|Year : 2014 | Volume
| Issue : 2 | Page : 238-242
Psychiatry as a career choice: Perception of students at a private medical college in South India
Animesh Jain1, M Shashidhar Kotian1, Rashmi Jain2, Nitin Joseph1
1 Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
2 Department of Ophthalmology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
|Date of Web Publication||11-Nov-2014|
Department of Community Medicine, Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore - 575 001, Karnataka
Source of Support: None, Conflict of Interest: None
Background and Aim: People with mental illness are often subjected to stigma and discrimination. The poor popularity of Psychiatry as a field of specialty has been a global concern. Any preconceived notions, perceptions and formative influences among medical students could have strong influence on their future choice of career. This study aimed to determine the students' perception of Psychiatry as career choice and the factors influencing their perception and career choice. Subjects and Methods: Following approval from Institutional Ethics Committee and necessary permissions, consenting medical students at a private medical college in Mangalore, India were surveyed using a pilot-tested questionnaire. The responses were compiled and data analyzed using Statistical Package for the Social Sciences (SPSS) version 10. Chi-square test was performed and P < 0.05 was considered significant. Results: Of the 250 participants, 152 (60.8%) were males while 96 (38.4%) were females aged 17-25 years. Only 28 (11.2%) wanted to pursue Psychiatry as a career while 97 (38.8%) considered it as an option although not their first choice. There was no association between gender and completion of Psychiatry postings on the decision regarding Psychiatry as a career. However, an exposure to a mentally ill person had a statistically significant association with Psychiatry as career choice (P < 0.001). Conclusion: Very few students aspire for Psychiatry. Targeted interventions including focused approach and creating an interest during undergraduate posting may inspire more students to take up Psychiatry.
Keywords: Career choice, India, medical students, psychiatry
|How to cite this article:|
Jain A, Kotian M S, Jain R, Joseph N. Psychiatry as a career choice: Perception of students at a private medical college in South India
. Arch Med Health Sci 2014;2:238-42
|How to cite this URL:|
Jain A, Kotian M S, Jain R, Joseph N. Psychiatry as a career choice: Perception of students at a private medical college in South India
. Arch Med Health Sci [serial online] 2014 [cited 2020 Apr 8];2:238-42. Available from: http://www.amhsjournal.org/text.asp?2014/2/2/238/144362
| Introduction|| |
The burden of disease due to mental illness is ever increasing. As per World Health Organization (WHO) estimates in 2004, there were about 500 million people worldwide with symptoms of neurosis and stress-related disorders and another 200 million suffered from chronic depression, bipolar, and mood disorders. , As per projected estimates, neuropsychiatric illnesses will rank as the fourth leading cause of disease burden in India in 2020. 
Despite the widespread prevalence of mental illness, people with mental illness are often subjected to stigma and discrimination. The number of Psychiatrists in India is dismal and insufficient to deal with the growing burden of mental illness.  The poor popularity of Psychiatry as a field of specialty has been a global concern.  There was a steady decline reported, mainly in the USA and Canada, in the percentage of students choosing to specialize in Psychiatry. ,,, Moreover, lately, there has been a huge demand for Psychiatrists in countries like Britain, Australia, and New Zealand, leading to regular migration of trained Psychiatrists from India to these countries. Thus, there will remain a huge gap between demand and supply of Psychiatrists within the country.  So, to deal effectively with the mental health burden, it is imperative that the medical graduates possess the right attitude towards Psychiatry. Further, Psychiatry needs to be taken up as a career by the young graduates so as to provide a much needed boost to the specialty as well as care to those suffering. While there could be many reasons for the choice of a specialty, we believe that any preconceived notions, perceptions and formative influences among medical students, could have strong influence on the future choice of specialty they pursue, especially in branches like Psychiatry. This study aimed to determine the influence of various factors including gender, clinical and personal exposure to patients with mental illness on the students' perception of Psychiatry as career choice.
| Materials and Methods|| |
This cross-sectional study was conducted at a private medical college affiliated to a deemed University in the South Indian city of Mangalore. Mangalore is a coastal city with around 0.42 million population as per the 2001 census.  This city has six private medical colleges affiliated to four different universities.
This study was approved by the Institutional Ethics Committee. Necessary permissions were obtained from the Dean of the institution and teachers concerned. For feasibility and easy operationalization, non-random (convenience) sampling was followed. Two groups of students were selected: one each from 4 th semester and 6 th semester of MBBS course. Each group comprised 125 students. There are two sections of 125 students each in every semester. All the 125 students from one of the two sections of each of the 4 th and 6 th semester were approached to participate in the study. Thus, we did not exclude anyone from the entire section leading to minimizing selection bias. As the objective was to compare between pre- and post-Psychiatry posting, we could take students from 4 th and 6 th semester. The students from 4 th semester had not been exposed to Psychiatry theory lecture classes and clinical postings while the students from 6 th semester had already completed clinical posting in Psychiatry. A questionnaire [Annexure I] [Additional file 1] was prepared after reviewing the relevant literature to collect the socio-demographic details, interest in pursuing Psychiatry as a career, and the reasons for same. The questionnaire was pilot tested and modified suitably before being distributed among the two groups of students during lecture hour after obtaining informed consent. Participation was voluntary and the students were free to opt out of the study without filling up the questionnaire or assigning a reason.
The collected forms were scrutinized for completeness and then entered into and compiled in MS Excel. The data were analyzed using SPSS version 10. Chi-square test was performed and P < 0.05 was considered significant. The results were expressed in form of percentages and were displayed as tables.
| Results|| |
Demographic characteristics of respondents
Of the 250 participants, 152 (60.8%) were males while 96 (38.4%) were females. Two respondents had not mentioned their gender. Among the participants, 222 (88.8%) were Indians, the remaining 24 (9.6%) were non-Indians while 6 (2.4%) did not indicate their nationality. Majority (147, 58.8%) of students was in the age range of 20-22 years, 88 (35.2%) were between 17-19 years, and 15 (6%) were between 23-25 years of age. Of the 250 participants, 123 (49.2%) had already completed their clinical posting in Psychiatry while 127 (50.8%) had not been exposed to Psychiatry posting yet. Among the 250 students, 86 (34.4%) were found to have had personal exposure to a patient of mental illness while 163 (65.2) had no such contact. One respondent (0.4%) had not answered the question regarding exposure to a person with mental illness. Personal exposure to a person with mental illness was defined as having interacted with relative(s)/patient(s) with Psychiatric illness in the last 2 years for at least a period of 1 week not as a part of the medical curriculum.
Psychiatry as a career
Perception of students towards Psychiatry as a career was assessed by a direct question asking if they would choose Psychiatry for further postgraduate studies. Only 28 (11.2%) were willing to pursue Psychiatry as a career choice while 97 (38.8%) said they would consider it even though it was not their first choice. Nearly half (49.2%) of the respondents did not want to pursue Psychiatry as a career. Two (0.8%) of the respondents did not indicate their preference. There was no significant difference between genders in their desire to become a Psychiatrist. Foreign students had a more positive perception about Psychiatry as a career as compared to Indian students [Table 1]. There was no statistically significant difference in students' aspiration to pursue Psychiatry as a career option among those exposed and not exposed to clinical postings in Psychiatry [Table 2].
|Table 1: Gender and nationality in relation to Psychiatry as a career choice|
Click here to view
As stated before, 86 students had interacted with patients having mental illness, not necessarily during their clinical postings. The influence of previous interaction with mental illness patient on the perception about Psychiatry as a career was found to be significant (P < 0.0001) [Table 3].
|Table 3: Personal exposure to a person with mental illness and Psychiatry as a career choice|
Click here to view
| Discussion|| |
Though almost half of respondents may be interested in pursuing Psychiatry, very few have indicated it to be a specialty of first preference. However, it is good to note that more than a third of our respondents would consider Psychiatry as a career option, if they don't end up with a specialty of their choice. Further, the result indicates that clinical posting has not had much positive influence on the study population when it comes to attitude towards mentally ill or Psychiatry as a specialty. Though the definite willingness to take up a career in Psychiatry doesn't differ much in the two groups, the clinical exposure increases the students' willingness to consider Psychiatry as a career option as seen in the more number of "May be" option selected by those having completed Psychiatry postings. In Greek medical students, a longer duration of clinical training in Psychiatry produced a more positive response towards the subject among the students.  The low number of students willing to consider Psychiatry as a career might be due to stressful environment and conditions of the profession as noted by Cutler et al. 
The findings of our study are very similar to those reported by Tharyan et al.,  among students at Vellore which showed that Psychiatry clinical postings has a positive influence on students' perception of Psychiatry as career choice but does not necessarily increase their willingness to pursue a career in Psychiatry. Also, in their study they had found that women were more willing to pursue Psychiatry than men. While in the present study findings though not statistically significant are exactly opposite to this, i.e., more men than women were willing to take up Psychiatry. Another study at Malaysia had reported positive attitudes after the Psychiatry posting and also a difference in gender with more favorable attitude among females.  Role modeling plays a very important part in medical education and role models have the potential to influence the specialty preference of medical students. However, we have not specifically looked into this aspect in this study. It would be helpful as well as interesting to explore the role of clinical mentors in students choosing particular career paths. Whether the students perceived their teachers as being inspirational, and comparing perhaps with other disciplines in the same teaching institution to see how the influence of role models fared between specialties.
It was seen that students coming from countries other than India are more willing to take up Psychiatry as a career compared to Indian students. Though the findings can't be generalized as this study was conducted at one college, these do bring to the fore some important issues. In the light of these findings, further probe into the cause and reasons for such an attitude needs to be explored. This is further important as the interaction with a mentally ill person either during rotation or in personal life seems to have a positive influence in this study similar to that reported in America. 
It may be argued that the students of 4 th and 6 th semester may be too premature to decide on the specialty choice; however, there is literature to suggest that most of the students often have made up their mind regarding the residency long before entering clinical clerkships and sometimes even before joining a medical school. ,
While factors like availability of residency positions and financial resources at the disposal of the graduates may determine the specialty choice to an extent, it's not always a limiting factor. Besides, the subjects in our study are from a private self-sponsoring institution and come from well-to-do families, so financial resources is unlikely to be a limiting factor. However, there are a few limitations in this study. We did not look at the role of intellectual content, future economic implications and the issues related to quality of life in determining the preference for Psychiatry as a career. Another limitation could be the design of the study whereby we could modify it to conduct the survey among same set of students in 4 th and then in 6 th semester (pre- and post-Psychiatry postings), so as to compare the change in attitude and career choice preferences. That kind of design would be stronger and better predictor of influence of Psychiatry posting on career choices. We propose to incorporate the limitations in a future study.
| Conclusion|| |
Few students aspire for Psychiatry as a specialty of first choice as career. The reasons for this could be a subject of further investigation. We also recommend that the clinical posting in Psychiatry be modified so that student-patient interaction increases and arouses the interest among students. This will help in making the experience more practical for students. Targeted interventions including focused approach and creating an interest during undergraduate posting may inspire more students to take up Psychiatry.
| Acknowledgement|| |
The authors would like to thank the Dean for granting permission to conduct this study and the participants for their cooperation. The first author would also like to acknowledge the support and encouragement from FAIMER, Philadelphia, USA and faculty and fellows at PSG FAIMER Regional Institute, Coimbatore, India in particular. This study was presented at International Conference in Medical Education at Abu Dhabi during 4-7 December 2010.
| References|| |
|1.||The Cleveland Clinic and WebMD. Mental Illness Basics. Available from: www.medicinenet.com/mental_illness/article.html [Last accessed on 2013 September 30]. |
|2.||Park K. Mental Health. In Park K. (Ed). Textbook of Preventive and Social Medicine. 18th ed. Jabalpur, India: Banarsidas Bhanot Publishers; 2008. p. 632. |
|3.||Tharyan P, John T, Tharyan A, Braganza D. Attitudes of 'tomorrow's doctors' towards psychiatry and mental illness. Natl Med J India 2001;14:355-9. |
|4.||Reddy JP, Tan SM, Azmi MT, Shaharom MH, Rosdinom R, Maniam T, et al. 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;34:505-10. |
|5.||Garyfallos G, Adamopoulou A, Lavrentiadis G, Giouzepas J, Paraschos A, Dimitriou E. Medical students' attitudes towards psychiatry in Greece: An eight-year comparison. Acad Psychiatry 1998;22:92-7. |
|6.||Nielsen Ac 3rd, Eaton JS Jr. Medical students' attitudes about psychiatry: Implications for psychiatric recruitment. Arch Gen Psychiatry 1981;38:1144-54. |
|7.||Taintor Z, Nielsen A. The extent of the problem: A review of the data concerning the declining choice of psychiatric careers. J Psychiatr Educ 1981;5:63-87. |
|8.||Das MP, Chandrasena RD. Medical students' attitude toward psychiatry. Can J Psychiatry 1988;33:783-7. |
|9.||Murthy RS, Khandelwal S. Undergraduate training in Psychiatry: World perspective. Indian J Psychiatry 2007;49:169-74. |
|10.||Maps of India. Mangalore population. Available from: http://www.mapsofindia.com/mangalore/population.html [Last cited 2011 May 20]. |
|11.||Cutler JL, Alspector SL, Harding KJ, Wright LL, Graham MJ. Medical students' perception of psychiatry as a career choice. Acad Psychiatry 2006;30:144-9. |
|12.||Roth D, Antony MM, Kerr KL, Downie F. Attitudes towards mental illness in medical students: Does personal and professional experience make a difference? Med Educ 2000;34:234-6. |
|13.||Feldmann TB. Medical students' attitudes toward psychiatry and mental disorders. Academic psychiatry : The journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry [Internet] 2005;29:354-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16223897 [Last cited on 2011 May 20]. |
|14.||Koh KB. Medical students' attitudes toward Psychiatry in a Korean Medical College. Yensei Med J 1990;31:60-4. |
[Table 1], [Table 2], [Table 3]