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14/10/2013 12:14:48

An elective in psychiatric research


Zurich study

An elective in psychiatric research

As I write, I’m just coming to the end of a seven-week elective spent in Zurich working with Professor Jules Angst. 


Professor Angst is an enormous figure in epidemiological and clinical psychiatry and has hundreds of prestigious publications, so it’s been very exciting to learn from him.


One particular contribution he has made to the field has been the celebrated Zurich Study. Whereas most prospective enquiries seem to last for about five years (or less) before funding dries up or people feel a point is proved and move onto something else, the Zurich Study has followed subjects up for three decades now – with fascinating results. 


When I came, I had the impression that the data collected were largely psychometric with a few demographic details, but in fact the scope is much larger than that, covering somatic symptoms, personality, family characteristics and coping resources, as well as diagnostic information. Numerous analyses have then arisen from these data, tackling questions as diverse as conversion from unipolar to bipolar depression and whether smoking is associated with mental illness.



Building a strong case

Most of the work I’ve been doing has focused on quality of life, an increasingly important metric in medical research. We were interested in how aspects of demographics, personality and somatic symptoms are associated quality of life. In particular, are the relationships any different in a group with high psychopathology compared to a more representative sample? 



The first lesson I’ve learnt from my stay here has been not to make your research or clinical interests too narrow, especially when you’re starting out...


I’ve also had the chance to get involved with some work on suicidality and learn a bit about postpartum psychiatric disorders, so it’s been quite varied.



Enjoy the process

The first lesson I’ve learnt from my stay here has been not to make your research or clinical interests too narrow, especially when you’re starting out: you don’t know how the scientific landscape is going to change, so don’t put all your eggs in one basket. 



Finally, it’s been really instructive to see someone who is still humble in accepting other people’s ideas, despite his own vast experience.


Also, when looking at research findings, don’t just focus narrowly on p-values: examine effect sizes and evaluate whether there is anything interesting happening. 


Finally, it’s been really instructive to see someone who is still humble in accepting other people’s ideas, despite his own vast experience.


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19/08/2013 11:19:15

Process of Applying


The application - drawing on experience

New online resource to help people return to work after mental illness

When I was emailed the advert about the Pathfinder Fellowship from our undergraduate psychiatry course administrator I decided to apply for it although I did not think I would stand a chance of getting it. 


The elective bursary was an attraction but I had already set plans I was excited about which were located in the UK and so money was not my biggest concern. I was more interested in the mentorship scheme on offer and that the fellowship sounded like it would be brilliant in helping me achieve my goal of specialising in psychiatry. 


Although I had only recently decided that psychiatry was the career for me, I felt I had some experience I could draw upon to put into my CV. I felt one of the biggest strengths I could offer was that I had taken a year out doing a BMedSci degree which I had chosen to do in the field of psychiatry, specifically looking at auditory hallucinations in the healthy population. From this I was also able to attend the international congress in Liverpool to present a poster on my study which had stimulated my interest in psychiatry further.



Good links with the psychiatry clinical lead

My advice when writing your CV for the application would be to just consider any experience you have had that has been related to psychiatry. Hopefully you would have done your psychiatry rotation by the time you apply so at the very least you have some experience to dwell upon there. 


I would also suggest that your elective plans should be psychiatry related, but then if you want to become a pathfinder I would expect that that is what you would choose to do anyway. If you have time it may be also worth contacting the psychiatry lead at your university and asking for any additional experience or if there is any research they are doing you could get involved in.  Even if these are for future plans by the time you apply, it will all look good and show your interest in psychiatry and your willingness to go above and beyond your colleagues; and will help your future career as well. To be honest, I would recommend anyone who is interested in psychiatry to get in touch and make good links with the psychiatry clinical lead at their university. I find psychiatrists are often very happy to hear from and help out any student interested in their specialty who is willing to get some further experience. 


In addition make sure to include on your CV any of your other achievements during medical school; academic and non-academic, for example, if you are in any societies showing leadership or teamwork etc as this all shows you are a well-rounded person which is essential to becoming a balanced doctor.



The interview - relax

When it comes to the interview just try and relax as much as possible. The interviewers are not there to scare or intimidate you but want to see what you are like and your motivation for psychiatry. 


For preparation my advice would be to have a think about answers to the obvious questions you may be asked, for example, what it is about psychiatry that interests you, why you’ve chosen to do what you have for your elective/research plans and what it was about your previous psychiatry experiences you enjoyed (and what you didn’t enjoy about them). They are also likely to be keen to hear about your views on what could be done to stimulate interest in psychiatry amongst medical students and why many students are put off going into the specialty, and also about how you think we could reduce the stigma of mental health illness amongst the general population. Apart from that maybe have a read of some current psychiatric research/issues you are particularly interested in. 



It is not often you have the chance to talk to fellow students who are as interested in psychiatry as you are...


On the day on the interview its worth getting there a bit before you are due to go in so you can relax after the stressful London commute and it is also nice to have the opportunity to speak to some of the other applicants waiting. It is not often you have the chance to talk to fellow students who are as interested in psychiatry as you are and it is good to hear about others’ experience and future plans.



Why it's worth applying?

If you are thinking psychiatry is the field for you then I would whole heartedly recommend applying to become a Pathfinder Fellow. I am loving it and already finding it very useful. 


As I said at the start, I applied thinking I did not stand a chance of getting it, but in medicine you have to go for what you want - you may surprise yourself. At the very least it is an opportunity to see the Royal College, meet some like-minded students and eminent psychiatrists, and practise being interviewed; and if you do get awarded one of the fellowships you will have a wealth of opportunities opened up to you. 


If you have any questions then please do not hesitate to get in touch with me. Good luck to you all!



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06/06/2013 12:31:20

What I Wish I’d Known As A Medical Student


Work it out

What I Wish I’d Known As A Medical Student

We are taught a whole system of treating patients: diagnosing, giving interventions such as medication, our assumptions of the primacy of our opinions and status in all situations. We aren’t taught critical thinking to properly evaluate the strengths and weakness of our ways of doing things.


Obviously our medical system is tremendously successful at helping people. However it does rest on certain assumptions that we are not trained to evaluate or recognise. This means we often react defensively when people challenge these assumptions. What we should be doing instead is to understand our system properly.



It gave me a much better understanding of how difficult it was for them to change their lifestyles to improve their health outcomes (as well as seeing someone’s Elvis tribute shed).

So how do we understand our system properly?  You can study others’ opinions but they often tend to be written by people who only understand a bit but convince themselves the bit they know explains the whole.


The best way is to read a bit of philosophy and then try and work it out yourself.



Degrees of separation

Another shortcoming is that we separate the illness from the person (for good reason I know) in order to better use our scientific medical knowledge. I remember seeing heart attack patients in their own homes as part of research I was doing. It gave me a much better understanding of how difficult it was for them to change their lifestyles to improve their health outcomes (as well as seeing someone’s Elvis tribute shed). was a fresh amazing thing to talk to patients and our lack of perfectly practised medical histories meant that we got more information and related better.

As our scientific medical abilities progress we seem to be losing touch with the powerful but static human healing qualities of medicine. “Der Arzt hilft” (the Doctor helps) said the poster of my German colleague.


Patients want us to help them and sometimes that involves being interested in them as a person and putting their goals first rather than abstract disease management. As medical students I think we had these qualities, it was a fresh amazing thing to talk to patients and our lack of perfectly practised medical histories meant that we got more information and related better.


I wish I’d known as a medical student that the “art of medicine” skills that I had were as good as they would get and that was what patient’s appreciated. The scientific knowledge could be acquired but the skills needed constant practise.



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06/06/2013 10:48:33

The Power of Emotional Intelligence


Wish list

The power of emotional intelligence

It was a strange experience being a medical student who already knew that psychiatry was the only career on my wish list. I was also lucky enough to have studied at a medical school where psychiatry was respected and which produced more than the typical 4% of students who went on to be part of this stimulating discipline. 


Having said that, there is much that I would like to have been told when I look back on the days where I was enthralled by the challenge of eliciting psychopathology, making a diagnosis and learning that there is much that can be done to improve mental health and reduce mental suffering.



Only 20%

Writing this after 15 years as a consultant, I honestly believe that only about 20% of the skills that are taught in medical school equipped me for the rigours of being a consultant psychiatrist.


During my first week, echoes of my first consultant during my training telling me, "things will be very different when the case notes have your name on the front", rang in my ears. My first reaction was ‘help!’ Like most jobs, a lot of what you learn will be on the job, but there are certain things that I wish that I had known at an earlier stage.



Mental stamina

Psychiatry is not just about ‘chatting to people’. It is both an art and a science and any budding psychiatrists out there need to know that it takes immense mental stamina to use your knowledge and to communicate this in a form that engages the patient, generates a therapeutic relationship and uses all your powers of deduction to make a diagnosis and plan treatment. 


I remember a consultant surgeon once telling me that managing situations effectively means having to deal with ambiguity and also knowing when not to say anything.

Just remember that it takes incredible resolve and resilience to have the energy and enthusiasm to carry out an assessment that may last over an hour after being woken up in the early hours of the morning, only to face a hostile patient who is restless, irritable, disinhibited or aggressive. You need tact, patience and the clinical encounter will demand your full concentration.


Probably the most important skill to have (which I really wish someone had told me about) is emotional intelligence. I remember a consultant surgeon once telling me that managing situations effectively means having to deal with ambiguity and also knowing when not to say anything. I have been a consultant for long enough now to know that a considerable proportion of being an effective psychiatrist is being to lead and manage your team. You will almost certainly find all the defence mechanisms that you learn about in medical school in full flow within teams in which you will work. It is up to you to have the knowledge, skills, attitudes and emotional intelligence to manage complex situations.



A voyage of discovery

Now to rewind the clock, back to my psychiatry firm. I would really like to have been told more:


  • about leadership and its different styles;
  • about how to deal with complex encounters involving  both patients and relatives;
  • about the importance of seeking support from peers and seniors (doctors are only human, no matter how we think that we can do it alone)
  • and learning from serious untoward incidents.


Above all, I wish I had known that it is alright to feel uncertain and apprehensive in the face of situations that are unpredictable, knowing also that you working in a world where there are few people who are going to pat you on the back or give you wine and chocolates for the time that you invest in carrying out your everyday work to a high standard.


...there are few people who are going to pat you on the back or give you wine and chocolates for the time that you invest in carrying out your everyday work to a high standard.

Psychiatry is still an expanding field where the world is your oyster. Never a minute has gone by when I have regretted it as a career choice. I just wish that I could have been better prepared for developing myself as ‘whole person’ before embarking on my chosen career path, in being able to think, reflect, learn and develop from clinical experience with both patients and colleagues.


It would have been even more fulfilling than it already has been and voyage of discovery rather than one of uncertainty.


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15/05/2013 11:44:34

Mental Health Services For Generation Y


Generation Y

Mental Health Services For Generation Y

Generation Y encompasses those who were born from the 1980s onwards. They are sometimes referred to as digital natives; perceived as being more familiar with digital technology, the internet is a natural space for them and has become an integral part of their lives.

There is a synergistic relationship between Generation Y and the internet, which is reflected in how social interactions have changed and evolved. This is especially relevant for the provision of mental health services in our ever advancing technological age, as current data from the Office of National Statistics show that 1 in 10 children or adolescents suffer from a mental health disorder.


Support, stigma and savvy online              

According to a YouthNet survey, 82% of young people will use the internet for health advice. As such, the internet is becoming an increasingly more robust forum to disclose and discuss mental health issues.

Online patients tend to be younger, more educated and are less likely to have ever attended psychiatric services. They generally use websites that are reputable and accurate. The internet provides disinhibition, giving young people the security of anonymity. This allows them to dissociate from their day to day identities, in turn allowing them to attain better insight into their own problems (Suler, 2004).

The sense of anonymity and inconspicuousness afforded by the internet is in many ways vital to Generation Y - due to the stigma still associated with mental health disorders. A study by Irish charity found that 61% of young people would use internet support during a tough time; whilst only 31% would talk to a health professional (Chambers and Murphy, 2011).


The sense of anonymity and inconspicuousness afforded by the internet is in many ways vital to Generation Y - due to the stigma still associated with mental health disorders.

Online resources, such as; the official RCPsych website, The Samaritans and YourMentalHealth aim to raise heightened awareness of mental health problems and serious issues such as self-harm and suicide. They strive to achieve a positive and resounding impact amongst Generation Y by reducing the apparent stigma surrounding mental health issues and encourage open discussion of these matters in a dynamic and overt medium.


Untangling the Web   

The advancement of technology has resulted in Generation Y now utilising the internet as a powerful instrument in the promotion of mental health awareness and advice. This has resulted in the emergence of a number of e-mental health web based interventions.

Countries such as Australia, Sweden and the Netherlands, have legitimised and highlighted the importance of Internet based mental health services by incorporating them into their respective national health systems. 

Australia continues to spear head this movement through the establishment of a web portal that offers a range of federally funded online interventions and connects its users to a range of web-based mental health services.

With regard to reducing adolescent anxiety disorders, one particular study found that online cognitive behavioural therapy is as effective and acceptable to young patients as clinic-based CBT (Spence et al, 2011). Parents of these patients however, preferred their child to receive CBT in a clinic based setting and this may indeed be representative of the discrepancies and disparities between Generation Y and X in terms of their attitudes to how the Internet is used in relation to dealing with health and wellbeing.

Another study, relating to adolescent depression, found internet CBT to be no more effective than the waiting list control group (Hoek et al 2012). A major benefit of online services is that they introduce a new level of flexibility; patients can tailor them to their own needs and lifestyles as opposed to the rigidity of attending regimented outpatient clinics in the community or hospital. It is also very appropriate for generation Y, as this era of app-loving young people are accustomed to instant information and have a low threshold for waiting times or being kept on hold for too long. By using online therapies, it enables mental health services to connect with these patients who may otherwise be lost to a system of waiting lists, delays or cancellations.

The internet can however be enigmatic in its promotion of mental health issues and the ways in which they are perceived by young and quite often vulnerable people. This is encapsulated by the prevalence of certain Internet sites which romanticise the concept of suicide thus increasing suicidal ideology amongst users, as well as the online pro-ana movement supporting and encouraging anorexia.

For those with a suicidal intent, the internet can be a potent and dangerous tool. Researching online methods or ways in which to end one’s life can unlock hundreds of un-monitored websites or forums which breed or evoke similar interest. They stand to have dangerous adverse effects on the mental health of users and show no regard for their safety or wellbeing. 

This emphasises the need to put restrictions in place, in terms of what is accessible online and how to ensure user safety. 

This is highlighted by the work of the search engine Google where user ideas of suicide and self harm are met with links to The Samaritans, which although was not the search result requested, may in fact, be exactly what is needed.



Scrolling down - What’s Next?

Mental Health Services For Generation Y

The therapeutic encounter forms a vital component of traditional Cognitive Based Therapy however could this be tailored to meet the needs of an increasingly internet savvy generation (Langhoff et al, 2008). According to an EU survey, the average young person now spends at least an hour online every day (O’Neill, Grehan and Ólafsson, 2011). As such this begets the question – is the most effective therapeutic encounter now found online for generation Y?

Google and the Samaritans collaboration to target suicidal individuals is an excellent example of how Mental Health Services are adapting to target generation Y and influence their perception of mental illnesses.


If these services are to keep up with and engage generation Y, they need to offer appropriate online services and therapies, but also need to infiltrate the sites and services used regularly by these young people. By doing this, the awareness of Mental Health can be raised and the stigma surrounding these conditions can be broken down for generation Y and those who follow.




Chambers, D. and Murphy, F. (2011) Learning to reach out: Young people, mental health literacy and the Internet, Dublin: Inspire Ireland Foundation.

Hoek W., Schuurmans J., Koot H.M., Cuijpers P. (2012) Effects of Internet-Based Guided Self-Help Problem-Solving Therapy for Adolescents with Depression and Anxiety: A Randomized Controlled Trial. PLoS ONE 7(8): e43485.

Langhoff, Christin; Baer, Thomas; Zubraegel, Doris; Linden, Michael (2008) 'Therapist-Patient Alliance, Patient-Therapist Alliance, Mutual Therapeutic Alliance, Therapist-Patient Concordance, and Outcome of CBT in GAD ', Journal of Cognitive Psychotherapy, 22(1), pp. 68-79.

O’Neill, B., Grehan, S., Ólafsson, K. (2011). Risks and safety for children on the internet: the Ireland report. LSE, London: EU Kids Online.

Spence SH, Donovan C.L., March S., Gamble A., Anderson R.E., Prosser S., Kenardy J. (2011) 'A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety', Journal of Consulting and Clinical Psychology, 79(5), pp. 629-42.

Suler, J. (2004). CyberPsychology and Behavior, 7, 321-326

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07/02/2013 10:56:49

RCPsych Eating Disorders Section Annual Conference 2012


Bursary opportunities

Eating Disorders Section My experience with psychiatry as a specialty during medical school focussed mainly on general adult and inpatient psychiatry – eating disorders were simply not a huge focus on the curriculum. So when bursary opportunities became available for the Eating Disorders Section Annual Conference, I was lucky enough to be successful in my application to attend.



High profile speakers               

This year’s conference focussed on the medical manifestations and management of eating disorders, with several high profile speakers in attendance.

The first section discussed bone health in those with eating disorders. Dr Sanjeev Patel (Consultant rheumatologist at Epsom & St Helier’s NHST) ran through the pathophysiology of what to expect in women with eating disorders and covered medical interventions for the ensuing osteoarthritis and osteopenia as an adjunct to psychiatric interventions.


Dr Debra Katzman from the Hospital for Sick Children at the University of Toronto summised that transdermal oestrogens are more effective than the oral equivalent for bone health in those with eating disorders. Overall, the evidence base presented showed clear long-term health benefits through bone interventions in the eating disorder population.


The second section saw Professor Rona Moss-Morris from the Institute of Psychiatry, King’s College London map a CBT approach of irritable bowel syndrome onto the treatment of eating disorders, drawing several similarities between the cognitive processes in these two, seemingly different, patient populations.


Professor Helen Mason from St George’s, University of London presented her work on the use of pelvic ultrasound as a staging tool in the recovery from eating disorders in women. The results were very promising, correlating endometrial thickness with the stage of the disease.



Functional neurobiology of pleasure     

The delegates were treated to an inspiring talk from Professor Morten Kringelbach (University of Oxford and Aarhus, Denmark), where he presented his internationally renowned work on the functional neurobiology of pleasure. He suggested ways in which his work and methodologies could be used to understand the cognitive challenges that eating disorder sufferers must endure.


...this should not be seen as a quick fix in the way that lobotomies once were.

In an appropriate digression, Professor Kringelbach also explored the future of therapeutic deep brain stimulation in psychiatry, but also warned that this should not be seen as a quick fix in the way that lobotomies once were.



Into the unknown

Resources for eating disordersThe day concluded with presentations from large multi-centre treatment trials for anorexia nervosa. Interventions compared ‘best supportive treatment’ to experimental talking therapies and different types of family therapies.


The conference was well run and drew on some enthralling speakers. Debates that followed presentations were often lively and intellectually stimulating. The only negative would be that I am now even more confused about which higher speciality I want to pursue in the future!


This conference offered an opportunity to experience a sub-speciality of psychiatry that few get to see during their undergraduate training. I strongly recommend RCPsych Student Associates to pursue any bursaries on offer to attend events like these. They really are valuable and allow you to gain an insight into the relatively unknown parts of the speciality.



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30/11/2012 11:59:46

‘The final frontier’ – Scotland’s first ever Psychiatry Summer School, a review

Jenny Reid and Gordon McKinnon, 4th year medical students, Edinburgh University


Weekend events

‘The final frontier’ – Scotland’s first ever Psychiatry Summer School, a review

Psychiatry is a medical specialty like no other. Mental illnesses are diverse, and represent a major proportion of morbidity worldwide.  Although 1 in 7 medical students are reportedly interested in psychiatry as a future career option, negative attitudes from senior clinicians and a perception that treatment options are archaic and limited stop many from pursuing the specialty in their postgraduate training1


Stimulating medical students and maintaining interest in psychiatry throughout the undergraduate curriculum is therefore a major goal for both the Royal College of Psychiatrists and medical schools. Many specialties host weekend events to nurture interest, and this year saw the launch of the first psychiatry summer school in Scotland.



The place to be

The inaugural ‘Scottish Psychiatry Summer School’ was held in Edinburgh on the 31 August-1 September 2012. Chaired by Professor Lindsay Thomson and Dr Tom Brown, the summer school was attended by undergraduates from across Scotland, a school leaver and eminent speakers from a wide range of specialties. The message and enthusiasm were clear; 21st century psychiatry is exciting, diverse and the place to be in modern medicine.


In April 2012 the Lancet published a short article in its editorial detailing psychiatry’s international ‘identity crisis’2. Rather than a problem, the summer school presented the identity of psychiatry as one of the most exciting opportunities in medicine today. The vast range of talks highlighted the diversity of psychiatry, from medical, legal, psychosocial and philosophical domains to prospects in research, public health policy and leadership.



Complimentary glass of wine

The summer school sche dule was itself innovative. A ‘speed-dating’ session, with a complimentary glass of wine, was a novel way to meet professionals from many different subspecialties; from learning disability, forensics and old age psychiatry to psychotherapy, substance misuse, and academia, to name but a few.


Psychiatry has been criticised for lagging in the past, and there still exists a stigma and ignorance towards the profession. To the contrary, the lectures at the summer school were absolutely current; they reflected upon the way psychiatry must respond to social, environmental and economic circumstances, the ever-growing evidence base and the emerging understanding of biology and genetics. Dr Mandy Johnstone’s talk on modeling psychosis using stem cells showed how forward-thinking psychiatry can be and demonstrated how such spectacular developments could alter future diagnosis in psychiatry.



These talks illustrated the evolution of psychiatry, a specialty with groundbreaking research, pushing the boundaries on our understanding of the human mind/condition.


The summer school did not neglect psychiatry’s past. Pivotal figures like Leon Eisenberg, famous for attaching the social with molecular medicine in the diagnosis and treatment of autism, and Goffman’s essays3 on the social situation of patients were part of the narrative. However, the focus of the weekend was psychiatry today and the psychiatrists of the future.



Dish of the day

Of particular note during the lecture schedule was Dr James Currie’s captivating talk about current research in neuro-economics and decision making in schizophrenia, game theory and functional neuro-imaging. Professor David Owens also presented an inspiring talk on human minds. These talks illustrated the evolution of psychiatry, a specialty with groundbreaking research, pushing the boundaries on our understanding of the human mind/condition.


Above all, what made the summer school stand out from other conferences and summer schools, and what makes psychiatry stand out to us as a profession, was humanity. A meal on the first day allowed a dialogue between undergraduates, trainees and professors, all of whom were friendly, approachable and keen to share their experience.



First ever

The future of psychiatry is not only fascinating but it is also practically appealing; there is flexibility in the training, a great deal of personal support and there are a number of additional opportunities along the way. No other specialty is so fundamentally based upon the bio-psycho-social model that is humanity itself. Mental health affects all of us on a daily basis and a career in psychiatry offers life changing, stimulating and fulfilling work.


Psychiatry cannot be disregarded; it is clearly embedded within every area of medicine. For those skeptics that believe that psychiatry will be superseded in the future by neuro-psychiatry the summer school was a reminder of the diversity of modern psychiatry and its fundamental crux; human beings and all their idiosyncrasies.


To be a part of the first ever Psychiatry Summer School in Scotland was a privilege and the authors thoroughly recommend future Scottish Psychiatry Summer Schools. It opened up questions, was inspirational and presented opportunities and challenges in a specialty that in our opinion is mind-blowlingly exciting.


If psychiatry is the ‘final frontier’ of medicine then it requires bravery and innovation in its future approach. Humanity is dynamic, and so too must be psychiatry.




1. Budd S, Kelly R, Day R, Variend H & Dogra N. Student attitudes to psychiatry and their clinical placements.  Medical Teacher 2011; 33: 586-592.

2. Editorial published online. The Lancet 2012; 379: 9828:1274 (DOI:10.1016/S0140- 6736(12)60518-2. Accessed October 1st 2012)

3. Erving Goffman, Asylums, 1968, Penguin books.



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26/10/2012 11:43:14

Professional procrastination: using social media for recruitment to psychiatry

Samantha Batt-Rawden, Final Year Medical Student, University of Bristol

Social networking

Joining in the conversation - social media and mental health servicesI am staring at the essay before me. It doesn’t very much look like an essay. In fact, it’s just the title, but that in itself was an arduous 10 minutes of mental exertion and I decide I’ve earned the right to a well-deserved break.


And I’m back where I was 10 minutes ago; on Facebook.


I am just one of 901 million active users of Facebook1 and have recently been adding to the 200 million tweets that are posted on Twitter each day.2 Whilst the use of social media by students can only be described as prolific, medical professionals are not immune from these statistics. According to a recent survey, social networking sites have been adopted into the lives of 79.4% of doctors - well above the national average.3


Medicine 2.0

The rapid incorporation of internet tools for education, research and collaboration within the field of medicine has been dubbed Medicine 2.0, a nascent yet thriving machine within which social media is a just a small cog.4

Whilst many readers will be well acquainted with the personal benefits of social networking, the broader implications for healthcare may be less readily apparent - psychologists have been crafting virtual reality worlds for psychotherapy patients5 and social media has been successfully applied in cultivating empathy, humanism and professionalism in medical students.6.

Engagement with such tools may present a unique opportunity for recruitment. In these times, where psychiatry is looking for novel and innovative methods to recruit students, could social networking provide the answer? Recently, a small scale survey was carried out to investigate this possible strategy. media has been successfully applied in cultivating empathy, humanism and professionalism in medical students


What did we learn?

A total of 57 responses were received. All respondents used Facebook. 56% used Twitter, 18.2% used Google +, 13.6% used MySpace, Pinterest and Live Journal were both used by 6.8%, LinkedIn was used by 4.5%.

73% listened to podcasts, but of those only 16.2% listened on a regular basis (at least once weekly). Many reported difficulties in finding listenable, psychiatry-themed podcasts.


Respondents checked Facebook more than they checked their email, with most receiving ‘push’ updates in real-time via smartphone applications.


83% were members of their university psychiatry Facebook groups with 76.2% signed up to their mailing lists. Respondents felt that they were most likely to hear of psychiatry opportunites through Facebook and felt the current RCPsych groups weren’t relevant to students. An emerging theme during subsequent interviews was that students often missed College opportunities and external psychiatry events. This was attributed to the fact that university groups are often updated by a single committee member and that not all information is easily accessible and/or advertised to every university society.


And what of Twitter? Only 7.3% followed @RCPsych or @future_psych as many reported that tweets weren’t always directly relevant to students.


What did students want?

Respondents agreed that social media use in psychiatry made the specialty ‘technologically advanced’ (65%), ‘modern’ (82%), and ‘interested in students who are interested in them’ (88%). Furthermore, 41% endorsed that recruitment efforts of the College have made them more likely to consider psychiatry as a career.


Whilst 63% responded that current use of social media in psychiatry has made them feel more involved in the specialty as a student, many felt that there would be additional benefit from a national Facebook group (72%), student dedicated podcasts (66%) and an RCPsych Student Associate Twitter (25%). Figure 1 illustrates what students wanted from a psychiatry social media tool.



What did students want from a psychiatry social media tool



The RCPsych Student Associate Twitter is well established (@future_psych) and currently has 125 followers.


Although not officially affiliated with the College at this time, the National Student Psychiatry Network Facebook group has also been independently developed. With over 120 members, it is hoped that the group will continue to expand and become a national bulletin board for committee members from several university psychiatry societies to advertise their events and summer schools. It may also serve as a networking hub for students to connect with psychiatrists who are offering opportunites for SSCs, research, electives and mentorship.


Many studies have reported the tangible benefits of adoption of social media by students and doctors alike. Yet for many this is a cause for concern; much of this anxiety has centred on issues of confidentiality, professionalism, and doctor-patient boundaries. These are real, but manageable challenges and whilst the full potential of social media in healthcare has yet to be established, this article highlights its potential use for recruitment to psychiatry.


Please see the General Medical Council’s guidelines for medical students on social networking.





1.Facebook Newsroom Fact sheet. Accessed 14 May, 2012

2.Twittereng. 200 million tweets per day. Twitter Blog. Accessed 14 May, 2012

3.Bosslet G, et al. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med. 2011, 26(10):1168-1174

4.Eysenbach G. Medicine 2.0: social networking, collaboration, participation, apomediation, and openness. J Med Internet Res. 2008;10(3):22

5. Giuseppe R. Virtual reality and psychotherapy: a Review. Cyberpsychol Behav. 2005; 8(3): 220-230

6. Rosenthal S, et al. Humanism at heart: Preserving empathy in third-year medical students. Acad Med. 2001;86(3):350-358




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13/06/2012 11:45:18

Youth Offending: A Symptom of a Greater Crime

Russell Gibson is a 4th year medical student at Cardiff University


Youth Offending: A Symptom of a Greater Crime by Russell Gibson

Empiricist philosophy was founded upon the belief that a child is born with a mind that is a tabula rasa – a ‘blank state’, with the child’s ensuing development entirely attributable to the environment to which they are exposed. Modern views incorporate the role of genetic inheritance, but it is hard to see how children can overcome maltreatment, neglect, inadequate parenting and poor schooling. These are risk factors for juvenile offending, factors that tend to coalesce around one single denominator: poverty.


Detention centres

Current findings suggest the higher rates of crime found among children of low socioeconomic status are mediated through the disparate effects of poverty on a child’s life course, be that adverse family, individual, school or peer factors (i).  


It must therefore be the utmost priority for youth detention centres to act as places of nurture and rehabilitation, rather than punishment. Stereos, Playstations and pool tables may seem to reward criminality, but lest we forget, these offenders are also children. Indeed, the greatest outrage is that life inside the detention centre is often preferable to that outside, not merely in material terms but also in basic parental input.


Youth Offending: A Symptom of a Greater Crime by Russell Gibson

Detention centre staff provide excellent support for these children, often becoming the parental figures otherwise lacking. However, they also report their input is ultimately limited, for when the child leaves, he or she re-enters the same environment that led to crime in the first place. Social workers can and do intervene, but removing children from their parents comes at a cost. And often, it comes too late.


So we blame the parents, as occurred following the UK riots in the summer of 2011. However, parents are often products of environments similar to those they now provide for their children. This is a self-sustaining cycle of crime, punishment and missed opportunity where the inadequate parenting received by one generation is passed on to the next.


Wider problem

Youth offending, therefore, will never be cured by detention centres, as it is merely a symptom of a much wider problem: social injustice.  It incorporates more than socio-economic disparity: inequality of opportunity, from finding a job to experiencing prejudice.  We expect poor children to act a certain way and we don’t give them the opportunity to act otherwise.


As future doctors, we cannot prescribe a cure for criminality, but being unable to treat does not mean we should not strive to understand the cause.  After all, we too are the product of environments into which we just happened to be born.




Percentage among sentenced young offenders by sex (ii)

  Male Female
Mental and emotional problems 14 22
Been admitted to mental health ward 4 9
Personality disorder 80 84
Hazardous drinking 70 51
Use of illicit drugs 96 84

Drug dependence (not alcohol)

57 56



i. Fergusson D, Swain-Campbell N, Horwood J (2004). How does childhood economic disadvantage lead to crime? Journal of Child Psychology & Psychiatry 45(5): 956-66.

ii. Lader D, Singleton N and Meltzer H (2000).


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15/05/2012 11:10:49

Undergraduate Fellowship in Psychiatry

Dr Emma Brandish is a foundation year two doctor 

Single best decision

Undergraduate Fellowship in Psychiatry

I entered medical school in 2006 as a graduate, having previously read International Business with French at Loughborough University. My first degree included an industrial placement year which I spent working in London at the head office of a high street fashion retailer. Working in fashion was exciting and I planned to return as a graduate, but I changed my mind during my final year and applied for medicine instead; this was the single best decision I have ever made.


As a second year medical student I became increasingly aware of the role of research in clinical practice. I knew absolutely nothing about research but wanted to learn more so I emailed my personal tutor for advice. He was a psychiatrist and he invited me to spend the summer vacation doing research with him. I successfully applied to the Wellcome Trust for a Vacation Scholarship which funded 8 weeks of basic research training and the opportunity to contribute to a number of different studies. During that summer I had my first taste of both clinical and academic psychiatry and I loved it. It was as if a light switched on - I knew what I wanted to do.



Further experience gained during my psychiatry clinical attachments increased its appeal. I enjoyed spending time with patients, talking to them, entering into their world and exploring. I became fascinated by the interaction between mental illness and the unique human experience of individual patients.


In 2010 I was awarded an Undergraduate Fellowship in Psychiatry. The Fellowship scheme is a Southampton initiative where clinical medical students with an expressed interest in psychiatry have the opportunity to compete for a monetary prize (to support educational development in psychiatry) and are assigned a psychiatrist mentor.  They are also encouraged to assume an active role in further development of the local student psychiatry society.


It was the combination of these academic and clinical experiences which prompted me to apply for an Academic Foundation Programme in Psychiatry to further explore my interest in the specialty.


Cement my career choice

Day hospitals for older people with mental illnessPost qualification I have frequently encountered significant psychopathology within the general hospital setting. I often considered how this contributes to the presentation of physical illness and it has served to remind me how important mental well-being is to overall health.  


Despite enjoying aspects of medical and surgical jobs I continue to be drawn to psychiatry and my four months as an academic FY2 in psychiatry has cemented my career choice. I have recently been appointed as an Academic Clinical Fellow in General Adult Psychiatry in the Wessex Deanery. I start in August 2012 and I am very much looking forward to the next stage of fmy psychiatric career.


I cannot deny that I have been lucky and mentorship has been a key factor in my progress to date. In particular, that of Professor David Baldwin and Dr Julia Sinclair who have supported me and guided me whilst introducing me to a world of clinical and academic possibilities. However, despite the convenience of having a receptive and supportive academic psychiatrist as a personal tutor I have met many psychiatrists who are extremely receptive to opportunistic emails from keen medical students and junior doctors looking for further clinical or academic experience. Therefore I would always encourage colleagues who express an interest in psychiatry to take that first step.


Psychiatry is still evolving, there is still so much to discover and learn, so much we don't understand and that is incredibly exciting. I want to be a part of its future. I shamelessly promote the virtues of psychiatry as a specialty wherever I go, both to medical students and to other doctors. I also encourage medical students and other junior doctors to consider academic medicine as I don't feel it is sufficiently well promoted to them yet it presents diverse, stimulating and exciting career opportunities.


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