Attitude of medical students towards psychiatry
Summary. Findings are presented from J survey of all mcdical students at the College of Medicine. Abha, Saudi Arabia dealing with students’ attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned ftiture delivery o f services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their spccializatioii after graduation. T h e Scicntific Coniniittee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from nicdical schools in the nation to discuss this priority topic. A year later. a new course called ‘Iiitroduction to Psychosomatic Medicine’ \vas introduced as a n elective for niedical students with its practice a t the general hospital. I t tries to introduce students to ‘voluntary and active as against passive learning . . . and problcm-solvirig rather than imposed memorizing’ o f medicalizcd fornis of psychiatry, an innovation cornpared with the previous conventional method. A significant diffcrcncc in attitude w a s demonstrated bctwccn students w h o had their exposure to psychiatry from this course and those w h o followed only the conventional nicthods o f learning.
over a decade does not seem to hal-c gcricratcd cnough interest in the subject a m o n g nicdical students for it to be scriously regarded as a field for spccializatioii. Although the country needs psychiatrists of Saudi background, few if any arc‘ interested in this training, ‘resulting in a drastic undersupply of psychiatrists’ (Dubovsky 1983). It is not enough t o have a doctor xvho spc‘aks Arabic to communicate properly with the niajority of patients w h o conic from more than 7000 different villages and remote vallcys of the rural area; one has t o be able to tinderstaiid their culture and prescribe a n acceptable remedy. I n Saudi Arabia, psychiatry, which is still in its early stage of developmcnt, has not yet been perceived as a nicdical subject. Individ~ialswith psychiatric disorders continue to 8 0 first to .i traditional healer. Medical students w h o look a t psychiatry a s a practice for the healer may not wish to spend niaiiy years o f niedical study pursuing this specialty and risk being regarded as second best compared to a healer. Rather they wish to become respected doctors. Hciice, the student community may not support the choice ofpsychiatry for specialization as ‘cultural factors strongly influenced the niedical students’ attitudes’ (Abdul-liahim Kc El-Assra 1989). T h c thinking here sccnis to indicate that ifpsychiatry lies in the spiritual domain i t requires a spiritual healer, not a doctor. O n the other hand. psychiatry can be vicwed from the o t h e r extrenie, and see11 a s part of the doniaiii o f iicurology, where patients’ conditions are euphcmistically referred to as i ~ i n a h , meaning ‘nerves’ (Racy 1970), to substitute what \rill avoid a stigmatized association with psychiatric conditions. We have not found this used today in Saudi Arabia. An approach that docs riot compete a t any level of application xvith the traditional healer, yet delineates its border and presents itself by n a m e
Kcy \rords: students, mcdical/*psychol; *specialties, mcd; *psychiatry; *attitude ofhealth pcrsonncl; *attitude to health; cduc, rned, undcrgrad; career choice; Saudi Arabia Introduction Thc teaching of psychiatry in Saudi Arabia for (:orrrspvndcnce: I l r H . E. Soufi, I l c p a r t m r n t of Psychiatry. ( h l l e g e of Mcdiciiie. Abha B r a n c h . P O Box 116h. Abha, Sdiidi Arahia.
3x
Approach to students’ attitude to psychiatry Table 1. Specialty choice (n = 64)
Specialty
Yo
Surgery
28 20 18 9 6 3 2
Internal medicine Others or did not k n o w
Paediatrics Ophthalmology ENT
Psychiatry
14% stated a preference to become general practitioners.
and by practice as a medical subject, may prove more acceptable socioculturally. A 2-credit-hour elective course entitled ‘Introduction to Psychosomatic Medicine’ was introduced in 1987. It is composed o f a weekly lecture with a clinical session at the out-patient clinic of the main referral hospital of the region. The present lack ofelective courses and students’ need to achieve the required number of credit hours lead almost all students eventually to take all available elective courses, irrespective of their actual interests. An average of ten students attended the course every semester. All kinds of psychiatric patients a t the general hospital are referred to the ‘psychosomatic clinic’. Most patients express that they prefer this to being referred to the psychiatric hospital, to which many d o not go whcn so advised, losing the chance for treatment.
Methods The principal questionnaire that was used in the survey reviewed students’ backgrounds, attitudes towards different medical specialties and the impact of sociocultural and traditional factors o n their choice for specialization. The survey also compared a group of students that took a onesemester trial course on ‘Introduction to Psychosomatic Medicine’ which tried to introduce them to psychiatry through a different method to the previously employed conventional way. This method is a modified bio-psycho-social approach, which focuses o n and tries to integrate the medico-biological model, the psycho-social and the socio-cultural aspects of diseases, giving priority in treatment to psycho-pharmacology
39
and behavioural modification starting at the physiological level. The use of psychodynamics was not primarily pursued, yet referred to whcn the occasion called for it.
Results Before presenting the results of the student survey, a summary of the background of the medical students at the time of the survey is set out: Number of medical students at the college: 130 (all men at present), from all parts of Saudi Arabia. About half o f those responded to the questionnaire. They ranged in age from 20 to 25 years. 17% ofthe students were married, 60% of those with children (one child only). 55% came from families of 9 or more children. In reviewing the birth order of each respondent, only 3 % were found to be the youngest of their siblings, whereas about 16% were first-born. 78% came from middle-class families, with an employed father; 5% of the fathers were farmers. The remaining fathers had retired or died. Only 3% of the students had first-degree relatives as doctors; 11% had second-degree relatives as doctors. Questioned concer&ng the person w h o had affected their choice of studying medicine: 66% said no one, while 16% said they had been influenced by a family member, 8 % by peer groups and 4% by teachers. The age of decision for the majority was between 13 and 19 years of age. Table 1 presents their specialty choices. In answering the question asking iftheir choice of specialty had undergone a change since entering medical school: 67% stated n o change, though in regard to psychiatry one single student felt he wanted to change from ENT to psychiatry.
Table 2. Reasons chosen for specialty choices Reason
Yo
To work in medical research Social prestige
50 33 31 23 11 2
Interest in the subject Want to teach Want high income Want to work as administrators
Table 3. lleasons tor riot c h o o s i n ~psychiatry
as
‘1
spCCialty I~eJSon
Summary. Findings are presented from J survey of all mcdical students at the College of Medicine. Abha, Saudi Arabia dealing with students’ attitudes towards specialization in psychiatry. The health region of Asir in south-west rural Saudi Arabia, of about one million inhabitants, needs Saudi Nationals to specialize in psychiatry to provide planned ftiture delivery o f services. Medical students all over Saudi Arabia, however, have not been choosing psychiatry for their spccializatioii after graduation. T h e Scicntific Coniniittee for Mental Health, convened at the Ministry of Health in Riyadh in February 1986, invited representatives of psychiatry from nicdical schools in the nation to discuss this priority topic. A year later. a new course called ‘Iiitroduction to Psychosomatic Medicine’ \vas introduced as a n elective for niedical students with its practice a t the general hospital. I t tries to introduce students to ‘voluntary and active as against passive learning . . . and problcm-solvirig rather than imposed memorizing’ o f medicalizcd fornis of psychiatry, an innovation cornpared with the previous conventional method. A significant diffcrcncc in attitude w a s demonstrated bctwccn students w h o had their exposure to psychiatry from this course and those w h o followed only the conventional nicthods o f learning.
over a decade does not seem to hal-c gcricratcd cnough interest in the subject a m o n g nicdical students for it to be scriously regarded as a field for spccializatioii. Although the country needs psychiatrists of Saudi background, few if any arc‘ interested in this training, ‘resulting in a drastic undersupply of psychiatrists’ (Dubovsky 1983). It is not enough t o have a doctor xvho spc‘aks Arabic to communicate properly with the niajority of patients w h o conic from more than 7000 different villages and remote vallcys of the rural area; one has t o be able to tinderstaiid their culture and prescribe a n acceptable remedy. I n Saudi Arabia, psychiatry, which is still in its early stage of developmcnt, has not yet been perceived as a nicdical subject. Individ~ialswith psychiatric disorders continue to 8 0 first to .i traditional healer. Medical students w h o look a t psychiatry a s a practice for the healer may not wish to spend niaiiy years o f niedical study pursuing this specialty and risk being regarded as second best compared to a healer. Rather they wish to become respected doctors. Hciice, the student community may not support the choice ofpsychiatry for specialization as ‘cultural factors strongly influenced the niedical students’ attitudes’ (Abdul-liahim Kc El-Assra 1989). T h c thinking here sccnis to indicate that ifpsychiatry lies in the spiritual domain i t requires a spiritual healer, not a doctor. O n the other hand. psychiatry can be vicwed from the o t h e r extrenie, and see11 a s part of the doniaiii o f iicurology, where patients’ conditions are euphcmistically referred to as i ~ i n a h , meaning ‘nerves’ (Racy 1970), to substitute what \rill avoid a stigmatized association with psychiatric conditions. We have not found this used today in Saudi Arabia. An approach that docs riot compete a t any level of application xvith the traditional healer, yet delineates its border and presents itself by n a m e
Kcy \rords: students, mcdical/*psychol; *specialties, mcd; *psychiatry; *attitude ofhealth pcrsonncl; *attitude to health; cduc, rned, undcrgrad; career choice; Saudi Arabia Introduction Thc teaching of psychiatry in Saudi Arabia for (:orrrspvndcnce: I l r H . E. Soufi, I l c p a r t m r n t of Psychiatry. ( h l l e g e of Mcdiciiie. Abha B r a n c h . P O Box 116h. Abha, Sdiidi Arahia.
3x
Approach to students’ attitude to psychiatry Table 1. Specialty choice (n = 64)
Specialty
Yo
Surgery
28 20 18 9 6 3 2
Internal medicine Others or did not k n o w
Paediatrics Ophthalmology ENT
Psychiatry
14% stated a preference to become general practitioners.
and by practice as a medical subject, may prove more acceptable socioculturally. A 2-credit-hour elective course entitled ‘Introduction to Psychosomatic Medicine’ was introduced in 1987. It is composed o f a weekly lecture with a clinical session at the out-patient clinic of the main referral hospital of the region. The present lack ofelective courses and students’ need to achieve the required number of credit hours lead almost all students eventually to take all available elective courses, irrespective of their actual interests. An average of ten students attended the course every semester. All kinds of psychiatric patients a t the general hospital are referred to the ‘psychosomatic clinic’. Most patients express that they prefer this to being referred to the psychiatric hospital, to which many d o not go whcn so advised, losing the chance for treatment.
Methods The principal questionnaire that was used in the survey reviewed students’ backgrounds, attitudes towards different medical specialties and the impact of sociocultural and traditional factors o n their choice for specialization. The survey also compared a group of students that took a onesemester trial course on ‘Introduction to Psychosomatic Medicine’ which tried to introduce them to psychiatry through a different method to the previously employed conventional way. This method is a modified bio-psycho-social approach, which focuses o n and tries to integrate the medico-biological model, the psycho-social and the socio-cultural aspects of diseases, giving priority in treatment to psycho-pharmacology
39
and behavioural modification starting at the physiological level. The use of psychodynamics was not primarily pursued, yet referred to whcn the occasion called for it.
Results Before presenting the results of the student survey, a summary of the background of the medical students at the time of the survey is set out: Number of medical students at the college: 130 (all men at present), from all parts of Saudi Arabia. About half o f those responded to the questionnaire. They ranged in age from 20 to 25 years. 17% ofthe students were married, 60% of those with children (one child only). 55% came from families of 9 or more children. In reviewing the birth order of each respondent, only 3 % were found to be the youngest of their siblings, whereas about 16% were first-born. 78% came from middle-class families, with an employed father; 5% of the fathers were farmers. The remaining fathers had retired or died. Only 3% of the students had first-degree relatives as doctors; 11% had second-degree relatives as doctors. Questioned concer&ng the person w h o had affected their choice of studying medicine: 66% said no one, while 16% said they had been influenced by a family member, 8 % by peer groups and 4% by teachers. The age of decision for the majority was between 13 and 19 years of age. Table 1 presents their specialty choices. In answering the question asking iftheir choice of specialty had undergone a change since entering medical school: 67% stated n o change, though in regard to psychiatry one single student felt he wanted to change from ENT to psychiatry.
Table 2. Reasons chosen for specialty choices Reason
Yo
To work in medical research Social prestige
50 33 31 23 11 2
Interest in the subject Want to teach Want high income Want to work as administrators
Table 3. lleasons tor riot c h o o s i n ~psychiatry
as
‘1
spCCialty I~eJSon
