Here - Surrey and Borders Partnership NHS Foundation Trust

More documents

Recommendations

Info

Commentary and Debate How can we look at improving recruitment into psychiatry? January 2009 By Josie Jenkinson If recent figures are to be believed, fewer UK graduates are entering higher specialist training in psychiatry than ever before. Just 6% of candidates sitting Paper 1 of the MRCPsych in diet one of 2008 were UK graduates (Oxtoby, 2008), and this is likely to be a national indicator of recruitment trends (Brown et al, 2009). This has lead to widespread attention being focused on potential ways of improving recruitment into psychiatry, and the Royal College of Psychiatrists having taken specific steps to address the issue (Royal College of Psychiatrists, 2009). The current recruitment crisis is by no means a new problem. In fact, concerns regarding poor recruitment into psychiatry have been discussed since the 1970’s and there have been similar issues in other countries, most notably in the USA (Brockington, 2002). As a result, there has been a substantial amount written on the subject of recruitment into psychiatry. Much of the literature has been concerned with identifying the factors influencing the choice of psychiatry as a career as well as suggesting strategies that might be adopted to improve recruitment based on these factors. However, in the light of ongoing change within the NHS and medical education, as well as a current climate of doubt and uncertainty as to the future role of the psychiatrist this is a very real and current issue facing the profession. Increasing reliance on international medical graduates to support and maintain delivery of psychiatric care increases the pressure to improve the current situation even further, given the possible impact of Home Office immigration policy changes (Brown et al, 2009). Any strategy aimed at improving recruitment into psychiatry would need to take into account the possible reasons why people choose psychiatry as a career, as well as what might deter them. This may be difficult as processes which influence doctors in their choice of career have been described as “subtle and complex” (Eagles 2007), however I shall outline some of the possibilities below. Prior to entering medical school, many specialties including psychiatry are rated as a very attractive option (Maidment et al, 2003). However, this attitude is not maintained throughout the years of undergraduate training, with medical students tending to develop more negative attitudes about the specialty (Brockington, 2002). This may in part be due to the negative attitudes towards the profession from non-psychiatrists and even psychiatrists themselves, for example describing psychiatrists as ‘not proper doctors’ (Craddock, 2008 p70). This is confounded by the sadly ever present stigma surrounding those with mental health problems and those who treat them, which medical students are exposed to both inside and outside of their training (Brockington, 2002). Four broad categories of negative opinions surrounding psychiatry as a specialty have been identified amongst medical students. These are related to the assumption that psychiatry lacks objectivity and is unscientific, that treatments are ineffective, that psychiatrists are ‘emotionally unstable’ and ‘second rate’ doctors, and a dislike of the patient population treated by psychiatrists (Scott, 1986 p99). However, undergraduate exposure to psychiatry seems to be particularly important as a potentially positive influence, with consultants in psychiatry citing a lasting influence of medical 24 Surrey and Borders Online Journal www.sabp.nhs.uk/journal
school exposure to psychiatry as an influence on their ultimate choice of specialty, even if their career choice was made after leaving medical school (Dein et al, 2007). Several studies have found that intentions of students to pursue psychiatry as a career were increased following exposure to a psychiatric attachment during their years at medical school. Specific factors are likely to be associated with a greater intention to pursue psychiatry as a career following a psychiatric attachment; namely receiving encouragement from consultants, seeing patients respond to treatment and having direct involvement in patient care (McParland, 2003). Positive elements of career in psychiatry which have been identified as appealing to prospective trainees are empathy for patients with a mental disorder, better working conditions, and the interface of psychiatry with neuroscience and the social sciences (Dein et al, 2007). Other factors identified as being important when choosing psychiatry as a specialty are enthusiasm and commitment for the specialty, and self appraisal of one’s own skills and aptitudes (Goldacre, 2005). In the light of the above, it would seem that focusing on the undergraduate experience of psychiatry as a target for increasing recruitment is paramount. Historically, this has been the reaction to the recruitment problem, and as a result pre-clinical teaching in psychology, social science and behavioural science now has a much greater emphasis. Inclusion of a psychiatry placement is now universal, however unfortunately it would seem that in recent years with the ever expanding demands placed on the curriculum, placements have decreased in length (Brown et al 2009). As such it is increasingly important that the best use is made of these placements, with students being actively involved in clinical care, being taught enthusiastically with an emphasis on evidence based medicine and patient recovery. Psychiatric trainees may be ideally placed to provide additional teaching and support to medical students, and should be encouraged to do so by their supervising consultants. Liaison psychiatry placements have been identified as being of particular appeal to medical students and may have special value in aiding recruitment in the future (Brockington, 2002). Medical students who show an interest in pursuing psychiatry as a career should be encouraged and given ongoing support and careers advice (Eagles et al, 2007). Another potential target for recruitment are those who have not yet entered medical school. It has been found that the type of person likely to pursue psychiatry as a career tends to have an interest in more psychological, sociological and artistic subjects, with many tending to have one A-level in a non-science subject (Brockington, 2002). They are also more likely to be from a lower social class, come from cities and be politically liberal (Eagle and Marcos, 1980). It may be that development of widening participation schemes and graduate entry programmes may result in a greater number of students with these interests and attributes entering medical school and hence moving into psychiatry, although the effect of these developments has yet to be evaluated. Greater public awareness of mental health issues and the ongoing challenge of tackling stigma, possibly by improvement in public education and covering of mental health issues as part of the primary and secondary school curriculum may in time raise the profile of psychiatry and lead to greater understanding and appeal of the specialty, however this is unlikely to yield results in the short term. Several surveys have identified that the majority of people choose psychiatry as a career after graduation rather than during the undergraduate years (Brockington, 2002). With this in mind, increasing positive exposure to psychiatry during the foundation years may well have a positive effect on recruitment. By the end of their first year of work post Commentary and Debate Surrey and Borders Online Journal www.sabp.nhs.uk/journal 25
Page 1 and 2: Issue 1 Summer 2010 Surrey and Bord
Page 3 and 4: Do you ever wonder why you agree to
Page 5 and 6: We are not so aware of the hidden f
Page 7 and 8: esorting too soon to complex statis
Page 9 and 10: Bipolar Disorder: how effective is
Page 11 and 12: Research Method The study was condu
Page 13 and 14: Screened for Hypomania Yes No Total
Page 15 and 16: In our sample the GPs screening met
Page 17 and 18: Audit of risk assessment documentat
Page 19 and 20: Fig. 2 Re-audit May 2009 - distribu
Page 21 and 22: An evolving service - results of a
Page 23: having clinical responsibility for
Page 27 and 28: The measures outlined above will ho
Page 29 and 30: Interview with Fiona Edwards, Chief
Page 31 and 32: Q. Very topical to that is the appo

Here - Surrey and Borders Partnership NHS Foundation Trust

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?