Professional Report

Due to the psychiatry teaching module being organised and taught predominantly by psychiatrists in

clinical practice, the summary has been developed in the format of a brief professional report.

Investigating third year medical students’ racial and mental health attitudes

Importance of the Study

Given that education holds a key role in anti-stigma, and the increasing ethnic and cultural diversity in

the United Kingdom [UK] (Office of National Statistics, 2012), medical students regardless of their

future speciality will inevitable treat BME patients with mental illness. Therefore, understanding medical students’ conceptualisations of mental illness and their racial and mental health biases

towards mental health patients is important for tackling healthcare inequalities in later practice.

Study’s Aims

The aims of this study were (a) to investigate third year medical students’ racial and mental health

attitudes across Black and Minority Ethnic (BME) and non-BME mental health vignettes, ( b)

examine how students conceptualise mental illness, and (c) explore the relationship between mental

health attitudes, conceptualisations of mental illness and clinical communication with simulated

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Participants

All third year medical students were invited to take part. Student’s data was collected at the start of

the first and final lecture of their introductory psychiatry module and during the OSCE. During the first lecture 201 students took part, of which 102 students were from a BME background and the

remaining 96 students were non-BME. At the final lecture 141 participated, of which 63 students were

BME. Only 114 students completed the questionnaires at both lectures.

Methodology

Students were randomly given either a vignette of a BME or non-BME patient with probable

schizophrenia, and were asked to complete the attached questionnaire pack in relation to the vignette.

The questionnaire pack looked at students’ levels of previous contact with mental illness, willingness

to socially interact with people with mental illness (social distance), perceived likelihood that people

with mental illness would be devalued and discriminated against by society (perceived stigma in

others), conceptualisations about the causes of mental illness; and students’ explicit racial attitudes. A

web-link to the on-line Implicit Association Test (IAT) was also sent to students to complete. Data

collection was repeated six weeks later at the final-psychiatry lecture. Students’ ability to respond to

and communicate with a stimulated patient with depression was also collected during the OSCE.

Findings

 Overall students were ‘probably willing’ to interact with mental health patients.

 Students’ willingness to interact socially with mental health patients were not affected by student’s racial attitudes or if they were given a BME or non-BME vignette.

 Students with no or limited previous contact with people with mental illness were less willing to interact socially with people with mental illness.

 BME students were less willing to interact socially with people with mental illness in comparison to non-BME students before and after the teaching module.

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 Students were able to account for both psycho-social (e.g. Mental illness is a response to traumatic or distressing early experiences’) and biological (e.g. The way in which a person

thinks about themselves and the world is affected by genetic abnormalities) explanations for causes of mental illness. Students’ agreement for a bio-psycho-social model to explain mental

illness increased further after the teaching module.

 Students who agreed highly with psycho-social factors causing mental illness were less willing to socially interact with people with mental illness.

 Students’ overall willingness to socially interact with mental health patients did not change significantly after the teaching module.

 Students’ mental health attitudes did not influence how students responded to mental health patients at the OSCE.

Future Recommendations

To reduce the potential for biases to influence patient care, it is important that their medical training provides educational resources and skills that foster medical students’ awareness of and ability to curtail the processes that lead to the activation and use of biases when they interact with mental health patients. This can be done through the following:

 Exploring and understanding attitudes and biases of mental illness when students come from different cultures and ethnicities, by routinely offering cultural psychiatry teaching that looks at cultural variations from the clinicians’ perspective.

 Ensuring that students gain contact with mental health patients during their clinical placement that is supported by the institution, adequate in duration and frequency, and consists of high levels of intimacy, co-operative and equal status interaction, and include frequent contact with recovered individuals or individuals who mildly disconfirm to the

stereotype of mental illness.

 Ensuring that the teaching provides students with an array of models to conceptualise mental illnesses and to support students to develop skills to challenge biases associated

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with holding a higher agreement with psycho-social causal factors of mental illness. This

can be achieved through the implementation of practical skills put forward by Stone and

Moskowitz (2011). These skills included counter-stereotypical information about a patient, viewing a patient as having several social identities rather than one stereotyped identity, taking the patient’s perspective, and seeing patient care as representing

opportunities to put into practice one’s goal of helping others.