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'' 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.     

Doctors'' interest in psychiatry as a career

Fifty pre-registration housemen were interviewed to elicit their attitudes towards a career in psychiatry. The doctors were all those in one academic year who were recommended for honours on the basis of their performance during the psychiatry clerkship. Those who gained honours in other subjects as well as psychiatry were unlikely to choose a career in psychiatry. The study indicates that further improvements in the psychiatry clerkship will not improve recruitment. Factors outside psychiatry--the pull to general practice and other specialties and the negative attitudes towards psychiatry expressed by other doctors--are among the major deterrents for young doctors considering a career in psychiatry. Collaborative teaching between psychiatrist, physicians and surgeons during the pre-registration year should encourage recruitment and gradually improve the widely held negative attitudes towards psychiatry.     

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.     

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.     

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 student opinion of methods used to teach child and adolescent psychiatry

Medical student opinion of the various methods used to teach child and adolescent psychiatry at Westminster Medical School, London was determined with reference to four general teaching objectives. Their ratings and comments concerning the different methods were used to evaluate the various techniques and make suggestions concerning the planning of undergraduate teaching programmes in child and adolescent psychiatry.     

Students'' assessment of a course in obstetrics and gynaecology

A complete annual entry of 181 students were administered a questionnaire in which they were invited to make value judgements about all aspects of their 3-month course in obstetrics and gynaecology. The resulting performance indicators were used to compare individual staff and clinical firms.     

Psychiatry as compared to other career choices: a survey of medical students in Hong Kong

A questionnaire was administered to two groups of medical students, one preclinical and the other clinical, to assess their career choices, opinions of six specialties (including internal medicine, general practice, obstetrics and gynaecology, paediatrics and psychiatry as well as surgery) and anxieties about psychiatry. It was found that both groups of students conceptualized clinicians according to stereotypes which were modified but not abated by clinical exposure. Although the clinical students compared to preclinical students attributed more positive personality traits to psychiatrists, students interested in taking up careers in psychiatry were few in both groups. Compared to the preclinical class, clinical students were less worried about disturbed patients and emotional involvement with patients, but were more concerned about their deficiency in knowledge and skills relevant to psychiatry.     

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.     

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 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.     

Changes in students'' attitudes and values during medicine versus surgery clerkships

A prospective study of students' attitudes and values was conducted during medicine and surgery clerkships over the first clinical year. Students who finished the surgery clerkship first were more cynical and intolerant of ambiguity than the medicine students. Surgery students also felt they lacked self-confidence and had stronger feelings of being victimized. Cynicism and attitudes towards ambiguous situations improved during the medicine clerkship. Feeling victimized was strongly correlated with their problems with self-confidence, with cynicism, and a feeling of having to submit to authority figures. The findings of this study suggest that the clerkship order significantly affects the development of students' attitudes. Students also became more punitive and less confident as the first clinical year progressed. The implications of these changes in attitude on educational planning are discussed.     

The effect of medical education on the attitudes of medical students towards disabled people

The negative attitudes of society towards disability and the resulting prejudicial behaviour affects the lives of disabled people. One of the declared aims of the Faculty of Medicine of the University of Southampton is to improve attitudes. Hence, an attempt has been made to assess differences in the attitudes held by first- and fourth-year medical students, senior house officers and members of the general public towards disabled people. The measurement instrument used was the 'Attitudes Towards Disabled Persons (ATDP) Scale'. The total number of subjects in the survey was 428, of whom 263 (61%) responded. No significant differences were found between the attitudes of the four groups studied. However, a subpopulation of subjects who agreed with the statement that 'Disabled people cause more problems to doctors than non-disabled people' had attitudes which were significantly more negative.     

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 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.     

A factor analytic study of clinical competence in undergraduate psychiatry

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.     

The ATP 30—a scale for measuring medical students' attitudes to psychiatry

The development and validation of a thirty item, Likert-type scale designed to measure medical students' attitudes to psychiatry—the ATP-30 (Attitudes Toward Psychiatry—30 items)—are described. We had hoped to demonstrate that 'attitude to psychiatry' was not a unitary matter but an amalgam of attitudes to a number of things to do with psychiatric practice. This hope was not fulfilled, as a unitary dimension was obtained. A positive change in the attitudes of students toward psychiatry was demonstrated in third and fourth medical year students in relation to exposure to psychiatry. Such a change was not demonstrable in two classes of occupational therapy students exposed to a course in psychiatry. The reasons for this difference between medical students and occupational therapy students are discussed—there possibly being important implications here for psychiatric curriculum planning in medical school. Lastly, we have demonstrated that the positive change in attitudes amongst medical students was transient rather than lasting—a matter which most studies of attitude change do not address. In spite of the apparent impermanence of the positive change in attitudes among medical students, there are a number of possible uses to a scale such as the ATP-30, and these are discussed.     

Teaching medicine in general practice: the Guy''s experience

The development of teaching in general practice at Guy's Hospital Medical School is described. Important features of the current programme (a new programme for the United Schools of Guy's and St Thomas' Hospitals will come into effect this year) are the emphasis on learning directly from patients and the active role and responsibility given to clinical students. Students welcome the opportunities to see patients first, to deal with undifferentiated problems, to work with one clinical teacher, to put to use knowledge and skills and to test themselves as clinicians. In these circumstances they gain confidence and display the human qualities required of doctors. An acceptable service to patients, the essential basis for effective clinical teaching, requires the general practitioner teachers devote more of their time to service than to clinical teaching.     

General practice in the undergraduate curriculum: 20 interviews with Southampton final-year students

The Primary Medical Care Group at the University of Southampton contributes to the medical curriculum in the first, third and final years. A visiting lecturer from Sweden took the opportunity to interview a sample of 20 final-year students using a qualitative approach. Questioning centered on the impact of the primary care course both in relationship to medicine as a whole and to general practice. It was found that primary medical care was often not seen as a central or integral part of the curriculum but many students acknowledged its important contribution to seeing the patient as a whole and in integrating the various other parts of the curriculum, with significant opportunity for role modelling and informing career choice. A hidden curriculum emerged of attitudes which provided a conflict for some students. Improvements should include clearer dovetailing of primary medical care with other curricular components, limitation of aims with more specific and rigorous assessment and a wide strategy of staff development not confined to those directly involved in general practice attachments.