Improving recruitment into psychiatry: teaching strategies to enhance undergraduate interest

L ike many medical disciplines, interest in the practice of psychiatry is subject to a myriad of social and economic forces. Perhaps more so than most specialties, current events and the manner in which they are reported undoubtedly influence how mental illness and, subsequently, psychiatry are publicly viewed. The recent tragic shooting incident at a cinema in the United States, and the ‘disclosure’ that the shooter had seen a psychiatrist, exemplifies the media’s often sensational interest in mental illness. Indeed, mental health is brought to the fore by the media time and time again in coverage that often overgeneralizes mental illness and, on occasion, may not be fully accurate. Such portrayals may not only further stigmatize sufferers of mental illness but also those who work or are contemplating careers in the field of psychiatry. The effects of the anti-psychiatry movement in the 1960s have been far reaching, affecting the views of many that several mental illnesses are social constructs with little, if any, biological underpinnings. Although neurobiological research has since made compelling scientific challenges to this standpoint, the legacies of Szasz, Laing, and Foucault (for example), as well as other influential thinkers, remain poignant. Subsequently, it is perhaps not surprising that psychiatry is often viewed as a comparatively non-scientific and less efficacious career choice amongst medical graduates. Recruitment into psychiatry is a global challenge. In their national survey of United Kingdom (UK) graduates and their career choices in the period 1974 2000, Goldacre and associates (1) found that only 4 5% of graduates chose psychiatry a percentage that has remained largely unchanged over the years. In the United States, recruitment has been gradually decreasing since the 1970s, reaching its lowest in 1994, with just 3.2% of medical graduates choosing psychiatry (2). In a more recent survey of second year Australian medical students (3), only 15% of respondents indicated a strong likelihood of choosing psychiatry as a specialty. In contrast, other specialties attracted higher proportions of students in the range of 19 49% (3). One of the main reasons for choosing psychiatry was learners’ experience of the subject as medical students substantiating the claim that ‘the psychiatry clerkship is the most important medical school influence on recruitment’ (2).