The second wave of coronavirus disease 2019 (COVID-19) pandemic in India has been devastating. Over 4000 deaths every day and more than 300,000 cases have been reported by the end of May 2021. The calamity has adversely affected teaching-learning across the nation, where rightfully, most of the postgraduates and teachers were involved in COVID-19 care. As the number of active cases is reducing, there is a need for serious debate on prioritizing teaching-learning for postgraduates in the middle of an unpredictable course of the COVID-19 pandemic. While there is a need to minimize infection risk for patients, students and teachers must deliver optimal training for postgraduate psychiatry students. One needs to relook at the curriculum, teaching and learning processes, and the welfare of students. In an earlier publication, discussion on the aspects related to examination during COVID-19 has been covered.
More than 300 institutions in India offer psychiatry postgraduate training. Every year nearly 1000 postgraduates in (DPM, MD, DNB) join the residency program. Training of these postgraduates is paramount for a country with a significant gap in mental health services. In a pandemic, every health-care service caters to COVID-19 emergencies. Although required, it has invaded the period demarcated for becoming a competent professional. In this constrained scenario, the faculty who engage psychiatry postgraduates in teaching-learning must prioritize methods to quickly and efficiently ensure psychiatry learning.
The first step is to be aware of the essential competencies that the graduate should possess. The National Medical Commission has published a document outlining the curriculum for psychiatry postgraduates. Postgraduate Faculty should quickly identify the critical elements of the curriculum and delineate the mandatory competencies. Some competencies and conditions, such as those involving research, may have to be curtailed. An edited universal outline of essential competencies required is enumerated below.
- Elicit a comprehensive history, perform a dependable examination including all parts of mental state examination
- Make a lucid case presentation
- Evaluate for physical comorbidity
- Be able to delineate the possible differential diagnosis using the diagnostic system
- Identify the predisposing, precipitating, perpetuating, and protective factors
- Formulate a plan for the assessment of patient
- Interpret the results of investigations
- Liaise and communicate with members of other professions
- Formulate an appropriate treatment plan
- Comprehensively assess risks to patients
- Assess the potential of the dangerousness of patient to harm self or others
- Apply the appropriate laws
- Encourage and establish a therapeutic alliance with patients.
Once teachers are clear about expectations, they need to assess the current competency level of the student. The faculty can evaluate the competencies using simple tools for assessment. Postgraduates can identify their learning gaps and express what they want to learn. Self-Directed Learning is a hallmark of a reflective adult learner. The collaborative approach of the teacher and student is essential to achieve the goals.
A customized plan is formulated on completing the assessment. For example, has the postgraduate acquired skills of a patient interview, rapport development, and mental status examination? If yes, the next phase can emphasize diagnosing common psychiatric conditions such as depression, substance use disorders, anxiety disorders, and psychotic disorders as per the World Health Organization International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders criteria. In times of pandemic, the teaching-learning may be tailored to the individual needs of the postgraduate. The time crunch would be a good reason to encourage self-study and reflection. Resources can be shared, and access to webinars organized by the Indian Psychiatric Society would be an excellent resource.
Innovative learning methods have to be implemented in many institutes, as the outpatient and inpatient psychiatry departments have been temporarily suspended. The department can use case reports or role-play and simulations to impart the teaching. While physical, academic meetings and case conferences may have to be limited, the virtual format can continue. Journal clubs, topic discussions, seminars, the flipped classroom will easily transition into a virtual design. Virtual grand rounds substitute crowded bedside clinics. The remote medium allows for interaction with speakers beyond the state and country. The principles of good quality education remain the same across online or offline platforms.
Trainees have to adapt to novel requirements, and programs will have to define pathways for trainees to meet the core values of teaching. Teleconsultation can also help in imparting clinical skills. A critical feature in all postgraduate training programs is mentoring. Mentors should communicate regularly with the students in these challenging times.
Skills are a challenge to teach in a virtual medium, and simulations and augmented reality can bridge the gap. Learning to handle a wide variety of patients, emergencies and using neuromodulation techniques may get hampered. Special care has to be taken that there are opportunities to learn this in future.
The remote environment is neither perfect nor ideal. One needs to realize that shifting the curriculum online does not imply the same learning. Social interaction is essential and is lost. A few practical tips to ensure a smoother transition are the following (fawns).
- Do not try to reproduce the same session that one teaches on an offline platform. Based on the goals, faculty can think of ways to engage students virtually
- Use tools that are simple and familiar
- Since the availability of Internet connection may be variable, the use of low-tech facilities should be encouraged
- These are unpredictable times, and being flexible is mandatory
- Accept more deficient knowledge about technology and be open to learning together with the students
- Use asynchronous discussion boards which will encourage introverts to contribute
- Do not create an infodemic and overload the students
- Ensure a quality check on the teaching.
While an attempt to keep a continuity of planned training, faculty need to acknowledge the opportunistic learning that has occurred due to the pandemic. Students in COVID duty learn about the psychological impact of COVID-19 and its management. Overcoming the challenge of building a rapport while wearing personal protective equipment requires skill. Learning to work in interprofessional teams, dealing with medical emergencies is wisdom acquired in the COVID wards. Management of grief and bereavement are other competencies developed. Facing death, uncertainty about the course of a pandemic and their academic progress, and long hours of duty takes a toll on students. Assessing their welfare and encouraging stress management and strategies to be resilient is equally essential.
In future, faculty will have to decide which sections of the “traditional” teaching environment are worth retaining and what parts can be transformed into virtual learning formats. Further, while teachers determine the next steps, teachers need to keep contingency plans as the future remains uncertain yet.
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Conflicts of interest
There are no conflicts of interest.
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
2. National Medical Commission. Available from: https://www.nmc.org.in/wp-content/uploads/2019/09/MD-Psychiatry.pdf
Last accessed on 2021 Jun 12