Medical Students' Attitudes Toward a Career in Psychiatry: A Realist Evaluation.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.