Medical students’ attitudes
RECRUITMENT
Tasha Robertson
Student, University of Sydney Graduate Medical Program,
University of Sydney, Sydney, NSW, Australia.
Garry Walter
Professor of Child and Adolescent Psychiatry, Discipline of
Psychological Medicine, University of Sydney, and Area Clinical
Director, Child and Adolescent Mental Health Services,
Northern Sydney Central Coast Health, NSW, Australia.
Nerissa Soh
Research Officer, Child and Adolescent Mental Health Services,
Northern Sydney Central Coast Health, NSW, Australia.
Glenn Hunt
Senior Research Fellow, Discipline of Psychological Medicine,
University of Sydney and Research Unit, Sydney South West
Area Mental Health Service, NSW, Australia.
Michelle Cleary
Clinical Nurse Consultant, Research Unit, Sydney South West
Area Mental Health Service, NSW, Australia.
Gin S. Malhi
Head, Academic Discipline of Psychological Medicine, Northern
Clinical School, University of Sydney, Sydney, NSW, Australia.
Correspondence: Professor Garry Walter, Coral Tree Family
Service, PO Box 142, North Ryde, NSW 1670, Australia.
Email: gwalter@mail.usyd.edu.au
doi: 10.1080/10398560902874298
# 2009 The Royal Australian and New Zealand College of Psychiatrists
towards a career in psychiatry
before and after viewing a
promotional DVD
Tasha Robertson, Garry Walter, Nerissa Soh, Glenn Hunt,
Michelle Cleary and Gin Malhi
Objectives: The objectives were, first, to determine attitudes towards
psychiatry as a career among medical students currently enrolled at the
University of Sydney and, second, to establish the immediate impact on those
attitudes of a promotional DVD, released by the Royal Australian and New
Zealand College of Psychiatrists.
Method: Medical students enrolled in the University of Sydney in 2008 were
invited to complete a voluntary online questionnaire, in which their attitudes
towards psychiatry were explored, and the immediate effects of a 15-minute
DVD were ascertained.
Results: A total of 123 students participated. Only one student identified
psychiatry as their chosen career. Medical students viewed psychiatry as the
least attractive specialty for the degree to which patients are helped effectively
and in terms of having a reliable scientific foundation. However, it rated well in
regard to being intellectually challenging, a rapidly advancing field of medicine,
and providing research opportunities and a good lifestyle. Psychiatry is less
respected than most other specialties by students and they perceive this
discipline to be poorly respected by other medical students and current medical
practitioners. After viewing the DVD, there were improved student ratings of the
benefits of a career in psychiatry, especially in relation to the specialty being
enjoyable, offering effective treatment and having a scientific foundation. There
was also enhanced understanding of the role of a psychiatrist in just over half of
the participants and increased interest in psychiatry in about 30% of
participants. The DVD was most effective in increasing awareness of the
diversity of subspecialties available within psychiatry, good lifestyle factors,
and the training involved.
Conclusion: Among medical students, psychiatry is perceived as unattractive
and fails to command the respect afforded other specialties. The viewing of a
Australasian Psychiatry . Vol 17, No 4 . August 2009
promotional DVD by medical students was found to be effective in improving
their attitudes towards psychiatry and increasing their interest in pursuing a
career in the specialty. However, the long-term impact of this modest
improvement is unknown and the low survey response rate limits the extent
to which the results can be generalized.
Key words: attitudes, career, DVD, medical students, psychiatry, RANZCP.
Like some other medical specialties, psychiatry in Australia is suffering a
considerable workforce shortage. Difficulty attracting sufficient trainees
has contributed to a lack of available psychiatrists to meet the growing
mental health needs of the Australian population. Despite there being an
increase in the overall number of medical students, the dearth of
311
 psychiatry trainees reflects diminishing interest
among medical students and junior doctors.1,2 This
has also been evident overseas; for example, an
American study by Feifel and colleagues3 reported ‘‘a
distinct decline over the past two decades in the
attraction of freshman medical students to careers in
psychiatry’’ (p. 1400), with most entering medical
school with a negative attitude toward psychiatry
compared with other medical careers.
The Australian Medical Workforce Advisory Commit-
tee (AMWAC)4 in 1999 published a review of psychia-
try training and recommended that the number of first
year trainees increase to 131. However, over the past
few years the number of first-year psychiatry trainees
has not reached the AMWAC target.
The ongoing difficulty recruiting into psychiatry has
led to several studies to identify reasons for the lack of
interest in the profession as a career choice among
medical students. Malhi et al.1 and Feifel et al.3
identified two important factors that influence pro-
gression from medical school to psychiatry trainee.
The first is the stigma surrounding psychiatry among
medical students, and the second entails views such as
the perceived absence of a scientific foundation and
the limitations of psychiatric treatment. Malhi et al.
looked at medical student attitudes before clinical
exposure and reported that students attracted to
psychiatry considered the specialty an interesting and
intellectually challenging field, with high job satisfac-
tion and ‘‘an enjoyable job’’.1
A few reportse.g.5,6 have suggested that the stigma and
misconceptions surrounding psychiatry can be chan-
ged by illustrating the positive attributes of the speci-
alty to medical students and junior medical officers,
especially through their clinical experience. The posi-
tive features of a career in psychiatry that have been
identified by these studies, and that need to be
reinforced, include lifestyle factors, flexible hours,
patient interaction, psychiatry’s intellectually challen-
ging nature, the holistic approach to assessment and
treatment, and its scientific basis. Research by
Manassis et al.7 also emphasizes the importance of
nurturing and encouraging students interested in
. August 2009
psychiatry, and a positive educational experience.
They found that students with a high initial interest
in psychiatry tended to go on to become psychiatrists
but those with a low initial interest used a ‘process of
elimination’ to choose their future career.
Vol 17, No 4
Two recent Australian studies by Wigney and Parker2,8
questioned senior medical students after their psychia-
try rotation about why a career in psychiatry may or
Australasian Psychiatry .
may not be an attractive choice. The 2007 study
established that the lack of prestige and respect from
the medical profession fostered a negative perception
of psychiatry as a career and that ‘‘there is clearly a
need to address stigmatizing attitudes within the
medical hierarchy, and provide positive educational
experiences for medical students’’ (p. 726).8 Other key
312
themes that emerged were the ‘‘limitations of treat-
ment, lack of funding and the ‘unscientific’ nature of
psychiatry’’ (p. 731).8 Wigney and Parker’s 2008 study
suggested that the positive factors influencing medical
students to become psychiatrists included financial
and lifestyle advantages, the challenging nature of the
work, and stimulating research opportunities.2
In light of the current shortage of psychiatrists and
trainees, and the image problem contributing to the
lack of interest among medical students, in 2008 the
Royal Australian and New Zealand College of Psychia-
trists (RANZCP) and the Australian Government’s
Department of Health and Ageing released a promo-
tional DVD designed to attract potential trainees to a
career in psychiatry.9 The DVD, titled Psychiatry: A
Better Understanding, aims to address the misconcep-
tions of the current student population by helping to
dispel the stigma surrounding mental disorders, and to
provide better information about the benefits of a
career in psychiatry by reinforcing its positive attri-
butes. This could be of significant benefit to the
profession considering that Malhi et al. found nearly
one in six first-year Australian medical students were
‘‘open to the possibility of pursuing a career in psy-
chiatry’’ (p. 420).1
Recruitment strategies like this DVD are supported by
a recent study by Thomas, which examined psychiatry
trainees’ reasons for choosing psychiatry and their
satisfaction with opportunities within the field.10 The
study reported that once trainees became involved in
the training program, over 80% were satisfied with
their choice of career and positive about career
opportunities within the specialty. More than two-
thirds of trainees identified a general interest in the
area, enjoyable clinical experience, good work-life
balance and patient contact as positive aspects.
The aim of our study is, first, to determine current
attitudes towards psychiatry as a career among medical
students enrolled at the University of Sydney, and,
second, to establish the immediate impact of the DVD,
Psychiatry: A Better Understanding, on medical students’
attitudes towards a career in psychiatry.
METHOD
During June to October 2008, medical students en-
rolled in all four years of the University of Sydney
Graduate Medical Program (GMP) were invited to
complete an online questionnaire regarding their
views and attitudes towards psychiatry. The question-
naire was voluntary and anonymous. Several of the
items were adapted from similar studies by Feifel et al.3
and Malhi et al.11 The study was approved by the
Human Research Ethics Committee (HREC) of the
University of Sydney.
Students were invited to participate via an email and
the GMP website bulletin board. Several reminder
emails were subsequently sent to the students to
encourage participation. Approximately 30 minutes Overall, being an internal medicine specialist (physi-
was required to complete the survey; this included cian) was rated the most likely career, with 85 (69.1%)
15 minutes viewing the DVD. students indicating this as a chosen/quite possible
career and only three as definitely not. This was
The questionnaire sought background information
followed by general practitioner (69 students), paedia-
about the students (e.g. age, gender, year of medical
trician (47), surgeon (44), obstetrician/gynaecologist
degree, undergraduate degrees, marital status). The
(30) and public health specialist (24). The full results
next section ascertained attitudes towards different
are shown in Table 2.
specialties (e.g. psychiatry, general practice, internal
medicine, surgery, paediatrics, obstetrics/gynaecology, A x2 test was performed to assess for any relationship
and public health) as career options; students were between gender and psychiatry choice, but no associa-
asked the current likelihood of a career in certain tion was found (x2 1.68, df 1, p 0.2).
specialties and the attractiveness of these specialties in
terms of various factors (e.g. interesting subject, job Attractiveness of the various specialties
satisfaction, lifestyle, prestige, financial reward,
research opportunities, etc). Students were then asked Ratings of attractiveness for the various specialties,
to estimate the degree to which they, their families, according to 11 features listed on the questionnaire,
other medical students and medical practitioners are shown in Table 3. It was noteworthy that psychia-
respect the doctors in each specialty. try did not rate as the most attractive career option for
any of the features, and returned the lowest attractive-
Next, students were asked to rate their understanding ness rating for the degree to which patients are helped
of the benefits of a career in psychiatry, both before effectively and for having a reliable scientific founda-
and immediately after viewing the DVD, and to then tion. Psychiatry did rate higher than general practice
indicate the effect of the DVD on their understanding and obstetrics/gynaecology in terms of being intellec-
of and interest in psychiatry. Finally, open-ended tually challenging, a rapidly advancing field of medi-
questions provided an opportunity for the students cine and research opportunities; psychiatry also rated
to express their views concerning the DVD, as well as
the study and their attitudes towards psychiatry in
general.
Quantitative analysis was performed using SPSS (ver- Table 1: Characteristics of participating medical
sion 15) for frequency data and x2 tests were used to students (n 123)
evaluate associations between some of the results.
Paired t-tests were used for the assessment of the n %
effectiveness of the DVD. Written comments were
collated to identify common themes. Year in medical First 22 17.9
degree Second 20 16.3
Third 49 39.8
RESULTS Fourth 32 26.0
Across the four years of medicine, a total of 123
students responded to the survey out of a possible Age (years) 20
25 56 45.5
1103 students (11.2% response rate). Sixteen of the 26
30 53 43.1
respondents (13%) did not complete all survey ques-
30 14 11.4
tions.
Gender Female 77 62.6
Participant characteristics Male 46 37.4
The majority of participants were female, third year Australasian Psychiatry . Vol 17, No 4 . August 2009
Undergraduate Biology/Sciences 88 66.7
students, had a background in biology/science and
were single or had a partner but were not married. degreea Humanities/Arts/Law 16 12.1
Participant characteristics are shown in Table 1. Maths/IT/Computers 10 7.6
Other 18 13.6
Choice of career
Marital status Single 56 45.5
When asked to assign a rating for the degree to which Partner, not married 54 43.9
they considered careers in various specialties, only one Married 12 9.8
student out of the 123, a female, identified psychiatry Separated/divorced 1 0.8
as their chosen career. Out of the 37 considering
psychiatry ‘quite possible’, 26 were female and a
The total is larger than the number of participants because several
11 male. Thirty-one students (25%) had already students had more than one degree.
deemed psychiatry ‘definitely not’ a career choice.

313
 Table 2: Student ratings of the likelihood of pursuing various careers
Chosen career Quite possible Unlikely Definitely not Unsure

n % n % n % n % n %

General practice 2 1.6 67 54.5 28 22.8 11 8.9 15 12.2

Internal medicine 9 7.3 76 61.8 26 21.1 3 2.4 9 7.3
Surgery 8 6.5 36 29.3 43 35.0 28 22.8 8 6.5
Paediatrics 4 3.3 43 35.5 45 37.2 21 17.4 8 6.6
Obstetrics/Gynaecology 6 4.9 24 19.5 56 45.5 28 22.8 9 7.3
Psychiatry 1 0.8 37 30.1 47 38.2 31 25.2 7 5.7
Public health medicine 1 0.8 23 18.9 38 31.1 55 45.1 5 4.1

higher than internal medicine, surgery, paediatrics and
obstetrics/gynaecology for good lifestyle. Public health
medicine rated lowest for seven of the 11 features.
Comparing those students interested in psychiatry
(who considered a career in psychiatry ‘chosen’ or ‘quite
possible’) with the remainder, students interested in
psychiatry rated all the career features higher (more
attractive) and this difference was significant for all
except two of these features (rapidly advancing field of
medicine (p 0.09) and career opportunities (p 0.08)).
Respect for specialties
When asked to estimate the degree to which each
specialty is respected by themselves, their family, other
medical students and medical practitioners, students
rated internal medicine most respected by themselves
and medical practitioners (Table 4). The students
considered surgeons would be the most respected by
their families and other medical students. Public
health medicine was rated least respected by all four
groups and psychiatry second least respected.

Table 3: Mean attractiveness ratings for each of the medical specialties across nominated career features
General Internal Obstetrics/
Career feature practice medicine Surgery Paediatrics Gynaecology Psychiatry Public health

Interesting subject 4.07 2.40 3.37 3.73 4.41 4.19 5.50

Intellectually 4.24 2.02 3.72 3.50 4.58 3.88 5.67
challenging
Offers good lifestyle 2.06 4.06 6.16 4.20 5.55 3.04 2.77
Job satisfaction 3.88 2.84 3.17 3.04 3.50 5.14 5.70
Financial rewards 5.07 2.84 1.57 4.23 2.92 4.36 6.34
Prestige among 5.32 2.18 1.75 3.52 3.45 5.07 6.19
medical community
Degree to which 3.53 2.97 2.45 3.58 3.40 5.50 5.48
. August 2009

patients are
helped effectively
Rapidly advancing 5.15 2.42 2.52 3.88 4.25 4.18 5.04
field of medicine
Vol 17, No 4

Career opportunities 3.26 2.88 3.67 4.34 4.11 3.99 4.98

Based on reliable 4.29 2.00 2.61 3.29 3.76 5.68 5.29
scientific
Australasian Psychiatry .

foundation
Research 5.81 2.18 3.57 3.72 4.37 3.90 3.48
opportunities

In survey: 1 most attractive, 7 least attractive.

Boldmost attractive, bold italicleast attractive.

314
 Table 4: Mean rankings of respect for the various specialties
General Internal
practice medicine Surgery Paediatrics
Your respect 3.66 2.37 2.65
Your family’s respect 3.63 2.31 1.92
Medical students’ 4.74 1.93 1.58
respect
Medical 4.67 1.72 2.02
practitioners’
respect
1 most respected, 7 least respected.
Boldmost respected, bold italicleast respected.
When asked their opinion on how much medical
students respect psychiatry, two students (1.6%) in-
dicated ‘respect greatly’, 57 (46%) said ‘respect some-
what’, 26 (21%) were ‘neutral’, 35 (28%) indicated
‘disrespect somewhat’ and three (2.4%) suggested
‘disrespect greatly’. When asked how much qualified
medical practitioners respect psychiatry, one student
reported ‘respect greatly’, 53 (43%) said ‘respect some-
what’, 35 (28%) were ‘neutral’, 30 (24%) indicated
‘disrespect somewhat’ and three (2.4%) suggested
‘disrespect greatly’.
Effect of DVD
Students were asked to rate the benefits of a career in
psychiatry (strongly agree, agree, neutral, disagree,
strongly disagree) in terms of the features listed in
Table 5 before and after viewing the DVD. There was a
significant improvement in all areas except ‘intellec-
tually challenging’. The largest changes in opinion
were in relation to believing the specialty is enjoyable,
psychiatry offering effective treatment and having a
scientific foundation.
Students were also asked to rate how viewing the DVD
has affected their understanding of the role of a
psychiatrist; 64 (52.9%) students indicated the DVD
had enhanced their understanding, 53 (43.8%) said it
had not changed their understanding at all and four
(3.3%) felt more confused. In terms of how the DVD
affected their interest in a career in psychiatry, 34
(28.6%) students reported an increase in interest, 77
(64.7%) said it had no effect and eight (6.7%) felt less
interested.
A large proportion of participants indicated either
an enhanced understanding and increased interest
(n 28, 23.5%) or no change in understanding and no
effect on interest (n 42, 35.3%), as shown in Table 6.
The overall measure of agreement between values was
significant (kappa 0.281, p  B0.001).
Obstetrics/
Gynaecology Psychiatry Public health
3.35 3.85 4.48 5.63
3.45 3.66 5.02 5.97
3.31 3.77 5.14 6.11
3.34 3.73 5.11 6.00
Two open questions concerned the DVD’s effect on
understanding and interest in psychiatry. When asked
how the DVD changed their understanding, most
comments related to the following ideas: the diversity
of roles available within psychiatry, lifestyle factors
especially relating to the flexibility of work hours (e.g.
potential for part-time work) and training, the extent of
the training involved, and the importance of mental
health in the management of all types of illnesses.
When asked to explain how the DVD changed their
interest in psychiatry, the major themes were similar to
those just mentioned and were concentrated on good
lifestyle aspects (e.g. flexibility of training and work),
how they now think more highly of psychiatry as a
specialty, and the diversity of subspecialties on offer.
Why psychiatry is not regarded as an attractive
career
Student opinions on why psychiatry may not be
regarded as an attractive career option included psy-
chiatry involving difficult/unstable patients with
chronic diseases and treatment being ineffective;
soft/non-scientific/not ‘real’ medicine; lacking the
use of procedural skills; emotionally draining interac-
tions and demanding area; and being an often un-
appreciated field to work in. The effect that daily work
Australasian Psychiatry . Vol 17, No 4 . August 2009
with mentally ill patients would have on them, the
lower pay associated with the specialty and the lack of
high regard by members of other specialties were
frequently mentioned, as was the lack of exposure to
psychiatry during their medical training.
General comments in relation to psychiatry as a
career choice or general comments about the DVD
A recurring comment was the need for earlier exposure
to psychiatry and psychiatric patients during the
medical degree to help increase interest in the subject,
and early viewing of this DVD before the psychiatric
rotation to help influence attitudes. Students thought
the information in the DVD would be very useful for
315
 Table 5: Effectiveness of DVD (mean of the difference between pre and post DVD viewing)
Mean difference SD 95% CI df p value

Good lifestyle factors 0.34 0.69 0.22
0.46 120 B0.001

Flexible hours 0.38 0.70 0.25
0.51 120 B0.001
Lots of patient interaction 0.15 0.59 0.04
0.25 120 B0.01
Emphasis on treating the ‘whole person’ 0.32 0.74 0.19
0.46 120 B0.001
Intellectually challenging 0.12 0.71 0.01
0.25 119 0.08
Has a scientific foundation 0.50 0.71 0.37
0.62 120 B0.001
Offers effective treatment 0.53 0.77 0.39
0.66 119 B0.001
Interesting research opportunities 0.33 0.69 0.20
0.45 118 B0.001
Good salary 0.32 0.67 0.20
0.44 120 B0.001
The work is enjoyable 0.60 0.80 0.46
0.75 120 B0.001

medical students with an interest in psychiatry, espe- DISCUSSION

cially in relation to the training program.
Suggestions were made on how to improve the DVD
and other recruitment material, with several students
mentioning more information should be included on
the challenges involved in working with patients from
different cultures (as beliefs about mental health are
perceived differently by different nationalities/cul-
tures), and highlighting this as an interesting feature
of psychiatry.
Several students commented on how they disliked the
way the DVD criticized other specialties and expressed
the need to frankly present both good and bad aspects
of the profession. There were also remarks that the
DVD seemed artificial and ‘staged’.
Providing more information on actual psychiatric ill-
ness, the day-to-day role of the psychiatrist (including
methods used by psychiatrists to deal with the emo-
tional impact of listening to traumatic/depressing
experiences of patients each day), promoting new
and future areas/treatments in psychiatry and average
salary were all recommended additions. In terms of
how to change some of the stigma surrounding the
profession, it was suggested that real case studies
should be presented, with patients describing how
. August 2009
The results of our study confirm and, through apprai-
sal of the effects of a DVD, build on findings of earlier
research about medical student attitudes towards a
career in psychiatry. For example, factors previously
documented as negative influences in the progression
of medical students to psychiatry trainees include the
perceived absence of a scientific foundation and lack of
effective psychiatric treatments.1,3 Our findings were
similar, with psychiatry being rated least attractive in
these two areas compared with other specialties. It was
encouraging that after watching the DVD, students’
views about these issues were more positive.
Research by Malhi et al.11 and Sierles et al.6 identified
two other important influences on a psychiatry career:
flexibility of practice hours and respect for psychiatry
among other specialties. The DVD successfully out-
lined the flexibility available in working in the dis-
cipline, as evident by this issue being a recurring
theme identified by students that positively influenced
their view of psychiatry. Respect for psychiatry is still
of major concern especially as this study found that
psychiatry is much less respected compared to most
other specialties by the medical students themselves
and in terms of students’ perception of how other

psychiatric treatments have or have not helped them. medical students and current medical practitioners’

Table 6: Agreement between the effect of the DVD on understanding and interest in psychiatry
Vol 17, No 4

Effect of DVD on interest in psychiatry

Increased interest Decreased interest No effect

Australasian Psychiatry .

n % n % n %

Effect of DVD on Enhanced understanding 28 23.5 2 1.7 32 26.9

understanding Made me more confused 0 0 1 0.8 3 2.5
of psychiatrist’s role No change in understanding 6 5 5 4.2 42 35.3

316
respect psychiatry. These results support the finding by
Wigney and Parker8 that psychiatry is seen as less
prestigious and less respected than some other special-
ties by current (and future) medical professionals.
It was pleasing that the DVD appeared to improve the
understanding of the role of a psychiatrist in about
50% of the participants and increased the interest in
psychiatry in about 30% of participants, with almost
one-quarter (23.5%) indicating improvement in both
areas. At the same time, it was disappointing to find
that a large percentage of students felt the DVD had no
effect on their understanding of or interest in this
profession.
Students identified explanations about the diversity of
roles available within psychiatry, flexible lifestyle
factors, and the extent of training as areas the DVD
covered that helped improve their understanding and
interest in psychiatry. It may thus be valuable to
develop these areas further in future promotional
material, as well as address the various concerns raised
by students about why psychiatry is not seen as an
attractive profession.
The major shortcoming of the study was the low
response rate, despite several reminder emails, which
may be partly attributable to the survey length (30
minutes) and lack of financial or other incentives
being offered to students. The response rate and
inclusion of only a single medical school limits the
extent to which the results can be generalized.
Nevertheless, our findings support those of McPar-
land et al.5 and Sierles et al.6 that demonstrated that
negative views about psychiatry can be changed by
highlighting the positive aspects of the field to
medical students and junior doctors. Our preliminary
study shows the potential value of simple promo-
tional tools, such as a DVD, in improving attitudes
towards and interest in psychiatry, at least in the
short term.
ACKNOWLEDGEMENTS
We thank the medical students who participated in the study and the Royal Australian and
New Zealand College of Psychiatrists for providing copies of the DVD.
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