Hollands Lucy, McCulloch Elizabeth, Scott Jessica, Hancock Jason, Mattick Karen
University of Exeter, Exeter, UK.
Devon Partnership NHS Trust, Exeter, UK.
Acad Psychiatry. 2025 Mar 21. doi: 10.1007/s40596-025-02125-7.
There is a global recruitment crisis in psychiatry, with insufficient medical students choosing this specialty as their medical career. Previous research describes multiple interacting factors that may influence medical students' attitudes toward a psychiatry career but not which are most important for whom, in what respects, and in what contexts, nor how they interact to shape attitudes. Therefore, this study aimed to develop a theory to explain the complex factors shaping medical students' attitudes toward a psychiatry career.
This realist evaluation involved three phases: phase 1 was the development of an initial program theory from published literature; in phase 2, a final program theory was developed from realist interviews with 31 UK medical students; in phase 3, evidence-based recommendations were developed.
This study identified seven important contexts (positive personal experiences of mental health services; exposure to multiple psychiatry subspecialties as undergraduates; positive experiences on psychiatry placement; perceived good work-life balance for psychiatrists; perceived danger from psychiatric patients; perceived poor patient prognoses; perceived negative emotions evoked through work) and six important mechanisms (being inspired to make a difference; being interested in psychiatry; seeing psychiatry as aligned with desired lifestyle; being concerned about safety; feeling unable to make a difference; being concerned about emotional burden). These contexts and mechanisms interacted to shape positive or negative attitudes toward a psychiatry career.
Based on the findings, the authors recommend more pre-clinical psychiatry placements, exposure to passionate psychiatry teachers especially on psychiatry placements, and a focus on retention of interested students.
精神病学领域存在全球招聘危机，选择该专业作为医学职业的医学生不足。先前的研究描述了多个相互作用的因素，这些因素可能会影响医学生对精神病学职业的态度，但未指出哪些因素对谁、在哪些方面以及在何种背景下最为重要，也未说明它们如何相互作用以塑造态度。因此，本研究旨在构建一种理论，以解释塑造医学生对精神病学职业态度的复杂因素。
这项现实主义评价包括三个阶段：第一阶段是根据已发表的文献制定初始项目理论；第二阶段，通过对31名英国医学生进行现实主义访谈，制定最终项目理论；第三阶段，制定基于证据的建议。
本研究确定了七个重要背景（心理健康服务的积极个人经历；本科阶段接触多个精神病学亚专业；精神病学实习的积极经历；认为精神科医生的工作与生活平衡良好；感知到来自精神科患者的危险；感知到患者预后不佳；感知到工作引发的负面情绪）和六个重要机制（受到启发想要有所作为；对精神病学感兴趣；认为精神病学与期望的生活方式相符；担心安全问题；觉得无法有所作为；担心情感负担）。这些背景和机制相互作用，塑造了对精神病学职业的积极或消极态度。
基于研究结果，作者建议增加临床前精神病学实习机会，让学生接触充满热情的精神病学教师，尤其是在精神病学实习期间，并重点留住感兴趣的学生。
