric attachment, 110 fourth-year medical students (45 old curriculum; 65 new curriculum) completed two self-administered attitudinal measures: the Attitude to Psychiatry Questionnaire (ATP-30) and the Attitude to Mental Illness Questionnaire (AMI). We found that students had favourable attitudes towards psychiatry and mental illness before the attachment. These attitudes became more positive after the attachment in students from both curricula, with no significant difference between the groups and no gender difference. Students found patient contact rewarding, become more accepting of community care, and had greater appreciation of the therapeutic potential of psychiatric interventions. The interactive, student-centred, problem-oriented teaching of the shortened new curriculum appeared as effective in changing medical students' attitudes as a longer attachment with traditional teaching.     

Assessment of clinical psychiatric skills in final-year medical students: the use of videotape

Sixty final-year medical students had their clinical performance in psychiatry assessed by the following three methods: a multiple choice questionnaire based on a series of short videotaped interviews with psychiatric patients; the examination of a traditional long 'case' with presentation of the history, mental state findings and formulation about diagnosis and management to a panel of three examiners; and a conventional oral examination about the principles and practice of psychiatry with a different trio of examiners. The total mark on the videotape session correlated significantly with the combined clinical and oral marks. There was also a significant positive correlation between the total video marks and the individual clinical marks, but none between the marks obtained during the video and oral components of the examination. However, the significant positive correlations between the video marks and those of the clinical examination were modest and only accounted for not more than 14% of the variance. Inspection of the distribution of correct answers to the videotape questions shows that students do best in identifying mental state symptoms and signs and in choosing the correct diagnosis. They do less well in the areas of aetiology and treatment. Indeed, optimal performance in the latter distinguishes those who do well in the clinical/oral examination from those whose performance is mediocre. The significance of these findings to the teaching and assessment of psychiatric skills in medical students is discussed.     

Does clinical clerkship alter students' attitudes to a career choice of psychiatry?

A 50-item questionnaire, designed to link attitudes to psychiatry directly with how these might influence a career choice of psychiatry, was administered to medical students before and after their clinical clerkship in psychiatry. Many of these changed in a positive direction, e.g. 'job satisfaction', 'life-style', 'training available' and 'multidisciplinary approach'. The influence of important people in their lives was predominantly negative; this may emphasize the impact of psychiatric 'role models'. Male and female students differed in how they changed. Males appeared influenced by external factors, e.g. 'work hours' and 'career structure', and females by internal ones, e.g. 'interest in knowing more about self'. Females were also more likely to wish for a career in psychiatry. Psychiatry was ranked higher in career choice at the end of the clerkship.     

Medical students'' attitudes to old people and career preference: a comparison of two universities

Medical students' attitudes to old people were compared at broadly similar points in their education at two medical schools, one with a department of health care of the elderly (Nottingham), the other without such a university department (Leeds). The students were tested at both schools before their clinical training in care of the elderly, using a modified Rosencranz-McNevin semantic differential scale to measure general attitudes to old age, and a Likert scale to measure attitudes to medical care. Questions were also asked about career preferences. Both groups of students showed similar general attitudes to ageing. The Nottingham students showed more positive attitudes to care of old people, and this was reflected in career preferences.     

Medical student attitudes to psychiatry: lack of effect of psychiatric hospital experience

Medical students' attitudes towards psychiatry before and after their final (sixth) year psychiatric clerkship at a large psychiatric hospital were measured. We anticipated that exposure to severe, chronic psychiatric illness would affect student attitudes, and we undertook this study to investigate the direction and parameters of attitude change. However, no significant change in attitude was found. Variables considered included the students' interest in a career in psychiatry, their perception of the adequacy of their psychiatric training, their final examination results, and the gender of students and preceptors, none of which were found to correlate with attitudes.     

Attitude of medical students towards psychiatry

Findings are presented from a survey of all medical students at the College of Medicine, Abha, Saudi Arabia dealing with students' attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned future delivery of services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their specialization after graduation. The Scientific Committee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from medical schools in the nation to discuss this priority topic. A year later, a new course called 'Introduction to Psychosomatic Medicine' was introduced as an elective for medical students with its practice at the general hospital. It tries to introduce students to 'voluntary and active as against passive learning ... and problem-solving rather than imposed memorizing' of medicalized forms of psychiatry, an innovation compared with the previous conventional method. A significant difference in attitude was demonstrated between students who had their exposure to psychiatry from this course and those who followed only the conventional methods of learning.     

Child and adolescent psychiatry in the undergraduate medical curriculum

The preliminary findings of a prospective controlled investigation to evaluate the effects of teaching child and adolescent psychiatry to medical students are presented. The results confirmed that the combined teaching of child and adolescent psychiatry, psychiatry and paediatrics led to significant changes as assessed using a multiple choice questionnaire and an attitude questionnaire. Students who had received the combined teaching acquired greater knowledge and more positive attitudes. Caution is warranted when interpreting the results, however, due to the multiplicity of factors affecting outcome: the absence of any measure of the acquisition of clinical skills; no attempt to determine separate or interactive effects of psychiatry and paediatric teaching; and no measure of stability of the changes over time.     

Medical students'' attitudes towards ageing and death: a cross-sequential study

This study presents an analysis of possible changes in attitudes towards older persons and in attitudes towards personal death anxiety that might occur over the course of undergraduate medical education. Three entering classes of medical students at a university in the Mid-western United States completed an attitudes towards old people scale, a death anxiety scale, and a standard personality inventory. As graduating seniors, they again completed the attitudes towards old people scale and the death anxiety scale. Significant changes did not occur. In comparison with baseline data from a group of 212 university graduate students in the USA, these 234 medical undergraduates had significantly more positive attitudes towards the aged; in another comparison, their death anxiety was significantly lower than a group of 599 from the general population. Implications are discussed.     

Assessment in undergraduate psychiatric education

An assessment of medical students' psychiatric performance demonstrated no association between the ability to rate psychopathology or to observe interview behaviour and traditional written methods of academic achievement. This is in accordance with those few studies which have addressed this issue and indicates that there may well be at least three independent skills involved in clinical decision-making: the ability to engage in interpersonal interaction and elicit information; and the ability to acquire and use academic knowledge. This is consistent with work suggesting that maturational and learning processes influence clinical reasoning, and demonstrates that each component should be addressed in assessing students in psychiatry.     

Medical curricula and students'' attitudes towards general and family practice in Mexico

In an exploratory study of the influence of different undergraduate curricula on students' attitudes towards general and family medicine, a questionnaire including a Likert attitude scale was administered to a sample of 1217 first- and fourth-year students at five medical schools with different curricula in Mexico City. The preliminary results suggest that the innovative educational programmes have not apparently had a significant impact on students' attitudes. It is hypothesized that students' perceptions of the job market are stronger in determining their attitudes than the orientation of the curriculum itself. It is also suggested that the differences found among the students of the five schools might have been due to differences in the populations entering them. The instrument developed during the study proved to be sufficiently reliable to warrant further use.     

Medical students in a time of HIV: education and the duty to treat

This article concerns medical education about the ethics of professional duties and treatment of HIV-infected patients. The issue at hand is not whether medical students have a duty to treat HIV-infected patients, since it is a matter of consensus that they do. Medical schools have reasserted that risks are inherent in medicine, and that medical school admission should be based on the willingness to accept some risks, in addition to intelligence and personal skills. Those who wish to avoid risks are free to enter other professions. While it is imperative to assert a duty to treat, this requires thoughtful explanation to match the understandably high anxiety levels of many medical students.     

Medical students’ attitudes towards women: a sex-linked variable?

Two hundred and ten (95%) second-year clinical students at the London Hospital Medical College answered a questionnaire before and after their 2-month attachment in obstetrics and gynaecology, in an attempt to measure their attitudes to women and the subject being studied.
In only six of the thirty-two questions were there significant changes in the pre- and post-course responses, and these related to abortion, sterilization and obstetric practice. Students did not often answer 'don't know' to the questions, and the most striking finding was that the responses of male and female students differed, with statistical significance at the 1% level in twenty-six of the thirty-two questions. The male students were more likely to agree with statements which stereotyped women in a negative way and this suggests that, unless active steps are taken by medical teachers to help students to question their attitudes, women will continue to complain about the way they are treated by the medical profession, and women doctors will not fulfil their potential.     

Medical students'' attitudes to old people and career preference: the case of Nottingham Medical School

Medical students' attitudes to the elderly population were compared at entry to and exit from a month-long clinical attachment in the Department of Health Care of the Elderly at Nottingham University. The study investigated clinical students for the 1983-4 and 1986-7 academic years using a questionnaire employing a Rosencranz-McNevin semantic differential scale to measure general attitudes to old age and a Likert scale to measure attitudes to medical care. A question was also asked about career preferences. Improvements in attitudes during the month were noted for both cohort groups, but different trends for the two groups are discussed in the context of the growing pre-clinical effects of such a specialist department in a medical school.