Canadians Work to Recruit More Students Into Psychiatry

With fewer medical students entering psychiatry in Canada, the Canadian Psychiatric Association (CPA) is looking for ways to boost recruitment and reverse the downward trend.

Last year psychiatry was the first choice of only 5 percent of Canada’s approximately 2,000 medical school graduates, and approximately 20 psychiatry residency positions, or 14 percent, went unfilled. This year 20 positions were vacant after the first round of residency matching through the Canadian Resident Matching Service.

The total number of Canadian graduates accepted after the first round of matching has fluctuated during the last eight years between 64 and 82, not including students from two medical schools in Quebec that do not participate in the match. And for the first time, the University of Toronto, which has furnished from 25 to 30 psychiatrists, or one-third of the nation’s supply, each year drew a blank after the first round of residency matching this year.

“Our biggest concern is that a large group of psychiatrists will retire within the next 10 years,” said CPA President Jean-Marie Albert, M.D., “so we believe that early grooming of undergraduate students for a career in psychiatry would be a good long-term solution to the shortage.”

Michael Myers, M.D., immediate past president of the CPA and a former APA trustee, said, “Among the issues we are discussing are the content of courses, the methodology of teaching, and how teachers function as role models.”

“An increasingly important factor for graduating students is the rising debt they have accumulated,” said Myers, who is also chair of the Psychiatric News Editorial Advisory Board. “That may deter prospective students who perceive that psychiatrists work hard and that their remuneration is modest compared with that of other specialists.”

A CPA committee is seeking answers to a variety of questions. Are men unwilling to become psychiatrists because their income might not be enough to support a family? Are women who enter the field planning to be self-supporting? And do they plan to have a partner or spouse whose income is equal to or greater than their own? What other issues may be relevant?

Praful Chandarana, M.D., who conducted the latest CPA recruitment study, believes that today’s medical school graduates find psychiatry less appealing than other specialties.

“Since students have to choose their specialty before they begin specialty training, upgrading undergraduate education would give students a more favorable view of psychiatry,” said Chandarana, director of postgraduate education at the University of Western Ontario.

The various factors that discourage students from choosing a career in psychiatry are discussed in detail in the chapter “Canadian Perspectives on Undergraduate Education in Psychiatry” by Chandarana and J.R. Pellizarri in Psychiatry in Canada: 50 Years (1951 to 2001), published by the Canadian Psychiatric Association.

Before they enter medical school, some students already have a jaundiced view of the specialty. Others have their impressions of psychiatry shaped by physicians who make derogatory remarks about the specialty. Students sometimes hear that psychiatry is an unscientific specialty with low prestige.

A recent study of 223 U.S. medical students surveyed upon entrance into medical school found that they began their training viewing a career in psychiatry as “distinctly and consistently less attractive” than other specialties, according to David Feifel, M.D., Ph.D., and colleagues in the report “Attitudes Toward Psychiatry as a Prospective Career Among Students Entering Medical School,” which appeared in the September 1999 American Journal of Psychiatry. Some are turned off by their experience during clinical clerkship when they find psychiatric patients are “difficult to handle and unresponsive to treatment.”

Many students are unaware that, thanks to advances in neuroscience and genetics, psychiatry has undergone a revolution. Diagnostic tools such as PET scans can uncover abnormalities in the brain that were never visualized before. A.G. Awad, M.D., editor in chief of the CPA Bulletin, said, “Some of the recent modern scientific knowledge base in psychiatry has not permeated enough into the training curricula, nor has it been grounded well enough into the philosophy of the training of new physicians.”

What can be done to present psychiatry as a vibrant specialty and increase enrollment is described in the February CPA Bulletin by psychiatry resident Eugenia Zikos, M.D., director-in-training in the department of psychiatry at McGill University. She believes the answer lies in changing both the methods of selecting and teaching medical students.

“We need to enhance recruitment by favoring admission of medical school applicants who harbor positive feelings toward psychiatry. And we need to make the psychiatry clerkship experience more valuable.”

The most promising approach so far has been the development of a five-minute questionnaire, given to students before they enter medical school, that reliably identifies those most likely to become psychiatrists, according to Walter Weintraub, M.D., and colleagues in the article “Recruitment Into Psychiatry: Increasing the Pool of Applicants,” which appeared in the June 1999 Canadian Journal of Psychiatry.

The questionnaire was derived from studies showing that the most promising students are more likely to be women, are less likely to have majored in biological sciences, are significantly more flexible in their intellectual interests, have good social skills and lower attitudes of prejudice and authoritarianism, and have had mental health work experience or know someone with mental illness.

Since 1970 the University of Maryland has found the questionnaire helpful in selecting students who go on to become psychiatrists. In addition, the university has instituted a Combined Accelerated Program in Psychiatry (CAPP) designed to encourage medical students to choose careers in psychiatry. A report by Weintraub and colleagues describes the use of the CAPP in recruiting some of the top graduates of the University of Maryland into psychiatry. The report, titled “Medical School Electives and Recruitment Into Psychiatry: A 20-Year Experience,” appeared in the June 1996 issue of Academic Psychiatry.

While an infallible method for the recruitment of psychiatry trainees has yet to be formulated, common factors in most successful programs have included involvement of senior faculty, small-group teaching, and early patient contact. To help counter the erosion of interest among medical students interested in psychiatry, researchers have found it necessary to offer high-quality clinical clerkships that include both outpatient as well as inpatient experience.

The article “Recruitment in Psychiatry: Shrinking Interest?” can be accessed on the Web at www.cpa-apc.org/Publications/Archives/Bulletin/2002/february/february2002.asp by clicking on the report title in the frame on the left. ▪