Influence of educational programs on attitudes of medical students towards psychiatry: Effects of psychiatric experience, gender, and personality dimensions

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Practice points

Previous psychiatric experiences are associated with more positive attitudes towards psychiatry – this should be considered in curriculum development. Studying in a problem-based program might affect students’ attitudes towards psychiatry positively. Gender aspects have to be taken into account to improve attitudes towards psychiatry while planning a curriculum – male students in traditional curricula showed the least positive attitudes towards psychiatry.

Table 1.  Return rate of questionnaires and attitudes of medical students (sum of scores) towards psychiatry (ATP-30), (ATP-30 sum of scores: 30 = very negative attitude, 150 = very positive attitude)

	PBL program Medical Faculty of Hamburg University			Traditional program Medical Faculty of Duisburg-Essen University
	2nd semester	4th semester	Total	2nd semester	5th semester	Total
Number of distributed questionnaires	40	21	61	200	80	280
Return rate	38 (95%)	19 (90.5%)	57 (93.4%)	181 (91%)	60 (75%)	241 (86.1%)
ATP-30 Sum of scores S ± SD	111.7 (±15.5)	110.5 (±7.2)	111.3 (±13.3)	106.9 (±13.8)	108.8 (±11.9)	107.3 (±13.4)

Table 2.  First choice for students' future field of specialty

		PBL program (Medical Faculty of Hamburg University)			Traditional program (Medical Faculty of Duisburg-Essen University)
Rank	Field of specialty	Desired field of specialty (n = 53)	Rank	Field of specialty	Desired field of specialty (n = 219)
1	Pediatrics	26.4% (n = 14)	1	Surgery	20.1% (n = 44)
2	Internal medicine	15.1% (n = 8)	2	Pediatrics	17.4% (n = 38)
3	Surgery	13.2% (n = 7)	3	Anesthetics	8.7% (n = 19)
4	Gynecology	9.4% (n = 5)	4	Gynecology	7.8% (n = 17)
4	Neurology	9.4% (n = 5)	5	Internal medicine	5.9% (n = 13)
5	Psychiatry	5.7% (n = 3)	6	Neurology	5.5% (n = 12)
5	Orthopedics	5.7% (n = 3)	7	Psychiatry	5% (n = 11)
5	General medicine	5.7% (n = 3)	7	General medicine	5% (n = 11)
		*Others: (<5%; n = 5)	7	Orthopedics	5% (n = 11)
					Others: (<5%; n = 43)

Note: *Others (desired field of specialty <5%).

Table 3.  Attitudes of medical students towards psychiatry (ATP 30) according to gender and psychiatric experience

University	Statistical values	Comparison groups		Significance
		Female students	Male students
PBL program (Medical Faculty of Hamburg University)	n/percent ATP-30 sum of scores SD	37/65%	20/35%	n.s.
		111.7**	110.5**
		13.7	12.8
		With*	Without*
	n/percent ATP-30 sum of scores SD	Previous psychiatric experience		n.s.
		28/49%	29/51%
		110.4**	112.2**
		16.9	8.7
Traditional program (Medical Faculty of Essen-Duisburg University)	n/percent ATP-30 sum of scores SD	Female students	Male students	p < 0.001
		152/63%	89/37%
		110,3**	102.2**
		12.5	13.2
		With*	Without*
	n/percent ATP-30 sum of scores SD	Previous psychiatric experience		p < 0.002
		96/39%	149/61%
		110.5**	105.4**
		14.0	12.6

Note: Responses expressed as percentage (*Do you have any previous psychiatric experience (e.g. clinicaltraineeship, night watch, personal experience, mentally ill relatives, etc.?), ATP-30 sum of scores (**30 = very negative attitude; 150 = very positive attitude; S = sum values; SD = standard deviation).

Table 4.  Correlation of attitudes towards psychiatry (ATP-30 sum of scores) with the personality field, openness and agreeableness (NEO-FFI means) from students of the PBL curriculum in Hamburg and of the traditional curriculum in Duisburg-Essen

	PBL curriculum Medical Faculty of Hamburg University (n = 57)	Traditional curriculum Medical Faculty of Duisburg-Essen University (n = 240)
ATP-30	Attitudes towards psychiatry	Attitudes towards psychiatry
NEO-FFI
Openness to experience	r = 0.518*, p ≤ 0.0001	r = 0.245*, p ≤ 0.0001
Agreeableness	r = 0.575*, p ≤ 0.0001	r = 0.268*, p ≥ 0.0001

Note: r = Pearson's Product Moment Correlation, p = level of significance, NEO-FFI-Scale: 0 = strongly disagree, 4 = strongly agree, ATP-30: five-point Likert Scale with 1 = strongly agree and 5 = strongly disagree/ATP-30 sum of scores: smallest negative value = 30, highest positive value = 150; *direction of correlation: the higher openness to experience/agreeableness the more positive attitudes towards psychiatry.

Table 5.  Students' personality dimensions based on the NEO-FFI (Score: 0 = strongly disagree, 4 = strongly agree, M = means, SD = standard deviation)

	PBL curriculum (Medical Faculty of Hamburg University)	Traditional curriculum (Medical Faculty of Duisburg-Essen University)
	n = 57	n = 245
NEO-FFI-scale	M/SD	M/SD	p
Neuroticism	1.66/0.60	1.66/0.66	n.s.
Extraversion	2.48/0.47	2.50/0.51	n.s.
Openness to experience	2.82/0.47	2.56/0.51	<0.0007
Agreeableness	2.74/0.49	2.56/0.48	n.s.
Conscientiousness	2.65/0.56	2.69/0.57	n.s.

Table 6.  Coefficient of correlation of the attitudes towards psychiatry (ATP-30 sum of scores) with the items, working in psychiatry and interest in psychiatry and students' probability of working in psychiatry and their personal interest in psychiatry as a subject

		Study participants
Topic	Statistical analysis	PBL program (Medical Faculty of Hamburg University) (n = 57)	Traditional program (Medical Faculty of Duisburg-Essen University) (n = 245)
Choice of profession	Probability of working in psychiatry in the future? Mean/SD	4.8*/1.9	5.3*/2.3
	Correlation: ATP-S/Probability of working in psychiatry	| r | = 0.50 (p < 0.0001)**	| r | = 0.59 (p < 0.0001)**
Interest in specialty	Personal interest in psychiatry as a subject? Mean/SD	2.5*/1.3	3.3*/2.1
	Correlation: Personal interest in psychiatry as a subject/Probability of working in psychiatry	| r | = 0.50 (p < 0.0001)**	| r | = 0.59 (p < 0.0001)**

Note: (r = Coefficient of correlation based on Pearson, p = Level of significance); Probability of working in psychiatry (‘How probable is it that you will work in the field of psychiatry in the future?’) and Personal interest in psychiatry as a subject ('Please rate your personal interest in psychiatry as a subject’) (*Visual analogue scale: 0 = very probable/very high; 8 = very improbable/very poor; SD = standard deviation). **Direction of correlation: the better the attitude towards psychiatry (ATP), respectively, the higher the interest in the subject, the higher the possibility to work in psychiatry.