511676
2013
APY22110.1177/1039856213511676Australasian PsychiatrySinha et al.
AP
Teaching and training
Baptism by conference: an effective Royal Australian and New Zealand College of Psychiatrists recruitment tool?
Australasian Psychiatry 2014, Vol 22(1) 62–65 © The Royal Australian and New Zealand College of Psychiatrists 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856213511676 apy.sagepub.com
Shampa Sinha MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Shane Antao MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Jennifer Gunn MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Tamara Yuen
MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia
Abstract Objective: To explore common barriers medical students perceive to choosing psychiatry as a medical specialty as reflected in existing literature and the authors’ own experiences and whether funding student attendance of a Royal Australian and New Zealand College of Psychiatrists Congress serves to overcome some of these perceptions. Conclusions: Common barriers to selecting psychiatry as a career include stigma due primarily to lack of information about this specialty; concerns about personal safety; concerns about losing clinical skills and fear of burn-out. Bursaries funding student attendance to the Royal Australian and New Zealand College of Psychiatrists 2013 Congress were an excellent initiative that gave students a panoramic view of the variety of fields within the specialty and exposure to current debates and research, as well as the chance to discuss various subspecialties with keynote speakers and other professionals working in these areas. Undertaking more outreach activities and on-campus information sessions targeting final year students may help to further combat misperceptions and improve recruitment. Keywords: medical students, choosing psychiatry as a career, recruitment, conferences, prejudices about psychiatry and mental illness
‘G
osh it’s so great to see so many familiar faces in the room!’ gasped comedienne Jean Kittson, speaking at the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Congress gala dinner. The band luring attendees out onto the dance floor is, of course, none other than “Mental As Anything”. Jokes about psychiatrists are part of the course on this annual night of nights for mental health professionals. The dinner came on the penultimate day of a week of presentations, art exhibitions and conversations with keynote speakers that had expanded our perspective of what being a psychiatrist entails. The four of us were among 20 students selected from various medical schools in New South Wales (NSW) to participate in RANZCP’s inaugural programme of bursaries aimed at encouraging students to consider psychiatry as a specialisation. In order to secure our place at the Congress we had to submit an application demonstrating our interest in psychiatry. Some of us were already true believers, had decided this was our calling and were
at the Congress simply seeking affirmation of our choice; others were dabblers – sure we wanted to incorporate a wider knowledge of psychiatry into our clinical practice but were not yet convinced we wanted to specialise in it. It was certainly an interesting time to be attending a psychiatrists’ conference. Not only did the 2013 meeting commemorate the RANZCP’s 50th anniversary but it also occurred a few days after the release of the controversial DSM-5. In many ways, in the course of the week, it seemed as though we were on the cusp of a new era of psychiatry. One in which, as Dr Ralf Ilchef, Staff Specialist at Royal North Shore Hospital, put it, ‘we are no longer stuck in the dark ages of medicine, but we strive ahead into the light, and off the couch’. Correspondence: Shampa Sinha, School of Medicine, University of Notre Dame Sydney, 160 Oxford Street, Darlinghurst, NSW 2010, Australia. Email: [email protected]
62 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Sinha et al.
This seemed like an opportune moment then to examine existing literature to see how successful psychiatry is in selling itself to the new generation of medical students, some of the perceived barriers to selecting psychiatry as a career and the extent to which attending the conference influenced our perspectives.
Barriers to considering psychiatry as a career General perceptions of psychiatry
A recent Australian survey revealed that medical students viewed psychiatry as the least attractive specialty with regard to the extent to which patients are helped effectively and the degree to which it is seen as having a reliable scientific foundation. However, psychiatry rated well in terms of being intellectually challenging, a rapidly advancing field of medicine and providing research opportunities and a good lifestyle.1 Another study examined whether a brief advocacy presentation enhanced student interest in child and adolescent psychiatry as a career choice.2 Students who attended the presentation were better informed about the specific details relating to the profession; however, their interest in psychiatry as a career choice did not change. The extent of student interest was positively influenced by having had contact with a psychiatrist and a favourable clinical experience in the field prior to the study.2
It is possible that many of these biases exist due to lack of information. Due to our limited exposure to psychiatry during medical school, most of us had little knowledge of the training requirements and possible career pathways, prior to attending. At the Conference, RANZCP representatives briefed us on the College’s recent endeavours to streamline and improve the training model, most recently in 2012 with the introduction of the new Fellowship Programme. Two poster presentations showcased within the Congress presented the results of a survey of perceptions of the current RANZCP training programme from the perspective of both trainees and supervisors. Halley et al.5 found that trainees are generally satisfied with the current model, although quality of supervision varies considerably between hospitals and regions. These satisfaction levels were mirrored by those of supervisors. Additionally, a previous survey of Australian trainee-psychiatrists found that the majority were satisfied with their training programme despite experiencing high levels of stress.6 Many of us were also unaware of just how diverse psychiatry is as a field and found it valuable to attend sessions on the relevance of art, theatre and history to contemporary psychiatric practice. A fascinating presentation by Dr Robert Kaplan featured actual footage of the effects of malariotherapy on patients suffering from neurosyphillis, trialled by Dr Reg Ellery in 1925 at Victoria’s Mont Park mental asylum. The footage is reputed to be the oldest surviving movie of psychiatric treatment in Australia.7
From our personal experiences, it appears that lack of exposure to different areas of psychiatry during medical school serves to restrict student perspectives of the discipline. Several psychiatrists we met at the conference lamented the fact that the typical medical school psychiatric rotation is confined to acute or chronic care within the hospital setting and students rarely gain insight into areas like psychotherapy, neuropsychiatry or have the opportunity to deal with less severely impaired patients – the vast majority.
As stated by Professor Gordon Parker in his small group session with the student award recipients, ‘psychiatrists used to have a reputation of being rather odd’. While that may no longer be the case, there is still a lingering perception that you might have to be slightly off-kilter to want to enter this profession in the first place. It was refreshing to hear Dr Ralf Ilchef tell us, at our inaugural student briefing: ‘In my view, to enjoy psychiatry you basically need four attributes: diligence, thoughtfulness, the ability to tolerate ambiguity, and, most importantly, an inexhaustible interest in people’.
Stigma
Concerns about personal safety
‘I was half way through the surgical rotation when the Congress started. After telling the supervisor and my peers about it, I was met with a glazed look and incredulity’. Final year medical student Stigmatisation of mental illness and its treatment is not only rife within the general public3 but is also pervasive among medical professionals.4 We believe that, while stigma does not worry the authors of this paper or influence our individual decisions about whether or not to specialise in psychiatry, it is disheartening to realise our colleagues think that we are choosing an ‘easier’ path to specialisation.
During our psychiatric rotations, particularly in acute or emergency settings, we occasionally witnessed or heard about violent behaviour of psychiatric patients towards staff. Television dramas also help to fuel this concern, with programmes such as ER and Grey’s Anatomy often featuring a psychiatric patient running amok in the hospital with weapons, inevitably leading to injury or even death to medical staff or other patients. To a large extent, the data also support this perception. According to the United States Department of Justice’s National Crime Victimization Survey, between 1993 and 1999 the incidence of non-fatal, job-related violent crime of occupants in psychiatry was 68.2 per 1000 psychiatrists and mental health professionals compared
63 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Australasian Psychiatry 22(1)
to 16.2 per 1000 amongst physicians in general and 12.6 per 1000 in across all professions.8 In the US, 40–50% of psychiatry residents are at risk of being physically attacked by a patient during their 4-year training.9 Of the 42,338 incidents reported to the Australian Patient Safety Foundation between July 2000 and June 2002, violence was involved in 9% of all health unit incidents, 16% of emergency department incidents and 28% of mental health units. However, over half of the incidents occurring in the emergency department involved psychiatric patients and 25% involved drug or alcohol intoxicated patients. In mental health units, 79% of reported incidents involved involuntary patients with refusal of privileges, a common precipitating factor.10 A large survey of Australian psychiatrists reported that 67% had been verbally or physically abused by patients or relatives in the previous 12 months.11 While safety, particularly in emergency settings and small peripheral hospitals, concerns all of us, we are reasonably happy with the steps taken to protect staff, such as searches of patients prior to them being seen by the psychiatric team, duress alarms, the presence of alternative exits and video monitoring and this would not prevent us from pursuing a psychiatric career. However, this is a problem for all medical professionals, not just psychiatrists, and more training in medical school about managing patients’ and relatives’ aggressive behaviour would be welcome. Losing or under-utilising clinical skills The general perception that psychiatrists do not routinely physically examine their patients is borne out by old surveys conducted in the 1970s and 1980s.12 What is less evident, however, is to what extent that practice has changed. Between 6 and 20% of patients with physical illness are misdiagnosed as having a mental disorder and, moreover, once a patient is admitted to a psychiatric unit, in many cases, physical diseases are not diagnosed and treated.13 This places the burden on psychiatrists to take a comprehensive history and physically examine their patients in order to exclude an organic cause for their symptoms. Therefore, psychiatrists are required to maintain a good working knowledge of general medicine in order to provide patients with an adequate level of care. At a symposium on smoking in mental health, Tracey Greenberg reiterated the point that all psychiatrists should use a stethoscope since, as physicians, they need to evaluate their patients medically as well as psychiatrically. The fact that psychiatry also offers a fertile field for clinical research, at the frontiers of neuropsychiatry, was also underscored by the keynote address at the Congress by Professor Matcheri Keshavan, in which he outlined new developments in neuroplasticity research and its implications for the future treatment of schizophrenia. This move towards expanding our neurobiological knowledge and understanding of most psychiatric disorders was in
turn echoed in presentations such as those by Professor Gin Malhi, detailing new research aimed at improving our understanding of the differences in neural activity between patients with bipolar disorder and those with borderline personality disorder. Dr Sanil Rege highlighted how his research has shown the association between antiphospholipid syndrome and psychosis, depression, dementia and the neurological manifestations of systemic lupus erythematosus. Burn-out There is a perception among students that psychiatrists suffer higher rates of burn-out due to the emotional intensity of their work and the demands made by their patients, as evidenced by questions directed by members of our group during our small group sessions with selected conference speakers. Data on this are conflicting. A large survey of psychiatrists suggested high burn-out rates and identified factors such as out of hours or long hours of duty, dealing with difficult and hostile relatives of patients, arranging admissions, paperwork, balancing personal and professional lives and managing suicidal or homicidal patients as contributory factors.14 Surprisingly, whereas in other professions, an inverse relationship exists between stress and job satisfaction, this does not appear to be true with regard to psychiatry. A majority of Australian psychiatrists (79%) are proud of their profession and most (88%) are satisfied with their work.11 Despite experiencing depression and burn-out, most psychiatrists continue to enjoy their work and consistently score high in job satisfaction surveys in the UK, Australia and the USA.15 This was also a view echoed by psychiatrists we spoke to at the conference, most of whom said they were satisfied with their work–life balance.
Conclusion The opportunity to attend the RANZCP Congress provided us with far greater exposure to the richness and diversity of the field of psychiatry than we would ever be able to obtain during a standard clinical rotation. Additionally, the privilege of meeting as a group with several keynote speakers, including Professor Gordon Parker, helped to expand and deepen our understanding of various aspects of the profession. We were able to better appreciate the breadth of professional niches within psychiatry, ranging from neuropsychiatry to forensic psychiatry to psychotherapy and encompassing media as diverse as drama, fiction and Daoist painting. For those of us with a particular interest in indigenous mental health, the Congress also provided the opportunity to talk to key mental health professionals working in this field and learn about the importance of modifying the standard psychiatric assessment to make it culturally appropriate when interviewing indigenous patients. Moreover, we realised that psychiatrists, more so perhaps than any other medical specialist, are indeed
64 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Sinha et al.
permitted, even encouraged, to have a life and multifaceted interests such as music, art and literature outside of the medical realm and these life experiences in fact serve to enhance their clinical skills and diagnostic acumen. We unanimously agree on the benefits of these student awards for future medical student cohorts and will most certainly share our positive experiences of the Conference with our fellow medical students. We would also recommend that RANZCP complement this initiative with outreach information sessions aimed at providing more information to final year medical students about pathways, what placements are required and available during training, the supervision offered and flexibility about part-time training (taking into account that many students may wish to start a family). These sessions could take place during on-campus information evenings with a panel of current trainees to share their experiences and address questions and concerns. Acknowledgements The authors wish to express their thanks to Professor Joseph Rey, Head of Psychiatry, University of Notre Dame, Sydney for his guidance in writing this article. We would also like to thank RANZCP for the bursaries that made our attendance possible. In particular, we are very grateful to Dr Ralf Ilchef, Senior Staff Specialist in Consultation-Liaison Psychiatry, Royal North Shore Hospital and Olivia Henriksen, Specialist Training Program Project Officer, RANZCP, for their assistance and support during the conference.
Disclosure
2. Martin VL, Bennett DS and Pitale M. Medical students’ interest in child psychiatry: a clerkship intervention. Academic Psychiatry 2007; 31: 225–227. 3. Reaveley NJ and Jorm AF. Young people’s stigmatizing attitudes towards people with mental disorders: findings from an Australian national survey. Aust N Z J Psychiatry 2011; 45: 1033–1039. 4. Adriaensen K, Pieters G and De Lepeleire J. Stigmatisation of psychiatric patients by general practitioners and medical students: a review of the literature. Tijdschr Psychiatrie 2011; 53: 885–894. 5. Halley E, Fletcher S, Schapper C, et al. Trainee and supervisor perceptions of the RANZCP training program and ‘Supervisor perceptions of the RANZCP training program. Posters RANZCP congress 26–30 May 2013. 6. Walter G, Rey J and Giuffrida M. What is it currently like being a trainee psychiatrist in Australia? Australas Psychiatry 2003; 11: 429–434. 7. Kaplan RA. Psychiatric gadfly: in search of Reginald Ellery. Australas Psychiatry 2012; 20: 7–13. 8. Anderson A and West SG. Violence against mental health professionals: when the treater becomes the victim. Innov Clin Neurosci 2011; 8: 34–39. 9. Rueve M and Welton R. Violence and mental illness. Psychiatry 2008; 5: 34–48. 10. Benveniste KA, Hibbert PD and Runciman WB. Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis. Med J Aust 2005; 183: 348–351. 11. Rey JM, Walter G and Giuffrida M. Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future. Aust N Z J Psychiatry 2004; 38:105–110. 12. McIntyre JS and Romano J. Is there a stethoscope in the house (and is it used)? Arch Gen Psychiatry 1977; 34: 1147–1151.
The authors’ attendance of the Congress was funded by the RANZCP.
13. Felker B, Yazell JJ and Short D. Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv 1996; 47: 1356–1363.
References
14. Rathod S, Roy L, Ramsay M, et al. A survey of stress in psychiatrists working in the Wessex Region. Psychiatry Bull 2000; 24; 133–136.
1. Robertson T, Walter G, Soh N, et al. Medical students attitudes to a career in psychiatry before and after a promotional DVD. Australas Psychiatry 2009; 17: 311–317.
15. Kumar S. Burnout in psychiatrists. World Psychiatry 2007; 6: 186–189.
65 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
2013
APY22110.1177/1039856213511676Australasian PsychiatrySinha et al.
AP
Teaching and training
Baptism by conference: an effective Royal Australian and New Zealand College of Psychiatrists recruitment tool?
Australasian Psychiatry 2014, Vol 22(1) 62–65 © The Royal Australian and New Zealand College of Psychiatrists 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856213511676 apy.sagepub.com
Shampa Sinha MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Shane Antao MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Jennifer Gunn MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia Tamara Yuen
MBBS student, School of Medicine, University of Notre Dame Sydney, Darlinghurst, NSW Australia
Abstract Objective: To explore common barriers medical students perceive to choosing psychiatry as a medical specialty as reflected in existing literature and the authors’ own experiences and whether funding student attendance of a Royal Australian and New Zealand College of Psychiatrists Congress serves to overcome some of these perceptions. Conclusions: Common barriers to selecting psychiatry as a career include stigma due primarily to lack of information about this specialty; concerns about personal safety; concerns about losing clinical skills and fear of burn-out. Bursaries funding student attendance to the Royal Australian and New Zealand College of Psychiatrists 2013 Congress were an excellent initiative that gave students a panoramic view of the variety of fields within the specialty and exposure to current debates and research, as well as the chance to discuss various subspecialties with keynote speakers and other professionals working in these areas. Undertaking more outreach activities and on-campus information sessions targeting final year students may help to further combat misperceptions and improve recruitment. Keywords: medical students, choosing psychiatry as a career, recruitment, conferences, prejudices about psychiatry and mental illness
‘G
osh it’s so great to see so many familiar faces in the room!’ gasped comedienne Jean Kittson, speaking at the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Congress gala dinner. The band luring attendees out onto the dance floor is, of course, none other than “Mental As Anything”. Jokes about psychiatrists are part of the course on this annual night of nights for mental health professionals. The dinner came on the penultimate day of a week of presentations, art exhibitions and conversations with keynote speakers that had expanded our perspective of what being a psychiatrist entails. The four of us were among 20 students selected from various medical schools in New South Wales (NSW) to participate in RANZCP’s inaugural programme of bursaries aimed at encouraging students to consider psychiatry as a specialisation. In order to secure our place at the Congress we had to submit an application demonstrating our interest in psychiatry. Some of us were already true believers, had decided this was our calling and were
at the Congress simply seeking affirmation of our choice; others were dabblers – sure we wanted to incorporate a wider knowledge of psychiatry into our clinical practice but were not yet convinced we wanted to specialise in it. It was certainly an interesting time to be attending a psychiatrists’ conference. Not only did the 2013 meeting commemorate the RANZCP’s 50th anniversary but it also occurred a few days after the release of the controversial DSM-5. In many ways, in the course of the week, it seemed as though we were on the cusp of a new era of psychiatry. One in which, as Dr Ralf Ilchef, Staff Specialist at Royal North Shore Hospital, put it, ‘we are no longer stuck in the dark ages of medicine, but we strive ahead into the light, and off the couch’. Correspondence: Shampa Sinha, School of Medicine, University of Notre Dame Sydney, 160 Oxford Street, Darlinghurst, NSW 2010, Australia. Email: [email protected]
62 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Sinha et al.
This seemed like an opportune moment then to examine existing literature to see how successful psychiatry is in selling itself to the new generation of medical students, some of the perceived barriers to selecting psychiatry as a career and the extent to which attending the conference influenced our perspectives.
Barriers to considering psychiatry as a career General perceptions of psychiatry
A recent Australian survey revealed that medical students viewed psychiatry as the least attractive specialty with regard to the extent to which patients are helped effectively and the degree to which it is seen as having a reliable scientific foundation. However, psychiatry rated well in terms of being intellectually challenging, a rapidly advancing field of medicine and providing research opportunities and a good lifestyle.1 Another study examined whether a brief advocacy presentation enhanced student interest in child and adolescent psychiatry as a career choice.2 Students who attended the presentation were better informed about the specific details relating to the profession; however, their interest in psychiatry as a career choice did not change. The extent of student interest was positively influenced by having had contact with a psychiatrist and a favourable clinical experience in the field prior to the study.2
It is possible that many of these biases exist due to lack of information. Due to our limited exposure to psychiatry during medical school, most of us had little knowledge of the training requirements and possible career pathways, prior to attending. At the Conference, RANZCP representatives briefed us on the College’s recent endeavours to streamline and improve the training model, most recently in 2012 with the introduction of the new Fellowship Programme. Two poster presentations showcased within the Congress presented the results of a survey of perceptions of the current RANZCP training programme from the perspective of both trainees and supervisors. Halley et al.5 found that trainees are generally satisfied with the current model, although quality of supervision varies considerably between hospitals and regions. These satisfaction levels were mirrored by those of supervisors. Additionally, a previous survey of Australian trainee-psychiatrists found that the majority were satisfied with their training programme despite experiencing high levels of stress.6 Many of us were also unaware of just how diverse psychiatry is as a field and found it valuable to attend sessions on the relevance of art, theatre and history to contemporary psychiatric practice. A fascinating presentation by Dr Robert Kaplan featured actual footage of the effects of malariotherapy on patients suffering from neurosyphillis, trialled by Dr Reg Ellery in 1925 at Victoria’s Mont Park mental asylum. The footage is reputed to be the oldest surviving movie of psychiatric treatment in Australia.7
From our personal experiences, it appears that lack of exposure to different areas of psychiatry during medical school serves to restrict student perspectives of the discipline. Several psychiatrists we met at the conference lamented the fact that the typical medical school psychiatric rotation is confined to acute or chronic care within the hospital setting and students rarely gain insight into areas like psychotherapy, neuropsychiatry or have the opportunity to deal with less severely impaired patients – the vast majority.
As stated by Professor Gordon Parker in his small group session with the student award recipients, ‘psychiatrists used to have a reputation of being rather odd’. While that may no longer be the case, there is still a lingering perception that you might have to be slightly off-kilter to want to enter this profession in the first place. It was refreshing to hear Dr Ralf Ilchef tell us, at our inaugural student briefing: ‘In my view, to enjoy psychiatry you basically need four attributes: diligence, thoughtfulness, the ability to tolerate ambiguity, and, most importantly, an inexhaustible interest in people’.
Stigma
Concerns about personal safety
‘I was half way through the surgical rotation when the Congress started. After telling the supervisor and my peers about it, I was met with a glazed look and incredulity’. Final year medical student Stigmatisation of mental illness and its treatment is not only rife within the general public3 but is also pervasive among medical professionals.4 We believe that, while stigma does not worry the authors of this paper or influence our individual decisions about whether or not to specialise in psychiatry, it is disheartening to realise our colleagues think that we are choosing an ‘easier’ path to specialisation.
During our psychiatric rotations, particularly in acute or emergency settings, we occasionally witnessed or heard about violent behaviour of psychiatric patients towards staff. Television dramas also help to fuel this concern, with programmes such as ER and Grey’s Anatomy often featuring a psychiatric patient running amok in the hospital with weapons, inevitably leading to injury or even death to medical staff or other patients. To a large extent, the data also support this perception. According to the United States Department of Justice’s National Crime Victimization Survey, between 1993 and 1999 the incidence of non-fatal, job-related violent crime of occupants in psychiatry was 68.2 per 1000 psychiatrists and mental health professionals compared
63 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Australasian Psychiatry 22(1)
to 16.2 per 1000 amongst physicians in general and 12.6 per 1000 in across all professions.8 In the US, 40–50% of psychiatry residents are at risk of being physically attacked by a patient during their 4-year training.9 Of the 42,338 incidents reported to the Australian Patient Safety Foundation between July 2000 and June 2002, violence was involved in 9% of all health unit incidents, 16% of emergency department incidents and 28% of mental health units. However, over half of the incidents occurring in the emergency department involved psychiatric patients and 25% involved drug or alcohol intoxicated patients. In mental health units, 79% of reported incidents involved involuntary patients with refusal of privileges, a common precipitating factor.10 A large survey of Australian psychiatrists reported that 67% had been verbally or physically abused by patients or relatives in the previous 12 months.11 While safety, particularly in emergency settings and small peripheral hospitals, concerns all of us, we are reasonably happy with the steps taken to protect staff, such as searches of patients prior to them being seen by the psychiatric team, duress alarms, the presence of alternative exits and video monitoring and this would not prevent us from pursuing a psychiatric career. However, this is a problem for all medical professionals, not just psychiatrists, and more training in medical school about managing patients’ and relatives’ aggressive behaviour would be welcome. Losing or under-utilising clinical skills The general perception that psychiatrists do not routinely physically examine their patients is borne out by old surveys conducted in the 1970s and 1980s.12 What is less evident, however, is to what extent that practice has changed. Between 6 and 20% of patients with physical illness are misdiagnosed as having a mental disorder and, moreover, once a patient is admitted to a psychiatric unit, in many cases, physical diseases are not diagnosed and treated.13 This places the burden on psychiatrists to take a comprehensive history and physically examine their patients in order to exclude an organic cause for their symptoms. Therefore, psychiatrists are required to maintain a good working knowledge of general medicine in order to provide patients with an adequate level of care. At a symposium on smoking in mental health, Tracey Greenberg reiterated the point that all psychiatrists should use a stethoscope since, as physicians, they need to evaluate their patients medically as well as psychiatrically. The fact that psychiatry also offers a fertile field for clinical research, at the frontiers of neuropsychiatry, was also underscored by the keynote address at the Congress by Professor Matcheri Keshavan, in which he outlined new developments in neuroplasticity research and its implications for the future treatment of schizophrenia. This move towards expanding our neurobiological knowledge and understanding of most psychiatric disorders was in
turn echoed in presentations such as those by Professor Gin Malhi, detailing new research aimed at improving our understanding of the differences in neural activity between patients with bipolar disorder and those with borderline personality disorder. Dr Sanil Rege highlighted how his research has shown the association between antiphospholipid syndrome and psychosis, depression, dementia and the neurological manifestations of systemic lupus erythematosus. Burn-out There is a perception among students that psychiatrists suffer higher rates of burn-out due to the emotional intensity of their work and the demands made by their patients, as evidenced by questions directed by members of our group during our small group sessions with selected conference speakers. Data on this are conflicting. A large survey of psychiatrists suggested high burn-out rates and identified factors such as out of hours or long hours of duty, dealing with difficult and hostile relatives of patients, arranging admissions, paperwork, balancing personal and professional lives and managing suicidal or homicidal patients as contributory factors.14 Surprisingly, whereas in other professions, an inverse relationship exists between stress and job satisfaction, this does not appear to be true with regard to psychiatry. A majority of Australian psychiatrists (79%) are proud of their profession and most (88%) are satisfied with their work.11 Despite experiencing depression and burn-out, most psychiatrists continue to enjoy their work and consistently score high in job satisfaction surveys in the UK, Australia and the USA.15 This was also a view echoed by psychiatrists we spoke to at the conference, most of whom said they were satisfied with their work–life balance.
Conclusion The opportunity to attend the RANZCP Congress provided us with far greater exposure to the richness and diversity of the field of psychiatry than we would ever be able to obtain during a standard clinical rotation. Additionally, the privilege of meeting as a group with several keynote speakers, including Professor Gordon Parker, helped to expand and deepen our understanding of various aspects of the profession. We were able to better appreciate the breadth of professional niches within psychiatry, ranging from neuropsychiatry to forensic psychiatry to psychotherapy and encompassing media as diverse as drama, fiction and Daoist painting. For those of us with a particular interest in indigenous mental health, the Congress also provided the opportunity to talk to key mental health professionals working in this field and learn about the importance of modifying the standard psychiatric assessment to make it culturally appropriate when interviewing indigenous patients. Moreover, we realised that psychiatrists, more so perhaps than any other medical specialist, are indeed
64 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
Sinha et al.
permitted, even encouraged, to have a life and multifaceted interests such as music, art and literature outside of the medical realm and these life experiences in fact serve to enhance their clinical skills and diagnostic acumen. We unanimously agree on the benefits of these student awards for future medical student cohorts and will most certainly share our positive experiences of the Conference with our fellow medical students. We would also recommend that RANZCP complement this initiative with outreach information sessions aimed at providing more information to final year medical students about pathways, what placements are required and available during training, the supervision offered and flexibility about part-time training (taking into account that many students may wish to start a family). These sessions could take place during on-campus information evenings with a panel of current trainees to share their experiences and address questions and concerns. Acknowledgements The authors wish to express their thanks to Professor Joseph Rey, Head of Psychiatry, University of Notre Dame, Sydney for his guidance in writing this article. We would also like to thank RANZCP for the bursaries that made our attendance possible. In particular, we are very grateful to Dr Ralf Ilchef, Senior Staff Specialist in Consultation-Liaison Psychiatry, Royal North Shore Hospital and Olivia Henriksen, Specialist Training Program Project Officer, RANZCP, for their assistance and support during the conference.
Disclosure
2. Martin VL, Bennett DS and Pitale M. Medical students’ interest in child psychiatry: a clerkship intervention. Academic Psychiatry 2007; 31: 225–227. 3. Reaveley NJ and Jorm AF. Young people’s stigmatizing attitudes towards people with mental disorders: findings from an Australian national survey. Aust N Z J Psychiatry 2011; 45: 1033–1039. 4. Adriaensen K, Pieters G and De Lepeleire J. Stigmatisation of psychiatric patients by general practitioners and medical students: a review of the literature. Tijdschr Psychiatrie 2011; 53: 885–894. 5. Halley E, Fletcher S, Schapper C, et al. Trainee and supervisor perceptions of the RANZCP training program and ‘Supervisor perceptions of the RANZCP training program. Posters RANZCP congress 26–30 May 2013. 6. Walter G, Rey J and Giuffrida M. What is it currently like being a trainee psychiatrist in Australia? Australas Psychiatry 2003; 11: 429–434. 7. Kaplan RA. Psychiatric gadfly: in search of Reginald Ellery. Australas Psychiatry 2012; 20: 7–13. 8. Anderson A and West SG. Violence against mental health professionals: when the treater becomes the victim. Innov Clin Neurosci 2011; 8: 34–39. 9. Rueve M and Welton R. Violence and mental illness. Psychiatry 2008; 5: 34–48. 10. Benveniste KA, Hibbert PD and Runciman WB. Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis. Med J Aust 2005; 183: 348–351. 11. Rey JM, Walter G and Giuffrida M. Australian psychiatrists today: proud of their profession but stressed and apprehensive about the future. Aust N Z J Psychiatry 2004; 38:105–110. 12. McIntyre JS and Romano J. Is there a stethoscope in the house (and is it used)? Arch Gen Psychiatry 1977; 34: 1147–1151.
The authors’ attendance of the Congress was funded by the RANZCP.
13. Felker B, Yazell JJ and Short D. Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv 1996; 47: 1356–1363.
References
14. Rathod S, Roy L, Ramsay M, et al. A survey of stress in psychiatrists working in the Wessex Region. Psychiatry Bull 2000; 24; 133–136.
1. Robertson T, Walter G, Soh N, et al. Medical students attitudes to a career in psychiatry before and after a promotional DVD. Australas Psychiatry 2009; 17: 311–317.
15. Kumar S. Burnout in psychiatrists. World Psychiatry 2007; 6: 186–189.
65 Downloaded from apy.sagepub.com at University of Manitoba Libraries on June 9, 2015
