Psychiatry as a specialization: influential factors and gender differences among medical students in a low- to middle-income country.

OBJECTIVES: To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions. METHODS: This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20. RESULTS: Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided. CONCLUSION: Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.

An evidence-based checklist to assess neuropsychological outcomes of epilepsy surgery: how good is the evidence?

PURPOSE: We aimed to assess the quality of evidence on neuropsychological outcomes after epilepsy surgery (ES). Accordingly, we created an evidence-based neuropsychology (EBNP) checklist to assess neuropsychological outcomes and applied this tool to studies from a systematic review. METHODS: The EBNP checklist was created using clinical expert input, scale development methodology for item generation and reduction and inter-rater reliability, and critical appraisal guidelines for studies about treatment. The checklist was applied to articles obtained through a systematic review of resective ES neuropsychological outcomes. The proportion of studies fulfilling the quality criteria and the total quality score were used to assess the quality of the evidence. RESULTS: An initial 45-item checklist was applied to 147 articles, with excellent inter-rater agreement (kappa=0.80). The mean quality score was 23 (SD: 4, range: 12-33). There was substantial variability in the percentage of studies meeting the criteria for specific items (0-99%). The median proportion of papers fulfilling various quality criteria was 1.4% for items related to group comparisons, 37% for clinical applicability, 67% for patient description, 78% for outcome assessment, and 91% for interventions. Higher quality correlated with longitudinal design, reporting presurgical IQ, seizure frequency and antiepileptic drugs, and using validated measures of change in individual patients. The final EBNP checklist consisted of 19 items. DISCUSSION: The EBNP checklist reliably identified quality strengths and threats to validity of neuropsychological outcome studies in ES. Studies would be most improved by the inclusion of random allocation to interventions or at minimum blinded outcome assessment, empirically based measures of reliable change and completeness of reporting of follow-up.