Portugal, like many other countries [1
], is currently struggling with a shortage of psychiatrists in its public health system. Though not with the severity found in other countries, the ratio of psychiatrists per 100,000 inhabitants found in Portugal, a country with 10 million inhabitants, is still clearly inferior to that existing in the more developed countries in the European Union.
According to the available data [6
], Portugal's ratio (4,7/100.000) is in stark contrast with those found in Central and North European countries (Sweden - 20/100.000, France - 22/100.000, UK - 11/100.000), as well as with Southern European countries (Italy - 9,8/100.000, Greece: 15/100.000).
This issue, resulting from a combination of several factors, has recently worsened. Firstly, the small number of physicians graduating from Portuguese medical schools, a direct result of the Governmental policy of restricted admission (numerus clausus), which has been the norm over the past 30 years. The number of graduating physicians has dwindled so acutely that the yearly Internship allocations have seen an excess of vacancies. Secondly, due to the scarcity of physicians in a given field, particularly in primary care, the Government has allocated substantial amounts of vacancies to fields like family medicine (accounted for 30% of vacancies in the 2009), thus reducing the amount available for other fields.
Thirdly, the changes in the management model of the National Health Service, together with a booming private health sector and health insurance companies, have contributed to the existing flow of physicians from the National Health Service toward private enterprises, where the salary is higher, thus further reducing the number of physicians available in the National Health System.
Lastly, if the advanced average age of the psychiatrists is taken into consideration, it becomes clear that within the next 5-10 years their numbers will decline sharply, with added risk to the availability and delivery of mental healthcare in the public sector.
The scarcity of medical resources, worrying in itself, is becoming a challenging issue given the reform of the Portugal's Mental Healthcare System, under way since 2007. The 'National Mental Health Plan 2007-2016', developed by the Ministry of Health with input from the World Health Organization, aims at the development of mental healthcare services across the Country, in order to ensure a comprehensive coverage of the population, regardless of their location. The development of this network requires the creation of new services in regions with greater need, in order to guarantee the implementation of new healthcare programmes in fields such as severe mental illness, child psychiatry, liaison with primary care and psychogeriatrics. Though the 'National Mental Healthcare Plan 2007-2016' underlines the importance of a multidisciplinary approach and the importance of non-physicians in the local Mental Health teams, there is an undeniable shortage of psychiatrists and child psychiatrists in the public system, with particular severity outside the great urban areas, and a clear trend toward its growth in the mid-range.
In the present context of simultaneous dwindling of medical resources and increased need, it is crucial that greater efforts are made to improve the recruitment of new psychiatrists, which must begin with undergraduate medical training.
Portuguese medical students are not immune to the factors which, according to the literature, seem to push student away from pursuing a medical career in psychiatry, such as: low status when compared with other specialties; seemingly less scientific, stigma, lower consideration among peers, lower financial benefits, and 'bad-mouthing' by medical specialists from other fields [7
The impact of such factors may only be reduced through processes that induce a change to the negative outlook toward psychiatry. According to the existing literature on the subject, the carrying out of clerkships can produce significant changes to the student's attitude toward psychiatry, which is why their impact is being studied in various socio-economic environments.
Several studies seem to underline the positive effect a clerkship has on the student's attitude towards psychiatry. This effect is particularly visible in clerkships that allow students to participate in the direct provision of healthcare, to witness patient recovery, and to join the staff group [10
]. In Portugal, these clerkships, which take place in the final year of undergraduate medical training, have suffered profound changes and standardization by Governmental initiative. This initiative was supported by the creation of guidelines[16
] based on a set of well known international documents on medical education[17
]. However, little is known on the real impact of these curriculum changes on the learning process, on performance evaluation, or the student's attitude towards the various fields of clinical medicine. This study seeks to assess the medical students' perception of psychiatry and ascertain the impact of this new model of clerkship in this perception, with particular emphasis on the perspective of psychiatry as a future specialty option.