There have been lots of discussion regarding postgraduate (PG) training in psychiatry, initially regarding increase in the number of seats and also improvement in the quality of training. The Indian Psychiatric Society has also, from time to time, tried to formulate syllabi. Recommendation was provided by an expert committee under the leadership of Prof. Mohan Isaac and Prof. Pratima Murthy, which covered minute details, but sadly could not be implemented.
The main areas of concern regarding PG teaching in psychiatry have been the following:
- There is lack of uniformity in psychiatry training in different institutions. On one side, there are premiere teaching institutes like NIMHANS, whereas on the other side there are colleges where there is hardly any teaching program.
- Basic sciences as well as psychotherapy are not properly taught.
- No competency develops regarding newer modalities of treatment like repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation as these are not mandatory.
- Since students are directly joining after completing internship, there is lack of medical competency noticed in students and hesitation in managing organic cases as well as treatment-emergent side effects.
- There is difference in people trained in General Hospital Psychiatry Units (GHPUs) and Mental Hospital–based training centers.
- Training in neurology is in decline.
- Evaluation is based on teachers’ overall impression, and there is lack of objective method of assessment.
- There is lack of interest in community psychiatry and forensic psychiatry among students.
- There have been issues related to teachers’ training as well as availability.
National medical Commission has tried to address some of these problems. First of all, it made training in teaching methods and research methodology mandatory for teachers. Then, it introduced competency-based curriculum for undergraduate (UG) students and now for PG students.
The main areas which have been highlighted are as follows:
- Training of psychiatrists who are able to provide ethical, evidence-based diagnosis and treatment to the patients. They should also be able communicators and should have learnt teaching skills. They should have competencies in research methodology and epidemiology.
- They should have knowledge of normal child development along with childhood disorders.
- They should have training in delirium, dementia, sleep disorders, sexual and gender identity disorders, which have been an area of debate and poaching by other specialities.
- Skill in performing modified electroconvulsive therapy is made compulsory.
- Rotational posting in subspecialities has been specified as follows:
Schedule of clinical postings for MD Psychiatry- 36 months
- Area/specialty ward and outpatient department (OPD; concurrent)- 18 months
- Neurology- 2 months
- Emergency medicine/internal medicine- 1 month
- Consultation liaison psychiatry- 3 months
- Psychiatric hospital and forensic psychiatry- 1 month
- Clinical psychology- 1 month
- Addiction psychiatry- 3 months
- Child and adolescent psychiatry- 3 months
- Community psychiatry- 2 months
- Elective posting- 2 months (as per choice in the same institute).
- There is special emphasis on GHPU training, and the residents must complete 100 h of supervised psychological interventions. Teaching methods and assessment methods have been fixed in a structured manner and documented.
This effort will go a long way in improving the quality of psychiatry training and making it uniform across all the centers in India. However, many concerns remain, which are as follows:
- Newer modalities of treatment like rTMS have not been emphasized.
- More competencies should be there, for example, in managing withdrawals like alcohol withdrawal delirium, metabolic syndromes, and neurolept malignant syndrome.
- The mandatory requirement of psychiatry teachers in a psychiatry department, which currently consists of one professor, one associate professor, and one assistant professor, must be increased because the teaching work required from teachers in both UG and PG curricula is huge and almost impossible to manage. We must not forget that teachers also have to perform clinic duties, which include indoor, OPD, and specialist OPDs. This is a seemingly impossible task unless mandatory requirement of teachers is increased. Otherwise, recommendations will be on paper only and logbooks will be filled and signed without actual competency.
Currently, with the number of years required for being professor having been reduced as per the recent eligibility criteria and significantly higher number of psychiatry PGs passing out each year, there should not be lack of teaching faculty with adequate planning.
1. Issac MK, Murthy P, Kewalramani M Guidelines for post-graduate training in Psychiatry in India Sub Committee on Psychiatric Education, Indian Psychiatric Society 2002 Available from: http://indianteachersofpsychiatry.com/wp-content/uploads/2020/03/2003-IPS-PG-Training-guidelines.pdf
[Last accessed 2022 June 30]
2. Guidelines for competency based postgraduate training programme for MD in Psychiatry Available from: https://www.nmc.org.in/wp-content/uploads/2019/09/MD-Psychiatry.pdf
[Last accessed on 2022 Jun 26]