effect of training and other influences on the development of career interest in geriatric...

300 Am J Geriatr Psychiatry 11:3, May-June 2003

Effect of Training and Other Influenceson the Development of Career Interest

in Geriatric Psychiatry

Susan J. Lieff, M.D., M.Ed., FRCPCGeorge S. Tolomiczenko, Ph.D., M.P.H.

Laura B. Dunn, M.D.

Objective: The authors examined the relationship between the timing and nature ofeducational exposure to geriatric psychiatry and other potential influences and sub-sequent development of career interest in geriatric psychiatry. Methods: A 46-itemsurvey was distributed to residents and fellows who attended one of the two sponsoredprograms for residents at the three American Association of Geriatric Psychiatry(AAGP) annual meetings held between 2000 and 2002, inclusive. Results: Ninety-three percent of attendees responded (N�184). Sixty-five percent first developed in-terest in geriatric psychiatry during their residency years (the majority during theirPGY1 or PGY2 year). The timing of individualized teaching exposure, as well aslectures in geriatric psychiatry, was associated with the development of first interestin the field. The most important influences on the development of interest in the fieldincluded specific teacher attributes, training experiences, personal experiences withseniors, and characteristics cited as unique to geriatric psychiatry, such as the medical,neuropsychiatric, and multifactorial nature of the field. Patient personal histories andoutcomes, as well as non-educational experiences with seniors and cultural attitudes,also contributed to interest. Conclusion: It behooves geriatric psychiatry programs tocreate exemplary educators and commit them to teaching in the early years of generalpsychiatry programs as well as in medical school. These educators should be identi-fying potential recruits by enquiring about trainees’ previous experiences with olderpersons as well as emphasizing the unique aspects of geriatric psychiatry that areattractive to trainees. (Am J Geriatr Psychiatry 2003; 11:300–308)

Received December 2, 2002; revised February 17, 2003; accepted February 19, 2003. From the University of Toronto, Toronto, Ontario, Canada(SJL,GST) and the University of California–San Diego, California (LBD). Address correspondence to Dr. Susan Lieff, Baycrest Centre for GeriatricCare, Department of Psychiatry, 3560 Bathurst Street, North York, Ontario M6A 2E1, CANADA. e-mail: [email protected]

Copyright � 2003 American Association for Geriatric Psychiatry

Recruitment of individuals to undertake trainingin geriatric psychiatry may be the most impor-

tant challenge facing geriatric psychiatry currently.Reports have consistently underscored the imbalance

between the demographic need for a larger supply ofgeriatric specialists, on the one hand, and trends inthe numbers of faculty, clinicians, and trainees, on theother.1–3 Recent estimates for the year 2010 place the

Lieff et al.

Am J Geriatr Psychiatry 11:3, May-June 2003 301

need for academic geriatric psychiatrists at 400–500and for actively practicing geriatric psychiatrists at4,000–5,000.4,5 The prevalence of psychiatric disor-ders in adults over age 65 is expected to increase by2030 to a projected 15 million people, compared with6 million in 1990.6 Furthermore, as the ranks of the“oldest old” (those 85 and older) swell, demand willgrow for geriatric psychiatrists who can competentlydiagnose and manage the complex mental-healthneeds of this group.

Currently, the American Association for GeriatricPsychiatry (AAGP) lists 1,559 members (personalcommunication, Janice Allen, AAGP, September 20,2002). Although 2,595 psychiatrists initially obtaineda Certificate of Added Qualification (CAQ) in geri-atric psychiatry, 310 did not re-certify when theirCAQ lapsed (personal communication, Patti Von-drak, American Board of Psychiatry and Neurology,Inc., November 1, 2002), resulting in a current totalof only 2,285 psychiatrists with CAQs.7 Despite theexpansion in number of accredited geriatric psychi-atry fellowships from 13 programs in 1980 to 62 to-day, many of these 132 first-year positions go unfil-led.2,8–13

This relative shortage of trainees, given the antici-pated demand for geriatric psychiatrists, highlights arecurring theme in psychiatric recruitment—how toattract medical students and residents to psychiatryand, specifically, psychiatric subspecialties such asgeriatric psychiatry. One survey revealed that nega-tive attitudes held by first-year medical students to-ward psychiatry may be based on potentially reme-diable false beliefs regarding psychiatric populationsand the scientific effectiveness of psychiatric treat-ments.14 Consistent with this notion is research indi-cating that the most influential factor during medicalschool on later choice of psychiatry as a career was apositive clerkship experience.15

It is unclear whether similar factors affect recruit-ment of psychiatry residents into geriatric psychiatry.An older study of practicing psychiatrists supportsthe idea that negative attitudes may be aversive tothis career choice: Ford’s 1980 survey of 179 UnitedStates psychiatrists revealed ageism in respondents’perceptions of elderly patients.16 It is also possiblethat lack of exposure to geriatric psychiatry and togeriatric psychiatrists amounts to missed opportuni-ties to attract trainees. In two studies using the Delphitechnique to generate opinions, Lieff and Clarke

found that educational experiences, particularly ex-cellent supervision and positive clinical exposure, fig-ured strongly in the development of an interest ingeriatric psychiatry.17–19 In the study of residents, 23trainees doing mandatory geriatric psychiatry train-ing and 3 doing advanced training in geriatric psy-chiatry were asked to list factors they felt would in-fluence interest in seeing geriatric patients. They thenrated how influential they believed these factorswould be.18 In the other study, 19 identified “experts”(members of the Canadian Academy of Geriatric Psy-chiatry, who devoted most or all of their practice togeriatric patients) generated and then provided re-sponses regarding the most influential factors ontheir focus on geriatric psychiatry.19 Although thesestudies suggest that supervisor characteristics andpositive experiences during residency are highly in-fluential among trainees and those choosing to prac-tice geriatric psychiatry, we need studies elucidatingwhen and how career-influencing factors act. Such in-formation would enable the field to develop recruit-ment strategies that capitalize on existing opportu-nities and create new ones.

In this study, we examined whether there is arelationship between the timing and nature of edu-cational exposure to geriatric psychiatry and subse-quent development of an interest in geriatric psychi-atry. Our approach consisted of assessing perceptionsof the field of geriatric psychiatry among traineeswho had expressed some level of interest. We alsoevaluated the relative influence of various factors oninterest in geriatric psychiatry at the time of careerdecision-making. Our hypotheses were the following:1) the timing of individualized teaching exposure ingeriatric psychiatry would be associated with the de-velopment of first interest in the field; and 2) the mostimportant influences on the development of interestin the field would include: specific teacher attributes,training experiences, personal experiences with sen-iors, and characteristics cited as unique to geriatricpsychiatry such as the medical, neuropsychiatric, andmultifactorial nature of the field.

METHODS

A 46-item survey was distributed to residents andfellows who attended one of the two sponsored pro-

Training Influences on Career Interest


grams (a recruitment program and a mentorship pro-gram) for residents at the three AAGP annual meet-ings held between 2000 and 2002, inclusive. Theseprograms are advertised to general and geriatric psy-chiatry training directors throughout Canada and theUnited States and not directly to trainees. With theexception of the meeting held in 2001, they were onlyopen to residents beyond their PGY2 year. Interestedapplicants submitted a curriculum vitae, a personalstatement, and letters of reference. Participants wereselected on the basis of their interest in geriatric psy-chiatry, as demonstrated by these materials. Surveyswere distributed to attendees at the beginning of theirrespective programs. If they had been surveyed in aprevious year or program, they were asked not to fillout a second survey. Once the surveys had been com-pleted, the program proceeded.

The three-page survey was divided into six con-ceptually different sections, which included the fol-lowing data: 1) demographic information; 2) timingand nature of exposure to geriatric psychiatry duringmedical school and residency (lectures, small groups,individual teaching, supervised experiences, mentor-ing, patient exposure); 3) interest in, and commitmentto, a future practice in geriatric psychiatry; 4) timingof first interest in geriatric psychiatry, whether super-visors influenced their interest positively or negatively,and timing of exposure to influential supervisors;5) perceptions of financial payment, employment, fel-lowship, and research opportunities; and 6) ratings ona five-point Likert scale of the degree of influence of23 factors on their interest in geriatric psychiatry (spe-cific items are listed in Table 1).

Data Analysis

We used descriptive statistics (frequencies andcross-tabulations) to characterize the sample and con-trast response patterns of relevant subgroups of oursample. For comparisons between subgroups onnominal variables, chi-square tests of significancewere used. For ordinal scale variable comparisons,Kendall’s tau-b tests of significance were used; t-testswere used to test for significance of mean age differ-ences between any two-group comparisons. All anal-yses were conducted with SPSS 11.20

RESULTS

Over the 3 consecutive years, 199 surveys were dis-tributed and 185 returned, resulting in a 93% re-sponse rate.

Characteristics, Attitudes, andInterest in Geriatric Psychiatry

Characteristics of the entire group are summarizedin Table 2. One hundred forty (76%) reported thatthey were very interested and 33 (18%) moderatelyinterested in devoting some of their future profes-sional time to geriatric psychiatry. One hundred four-teen (62%) planned to spend more than half of theirtime devoted to geriatric psychiatry in the next 5years. Eighty-eight percent agreed, or stronglyagreed, that employment opportunities in geriatricpsychiatry are available, as well as fellowship (89%)and research (86%) opportunities. Only 41% felt thatfinancial payment for geriatric psychiatric care wasadequate.

TABLE 1. Factors that influenced interest in geriatricpsychiatry (N)

Specialty-specific1. Neuropsychiatric nature of the specialty (177)2. Medical psychiatric nature of the specialty (179)3. Multifactorial nature of the problems of geriatric

psychiatric patients (179)4. Outcomes among geriatric psychiatric patients that you

have treated (177)5. Providing care to an underserviced population (178)6. The extensive personal histories of geriatric psychiatric

patients (178)7. Employment opportunities in geriatric psychiatry (173)8. Fellowship opportunities in geriatric psychiatry (176)9. Demographic pressures of an aging population (177)

10. Research opportunities in geriatric psychiatry (173)11. Financial payment for geriatric psychiatric care (177)

Personal1. Personal relationships with seniors (177)2. Cultural attitudes toward elderly persons (177)3. Other non-educational experiences with seniors (155)4. Volunteer work with seniors (125)

Education-specific1. Teacher/supervisor attitudes toward the care of elderly

patients (179)2. Teacher/supervisor competence in the care of elderly

patients (179)3. Teacher/supervisor teaching ability (178)4. Teacher/supervisor ability to support and respond to your

learning (178)5. Teacher/supervisor ability to mentor you about your

career (177)6. Teacher/supervisor with whom you could identify (149)7. Clerkship experiences with geriatric psychiatry (149)8. Medical school preclinical experiences with geriatric

psychiatry (124)

Note: Each item was rated with the following scale: 1: Verynegative influence; 2: Slightly discouraged me; 3: Neutral; 4:Stimulated my interest; 5: Very positive influence.

Lieff et al.


TABLE 2. Characteristics of respondents (N�184)

Characteristic Respondent N (%)

Mean age, years 35standard deviation: 5.7

(range: 27–60)Gender

Male 94 (51)Female 87 (47)

Year of trainingPGY2 3 (2)PGY3 55 (30)PGY4 35 (19)PGY5 85 (46)PGY6� 6 (3)

Country of residencyUnited States 163 (89)Canada 19 (10)

Anticipated country of practiceUnited States 152 (83)Canada 19 (10)Other 13 (7)

Cohort year2000 48 (26)2001 69 (38)2002 67 (36)

Medical School Exposure to Geriatric Psychiatryand Development of First Interest

Sixty-three percent of respondents had exposure togeriatric psychiatry during their medical schoolyears. Fifty-seven percent had preclinical exposure togeriatric psychiatry, with slightly more than half ofthem receiving individual teaching by a geriatric psy-chiatrist. Fifty-eight percent had a clerkship experi-ence in geriatric psychiatry, of which approximatelytwo-thirds had a supervised clinical experience. Themedical school years stimulated first interest for 20%of respondents (67% of this group during the clerk-ship). During the medical school years, there was nosignificant association between timing of exposure togeriatric psychiatry or the nature of the geriatric psy-chiatric teaching experience (individual versus didac-tic) and the development of interest in the field.

Residency Exposure to Geriatric Psychiatryand Development of First Interest

Sixty-five percent first developed interest in geri-atric psychiatry during their residency years (ofthese, 63% felt an initial interest developed duringtheir PGY1 or PGY2 year). The 13% who became in-terested at a time unrelated to training were older(38.0 years; standard deviation [SD]: 7.9 versus 34.5years; SD: 5.2; t[169]� –2.79; p�0.006). One hundred

fifty-one residents (82%) answered Yes to the ques-tion, “Do you feel that your training supervisors/teachers had any influence (positive or negative) onyour interest in geriatric psychiatry?” Of these 151respondents, 13 (9%) reported negatively influentialexperiences with these teachers. The timing of expo-sure to the positively-influential teachers was asso-ciated with the development of interest (v2

[1, 148] �

29.85; p�0.0005). Fifty-nine percent developed inter-est at the time of exposure and 24%, subsequently.

During residency training, there was an associationbetween timing of exposure to certain types of geri-atric psychiatric teaching experiences and the devel-opment of interest in the field (see Table 3). The stron-gest associations for the development of first interestin geriatric psychiatry were for supervised clinical ex-periences with geriatric psychiatric patients by a ge-riatric psychiatrist, mentoring by a geriatric psychi-atrist, and lectures in geriatric psychiatry. Alsosignificant were one-to-one teaching by a geriatricpsychiatrist and exposure to geriatric psychiatric pa-tients. There was no association with timing of small-group teaching in geriatric psychiatry and develop-ment of interest. During the PGY1 or PGY2 years ofthe 36 who developed first interest in medical school,more than 90% had geriatric psychiatric patient ex-posure and lectures. More than 70% had mentoringor one-to-one teaching by a geriatric psychiatrist.

Factors Influencing Interestin Geriatric Psychiatry

We divided the factors for which there was themost consensus regarding degree of influence intothree conceptual categories: specialty-specific, per-sonal, and educational.

Specialty-specific factors. The specialty-specific fac-tors are described in Table 1; the degree of influenceof each factor on interest is illustrated in Figure 1. Ofnote is that close to 90% of respondents felt that theneuropsychiatric, medical/psychiatric, and multifac-torial nature of the problems in the field had stimu-lated their interest, with more than half specifyingthis as a very positive influence. More than 70% ofparticipants felt that the outcomes of the patients theyhad treated, the extensive personal histories of geri-atric psychiatric patients, and the idea of providingcare to an under-serviced population had stimulatedtheir interest or been a very positive influence. Em-



TABLE 3. Type and timing of earliest exposure to geriatric psychiatry and time of first interest in the field

First Developed Interest During Training

Geriatric Psychiatry Residency ExposureEarliest Year of

Experience

Medical School(N�29–36) b

N (%)

PGY1/PGY2(N�64–74) b

N (%)

PGY3/PGY4(N�38–44) b

N (%)

Supervised clinical experiences with geriatricpsychiatry patients by a geriatric psychiatrist(p�0.003) a

Never 6 (17) 5 (7) 3 (8)

PGY1/PGY2 21 (60) 58 (78) 15 (37)PGY3/PGY4 8 (23) 11 (15) 22 (55)

Mentoring by a geriatric psychiatrist (p�0.002) a Never 1 (3) 10 (14) 4 (11)PGY1/PGY2 24 (73) 40 (58) 7 (18)PGY3/PGY4 8 (24) 19 (28) 27 (71)

One-to-one teaching by a geriatric psychiatrist(p�0.013) a

Never 1 (3) 5 (7) 2 (5)

PGY1/PGY2 24 (71) 52 (77) 15 (37)PGY3/PGY4 9 (26) 11 (16) 23 (58)

Lectures (p�0.001) a Never 0 1 (1) 1 (2)PGY1/PGY2 32 (91) 63 (86) 24 (55)PGY3/PGY4 3 (9) 9 (12) 19 (43)

Small-group learning (p�0.137) a Never 7 (24) 18 (28) 10 (25)PGY1/PGY2 17 (59) 34 (53) 12 (31)PGY3/PGY4 5 (17) 12 (19) 17 (44)

Exposure to geriatric psychiatric patients(p�0.025)a

Never — — 1 (2)

PGY1/PGY2 34 (94) 73 (100) 30 (71)PGY3/PGY4 2 (6) — 11 (26)

astatistical measure: Kendall’s tau-b.bbecause of non-response.

ployment and fellowship opportunities and demo-graphic pressures of an aging population stimulatedinterest or were very positive influences in more than60% of the group. Research opportunities stimulatedinterest in 33% of the participants and were a verypositive influence in only 14%. There was no consen-sus regarding the influence of financial payment oninterest.

Personal factors. Eighty-seven percent of partici-pants reported that personal relationships with sen-iors were influential. Sixty percent noted a very posi-tive influence, and in 27% it stimulated interest(Figure 2). Other personal experiences that stimu-lated interest or were a very positive influence in-cluded other non-educational experiences with sen-iors in 80% and cultural attitudes toward elderlypersons in 76%.

Educational factors. Teacher attributes of attitudestoward the care of elderly patients, competence,teaching ability, and ability to support the trainee’slearning were influential in more than 80% of thegroup (Figure 3). Mentorship and teachers withwhom students could identify positively influencedmore than 70%, and clerkship experiences, more than

FIGURE 1. Influence of specialty-specific factors

Note: Specific factor numbers correspond to those in Table 1.

Lieff et al.


FIGURE 3. Influence of education-specific factors


60% of the group. Fewer than 50% of respondents feltthat medical school preclinical experiences with ge-riatric psychiatry had contributed to their interest.

Gender differences. There were no gender differ-ences for interest in geriatric psychiatry, timing of de-velopment of interest, or attitudes toward geriatricpsychiatry. There were some significant differencesbetween women and men in their ratings of the de-gree of influence of various factors on their devel-

opment of interest in geriatric psychiatry. Womenwere more likely to report that outcomes among theirgeriatric patients (Kendall’s tau-b�0.165; N�175;p�0.02) and non-educational experiences with sen-iors (Kendall’s tau-b�0.199; N�153; p�0.008) wereeach very positively influential in their developmentof interest. Men were more likely to report that fel-lowship opportunities had been a very positive influ-ence (Kendall’s tau-b�–0.263; N�174; p�0.001).Men’s interest was also more likely to have been stim-ulated or very positively influenced by research (Ken-dall’s tau-b�–0.194; N�171; p�0.005) and employ-ment opportunities (Kendall’s tau-b�–0.201;N�176; p�0.004). There were no attitudes towardgeriatric psychiatry or influences that distinguishedthe group who developed interest during trainingfrom the group who developed it at another time.

DISCUSSION

Our findings support both of our hypotheses: 1) thatthe timing of individualized teaching exposure in ge-riatric psychiatry is associated with the developmentof first interest in the field; and 2) that the most im-portant influences on the development of interest inthe field include educational factors, such as specificteacher characteristics and training experiences; per-sonal factors, such as relationships, non-educational,and cultural experiences with seniors; and specialty-specific characteristics. Not surprisingly, this group oftrainees endorsed strong interest in careers in geri-atric psychiatry, with half of them currently enrolledin subspecialty training. Their attitudes toward em-ployment, research, and fellowships were generallyoptimistic, but less so regarding financial reimburse-ment.

Although the vast majority of trainees first devel-oped interest in geriatric psychiatry during their res-idency training, almost two-thirds of them had someexposure to geriatric psychiatry during their medicalschool years. Teachers, but not the nature of the teach-ing experience itself, were associated with the devel-opment of first interest during medical school. Thepsychiatry clerkship experience, in particular, wasnoted to stimulate interest, although only a minorityactually became aware of a career interest at that time.The exposure to teachers, patients, and the specialtyduring medical school may have been a necessary

FIGURE 2. Influence of personal factors




precondition for the development of later career in-terest. Such experiences, incubated by an enthusiasticteacher, may help desensitize students to their ageistassumptions, thereby enabling them to bring a lessstigmatized view of geriatric psychiatry to psychiatryresidency training.21–24 The fact that more geriatri-cians develop interest during medical school than thisgroup may reflect better integration of geriatric med-icine and its faculty in the medical school curricu-lum.26 Opportunities for geriatric psychiatry facultyto teach in the undergraduate curriculum should beaggressively pursued. Although the yield in recruit-ment may not be apparent at that time, it may lay acritical foundation to the later development of careerinterest. Presumably, those who were inspired duringmedical school specifically selected psychiatry pro-grams with geriatric strength, given their high ratesof exposure to geriatric psychiatry early in residency.

The majority of these residents developed their in-terest during their residency years, a higher propor-tion than that reported by recently graduated geria-tricians. This difference is likely due to the fact thatsome of these trainees will not pursue further geri-atric training despite their interest. It is intriguing tonote that lectures and individualized teaching expe-riences with geriatric psychiatrists had the strongestassociations with development of first interest. Thefact that teachers were also felt to be very influentialin the development of first interest throughout a stu-dent’s experience suggests that teachers—their teach-ing ability and mentorship—rather than the methodsused, are what stimulate interest in the field—find-ings that support previous work.18,19 It is likely thefact that these teachers are able to clearly communi-cate their attitudes and competence that students findso influential. Their enthusiastic role-modeling andteaching allows their students to “try on” their ca-reers—what Burack has called “trying on possibleselves.”25 Forty-eight percent of recently graduatedgeriatricians also felt that mentors had influencedtheir career track.26 Swenson’s description of mentorsas advisers, role models, teachers, and sponsors res-onates with the qualities that students rated of theinfluential teacher.27 It may be that small-group teach-ing is not influential because it does not provideteachers with an opportunity to demonstrate theirclinical competence and role-modeling.28 These find-ings highlight the need for concerted efforts on thepart of geriatric psychiatry programs to promote ex-

cellence in clinical teaching and mentorship skillswithin their faculty. Residents must become involvedwith these faculty members and geriatric psychiatricpatients in the PGY1 and PGY2 years to stimulateinterest in the field, thereby maximizing opportuni-ties for recruitment. The recent Residency ReviewCommittee requirement for geriatric training in gen-eral psychiatry can add fuel to such initiatives.29

Consistent with the Delphi studies, the neuropsy-chiatric, medical/psychiatric, and multifactorial na-ture of the problems in the field were major influenceson interest.18,19 Geriatricians also noted that the rangeof medical problems and multidisciplinary aspects ofthe specialty were significant factors in their careerdecision-making.26,30 In the past decade, geriatricpsychiatry has become increasingly identified as aneuropsychiatric field. Our aged and aging patientpopulation is becoming increasingly complex, withmultiple comorbidities, and are engaged in many sys-tems of care and support. This appears to excite thisgroup while discouraging others,22 begging the ques-tion of whether the lack of interest in geriatric psy-chiatry reflects ageist attitudes or whether some ofthose who choose psychiatry may be uncomfortablewith a medically complex population.31 Our findingthat personal histories and outcomes of treated geri-atric psychiatric patients influenced a majority of re-spondents supports the notion that unique aspects ofgeriatric psychiatry are distinctly attractive to inter-ested residents. Others have reported on the rewardof treating, as well as enjoying, the histories of geri-atric patients.22,26,30

The influence of personal relationships, non-educational experiences, and cultural attitudes to-ward seniors, is consistent with Green’s findings thatmedical students’ positive attitudes toward elderlypatients correlated with positive feelings about pre-vious personal contact with elderly persons.32 Aca-demic geriatricians have also reported on the influ-ence of personal and early life experiences in theircareer choice.30 For the past 5 years, more than 50%of geriatric psychiatry fellows have been interna-tional medical graduates.8–13 One wonders whether,in part, the interest of these graduates reflects societaland cultural attitudes that are more favorable towardelderly people. Similar to recently graduated geria-tricians, the respondents reported a desire to care forunderserved groups.

Our finding that fellowship, research, and employ-

Lieff et al.


ment opportunities, as well as financial reimburse-ment, were more influential for the male respondentsis consistent with studies of college students, as wellas practicing physicians, demonstrating that statusand pay are more likely to factor into men’s careerchoices.33,34 The finding that female respondentsreported a greater impact of treatment outcomes ofgeriatric patients and non-educational experienceswith seniors also supports previous research. Womenin medicine are more likely to value recognition ofpatients and local peers and less likely to value ac-complishment or financial rewards.35 Anticipation ofbeing in dual-income families may also have dimin-ished financial issues as a factor in career choice forsome women.36

This study is limited in several ways. Respondents,although anonymous, were selected specifically be-cause of expressed interest in geriatric psychiatry andto maximize compliance. Thus, factors that discour-age trainees from the field are likely underreportedhere, whereas perceived interest of the group may beinflated because of social-acceptability bias. Anotherlimitation was the use of multiple statistical tests anda significance level of 0.05. However, we were lookingfor suggestive findings as starting-points for futureresearch. We believe that this is the first study of itskind to examine training and recruitment issues insuch detail. Readers may wish to apply a more strin-gent significance level of 0.01. Although this study isinformative regarding factors influencing interestedresidents, it does not provide insight into why unin-terested residents lack interest. In order to maintainconfidentiality, current and previous residency train-ing programs were not identified by the study. Con-

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From an educational perspective, it seems that inter-est in geriatric psychiatry is both born and bred.Given the association of development of first interestwith teachers and teaching experiences, it behoovesgeriatric psychiatry programs to create and promoteexemplary educators and commit them to teaching inthe early years of general psychiatry programs, aswell as medical school. These educators should beidentifying potential recruits by enquiring abouttrainees’ previous experiences with seniors as well asemphasizing the unique aspects of geriatric psychia-try that are attractive to trainees. In order to developa comprehensive understanding of recruitment to thefield, a study of psychiatry residents who are not in-terested would inform us about barriers. It wouldalso be useful to look at the recruitment patterns ofvarious psychiatric training programs to determinewhether there are unique aspects of their curriculathat contribute to interest.



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effect of training and other influences on the development of career interest in geriatric...

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