Junior doctor psychiatry placements in hospital and community settings: a phenomenological study

Abstract

ObjectivesThe proportion of junior doctors required to complete psychiatry placements in the UK has increased, due in part to vacant training posts and psychiatry career workforce shortages, as can be seen across the world. The aim of this study was to understand the lived experience of a Foundation Year 1 junior doctor psychiatry placement and to understand how job components influence attitudes.DesignThe study was conducted using a cross-sectional qualitative phenomenological approach.SettingHospital and community psychiatry department settings in the North East of England, UK.ParticipantsIn total, 14 Foundation Year 1 junior doctors were interviewed including seven men and seven women aged between 23 and 34 years. The majority had completed their medical degree in the UK and were White British.ResultsThe lived experience of a junior doctor psychiatry placement was understood by three core themes: exposure to patient recovery, connectedness with others in the healthcare team and subjective interpretations of psychiatry. The experiences were moderated by instances of role definition, reaction to the specialty and the organisational fit of the junior doctor capacity in the specialty.ConclusionsThe study reinforces and adds to the literature by identifying connectedness as being important for both job satisfaction and morale, which is currently damaged within the junior doctor population. The study provides in-depth insights into the lived experience of psychiatry placements and can be taken forward by educationalists to ensure the placements are meaningful experiences for junior doctors by developing role definition, belonging, structure and psychiatric care responsibility.

Sociodemographic and educational characteristics of doctors applying for psychiatry training in the UK: secondary analysis of data from the UK Medical Education Database project

“…3,9,11,23 Authors of a recent systematic review declared that ‘Psychiatry as a career has been negatively regarded and unpopular among medical students’ and, as a consequence, ‘about 3.6% of British graduates decide on a career in psychiatry whereas 6% are needed.’ 9 Evidence from other studies indicates that perceptions about psychiatry may be influenced by experiences at medical school (including the type and amount of teaching), at foundation school, and during undergraduate and postgraduate placements. 10,24,25 However, a survey of medical students, aged 18 to 37 years, found that age was not significantly associated with having rated psychiatry in the top three most interesting specialties. 25 Moreover, surveys of UK medical graduates' career intentions between 1974 and 2009 found little variance among medical schools in the proportion reporting psychiatry as a first-choice long-term career, albeit females were slightly more likely to report this than males.…”

“…7 Extant literature, predominately survey-based, indicates that cultural and institutional biases against psychiatry influence junior doctors' specialty choice and are a phenomenon, to a greater or lesser extent, internationally. [9][10][11] However, to our knowledge, research has not been carried out to examine the likelihood of actual application to psychiatry training, given doctors' sociodemographic and educational background, medical education performance, and medical school and foundation school attended.…”

Accuracy of prescribing documentation by UK junior doctors undertaking psychiatry placements: a multi-centre observational study

“…High levels of stress amongst FY doctors have been identified nationwide [24] and those undertaking psychiatry placements have highlighted their uncertainty with working with patients with mental illness [25]. The combination of personal vulnerabilities and influences from mentally unwell patients, especially those with SMI, may therefore be overwhelming, affecting overall performance that declines during their placement [26].…”

Evaluating the effectiveness of video cases to improve patient-centeredness in psychiatry: a quasi-experimental study

“…40 Another reason for the lack of change in attitudes could be the specific components of the psychiatry clerkship. Recently, a number of contextual clerkship factors, such as interpersonal skills training related to patient management, 41 educational models like student-run clinics to increase medical students' perceived knowledge and comfort with psychiatry 42 , and enthusiastic and positive clinical staff encouraging the students' social integration 43 , have been proposed as influential in furthering students' long-term positive attitude towards psychiatry. Thus, efforts to improve attitudes towards psychiatry may require more than just one two-hour lecture.…”