Early Psychiatry Exposure in Medical School Could Ease a Growing Workforce Crisis

The United States does not have enough psychiatrists, and the gap is widening rather than closing. As of December 2025, more than 134 million Americans were living in a designated Mental Health Professional Shortage Area, a figure that means a substantial share of the population relies on primary care physicians, emergency departments, or no one at all for psychiatric care. Against that backdrop, a new correspondence published in the journal Academic Psychiatry argues that the most powerful lever for change may lie not in residency programs or recruitment fairs, but in the first and second years of medical school, long before most students have seriously considered what kind of physician they will become.

The letter, authored by psychiatry educators at five institutions, makes a deceptively simple case: medical student educators must not only spark interest in psychiatry as a career but also cultivate a foundational appreciation of the specialty among all future physicians, whatever field they ultimately enter. The authors contend that early, intentional engagement of preclinical students represents a critical and underutilized opportunity to shape attitudes, build clinical skills, and ultimately strengthen the psychiatric workforce. Their argument is grounded in a growing body of evidence about how and when specialty choices actually form.

Research on career decision-making in medicine suggests that the path to psychiatry often begins well before medical school. Prior experiences, including backgrounds in the humanities, service activities in mental health settings, and a strong social orientation, have been shown to predict interest in the field. During medical school itself, clinical psychiatric experiences and positive institutional, faculty, and peer attitudes toward psychiatry further reinforce that interest. Attitudes toward mental illness and the specialty of psychiatry are demonstrably shaped by the quality of contact students have with psychiatric patients and psychiatrists, which makes the timing and design of those contacts a matter of practical consequence.

The most striking data cited in the letter come from the 2025 Association of American Medical Colleges Matriculating Student Questionnaire and Graduation Questionnaire. Among students who matched into psychiatry, only 22.1 percent expressed interest in the specialty at the time they entered medical school. A remarkable 57.1 percent were initially interested in a different specialty, and 13.9 percent were undecided. In other words, roughly seven in ten future psychiatrists arrived at medical school without psychiatry in mind. For educators, that statistic reframes the problem: the task is less about recruiting students who already know their destination and more about engaging, informing, and converting learners throughout their education.

To illustrate what that engagement can look like, the authors describe programs developed independently at the University of Texas Southwestern Medical Center, the University of California San Diego, Baylor College of Medicine, the University of Nebraska Medical Center, and Dell Medical School at the University of Texas at Austin. Although each institution built its offerings separately, the programs converge on a shared set of strategies, suggesting that certain approaches to early psychiatry exposure may generalize across very different institutional contexts. The authors organize these efforts into four categories of pre-clerkship exposure: preclinical, clinical, longitudinal, and extracurricular.

On the preclinical front, the Psychiatry Student Interest Group at UT Southwestern was expanded to address the scarcity of psychiatry content in the first two years of the curriculum. The group provides a near-peer mentoring community, hosts regular presentations showcasing careers in psychiatry, compiles research opportunities, and has recently developed a database of shadowing opportunities. Notably, students drive the programming while faculty play a supporting role, championing student initiatives and liaising with student affairs. The authors argue that interest groups of this kind create a community of belonging for students curious about psychiatry long before they set foot on a clinical rotation, a psychological mechanism that may matter as much as the informational content itself.

Clinical exposure before the clerkship is exemplified by the CARES program, short for Compassionate Action and Real community Engagement in Service, at UC San Diego. First- and second-year medical students are matched with a faculty mentor for three half-day clinic sessions per quarter, beginning with observation and progressively working toward direct patient contact. This longitudinal preceptor model allows students to explore specialties of interest, including psychiatry, while building clinical skills and professional identity in an authentic and supportive environment. For psychiatry faculty, serving as a CARES mentor offers a structured way to make an early impression on students at the very stage when the majority of future psychiatrists are still leaning toward other fields.

Longitudinal and community-oriented pathways are highlighted at Baylor College of Medicine, where students can pursue the Dean’s Distinction in Service Learning, a multi-year program combining community service engagement, service-learning educational activities, a reflective exercise, and a symposium presentation. Several of the community sites serve people with psychiatric illness, substance use disorders, and other vulnerable populations. Additional pathways, including the Psychiatry Residency Outreach to Public Sector program and Albert Schweitzer Fellowships, allow students passionate about community mental health to connect their personal values with sustained service. The design principle is continuity: rather than a single lecture or a one-off volunteer day, these programs weave psychiatric populations and mental health settings into a student’s experience over years.

The extracurricular category spans two distinct models. At the University of Nebraska Medical Center, a fourth-year Psychiatry Student Chief program places selected senior students in a structured leadership role: they lead review sessions, hold office hours, remain available on an as-needed basis for clerkship students, and serve as liaisons between students and faculty. Faculty cultivate the chiefs’ skills as near-peer educators. The model addresses two pressures at once, easing the high-stress nature of clinical rotations and the increasing competitiveness of psychiatry residency, while giving junior students accessible, relatable guidance from peers who have just navigated the same terrain. At Dell Medical School, meanwhile, students connect with psychiatry research through their interest group, meetings with the Associate Chair of Research, and research meet-and-greet events. A unique third-year exploration year allows students to devote an entire year to psychiatric research, a departmental travel scholarship supports scholarly work, and fourth-year students, including visiting students, can choose from nine month-long research electives, with invitations to departmental and school-wide showcases making the resulting work visible.

Taken together, the five institutional portraits support the framework the authors propose: engaging medical students in psychiatry across the continuum of training through exposure opportunities that span preclinical, clinical, longitudinal, and extracurricular domains. No single program is sufficient, and no one approach is right for every institution, but the underlying principle is consistent. By intentionally creating multiple, varied touchpoints with psychiatry early in medical education, faculty can meaningfully shift students’ perceptions of, and interest in, the specialty. The convergence of independently developed programs on similar strategies offers a form of natural replication that strengthens the case that these methods are transferable rather than idiosyncratic.

The authors are explicit that the psychiatric workforce shortage will not be solved by residency training alone. It requires upstream investment in the first and second years of medical school, in student interest groups, in research mentorship, and in near-peer relationships. A consistent theme across all five institutions is that these programs require a dedicated faculty champion to thrive, a finding that carries practical weight for departments weighing where to spend limited faculty time. The authors invite educators elsewhere to reflect on the engagement opportunities already present in their environments and to consider where new programs might take root, arguing that looping in learners early is not merely good recruitment but good medical education. For a specialty facing a shortage measured in the tens of millions of underserved Americans, the earliest years of training may prove to be the most consequential.

Subject of Research: Strategies for engaging pre-clerkship medical students with psychiatry to strengthen the psychiatric workforce

Article Title: Looping in Learners: Strategies to Connect Medical Students with Opportunities in Psychiatry

Article References: Looping in Learners: Strategies to Connect Medical Students with Opportunities in Psychiatry. (n.d.). https://doi.org/10.1007/s40596-026-02455-0

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02455-0

Keywords: psychiatry, medical education, workforce shortage, medical students, preclinical exposure, mentorship, student interest groups, near-peer teaching, clinical preceptorship, research electives, specialty choice, Academic Psychiatry