These data suggest that during the OPEC experiment, attitudes towards psychiatry improved significantly, even in an already favorably disposed group. Presumably, the large effect size occurred not only due to the high quality instructors the students were exposed to, but possibly also due to exposure to others with a common interest, giving perhaps a sense of community by being surrounded by like-minded individuals. . These improvements regressed 2–3 years later, although they still tended to be higher than the scores before OPEC started and the scores of non-OPEC students who had completed their externship. In addition to adding the longitudinal outcome of participation in an enrichment program that few previous studies have tracked, these data build on that by illustrating the outcomes of selecting participants who already have high interest. early in their career, as opposed to selecting those who might be more undecided. Additionally, unlike previous evaluations of other enrichment programs, this data also highlights the outcomes of those who were not selected for the program (either because they applied and were not selected , or because they did not apply). To our knowledge, this is the only study of enrichment programs that has tracked this type of data. Approximately 5% of Ottawa learners who did not apply to OPEC were still matched to Psychiatry, which is comparable to historical CaRMS match rates . Additionally, unlike other research on such enrichment programs, a comparison can be made between the attitude changes of OPEC participants and a standard group of day school students, and illustrates that even with a pre-determined high interest, further improvements in attitudes toward psychiatry could be seen with OPEC. (although they declined over time), which were beyond the improvements seen with a ‘standard’ clerkship experience for those who were presumed to have less pre-determined interest.
These data suggest that the selection process did select candidates for OPEC who had a very favorable attitude toward psychiatry, as expected. While OPEC was designed to further improve attitudes toward psychiatry, it is also possible that a social desirability bias contributed to the significant increase in ATP-30 scores after OPEC. Although reassured about the anonymity of the survey, students may have thought that reporting more “positive” attitudes toward psychiatry made them more “desirable” candidates for residency. . Clinical clerkship has been shown to improve attitudes toward psychiatry among medical students  and was also observed in these data. Previous work, however, has identified a breakdown in attitudes toward psychiatry during the latter part of clerkship after medical school. [24,25,26]and was also seen with these OPEC graduates during the CaRMS match.
Almost half (43%) of Ottawa OPEC graduates were matched to psychiatry two or three years later. These results are comparable to the results of learners enrolled in other enrichment initiatives such as the Claasen Institute (36%) and the Psychiatry Institute of Toronto (43%) [15, 16]. Of the total 23 students who were matched to psychiatry from this 2-year cohort of 313 students from Ottawa, 15 out of 23 students (65%) never applied to OPEC. These data suggest that for 8/23 students, interest in psychiatry appeared earlier hence their interest in applying to OPEC, while for the other 15 students, possibly, their interest developed later. in their medical career. However, it is not clear if these students were able to participate in any other enrichment program such as the Psychiatry Institute of Toronto (the only other program advertising nationally to students). Also, it is possible that some Ottawa students did not apply due to the novelty of OPEC, as they may not have known enough about OPEC or may not have been some of his credentials. Moreover, it is possible that these students were not interested or had competing obligations. Further work could also be considered to improve selection procedures, since only a third of Ottawa students who have been matched to psychiatry have been identified by OPEC.
Strengths of our study include the inclusive nature of our longitudinal follow-up with a high response rate (96%) after the CaRMS match, and the availability of clerkship class comparison data. Unfortunately, however, just under half of clerkship classes completed ATP-30 before and after clerkship, perhaps introducing bias.
Limitations of this study include the small sample size. Therefore, caution should be exercised in interpreting these results, even though the recruitment results for residency programs are consistent with those for other enrichment programs and highly significant. Additionally, it is unclear whether students who did not fit psychiatry may have ranked psychiatry first but were not selected. Anecdotally, an OPEC graduate mentioned ranking 3 psychiatry programs before she was finally matched to her 4and choices in family medicine. As an additional observation, of the 13 students who came to OPEC from outside Ottawa and were matched, none were matched with Psychiatry in Ottawa. These data therefore suggest that enrichment programs may be more successful in attracting internal applicants to internal programs than in bringing external applicants to such a program, although the numbers are small, caution in the interpretation is therefore warranted. Additional longitudinal tracking would be ideal, as 6 students matched in 2019, while 17 matched in 2020; this can increase bias because the majority of tracked applicants were matched within a year. It is also unclear whether these students who were not followed would be significantly different from the students who completed the follow-up questionnaires. Ideally, all clerkship students would also complete the ATP after matching in CaRMS, but unfortunately this was not possible. Such results could help determine the extent to which attitudes might be predicted to deteriorate after clerkship and could help understand whether enrichment programs like OPEC might “raise the floor” on such patterns of deterioration in attitudes. attitudes among students endorsing early career interest. The 2021 CaRMS match, however, is different than any other match in previous memory due to the impact of COVID-19 (e.g. no national choices).
Psychiatry as a field has become more popular, as evidenced by recent increases in the number of students matching psychiatry residency programs in the United States and Canada. [9, 27]. In Canada, the percentage of medical students matched to psychiatry was 7.5% in 2020 . 2020 was the first year that 100% of psychiatry positions in Canada were filled by the 1st iteration. A possible contributing factor is the emergence of several enrichment programs. As of 2017-18, UBC, McMaster, and Western had also launched their own enrichment programs, although these were primarily only open to local medical students. . Together with Ottawa and Toronto, this represents 5/17 (29%) of medical schools in Canada. In the future, it could also be useful to offer such programs to French-language schools in Canada. Such programs could be seen as not only increasing but also maintaining interest in psychiatry, as students who apply already identify an early interest. It may also be incumbent on departments to examine disincentives to psychiatry, since these and other data suggest deterioration in attitude and interest over 2-3 years. The improvements observed with this data can also be useful for educators, since participation in such a program consumes significant human resources in terms of time commitment. An enrichment program is more likely to be effective with quality speakers and supervisors. These teachers may be more likely to participate knowing that their efforts in such a program are changing the attitudes of those involved, and high quality instructors and mentors have been highlighted to be helpful in recruitment. [10, 28].
Psychiatry, more than other specialties, is subject to stigma, both from patients and from our colleagues , which threatens recruitment. As we accelerate further into a world of virtual education, the incorporation of videoconferencing software may be beneficial in future OPEC or similar enrichment sessions. In addition, the Ontario Telehealth Network (OTN), a provincially funded clinical telehealth portal, is widely accessible in Ottawa and could be used for the OPEC observation component. Pre-recorded sessions could also be available for students after OPEC, potentially enhancing its capacity for longitudinal impact. Reminder or “birthday” emails, similar to similar notifications on social media, can also serve to jog students’ memories of the OPEC experience, to possibly reinvigorate steps toward interest. for psychiatry. More robust programs such as the UK’s PEEP program offer insight into the possibilities of sustainably improving attitudes towards psychiatry with ongoing contact with preceptors, but some schools may not have such resources to devote to learners. Perhaps some sort of middle ground with an enrichment program added to the aforementioned considerations might be more broadly feasible and part of a larger strategy to increase interest in psychiatry both as a field of medicine and potentially as a career for more medical education programs. . Overall, the long-term implementation of enrichment programs may be helpful in exposing students early in their careers to role models in psychiatry, and perhaps along with other measures could foster development. student/mentor relationships that have been suggested as helpful for recruiting . Given the COVID climate and the difficulty for students to travel for external electives, we urge psychiatric educators to consider more innovative approaches to help improve field recruitment.