Sir,
We read the article “Absence of undergraduate medical students from psychiatric training: A study from central India” with interest.[1] The authors have reported low attendance by undergraduate medical students in psychiatry. They found a lack of separate exams in psychiatry and adjustment of attendance in other subjects as the main reasons for non-attendance. In this letter, we share a dissimilar experience with undergraduate medical students at our institute.
Review of our departmental records found that the number of second MBBS students (n = 142) attending <50%, 50%–75%, and >75% attendance in clinical postings was 2.8%, 21.1%, and 76.1%, respectively, and number of third MBBS students (n = 84) attending <50%, 50–75%, and >75% lectures was 21%, 53.6%, and 21.4%, respectively. Higher attendance rates may be explained by 1) optimum use of teaching-learning methods (TL methods) to generate interest amongst the students, regular assessment process (for theory and practical) and 2) strict adherence to the attendance policy. TL methods used by the department include the use of OSCE, simulated role-plays, and mental status examinations skills practice on patient videos.
Mishra et al. have recommended “strict adherence to the attendance by the institutional authority.” Our institutional and department policy is to (1) count marks obtained in ward-examination for each allied medical subject in the internal assessment for 3rd Part II preliminary examination, (2) allow students to appear for ward-ending examinations only if they have >50% attendance in clinical postings, (3) students having <50% attendance have to make up for missing attendance by remediation, (4) score are shared by the department with the academic administration only on completion of 75% attendance by remediation, (5) minimum 75% attendance expected in lectures to be eligible for preliminary examinations.
A part of the vision of the institute has been “to shine as an example of what the profession of medicine has to be” and the core values of the organization are commitment, excellence, honesty, and integrity.[2] Integrity means a habitual adherence to moral principles and standing up when they are under attack.[3] Integrity forms the basis of the “social contract” between the profession and society, which grants it the privilege of self-regulation.[4] Unexplained absence and disregard for policy are passive-aggressive disruptive behaviors (incivilities), which need to be regulated in the developing professional to uphold the social contract with the society. Unregulated disruptive behaviors send a message that disruptive behavior is acceptable, and they are likely to recur in the future.
Lecture attendance rates and their impact on academic performance have been rarely studied. Luder has reported preliminary evidence that mandated attendance improved attendance rates but the performance among absentee students was similar to the attendee students.[5] Hence, the medical teachers should debate and research on whether, in the era of online education, physical attendance is mandatory or can be blended with methods like asynchronous learning of theory material.
Mishra et al. have also recommended establishing Psychiatry as a separate examination at the undergraduate level based. Initial attempts have been made towards this and we agree with this recommendation.[6]
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Mishra KK, Rawekar AT, Reshamvala AM. Absence of undergraduate medical students from psychiatric training: A study from central India Ind Psychiatry J. 2021;30:102–5
2. Vision & Mission-Charutar Arogya Mandal. Charutarhealth. org. 2021.Last accessed on 2021 Aug 11 Available from:
http://www.charutarhealth.org/about-us/vision-mission
3. Miller-Keane M Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health. 20037th ed Philadelphia, PA Saunders, An Imprint of Elsevier, Inc.
4. Cruess SR, Cruess RL. Professionalism and medicine's social contract with society AMA J Ethics. 2004;6:185–8
5. Luder A. Lecture attendance by medical students – Is it a compelling issue? Harefuah. 2016;155:223–5
6. Das A, Krishnan V, Dhiman V, Rohilla JK, Rawat VS, Basu A, et al Need and learnings from having psychiatry as major subject during medical graduate examination Indian J Psychiatry. 2020;62:723–7
