Towards protecting the endangered discipline of psychiatry

The recent Editorial by Henderson and colleagues (2015) expressed concern that academic psychiatry in Australia and New Zealand is ‘endangered’. Not long ago, a similar international trend was identified by Katschnig (2010), who posed an almost identical question: ‘Are psychiatrists an endangered species?’.

Both articles discuss strategies that could assist in reviving psychiatry to become an attractive career pathway for students, interns and clinicians that is adequately remunerated, resourced and respected. The authors acknowledge that the first step is to improve recruitment of medical students to psychiatry as a career; however, for decades it has been unpopular the world over. A number of negative factors that detract students from psychiatry have been identified, including a perception that psychiatry is an unscientific, stressful and second-class speciality. Psychiatric patients are perceived as dangerous and emotionally draining, and treatment as questionable and ineffective (Lyons, 2013).

We agree with the view expressed by Henderson and colleagues who suggest that in order to protect academic psychiatry, educators should aim to improve teaching in medical schools to make the student experience as rewarding and stimulating as possible.

Limitations of the psychiatry rotation

The clinical rotation is usually the first exposure that students have of psychiatry, providing them with the opportunity for involvement in patient care and interaction with clinical and academic psychiatrists. Psychiatry rotations are an integral component of medical courses in Australia, and their core role is to teach the basics of the discipline, including patient interviewing, symptom recognition, diagnosis and classification of mental disorders. However, psychiatry rotations are not primarily developed as a recruitment tool, and while they can be effective in improving students’ attitudes towards psychiatry, evidence of their impact on psychiatry as a career is mixed.

The move by many universities from undergraduate to 4-year graduate courses has resulted in greater competition between disciplines for clinical teaching time and a significant reduction in rotation length. With less time to teach, we need to work harder and do more to promote psychiatry as a rewarding and fulfilling professional career to ensure that the psychiatric workforce is sustainable. In our view, this can be achieved by the implementation of more creative and innovative teaching strategies that deliver enrichment programmes that are over and above expected conventional teaching and more specifically designed and targeted towards attracting students to psychiatry as a career.

Our approach to creative teaching and recruitment

In 2008, the School of Psychiatry and Clinical Neurosciences at the University of Western Australia established an innovative enrichment programme: the Claassen Institute of Psychiatry for Medical Students (the Claassen Institute). The Claassen Institute is an intensive, week-long programme that provides students with an extended view of the discipline with the aim of increasing their interest in psychiatry as a career, and raising awareness of areas for sub-specialisation. Students participate in interactive seminars and debates that cover a range of diverse topics and visit local community and hospital-based mental health services. Students are able to interact informally with presenters throughout the week, which provides opportunities for future mentorship. Places are limited to 20 and over the years students from New Zealand and Hong Kong have attended, adding an international perspective and allowing for cross-cultural exchange between students.

An initial evaluation of the Claassen Institute undertaken in 2010 found that students’ interest and knowledge in psychiatry had improved, and that the number of students seriously considering psychiatry as a career had increased significantly (Lyons et al., 2010). The Claassen Institute has now been running for 7 years and 117 students have attended. A recent follow-up evaluation found that, by the end of the Claassen Institute week, 90 (77%) of these students were ‘definitely’ considering a career in psychiatry.

RANZCP attempts to improve recruitment

The importance of recruitment to psychiatry has also been recognised by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and, in response, a number of initiatives targeted towards medical students and junior doctors have been implemented. These include the development of a section of the RANZCP website specifically targeted towards students and graduates, and the Psychiatry Interest Forum (RANZCP, 2013). An initiative that encourages students to attend the annual RANZCP Congress and participate in a range of special activities has also been implemented. More recently, a series of weekend ‘Introduction to Psychiatry’ workshops have been run, aimed at encouraging students and junior doctors to consider psychiatry as a career (Maria Tomasic, Former President RANZCP, personal communication, 17 October 2014).

In summary, we firmly believe that creative and innovative enrichments programmes such as the Claassen Institute and more recent RANZCP initiatives are proving to be effective strategies to encourage students towards psychiatry as a career. The establishment of similar programmes in Australia and New Zealand will protect our endangered discipline and further strengthen and future-proof the psychiatric workforce for decades to come.

See Editorial by Henderson et al., 2015, 49(1): 9–12.