Indian Journal of PsychiatryIndian Journal of Psychiatry
Home | About us | Current Issue | Archives | Ahead of Print | Submission | Instructions | Subscribe | Advertise | Contact | Login 
    Users online: 2029 Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Tables

 Article Access Statistics
    Viewed2074    
    Printed8    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
VIEWPOINT  
Year : 2021  |  Volume : 63  |  Issue : 3  |  Page : 290-293
Development of psychiatry curriculum as a major subject during MBBS in India


1 Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Consultant Psychiatrist, Mumbai, Maharashtra, India
4 Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
5 Department of Psychiatry, MOSC Medical College, Ernakulum, Kerala, India
6 Department of Psychiatry, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
7 Department of Psychiatry, Shri Guru Ram Rai Medical College, Dehradun, Uttarakhand, India
8 Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
9 Department of Dean Academic, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
10 Department of Director, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Click here for correspondence address and email

Date of Submission08-May-2020
Date of Decision06-Jun-2020
Date of Acceptance26-Jan-2021
Date of Web Publication17-Jun-2021
 

How to cite this article:
Dhiman V, Krishnan V, Basu A, Das A, Rohilla J, Rawat VS, Nishchal A, Dave M, Solanki RK, Sahadevan S, Pal A, Garg S, Tikka SK, Dhyani M, Avinash P, Gupta M, Kant R, Gupta R. Development of psychiatry curriculum as a major subject during MBBS in India. Indian J Psychiatry 2021;63:290-3

How to cite this URL:
Dhiman V, Krishnan V, Basu A, Das A, Rohilla J, Rawat VS, Nishchal A, Dave M, Solanki RK, Sahadevan S, Pal A, Garg S, Tikka SK, Dhyani M, Avinash P, Gupta M, Kant R, Gupta R. Development of psychiatry curriculum as a major subject during MBBS in India. Indian J Psychiatry [serial online] 2021 [cited 2021 Sep 25];63:290-3. Available from: https://www.indianjpsychiatry.org/text.asp?2021/63/3/290/318724




Recently, psychiatry has been declared as a major subject in medical graduate curriculum at All India Institute of Medical Sciences, Rishikesh (AIIMS-Rishikesh), with separate examinations at the end of the seventh semester.[1] This necessitated a revamp of the existing curriculum at AIIMS-Rishikesh, in which psychiatry was seen as a section under the General Medicine curriculum, in line with the curriculum recently devised by the Medical Council of India (MCI).[2] This was also seen by the department as an opportunity to develop a robust curriculum which would further help in meeting the training needs of Indian Medical Graduates (IMGs). Innovation in medical education falls in the one of the mandates of AIIMS-Rishikesh.

Process of deliberations

Toward this end, for the development of curriculum, a process of expert consultation was evolved. For the purpose, a meeting (National Workshop for Undergraduate Curriculum of Psychiatry) was organized at AIIMS-Rishikesh under the aegis of the Indian Psychiatric Society (IPS), where members of IPS with ample experience in undergraduate teaching from all zones were approached. The aim of the meet was to discuss and deliberate upon the developments regarding undergraduate curriculum which could be applicable throughout India.[3] Those who agreed were allotted broad topics and were asked to develop a preliminary list of subtopics and competencies, as well as specifying suggested teaching and assessment methods. This list was collated. At the meeting held on 23–24 September 2019 at AIIMS-Rishikesh, separate sessions were devoted for discussions of individual broad topic areas. At each such session, the participants presented their approach to teaching in this topic area. Subsequently, deliberations were done among all participants to reach to a consensus on the content and the teaching methods to be used. Outcomes of deliberations are shown in [Table 1].
Table 1: Outcomes of the deliberations held at All India Institute of Medical Sciences, Rishikesh, for undergraduate curriculum in psychiatry

Click here to view


Development of undergraduate curriculum at All India Institute of Medical Sciences, Rishikesh

In view of the recommendations from the group, AIIMS-Rishikesh has developed a curriculum to accommodate nearly 45 hours of theoretical teaching and about 4 weeks of clinical skills posting in psychiatry during the undergraduate training. This training would be followed by examination as a separate subject.[1]

How the outcomes of deliberations were met?

Generating interest toward psychiatry as a medical subject among IMG was one of the issues that was discussed in detail. A plethora of literature is available that shows that medical students either have negative or neutral attitude toward psychiatry and very few of them wish to pursue psychiatry as a career. One systematic review reported that main barriers toward opting psychiatry were challenges and efficacy of psychiatry as a medical branch, lack of scientific foundations of diseases and treatments, and loss of opportunity to use clinical skills.[4] Most of the students report that they would not be considered as “real doctor” and would lose skills learned during graduate years as a factor discouraging them to opt psychiatry.[5] Apathy toward psychiatry as a medical subject results from the perception of medical students that psychiatric disorders probably emerge out of 'excessive emotions' and 'loneliness'.[6] However, it has been shown that training during medical graduation improves knowledge regarding psychiatric disorders.[7] Members realized that new curriculum would be an opportunity to address these issues. Care was also taken to ensure that teaching methods would also be used appropriately to the content. A second aim of the choice of teaching methods was to sustain students' interest in the subject. In line with our current understanding of the nature of adult learning, this curriculum indicates topic areas that would be suitable for integrated teaching and suggests a range of large- and small-group teaching methods for delivery. Teaching focuses not just upon transferring information but also in the development of clinical skills, professional attitudes, and a deep understanding of medical ethics. With the understanding of the effectiveness of student-led learning for the retention of information, topics that are suitable for student seminars have also been specified.

It was decided that teaching should consider conditions that would commonly be met with in general practice as per the current evidence from epidemiological studies and medical practice.[8] This has decided the current weightage of different disorders in curriculum, where substance use disorders and mood disorders were given more space as compared to less common psychotic disorders (available at https://drive.google.com/file/d/1ybo6B7zTpdYk0oZbl1 × 2Svz0CNhs-3 ml/view? usp = sharing). Other conditions that are common in general practice and intricately related to psychiatry, but are not sufficiently addressed in the medical curriculum elsewhere, have also been included, e.g., sleep disorders.[9],[10],[11],[12],[13]

The curriculum is designed to be in line with current international classification systems, including the Diagnostic and Statistical Manual-5 of the American Psychiatric Association and the International Classification of Diseases-11.[14],[15] These classification systems emphasize a medical model of psychiatric disorders, and it deemphasizes artificial distinctions between “organic” and “functional” disorders. It was felt that the use of such models would also be more congruent with IMGS' primary responsibilities as medical practitioners. Moreover, bio-psycho-social model is too complex to be taught during medical graduation as it is pillared on concepts of gene–environment interaction and neuroplasticity.[16],[17] This outcome is to be effected through the inclusion of relevant research during clinical and theoretical teaching. Social factors play an important role in all diseases including psychiatric disorders, thus, they have been given due weightage in the syllabus.[18]

Most of the psychiatric disorders are diagnosed clinically. However, laboratory investigations are required for many purposes such as finding comorbid other medical disorders, assessing safety of pharmacotherapeutic agents before starting them, following up compliance to treatment, avoiding adverse effects, and diagnosing certain psychiatric disorders.[19] Moreover, functional neuroimaging is increasing recognized as an important tool in psychiatry research and management in recent past.[20],[21],[22],[23],[24],[25],[26] Thus, these techniques were included in the curriculum. In addition, certain other investigations that are available in institution, e.g., polysomnography, were also included in the curriculum.

In defining competencies, the needs of the IMG as a generalist physician were placed at centerstage. In the proposed curriculum, as far as possible, expected competencies have been specified along with citations (wherever required). As far as possible, the extent and content of desired theoretical knowledge and clinical skills have been clearly specified. For example, curriculum mentions that IMG “should be able to elicit auditory hallucinations and paranoid delusions” during the training of Schizophrenia rather than mentioning “able to elicit sign and symptoms of psychosis” or “able to prescribe nicotine replacement therapy and follow-up patients nicotine replacement therapy” in nicotine use disorder. All efforts have been put to reduce ambiguity and duplication in all sections of the curriculum. This process was important as clear delineation of competencies ensures the development of a competent physician.[27] The curriculum also stresses a level of desired competence, in recognition of the fact that this curriculum does not represent the entirety of psychiatric knowledge.

Experts recognized that curriculum should integrate with other subjects with regard to philosophy of syllabus, knowledge transfer, and modes of teaching. In such a case, within the subject need for inclusion of only prevalent, clinically important and prototype disorders were felt. Hence, in the proposed curriculum, among various categories, only selected disorders were emphasized. For example, in the area of sexual disorders, premature ejaculation and erectile dysfunction were included for detailed discussion; others, which are not likely to be encountered in clinical practice, have been excluded. Similarly, among psychotic disorders, schizophrenia was the prototype, and in sleep disorders, insomnia, obstructive sleep apnea, and insufficient sleep syndrome were selected for detailed discussion. Even in these disorders, specific aspects of the disorders that are pertinent to general practice and required for all the above objectives were included. For example, treatment of disorders was primarily focused on pharmacotherapy. However, counseling skills and a wide range of behavioral skills, which are important for all medical disorders and can be delivered competently by IMGs, are emphasized over intricate psychotherapeutic techniques. At the same time, redundancies and duplications should best be avoided by leaving scope for vertical as well horizontal integration of selected topics.

This is the first model curriculum for training in UG psychiatry where the student writes a full 100 marks paper at the end of training. Having such an end point and thus needing an intensive curriculum in keeping with the mandates of the Department of Psychiatry at AIIMS is a major landmark in progress of UG Psychiatry Training in the country. The authors, who were also members of the workshop that debated on this curriculum, agree that the scope of training for UG psychiatry as per the current MCI curriculum may be different from what has been put together here. The authors also emphasize that “AIIMS-Rishikesh model” for psychiatry during under graduation could be used as a guide by other institutions in India after critical evaluation.

Acknowledgments

We acknowledge the support and guidance provided by Dr. Murgesh Vaishanv, Dr. P K Dalal, Dr. Vinay Kumar, and Dr. Gautam Saha.

We also acknowledge the following experts who attended meeting at AIIMS, Rishikesh.

  1. Mohan Issac


  2. Department of Psychiatry, University of Western Australia, WA, Australia.

  3. M Kishor


  4. Department of Psychiatry, JSSMC, JSSAHER, Mysuru, Karnataka, India.

  5. MV Ashok


  6. Department of Psychiatry, St. John's National Academy of Health Sciences, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.

  7. Om Prakash Singh


  8. Editor, Indian Journal of Psychiatry.

  9. Rakesh Kumar Chadda


  10. Department of Psychiatry, AIIMS, New Delhi.

  11. PK Singh


  12. Department of Psychiatry, Patna Medical College, Patna, Bihar, India.

  13. Henal Shah


  14. Department of Psychiatry, TN Medical College, Mumbai, Maharashtra, India.

  15. Vinay HR


  16. Department of Psychiatry, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India.

  17. Pankaj Kumar


  18. Department of Psychiatry, AIIMS, Patna.

  19. Mukesh Swami, Naresh Nebhinani


  20. Department of Psychiatry, AIIMS, Jodhpur.

  21. Rajat Ray


  22. Former Professor, AIIMS, New Delhi.

  23. Vikas Menon


  24. Department of Psychiatry, JIPMER, Pondicherry, India; Contribution in Absentia, India.

  25. Suhas Chandran


  26. Contribution in Absentia.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Das A, Krishnan V, Dhiman V, Rohilla J, Rawat V, Basu A, et al. Need and learnings from having psychiatry as major subject during medical graduate examination. Indian J Psychiatry 2020;62:723-7.  Back to cited text no. 1
  [Full text]  
2.
Medical Council of India. Competency Based Undergraduate Curriculum for the Indian Medical Graduate Vol. II. Available from: https://www.mciindia.org/CMS/wpcontent/uploads/2019/01/UG-Curriculum-Vol-II.pdf. [Last accessed on 2020 Nov 20].  Back to cited text no. 2
    
3.
Kishor M, Gupta R, Ashok MV, Isaac M, Chaddha RK, Singh OP, et al. Competency-based medical curriculum: Psychiatry, training of faculty, and Indian Psychiatric Society. Indian J Psychiatry 2020;62:207-8.  Back to cited text no. 3
  [Full text]  
4.
Lyons Z. Attitudes of medical students toward psychiatry and psychiatry as a career: A systematic review. Acad Psychiatry 2013;37:150-7.  Back to cited text no. 4
    
5.
Appleton A, Singh S, Eady N, Buszewicz M. Why did you choose psychiatry? A qualitative study of psychiatry trainees investigating the impact of psychiatry teaching at medical school on career choice. BMC Psychiatry 2017;17:276.  Back to cited text no. 5
    
6.
Chawla JM, Balhara YP, Sagar R, Shivaprakash. Undergraduate medical students' attitude toward psychiatry: A cross-sectional study. Indian J Psychiatry 2012;54:37-40.  Back to cited text no. 6
  [Full text]  
7.
Chadda RK, Singh MM. Awareness about psychiatry in undergraduate medical students in Nepal. Indian J Psychiatry 1999;41:211-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Goverment of India. National Mental Health Programme | National Health Portal of India; 2019. Available from: https://www.nhp.gov.in/national-mental-health-programme_pg. [Last accessed on 2020 Apr 5].  Back to cited text no. 8
    
9.
Gupta R, Ulfberg J, Allen RP, Goel D. Comparison of subjective sleep quality of long-term residents at low and high altitudes: Saraha study. J Clin Sleep Med 2018;14:15-21.  Back to cited text no. 9
    
10.
Khan IW, Juyal R, Shikha D, Gupta R. Generalized anxiety disorder but not depression is associated with insomnia: A population based study. Sleep Sci 2018;11:166-73.  Back to cited text no. 10
    
11.
Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest 2006;130:149-56.  Back to cited text no. 11
    
12.
Haynes P. The link between OSA and depression: Another reason for integrative sleep medicine teams. J Clin Sleep Med 2013;9:425-6.  Back to cited text no. 12
    
13.
Hartwell KJ, Tolliver BK, Brady KT. Biologic Commonalities between Mental Illness and Addiction. Prim psychiatry 2009;16:33-9.  Back to cited text no. 13
    
14.
World Health Organization (WHO). ICD-11-Mortality and Morbidity Statistics. Available from: https://icd.who.int/browse11/l-m/en#/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F334423054. [Last accessed on 2020 Feb 1].  Back to cited text no. 14
    
15.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: American Psychiatric Association; 2013.  Back to cited text no. 15
    
16.
Garland EL, Howard MO. Neuroplasticity, psychosocial genomics, and the biopsychosocial paradigm in the 21st century. Health Soc Work 2009;34:191-9.  Back to cited text no. 16
    
17.
Carey TA, Mansell W, Tai SJ. A biopsychosocial model based on negative feedback and control. Front Hum Neurosci 2014;8:94.  Back to cited text no. 17
    
18.
Bolton D, Gillett G. Biopsychosocial conditions of health and disease. In: The Biopsychosocial Model of Health and Disease. Cham: Springer International Publishing; 2019. p. 109-45.  Back to cited text no. 18
    
19.
Guze BH, Love MJ. Medical assessment and laboratory testing in psychiatry. In: Sadock BJ, Sadock VA, Pedro R, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Philadelphia: Lippincott Williams & Wilkins (LWW); 2017.  Back to cited text no. 19
    
20.
Indian Journal of Psychiatry; 2006. Available from: http://www.indianjpsychiatry.org/. [Last accessed on 2019 Dec 19].  Back to cited text no. 20
    
21.
American J Psychiatry. Available from: https://ajp.psychiatryonline.org. [Last accessed on 2019 Dec 20].  Back to cited text no. 21
    
22.
Journal of Clinical Psychiatry. Available from: https://ascpp.org/resources/psychiatry-resource/journal-of-clinical-psychiatry/. [Last accessed on 2019 Dec 19].  Back to cited text no. 22
    
23.
Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia, PA: Wolters Kluwer Health; 2017.  Back to cited text no. 23
    
24.
Harrison P, Cowen P, Burns T, Fazel M, editors. Shorter Oxford Textbook of Psychiatry. 7th ed. Oxford: Oxford University Press; 2017.  Back to cited text no. 24
    
25.
Dave KP. Field of psychiatry: Current trends and future directions: An Indian perspective. Mens Sana Monogr 2016;14:108-17.  Back to cited text no. 25
[PUBMED]  [Full text]  
26.
Gupta R. Hoped horizon of psychiatry. Seishin Shinkeigaku Zasshi 2010;112:166-70.  Back to cited text no. 26
    
27.
Ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ 2017;34:Doc69.  Back to cited text no. 27
    

Top
Correspondence Address:
Jitendra Rohilla
Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_466_20

Rights and Permissions



 
 
    Tables

  [Table 1]



 

Top