How to teach psychiatry to medical undergraduates in India?: a model

A cross-sectional study of opinion about mental illness among undergraduate medical students with and without exposure to the psychiatry clinical rotation/postings during their undergraduate training

Background

A positive attitude toward mental illness is a prerequisite for the provision of holistic care. Thus, a study was undertaken to know the opinion about mental illness among medical students with and without exposure to the psychiatry clinical rotation/postings during their undergraduate training.

Materials and Methods

This is a descriptive, cross-sectional study conducted at Adichunchanagiri Institute of Medical Sciences (AIMS), Karnataka. The sample comprised medical undergraduate students with and without exposure to psychiatry clinical postings, respectively. Self-administered socio-demographic and opinion about mental illness (OMI) questionnaires were used to collect the data.

Result

Medical undergraduates from 1st and 2nd years who were unexposed to psychiatry and students from 3rd and 4th years who had exposure to psychiatry constituted about 52.17% (n = 252) and 47.83% (n = 231) of the overall sample size. A positive opinion toward mental illness was seen across various subsections of OMI questionnaire, especially in students who had attended psychiatry clinical posting.

Conclusion

Opinions can change based on one's experiences. A positive opinion toward mental illness was seen across medical undergraduate students who had completed psychiatry clinical postings in our study. The study provides valuable insights across various domains or areas wherein a teacher can focus and adjust the teaching methodologies accordingly. In the long run, it might have a positive influence on medical students to understand mental disorders, diagnose them, and manage patients with mental illness.

Psychiatry and mental health teaching programs of eight portuguese-speaking schools of medicine: A comparative analysis

Background

Improvement of teaching methods in psychiatry has been the subject of permanent adaptation and innovation. Strengthening graduate education skills in psychiatry and mental health will allow physicians to have the knowledge, skills, and attitudes to carry out early diagnosis and treatment at primary healthcare settings, taking into consideration that the population should benefit from the best interventions by general practitioners.

Objective

The objective of this study was to examine how the undergraduate program of psychiatry and mental health subject in the schools of medicine of the Community of Portuguese-Speaking Countries in the three continents is structured.

Methods

The methods include a narrative description of the program of psychiatry, the workload, the delivery and assessment methods, and the ethical and socio-cultural aspects in psychiatry and research made by the director of the course of psychiatry in Portugal, Brazil, and Mozambique.

Results

Eight schools of medicine from Portugal, Brazil, and Mozambique participated in the study. All these schools use standards which are defined by the regulatory bodies of their countries. The teaching year varied between the third and the sixth. The workload varied between 140 and 224 h. Topics were addressed in presence or virtual methods. Combined qualitative and quantitative assessment is done to encompass competencies, skills and knowledge based on clinical histories, ongoing assessment, seminars, and final written tests. Ethical and socio-cultural aspects in various strands are taught to be linked to the local reality. Research is encouraged by using grants.

Conclusion

Teaching psychiatry follows global and national standards and is organized according to the reality of each country. Psychiatry departments from these three continents invest in teaching methodologies that encourage self-knowledge and the development of critical thinking, which is evaluated in a holistic context. The authors consider that the programs should have a workload according to the current burden of mental illness.

Effective and innovative teaching methods in psychiatry for the medical undergraduates in South India: An exploratory study of teachers' and students' perspectives

Background

Effective teaching methods are important in psychiatry. Previous studies have focused on the assessment of students about the effective teaching methods but not on a self-assessment by teachers.

Aims

Primary objective is to evaluate the teachers' and students' perspectives of effective teaching methods in psychiatry for medical undergraduates. Secondary objectives include assessment of the concordance of each item and exploring innovative teaching methods.

Settings and Design

A cross-sectional study design used in teachers and medical students from St. John's Medical College, Bangalore (India).

Methods and Material

A modified teachers and medical students perspectives of effective psychiatry teaching methods were used.

Statistical Analysis

Differences in continuous variable assessed with independent sample-test and categorical variables with Chi-square test. The Domain scores were divided into tertiles and the highest and lowest tertiles were analyzed.

Results

Both students and teachers had high perspectives on most of the teaching methods. Differences were found in items such as "using multimedia slide effectively," "good sense of humor while teaching," "presentation summarizes the key points," and "presentation links ideas effectively." Role play-based and live/simulated patient-based teachings were reported most frequently by both. Significantly, a higher proportion of the 6th term students and a lesser proportion of teachers were associated with the lowest tertiles for Domain 1, 2, and 3. Significantly, increased number of 8th term students were found in the higher tertiles in Domain 3.

Conclusions

These findings have practical implications in identifying the gaps in effective teaching methods by the teachers. Teachers can improve their teaching methods by upgrading their presentation skills, employing new and innovative teaching skills.

Facilitators and Barriers to Student Learning and Impact of an Undergraduate Clinical Posting in Psychiatry: A Thematic Analysis

BACKGROUND

There is an absence of information on empirical evaluation of undergraduate psychiatry training programs in India. We aimed to evaluate a clinical posting in psychiatry for undergraduate medical students.

METHODS

We employed levels one and two of Kirkpatrick's four-level program evaluation model. The qualitative study used written feedback that was collected using a semistructured questionnaire. For quantitative metrics, we used end-of-posting assessment scores and frequencies of standard comments provided by examiners on case-based discussions with students to evaluate their clinical skills.

RESULTS

We obtained written feedback from 40 female and 19 male fifth-semester students. We identified facilitators (patient interaction, outpatient department observation and teaching, demonstration of signs, case presentation and discussion, evening posting, observation of clinical work, use of anecdotes while teaching, and lectures by senior faculty) and barriers (organizational issues related to evening posting and disinterest in didactic teaching) to the students learning psychiatry, and the perceived impact of the posting for the students (changed attitudes, knowledge, self-efficacy, and skills acquired). The mean total score on case-based discussion, assigned to 22 groups of students, was 3.86 out of 5.

CONCLUSION

We described the impact of the posting and identified unique facilitators and barriers to students' learning in psychiatry. These findings will inform the choice of teaching-learning methods in the context of the new Competency-Based undergraduate Medical Education (CBME) curriculum.

Education and training in psychiatry in South Asian countries

"Show me a sane man and I will cure him for you."-Carl Jung. Essentially, Jung was saying that a sane man does not exist. Emotional problems and difficulties are present in a benign form in the vast majority of people. Therefore, psychiatric education should focus on the very common nature of mental and emotional problems. Training of psychiatrists to provide the best quality care and conduct the highest quality research continues to remain a priority across the globe. The treatment and training gaps in many countries continue despite the sustained efforts at improving these, especially in low- and middle-income (LAMI) countries. Although many LAMI countries have improved curricula for undergraduate and postgraduate training, yet the treatment and training gap continues. This article will look to explore education and training in psychiatry in some of the South Asian countries with a special focus on India.

What Influences Mental Illness? Discrepancies Between Medical Education and Conception

OBJECTIVE

This preliminary study examined the differences between what was taught during a formal medical education and medical students' and psychiatry residents' conceptions of notions regarding the causes and determinants of mental illness.

METHODS

The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant's formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception.

RESULTS

Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences.

CONCLUSIONS

If these notions are therefore part of students' and residents' conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

How do psychiatrists in India construct their professional identity? A critical literature review

Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient-carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care.

Impact of differences in psychiatry curriculum of undergraduate medical and physiotherapy students on their attitude towards psychiatry

BACKGROUND

Negative attitude toward psychiatry (ATP) among medical students is a serious concern. Some studies have concluded that after training in the subject, attitude changes toward positive side. Currently in India, medical students have a less intense course without separate exam or binding to attend training whereas physiotherapy students have more intense course with separate subject exam and binding to attend training in psychiatry.

OBJECTIVE

To ascertain and compare the positive and negative ATP in final year MBBS students and final year physiotherapy (BPTh) students who have completed psychiatry curriculum.

METHODS

This is a cross-sectional study with semi-structured pro forma for sociodemographic variables and ATP-30 questionnaire to evaluate ATP of 94 medical and physiotherapy students each. Nonparametric methods were used for statistical analysis with appropriate tests of significance and P value was set at 0.05.

RESULTS

Mean ATP-30 score for medical students was 91.9 (standard deviation [SD] =7.0) and that of physiotherapy students was 105.8 (SD = 9.7), this difference in two groups was highly significant (Kruskal-Wallis H = 81.3, df = 1, P < 0.001). Of all medical students, 36 (41.4%) had negative attitude while only 2 (2.1%) of the physiotherapy students had negative ATP (χ(2) = 41.7, P < 0.001). Boys were 2.6 times more likely to have negative ATP than girls (relative risk = 2.6, P = 0.005).

CONCLUSIONS

Physiotherapy students with intense and planned training in psychiatry as an exam subject have significantly more positive ATP than medical students.

Attitudes toward people with mental illness among medical students

Background:

Globally, people with mental illness frequently encounter stigma, prejudice, and discrimination by public and health care professionals. Research related to medical students’ attitudes toward people with mental illness is limited from India.

Aim:

The aim was to assess and compare the attitudes toward people with mental illness among medical students’.

Materials and Methods:

A cross-sectional descriptive study design was carried out among medical students, who were exposed (n = 115) and not exposed (n = 61) to psychiatry training using self-reporting questionnaire.

Results:

Our findings showed improvement in students’ attitudes after exposure to psychiatry in benevolent (t = 2.510, P < 0.013) and stigmatization (t = 2.656, P < 0.009) domains. Further, gender, residence, and contact with mental illness were the factors that found to be influencing students’ attitudes toward mental illness.

Conclusion:

The findings of the present study suggest that psychiatric education proved to be effective in changing the attitudes of medical students toward mental illness to a certain extent. However, there is an urgent need to review the current curriculum to prepare undergraduate medical students to provide holistic care to the people with mental health problems.