Year : 2020  |  Volume : 62  |  Issue : 4  |  Page : 431--434

Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry


M Kishor1, Henal Shah2, Suhas Chandran2, Ashok V Mysore3, Ajay Kumar3, Vikas Menon4, HR Vinay5, Mohan Isaac6, OP Singh7,  
1 Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
2 Department of Psychiatry, St John's Medical College, Bengaluru, Karnataka, India
3 Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
4 Department of Psychiatry, JIPMER, Puducherry, India
5 Department of Psychiatry, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India
6 Department of Clinical Psychiatry, University of Western Australia, Perth, Australia
7 Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India

Correspondence Address:
Dr. M Kishor
Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka
India

Abstract

The COVID19 pandemic is an unprecedented disaster. In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions. The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. Hence, there is an urgent need to look at solutions within the profession for the completion of examination. Teachers of psychiatry play an important role in the national mental health services. Their expertise can be valuable for finding solutions that work. This article has compiled suggestions from Indian teachers of psychiatry.



How to cite this article:
Kishor M, Shah H, Chandran S, Mysore AV, Kumar A, Menon V, Vinay H R, Isaac M, Singh O P. Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry.Indian J Psychiatry 2020;62:431-434


How to cite this URL:
Kishor M, Shah H, Chandran S, Mysore AV, Kumar A, Menon V, Vinay H R, Isaac M, Singh O P. Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry. Indian J Psychiatry [serial online] 2020 [cited 2020 Sep 21 ];62:431-434
Available from: http://www.indianjpsychiatry.org/text.asp?2020/62/4/431/290993


Full Text



 Background



The COVID19 pandemic is an unprecedented disaster that has affected millions of people across the globe.[1] In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions right from preschool to higher education. Health-care professionals are frontline workers in this crisis, and their presence is needed in large numbers for providing essential services, whose demand has increased drastically. Mental health services are an integral part of public health services, more so in disaster.[2] However, in India, the numbers of mental health professionals are grossly inadequate for the population that needs these services.[3]

Annually, around 800 psychiatry residents from more than 200 medical institutions take up the final examinations in India.[4] The successful ones start their practice as professionals to render mental health services. However, this year, the COVID19 pandemic has created hurdles for examination.

 Barriers for Postgraduate Examinations at the Time of COVID19



The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. The practical examination becomes more difficult as the process involves proximity with the patients and health-care professionals in the teaching hospitals, all of which can lead to high risk for infection. Some of the teaching hospitals have also been converted to designated COVID19 hospitals.

Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. However, there are equally compelling reasons for all stakeholders to complete the examination, and a further delay can adversely affect the students, faculty, and institutions in varied ways. Furthermore, the World Health Organization has warned that the pandemic and issues such as reinfection will prevent normalcy for many more months, ushering an unpredictable time frame to plan the ideal period for examination. Hence, there is an urgent need to look at solutions within the profession for the completion of examination.

 Possible Solutions from Indian Teachers of Psychiatry



Teachers of psychiatry play an important role in the national mental health services.[5] Their expertise can be valuable for finding solutions that work. The Indian Psychiatric Society (IPS) faculty training task force in association with the psychiatric postgraduate education subcommittee organized a focused webinar in early May 2020. The program invited all the Indian psychiatry postgraduate examiners and psychiatry faculty involved in the conduct of examinations to provide suggestions on how to carry out the examination. More than 200 faculty representing 65 educational institutions provided suggestions. These suggestions have been compiled here and presented for the dissemination of valuable input, particularly for this unprecedented postgraduate examination year 2020 in India.

Many have acknowledged that given the current crisis, there cannot be any single method or process, which is good for all institutions. Hence, it is important to choose or decide a postgraduate examination process that is best suited for respective institutions. The following suggestions given here should be viewed in this context.

Many have urged that the psychiatry faculty, the heads of departments, and the potential examiners should proactively communicate or discuss the concerns and plans about this year's examination process with the respective examination authorities or registrars in their institution or university. This is because institutions or universities are currently responsive to such discussion and are accommodating various possible courses of action. It is important to voice out and facilitate discussions at all levels.

Many have suggested that the safety of examiners or facilitators, postgraduate residents taking examinations this year, as well as patients are all equally important. Hence, planning ahead and following all the prescribed safety measures is going to be crucial.

Suggestions highlighted that the examination process is also about the responsibility of examiners and that of institution toward society in certifying a budding professional for certain standards in service to public health. Hence, examination standards cannot be much compromised.

The theory examination was considered by many as a relatively feasible process compared to issues involved with practical examination. However, where possible, online theory examination with multiple choice questions or clinical application question can be used to evaluate a student who, in turn, answers from any place which can be monitored and considered as safe. Some institutions or universities, in recent years, have stepped up digital evaluation of answer scripts which are scanned and uploaded for examiners to evaluate in a safe environment. These methods can be considered by other institutions across India.

Practical examinations can be held as before, if the department or institution can manage the necessary resources and implement safety measures, for example, in green zone areas or as notified by the government.

If the department is planning to change the pattern of the practical examination after consultation with institution or university, it is important to notify the examination going postgraduate immediately and give minimum of 2 weeks' notice for the candidate, before examination or as per the policy of that institution. It is indeed important to orient postgraduates or train them in the new pattern of examination accepted by the institution or university.

There are ways to carry out practical examination by involving patients as examination cases. This includes patient examination by maintaining social distance or live video streaming or playing recorded patient examination videos etc. It is important to explore all the methods examination and have them weighed against these three factors: reliability, validity, and resources. Checking these factors and discussing the possible issues in every department will assist in realistic and working solutions for the respective institution and those that can be implemented in all examination centers within the institution or university.

Wherever technology is involved in finding solutions, particularly video streaming or use of the Internet, many had apprehension about network issues that should be evaluated and ascertained at each geographical area.

It may become important for each institution or university to develop and archive e-resources such as video recording of simulated case vignette for examination. IPS can also develop and have a repository of such e-resources.

Similarly, one can conduct practical examinations by involving “nonpatients” such as simulated patients (considered as safe for health concerns) as “examination cases.” These simulated patients can be other postgraduates or interns or nurses or actors, who are trained and verified, so that they can act as real cases to facilitate examination. This method can be used for all examination cases such as long case or short case or neurology case.

The other ways to conduct practical examinations include the use of “written case scripts” or “audio recordings” or if institutions have designed mannequin (dummy/articulated doll) as examination cases. Designed mannequin can mimic a desired clinical condition. It is suggested considering these options for feasibility at the respective institution. Suggestions have also been received on the combination of the above methods and/or Objective Structured Clinical Examination (OSCE) or Tele OSCE to conduct examinations. If examiners and postgraduates are new to these concepts, it is important to discuss with the respective medical education unit in the institution or learning from experts or through video tutorials on the website. Training examiners will be the responsibility of the institution or university which chooses to go with such modifications.

About the requirement of external examiners where safe transport and infection are indeed a matter of concern, many have opined that having only regional examiners or available examiners in the respective city or examiners in neighboring cities, including former examiners, can be considered for conducting the examination. It is important to discuss with the respective institutional authorities about external examiners. All examiners should be oriented about the examination pattern well in advance.

There have also been suggestions to involve or encourage all postgraduates taking up the examination to contribute in patient care in all their capacity, particularly if there is a long delay in return to normalcy. It was suggested to look at ways and means to empower postgraduates in all aspects to utilize their acquired skill and knowledge in psychiatry services during pandemic. Some have suggested that if the postgraduates have been assessed periodically in a systematic manner that has been documented, the institutions can take a call on utilizing the documents to consider completion.

Along with the above suggestions, there was a consensus from all that, as a department or as an examiner or expert or institutional representative, this is an opportunity for the entire psychiatry collective to collaborate with decision-making authorities or policy-making bodies at all levels. It is necessary to proactively lobby for a safe and actionable plan for conducting examinations and associated issues.

 Conclusion and the Way Forward



It is important to be open to the ideas and suggestions, especially those which are based on available technology. Such methods can become a norm or an alternate method for conducting examination in the future, for example, to video stream the examination from one place to other or directly to the external examiner.

During the times of a pandemic of this magnitude, it is expected that each one, with their experiential wisdom and goodwill, shall do their best in relation to all issues arising out of COVID19 including that of the postgraduate examinations.

Disclaimer: It is important to note that these are suggestions from individuals and not to be considered as the official stand of IPS or any other organization or group or institution. These cannot be considered as guidelines. It is primarily intended for sharing imminent concerns regarding postgraduate examinations in psychiatry and looking at possible solutions. On 15 June 2020, the MCI released advisory to incorporate some suggestions mentioned as alternative in skill evalution such as simulations, case scenarios etc as one-time exception in view of COVID19.

Acknowledgments

We would like to sincerely express our gratitude to all the Indian teachers of psychiatry who offered their suggestions and participated in discussion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2020 May 11].
2Raphael B. Overview of development of psychological support in emergencies. In: Prewitt Diaz JO, Murthy SR, Laskhimnarayana R, editors. Advances in Psychological and Social Support after Disasters. 1st ed. New Delhi: VHAI-Voluntary Health Association of India Press; 2006. p. 6-20.
3World Health Organization. Mental Health Atlas 2017. Geneva: WHO; 2018. Available from: https://www.who.int/mental_health/evidence/atlas/profiles-2017/IND.pdf?ua=1. [Last accessed on 2020 May 11].
4Medical Council of India. Available from: https://www.mciindia.org. [Last accessed on 2020 May 11].
5Kishor M, Isaac M, Ashok MV. Role of psychiatry teachers training in national mental health services in India, reflection and roadways for future. Int J Health Allied Sci 2019;8:151-4.