BackgroundRecruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice.MethodsCross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students’ career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students’ attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome.Results2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were “quite likely”, and 25% were “definitely not” considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p < 0.001) and number of placements (correlation coefficient =0.21, p < 0.001) were associated with higher ATP scores. During medical school, experience of psychiatric enrichment activities (special studies modules and university psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry.Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p < 0.001); interest in psychiatry before medical school, OR 10.8 (5.38 to 21.8, p < 0.001); undertaking a psychiatry special study module, OR 1.45 (1.05 to 2.01, p = 0.03) or elective OR 4.28 (2.87- 6.38, p < 0.001); membership of a university psychiatry club, OR 3.25 (2.87 to 6.38, p < 0.001); and exposure to didactic teaching, OR 0.54 (0.40 to 0.72, p < 0.001).ConclusionsWe report factors relevant to medical student selection and psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally.

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Psychiatry as a discipline will undergo major changes in the coming years. Although changes can be particularly stimulating and challenging from an intellectual, scientific and social viewpoint, the new generations of psychiatrists must be prepared to face these changes and deal with them appropriately. Paradigms which have represented the foundations of psychiatry in the last century now need a major revision. In particular, both trainees in psychiatry and early career psychiatrists need to (1) (re)discover psychopathology, (2) improve mental healthcare through integrated treatments, (3) identify and treat new syndromes, (4) promote an image of psychiatry with patients at the heart of care and as advocates for each other by fighting stigma and promoting the recruitment in psychiatry by medical students. These can be achieved by increasing involvement in institutions and organizations to influence the agenda. In this paper the possible contribution of trainees and early career psychiatrists is discussed and recommendations are made in order to set a new agenda for early career psychiatrists who will still be practising 2-3 decades from now.

Psychiatry recruitment continues to be a problem in the UK and large-scale studies are required to understand the factors surrounding this. A quantitative, cross-sectional online survey, incorporating demographics, career choices, teaching exposure, attitudes to psychiatry and personality factors, was administered to final-year UK medical students. A total of 484 students from 18 medical schools responded (66% women). Sixteen (16%) had chosen psychiatry at medical school entry. By final year, 15 respondents (3%) had decided to pursue a career in psychiatry, while another 78 (17%) were seriously considering it. There was little difference in the quality ratings of lectures and small group teaching between those interested in psychiatry and those not. Experience of 'enrichment activities' (psychiatry special study modules or components, psychiatric research, university psychiatry clubs, and psychiatry electives) were significantly more likely to take up psychiatry. Causality cannot, however, be determined in this study. The study identified several distinct groups of UK students: those deciding on psychiatry before medical school and maintaining that career choice, those deciding on psychiatry during medical school, and those interested in other fields. Addressing psychiatry teaching and exposure may improve recruitment into the speciality.

There are attempts to harmonise training in psychiatry across Europe but the very different political and social arrangements in European countries present a real challenge to attaining this goal.

There is an increasing demand for psychiatrists in France. This paper reviews the reasons for French medical students choosing psychiatry and the rationale and mechanisms for encouraging them towards this medical speciality. The main factors associated with choosing psychiatry as a career are the quantity and quality of undergraduate training and placements in psychiatry, better attitudes towards psychiatry and more emphasis on a positive life/work balance. The quality of postgraduate training can also influence students' decisions. Medical students should be encouraged to choose psychiatry first to counterbalance the existing stigma towards mental illness within the society, but also towards psychiatry within the medical profession, and second because of the current decline in French medical demography. Ways to improve recruitment are a selection process that favours a large number of psychiatric trainees, and an increase in the quality and quantity of training. Providing medical students with relevant information about training in psychiatry, notably through a national trainees' association, will not only improve the quality of care by increasing recruitment in psychiatry, but also ensure that all future doctors are familiar with and develop positive attitudes towards mental health issues.

There is evidence that with suitable training of assessors and trainees, WPBAs can be introduced and are feasible in assessing some competencies.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Highlights  Depression rates among psychiatric residents were lower than previously reported data, while suicide ideation rates were similar to previous reports in this population.  Poor working conditions such as long working hours and no clinical supervision are associated with experiencing depression during training  Residents who are single and female report worse mental health during training