OpenLB
Open Library of Bioscience
Advanced Search
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
Apr, 2022;46 (2): 194-201.

Medical Students' Attitudes toward Self-harm, and Curricular Influences on Attitude Development.

Adam B Joiner, Christina Kaewchaluay
Author Information
  1. Adam B Joiner: Lancashire and South Cumbria NHS Foundation Trust, Chorley, Lancashire, UK. adam.joiner@lscft.nhs.uk. ORCID
  2. Christina Kaewchaluay: Lancashire and South Cumbria NHS Foundation Trust, Chorley, Lancashire, UK.
PMID: 33759139 DOI: 10.1007/s40596-021-01436-9

Abstract

OBJECTIVES: The authors explore attitudes that first and final year medical students have toward self-harm, and examine how the curriculum may influence the development of these attitudes.
METHODS: Six focus groups, involving a total of 21 medical students, were used to explore the objectives. Thematic framework analysis was used to analyze the data through iterative development of a coding framework and identification of themes.
RESULTS: Medical students demonstrated simultaneously positive and negative attitudes. Students reported minimal exposure to self-harm through the formal curriculum and being exposed to negative attitudes exhibited by healthcare professionals through the informal curriculum. Students felt that self-harm was not as important as other subjects competing for their attention in their curriculum. Many students were discouraged by healthcare staff from seeing people who self-harm, in particular on psychiatry placements. The hidden curriculum may be encouraging negative attitudes toward people who self-harm; students learn that self-harm is "not important."
CONCLUSIONS: Findings from this study identify how the curriculum might influence the development of negative attitudes toward self-harm. Students would benefit from being encouraged to interact with people who self-harm and then having the opportunity to discuss the emotions these interactions create.

Keywords

Attitudes Curricula influences Medical students Self-harm Stigma

References

  1. National Institute for Health and Care Excellence (NICE). Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. 2004. Available from: https://www.nice.org.uk/guidance/cg16/evidence/full-guideline-189936541 . Accessed on 8th September 2015.
  2. Friedman T, Newton C, Coggan C, Hooley S, Patel R, Pickard M, et al. Predictors of A&E staff attitudes to self-harm patients who use self-laceration: influences of previous training and experience. J Psychosom Res. 2005;60(3):273–7. [DOI: 10.1016/j.jpsychores.2005.07.007]
  3. Patterson P, Whittington R, Bogg J. Measuring nurse attitudes towards deliberate self-harm: the self-harm antipathy scale (SHAS). J Psychiatr Ment Health Nurs. 2007;14:438–45. [DOI: 10.1111/j.1365-2850.2007.01102.x]
  4. Shaw DG, Sandy PT. Mental health nurses' attitudes toward self-harm: curricular implications. Health SA Gesondheid J Interdiscip Health Sci. 2016;21:406–14. [DOI: 10.1016/j.hsag.2016.08.001]
  5. Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–7. [DOI: 10.1097/00001888-199804000-00013]
  6. Lown BA. A social neuroscience-informed model for teaching and practicing compassion in health care. Med Educ. 2016;50(3):332–42. [DOI: 10.1111/medu.12926]
  7. Taylor TL, Hawton K. Attitudes towards clinical services among people who self-harm: systematic review. Br J Psychiatry. 2009;194:104–10. [DOI: 10.1192/bjp.bp.107.046425]
  8. Law GU, Rostill-Brookes H, Goodman D. Public stigma in health and non-healthcare students: attributions, emotions and willingness to help with adolescent self-harm. Int J Nurs Stud. 2009;46:108–19. [DOI: 10.1016/j.ijnurstu.2008.08.014]
  9. Ougrin D. Commentary: self-harm: a global health priority – reflections on Bruner et al. (2014). J Child Psychol Psychiatry. 2014;55(4):349–51. [DOI: 10.1111/jcpp.12232]
  10. Oppenheim A. Questionnaire design, interviewing and attitude measurement. London and New York: Pinter Publishers; 1992.
  11. Simon ST, Ramsenthaler C, Bausewein C, Krischke N, Geiss G. Core attitudes of professionals in palliative care: a qualitative study. Int J Palliat Nurs. 2009;15(8):405–11. [DOI: 10.12968/ijpn.2009.15.8.43800]
  12. Cumberbatch G, Humphreys P. Social psychology. In: Gupta D, Gupta R, editors. Psychology for psychiatrists. London: Whurr Publishers; 2004. p. 375–411.
  13. Kavalidou K. Suicidal thoughts and attitudes towards suicide among medical students and psychology students in Greece. Suicidology Online. 2013;4:4–11.
  14. Nebhinani N, Chahal S, Jagtiani A, Nebhinani M, Gupta R. Medical students’ attitude toward suicide attempters. Indian J Psychiatry. 2016;25(1):17–22. [DOI: 10.4103/0972-6748.196050]
  15. Crotty M. The foundations of social research. London: Sage; 1998.
  16. Charmaz K. Constructing grounded theory. Thousand Oaks, CA: Sage; 2014.
  17. Barbour RS, Schostak J. Interviewing and focus groups. In: Somekh B, Lewin C, editors. Research methods in the social sciences. London: Sage; 2005. p. 41–8.
  18. Kitzinger J. Introducing focus groups. Br Med J. 1995;311:299–302. [DOI: 10.1136/bmj.311.7000.299]
  19. Pope C, Ziebland S, Mays N. Analysing qualitative data. Br Med J. 2000;320(7227):114–6. [DOI: 10.1136/bmj.320.7227.114]
  20. Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. London: The stationary office; 2013.
  21. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–22. [DOI: 10.4065/80.12.1613]
  22. Mind. Understanding self-harm. Available from: http://www.mind.org.uk/media/619077/understanding-self-harm-2013.pdf . Accessed 20th August 2015.
  23. Young R, Beinum MV, Sweeting H, West P. Young people who self-harm. Br J Psychiatry. 2007;191:44–9. [DOI: 10.1192/bjp.bp.106.034330]
  24. Swanwick T. Informal learning in postgraduate medical education: from cognitivism to ‘culturism’. Med Educ. 2005;39:859–65. [DOI: 10.1111/j.1365-2929.2005.02224.x]
  25. Helmich E, Bolhuis S, Dornan T, Laan R, Koopsman R. Entering medical practice for the very first time: emotional talk, meaning and identity development. Med Educ. 2012;46:1074–87. [DOI: 10.1111/medu.12019]
  26. Katz D. The functional approach to the study of attitudes. Public Opin Q. 1960;24(2):163–204. [DOI: 10.1086/266945]
  27. King EB, Hebl MR, Heatherton TF. Theories of stigma: limitations and needed directions. In: Brownell KD, Puhl RM, editors. Weight bias: nature, consequences, and remedies. England: Guilford Press; 2005. p. 109–210.
  28. Helmich E, Bolhuis S, Prins J, Laan R, Koopsman R. Emotional learning of undergraduate medical students in an early nursing attachment in a hospital or nursing home. Med Teach. 2011;33:e593–601. [DOI: 10.3109/0142159X.2011.610837]
  29. Mezirow J. Transformative learning: theory to practice. New Directions for Adult and Continuing Education. 1997; 74:5-12.
  30. Cutler JL, Harding KJ, Hutner LA, Cortland C, Graham MJ. Reducing medical students’ stigmatization of people with chronic mental illness: a field intervention at the “Living Museum” state hospital art studio. Acad Psychiatry. 2012;36(3):191–6. [DOI: 10.1176/appi.ap.10050081]
  31. Gronholm PC, Henderson C, Deb T, Thornicroft G. Interventions to reduce discrimination and stigma: the state of the art. Soc Psychiatry Psychiatr Epidemiol. 2017;52:249–58. [DOI: 10.1007/s00127-017-1341-9]
  32. Knaak S, Modgill G, Patten SB. Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. Can J Psychiatr. 2014;59(10 Suppl 1):S19–26. [DOI: 10.1177/070674371405901S06]
  33. Saunders K, Hawton K, Fortune S, Farrell S. Attitudes and knowledge of clinical staff regarding people who self-harm: a systematic review. J Affect Disord. 2012;139(3):205–16. [DOI: 10.1016/j.jad.2011.08.024]
  34. Yamaguchi S, Wu S-I, Biswas M, Yate M, Aoki Y, Barley EA, et al. Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review. J Nerv Ment Disord. 2013;201:490–503. [DOI: 10.1097/NMD.0b013e31829480df]
  35. Dearman SP, Joiner AB, Gordon M, Vince G. Experiences of patients with mental illness’ interactions with medical students: a systematic review. Can J Psychiatry. 2018;63(1):4–11. [DOI: 10.1177/0706743717730824]
  36. Eynan R, Bergmans Y, Antony J, Cutliffe JR, Harder HG, Ambreen M, et al. The effects of suicide ideation assessments on urges to self-harm and suicide. Crisis. 2004;35(2):123–31. [DOI: 10.1027/0227-5910/a000233]
  37. Blades CA, Stritzke WG, Page AC, Brown JD. The benefits and risks of asking research participants about suicide: a meta-analysis of the impact of exposure to suicide related content. Clin Psychol Rev. 2018;64:1–12. [DOI: 10.1016/j.cpr.2018.07.001]
  38. Dornan T, Boshuizen H, King N, Scherpbeier A. Experience-based learning: a model linking the process and outcomes of medical students’ workplace learning. Med Educ. 2007;41:84–91. [DOI: 10.1111/j.1365-2929.2006.02652.x]
  39. Karnieli-Miller O, Vu R, Holtman MC, Clyman SG, Inui TS. Medical students’ professionalism narratives: a window on the informal and hidden curriculum. Acad Med. 2010;85(1):124–33. [DOI: 10.1097/ACM.0b013e3181c42896]
  40. Friedrich B, Evans-Lacko S, London J, Rhydderch D, Henderson C, Thornicroft C. Anti-stigma training for medical students: the Education not Discrimination project. Br J Psychiatry. 2013;202(s55):s89–94. [DOI: 10.1192/bjp.bp.112.114017]

MeSH Term

Attitude of Health Personnel
Curriculum
Humans
Psychiatry
Self-Injurious Behavior
Students, Medical
Journal Article
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0self-harmattitudesstudentscurriculumtowardnegativedevelopmentMedicalStudentspeopleexploremedicalmayinfluenceusedframeworkhealthcareimportantAttitudesSelf-harmOBJECTIVES:authorsfirstfinalyearexamineMETHODS:Sixfocusgroupsinvolvingtotal21objectivesThematicanalysisanalyzedataiterativecodingidentificationthemesRESULTS:demonstratedsimultaneouslypositivereportedminimalexposureformalexposedexhibitedprofessionalsinformalfeltsubjectscompetingattentionManydiscouragedstaffseeingparticularpsychiatryplacementshiddenencouraginglearn"not"​CONCLUSIONS:FindingsstudyidentifymightbenefitencouragedinteractopportunitydiscussemotionsinteractionscreateStudents'CurricularInfluencesAttitudeDevelopmentCurriculainfluencesStigma

Similar Articles

Cited By