THE NEED FOR ITOP STEPS
Psychiatry teachers in India play an important role in national mental health services; however, there has been the least emphasis on this aspect. More than 90,000 doctors who graduate every year along with more than 1000 psychiatrists specializing annually are trained by psychiatry teachers across India to provide mental health services. In a country that has a large gap in the treatment of mental health disorders, that affects one in seven as per the Global Burden Study carried out by the World Health Organization (WHO), Indian Council of Medical Research (ICMR), and other organizations, the services of psychiatry teachers are crucial. More so in a country where emphasis on undergraduate psychiatry is inadequate despite the implementation of Competency-based Medical Education (CBME). The involvement of psychiatry teachers and enrichment of teaching skills has been highlighted in recent years with a series of symposiums and workshops carried out since the year 2013 at the Annual National Conference of Indian Psychiatric Society (ANCIPS).[4,5] In the year 2016, a forum for Indian Teachers of Psychiatry (IToP) was inaugurated to enhance the exchange of resources and experiences based on the felt need of psychiatry teachers. The emphasis and continued focus on psychiatry teachers in India for enhancing the quality of neuropsychiatry training won the year 2018 International Neuropsychiatric Association (INA) T N Srinivasan Award. The cash prize from the award was contributed to Minds United for Health Sciences & Humanity Trust, which initiated an annual award for psychiatry teachers for best practices in psychiatry education in association with the Indian Teachers of Psychiatry (IToP) forum. With such incentives for psychiatry teachers to provide the best in the training of medical undergraduates and psychiatry postgraduates, there was the need for a focused faculty development program that is tailored to psychiatry teachers in India, which gave rise to an exclusive scholarship for psychiatry teachers IToP-STEPS (Scholarship for Teachers toward Enrichment of Psychiatry Teaching Skills). The program is an initiative of public charitable trust at Mysore, Minds United for Health Sciences & Humanity Trust, funded by Infosys Foundation in association with the IToP forum. This program was launched across the nation on World Mental Health Day, October 10, 2020, as an online 20-session program. The annual scholarships are open to all faculties across India. Equal representation from government and private institutions is ensured in scholarships provided. The successful psychiatry teachers are rewarded each with INR 10000/- at the end of the program. The peer faculties are also provided with an honorarium of INR 10000/-. The COVID-19 pandemic shifted focus toward online teaching and learning, and the IToP-STEPS online program was rightly planned to ensure undisturbed completion.
Psychiatry teachers’ training has not been emphasized in most parts of the world, and to our knowledge, this is the first of its kind across the globe. The success of the program over a period needs to be evaluated, but the completion of the first batch and relevance of the program are documented by the recipients of IToP-STEPS 2020-21. Such kind of structured programs for psychiatry teachers can be utilized as models for many countries where due emphasis on psychiatry education or psychiatry training is not provided, thereby enhancing the quality of mental health services. Online learning which clearly emerged as a major mode of alternative learning during the COVID-19 pandemic has provided an opportunity to make such training programs available to enthusiastic teachers from far and wide geographical locations. Also, without the need for physical infrastructure, online training thus adds to the cost-effectiveness of the program. Additionally, the online mode approach is a new norm in education, and teachers who receive training in such programs have the opportunity to learn online teaching skills. Customized offline and online modes of training psychiatry teachers can be planned as per the requirements of the region and guidelines associated with COVID-19 pandemic.
Adopting the program curriculum for IToP-STEPS
With an objective to develop a focused faculty development program that is tailored to psychiatry teachers in India, the unique scholarship thus initiated had to include the basic medical education principles in its curriculum with customization to the subject of psychiatry. The faculty development program for medical college teachers under the aegis of erstwhile MCI (Medical Council of India) began only in 1997, which was a three-day workshop on various aspects of teaching-learning named Basic Medical Education Technology (BMET). This was revised later on with the addition of a module on attitude ethics and communication. The rolling out of CBME in 2019 for undergraduates kicked off curriculum implementation support programs as well for teachers in medical colleges. Apart from these background issues, the peer faculty team of the IToP-STEPS program also had insights from a survey among teachers of psychiatry to improve the quality of undergraduate training while discussing and deliberating on the development of the curriculum. The team finalized the outline of 20 sessions as presented below. Out of these, 16 sessions had standard topics and the last 4 sessions were kept aside for customization as per the dynamic needs of the scholarship recipients. Everyone opined that the program needs to start with an overview of psychiatry education in India and the evolving role of psychiatry teachers. The principles of adult learning, domains of learning namely cognitive, psychomotor and affective domains, the concept of specific learning objectives (SLOs), and teaching-learning methods were included in initial sessions. Since the curriculum document released for implementation of CBME had only competencies mentioned in it, these initial sessions were designed to help the participants to align the goals, competencies, and derived SLOs to teaching-learning methods and subsequently to assessment methods. On a broader note, topics such as reflections and feedback were included as they are vital in the teaching-learning process. Set induction methods, strategies to make lectures interactive, and various small-group teaching methods were also included. Given the current context, sessions on online teaching-learning methods were felt necessary. There was a consensus to include an orientation session on educational research, a session each on concepts like problem-based learning, self-directed learning (SDL), and suggestions for working with students beyond academics. A session on bedside clinics became a part of the program to discuss improvisations both for UG and PG students. Finally, the sessions on the fundamentals of assessments were made part of the curriculum as mentioned in Table 1. A provision was made to revise the curriculum based on inputs from psychiatry teachers and recipients of IToP STEPS award annually so as to make it truly a collaborative and upgraded effort.
The IToP-STEPS process and methodology
Candidates for the IToP-STEPS scholarship award were selected through a two-step process. In the first stage, a call for applications from interested teachers of psychiatry was circulated through the mailing group of the Indian Psychiatric Society and relevant WhatsApp/social media groups to improve the reach and visibility of the proposed scholarship. Interested candidates had to submit an application form, duly filled-in, along with a motivation letter and a short sample teaching video. These were scrutinized and graded independently by a six-member panel predominantly comprising faculty in the field of psychiatry with domain expertise in medical education; one faculty was from outside psychiatry and had vast experience in medical education.
Next, all the candidates who applied for the scholarship were interviewed sequentially. This was done in multiple sittings, based on the mutual convenience of the participant and members of the expert panel, through adequate prior intimation using online videoconferencing platforms. All members of the panel interviewed every candidate. Following the interview, each expert assigned a combined grade for every applicant, taking into account factors such as their clarity of vision, their interest in medical education, and their potential to influence others. Academic merit or their scholarly profile was not the main criterion; rather, their commitment to medical education and potential impact in terms of dissemination of skills gained through the scholarship was given weightage. Following this process, the experts discussed their individual grades and arrived at a consensus on the candidates to be offered the scholarship. Adequate gender and public versus private sector diversity were also targeted.
The scholarship program was based on the principles of peer-to-peer learning and peer-assisted learning. The curriculum focused on topics relevant to both the content and the process of medical teaching; a complete list of topics and time allotted is given in Table 1. Assignments related to every session were uploaded on Google Classroom by the respective session facilitators; these were completed and graded before the sessions themselves so that related questions could be discussed during the sessions. Efforts were made to have two student observers for every session: one undergraduate and one postgraduate resident, who were encouraged to give their feedback about the content and delivery of the sessions.
The teaching-learning methodology adopted during the course consisted of interactive lectures and case-based learning to promote critical analysis and learning.[10,11] For instance, participants were given potential scenarios of class strength and the topic to be covered. They were asked to choose the T-L method and discuss the pros and cons. Both synchronous and asynchronous T-L methods were used in a complementary fashion; as an example, the small group discussions between participants on assignments posted in Google Classroom fostered peer-to-peer learning and the broadening of insights. Many sessions used video-based discussions to enhance the take-home message; for instance, in large group teaching, a video of a badly conducted lecture triggered a discussion on how to deal with latecomers and the preparation of a lesson plan prior to the lecture. Participant reflection was encouraged throughout; they could reflect on their T-L experiences and discuss ways to augment them. Self-directed learning was another aspect that was given due emphasis. In sessions such as educational research, the participants were asked to prepare and present a one-page concept proposal of their choice related to research in medical education.
The intended goals were to upskill the young psychiatry teacher to effectively perform as a teacher, researcher, and lifelong learner by honing skills of critical analysis, reflection, and creativity.
Intended outcomes and assessment of IToP-STEPS
Assessment needs to be effective and has to be aligned with the objectives and the teaching-learning strategies. The purpose of this course was to provide knowledge and direction in newer ways of teaching, especially in the context of psychiatry, the newly mandated CBME, and to empower the participants with skills in teaching, assessing, and basics of educational research. The course aimed to motivate future learning, including knowledge, skills, and professionalism. The program targeted assessment for and as learning.
The program included microteaching frequently as a means of learning. This is one of the training techniques that provides a teaching environment, offers an opportunity to enhance skills, and also gains a richer understanding of the process of teaching. It combines the principles of situated learning and reflective practices. The learning was facilitated with peer and teacher feedback. Feedback was the core of the assessment process and was on content, process, skills, and demonstrated values. This was provided in written and oral form. Many sessions had students (undergraduate and postgraduate) also giving feedback. This nearly 360-degree feedback went a long way in helping the participants in improving both knowledge and skills.
Assignments were corrected with feedback offered within a short time. The students were asked to hand in reflections that received feedback and were powerful tools for change. Finally, the importance of entrusting the participants to be a facilitator was a mark of their proficiency in acquiring skills.
Program evaluation of IToP STEPS
As any structured program would always need an evaluation, so does the IToPS-STEPS scholarship program. At the end of one year of teaching-learning activities, an attempt was made by the facilitators to evaluate the program. Such an evaluation is needed to determine whether the program was heading in the right direction for which it was intended and designed. When medical educational programs, like the IToPS-STEPS, are considered, it should be understood that it was fundamentally designed to bring about a “change.” The participants in this program, like scholars, facilitators, and internal and external stakeholders, were also interested in change. To determine whether such a desired “change” was happening or has happened or not, this program needs to be “evaluated.”
As an effective program evaluation should focus on the change that is expected to happen, the nature of the change, and whether the change is deemed successful or not, was explored herewith. The Kirkpatrick’s approach is one of the most popular evaluation models and has enjoyed widespread popularity among educators. Its major contributions to educational evaluation are the clarity of its focus on program outcomes and its clear description of outcomes beyond simple learner satisfaction. Accordingly, the program gathered data to assess four hierarchical levels of program outcomes:
- 1. Reaction; Learner satisfaction or reaction to the program: Assessed by 360-degree feedback and reflections.
- 2. Learning: Measures of learning attributed to the program like knowledge gained, skills improved, attitudes changed: Ensured by assessments of the activities and reflections.
- 3. Impact: Changes in learners’ behavior in the context for which they are being trained: Assessed by feedback and reflections.
- 4. Outcome: The entire program’s final results in its larger context: Explored by the learners’ perceptions expressed during the concluding sessions at the end of one year.
With a fairly conducted above steps of evaluation, the IToPS-STEPS program was found to be proceeding in the right direction, and the scholars and the facilitators have expressed that they have undergone a change in teaching-learning methodologies. It is further intended to bring wider dimensions to the present curriculum to suit the ever-growing demand for psychiatry teaching skills for medical educators in psychiatry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
IToP-STEPS is an initiative of Minds United For Health Sciences & Humanity Trust, Mysuru, India. Funded by Infosys Foundation, Bengaluru, India.
Dr Mahesh Jayaram, University of Melbourne, Australia & Dr Pratima Murthy, Director of NIMHANS, Bengaluru, for kind support toward IToP STEPS program.
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