Indian Journal of PsychiatryIndian Journal of Psychiatry
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 Table of Contents    
GUEST EDITORIAL  
Year : 2016  |  Volume : 58  |  Issue : 2  |  Page : 119-120
Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!


1 Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka, India
2 Department of Psychiatry, The University of Western Australia, Crawley-Nedlands, Australia
3 Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India
4 Department of Psychiatry, KIMS, Bengaluru, Karnataka, India

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Date of Web Publication10-Jun-2016
 

How to cite this article:
Kishor M, Isaac M, Ashok M V, Pandit LV, Sathyanarayana Rao T S. Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!. Indian J Psychiatry 2016;58:119-20

How to cite this URL:
Kishor M, Isaac M, Ashok M V, Pandit LV, Sathyanarayana Rao T S. Undergraduate psychiatry training in India; past, present, and future looking for solutions within constraints!!. Indian J Psychiatry [serial online] 2016 [cited 2020 Nov 30];58:119-20. Available from: https://www.indianjpsychiatry.org/text.asp?2016/58/2/119/183794


Psychiatric disorders are considered one of the leading causes of morbidity and mortality worldwide.[1] They are closely associated with other medical conditions such as diabetes and hypertension, adversely affecting their outcome.[2],[3] India has more than 1/6th of the global population, and is a rapidly developing country with enormous changes in all spheres of life. Mental health issues are gaining a great deal of importance, in keeping with other health issues, and are likely to play a key role in the diverse indicators of development. Suicide rates in India are reportedly one of the highest in the world and have already attracted political and socio-cultural trajectories in both causation and solutions for the problem, underplaying mental health causes for the same, as well as understating the inadequacy of mental health services in India.[4] Concerns regarding the mental health scenario in India are directly related to a lack of awareness among the public and a lack of the minimal mandatory training in psychiatry for medical undergraduates, which has consistently produced thousands of doctors who are incompetent to diagnose and manage common conditions such as depression and suicide.[5]

Training undergraduates in the field of psychiatry can be considered as one of the most important pathways to improve mental health services in India. That undergraduate training in psychiatry is inadequate has been the contention from the first report of the subcommittee on undergraduate teaching in psychiatry, Indian Psychiatry Society (1965).[6] The emphasis has been on inadequate hours of training in psychiatry as well as a lack of the required trained staff. Painfully, despite the numerous evidences about benefits of undergraduate psychiatry training [7],[8],[9] nothing seems to have changed in this half of the century (1965–2015) as the Medical Council of India is reluctant to make psychiatry a mandatory subject for the MBBS examination,[10] impairing the mental health component of basic health services in India. This great lacuna in Indian medical education is likely to have an adverse effect on mental health services for the next few decades. In addition is the issue that India has a large deficit of psychiatrists with just 0.3 for 100,000 populations, as mentioned in world mental health  Atlas More Details 2014.[11]

To address this challenge, we may have to look for solutions that enable us to attract medical students to the subject of psychiatry, and build psychiatric knowledge and skill in them through diverse ways. The onus for achieving this lies on each faculty and the department as a team, the policies of the Institution and University to which they belong, as well as professional bodies like the Indian Psychiatric Society, each of whom will have a major role to play. The efforts of Indian Psychiatry Society have been well-summarized by Dr. Roy Abraham Kallivayalil in his presidential address at ANCIPS 2012, Kochi.

The Medical Council of India had made it mandatory for all medical colleges to have a department of psychiatry as a part of teaching hospitals, providing mental health services in a general hospital setting. Needless to say, most nonteaching hospitals in India, public or private, do not have psychiatric services on a regular basis. Hence, medical colleges are crucial centers for providing Mental Health Services. Currently, there are 412 medical colleges in India with 52,325 MBBS seats.[12] The onus of training these medical graduates in psychiatry for whom the subject is not mandatory, as in, not assessed in the current examination system, lies with the faculty in psychiatry, they have to use their knowledge and passion in delivering psychiatric training for these students. Departments that have recognized postgraduate seats must also put in the same degree of effort in teaching the undergraduates. There have been some innovative ways and experiences on undergraduate psychiatry training, including one from the authors of this article.[13],[14] Looking beyond individual faculty, it is the Department of Psychiatry who as a team should have a unified goal to do everything possible in strengthening undergraduate psychiatry teaching. The efforts need to be customized to the respective institutional realities. For example, it is worth mentioning that Psychiatry postgraduates alumni of KIMS, Bengaluru have instituted an exclusive annual award for best undergraduate in Psychiatry at KIMS and best young teacher award in psychiatry at the Karnataka IPS, such efforts are important in attracting and appreciating the students and teachers at medical colleges.

Sharing successful models of undergraduate teaching would go a long way in improving patterns followed by institutions. Unfortunately, there are very few avenues to share successful models other than through published studies. A platform to enable this is important so as to share certain real world issues, which can be narrated and discussed. To facilitate this process an annual exclusive CME, and/or allocating a session of the annual psychiatry conference, and/or a regular corner in the Indian Journal of Psychiatry can go a long way in improvizing undergraduate psychiatry teaching in India.

The upcoming of numerous deemed universities in India can be an opportunity to teach psychiatry to the undergraduate student, as the University Grants Commission has given them enough flexibility to design their curriculum, resulting in some of them accommodating psychiatry as a mandatory part of their examination system.[15] This needs to be replicated in other universities as well. Professional bodies like the Indian Psychiatry Society can move a step ahead and consider launching exclusive psychiatry journals for undergraduates, catering to their special needs as well as encouraging their interest in research.

The second most important aspect in this challenge is the training of teachers in teaching undergraduate psychiatry. As mentioned earlier, the last few decades have seen a substantial increase in the number of medical colleges in India, and most institutions have recruited fresh postgraduates as regular staff in the Department of Psychiatry. These young staffs have little or no formal training in teaching methodologies. They also have new found responsibilities with respect to patient care, and demand to participate actively in departmental teaching activities. There have been some sporadic efforts in the past, to train these teachers, but details are unavailable.[16] Documenting such efforts as booklets and building archives of such CME/Symposium will benefit future efforts. It may well be the right time to start a forum in India for teachers of psychiatry active in the social media, as well as having an agenda for all teachers to meet annually and make their experiential contributions for strengthening and streamlining this process.[17]

To summarize, mental health services in India strongly depends on undergraduate psychiatric training. The goal can be achieved by working on a diverse and sustained approach to train medical students despite constraints and by actively training and motivating teachers in Psychiatry.

 
   References Top

1.
World Health Organization (WHO). Fact Files on Mental Health. Available from: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index1.html. [Last accessed on 2015 Nov 29].  Back to cited text no. 1
    
2.
Balhara YP. Diabetes and psychiatric disorders. Indian J Endocrinol Metab 2011;15:274-83.  Back to cited text no. 2
    
3.
Igwe MN, Uwakwe R, Ahanotu CA, Onyeama GM, Bakare MO, Ndukuba AC. Factors associated with depression and suicide among patients with diabetes mellitus and essential hypertension in a Nigerian teaching hospital. Afr Health Sci 2013;13:68-77.  Back to cited text no. 3
    
4.
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: A nationally representative survey. Lancet 2012;379:2343-51.  Back to cited text no. 4
    
5.
Kishor M, Vinay HR. Awareness about depressive disorder among final year medical undergraduates. Indian J Psychiatr 2012;54 Suppl 5:S53.  Back to cited text no. 5
    
6.
Neki JS. Reports of the sub-committee of the Indian psychiatric society on undergraduate teaching in psychiatry. Indian J Psychiatr 1965;7:64-72.  Back to cited text no. 6
    
7.
Tharyan A, Datta S, Kuruvilla K. Undergraduate training in psychiatry an evaluation. Indian J Psychiatry 1992;34:370-2.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Rajagopalan M, Kuruvilla K. Medical students' attitudes towards psychiatry: Effect of a two week posting. Indian J Psychiatry 1994;36:177-82.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
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Trivedi JK. Importance of undergraduate psychiatric training. Indian J Psychiatry 1998;40:101-2.  Back to cited text no. 9
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Raju NN. From the secretary's desk. Indian J Psychiatr 2014;56:313-5.  Back to cited text no. 10
    
11.
World Health Organization (WHO). World Mental Health Atlas 2014. India. Available from: http://www.who.int/mental_health/evidence/atlas/profiles-2014/ind.pdf?ua = 1. [Last accessed on 2015 Nov 29].  Back to cited text no. 11
    
12.
Medical Council of India. List of Medical Colleges. Available from: http://www.mciindia.org/InformationDesk/ForStudents/ListofColleges TeachingMBBS.aspx. [Last accessed on 2015 Nov 29].  Back to cited text no. 12
    
13.
Issac M, Lakshmi VP, Kishor M. The art and practices of teaching psychiatry in medical colleges: Experiences, challenges, innovations. Indian J Psychiatr 2013;55 Suppl 1:S15.  Back to cited text no. 13
    
14.
Kishor M, Vinay HR. Innovative ways and customizing psychiatry training for undergraduates. Indian J Psychiatry 2015;57:431-3.  Back to cited text no. 14
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15.
Sathyanarayan MT. Psychiatry in UG curriculum of medicine in Karnataka-Presidential Address. Karnataka Annual Conference of Indian Psychiatry Society; 2011.  Back to cited text no. 15
    
16.
Bhaskaran K. Undergraduate training in psychiatry and behavioural sciences-the need to train the trainers. Indian J Psychiatry 1990;32:1-3.  Back to cited text no. 16
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17.
Issac M, Ashok MV, Kishor M. Is there need for a forum for teachers of psychiatry in India? Indian J Psychiatr 2015;57 Suppl 1:S163.  Back to cited text no. 17
    

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Correspondence Address:
Dr. M Kishor
Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.183794

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