THE EFFECT OF PSYCHIATRIC EDUCATION ON THE ATTITUDE OF MEDICAL STUDENTS OF GUILAN UNIVERSITY OF MEDICAL SCIENCES TOWARD PSYCHIATRYHTML Full Text
THE EFFECT OF PSYCHIATRIC EDUCATION ON THE ATTITUDE OF MEDICAL STUDENTS OF GUILAN UNIVERSITY OF MEDICAL SCIENCES TOWARD PSYCHIATRY
Jalali Mir Mohammad 1, Soleimani Robabeh * 2 and Asgarian Yazdi Mahdi 2
Department of Otolaryngology, Medical Education Research Center (MERC), Education Development Center (EDC) 1, Department of Psychiatry, Kavosh Behavioral Cognitive and Addiction Research Center, Shafa Hospital 2, Guilan University of Medical Sciences, Rasht, Iran.
ABSTRACT: Introduction: While many medical students have a special talent in psychiatry, attracting them to this specialty is a problem. The purpose of this study was to examine the impact of psychiatric education on the attitude of medical students on psychiatric patients. Method: In this observational study, 200 medical externs and interns were recruited. Before and after attending the 4-week psychiatry education course, the subjects were asked to express their attitude, knowledge, and experiences concerning psychiatry by completing the attitudes toward psychiatry (ATP-30) and the 6-item psychiatric experience, attitudes, and knowledge (PEAK-6) scales. Twenty-six subjects didn’t meet inclusion criteria or answered incompletely to the questionnaires Data were analyzed by t-test and paired t-test. All statistical assays were performed with SPSS19. Results: The average age of participants was 24.86 ± 1.85 years. Of the 174 students who were finally evaluated, 84 were externs (25 male, 59 female) and 90 were interns (35 male, 55 female). A significant statistical difference was found between the mean scores of PEAK-6 among the students before and after psychiatric education (P< 0.001). However, we couldn’t reveal a significant difference between ATP-30 scores before and after education (P = 0.25). Conclusion: We showed a significant difference between the mean scores of PEAK-6 not ATP-30 in the medical students before and after psychiatry course. It may be due to better sensitivity of the PEAK-6 in the detection of changes in attitudes toward psychiatry. We recommended larger studies to discover predicting factors lead to an improvement in attitudes toward psychiatry.
Psychiatry, Education, Attitude, Medical students
INTRODUCTION: Psychiatry is one of the medical specialties that deals with issues related to behavior, emotions, and prevention as well as treatment of human mental disorders. Over the last century, psychiatry has major developments in diagnosis, classification, assessment, and treatment of mental disorders. The inclusion of psychiatry as a core curriculum in medical education is now an accepted component of all medical courses.
Despite the integration of psychiatry and behavioral science in the preclinical and clinical periods, medical students’ attitudes toward psychiatry and psychiatry as a career option have been negative for decades. The attitude of medical students about psychiatry and psychiatric patients is important for several reasons. First, they are future physicians who would supervise and direct other healthcare professionals. Second, a previous study showed that the attitude of graduated physicians is more developed and resistant to change 1. Then educational interventions are more effective on undergraduates rather than medical graduates,
The attitude of medical students on psychiatry is affected by factors such as job opportunities, credibility and influence, income, and advanced educational prospects 2. Previous studies have pointed out that medical students have a negative attitude toward psychiatry and psychiatric diseases and believe that psychiatrists are dissatisfied with their work 3. The negative attitude toward psychiatry makes it unattractive to medical students 4. Moreover, most students believe that health care providers for psychiatric patients are at a lower socioeconomic status 5.
Pailhez et al., (2005) explored the impact of psychiatric education on modifying the attitudes of Spanish and American medical students toward this field. The results demonstrated that education could modify the negative attitude of medical students 6. In another study, Hofmann et al., (2011) at the University of Hamburg, Germany, investigated the impact of education on the attitude of medical students toward psychiatrists and people with mental disorders. They reported that participation in the psychiatric course might positively influence students' knowledge, experience, and attitude toward psychiatry, but not toward psychiatric patients 7. Some researchers documented that participation in the psychiatric course could change attitude more in externs versus interns, male versus female, and married versus single 8, 9, 10, 11, 12.
In most medical schools of Iran, medical undergraduate education takes a minimum of 7 years traditionally and includes "basic sciences" period, "physiopathology" period (theoretical aspects of different common diseases) "extern or stager" period (learning practical aspects of diseases at the patient’s bed), and "internship" period in which students are responsible for the diagnosis, treatment, and management of their patients in the hospitals.
Psychiatry education is restricted to two units in extern and internship periods. During the 4 weeks extern period, students introduce semiology and different psychiatric disorders. During the 4 weeks internship period, students involved with history taking, diagnosis, and management of psychiatric patients. The medical school of Guilan University of Medical Sciences (GUMS) is an important medical school in North of Iran. In GUMS, the content of both periods included non-clinical and clinical teaching. In the extern period, we use lectures, seminars, case presentation, exposure to adult inpatient wards / outpatient clinics and ward round. In addition to these activities, interns participate in a journal club, history taking and interviewing skills and are exposed to the emergency department. According to a prevailing negative attitude toward the psychiatry in the juniors 13, 14 and need to change of their attitude, the aim of this study was to addresses the question of whether a psychiatric course in Guilan University of Medical Sciences is effective on improving the attitude of medical students towards psychiatry.
MATERIALS AND METHODS: In an observational study, we recruited the externs and interns of Guilan University of Medical Sciences (GUMS) who referred to the Psychiatry Department, Shafa Hospital, Rasht, Iran from September 2016 to August 2017. The psychiatry course for externs and interns includes lecture sessions and bedside teaching in 4 weeks. Inclusion criteria comprise to be native medical students of GUMS, to pass the extern course of psychiatry at GUMS, and to have a normal profile of mental health (assessing with Symptom Checklist-90-Revised). After taking informed consent, the subjects asked to fill questionnaires before and after psychiatry course.
Approval for the study was obtained from the Review Board of the GUMS, Iran, which complies with the International Guideline for Human Research protection as required by the Declaration of Helsinki (No: 95040117).
The questionnaires consist of demographic questions, the Attitudes toward psychiatry (ATP-30) as well as the 6-item psychiatric experience, attitudes, and knowledge (PEAK-6) questionnaires. The Symptom Checklist-90-Revised assesses nine different dimensions of mental health including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism 15, 16. 17.
Burra et al., developed the attitudes toward psychiatry (ATP-30) which has 30 positively and negatively phrased items. The ATP-30 measure the strength of the respondent’s attitude toward various aspects of psychiatry. Each item has a5-point Likert scale, from "strongly agree" (1) to "strongly disagree” (5). The higher the score, the more positive the attitude (minimum score: 30, very negative attitude; maximum score: 150, very positive attitude) 18, 19. The Medical Research Team at Hamburg University developed a multidimensional questionnaire known as PEAK-6.
This questionnaire assays the attitudes, experiences, and opinions of individuals concerning mental disorders. Each item has a 7-point Likert scale, range from "absolutely disagree" (1) to "absolutely agree" (7) 7. Quantitative data were expressed using mean, and standard deviation and qualitative data were described in percentage. We used the paired t-test to compare the ATP-30 and PEAK-6 scores of students before and after the psychiatry course. We used a t-test to compare mean change scores of the ATP-30 and the PEAK-6 before and after the psychiatric education in different sub-groups (extern versus intern, male versus female, single versus married). The Bonferroni correction was considered for all p-values. Moreover, the impact of psychiatry course on each question of PEAK-6, Cohen's d effect size was calculated. Cohen`s d was measured by dividing the difference in means by standard deviation. All analyses were performed by using SPSS 19.
RESULTS: A total of 200 medical students (95 externs and 105 interns) participated in this research. The average age of participants was 24.86 ± 1.85 years. The minimum and maximum age of the study subjects was 22 and 35 years. Nineteen out of 200 students did not fill the questionnaires. Also, seven students (3.5%) did not have a normal profile in the SCL90-R. So, we analyzed the data of 174 subjects. The demographic characteristics of the subjects were shown in Table 1. We did not observe a significant change in the ATP-30 scores before and after the psychiatry course in the subjects or subgroups Table 2. Also, there were no significant differences in the mean change of the ATP-30 scores between the intern and extern (P=0.38), male and female (P=0.96), or married and single students (P=0.26). However, the medical students had significantly higher scores in all items of the PEAK-6 after psychiatry course Table 3.
TABLE 1: DEMOGRAPHIC CHARACTERISTICS OF MEDICAL STUDENTS
TABLE 2: COMPARISON OF ATP-30 SCORES OF MEDICAL STUDENTS (n = 174) BEFORE AND AFTER THE PSYCHIATRY COURSE
TABLE 3: COMPARISON OF PEAK-6 SCORES OF MEDICAL STUDENTS (n= 174) BEFORE AND AFTER THE PSYCHIATRY COURSE
TABLE 4: COMPARISON OF THE SCORES OF PEAK-6 QUESTIONS AS ANSWERED BY MEDICAL STUDENTS (n = 174) BEFORE AND AFTER THE PSYCHIATRIC INTERVENTION
|Questions||The beginning of the course||End of the
|Effect size (Cohen`s d)||p-value|
|My knowledge of psychiatry is||3.45±1.15||4.44±0.99||.64||.001>|
|My experience with psychiatry is||2.77±1.2||3.80±1.18||.60||.001>|
|My knowledge of individuals with mental disorders is||2.93±1.11||3.95±1.05||.69||.001>|
|My experience with individuals with mental disorders is||2.76±1.24||3.72±1.29||.55||.001>|
|My attitude toward psychiatry is||4.71±1.44||5.26±1.11||.32||.001>|
|My attitude toward individuals with mental disorders is||3.93±1.36||4.52±1.08||.35||.001>|
Again, there were no significant differences in the mean change of the PEAK-6 scores between subgroups (interns versus externs, P=0.08; male versus female, P=0.47; married versus single, P=0.73). Further analysis of the items of the PEAK-6 showed the highest effect sizes (Cohen’s d) in the items 1 and 3. The medical students had a lower score in items 5 and 6 than others Table 4.
DISCUSSION: This study aimed to explore the effect of psychiatry course on the attitude of students towards this field. Our data on attitudes from the PEAK-6 was in line with previous studies 2, 7, 20, showing the majority of students had positive attitudes towards psychiatry, which were positively correlated to the quality and quantity of teaching. Students in this study showed a positive attitude towards psychiatry possibly due to the subject being introduced during the extern and internships periods with mixed non-clinical and clinical teaching approaches. Lyons 21 performed a systematic review in 2014 to assess the impact of the clerkship on student attitudes. 16 out of 26 studies reported an improvement in attitudes towards psychiatry post-clerkship. Previous studies showed that the implementation of creative and novel programs, and the availability of elective options for students who have performed well in clerkships or expressed a particular interest in psychiatry increase recruitment 22, 23, 24, 25.
Another factor such as the relationships between students and teachers, curriculum content and teaching methods could improve attitudes toward psychiatry 26. We could not compare our results with previous studies directly due to differences in the methodologies of the studies and the level of training of the participants. Although we found a significant difference between the mean scores of PEAK-6 in the medical students before and after psychiatry course, we could not observe a significant change in the subjects’ attitude toward psychiatry. The ATP-30 results revealed that psychiatry course could not improve attitudes of the medical students. These results are in line with previous studies 2, 7.
Previous studies 27, 28 revealed that-30 results vary strongly and without relating the characteristics of the curriculum. Also, there are some conceptual difficulties in ATP-30 and content-related special characteristics 7. ATP-30 results are usually reported regardless of the outcome of the curriculum 27. On the other hand, the PEAK-6 might allow for statements about the examined population’s attitudes toward individuals with mental disorders, knowledge of psychiatry, and individuals with mental disorders, as well as experience with psychiatry and individuals with mental disorders.
Hofmann et al. noted that the PEAK-6 has better sensitivity in the detection of changes in attitudes toward psychiatry 7. Some studies have proposed that the negative attitude was not the only reason for refraining from choosing this field for one’s future career; in fact, other reasons, such as low employment opportunities for graduates of this field and its stereotypical social tags play significant roles in this regard 12. However, job dissatisfaction among the old practitioners of this field due to the low income, negative attitudes, and antipsychiatry atmosphere in the community is an influential and inescapable factor in the kind of decision students and medical graduates make regarding their will to choose this field as a future career.
In this study, the attitude of the study subjects toward psychiatry was examined concerning demographic characteristics. There was no statistically significant difference between sub-groups before and after the intervention. In contrast with previous studies 2, 9, 14, 29-33 we showed no greater improvement in attitudes in female students. Early clinical exposure in GUMS may probably exert some influences on the attitudes of male and female students and negotiate the difference between them. The further analysis of the PEAK-6 questionnaire illustrated that the maximum effect size is related to questions 1 and 3. These questions are about students' knowledge of psychiatry and mental illnesses. The results illustrated that the psychiatry course had changed participants’ knowledge and attitude toward this discipline.
Several limitations of our study have to be mentioned. This study recorded a high response rate when compared to most other similar studies. Although students may have felt obliged to participate, it is unlikely that this fact contributed greatly to the high response rate as anonymity was strictly maintained. This study was the inability to show which aspects of the clinical rotation influenced the attitude of the students. Also, Sivakumar et al., 34 noticed that a positive change in attitudes of the students immediately after the rotation might be transient. Another limitation of this study could be its reliance solely on information obtained from two questionnaires. Different answers could be found with face-to-face interviewing. Moreover, our study population was confined to one medical university. Therefore, it is likely to achieve different results by conducting such a study in other medical universities.
CONCLUSION: Various studies should be conducted to discover which educational strategies or specific student-teacher relationship lead to an improvement in attitudes toward psychiatry. So, replicating similar studies at other universities could yield more useful information and assist in improving the quality of undergraduate training in psychiatry in Iran. We recommended to design and implement a longitudinal study for predicting other effective factors in choosing psychiatry as a future career.
ACKNOWLEDGEMENT: The authors extend their gratitude to the Medical Education Research Center of Guilan University of Medical Sciences and the Deputy of Research for their support and allocating a grant (95040117) to this project.
CONFLICT OF INTEREST: The authors reported no potential conflict of interest.
- Smith JK and Weaver DB: Capturing medical students’ idealism. The Annals of Family Medicine 2006; 4(S-1): S32-7.
- Kuhnigk O, Hofmann M, Böthern AM, Haufs C, Bullinger M and Harendza S: Influence of educational programs on attitudes of medical students towards psychiatry: Effects of psychiatric experience, gender and personality dimensions. Medical Teacher 2009; 31(7): e303-10.
- Cutler JL, Alspector SL, Harding KJ, Wright LL and Graham MJ: Medical students’ perceptions of psychiatry as a career choice. Acad Psychiatry 2006; 30(2): 144-9.
- Malhi GS, Parker GB, Parker K, Carr VJ, Kirkby KC and Yellowlees P: Attitudes toward psychiatry among students entering medical school. Acta Psychiatrica Scandinavica. 2003; 107(6): 424-9.
- Kassam A, Glozier N, Leese M, Henderson C and Thornicroft G: Development and responsiveness of a scale to measure clinicians’ attitudes toward people with mental illness (medical student version). Acta Psychiatrica Scandinavica 2010; 122(2): 153-61.
- Pailhez G, Bulbena A, Coll J, Ros S and Balon R: Attitudes and views on psychiatry: a comparison between Spanish and US medical students. Academic Psychiatry. 2005; 29(1): 82-91.
- Hofmann M, Harendza S, Meyer J, Drabik A, Reimer J and Kuhnigk O: Effect of medical education on students’ attitudes toward psychiatry and individuals with mental disorders. Academic Psychiatry 2013; 37: 380-4.
- Sajid A, Khan MM, Shakir M, Moazam-Zaman R, Ali A. The effect of clinical clerkship on students’ attitudes toward psychiatry in Karachi, Pakistan. Academic Psychiatry 2009; 33(3): 212-4.
- Ghasemi GH, Yousefi A, Sanati A and Movahed A: Attitude of medical students of Boushehr University of Medical Sciences toward psychiatry as a course and a future career. Journal of Isfahan Medical School 2012; 29(170): 2672-86.
- Mohaghegh H and Birashk B: Medical student's attitude toward psychiatric wards at Iran University of Medical Sciences. IJPCP 1995; 2 (1-2): 48-54.
- Mehrabian S, Bahrampour M and Nakhae N: Attitude of Kerman Medical Sciences students on mental diseases. J of Qualitative Res in Health Sciences 2010; 10(1): 29-35.
- Khaled in N, Riahi F, Veysi MS, Hoseyni H and Mazidi SI: Do medical students' attitudes toward psychiatry and their intention to pursue psychiatry as a career change during psychiatric attachment? Iranian Jour of Psychiatry and Behavioral Sciences 2012; 6(1): 53-61.
- Niaz U, Hassan S, Hussain H and Saeed S: Attitudes towards psychiatry in pre-clinical and post-clinical clerk ships in different medical colleges of Karachi. Pakistan Journal of Medical Sciences 2003; 19(4): 253-63.
- Reddy JP, Tan SM, Azmi MT, Shaharom MH, Rosdinom R and Maniam T: The effect of a clinical posting in psychiatry on the attitudes of medical students towards psychiatry and mental illness in a Malaysian medical school. Ann Acad Med Singapore 2005; 34(8): 505-10.
- Derrogatis LR, Lipman RS and Covi I: The SCL-90: An outpatient psychiatric rating scale. Psychopharmacology Bulletin 1973; 9: 13-28.
- Derrogatis LR and Cleary PA: Confirmation of the dimensional structure of the SCL‐90: a study in construct validation. Jour of Clinical Psychology 1977; 33(4): 981-9.
- Mirzai R: Assessment and Reliability of SCL-90-R test in Iran. Thesis master of psychology and behavioral sciences. University of Tehran 1981; 50-53.
- Burra P, Kalin R, Leichner PW, Waldron JJ, Handforth JR and Jarrett FJ: The ATP 30-a scale for measuring medical students' attitudes toward Medical Education 1982; 16(1): 31-8.
- Ghasemi GH, Rahmani M and Nikfarjam M: Attitudes of Medical Students in Shahrekord University of Medical Sciences towards psychiatry. Journal of Isfahan Medical School 2012; 165(29): 1-10.
- Kuhnigk O, Strebel B, Schilauske J andJueptner M: Attitudes of medical students toward psychiatry: effects of psychiatric experience, gender, and personality dimensions. Adv Health Sci Educ 2007; 12: 87-101.
- Lyons Z. Impact of the psychiatry clerkship on medical student attitudes towards psychiatry and to psychiatry as a career. Acad Psychiatry 2014; 38(1): 35-42.
- Lofchy J, Brunet A and Silver I: The Psychiatry Institute for Medical Students: a novel recruitment strategy. Acad Psychiatry 1999; 23: 151-6.
- Pidd S: Recruiting and retaining psychiatrists. Adv Psychiatr Treat 2003; 9: 405-13.
- Lyons Z, Power B, Bilyk N, Lofchy J and Claassen J: Evaluation of the Claassen Institute of Psychiatry for Medical Students. Australas Psychiatry 2010; 18: 12-6.
- Andermann LF, De Souza C and Lofchy J: The Psychiatry Institute for Medical Students: a decade of success. Acad Psychiatry 2010; 34: 150-3.
- Gat I, Abramowitz MZ and Bentov-Gofrit D: Changes in the attitudes of Israeli students at the Hebrew University Medical School toward residency in psychiatry: a cohort study. Isr J Psychiatry Relat Sci 2007; 44: 194-203.
- Gazdag G, Zsargo E, Vukov P, Ungvari GS and Tolna J: Change of medical student attitudes toward psychiatry: the impact of the psychiatric clerkship. Psychiatr Hung 2009; 24: 248-54.
- Singh SP, Baxter H, Standen P and Duggan C: Changing the attitudes of “tomorrow’s doctors” towards mental illness and psychiatry: a comparison of two teaching methods. Med Educ 1998; 32: 115-20.
- Adebowale T, Adelufosi A, Ogunwale A, Abayomi O and Ojo T: The impact of a clinical psychiatry rotation on the attitude of Nigerian medical students to psychiatry. Afr J Psychiatry 2012; 15: 185-8.
- Al-Adawi S, Dorvlo A, Bhaya C, Martin RG, Al-Namani A and Al-Hussaini A: Withering before the sowing? A survey of Oman's ‘Tomorrow's Doctors’ interest in psychiatry. Educ Health 2008; 21: 1-10.
- Araya R, Jadresic E and Wilkinson G: Medical students' attitudes to psychiatry in Chile. Med Educ 1992; 26: 153-6.
- Al-Ansari A and Alsadadi A: Attitude of Arabian Gulf University medical students towards psychiatry. Educational Health 2002; 15: 180-8.
- Lambert TW, Goldacre MJ, Davidson JM and Parkhouse J: Graduate status and age at entry to medical school as predictors of doctors’ choice of long‐term career. Medical Education 2001; 35(5): 450-4.
- Sivakumar K, Wilkinson G, Toonc B and Grecr S: Attitudes to psychiatry in doctors at the end of their first post-graduate year: two-year follow-up of a cohort of medical students. Psychological Medicine 1986; 16: 357-60.
How to cite this article:
Mohammad JM, Robabeh S and Mahdi AY: The effect of psychiatric education on the attitude of medical students of Guilan University of medical sciences toward psychiatry. Int J Pharm Sci & Res 2019; 10(2): 863-68. doi: 10.13040/ IJPSR.0975-8232.10(2).863-68.
All © 2013 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
J. M. Mohammad, S. Robabeh * and A. Y. Mahdi
Department of Psychiatry, Kavosh Behavioral Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran.
12 June 2018
01 August 2018
07 August 2018
01 February, 2019