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ORIGINAL ARTICLE
Year : 2018  |  Volume : 27  |  Issue : 1  |  Page : 124-130  Table of Contents     

Attitude of undergraduate medical students toward psychiatry: A cross-sectional comparative study


1 Department of Psychiatry, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India
2 Department of Psychiatry, JLN Medical College, Ajmer, Rajasthan, India

Date of Web Publication15-Oct-2018

Correspondence Address:
Dr. Parth Singh Meena
5, Department of Psychiatry, Jawaharlal Nehru Medical College, Ajmer, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_82_17

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   Abstract 


Context: Both psychiatry as a specialty and mental illnesses carry a lot of stigmatizing attitudes. Even medical professionals are not immune to prevailing stigma. Psychiatrists are perceived to have less scientific attitude, earn less money, to be less respected, and to have less prestige. Aims: The present study was designed to know the attitude of medical students with different years of exposure to medical education, toward psychiatry as a specialty. Settings and Design: The study was conducted at JLN medical College, Ajmer. The participants were divided into two groups, undergraduate and interns, respectively. It was a cross-sectional descriptive study. Materials and Methods: Self-administered sociodemographic and Attitude Toward Psychiatry-30 items questionnaires were given to the second-year and medical intern and the scores were analyzed using appropriate statistical tools. Statistical Analysis Used: Student's t-test and Chi-square test using SPSS version 21. Results: Nearly 84% of second-year medical students and 52% of interns had positive attitude toward psychiatry (P = 0.001). Only five second-year (5%) and two intern (1.8%) students affirmatively indicated to choose psychiatry as a career choice, while 73% denied choosing psychiatry as a specialty. Conclusions: Second-year medical students showed more positive attitude than the intern group. Increasing negative attitude in higher classes might be due to poor teaching of psychiatry in under graduate training, ridiculous stereotypic comments and remarks by medical teachers and practitioners belonging to other specialty branches.

Keywords: Attitude, psychiatric hospital, psychiatric illness, psychiatrist, stigma


How to cite this article:
Jilowa CS, Meena PS, Jain M, Dhanda G, Sharma KK, Kumawat AK, Dosodiya Y, Moond S. Attitude of undergraduate medical students toward psychiatry: A cross-sectional comparative study. Ind Psychiatry J 2018;27:124-30

How to cite this URL:
Jilowa CS, Meena PS, Jain M, Dhanda G, Sharma KK, Kumawat AK, Dosodiya Y, Moond S. Attitude of undergraduate medical students toward psychiatry: A cross-sectional comparative study. Ind Psychiatry J [serial online] 2018 [cited 2018 Dec 13];27:124-30. Available from: http://www.industrialpsychiatry.org/text.asp?2018/27/1/124/243327



Stigma is perceived as presence of an appalling or unacceptable situation for an individual or group of individuals. It includes making derogatory remarks to an individual by the other community members with the belief that he or she does not follow the typical norms of the community.[1] Psychiatric disorders are prevalent in every part of the world. Almost 10% adults are affected by psychiatric disorder at any given point of time.[2] The WHO has estimated that unipolar depression will rank first as leading cause of disease burden ahead of ischemic heart disease and road traffic accidents by the year 2030.[3]

Stigma and cultural stereotypes regarding psychiatry as a discipline, psychiatrist and psychiatric patients are doggedly present in both developed as well as developing countries. Social stigmatization and negative attitude toward psychiatry and psychiatric patients exist in majority of the people in society. Surprisingly, medical students, doctors, and medical teachers are not immune to social prejudices, stigma and deprecating remarks regarding psychiatry as a specialty and psychiatrist.[4],[5]

Negative attitude of medical professionals further contributes to the negative attitude of medical students. Meta-analysis by Schomerus et al. have reported that negative attitude toward psychiatry and psychiatric patients had not improved significantly in last two decades.[6] Prevailing negative attitude in the general population and mental health professional's leads to a great impediment in providing mental health care to the psychiatrically ill patients. It also contributes in inattention to the required mental health-care needs, superfluous referrals, indecent treatment, and poor social support and acceptance by family members. It is imperative to fill the gap in the knowledge and increasing awareness about mental disorders in society to deliver efficient mental health-care services.[7],[8],[9]

Existing stigma and negative attitude affects not the patient care only but choosing psychiatry as career option by medical students as well. Most medical students consider psychiatry an unrewarding and a stressful specialty.[10] Stigma attached to psychiatric illnesses is also reflected by the fact that very few among the doctors prefer to specialize in psychiatry and even familial pressure against the psychiatry as a career choice has been reported.[11]

Current literature suggests mixed results about attitude of undergraduate (UG) medical students but overall it is negative. There are studies which show positive results after short-term psychiatric training during undergraduation.[12] However, positive impact in attitude was found to be short lasting and a few other studies reported no shift in attitude.[13],[14],[15] Attracting medical students to specialize in psychiatry has been identified as a problem worldwide.[16] There is a contradiction between showing positive attitude and opting psychiatry as a career option.[17]

According to one of the studies, the teaching of psychiatry at the UG level was either disorganized or not done properly.[18] Other studies have reported that compared to other specialists, psychiatrists are perceived to earn less money, to be less respected, and to have less prestige,[16],[17],[18],[19] social stigma, disapproving attitude of nonpsychiatric faculty and assumed higher rate of psychiatric morbidity in psychiatrists are other factors enumerated.[20],[21] Notwithstanding, psychiatry has been rated higher than any other discipline on intellectual challenges.[19] The attitudes to psychiatry among medical UGs have been regarded as key factors in determining the choice of psychiatry as a career and willingness to deal with psychiatric disorders in general practice.[22]

Most part of attitude building toward specialty subjects takes place during UG training. Therefore, attitude of medical students is of utmost importance. Thus, an understanding of the attitudes of medical students toward psychiatry is important, as they are the potential trainees in psychiatry. The study was planned to know the perception, knowledge, and attitude toward psychiatry as a discipline and as a career option among UGs of different years of medical education.


   Materials and Methods Top


Study design

A cross-sectional study was conducted in JLN Medical College Hospital, a tertiary heath care center in North India. The study included 120 second-year and 132 interns respectively. A standardized and structured questionnaire (Attitude Toward Psychiatry-30 (ATP-30)) and a semi-structured socio-demographic profile was given to them to fill up after taking written consent to participate in the study. A total of 100 second-year students and 106 interns returned the filled questionnaire to the investigators. The responses were recorded and the data so obtained were analyzed using SPSS version 21 (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.).

The Attitude Toward Psychiatry-30

The ATP is a 5-point Likert scale designed and validated in Canada by Burra et al.[23] The scale consists of thirty positively and negatively phrased items that measure the strength of the respondent's attitude to various aspects of psychiatry. A score of 1 denotes a highly positive attitude, 5 denote a highly negative attitude, and 3 denotes a neutral response. The score of each positively phrased item was converted by subtracting it from 6. The total global scores range from 30 to 150. A global score of <90 (scores of 1 and 2 combined) suggests a negative attitude to psychiatry, a score of >90 (scores of 4 and 5 combined) denotes an overall positive attitude, while a global score of 90 (average score of 3) is considered to represent a neutral attitude. Each of the thirty questions were analyzed independently and thematically with groups of questions together. The study was conducted after obtaining approval from the Institutional Review Board and permission was sought from the college authorities.


   Results Top


Nearly 83.3% of second-year students and 80.3% interns completed the questionnaire and submitted to the investigator. For purposes of intergroup comparison of sociodemographic and attitudinal differences, Chi-square test and Student's t-test were utilized.

The mean age of interns and second-year students was 24.13 years and 19.7 years, respectively (P = 0.001) [Table 1]. There was no statistically significant difference in other sociodemographic characteristics [Table 2]. The junior students have more favorable attitude towards psychiatry than the interns (83% vs. 48.1%) (P = 0.001). Mean score of ATP-30 was 94.5 and 99.7 for the intern and second-year students, respectively (P = 0.001). Still, only 7 (6.6%) interns and 10 (10%) second-year students affirmatively said they wanted to become a psychiatrist [Table 3]. However, interns more firmly believed that psychiatric patients and illnesses were interesting (UG = 3.06 ± 1.07, interns = 3.46 ± 1.01, P = 0.007). Comparison of mean scores of item number 13, 24, and 26 [Table 5] between the groups shows significantly higher scores of interns (P = 0.001, 0.01, 0.002, respectively). Mean score of item number 23 which pertains to importance of psychiatry in MBBS curriculum was also higher in intern group (P = 0.003). Responses to item numbers 8 and 19 [Table 4] show significantly higher scores of UG students (3.67 ± 1.06 vs. 2.9 ± 1.1, P = 0.001 and 3.71 ± 1.1 vs. 3.03 ± 1.2, P = 0.001) showing negative views about psychiatrists. Similarly, items numbers 1, 2, 6, 7, 17, and 22 [Table 7] which pertains to negative views about psychiatry and psychiatrists had higher scores among UG students. However, interns show higher average scores for item numbers 20, 25, and 28 which pertains to positive views about psychiatry [Table 6].
Table 1: Sociodemographic characteristics of the participants

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Table 2: Attitude Toward Psychiatry-30 scores in terms of cutoff value 90 representing attitude toward psychiatry in both the groups (n=206)

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Table 3: I would like to be a psychiatrist (item 4 in attitude toward psychiatry 30)

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Table 4: Means of scores on items measuring attitude toward psychiatric patients and illnesses

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Table 5: Mean responses of items measuring attitude toward psychiatric knowledge and teaching

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Table 6: Mean responses of items measuring attitude toward psychiatric treatment and hospitals

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Table 7: Means of scores on items measuring attitude toward psychiatrists and psychiatry

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   Discussion Top


The present comparative study was designed to know the attitude of medical students with different years of exposure of medical education, toward psychiatry as a specialty and career option. Second-year medical students have more positive attitude than the interns. Similar findings were found in other studies also conducted in Kenya [17] and Bahrain.[24] Whether this downfall in attitude toward psychiatry was related to decrease in interest in psychiatry or to increase in interest in other fields needs further clarification. Fifteen percent of second year and 45.3% interns students have shown negative attitude.

Item no. 4 “I would like to be psychiatrist” has been given special concern because it provides an association between overall general attitude and career choice. Only ten students (10%) from second year and 7 students (6.6%) from intern group decided to be a psychiatrist. Similar disparity between positive attitude and choosing psychiatry as a career choice was also found in study done in Kenya,[17] Pakistan,[25] and the USA.[26] One Israeli study found that those 32.8% of medical students who determined to do residency in psychiatry, only 6% opted psychiatry as their career option.[27]

The possible explanation regarding dissonance could be the tenaciously persistent and ubiquitous stigma attached to mental disorders. Stereotypic notions attached to metal health-care professionals in society make the specialty an avoidable choice.

We found that both the groups showed positive attitude toward psychiatric patients and psychiatric illnesses and they all agree that psychiatric patients are not only human but they are interesting also and require great deal of attention [Table 4]. Another study with somewhat different methodology and questionnaire conducted in medical colleges of Karachi and Abbottabad of Pakistan [25] found similar results.

In the area of psychiatric knowledge and teaching, both groups showed that psychiatry is most important part of the curriculum in medical college, it helps them better understanding the medical and surgical patients and their psychiatric UG training has been valuable. Although most of the students agreed that psychiatry is vague and unscientific. It may be due to having no confirmatory test like laboratory investigation or imaging in psychiatry unlike other medical or surgical specialties and more reliance on psychological batteries and tools for explaining various disorders [Table 5]. Results of our study are encouraging in comparison to study done in Pakistan which shows neutral responses for most of the items regarding knowledge and teaching.[25]

Further students showed positive attitude for half of the items regarding psychiatric treatment and hospital [Table 6] and agreed that psychiatric hospitals have specific contribution to make to the treatment of the mentally ill person, psychiatric treatment has become effective now and psychotherapy is effective. Unlike interns, junior students perceived psychiatry as fraudulent and psychiatric hospitals little more than prisons. However, both the groups agreed that psychiatrist cannot do much about their patients. Difference in attitude might be due to less or infrequent visit of second-year students to psychiatric wards, especially indoor wards.

This shows that the UGs are not only unaware of the scientific principles of nonpharmacological modalities of treatment but reflects the poor state of psychiatric teaching and training at UG level also.[18] It emphasizes the requirement of integration of mental health facilities with community health services.

Most of the students do not consider psychiatry as a career choice, psychiatry would be excluded if they consider top-three exciting specialty and unlike junior students, intern students agreed that the psychiatrist are not equal to other doctors, they gets less satisfaction, they talk a lot but do very little, people who are taking psychiatric training are running away from participation in real medicine and psychiatry is unappealing [Table 7]. It may be because of psychiatrists are often subjected to ridiculous stereotypic comments and remarks by none other than medical teachers and practitioners belonging to other specialty branches. Al-Ansari et al. reported the same problem in their study conducted in Bahrain in 2002.[24] It is not uncommon to find medical teachers suggesting poor public image of psychiatrist, they do nothing more than prescribing sedatives and tranquilizers and their job is neither intellectually stimulating nor financially rewarding. It is also suggested that psychiatrists themselves are more susceptible to develop psychiatric disorders.[28]

To reduce prevailing stigma globally and to make psychiatry a preferable career option some remedies and possible interventions could be suggested.

Duration of clerkships in psychiatry should be increased rather than curbing it. Medical students will come to fully appreciate the work we do through their in-depth exposure to our field. Students should expose to various psychiatric subspecialties such as child psychiatry, addiction psychiatry, geriatric psychiatry, and sleep and headache clinics. Negative perception that psychiatrist cannot do much about their patients could change through emphasizing nature, prognosis and treatment of those psychiatric illnesses having more chances of relapse/recurrence such as substance dependence and schizophrenia. We must find innovative ways to introduce students to our specialty. High-quality teaching and clerkships containing a variety of clinical experiences will create interest. Demonstrating neurobiological basis of psychiatric illnesses with the help of modern neuroimaging techniques in undergraduation can create positive perception of psychiatry.

Like any other study, there are some limitations of this study including small sample size and it included medical students of single institution only. Therefore, it is suggested that a study with larger sample having homogenous properties of subjects from different medical colleges representing different part of the country may be carried out or similar study may be conducted in the rest of the country to show the overall impression of the country. The study participants were aware of our area of interest, which could have influenced some of the responses.


   Conclusions Top


In the current study, we found that the medical students have multiple lacunae in their knowledge about psychiatric patients, psychiatric illness, psychiatric treatment, psychiatrist and subject of psychiatry. The second-year medical students have more positive attitude than the intern students. Increasing negative attitude in higher classes might be due to poor social image of psychiatrist, relatively financially unrewarding specialty, poor teaching in under graduation, lesser duration of psychiatric clerkship, ridiculous stereotypic comments and remarks by medical teachers and practitioners belonging to other specialty branches. Through exposure in depth and high-quality teaching and clerkship containing a variety of clinical experience will decrease the negative attitude. It has been felt that psychiatry remains neglected subject during the UG training. Thus, there is a need to reassess and modify accordingly the UG medical student's current curriculum.

Acknowledgement

We are thankful to all the medical students and interns who wholeheartedly supported our cause.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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