The quality of psychiatry clerkships, as rated by medical students, appears to affect recruitment rates into psychiatry.
Additionally, the reputation of the psychiatry department, the quality of resident teaching as perceived by medical students, and the regard in which psychiatry is held by nonpsychiatric faculty and other students at a medical school are also related to how well a program does in recruiting students into psychiatry.
Those were among the findings of two separate surveys—one of psychiatry medical school education leaders and another of medical students—to determine variables associated with recruitment success. Findings from the survey of psychiatry faculty were presented at the February meeting of the American Association of Directors of Psychiatric Residency Training, and the analysis of the survey of medical students was presented at APA’s 2013 annual meeting in San Francisco in May.
Principal investigator John Spollen, M.D., an associate professor and vice chair for education at the University of Arkansas for Medical Sciences, said the quality of the psychiatry clerkship—when students get hands-on experience treating patients—appears to be a significant factor.
“There is a consistent finding that highly rated clerkships are associated with higher recruitment,” he told Psychiatric News. “That’s important to me because that is something I and other psychiatric educators have direct control over. Some of the other variables, such as stigma among nonpsychiatric faculty, are cultural factors that are harder to control.
“The clerkship is where students get the experience of hands-on patient care and seeing what it is that psychiatrists do,” Spollen said. “It’s a chance for students to see the strong interpersonal nature of the profession, when a lot of the rest of medicine doesn’t have the same quality of relationship with patients. So students who are inclined to value the relationship with patients can become excited about psychiatry.”
He noted that the relationship worked both ways—programs that had highly rated clerkships had better recruitment success, and those with poorly rated clerkships had poor recruitment.
Also noteworthy was the correlation between student perception of the quality of resident teaching and recruitment. “This was a measure of students’ perception that residents and fellows provided effective teaching,” Spollen said. “It may reflect something broader, like whether residents and fellows are good role models or provided a learning environment that makes psychiatry interesting.”
Spollen, along with Deborah Hales, M.D., and Nancy Delanoche, M.S., from APA’s Division of Education, gathered data from APA on recruitment rates from 124 U.S. allopathic medical schools from 2003-2011. Then they and colleagues from the Association of Directors of Medical Student Education in Psychiatry developed a 21-item survey of potentially relevant factors including information on curriculum (hours/length, settings, evaluations), educational leadership (course directors and deans), departmental and resident reputation, respect for psychiatry/antipsychiatry stigma among nonpsychiatric faculty, and availability of student interest groups.
Medical student education leaders in psychiatry from the top 25 and bottom 25 recruiting schools from 2003 to 2011 were subsequently surveyed by e-mail, and 76 percent completed the survey.
The second survey findings presented at the APA meeting used data from the American Association of Medical Colleges (AAMC) on NIH funding, tuition costs and student debt, as well as a subset of items from the Matriculation and Graduation Questionnaire (GQ) filled out by medical students across the country.
No significant correlations were found between recruitment rates for 2003 to 2011 and NIH funding, tuition, or various levels of debt. (However, in a subset analysis, 2009-2011 recruitment rates were negatively correlated with schools with an average student debt over $200,000.)
The survey of psychiatry faculty found that departmental/resident reputation and attitudes toward psychiatry as a profession by nonpsychiatric faculty and other students were related to recruitment success, while the AAMC and GQ results emphasized clerkship and resident teaching evaluations.
“These ‘educational/curricular’ and ‘environmental/cultural’ factors are probably not independent,” Spollen said. “Further study of this subject should include qualitative analysis of high- versus low-recruiting schools and evaluations of culture, climate, and stigma involving medical students directly in high- versus low-recruiting schools. Potential interventions to improve recruitment rates might include curricular and teaching improvements, mentoring programs and student interest groups that might help buffer against antipsychiatry stigma, and possibly 'appreciative inquiry-led’ culture-change initiatives.” ■