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|Year : 2017
: 59 | Issue : 1 | Page
|What they think of us: A study of teaching medical specialists' attitude towards psychiatry in India
Suravi Patra1, Binod Kumar Patro2
1 Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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|Date of Web Publication||12-Apr-2017|
| Abstract|| |
Context: Attitudes of teaching medical specialists are important in shaping medical students' attitudes toward psychiatry. Data on attitudes of teaching medical specialists of India toward psychiatry are limited.
Aims: The aim was to study the attitude of teaching medical specialists of an academic medical center in East India toward psychiatry.
Settings and Design: This was a cross-sectional descriptive study.
Materials and Methods: We administered attitude toward psychiatry-30 (ATP 30) scale to teaching medical specialists of the All India Institute of Medical Sciences, Bhubaneswar, based on convenience sampling. Of 104 specialists contacted, 88 returned the completed questionnaire.
Statistical Analysis: We carried out descriptive statistical analysis and expressed results in mean and standard deviation. We analyzed the association of demographic characteristics, specialization, and duration of professional experience with total ATP scores using Chi-square test. We used subgroup analysis to compare mean ATP scores in different demographic and professional groups. We used independent t-test and ANOVA for between group comparisons.
Results: The response rate was 84.62% with a mean ATP score of 88.60. Female gender and having a family member with mental illness was significantly associated with favorable ATP. Notable findings were that 97% of participants were favorable toward patients with psychiatric illness, 90% felt psychiatric interventions as effective whereas 87% found psychiatry unappealing and 52% said that they would not have liked to be a psychiatrist.
Conclusions: While favorable attitudes toward patients with psychiatric illness and psychiatric interventions may mean better patient care; unfavorable attitudes toward psychiatry as a career choice may adversely affect postgraduate recruitment rates.
Keywords: Attitude, India, psychiatry, specialists
|How to cite this article:|
Patra S, Patro BK. What they think of us: A study of teaching medical specialists' attitude towards psychiatry in India. Indian J Psychiatry 2017;59:100-5
| Introduction|| |
Psychiatry as a discipline continues to struggle with its negative image which results in reduced postgraduate recruitment rates in developed and developing countries., The number of medical graduates opting for psychiatry has shown a steady decline since the last four decades. The US and the UK have unfilled consultant posts in psychiatry, and recruitment to specialty training in psychiatry remains difficult.
In general, medical students have mixed views toward psychiatry: they consider it unscientific, imprecise, and of low status, yet interesting with favorable working hours and working conditions. These conflicting views influence their future career choice. In the United States, medical students feel that going to psychiatry is a waste of medical education. In India, students feel that psychiatry is opted by those who perform low in postgraduate selection exams which restricts the choice of specialties.
Opinions toward patients with psychiatric conditions also influence choosing psychiatry as a career. Many junior doctors find treating patients with psychiatric problems interesting yet challenging. At the same time, the general medical consensus is unfavorable toward patients with psychiatric problems. Patients with psychiatric manifestations are felt unsatisfying to treat and generate far less sympathy than those presenting with physical symptoms., Indian students find treating psychiatric patients uncomfortable.
Medical students' attitude toward psychiatry (ATP) is shaped by the prevailing image of the discipline in the society often created by the mass media; patients with psychiatric illness are often made fun of, psychiatrists and psychiatric treatments projected in a despicable manner in films. Newspapers and books also portray a negative image of psychiatry. These negative portrayals play a crucial role in creating as well as maintaining the negative image of psychiatry in the society. During medical training, students are exposed to teaching medical specialists' own prejudices and “bad-mouthing” (negative comments) with resulting damaging effect on student's attitudes and career choice.
The scientific division of the World Psychiatric Association created the images study group to study the issue of the negative image of psychiatry among the medical community. The group surveyed teaching medical specialists' attitudes toward psychiatry at 15 international academic centers. The dominant findings reported were: teaching medical specialists perceived psychiatry negatively, did not consider psychiatrists good role models, and also felt that psychiatric patients were emotionally draining who need treatment in specialized psychiatric centers. Gender, career stage, and specialization were significantly associated with attitude to psychiatry. Further, there were significant differences in attitudes among the different participating countries.
There is a need to understand the attitude of teaching medical specialists toward psychiatry in different parts of India. We designed the present study to assess ATP of teaching medical specialists of the All India Institute of Medical Sciences, Bhubaneswar. We also analyzed the influence of demographic variables, specialization, and duration of professional experience on attitudes toward psychiatry.
| Materials and Methods|| |
Study design and sample
We used convenience sampling to carry a cross-sectional survey at the All India Institute of Medical Sciences, Bhubaneswar. We invited teaching medical specialists (faculty and senior residents) of this institute and excluded those working in the department of psychiatry. The study period was July–November 2014.
A questionnaire consisting of three parts was used for the study: Part 1 captured the demographic details which included age, gender, and family member with the psychiatric illness. Part II included the field of specialization and duration of the experience. Part III was the modified version of ATP-30 scale. This is a 30-item self-administered, validated, and standardized questionnaire for assessing medical students' attitudes toward psychiatry. We modified the scale by reframing item numbers 4, 10, and 23 to make it appropriate for use in the specialist population [Table 1].
As reported by its authors, ATP-30 has good psychometric properties (split half reliability 0.9 and test-retest reliability of 0.87). The scale measures ATP on eight different nonoverlapping domains: psychiatric patients, psychiatric illness, psychiatric treatment, psychiatric knowledge, psychiatrists, psychiatric career choice, psychiatric institution, and psychiatric teaching. Responses to each item are rated on a five-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree). The total ATP score is the sum of scores obtained on all 30 items (minimum score is 30 and maximum score is 150).
We used IBM SPSS version 16.0 (Chicago, SPSS Inc.) for descriptive statistics. We subtracted all positively phrased item scores: item numbers 4, 5, 9–12, 14, 15, 18, 20, 23, 25, 27–29 from six and hence reversed the scores as per the scoring guidelines of the scale. Higher scores mean positive attitudes toward psychiatry. We calculated total ATP-30 and mean ATP-30 scores. Furthermore, keeping the cut off score of 90 as neutral, we categorized total ATP scores into three categories; total ATP >90 as positive ATP, total ATP=90 as neutral ATP and <90 as negative ATP., We used Chi-square test to study the association of three categories of total ATP-30 scores with demographic variables, specialization, and duration of the experience.
We used subgroup analysis to compare mean ATP scores in different demographic, specialization, and duration of experience groups. We used independent t-test for comparison between two groups and ANOVA for analysis involving three or more groups. We kept statistical significance at P< 0.05.
Ethical approval was received from the Institutional Ethics Committee. Participation was voluntary, and all data were de-identified.
| Results|| |
The questionnaire was canvassed to all 104 teaching medical specialists of the institute. Eighty-eight specialists gave consent to participate and provided their completed data sheets, resulting in a response rate of 84.62%. Forty-nine (55.68%) respondents were male and 65 (73.86%) were <40 years of age. Twenty-one reported having a family member with a psychiatric disorder. Clinicians (62%) outnumbered specialists in basic sciences (35%) with surgeons and physicians being similar in number. The detailed demographic profile is given in [Table 2].
|Table 2: Demographic profile and mean attitude toward psychiatry scores in different subgroups using independent t-test for two group comparisons and ANOVA for three or more group comparisons|
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The mean score of ATP questionnaire was 88.60 (range 72–104) and standard deviation was 6.64, which indicates overall negative attitudes of the participants toward psychiatry. Female gender, having a family member with mental illness and specialization in a clinical discipline, was associated with positive attitudes toward psychiatry (ATP score >90).
We used independent t-test to compare mean ATP-30 scores in two group comparisons of gender (male, female), age (<40 years, ≥40 years), having a family member with mental illness (Yes, No), and super-specialization (Done, Not done). In comparisons involving three or more groups: Specialization (medical, surgical, paraclinical, and preclinical) and duration of professional experience (5, 6–10, ≥11 years), we used ANOVA. Subgroup analysis revealed that female gender (P = 0.0010) and specialists having a family member (P = 0.00074) had a better ATP [Table 2].
We used Chi-square test to evaluate the association of demographic variables, specialization, and professional experience with three categories of total ATP scores (Positive, Negative, and Neutral). No significant association could be ascertained [Table 3].
|Table 3: Association of demographic variables and professional experience with total attitude toward psychiatry scores using Chi-square test|
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Attitude toward psychiatric illness, treatment, and patients
Most of the specialists (>95%) felt that psychiatric illness deserves at least as much attention as physical illness and that in recent years, psychiatric treatment has become quite effective. Nine out of ten felt that “it is interesting to try to unravel the cause of a psychiatric illness” and “psychiatric patients are as human as other patients” [Table 4].
|Table 4: Most favorable items of attitude toward psychiatry questionnaire|
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Attitude toward psychiatry and psychiatrists
Eight out of ten specialists found psychiatry unappealing and felt psychiatrists talk a lot but do nothing. More than half of the participants (>50%) felt that psychiatrists get less satisfaction from work and that they would not have liked to be a psychiatrist [Table 5].
|Table 5: Least favorable items of attitude toward psychiatry questionnaire|
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| Discussion|| |
The overall ATP of teaching medical specialists in our institute was negative as evidenced by the mean ATP-30 scores of 88.6. Female specialists and those having a family member with the psychiatric illness had favorable attitudes. Our participants had favorable attitudes toward patients with psychiatric illness but relatively less favorable ATP as a career choice. Till date, information about teaching medical specialists' attitudes toward psychiatry is limited to the images study. The study has reported overwhelming findings of the negative image of psychiatrists, psychiatry as a discipline, and patients with psychiatric illness among teaching medical specialists of fifteen academic centers worldwide. Psychiatrists were not considered good role models. Psychiatry was not considered exciting, intellectually challenging, or evidence-based. Patients with psychiatric illness perceived as emotionally draining to treat. Our findings are similar to the image group data in terms of overall negative attitude.
Image group has ascribed better attitudes toward psychiatry in mid and late career specialists to longer years of exposure to patients with mental illness or colleagues with mental illness who might have shown a response to treatment. The majority of our specialists (73%) were <40 years of age and in their early career phase, which might be the reason of predominant negative image. The image study had found negative attitudes associated with male gender and had explained it in terms of the notion that mental illness is considered a sign of weakness which is contrary to masculinity. Our results of better attitude in female participants can be understood in terms of these explanations. Our study could not find an association of attitude scores with specialization which is different from the results of image group study.
Our participants found psychiatric patients no less human than those with physical illness. They also felt that psychiatric interventions have become more effective. The sympathetic attitude toward patients and favorable attitude toward interventions can help in providing good liaison services in our center.
The attitudes of medical students toward psychiatry reported earlier from Chandigarh and Ahmedabad centers of India are negative., Students do not consider psychiatry as a high ranking medical specialty, feel patients with psychiatric illness should not be treated in general hospitals, and are reluctant to consider it as a career option. Negative views of medical specialists toward psychiatry adversely influence students' attitudes. Adverse comments by medical teaching specialists have been known to change the decision of students who have opted for psychiatry. Negative socialization hypothesis that unfavorable attitudes of nonpsychiatry specialists can dissuade medical students from opting for psychiatry as a career remains relevant in our sample as evidenced by unfavorable attitudes toward the discipline as a career.
While the attitude of medical students toward psychiatry as a discipline and psychiatrists as role models is likely to affect their future career choices, attitude toward patients is likely to affect the quality of clinical care these future doctors provide to patients with psychiatric illness. The proportion of medical students having the opinion “psychiatric illness is the result of previous misdeeds” in Chandigarh had reduced significantly after didactic lectures and clinical exposure highlighting the impact of teaching and clinical exposure on ATP.
Factors influencing attitudes toward psychiatry in our center need to be further explored and modifiable factors (knowledge and exposure in psychiatry) targeted with interventions. Replacement of didactic lectures with problem-oriented teaching, wherein there is more opportunity for patient interaction, can improve student's ATP. Furthermore, elective placements in psychiatry and involving students in brief psychotherapy during medical graduation can provide better opportunities for engaging with and understanding patients with psychiatric illness. Participation in short research projects can provide exposure to the scientific methodology employed in psychiatry. Involvement in these activities can improve the image of psychiatry among undergraduate students who often find psychiatry “unscientific,” “imprecise,” and “waste of medical education.”
Adopting scientific approaches toward diagnosis and treatment of psychiatric disorders can help in overcoming stigma and discrimination experienced by psychiatrists. Utilization of modern neuroimaging methods such as Functional Near Infrared (fNIR) Spectroscopy which assesses altered oxygenation of cortical tissue during cognitive tasks in patients with psychiatric disorders such as schizophrenia and major depression can demonstrate the neurobiological basis hence provide more credence to the medical nature of psychiatric disorders. These neuroimaging methods are simple to use, noninvasive, and potable which make them feasible for use in psychiatry patients. Adoption of these imaging methods in routine clinical practice and sharing these developments in seminars and CMEs organized by professional psychiatric bodies where colleagues from other clinical disciplines are invited can highlight neurological basis of psychiatric disorders. Negative attitudes like “Psychiatry is unappealing as it makes little use of medical training” can thus be countered by these activities.
Psychiatrists' job satisfaction varies in different geographical regions and is determined by workplace environment, job responsibilities, and salary. While in the US, UK, and Europe, psychiatrists suffer from burnout and have low work satisfaction; the scenario is different in Australia and New Zealand where residents report better lifestyle and financial opportunities in psychiatry., Psychiatrists' job satisfaction in India can be studied in the future and shared in different medical forums.
| Conclusions|| |
The attitude of teaching medical specialists in our center toward psychiatric illness, treatment, and patients is more favorable while that toward psychiatrists and psychiatry is less favorable. There is a need to understand the correlates of negative attitudes as prevailing negative attitudes may hamper recruitment rates into psychiatry. Improving image of psychiatry can improve recruitment rates into the specialty and quality of clinical care of patients with psychiatric illness.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]