Excellence in teaching

To start with, the focus should be on students’ experiences of psychiatry teaching in the classroom or lecture setting. Many students fed back that they would like psychiatry content to be more prominent earlier and throughout the course. Not only would this reflect how psychiatry is an integral part of medicine (rather than just an add-on), but it would allow students to explore at an earlier stage their potential interest in helping patients recover from episodes of mental illness.

A widely held view was that learning in ‘real-life’ contexts should be further promoted, through simulation teaching, learning videos, case-based discussions, testimonies from people with lived experience as patients or carers, and lectures involving a panel of psychiatrists working in a range of subspecialties. The ‘living library’ initiative outlined later in this article is an example of this.

Students also highlighted the importance of accentuating how psychiatry is unique in its integration of science with a whole-person approach, and the role it has in driving the most exciting medical advances to transform treatments and foster overall health and well-being globally.

High-quality placements

Providing high-quality psychiatry placements is an intuitively sensible way to increase the number of students interested in it as a career. Of the 792 students who participated in our survey, 52.2% said they were more inclined to choose psychiatry after their placement.

But what does a good placement look like? Fig. 1 illustrates a few components of medical students’ experiences of psychiatry placements.

Fig. 1 Students’ experiences of placements in psychiatry. A total of 792 students throughout the UK completed the survey. Note: it is rare to find undergraduate settings providing opportunities for undergraduates to offer talking therapy to patients under supervision, as students may not have received enough training to be able to deliver this. Source: unpublished survey run by the Royal College of Psychiatrists between 15 October 2018 and 7 January 2019.

While there is no singular ‘best’ model for placements, students did report aspects that were more positive.

They particularly enjoyed the variety of experiences provided by psychiatric placements, in contrast to other specialties. Appeal also lies in the ability to talk to patients, more so than in other placements, and learn their history in greater detail. Some medical schools have set up longitudinal placements to provide the opportunity to follow patients during several weeks and observe the longer-term benefits of psychiatric interventions.

Introducing medical students to patients and clinicians in extreme environments such as prisons or secure hospitals arguably has a larger impact on improving attitudes to psychiatry. Archer et al^{Reference Archer, Guliani, Johns, McCartney, Smith and Ross1} showed that a single-day visit to Broadmoor Hospital, a high-security psychiatric hospital in Berkshire, was effective in changing the attitudes of medical students towards forensic psychiatry, with 75% of participants stating that their attitude towards psychiatry had improved.

There is a common stereotype of psychiatrists working alone with patients. To combat this, students need to meet all members of the multidisciplinary mental health team. This will ensure that they understand how extensively professionals from a range of disciplines work together to treat patients’ needs holistically.

Students need to understand how psychiatric care fits into the healthcare system and see for themselves the high level of need. One way to do this would be for psychiatric placements to be better combined or coordinated with placements in other specialties and vice versa. The students would be able to (a) witness the interactions between general practitioners (GPs), doctors from other specialties and psychiatrists, (b) understand the benefits of integrated psychiatric care and (c) gain further skills in psychiatry, which will be helpful whatever specialty they end up choosing.

How can medical schools help students make the most of their placements? Some students said that they would like to feel better prepared before starting their placements in psychiatry. Budd et al^{Reference Budd, Kelly, Day, Variend and Dogra2} had previously suggested that this is important, particularly addressing their potential fears and negative perceptions of the specialty. The RCPsych's Choose Psychiatry guidance for medical schools includes suggestions of what inductions might cover based on feedback from students, including: basic guidance on the type of symptoms to expect from patients with different illnesses and how they should respond; a briefing on procedural issues involved in working in psychiatric settings, including health and safety; and information on how a placement in psychiatry might affect their own emotions and mental health (www.rcpsych.ac.uk/become-a-psychiatrist/choose-psychiatry).

Medical students also said that they need reassurance about getting adequate mental health and well-being support. Some medical schools have set up Balint groups to provide a safe space for students to discuss their emotional reactions to their patients’ experiences. These should be supported and further expanded where possible.

Leadership from psychiatrists

Everyone can remember someone who inspired their career choices. Medical students highlighted the importance of talking to inspiring consultant psychiatrists and trainees during their time at medical school. Some suggested that medical schools could create a ‘bank’ or database of psychiatry mentors.

To raise the profile of psychiatrists in undergraduate education, the RCPsych encourages medical schools to reflect on whether their senior leadership teams are composed of a multispecialty and diverse group of individuals, including psychiatrists, so that students can see them in leadership roles.

Psychiatrists’ progressive and thoughtful leadership could play an integral role in driving the strategic direction of medical schools. The RCPsych advises medical schools to ensure that psychiatric education is designed and led by psychiatrists with both clinical and educational expertise, and that students are presented with up-to-date research in psychiatry throughout the medical curriculum.

Enrichment activities

How can you help immerse students in psychiatry? Many medical schools have implemented enrichment activities to enhance students’ exposure to and experience of psychiatry, which are highly valued by the medical students we talked to.

Psychiatry societies (‘PsychSocs’) are student-led university societies set up to raise the profile of mental healthcare among medical students and to promote careers in psychiatry. Several next steps are recommended both locally and nationally to take advantage of PsychSocs to improve recruitment into psychiatry – including fostering enthusiastic mentoring by local psychiatrists via ‘buddy schemes’ and continuing to share ideas and learning across the country, as explained by Pandian et al^{Reference Pandian, Mohamedali, Chapman, Vinchenzo, Ahmed and Mulliez3} earlier in 2020.

The Psychiatry Early Experience Programme (PEEP) provides medical students with the opportunity to shadow core trainees in psychiatry. This initiative was developed by South London and Maudsley NHS Foundation Trust and King's College London Medical School. Given the success of the scheme, students asked for improved availability and access to such schemes.

Special study modules (SSMs) or student-selected components (SSCs) in a psychiatry-related subject are short courses and/or projects in subjects that students can select according to their personal interests. They offer opportunities to learn in innovative ways and have been recommended by the General Medical Council.

Career enrichment courses (often referred as summer, autumn or winter schools) offer an intensive programme of lectures, seminars, debates and networking opportunities to students who are considering a career in psychiatry.

Psychotherapy schemes give medical students the unique opportunity to deliver psychotherapy to one patient for an extended period. Yakeley et al^{Reference Yakeley4} highlighted that projects that involve medical students offering psychodynamic therapy (under the close supervision of staff) have contributed to an increase in the number of students choosing psychiatry as a career.

Extra-curricular initiatives to give students further opportunities to spend time with people with mental illness are also being developed across the country. The Time for Dementia initiative is an example of collaborative work that has had a demonstrable impact on students’ understanding of people with dementia.

Other schemes offered by the RCPsych that can be promoted to medical students include the Psych Star scheme, Student Associate membership, and Divisional and Faculty prizes.

A ‘living library’

Greater Manchester Mental Health NHS Foundation Trust decided to use an innovative approach based on the ‘living library’ concept, where experienced clinicians working in their respective fields (‘the books’) were available ‘on loan’ to students (‘the readers’). This was implemented to improve the student experience, enrich students’ learning, provide them with an insight into other professions, encourage the sharing of institutional knowledge and develop interprofessional learning.

The concept is designed to build a positive framework for conversations that can challenge stereotypes and prejudices through dialogue. It is based on the idea of interprofessional learning (defined as ‘when professionals learn with, from and about each other’) that has been identified as an innovative strategy that can help bolster the medical workforce.⁵ Literature reviews suggest that learning with, from and about other healthcare students has the potential to improve communication between professionals and, ultimately, care for patients.^{Reference Reeves, Perrier, Goldman, Freeth and Zwarenstein6}

Figure 2 depicts the book covers that were designed and displayed for students to help decide which ‘book’ they wanted to borrow.

Fig. 2 Living library book covers, designed by Lorna Dawson, Greater Manchester Mental Health NHS Foundation Trust.

In total, 25 living-library cards were made available to students on placement within the trust.

After signing up to the library and reviewing potential book choices, all readers were given a library card and were invited to reserve one of the books at a slot during the morning. There were six slots available throughout the day and readers would have around 20 min with each of their books. In theory, each reader could have conversations with six of the nine books.

In total, 22 readers booked places on the event, 13 of whom attended. Figure 3 shows which disciplines were the most popular and Fig. 4 describes what attracted the readers to them. Figures 5 and 6 show the impact of the initiative on readers’ views about both professions and the benefits of interprofessional practice.

Fig. 3 Responses of students (n = 13) to the question: ‘Which living book(s) did you read?’.

Fig. 4 Responses of students (n = 13) to the question: ‘What attracted you to the living book(s) you selected?’.

Fig. 5 Responses of students (n = 13) to the question: ‘Do you feel that your experience at the living library changed your views about another profession?’.

Fig. 6 Responses of students (n = 13) to the question ‘Has the living library changed your views about the benefits of interprofessional practice?’.

After the event, 9 (69%) of the 13 respondents rated their overall experience of the living library as ‘Excellent’ and 4 (31%) as ‘Good’; 100% of respondents would recommend living books to others; 11 readers (85%) strongly agreed that the living library was a good way to challenge prejudices and encourage interprofessional learning, with the other 2 (15%) also agreeing with this.

I'm a Medic Get Me Out of Here

I'm a Medic, Get Me Out of Here (shortened to I'm a Medic) is an online, student-led outreach programme, funded by Health Education England and designed to provide equality of opportunity for all school students to engage with the National Health Service (NHS) workforce. The aim is to help inform schoolchildren about a particular career and let them explore whether that career could be for them. The idea is based on research showing that young people start to develop their career aspirations early in secondary school, if not earlier.^{Reference Chambers, Kashefpakdel, Rehill and Percy7,Reference Blenkinsop, McCrone, Wade and Morris8} Findings from a survey with over 20 000 children showed that parents (and parents’ friends), the TV and media were most likely to influence children's career aspirations. Less than 1% of children had heard about the jobs through people coming to their school.^{Reference Chambers, Kashefpakdel, Rehill and Percy7}

I'm a Medic was trialled in psychiatry for the first time in 2019. With supervision from teachers, schoolchildren had secure access via a website to healthcare professionals, who answered questions in real time during a 30-min lesson. An online moderator was available for each chat. Pupils could also post a question to be answered at a later stage.

Three healthcare workers took part as individuals: a consultant psychiatrist (N.H.), a mental health nurse and an NHS mental health trust's head of human resources, responsible for managing and advising a wider team. Four healthcare teams based in various locations across England took part as a group: an arts therapy team, an early intervention team, a home treatment team and a psychiatry ward team.

Students were mainly in year 8 (generally 11.5–13 years old) from schools across England. A total of 47 classes from 20 schools participated in 40 live chats. Over 1000 students logged in, with approximately 85% participating in live chats, asking questions or leaving comments. Students could vote for who they felt they most engaged with and who answered their questions to their satisfaction. Figure 7 depicts the words most often used by students in these conversations.

Fig. 7 Frequent words used by schoolchildren in live online chats in the I'm a Medic, Get Me out of Here programme. The size of the word represents its popularity.

Students often asked what led healthcare workers to choose their jobs. They would, for instance, ask questions such as ‘What encouraged you to take this job?’ or ‘What inspired you to start what you've done?’.

They also asked healthcare workers about their qualifications and the qualifications they would need to attain certain roles in the sector. These were mostly focused on GCSE qualifications, as opposed to A-Levels.

When discussing mental illnesses, students focused heavily on more commonly known illnesses such as depression and anxiety, including how to discuss or treat them.^{Reference De Witt9}

During focus groups, students fed back that they particularly enjoyed the ability to interact directly with healthcare workers, in real time and in a ‘conversational’ way. Being able to vote also contributed to the engaging nature of the experience.

Additionally, interacting online provided some distinct advantages that face-to-face interactions might not provide. The first one is the ability for children in remote areas to interact with professionals who may not have visited the schools in person. Second, students often appreciated the opportunity to ask questions anonymously without being judged by their peers:

This benefit was also highlighted by their teachers:

Data also suggest that the personal and direct nature of the experience helped achieved the desired impact:

Fifty responses were collected through a post-survey questionnaire. 82% of the children (n = 41) agreed/strongly agreed that they had learnt more about ‘what it's like to work in healthcare’ and felt that they knew more about what they would need to study to get their ideal job; 66% (n = 33) agreed that they might get a job working in healthcare, and 60% (n = 30) said that they would enjoy working in healthcare. This is an increase from the pre-survey, with responses to those questions being 43% and 45%, respectively.^{Reference De Witt9}