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 Table of Contents    
LETTERS TO EDITOR  
Year : 2021  |  Volume : 63  |  Issue : 2  |  Page : 201-203
Experience of conducting MD examinations in the mid of COVID-19 crisis


1 Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

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Date of Submission17-May-2020
Date of Decision23-Oct-2020
Date of Acceptance29-Oct-2020
Date of Web Publication14-Apr-2021
 

How to cite this article:
Das A, Krishnan V, Gupta R, Grover S, Sagar R. Experience of conducting MD examinations in the mid of COVID-19 crisis. Indian J Psychiatry 2021;63:201-3

How to cite this URL:
Das A, Krishnan V, Gupta R, Grover S, Sagar R. Experience of conducting MD examinations in the mid of COVID-19 crisis. Indian J Psychiatry [serial online] 2021 [cited 2021 May 9];63:201-3. Available from: https://www.indianjpsychiatry.org/text.asp?2021/63/2/201/313717




Sir,

Amid the COVID-19 crisis, many essential aspects of our daily lives have transformed and challenged us to adapt to new ways of working around. In this context, clinical work, methods of teaching, student assessment, and research are adapting to the prevailing limitations. Thus, our “New Normal” is a shift from in-person to internet-assisted techniques. In early May this year, teachers of psychiatry came together under the auspices of the Indian Psychiatric Society to discuss the options for postgraduate examinations to chart future action.[1] To our belief, we were the first to conduct MD examination during COVID-19 (in mid-May). We elucidate some issues raised during the webinar using this experience.

Potential concerns that require addressing included were as follows: inviting external examiners, limited availability of examination cases in hospitals, logistical issues (stable internet connection, choosing correct hardware, and a video-conferencing platform), and finally, the format of assessment. We exempted examination-going residents from COVID-19 duties for a month and conducted theory examinations with social distancing norms, following the structure according to the institute policy. However, conducting clinical assessments was challenging due to the unique circumstances even though we had a single candidate. The plan for the practical examination was kept flexible but followed the typical format – one long case, three short cases, spotters, and viva.

It was unfeasible to invite external examiners to the institute; hence, we connected via video-conferencing using appropriate software according to the convenience and familiarity of all examiners. We sorted out connectivity issues from beforehand. For the long case examination, we had a single inpatient at that time. The patient was poorly responding to treatment and was stuck in the ward due to lockdown. She/he was also quarantined due to exposure to another COVID-19-positive patient (an incidental occurrence) in the adjoining inpatient ward. On the day of the examination, following his/her second COVID-negative result, consent for the examination was obtained. For short cases, we shortlisted a few consenting patients who were ready to join us telephonically. Such a telephone-based psychiatric evaluation method has its disadvantages, such as problems with rapport building, evaluation of nonverbal communication, and technological glitches. However, our plan failed as none later agreed to be interviewed. Hence, we executed our contingency plan to replace the short cases with an objectively structured clinical examination (OSCE). Senior residents enacted as patients for the OSCE. They followed a detailed script (developed by the examiners). The script was revealed to the senior residents on the day of the examination. However, using departmental colleagues and seniors as actors can introduce bias and (due to familiarity) may not simulate clinical practice. Actors may be biased to either help the candidate and may provide hints to reach a correct diagnosis or elicit signs or make the situation difficult for an anxious student. However, our prior experience of conducting such examinations for undergraduate students (reported else-were[2]) helped the team execute OSCE successfully.

Regarding logistics, institutional support for a stable high-speed internet facilitated the process. Our experience also suggests the importance of a sensitive microphone and a webcam with a wide-angle view along with (remote-controlled) zoom-in/out facility and maneuverable capturing field. Webcam on laptops or other devices is not preferred. It helps keep internal examiners, candidates, and actors in one frame during the viva, while allowing to zoom-in helps appreciate nuances of mental status examination and neurological examination through a closer view.

Notwithstanding the examination's format, seriousness was maintained. It is common now to conduct job interviews online, but some experimentation with similar virtual and tele-OSCE methods are also present.[3],[4] In the end, the examiners parted with a sense of happiness as it concluded without any glitches.

To summarize a considerable level of prior planning, a repository of patients who are willing and consenting for online evaluation for examination purposes with existing case records is crucial. The orientation of the examinee to the new format of the examination is a prerequisite. Consent from the examinee is also needed. [Table 1] shows a comprehensive list of issues. Finally, flexibility in approach, the safety of all parties, and informing universities for the same without compromise of quality are vital. Though, questions remain for other disciplines where a clinical examination is primarily through physical examination (palpation, percussion, and auscultation) of patients. Moreover, the modification of guidelines related to telemedicine consultation is also in need of the hour.
Table 1: Requirements for conducting a successful online examination

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kishor M, Shah H, Chandran S, Mysore AV, Kumar A, Menon V, et al. Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry. Indian J Psychiatry 2020;62:431-4.  Back to cited text no. 1
  [Full text]  
2.
Das A, Krishnan V, Dhiman V, Rohilla JK, Rawat VS, Basu A, et al. Need and learning from having Psychiatry as a major subject during medical graduate examination. Indian J Psychiatry 2020;62:723-7.  Back to cited text no. 2
  [Full text]  
3.
Palmer RT, Biagioli FE, Mujcic J, Schneider BN, Spires L, Dodson LG. The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners. Rural Remote Health 2015;15:3399.  Back to cited text no. 3
    
4.
Cantone RE, Palmer R, Dodson LG, Biagioli FE. Insomnia Telemedicine OSCE (TeleOSCE): A simulated standardized patient video-visit case for clerkship students. MedEdPORTAL 2019;15:10867.  Back to cited text no. 4
    

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Correspondence Address:
Anindya Das
Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_509_20

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