Early, Consistent Exposure to Psychiatry Attracts More Medical Students to the Field

At the Florida International University (FIU) Herbert Wertheim College of Medicine, medical students are introduced to psychiatry—and to the value of mental health as a part of overall quality medical care—from day one.

Daniel Castellanos, M.D., says a key to FIU’s success in attracting students to psychiatry is a positive “hidden curriculum” in which students observe psychiatrists integrated with other physicians in educational and practice settings.

“The principle of ‘no health without mental health’ is codified throughout our curriculum,” Daniel Castellanos, M.D., founding chair of the college’s Department of Psychiatry and Behavioral Health, told Psychiatric News. “We have endeavored to create a culture where psychiatry is accepted as an integral part of quality medical care, and our students are exposed to faculty psychiatrists throughout all of their clinical rotations.”

Such exposure throughout the four-year program has yielded results: this year, 10 percent of FIU’s graduating class of 80 medical students entered psychiatry residency programs around the country. Last year, 9 percent of the school’s graduating class entered psychiatry. These numbers are especially impressive for a fairly new school—the medical college and Department of Psychiatry and Behavioral Health were founded in 2008—that has yet to achieve wide name recognition and only received Accreditation Council for Graduate Medical Education approval for its residency program in psychiatry in February.

At the 2014 meeting of the Association of American Medical Colleges (AAMC), Castellanos and colleagues presented a poster outlining the school’s strategy, including a curricular emphasis on social determinants of health, the impact of behavior on health, and the involvement of faculty psychiatrists in all aspects of medical school curriculum planning, development, and implementation.

“Our students’ exposure to psychiatry faculty begins with a unique professional behavior course required of all students in the first and second year—‘How to Be a Doctor’—that teaches students about bedside manner, empathy, and how to deliver bad news,” Castellanos told Psychiatric News, noting the majority of faculty teaching the course are psychiatrists.

First- and second-year students are also required to take courses in clinical skills, professional behavior, and neuroscience—all of which involve psychiatry faculty working closely with primary care and specialty physicians. Psychiatry faculty participate as core faculty in longitudinal, case-based courses and as consultants in case development in years 1 to 3. Additionally, psychiatry has been integrated into all of the medical college’s faculty group practice sites.

“As a profession we know we need to integrate with our primary care colleagues, and at FIU we are always moving in that direction,” Castellanos said.

The school also provides a unique community-based service/learning program involving psychiatry faculty who work closely with other primary care and specialty physicians in underserved areas in Florida. FIU’s residency program in psychiatry will be the first to be operated out of a Federally Qualified Health Center, in partnership with a local community mental health center.

Every year only a small number of schools reach the 10 percent mark for graduating seniors entering psychiatry. According to the 2013-2014 APA Resident Survey, last year the University of Puerto Rico and Brown University School of Medicine each had 11 percent of its graduating 2013 class enter psychiatry residency programs, followed by Creighton University School of Medicine in Omaha, Neb., and Texas Tech’s Paul L. Foster School of Medicine at 10 percent.

In terms of numbers, the top schools of graduation for PGY-1 psychiatry residents were Baylor College of Medicine with 15 seniors choosing to enter psychiatry, followed by Brown and Creighton, each with 12.

Past interviews with psychiatry department chairs at schools that have achieved the 10 percent mark for graduating seniors into psychiatry reveal the same winning strategy: early, consistent exposure to lively and passionate psychiatric faculty and an emphasis on presenting psychiatry as an integral part of overall quality medical care.

Castellanos emphasized that key aspects of the implementation process at FIU included buy-in from curricular leaders and “a welcoming, inclusive attitude from all faculty.”

He said the psychiatry clerkship has consistently been rated highly by students and received the “Clerkship of the Year” award from the college’s first graduating class. And there has been a payoff, too, in student performance: Shelf exam scores for psychiatry have been consistently high at FIU compared with other clerkships, and United States Medical Licensing Exam (USMLE) Step 1 scores in behavioral sciences were 0.7-0.8 standard deviation above the national mean for the school’s first two graduating cohorts.

“Our lessons learned imply a benefit from integrating the teaching of behavioral concepts throughout a medical school curriculum and ensuring early inclusion and visibility of psychiatrists in the curriculum,” Castellanos said. “We feel that a receptive attitude on the part of leadership and nonpsychiatric faculty has developed a positive ‘hidden curriculum’ in which students observe psychiatrists integrated with other physicians in all of our educational and practice settings. This in turn has led to an atmosphere in which students do not perceive any stigma among their colleagues and mentors about selecting psychiatry as a career.” ■