Introduction

Despite substantial change in undergraduate medical education over the past two or three decades, in terms of student demographics, teaching methods and curriculum content, this has had little effect on recruitment into psychiatry in the UK, the rate remaining consistently at 4–5% of British medical graduates (Goldacre et al, 2005).

It is well established that undergraduate experience is of primary importance in influencing career choice (see Chapter 20), but when and why medical students become dissuaded from choosing psychiatry, having been at worst neutral before admission to medical school (Maidment et al, 2003), has still to be elucidated. A number of studies (e.g. Malhi et al, 2002; Brown et al, 2007) suggest that several factors operate during the undergraduate years that may reduce the likelihood of a student choosing psychiatry as a career. However, few inferences can be drawn from these studies, as they either offer ‘expert opinion’ (i.e. views from within the profession) or are surveys overtly conducted by psychiatrists, which may have influenced respondents.

While undergraduate experience may shape the basis of career choice, postgraduate experience appears to act as an important modifying influence; traditionally, psychiatry gained recruits within the early postgraduate years, which suggests that the balance of influencing factors changes, perhaps owing to positive and negative practical work experiences, opportunity or personal circumstance (Goldacre & Lambert, 2000). This is partly reassuring,though concerns have been raised recently about the impact that the more streamlined specialist training scheme may have on psychiatric recruitment. On the one hand, limiting potential experience by requiring an earlier specialty choice may reduce postgraduate gain. Alternatively, foundation programmes could improve recruitment, through trainees working in specialties that they may not otherwise have considered as a career.

It is therefore important to establish which factors encourage and discourage trainees into and from psychiatry, when these become influential and whether foundation experience improves recruitment. Establishing these factors should help to guide changes within the undergraduate and early postgraduate years that are required to improve psychiatric recruitment.