Does exposure to a seclusion and restraint event during clerkship influence medical student's attitudes toward psychiatry?

Sir,

Psychiatry is a part of the core curriculum of medical schools with clerkships 4–8 weeks long. The clerkship helps medical students gain clinical experience in psychiatry and is an opportunity to influence students in a positive manner. Psychiatry has been rated poorly as a career choice with low recruitment rates and shortages of trained personnel in several countries. There have been several studies done to assess the attitudes of medical students toward psychiatry. A review by Lyons[1] showed that students have a positive attitude toward psychiatry after their clerkship, but the number of students who want to pursue it as a career has not increased. Similar results were found in a survey done of interns in South India showed that while attitude toward psychiatry was good, only 13% considered it as a career choice.[2] Other studies have found that clerkship does not impact medical student's attitudes.[3]

Clinical experiences during clerkship rather than the nonclinical teaching activities are more likely to influence attitudes. These include the organization of the clerkship, quality of teaching and supervision, preceptors who are judged as high-quality teachers,[4] learning activities, and the opportunity to evaluate and treat diverse and challenging patients. Inpatient settings are intimidating, frightening, and stressful.[5]

There have been several studies evaluating the patients and staff perception and attitudes toward seclusion and restraints (S and Rs).[6] Patients who are secluded or restrained describe feeling angry, scared, humiliated, punished, or vulnerable and some report feeling calmer, safe, and protected. Seclusion is believed to be necessary to maintain therapeutic milieu and was not considered a punitive measure.[7] However, no study has assessed the impact of witnessing an S and R event on student's perception toward psychiatry.

METHODS

Medical students rotating in psychiatry at the Maricopa Integrated Health System were given a 13-item questionnaire assessing the overall quality of the rotation, including both clinical and didactic portions. Respondents were asked to rate statements related to their preceptor, involvement in clinical care, and exposure to the psychiatric setting, including an item on interest in becoming a psychiatrist. Responses to these statements were compared between those medical students who witnessed an S and R event and those who did not. Forty-five students rotating from September 2014 to October 2015 completed the survey on completion of their rotation. Statistical analyses were done using Pearson Chi-square and Fisher's exact test.

RESULTS

Of the 45 medical students who completed the survey, 36 witnessed an S and R event during rotation. All of those who did not witness S and R agreed that the quality of rotation was good as did 97% of those who did witness an S and R event. Witnessing S and R did not impact the perception of the quality of the rotation (P > 0.05) and almost all students in both groups agreed that the quality of rotation was good (P < 0.99). A greater proportion (93%) of students who witnessed S and R endorsed an increased interest in psychiatry than those (75%) who did not witness an S and R event while on rotation. Witnessing S and R also did not impact the students’ interests in becoming a psychiatrist (P > 0.05) or make students less likely to consider psychiatry as a career (P > 0.05). Both groups showed an increased interest in becoming a psychiatrist (P = 0.20). All students in both groups agreed that S and R is sometimes necessary in psychiatry settings and for patient safety.

DISCUSSION

Inpatient psychiatric units can be intimidating and unpredictable, violent, and thus potentially dangerous to both patients and staff. We sought to investigate students’ perception toward psychiatry and whether witnessing an S and R event would negatively impact medical students doing rotations in inpatient psychiatric settings. The students were surveyed to find out if they had witnessed an S and R event, and if so, how did this affect their overall perception of choosing psychiatry as a career. Most of the students agreed that their perception of psychiatry changed positively. They also agreed that an S and R event is sometimes necessary in the psychiatric setting. When asked if witnessing an S and R event would make them less likely to choose psychiatry as a career, most students disagreed with this and indicated that they would still choose psychiatry as a career.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.