To the Editor:
I read with great interest the recent report by Russo et al. regarding career choice factors in psychiatry interns. Greater understanding of recruitment factors will be instrumental in allowing the entire psychiatry specialty to progress and develop in parallel with changing demands of the population; this could be no more pertinent than now in the coronavirus pandemic era. Although highly insightful and of great benefit, I must raise concern with one aspect of their conclusion and one of the key messages presented by the work. This is the conclusion that now educators have a guide for the factors that attract students to the field and the supposition that with this, specific students are easier to identify and select. That identification relies on the prospective students’ background, values, and personality traits .
The 5 domains, the 5 Cs, embody all of the important themes that play a part in the influence and recruitment of new psychiatric interns, and they are each vital to examine. Nonetheless, as we endeavor to understand the nuance of each domain and each theme, this must be with a view to enhancing the field. Diversity must surely be a primary concern at the forefront of any attempt to encourage workforce growth. Given this need for diversity, I would caution significantly against any suggestion that these factors might be criteria to meet for the selection of future specialists.
Mental health has no barriers. This has very publicly been brought to the forefront during the current coronavirus pandemic. The pandemic crisis is already proving to be a hugely formative life experience, and the effects of this in particular will be vital to monitor over time . As the authors allude to, such events can be cataclysmic in shaping future generations and career paths. Still, as we strive to enhance the workforce in the short term, reports such as this provide incredibly useful basis for implementing change. It is simply that I believe more onus should be placed more on the speciality, the faculty, and the attendings to continue to develop all aspects for the better. We should not simply identify the specific traits of those within and try to select their mirror images; we should examine each and every factor influencing the choices, and then proactively address each to widen the appeal .
For example, under the theme of Control, stigma was highlighted as a factor that has improved in recent times, and this is an attractive feature for prospective doctors. Surely this finding should primarily be used to express that recent efforts to address stigma in psychiatry are effective, and the work should continue in earnest?
Within the Confidence theme, the authors rightly promote the importance of relationships between students and their teachers. However, the suggestion that students who mirror the traits of their residents are best suited to the specialty is potentially unhelpful. There is a very real possibility that this quickly leads to the establishment and reinforcement of stereotypes within specialties. Do we not require diversity in the field to cater to the diversity in the population?
One of the more interesting development suggestions is that by now knowing students are motivated by a desire to affect change, clerkship directors may be inspired to develop opportunities supporting this further. These are the kinds of directorates that such work should most actively promote. Fundamentally, I do fully support the authors’ statement that, “to continue growing the psychiatric workforce, educators need to understand what draws students today to pursue a career in psychiatry” . I merely maintain hope that with increasing insight comes growth in diversity of the workforce and not simply specificity.
Russo RA, Dallaghan GB, Balon R, et al. Millennials in psychiatry: exploring career choice factors in generation Y psychiatry interns [published online ahead of print, 2020 Jul 13]. Acad Psychiatry. 2020;10.1007/s40596-020-01272-3.
Ferrel MN, Ryan JJ. The impact of COVID-19 on medical education. Cureus. 2020;12(3):e7492.
Lachish S, Goldacre MJ, Lambert TW. Views of UK doctors in training on the timing of choosing a clinical specialty: quantitative and qualitative analysis of surveys 3 years after graduation. Postgrad Med J. 2018;94(1117):621–6.
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Sharma, R.K. Comment on: “Millennials in Psychiatry: Exploring Career Choice Factors in Generation Y Psychiatry Interns”. Acad Psychiatry 44, 809–810 (2020). https://doi.org/10.1007/s40596-020-01318-6