Medical students' attitudes toward psychiatry and mental disorders.

Received April 22, 2005; revised June 6, 2005; accepted June 7, 2005. Dr. Feldmann is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Address correspondence to Dr. Feldmann, Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY tbfeld01@ louisville.edu E-mail). Copyright 2005 Academic Psychiatry. Medical student education in psychiatry faces many challenges. Educators must balance the need to stimulate interest in psychiatry to improve recruitment versus the responsibility to provide adequate training in psychiatry for the approximately 95% of students who will choose other medical specialties. This balance must be achieved against a perceived background of diminishing resources for psychiatric medical student education. Although definitive data does not yet exist, psychiatric educators across the country have observed diminishing contact time by faculty with medical students due to demands for increased clinical revenues. The perception also exists that funding for medical student education-related roles and positions within departments of psychiatry is steadily decreasing. Shrinking infrastructure resources for medical student education is widespread. Many psychiatry departments now have fewer clinical sites that can accommodate medical students. In order to address the perceived lack of resources for psychiatric medical student education, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) is currently conducting a survey of its members to assess the adequacy of resources for psychiatric education (1). Competition from other departments for curriculum time has also threatened the quality of our medical student education programs. While most psychiatry clerkships remain 6 weeks in length, the number of 8-week psychiatry clerkships is steadily declining (2). At many schools psychiatry rotations are being decreased to 4 weeks. Decreased curriculum time not only negatively impacts the acquisition of psychiatric knowledge but also interferes with students’ ability to understand the importance of psychiatry as an essential medical specialty. Considerable interest has arisen within the past several years to reintegrate psychiatry, neurology, and other areas of clinical neuroscience. Much of this work has focused on expanding research training in psychiatry residency programs (3). A component of this endeavor, however, is examining the appropriateness of merging portions of the medical student curriculum in psychiatry with other neuroscience disciplines. This was a topic of intense discussion at the recent Education Summit cosponsored byAmerican Psychiatric Association (APA) and ADMSEP. While any aspect of this discussion have merit, these changes may drastically alter the way in which psychiatry is taught in medical school. Another challenge confronted by psychiatric educators is the view that students have of our specialty and our patients. It is likely that most students enter medical school with limited knowledge and understanding of psychiatry and psychiatric disorders. The stigma of mental illness is well-documented in our society. Negative student perceptions, coupled with the other factors outlined above, make it difficult for psychiatric educators to effectively train future physicians to recognize and treat psychiatric disorders. All of these issues also make recruitment more difficult. This issue of Academic Psychiatry contains two important articles describing medical students’ perceptions of general psychiatry, child psychiatry, and psychiatric illness and how those attitudes may impact upon career choice. These articles will be briefly reviewed, followed by a discussion of how psychiatric educators might address the challenges we face.