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Stigma toward mental illness remains common among medical trainees and may influence clinical care, help-seeking behavior, and interest in psychiatry as a career. This study examined the impact of a 7-week psychiatry rotation on medical students’ attitudes toward psychiatry, stigma toward mental illness, help-seeking attitudes, mental health service utilization, and psychological distress. Sixth-year medical students at the University of Hong Kong completed questionnaires before and after a compulsory psychiatry rotation between August 2024 and June 2025. Of 211 students completing baseline assessment, 128 (60.7%) completed follow-up and were included in analyses. Measures included the Attitudes Toward Psychiatry Scale, Mental Illness Clinicians’ Attitudes Scale, Attitudes Toward Seeking Professional Psychological Help – Short Form, Kessler Psychological Distress Scale (K6), and a self-reported service utilization item. Pre-post changes were examined using paired statistical tests, and regression analyses identified baseline predictors of post-rotation outcomes. Following the rotation, students reported increased psychiatric knowledge (p < 0.001) and greater consideration of psychiatry as a career (p < 0.001), although overall interest in the specialty did not change (p = 0.963). Overall stigma toward mental illness remained unchanged (p = 0.280), though students reported greater comfort interacting with individuals with mental illness (Holm-Bonferroni adjusted p = 0.016). Help-seeking attitudes improved (p = 0.015) and psychological distress decreased (p < 0.001). Self-reported lifetime mental health service utilization decreased from 28.3% to 20.0% (p = 0.006). Across outcomes, baseline measures were the strongest predictors of post-rotation scores in multivariate models (all p < 0.001). A brief psychiatry rotation was associated with improved psychiatric knowledge, greater consideration of psychiatry as a career, more favorable help-seeking attitudes, and reduced psychological distress among medical students, alongside increased comfort interacting with individuals with mental illness. However, overall stigma toward mental illness did not significantly change, suggesting that short-term clinical exposure alone may be insufficient to substantially modify broader attitudinal frameworks. More sustained, recovery-oriented educational strategies may therefore be required to promote deeper attitudinal change and foster longer-term engagement with psychiatry.