International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 8  |  Issue : 2  |  Page : 123--127

Attitude of future doctors toward psychiatry: A cross-sectional study at a medical college in Eastern India


Snehanshu Dey1, Soumya Swaroop Sahoo2, Udit Kumar Panda3, Jigyansa Ipsita Pattnaik4, Subhankar Swain5,  
1 Department of Psychiatry, IMS and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Community Medicine, AIIMS, Bhubaneswar, Odisha, India
3 Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
4 Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India
5 Department of Psychiatry, VIMSAR, Burla, Odisha, India

Correspondence Address:
Dr. Udit Kumar Panda
Department of Psychiatry, Room-4096, 4th Floor, Teaching Block, AIIMS, New Delhi - 110 049
India

Abstract

INTRODUCTION: Psychiatry is one of the emerging branches in medicine which has made rapid strides of late. However, the attitude of students toward psychiatry has not been favorable and it is one of the less popular subjects in the medical curriculum. In the present study, we explore the attitudes toward psychiatry (ATP) among the final-year students of a medical college of eastern India. MATERIALS AND METHODS: In this cross-sectional descriptive study, 147 final-year students were approached, of which 104 students consented for the study. They were assessed regarding their ATP as a subject, psychiatric patients, and illness and the treatment under the respective domains of ATP-30 scale. The analysis involved descriptive analysis of the data. RESULTS: A neutral to negative attitude was observed toward psychiatry as a subject in the students. The mean ATP score among the female students was slightly higher than the male students. The most neutral responses were received in the items such as “psychiatric illness deserves at least as much attention as physical illness,” “psychiatric hospitals have a specific contribution to make,” and “if we listen to them, psychiatric patients are just as human as other people.” CONCLUSION: The finding in our study is an indication of lacunae in the present undergraduate curricula and training in relation to psychiatry as subject of medical science. There is a need to reevaluate this aspect of undergraduate psychiatry teaching and look for potential solutions.



How to cite this article:
Dey S, Sahoo SS, Panda UK, Pattnaik JI, Swain S. Attitude of future doctors toward psychiatry: A cross-sectional study at a medical college in Eastern India.Int J Health Allied Sci 2019;8:123-127


How to cite this URL:
Dey S, Sahoo SS, Panda UK, Pattnaik JI, Swain S. Attitude of future doctors toward psychiatry: A cross-sectional study at a medical college in Eastern India. Int J Health Allied Sci [serial online] 2019 [cited 2019 Dec 15 ];8:123-127
Available from: http://www.ijhas.in/text.asp?2019/8/2/123/258178


Full Text



 Introduction



Psychiatry as a branch of medicine has grown both in magnitude in all aspects of patient care from diagnosis to treatment. However, stigma and not so favorable attitude toward psychiatric patients and mental illness continue to persist among the general masses, medical students, and the medical profession at large.[1],[2]

As a specialization of choice, it has not been looked up to in the same breath as that of other clinical subjects. It continues to struggle with its negative image which results in reduced postgraduate recruitment rates in developed and developing countries.[3],[4]

Medical students' educational experience with psychiatry plays a major role in their choice of specialization in the future. This unpopularity of psychiatry as a specialization is a matter of great concern because mental health as a public health problem is growing in magnitude. The dearth of psychiatrists further worsens the situation. In most of the cases, psychiatry or, for that matter, mental health is almost like an afterthought.

India with its developing background is no immune to it where the problem is magnified by the fact that less scientific, more religious, magical, and supernatural etiological and treatment approaches for mental illness exist in the society, particularly conspicuous in rural areas. With limited availability of mental health workforce (0.07 psychiatrists/100,000 population and 0.12 psychiatric nurses/100,000 population), India is facing an acute shortage of professionals with either zero or insufficient training, supervision, and support to recognize, refer, and follow-up those with mental illness.[5] There is a substantial treatment gap in most of the prevalent psychiatric disorders. This felt need is particularly palpable in rural areas where the gap between the provider and the population is the maximum. The performance of the mental health system varies widely between states. With the exception of few states – Gujarat, Kerala, and Tamil Nadu, performance in most of the states was far from satisfactory according to the National Mental Health Survey 2015–2016.[6]

In this backdrop, we tried to explore the attitudes toward psychiatry (ATP) among the final-year students at a tertiary medical college of eastern India.

 Materials and Methods



Aims and objectives

This study was undertaken to assess the attitude of final-year medical students, who were on the brink of becoming future doctors, toward psychiatry as a subject of specialty, patients with mental illness, treatment modalities offered in psychiatry, and their wishes to take up psychiatry as a career.

Ethical clearance

Permission and clearance from the Institutional Ethics Committee from a medical college where the study was conducted were obtained prior to conducting the study.

Study design and sample

This cross-sectional study was conducted at a tertiary care teaching medical college of Odisha. All of 147 final-year students were approached to be part of the study. We chose final-year students for the survey as they are the students who will be exposed to clinical duties and care decision to choose their specialty of choice in the immediate future. The students were explained about the objectives of the study and were requested to fill the ATP-30 questionnaire after taking informed consent. Anonymity was maintained, and students were asked only to fill their gender. Out of all the final-year students approached, 104 (71 males and 33 females) consented to take part (response rate of 70.75%) and filled and returned complete questionnaires. The ATP-30 scale was designed and validated by Burra et al. on a group of Canadian students.[7] This scale has been used in multiple surveys across different countries all over the world in English form and has proven validity. The questionnaire was administered in English as the students were expected to be proficient in English as it was the language in which they were taught the curriculum.

The components of the scale were grouped into four subgroups (1) psychiatric patients and psychiatric illness, (2) psychiatrists and psychiatry career choice, (3) psychiatric knowledge and teaching, and (4) psychiatric treatment and hospitals for analysis as done in previous studies.[8],[9]

It consists of 15 items positively scored and an equal number of items negatively scored. Positively phrased items were reversed by subtracting the score from 6. The total score was calculated by adding all the individual item scores. A score of 90 represents the neutral point of the scale, with higher scores indicating more positive ATP. It has adequate face validity, construct validity, split-half reliability, and high test–retest reliability. It has also been used previously by many Indian studies. The scale was used in its original form since it was used on final-year students who were expected to be proficient in English.

Statistical analysis

The questionnaires were checked for completeness, and data were entered into MS Excel for further analysis. Data were expressed in simple proportion and percentages. Means and standard deviations were used to present continuous variables. ATP scores of different groups were then compared by t-test. P < 0.05 was considered as statistically significant. Statistical analysis was done with the help of SPSS 17 version (SPSS Inc., Chicago, IL, USA).

 Results



Overall, there was a negative ATP as a subject in the final-year students. The mean ATP score among the students was 80.63 ± 10.47 [Table 1]. The total score was slightly higher among female students (81.88 ± 10.62) than males (80.06 ± 10.43) [Table 2]. It was higher in all the four subgroups in female students compared to male counterparts although the difference was not statistically significant.{Table 1}{Table 2}

We grouped the responses according to three categories of ATP scores (positive, negative, and neutral). Agree and strongly agree were grouped into positive responses and disagree and strongly disagree were grouped into negative responses. The most neutral responses were received in the items such as “psychiatric illness deserves at least as much attention as physical illness,” “psychiatric hospitals have a specific contribution to make,” and “if we listen to them, psychiatric patients are just as human as other people” [Table 3]. The negative attitudes were apparent regarding satisfaction in psychiatry in medical practice, scientific basis of the subject, and more importantly in choosing it as a future career option [Table 4]. It was interesting that the most positive attitudes were observed in some of the items of domains of ATP patients, hospitals, and teaching as outlined in [Table 5].{Table 3}{Table 4}{Table 5}

 Discussion



Mental illness is increasing getting recognition, particularly in the backdrop of increased detection and diagnosis of mental disorders. The overall negative attitude to psychiatry as a subject, psychiatric patients, and treatment is a matter of great concern since the burden of mental health problems is increasing day by day with limited human resources. Various studies have been conducted in many countries for studying the attitudes of medical students toward psychiatry. They have been on a continuum from negative to neutral to positive. We received an overall negative attitude of final-year students in our study. Studies from India have demonstrated similar results with negative to neutral attitudes in the studies conducted by Parikh et al., Chawla et al., Gulati et al., and Konwar et al.[9],[10],[11],[12]

The medical students had many gaps in their knowledge toward psychiatry, psychiatric disorders, psychiatric patients, psychiatric treatment, and psychiatrists. The possible reasons could be many. Inadequate exposure toward the subject in the undergraduate period and apparent lack of importance toward it as evident by total number of marks devoted to psychiatry as a subject belittles its importance. However, a potential easily rectifiable fact could be the casual approach with which we address psychiatry at undergraduate level, superimposed on the already existing stigma. The lesser number of hours assigned to psychiatry and the absence of mandatory separate section in theory examinations add to the cause by creating neglect in the mind of students. Subjects such as psychiatry are underrepresented also during the practical training. In addition to less number of hours spent in psychiatry posting, inadequate supervision due to a smaller number of psychiatrists might create jeopardy between expectations from the subject and clinical care in reality among the students.

We also found out that female students had a slightly more positive attitude than the male counterparts. This was also the case in the studies conducted by Khan et al. in Pakistan[8] and Hailesilassie et al. in Ethiopia.[13] This may be attributed to the general perception of more empathetic and compassionate nature in part of the females. However, a study from the UK contradicts such assumption and reports no significant difference in attitude in both sexes toward psychiatry.[14]

A thrust on psychiatry as a subject along with streamlining it to mainstream medicine with an exclusive section devoted to it will generate more interest among the undergraduate students. Furthermore, a positive experience during students' internship is one of the encouraging factors leading to a positive impact on their ATP. If they have a good, effective, and sufficient exposure, it will improve their ATP and will increase the likelihood that they take psychiatry as a specialization of choice. A positive and interesting exposure of psychiatry during internship can modify and improve the attitude of interns toward psychiatry.[15] Even in those opting for other branches of medicine, the positive ATP illnesses, patients, and treatment will be of significant consequence for advising treatment to patients of mental illness that they are very much likely to come across.

A good number of students gave “neutral” response to most of the items of ATP-30. This is expected to happen when the respondents have little knowledge about the topic of interest. This is likely the case with our students. It is likely that the students may be ambivalent to the various domains of the ATP-30.

Prior to starting medical education, the attitude toward mental illnesses and psychiatry as a branch of medical science is expected to be biased by socioeconomic and cultural environments. However, medical education is expected to diminish the biases, reduce stigma, and bring in a positive change toward the attitude for psychiatric illnesses and its treatment. A negative attitude and poor knowledge on this previously neglected branch in part of future doctors is likely to negatively affect future of psychiatry and is bound to have a detrimental effect on attitude of the community toward psychiatry. The finding in our study is an indication of lacunae in the present undergraduate curricula and training in relation to psychiatry as a subject of medical science. There is a need to reevaluate this aspect of undergraduate psychiatry teaching and look for potential solutions.

There are a few limitations to our study. The small sample size limits the generalizability of the findings. Multicentric studies with open-ended responses and qualitative components can bring to the fore the factors pertaining to regional discrepancies among students for the unpopularity of psychiatry in medical schools. They can be helpful in addressing the discrepancies at the system level to improve medical education and the psychiatry practice among professionals in medical colleges and hospitals.

 Conclusion



The findings in our study highlight the need for reevaluating the current module of psychiatry training imparted to the undergraduate students. Assigning more lecture hours to psychiatry theory classes, supervised exposure to clinical psychiatry work during clinical posting and internship training are initial steps that should be undertaken. Vertical integrative teaching by liaisoning psychiatry classes in relevant topics in collaboration with other departments like forensic medicine, community medicine, dermatology, pediatrics and internal medicine should be started. Guidelines for assessment of clinical competence in Psychiatry in addition to theoretical knowledge should be prescribed. These measures can possibly change the status of Psychiatry as an underrepresented and neglected subject during undergraduate training and bring about a positive change in prevailing attitude of the students towards Psychiatric illnesses and its treatment modalities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Wahl OF. Mental health consumers' experience of stigma. Schizophr Bull 1999;25:467-78.
2Lawrie SM, Martin K, McNeill G, Drife J, Chrystie P, Reid A, et al. General practitioners' attitudes to psychiatric and medical illness. Psychol Med 1998;28:1463-7.
3Barkil-Oteo A. Psychiatry's identity crisis. Lancet 2012;379:2428.
4Ndetei DM, Khasakhala L, Ongecha-Owuor F, Kuria M, Mutiso V, Syanda J, et al. Attitudes toward psychiatry: A survey of medical students at the university of Nairobi, Kenya. Acad Psychiatry 2008;32:154-9.
5Bagcchi S. Rethinking India's psychiatric care. Lancet Psychiatry 2014;1:503-4.
6Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: Prevelance, Patterns and Outcomes. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016.
7Burra P, Kalin R, Leichner P, Waldron JJ, Handforth JR, Jarrett FJ, et al. The ATP 30-a scale for measuring medical students' attitudes to psychiatry. Med Educ 1982;16:31-8.
8Khan SA, Yousafzai AU, Mehir RK, Inam-ul-Haq. Attitude of medical students towards psychiatry in NWFP. J Ayub Med Coll Abbottabad 2008;20:44-6.
9Parikh NC, Sharma PS, Chaudhary PJ, Gandhi HA, Banwari GH. Study of attitude of interns toward psychiatry: A survey of a tertiary level hospital in Ahmedabad. Ind Psychiatry J 2014;23:143-8.
10Chawla JM, Balhara YP, Sagar R, Shivaprakash. Undergraduate medical students' attitude toward psychiatry: A cross-sectional study. Indian J Psychiatry 2012;54:37-40.
11Gulati P, Das S, Chavan BS. Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry. Indian J Psychiatry 2014;56:271-7.
12Konwar R, Pardal PK, Prakash J, Rythem. Does psychiatry rotation in undergraduate curriculum bring about a change in the attitude of medical student toward concept and practice of psychiatry: A comparative analysis. Ind Psychiatry J 2012;21:144-7.
13Hailesilassie H, Kerebih H, Negash A, Girma E, Siebeck M, Tesfaye M. Attitude of medical students towards psychiatry: The case of Jimma University, Southwest Ethiopia. Ethiop J Health Sci 2017;27:207-14.
14Singh SP, Baxter H, Standen P, Duggan C. Changing the attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: A comparison of two teaching methods. Med Educ 1998;32:115-20.
15McParland M, Noble LM, Livingston G, McManus C. The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career. Med Educ 2003;37:447-54.