Regardless of the systems in place at medical schools, psychiatrists and psychiatry residents play an important role in molding medical students' attitudes toward mental illness.
Regardless of the systems in place at medical schools, psychiatrists and psychiatry residents play an important role in molding the attitudes of medical students toward mental illness. Studies have consistently demonstrated that attitudes on the part of medical students toward these patients are more negative than toward patients with other medical conditions.1-3 Even more concerning, it appears that these negative feelings may worsen over time. Further, students’ opinions of patients with substance use disorders are especially prone to degradation during medical school.1,4
It has been shown that patients who encounter doctors who are negative toward mental disorders are less inclined to seek help in the future and more likely to become psychologically distressed by the encounter.5-8 Addressing these concerns while students are still in medical school can potentially improve the future care of numerous patients. Here are some steps psychiatrists, faculty, and psychiatry residents can take to help medical students along the way, no matter what specialty they choose:
1. Examine your own attitudes. While the data is somewhat inconsistent, psychiatrists and psychiatry trainees have been found to possess more negative attitudes toward serious mental illness-especially substance use disorders and borderline personality disorder-than non-psychiatric illness.5-7,9 Medical students often model their thinking and behaviors after their more seasoned colleagues, so it is important that clinicians examine how they communicate both verbally and nonverbally with their students (and patients).
2. Engage in reflection with students about their experiences working with patients with psychiatric disorders. This should be done in a nonjudgmental and inviting way. Students are often overwhelmed by their psychiatry rotations and have difficulty expressing their thoughts and feelings. Routinely encouraging medical students to identify the personal emotions that various patients elicit can open a dialog.
3. Begin a discussion about countertransference and how to effectively use those feelings in the therapeutic space. Teach students to use their sensibilities and countertransference to more deeply understand and garner empathy for all patients. This can then lead to better therapeutic outcomes. Ballon and Skinner10 have demonstrated that open discussions, journaling, and mandatory end-of-rotation reflection papers can improve students’ outlook and experiences.
4. Exercise didactic thinking and offer educational reflection exercises. Even brief interventions have been shown successfully to improve attitudes, and a comprehensive curriculum can have a huge impact on patient outcomes.11-12
5. Give medical students strategies to tolerate uncertainty and to set realistic and attainable goals with their patients.
6. Encourage students to train in Motivational Interviewing (MI), which embodies an atmosphere of acceptance and compassion.13 This can help them view challenging patients in a new way and minimize frustration. Specifically, MI can provide clinicians with a way of interacting with patients that tends to increase the expression of empathy and support patient self-efficacy.
Dr Baez is a third-year psychiatry resident at Montefiore Medical Center in the Bronx, New York. Dr Avery is an Addiction Psychiatry Fellow at New York University School of Medicine in New York City. Dr Ascher is an Addiction Psychiatry Fellow at the University of Pennsylvania School of Medicine in Philadelphia.
1. Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma?Acad Psychiatry. 2012;36:197-204.
2. Schmetzer AD, Lafuze JE. Overcoming stigma: involving families in medical student and psychiatric residency education. Acad Psychiatry. 2008;32:127-131.
3. Galka SW, Perkins DV, Butler N, et al. Medical students’ attitudes toward mental disorders before and after a psychiatric rotation. Acad Psychiatry. 2005;29:357-361.
4. Lindberg M, Vergara C, Wild-Wesley, Gruman C. Physicians-in-training attitudes toward caring for and working with patients with alcohol and drug abuse diagnoses. South Med J. 2006;99:28-35.
5. Rao H, Mahadevappa H, Pillay P, et al. A study of stigmatized attitudes towards people with mental health problems among health professionals. J Psychiatr Ment HealthNurs. 2009;16:279-284.
6. Kreek MJ. Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment. Ann NY Acad Sci. 2011;1231:65-72.
7. Schulze B. Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry. 2007;19:137-155.
8. Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction. 2012;107:39-50.
9. Nordt C, Rossler W, Lauber C. Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophr Bulletin. 2006;32:709-714.
10. Ballon BC, Skinner W. “Attitude is a little thing that makes a big difference”: reflection techniques for addiction psychiatry training. Acad Psychiatry. 2008; 32(3): 218-224.
11. Galletly C, Burton C. Improving medical student attitudes towards people with schizophrenia. Aust N Z J Psychiatry. 2011;45:473-476.
12. Roberts LW, Bandstra BS. Addressing stigma to strengthen psychiatric education. Acad Psychiatry. 2012;36:347-350.
13. Martino S, Haeseler F, Belitsky R, et al. Teaching brief motivational interviewing to Year three medical students. Med Educ. 2007;41:160-167.