Medical students’ perspective towards discipline of psychiatry

Our findings suggested no significant difference in respondents’ views toward the discipline of psychiatry throughout medical training. It corresponds with the findings from a study by Kuhnigk, et al. [13], although the further interpretation of the result was limited due to various students’ characteristics, such as their personality and particular conditions they were in. However, many previous studies suggested favorable improvement of medical students’ perspective towards psychiatry following psychiatric training [14–18].

Over the past years, psychiatry has been presumed as a last resort whenever the underlying cause of one patient’s case has yet to be found. This presumption leads to an argument of psychiatry being unscientific or not a valid branch of medicine, as stated on the questionnaire. Despite the relevant and similar findings shown by earlier studies in Spain (2005) [9] and in India (2010) [19], Gulati, et al. revealed from their study that most of both interns and students did not consider psychiatry to be unscientific. The finding remarks that the development of psychiatry as a distinctive branch in medicine has inevitably risen and plays a vital role within our society [20].

Another critical finding implicated that about half of respondents, regardless of their exposure to psychiatric clerkship or length of study, perceived that psychiatrist had low wages compared to other specialties. The factor, as mentioned earlier, along with another financial drawback, such as lack of government funding, could affect the interest and attitude of medical students, regardless of the year of study, towards the discipline of psychiatry, as suggested by some previous studies [21].

There is also a significant difference between male and female students’ perceptions of wages, whereas male students viewed psychiatrists as having lower incomes than other specialists. A previous study assessed the most common factors that could influence medical specialty decision making, found that anticipated income was one of the top factors for male students [22]. Understanding that some male students might defer from studying psychiatry due to lower income is important, so future programs that attract students to enter psychiatry could explain the financial issue. A study in Ghana, another low-to-middle-income country, found that remuneration was essential in choosing psychiatry as a medical specialty. Over one-third of the students in the study would consider choosing psychiatry if they received financial incentives such as scholarships [23]. This financial incentive would be a topic that might be explored more in Indonesia since students going through medical residency in Indonesia must pay tuition fees and, therefore, could affect their decisions in choosing specialties.

Our findings revealed that most respondents from both groups found that psychiatry was intellectually challenging. Psychiatry incorporates medicine, psychology, sociology, and anthropology into the discipline. Therefore, emphasizing these aspects of psychiatry during clerkship or medical training through various previously mentioned measures could draw more interest towards the discipline, as suggested by Fischel et al. [24]. Identification and encouragement for students who showed significant interest in psychiatry had been shown to improve their attitudes and intention post-clerkship. Ay, Save, and Fidanoglu [25] stated that special training for psychiatric educators to address the problems encountered during medical education is needed and encouraged in medical institutions.

Medical students’ views, skills, and knowledge at the end of clerkship have many implications regarding how well they will manage patients with mental illness issues later in their clinical practice. Thus, ensuring a good clerkship experience may indirectly affect the quality of service that mental illness patients would receive in the future [26].

There is also a possibility that the views towards psychiatry had already existed prior to the clinical psychiatry rotation, and it may or may not get improved after medical training [25,27]. One important note is that attitudes are determined by factors such as family, society, and media influence, all of which are affected by the ongoing stigma in general and are hardly modified [28].

Medical students’ perspective towards psychiatric treatment

Our study suggested the joyous prospect of psychiatric treatment circulated among the students, even before any formal education of psychiatric courses for the first-year students. The high positivity can be justified by recent discoveries in the modern era where the uncertain theories of psychiatric treatment in the previous years are evidence-based and scientifically proven. Skull drills and electrical shock therapy have evolved into a more holistic approach emphasizing community-based care with specific treatments according to the patient’s needs and priorities [29].

Those findings are supported by the newly emerged discovery that proved a holistic approach to health and wellness, including physical and mental health. Furthermore, one study among medical students demonstrates that the stigma towards mental illness has started to decline [30]. Puspitasari, et al., from their study, mentioned that students who had the experience of visiting a psychologist or psychiatrist were proven to have better perception, knowledge, and attitude towards psychiatry and mental health disorders. At times, psychiatric treatment could be intriguing due to physicians’ different approaches than other medical fields. However, the people exposed to the line of psychiatric treatment may have a better understanding and therefore have a decent attitude towards the field [31]. In addition, aside from the new psychiatric theories, the favourable responses from medical students may be due to their personal experience in psychiatric wards or with family members or friends who were previously treated due to mental illness prior to their enrolment in medical school. Over time, being involved in medical training, particularly for having hands-on experience with psychiatric patients and their families, would make them practice empathetic psychiatric interviews and first-hand witness effective psychotherapy and psychopharmacology. These situations may result in fewer stigmatizing viewpoints.

Furthermore, studies indicated that being an undergraduate student in medicine may develop empathy and a sense of curiosity toward patients suffering from mental disorders. For example, Öster, et al., in their study, involved psychiatric patients mentioned that the participation of medical students in psychiatric care is essential. Not only did they learn about theory, but they also developed empathy from experience. However, this viewpoint would succeed if students would see the patients as individuals and subjects, not merely as learning objects [32].

Regarding the exposure of psychiatry, our study revealed there was not much significant difference in the perspective of psychiatric treatment between pre- and post-psychiatry rotation. This finding seemed to corroborate previous similar studies conducted in other countries. However, perspectives towards psychiatric treatment efficacy were varied [14,17,18]. Nevertheless, our results pointed out that more prolonged exposure to psychiatric wards or departments could still strengthen their knowledge concerning medical services provided by the psychiatrists.

Our analysis confirmed no notable differences between male and female respondents’ views toward psychiatric treatment or psychotherapy. This outcome corresponds with previous studies that concluded that gender did not associate with contrast to mental illness [33]. However, the discovery differed from earlier studies that stated that females have a higher sympathetic view and positive incline towards mental illness [34]. Sarhan et al. [35] found that more male students had an optimistic view of psychiatry treatment efficacy. Nevertheless, the apparent reason behind the influence of gender is still debatable in many of the studies. Hence, this matter of subject requires more descriptive and elaborative data.

Medical students’ perspective toward psychiatry as a career

The overall attitude of respondents on psychiatry as a career was generally positive. This result is per previous studies [35,36]. Our study is also in line with previous studies, whereas women had a more positive attitude towards psychiatry as a career. This condition may be linked to a more profound social aspect in psychiatry than other medical specialties, in which women tend to have a higher interest, according to other studies [13,37]. In contrast, more male students viewed psychiatry as having low prestige and that those who could not obtain other residencies would then choose psychiatry.

Furthermore, only slightly over half of them would encourage bright students to choose psychiatry. A career preference in psychiatry is subjective to clinical rotation as there are attributable factors that could not be modified during the rotation [38]. Cutler, et al. [8] also suggested one of the factors in which the preference of medical students in selecting psychiatry was often influenced by the negative outlook their family members had on a psychiatrist. Such comment of “career in psychiatry is a waste of time” and the inability to recognize psychiatrist as a valid medical profession did exist.

From our study, the number of students who had a positive attitude after psychiatric rotation was increased. One possible reason for this might be the quality of psychiatric education and the opportunity to communicate with psychiatric teachers, patients, and families, allowing students to see a career in psychiatry as a potential and promising path [39]. Previous studies revealed the same result in which interest in pursuing psychiatry as a career increased after being exposed to psychiatry training [14–18].

Badmouthing by medical students and teachers could also be one of the contributing factors affecting decision-making to become a psychiatrist [40]. Psychiatry and family medicine, general internal medicine, and general surgery frequently receive negative talk. How psychiatrist is perceived in medicine is essential because any negative prejudice could lead to a declining number of students taking psychiatry in the future. Despite the positive attitude from the students, a general acknowledgments that psychiatrist has low income and status in the eyes of society contributes to their decision in choosing psychiatry. Nevertheless, many students still assumed a psychiatrist as an intellectually challenging profession [10], which was in line with our data that most of the respondents agreed with the statement of encouraging bright students to enter psychiatry.

Medical students’ perspective toward psychiatrists as role models

Our study found that majority of the respondents had positive perceptions of psychiatrists as role models. Previous studies also noted positive outcomes that mentioned most students included in the study put respect on the skill and knowledge of psychiatrists [35,36,41]. This finding came out to be interesting, compared to different studies which had reported fewer positive responses towards psychiatrists [42]. The shifting trend of perspective towards psychiatrists as role models apparently will boost medical students’ enthusiasm in pursuing a career as mental health professionals.

In our study, the positive perspective towards psychiatrists as role models was similar between pre- and post-psychiatry clinical rotation groups. Meanwhile, other studies revealed an increasing trend of positive attitudes after exposure to psychiatry [17,18]. This trend could be attributed to how the teachers and staff in the Department of Psychiatry presented themselves to clerkship students and how psychiatry was taught and delivered.

Moreover, the majority of the students from both male and female groups in our study had positive perspectives towards psychiatrists as role models, despite having no statistical significance. This result is similar to a previous study that showed a nearly proportional ratio of medical students who had positive perspectives towards psychiatrists as role models [35].

Medical students’ perspective towards psychiatric patients

Our study indicated that most of the respondents had positive attitudes towards psychiatric patients, which was also similar to previous studies [35,43]. Our finding could conclude that psychiatry rotation may contribute to the shifting trend of medical students’ perspective towards psychiatric patients to be more positive, as supported by similar findings from previous studies [14,15,17,18]. Meanwhile, Aruna et al. [36] found an exciting result: final-year students were less sympathetic towards psychiatric patients than first-year students. Nevertheless, most of the students were optimistic regarding the treatability of psychiatric disorders.

In our study, the majority of the students of both genders had positive perspectives towards psychiatric patients. However, female students amounted to a slightly higher proportion, similar to a study by Sarhan, et al. [35]. This finding can be due to females’ better empathy and understanding towards mental illness than males.

Another finding in our study revealed that the majority of the medical students agreed to consider psychiatric illness was as important as physical illness. Mental illness affects the brain and physical function; hence, the patient is incapable of making irrational judgments and is shown unacceptable behavior. In addition, the illness affects a patient’s quality of life; therefore, medical intervention should be performed to improve current health conditions, as equal to physical illness.

Some students considered psychiatric patients violent, unpredictable, and emotionally draining regarding the behavior. According to a study by Naeem, et al., mood changes shown by a patient could affect the perception of a healthcare professional, whereby doctors seemed to be emotionally draining to treat psychiatric patients with this condition [43].

Based on our study, the proportion of students’ positive perspectives of working with psychiatric patients compared to other patients was generally in balance. Previous studies regarding medical students’ attitudes toward psychiatric patients also revealed inconsistent results [17,35,44]. Throughout pre-clinical years, students gain knowledge and experience limited to written materials, tutors, and personal experience from the specialists. By the time students are exposed to psychiatric rotation, they tend to find that psychiatric patients in clinical settings have such complexity in appearance and personal engagement. However, medical students expressed various responses regarding this situation, to a certain extent that some found it fascinating. Acute psychiatric patients with behavioral issues, making them unpredictable, are considered dangerous. As a result, medical students, particularly freshmen, agree that psychiatric patients should be treated in specialized facilities [45]. However, the trend has been changing over time. Our data showed that the number of students who agreed with isolating psychiatric patients was decreased by half after the exposure to psychiatry rotation. Clinical rotation provides an opportunity for doctors to communicate directly with psychiatric patients. Thus, students would view doctors objectively, and therefore opposing viewpoints toward them would decrease [44].

Medical students’ perspective toward psychiatric training

Overall, most of the respondents in our study showed a positive perspective toward psychiatric training. The positive and negative perspective proportion was generally similar among pre- and post-psychiatric clinical rotations. Previous studies supported our findings that positive attitudes among students dominated the result. However, these studies suggested favorable improvement of a positive perspective towards psychiatry following the exposure to psychiatry in the clerkship years [14,16,17].

Our study revealed that most of the respondents thought that their psychiatric training had been valuable and should be mandatory. A similar result was also found in a study by Konwar et al. [17]. However, one-third of respondents in our study believed that psychiatry was vague and imprecise. It is predicted that several factors could enhance positive attitude towards psychiatric teaching and career, including a more structured curriculum, an increased number of psychiatric classes, better research in the biological underpinnings of various aspects of psychiatry, and a formal guideline towards the practice of psychiatry [46]. Upon medical school training, students who were initially considering psychiatry as a career had attended more lectures and psychiatric training [47]. We believe that the teaching method delivered, and the ambience created throughout the rotation play an essential role because the positive energy from the tutors would draw the attention and make students feel welcomed and appreciated.

In conclusion, the overall perception of medical students towards psychiatry as a discipline, psychiatric treatment, psychiatrists as role models, psychiatry as a career, psychiatric patients, and psychiatry training was positive. Correcting misapprehension and removing the stigma on psychiatry during medical education and clinical rotation can decrease negative perspectives on psychiatry. A direct experience and a substantial presence of role models can depict a more accurate and objective presentation of psychiatry to maintain and increase positive viewpoints among medical students towards psychiatric patients. In contrast, a social campaign could be an example for societies to perform.

For further development, a cohort study might be considered to identify factors affecting medical students’ perceptions over a certain period. We suggest conducting a more extensive study scale, following this pilot study, involving different teaching sites and institutions to obtain more data and collect broader perspectives. Although this university is the largest and oldest university in Indonesia, located in the capital city and students from this university represent diverse students from different places all over Indonesia. A qualitative study exploring the motives and reasons for the differences between male and female students’ responses would also enrich further development of programs that aim to increase medical students’ positive attitudes toward psychiatry as a discipline or a career choice.