Factors or Reasons Influencing The Choice Of Psychiatry as a Medical specialty Among Postgraduate Psychiatry Trainees

Introduction

The following research has aimed to evaluate the influential factors that affect the decision of opting for psychiatry as a medical specialty. The research underpinned the case of post-graduate trainees residing in Scotland and to serve the purpose, the questionnaire was sent to 278 participants, however, only 83 responded to the assertion. Hence, the response rate has been calculated to be 30%. Considering this aspect, the following section is dedicated to a meticulous analysis of the factors. The analysis includes an assessment of the reliability of the variables using Cronbach Alpha. It also includes descriptive statistics for the comprehension of the general characteristics along with demographic variables. In furtherance, to evaluate the most influential factors in each category including financial, family, psychiatry as an interesting subject, rewarding aspects of working in psychiatry, societal factors, and personality factors, factor analysis has been used. To further substantiate the analysis, a comparative analysis has been conducted to explore the differences in the factors based on gender, MRCP, training stage, and psychiatry placement. 

Reliability Testing

Since the questions related to all the factors were based on the Likert scale, therefore, Cronbach Alpha has been used to determine the reliability of the 5-point Likert scale. The result of all the factors except for personality factors has been mentioned as follows:

Table 1: Reliability Analysis- 1

Concerning the results in Table 1, it has been found that the Cronbach Alpha statistics are computed to be 0.765. The study carried out by Leech, Barrett, and Morgan (2016) asserted that the minimum acceptable value is 0.7. Therefore, the results in Table 1 are acceptable as they are above the threshold. Considering the personality factors, the Cronbach Alpha is computed to be 0.907 which is presented in Table 2. It depicts the extreme reliability of the factors based on the 5-point Likert scale.

Table 2: Reliability Testing-2

Demographic Characteristics

In this section, the general characteristics have been analyzed, for instance, gender, age, place of medical qualification, and others. In terms of Table 3, most of the respondents fall in the age group ranging from 20 to 34 years with 53% concentration. Regarding gender, the results of Table 4 illustrate that 62.2% of females participated in this study. Moreover, Table 5 is illustrating that 91.6% of the participants acquired their primary medical qualification from the UK while 3.6% acquired it from Asia. In addition, Table 7 illustrates that 62.7% of the respondents hold MRCP while 37.3% did not. Moreover, according to Table 8, 74.7% of the respondents work full time. Table 9 depicts that 55.4% are at the core psychiatry training stage. According to Table 10, 71.7% had psychiatry training in the first foundation year. However, in terms of the decision-making stage, 43.4% decided in the foundation stage to opt for psychiatry as a medical specialty and the results are depicted in Table 11.

Table 3: Age of the Respondents

Table 5: Place of Primary Medical Education

Table 6: Membership of MRCP

Table 7: Work Type

Table 8: Training Stage

Table 9: Psychiatry Placement

Table 10: Decision Stage

Descriptive Statistics

In descriptive statistics, mean and standard deviation has been computed concerning each factor. In terms of financial or personal factors, the results have been depicted in Table 11. Most of the responses are inclined towards quite important to quite unimportant because the values are near 3 and approaching 4 while the standard deviation is minimal.

Concerning the results obtained in Table 12, it has been found that mean values near 4 and 5 are indicating a neutral response to unimportant responses, and values near 3 are indications quite important in the case of family or personal factors.

Table 13 illustrates that most of the responses are near 2 which is indicating that they are quite important. Even in the case of factors associated with psychiatry as a subject, the standard deviation is minimal.

Table 14 illustrates that most of the responses are near 2 which is indicating that they are quite important. Even in the case of factors associated with rewards, the standard deviation is computed to be lower.

The social factors are found to be seemingly less important than other factors based on mean values as depicted in Table 15.

In terms of Table 16, most of the respondents are inclined to state that personality factors are important. In this case, the deviation is minimal as found in other cases as well.

Factor Analysis

To determine which of the factors are significantly important that affect the decision to opt for psychiatry in the case of Scotland, factor analysis has been used. This section presents the key results concerning each main factor. The analysis has been conducted based on financial, family, and psychiatry as interesting subjects, rewarding aspects of working in psychiatry, societal factors, and personality factors based on KMO and Bartlett’s test and component matrix.

Financial / employment / training factors

In factor analysis, to assert whether or not the sample is considered inadequate, KMO and Bartlett’s test is used. Moreover, a component matrix has been further presented to determine which factors are retained based on factor loadings where 0.6 has been taken as a threshold value. This threshold is also supported by the study of Yong and Pearce (2013). In terms of financial factors or training factors, the results have been presented in Table 17 and Table 18. The KMO and Bartlett’s table is illustrating that the sample is adequate because the asymptotic significance is below 5% (0.05). Therefore, the sampling adequacy can be verified with this. Moreover, the sampling adequacy is computed to be moderate accurate as the value is 0.704. Concerning Table 18, it has been found that four factors are retained. These factors include securing a post after completion of training, recruitment to a training post, shorter duration of training in psychiatry than other medical fields, and the easily manageable aspect of psychiatry. 

Table 17: KMO Bartlett's Test- Financial Factors/ Training

Family or personal life factors/ preferences

By family factors or personal factors, the results have been presented in Table 19 and Table 20. The KMO and Bartlett’s table is illustrating that the sample is adequate because the asymptotic significance is below 5% (0.05) (p-value= 0.000< 0.05). Therefore, the sampling adequacy can be confirmed with this. Also, the sampling adequacy is computed to be satisfactory as the value is 0.426. Concerning Table 20, it has been found that two factors are retained. Those two retained factors comprise proximity of training facility which is near family and pressure, advice, or influence of parents/ family.

Table 19: KMO Bartlett's Test (Family Factors)

Factors Associated with Psychiatry as an interesting subject

About the factors associated with psychiatry as an interesting subject, the results have been presented in Table 21 and Table 22. The KMO and Bartlett’s table is illustrating that the sample is adequate because the asymptotic significance is below 5% (0.05). Therefore, the sampling adequacy can be confirmed with this. In furtherance, the sampling adequacy is computed to be moderate accurate as the value is 0.757. According to Table 22, it has been found that four factors are retained. The retained factors include opportunity in the field of psychiatry, personal interest, a person-centered approach, and an approach to determine the disease based on the bio-psycho-social model.

Table 21: KMO Bartlett's Test (Psychiatric Subject Factors)

Factors associated with Rewarding aspects of working in psychiatry

By the factors associated with rewarding aspects of working in psychiatry, the results have been presented in Table 23 and Table 24 of KMO and Bartlett’s test and component matrix respectively. The KMO and Bartlett’s table is illustrating that the sample is adequate because the asymptotic significance is below 5% (0.05) (p-value= 0.000< 0.05). Hence, sampling adequacy can be established with this. Moreover, the sampling adequacy is computed to be moderate accurate as the value is 0.711. According to Table 24, it has been found that five factors are retained. The retained factors include the absence of regular on-site calls, on-call work in psychiatry being easy to handle as compared to other medical fields, less work pressure, more work-life balance, and less complex work leading to fewer emergency cases in comparison to other medical fields.

Table 23: KMO and Bartlett's Test (Rewarding Factors)

Social or societal factors

In light of the social or societal factors, the results have been presented in Table 25 and Table 26 of KMO and Bartlett’s a test and component matrix respectively. The KMO and Bartlett’s table is demonstrating that the sample is adequate because the asymptotic significance is below 5% (0.05) (p-value= 0.001< 0.05). Henceforth, the sampling adequacy can be validated with this. Besides, the sampling adequacy is computed to be moderate as the value is 0.500. In Table 26, it has been found that only two factors are retained. The retained factors include opportunities to work abroad following the completion of training and another factor is the influence of external factors like media, television, and books that affect the decision to opt for psychiatry in the future.

Table 25: KMO and Bartlett's Test (Social Factors)

Personality factors

Concerning the personality factors, the results have been presented in Table 27 and Table 28 of KMO and Bartlett’s a test and component matrix respectively. The KMO and Bartlett’s table is showing that the sample is adequate because the asymptotic significance is below 5% (0.05) (p-value= 0.000< 0.05). Hence, the sampling adequacy can be recognized with this. In furtherance, the sampling adequacy is computed to be highly accurate as the value is 0.865 and is approaching 1. According to Table 28, it has been found that nine factors are retained. The retained factors include thorough analysis skills to investigate a patient, interest in solving complex problems with intellectual skills, friendly nature, and good communication skills. Some other factors include satisfactory social and interpersonal skills, sentiments of sympathy and empathy, comprehension of emotion, attentive listening, and cooperative nature.

Table 27: KMO and Bartlett's Test (Personality Factors)

Comparative Analysis

To evaluate the differences in perception based on gender and psychiatry placement, an independent sample t-test has been used.

Differences in Factors based on Gender

Firstly, a descriptive statistics table has been computed concerning gender as depicted in Table 29. Secondly, a t-test has been conducted concerning Levene’s test to confirm the homogeneity of variances. Following the confirmation, t-statistics have been evaluated and presented in Table 30. It has been found there exists no difference in the perception of male participants and female participants. However, at the 10% significance level, the difference is only found in the social factors. According to group statistics, males prefer social factors more than females as their total score is found to be inclined towards importance.

Table 29: Group Statistics

Differences in Factors based on Psychiatry Placement

In this case, the participants who have had psychiatry placement in the foundation year are compared with the ones who have not had this opportunity. The results have been presented in table 31 and Table 32. It has been found that perception of family factors significantly differs based on placement and group statistics revealed that those who have not had the placement in foundation year prefer family factors to be more important (p-value= 0.006< 0.05). In addition, some other factors that can be found having differences in perception if the threshold for significance is considered to be 10% are financial factors and rewarding aspects of psychiatry. In both cases, those who have not had the placement in foundation years deem them more important than the ones who have had the placement.

Table 31: Group Statistics

References

Leech, N.L., Barrett, K.C. and Morgan, G.A., 2014. IBM SPSS for intermediate statistics: Use and interpretation. Routledge.

Yong, A.G. and Pearce, S., 2013. A beginner’s guide to factor analysis: Focusing on exploratory factor analysis. Tutorials in quantitative methods for psychology, 9(2), pp.79-94.