Research papers
Objectives for the undergraduate teaching of psychiatry:
survey of doctors and students
D Goerg,1 C de Saussure2 & J GuimoÂn3
Objectives The principal aim was to assess the psychi-
atric topics that doctors and students considered most
important for undergraduate teaching. Differences
between doctors and students, men and women,
physicians/students with or without an interest in
psychiatry were examined.
Design A mailed questionnaire was used concerning the
knowledge and skills of psychological/psychiatric medi-
cine considered to be needed in medical practice.
Setting The Medical School of the University of
Geneva.
Subjects Doctors and undergraduate medical students
in their last 2 years of medical training.
Results Both doctors and students agreed on most
topics, even though the students tended to give all items
a higher rating. Both groups agreed on the importance
of the following main topics: the doctor±patient
relationship, identi®cation and management of the
principal psychiatric disorders and their associated risks
and problems of a psychosocial nature. Those doctors
Introduction
Faced with the changes currently taking place in western
medicine, the appropriateness of undergraduate medical
teaching is being brought into question. A number of
factors are exerting an in¯uence on medical practice:
scienti®c and technological discoveries, the restructur-
ing of health-care and social security systems, the
changes in the medical clientele brought about by
demographic factors ± such as ageing for example ± and
economic factors, such as the spread of unemployment
1
Sociologist, Sociological Investigation Unit, Psychiatry Clinic 1,
University Hospitals of Geneva, 2MD, Rampe de la Treille 3, Geneva,
Switzerland, and 3Professor and Chairman of the Department of
Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
Correspondence: D Goerg, DeÂpartement de psychiatrie, 2, Chemin du
Petit-Bel-Air, CH-1225 CheÃne-Bourg, Geneva, Switzerland
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showing an interest in psychiatry tended to accentuate
the importance attached to interpersonal skills. The
male and female doctors and students expressed very
similar opinions. The female doctors, however, tended
to attach greater importance to relational±emotional
aspects and to disorders affecting children and adoles-
cents than did their male colleagues, which is probably
a re¯ection of the speci®c role that women still play
within our society. When asked to assess the current
teaching they received in medical school, the students
considered that certain important aspects of psychiatry
were insuf®ciently taught.
Conclusion These results con®rm the importance of
teaching psychiatry with an emphasis on problems
encountered in general practice.
Keywords Attitude of health personnel; education,
medical, undergraduate, methods; psychiatry, *educa-
tion; questionnaires; Switzerland; teaching, *methods.
Medical Education 1999;33:639±647
and poverty which has an in¯uence on disease. In some
medical schools, traditional teaching is being replaced by
problem-based methods resulting in a need for a
re-examination of course syllabuses and the methods
needed to teach them. The teaching of psychiatry, like that
of other medical disciplines, must face up to these changes.
This teaching must satisfy two complementary edu-
cational requirements: ®rst, it has to provide basic
psychiatric knowledge for medical students in general
and secondly, it has to provide a sound psychiatric
background for those students who will be specializing
in psychiatry. Numerous authors have stressed the
necessity of teaching directed towards medical practice
and have set out the objectives of psychiatric training
for all medical students1±3, while others have put for-
ward more speci®c models4.
Students were interviewed concerning their psychi-
atric training and their attitudes towards psychiatry5. A
639
640 Teaching psychiatry: doctor±student opinions · D Goerg et al.
few researchers questioned the doctors themselves to
try to determine which aspects of psychiatry are
essential in medical practice. Lists of topics taught to
medical students were submitted to various categories
of doctors: general practitioners, psychiatrists, doctors
responsible for training, residents, hospital doctors,
doctors in private practice6±9. The results underlined
the importance of the knowledge required to manage
the principal psychiatric disorders and to develop in-
terpersonal skills. Although such knowledge is consid-
ered important by doctors, its teaching continued to
present a problem10. Failings in teaching methods can
result in a lack of treatment for patients with a high level
of psychiatric morbidity or the inappropriate prescrip-
tion of antidepressants and tranquillizers.
The Medical School of the University of Geneva is
currently introducing problem-based teaching meth-
ods. The Department of Psychiatry, which is involved
in this change, decided to survey doctors and students
on the psychiatric knowledge and skills needed by all
doctors, in order to answer the following principal
questions:
· What psychiatric and psychological topics do doctors
and students believe to be the most important for
undergraduate teaching?
· Is there agreement or disagreement between doctors
and students?
· For both doctors and students, are there differences
between men and women?
· Does the opinion of those with an interest in psy-
chiatry differ from those who have no speci®c interest
in this discipline?
· According to the students, to what extent are the
important topics actually taught?
Methods
Populations
Two populations were surveyed, one of doctors and
one of students.
In 1995, a total of 1593 questionnaires were sent out
to Geneva doctors in private practice and those who, in
public health establishments, had also completed their
specialization and thus held positions in the medical
hierarchy at the level of senior resident or above.
In 1996, another questionnaire was sent to 227 medi-
cal students attending the University of Geneva. They
were in their last 2 years of medical training (end of ®fth
and sixth-year students) which was still of the traditional
type. Teaching of psychiatry then included courses in
introduction to psychosocial medicine in ®rst, second
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and especially third years, and a course in psychiatry in
the ®fth year. This course, 4 h per week during
26 weeks, was composed of theoretical presentations
and practical seminars with patients. Its primary aim was
to provide students with the knowledge and skill neces-
sary to identify, diagnose and propose treatment for the
principal mental disorders. The possibility of psychiatric
clerkship existed, although it was very rarely used.
Questionnaires
The questionnaire sent to the doctors in 1995 consisted
mainly of a list of 23 psychiatric topics generally taught
to medical students. The topics are shown in Table 1
with their exact wording, but in a different order. This
list has been used by Johnson and Snibbe in the United
States6 and by GuimoÂn et al. in Spain7. Two new items
were added (basic principles of molecular biology and
neuroimaging related to psychiatry and knowledge of the
normal and pathological ageing process). Doctors were
asked to answer the following question: `what speci®c
psychiatric information and skills should a non-psychia-
tric doctor have?'. Each topic had to be rated on a scale
ranging from 0, `not at all important' to 3, `essential'.
The questionnaire sent to the doctors also included
questions concerning their ®eld of specialization and,
for the non-psychiatric physicians, the speci®c training
in psychiatry they had had (postgraduate psychiatric
clinical training, participation in Balint or sensitivity
groups).
The questionnaire sent to the students in 1996
included the same list of 23 psychiatric topics, and
students were also asked to answer the question about
knowledge and skills necessary to a non-psychiatric
physician. In addition, in order to investigate possible
discrepancies between the importance accorded by
students to the different psychiatric topics and
the teaching they say they had received in these ®elds,
the list of 23 psychiatric topics was used to evaluate the
extent to which these various aspects were dealt with at
medical school. Students were asked to answer the
following question: `To which extent had the following
topics been taught during undergraduate studies?'; each
topic had to be rated on a scale ranging from 0, `not at
all' to 3, `very extensively'. The questionnaire also
included items concerning planned speciality and psy-
chiatric experience (psychiatric clerkship, participation
in training groups).
Statistical methods
In order to compare answers concerning the topics
considered important (between doctors and students,
Teaching psychiatry: doctor±student opinions · D Goerg et al. 641

Table 1 Psychiatric knowledge and skills necessary to the non-psychiatric doctor according to doctors and students. Rank (in descending
order for doctors) and percentages of higher ratings (value 2±3 on a scale 0±3)

Doctors (n = 697) Students Fisher test

(n = 147)

What speci®c psychiatric information and skills should

a non-psychiatric doctor have? Rank % value 2±3 Rank % value 2±3 P

The ability to talk with patients about their personal problems 1 98á0 1 100á0 ±
The ability to evaluate the risk of suicide or the need for 2 92á4 4 98á6 **
psychiatric hospitalization
An awareness of when and how to refer a patient to a psychiatrist 3 89á9 9 95á2 *
A familiarity with the dynamics of the doctor±patient relationship 4 88á6 3 99á3 ***
A basic knowledge of alcohol and drug abuse 5 81á8 2 100á0 ***
An understanding of the emotional aspects of the chronically 6 81á0 6 96á6 ***
ill or dying patient
An understanding of the physiological concomitants of 7 77á1 10 95á2 ***
emotional stress.
A working knowledge of common psychopharmacologic medications 8 72á6 5 96á6 ***
A working knowledge of the social resources available to the patient 9 71á7 7 95á9 ***
The ability to differentially diagnose the principal psychiatric 10 66á5 8 95á9 ***
syndromes
A working knowledge of normal and pathological ageing 11 64á3 11 93á8 ***
A basic knowledge of current psychiatric treatment modalities 12 61á6 13 89á7 ***
An awareness of psychodynamic principles in evaluating a 13 61á1 12 91á7 ***
patient's behaviour
An understanding of the behaviour disorders of children and 14 56á6 14 88á4 ***
adolescents
An understanding of normal personality development 15 54á9 15 87á0 ***
The ability to diagnose and treat family and marital disturbances 16 45á5 17 80á0 ***
An understanding of sexual problems and their management 17 44á2 16 80á7 ***
The ability to carry out brief psychotherapy 18 24á1 19 60á4 ***
A familiarity with the principles of behaviour modi®cation 19 22á3 21 55á3 ***
The ability to diagnose and manage the mentally retarded 20 15á9 18 68á5 ***
An understanding of the principles of psychoanalytic theory 21 15á3 22 43á5 ***
A familiarity with the major types and uses of psychological tests 22 11á9 20 57á9 ***
Basic knowledge of psychiatric aspects of molecular biology 23 11á9 23 25á0 ***
and neuroimaging

* P < 0á05; ** P < 0á01; *** P < 0á001.

women and men, doctors and students with or without
an interest in psychiatry) and the extent to which these
topics were taught to undergraduates (between female
and male students), ratings were dichotomized into two
categories: higher ratings (2, 3) and lower ratings (0, 1).
The Fisher exact test was used to compare groups with
respect to percentages in each category.
Results
Principal characteristics of the sample populations
Doctors
A total of 697 analysable questionnaires were returned
giving a response rate of 44%. Since the characteristics
of the reference population are not accurately known, it
was not possible to determine whether our sample was
representative. The doctors who responded worked in
various medical specialities. The doctors considered in
this study as working in primary care were general
practitioners, internists and paediatricians, who in the
great majority worked exclusively in private practice
(GPs 92%, internists 64% and paediatricians 75%).
They accounted for 53% of the total. The non-primary-
care physicians ± specialists such as radiologists, der-
matologists, surgeons, etc. ± accounted for 26% and
psychiatrists for 21%. Slightly more than a quarter
(27%) of the doctors who responded were female. A
higher proportion of the women were specialized in
psychiatry (33% vs. 16% of the men) and fewer spe-
cialized in primary care (43% vs. 57%). The mean age
of the doctors was 48 years; the women were younger

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642 Teaching psychiatry: doctor±student opinions · D Goerg et al.
than the men (mean age of 45 years vs. 49 years).
Altogether two-thirds of the doctors worked in private
practice (65%), more than a quarter worked in public
health establishments (27%) and 8% worked in both
the private and the public sectors, there being no dif-
ference between men and women in this respect.
Almost half the male and female non-psychiatric
physicians (47%) had taken part in training groups for
psychological and interpersonal problems (such as Ba-
lint groups) or had received some postgraduate clinical
training in psychiatry, which can be interpreted as an
expression of interest in a psychiatric-type approach.
Students
The response rate was 65%; 147 questionnaires were
returned on time. The students had a mean age of
25á6 years (22±42 years). Like most Swiss medical
students they had begun, at the age of 19, very selective
studies which last for 6 years; doubtless, for some of
them, these studies represented a change of career path.
Females accounted for half the sample population
(54%). Most of the students were undergoing, or had
already completed, their clerkships in different medical
specialities (86%) and thus had personal experience
with patients. The remaining 14% were in a special
programme in which they took some of their ®nal ex-
aminations before their clerkships.
Although the vast majority had already decided on a
speciality, one-®fth of the students questioned (21%)
had still not chosen their postgraduate training.
Through clerkship in psychiatry (16%) or participation
in training groups for interpersonal relations (14%), a
number of the students had already acquired some
psychiatric experience. If we include those students
who thought they would eventually specialize in psy-
chiatry (6%), it may be said that more than a quarter of
the students who took part in this study (28%) ex-
pressed some interest in this ®eld.
Psychiatric knowledge and skills required
by the non-psychiatric physicians
When questioned concerning the importance of certain
types of psychiatric knowledge and skills in medical
practice, both doctors and students expressed clear
preferences (Table 1).
Doctors
The 10 psychiatric topics considered to be most im-
portant (Table 1, ranks 1±10) corresponded primarily
to the ability to handle the patient±doctor relationship,
to detect and deal with cases of the principal psychiatric
disorders and to treat illnesses which were often
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prolonged and had psychosocial implications. The
topics considered to be moderately important included,
above all, knowledge of the normal and pathological
development of patients at different stages in life and
the ability to treat these different problems. Finally, the
topics thought to be of least importance concerned
speci®c psychiatric techniques as well as state-of-the art
aspects of psychiatric research.
Students
Overall, there was agreement between doctors and
students concerning the most important, moderately
important and least important topics. The 10 most
important topics were the same for both groups,
although their relative order of importance was slightly
different. The students attached a higher level of
importance to knowledge about alcoholism and drug
abuse and to pharmacology, and attached less impor-
tance than doctors to the ability to know when to refer a
patient to a psychiatrist and to the concomitants of
emotional stress.
The students, however, gave a higher rating to all
topics, and this difference between students and doc-
tors was statistically signi®cant.
Differences between male and female doctors
and students
For both doctors and students, there was extensive
agreement between men and women concerning the
relative importance of the various topics. This was true
for the purely psychiatric topics (differential diagnosis,
treatment, drugs, etc.), for the doctor±patient rela-
tionship, normal development, various problems such
as alcohol and drug abuse and for the social resources
available to patients.
There were some differences, however (Table 2).
Among the doctors, the women attached greater im-
portance to the topics concerned with emotive states
and interpersonal relations and to disorders affecting
children and adolescents. Among the students, the
women attached more importance to a few topics
concerning interpersonal relations (short-term psycho-
therapy), ageing and family disturbances.
Subjects with an interest in psychiatry
Doctors
A speci®c interest in psychiatry was measured, for the
non-psychiatric physicians, on the basis of postgraduate
psychiatric clinical training undergone and/or partici-
pation in training groups on interpersonal relations.
Since this interest was much more pronounced among
Teaching psychiatry: doctor±student opinions · D Goerg et al. 643

Table 2 Psychiatric knowledge and skills necessary to the non-psychiatric doctor according to gender among doctors and students.
Percentages of higher ratings (value 2±3 on a scale 0±3): only items with statistically signi®cant differences

Doctors F (n = 187) M (n = 504) Fisher P Students F (n = 77) M (n = 67) Fisher P

An understanding of the 87á6 78á4 ** A working knowledge of 97á4 89á2 *

emotional aspects of the normal and pathological
chronically ill or dying ageing
patient
An understanding of the 83á3 74á9 * The ability to diagnose and 87á8 71á0 *
physiological treat family and marital
concomitants of disturbances
emotional stress
An awareness of 67á6 58á7 * The ability to carry out brief 69á7 49á2 *
psychodynamic psychotherapy
principles in evaluating
a patient's behaviour
An understanding of the 62á3 54á4 *
behaviour disorders of
children and adolescents

* P < 0á05; ** P < 0á01; *** P < 0á001.

primary-care doctors (general practitioners, internists,
paediatricians) than among non-primary-care physi-
cians (58% vs. 25%), it was decided to focus on the
former. Fifty-one per cent had participated in
training groups and 21% had postgraduate psychiatric
training.
The primary-care physicians who expressed an inte-
rest in psychiatry (Table 3) stressed the importance of
several topics and, in particular, those concerned with
the acquisition of interpersonal techniques (brief psy-
chotherapy and techniques for behaviour modi®cation,
for example).
Students
More than one-quarter of the students (28%), both
male and female, expressed an interest in psychiatry.
However, this interest had very little in¯uence on the
relative importance attached to the various different
aspects of psychiatry considered.
Teaching
With regard to teaching, the students rated the various
items systematically lower than the importance they
attached to knowledge and skills in these same ®elds,
except for the topic of molecular biology and neuro-
imaging as related to psychiatry. Several of the ®elds
which they, like the doctors, believed to be the 10 most
important were considered to be little or insuf®ciently
taught (Fig. 1). This was most particularly true for the
social resources available to patients. It was also the
case for the knowledge of when to refer a patient to a
psychiatrist, the evaluation of the risk of suicide, the
special dif®culties associated with chronic patients and
the patient interview. For other important ®elds,
assessment of the level of teaching was more positive
(alcoholism and drug abuse, psychiatric drugs).
There were no signi®cant differences between the
men and the women with regard to assessment of
teaching except for one topic (the emotional aspects of
the chronically ill or dying patient), which the women
rated less favourably.
Discussion
Consensus concerning the importance of various
psychological and psychiatric subjects
in undergraduate training
There was general agreement between the doctors and
students surveyed on the psychiatric knowledge and
skills required for medical practice, and which should
therefore be covered in undergraduate clinical training.
The following three aspects were considered to be most
important: the doctor±patient relationship, detection of
the principal psychiatric problems and their associated
risks, problems or illness with an important psychoso-
cial component.
Although it is obviously important to know how to
manage the doctor±patient relationship, the detection
and management of the principal psychiatric disorders
is also a very important aspect of medical practice.

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644 Teaching psychiatry: doctor±student opinions · D Goerg et al.

Table 3 Psychiatric knowledge and skills necessary to the non-psychiatric doctor according to the existence of an interest in psychiatry
among primary-care doctors and students. Percentages of higher ratings (value 2±3 on a scale 0±3): only items with statistically signi®cant
differences

Interest Interest

Yes No Yes No
Primary care doctors (n = 211) (n = 155) Fisher P Students (n = 40) (n = 105) Fisher P

A familiarity with the dynamics 95á3 86á3 ** A familiarity 64á1 42á5 *

of the doctor±patient relationship with the
major types
and uses of
psychological
tests
An understanding of the emotional 87á2 76á5 **
aspects of the chronically ill or dying
patient
A working knowledge of common 86á3 78á4 *
psychopharmacologic medications
A basic knowledge of current 77á1 64á9 **
psychiatric treatment modalities
A working knowledge of normal and 71á1 58á4 **
pathological ageing
An understanding of normal personality 66á3 51á9 **
development
The ability to diagnose and treat family 62á0 51á3 *
and marital disturbances
An understanding of sexual problems 57á4 47á4 *
and their management
The ability to carry out brief 45á0 26á6 ***
psychotherapy
A familiarity with the principles of 35á6 19á7 ***
behaviour modi®cation
An understanding of the principles of 20á0 10á3 **
psychoanalytic theory

* P < 0á05; ** P < 0á01; *** P < 0á001.

Thus, the ability to make a differential diagnosis,
knowledge of psychopharmacology and the ability to
identify the risk of suicide, the need for admission to a
psychiatric hospital, or for referral to a psychiatrist, are
considered an essential part of basic medical training.
The doctors and students surveyed also attached
importance to the knowledge of how to tackle a whole
set of disorders whose aetiology or whose effects are
psychosocial (stress-related somatic disorders, emo-
tional dif®culties associated with chronic or terminal
illness, alcoholism and drug abuse), which also requires
a familiarity with the social resources available to help
patients.
The topics which the doctors and students consid-
ered to be the most important corresponded broadly to
those mentioned by doctors interviewed in various
other surveys. Johnson and Snibbe6 in the United
States and GuimoÂn et al.7 in Spain reported very similar
results. General practitioners and doctors responsible
for undergraduate psychiatric training, interviewed by
Callen8 in the United States, also stressed the impor-
tance of the doctor±patient relationship and interview
techniques as well as the identi®cation of psychiatric
problems. Again in the United States, doctors working
in a variety of specialities, whether experienced or
recent graduates, attached greatest importance to the
doctor±patient relationship and psychosocial problems,
followed by problems related to compliance and to
psychosomatic disease9. The students and psychiatrists
interviewed by Chatham-Showalter et al.11 also stressed
the importance of knowing how to deal with the psy-
chiatric problems of patients and learning the necessary
interpersonal skills. In Switzerland, both the psychia-
trists and the non-psychiatrists interviewed shared the
same training objectives12. As the answers of physicians
interviewed in our study corresponded overall to those

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Teaching psychiatry: doctor±student opinions · D Goerg et al.
Figure 1 The 10 most important psychiatric topics and the extent to which they were taught, according to students. Percentages of
higher ratings (value 2±3 on scales 0±3).
obtained in other surveys, this would seem to con®rm
that, even if the reply rate ± 44% ± was lower than the
mean response rate for published mail surveys among
doctors ± 54% ± with great variation according to
subject studied and techniques used13, their replies
concerning important psychiatric topics in medical
practice were unbiased. The uniformity of the results
obtained in these various studies carried out at different
times (between 1975 and 1996), in different countries
(United States, Spain, Switzerland), and on different
subjects (students and doctors specializing in a variety
of ®elds), points unequivocally to those essential areas
of psychiatry that have the greatest bearing on general
practice. Conversely, certain ®elds at the frontiers of
psychiatric research, such as molecular biology and
neuroimaging, and certain speci®c psychiatric tech-
niques ± techniques for modifying behaviour, psycho-
therapy, psychoanalysis ± were only considered to be of
limited importance.
A few differences
The consensus between students and doctors with re-
gard to the teaching of psychiatry to undergraduates is
doubtless due to the fact that the students were all
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645
reaching the end of their medical studies. As such, they
were probably more concerned with the needs of their
forthcoming medical practice than with the more
technical aspects at the forefront of medical research.
The few differences in the ratings observed (mainly
problems associated with alcoholism and drug addic-
tion), may well be related to this anticipation of the
problems they would soon be facing in medical
practice.
It was found that the students gave a higher rating
than the doctors to all items on the questionnaire. The
insecurity brought about by their lack of experience,
and their situation as students undergoing tests and
required to send the questionnaire ± even anonymously
± to one of their teachers, may help to account for this
fact.
As the number of female medical students has greatly
increased (at the present time over 50% of our medical
students), it seemed important to obtain the opinions of
both female and male students and doctors. Their
opinions were very similar on the whole. However, the
women tended to place greater emphasis on what may
be called the relational±emotional sphere. Generally
speaking, in the division of labour between the sexes,
women tend to be more involved than men in the
646 Teaching psychiatry: doctor±student opinions · D Goerg et al.
maintaining of interpersonal relations and female
socialisation places emphasis on this point. Female
doctors appear to attach more importance to certain
interpersonal aspects of their profession than do their
male colleagues. This greater importance is re¯ected,
for example, in the longer consultation times recorded
for female doctors14. Women doctors also express
their desire to spend more time with their patients than
do their male counterparts15. The importance that the
female doctors attached to disorders concerning chil-
dren and adolescents can be interpreted as re¯ecting
the traditional role of women in the care and upbring-
ing of children. Female doctors tend to favour different
medical disciplines and a higher proportion of women
than men tend to specialize in paediatrics. Among the
doctors surveyed, 10% of the females were paediat-
ricians vs. 5% of the males, and among the students
21% of the females were considering this speciality
compared with only 6% of the males.
Among the doctors questioned, it was mainly the
primary-care doctors (general practitioners, internists,
paediatricians) who expressed an interest in psychiatry.
Frequently faced with complicated situations that they
have to manage in the long term, these doctors are
clearly aware of the need to develop their knowledge
and skills, especially in the interpersonal sphere.
Among the students, no such differences were noted
with regard to subjects expressing an interest in psy-
chiatry. There are various possible reasons for this lack
of variation. This was a young group of people whose
experience with patients was relatively uniform, and
who had not yet had to deal with dif®cult and persistent
problems of this type. They will eventually specialize in
a variety of different ®elds and will not all become
primary-care doctors like those with whom they were
compared.
Teaching
The students tended to give fairly low ratings overall.
This was possibly a sign of a degree of concern over the
hiatus that might exist between what is actually taught
and what they assume will be needed in future practice.
This unfavourable assessment may also be related to
the place occupied by psychiatry among the various
medical disciplines. Several studies have shown that,
although psychiatry is often considered to be an im-
portant discipline for the future doctor, it is neverthe-
less seen as relatively imprecise and low in prestige.
Daniel et al.10, repeating an earlier study, showed that
20 years on psychiatry continued to be seen as a poorly
taught branch of medicine, and this is in spite of the
many changes that have come about in psychiatric
Ó Blackwell Science Ltd M E D I C A L ED U C A T I ON 1999;33:639±647
training. Nevertheless, the proportion of respondents
who considered that they had not acquired suf®cient
psychiatric knowledge had fallen from 49% to 30%
over this period.
Conclusion
The teaching of psychiatry has to provide both basic
training for students, whatever branch of medicine they
will eventually specialize in, and suf®cient incentive to
ensure that some will choose psychiatry as their speci-
ality. The approach favoured by the respondents of our
study, while of necessity including a number of specif-
ically psychiatric aspects, underlines the importance of
an insight into the social problems experienced by pa-
tients and of developing the interpersonal skills of the
doctors. The very sharp rise in the number of women
coming into medicine will no doubt place even more
emphasis on this last point.
Furthermore, some of the results of this study, and
especially those concerning the needs of primary-care
doctors, demonstrate the importance of increased psy-
chiatric-type training at both the postgraduate and the
vocational levels.
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Received 5 May 1998; editorial comments to authors 27 July 1998;
accepted for publication 30 October 1998

Ó Blackwell Science Ltd ME D I C AL ED U C AT I ON 1999;33:639±647