Abstract
Education in modern medicine in India began in 1835 with the establishment of the Madras Medical College, in what is now Chennai. Initially the growth of new medical schools was slow but it gathered pace after independence in 1947. In the past decade or so, the growth in terms of the creation of new medical schools has been phenomenal.
Undergraduate medical education
The Medical Council of India (MCI) is a statutory body charged with the responsibility for regulating the establishment of medical schools in India. It lays down standards for undergraduate and postgraduate medical education and prescribes curricula for both. It has the power to accredit, recognise or de-recognise medical schools. According to a recent release from the MCI, India has 233 recognised medical schools, to which 25 374 students are admitted every year at the undergraduate level (see Table 1).
Table 1. Undergraduate medical schools in India, as listed by the Medical Council of India.
| State | Number of recognised medical schools | Yearly intake of students |
|---|---|---|
| Andhra Pradesh | 31 | 3 825 |
| Assam | 3 | 391 |
| Bihar | 8 | 510 |
| Chandigarh | 1 | 50 |
| Chhattisgarh | 2 | 100 |
| Delhi | 5 | 560 |
| Goa | 1 | 100 |
| Gujarat | 13 | 1 425 |
| Haryana | 3 | 350 |
| Himachal Pradesh | 2 | 115 |
| Jammu and Kashmir | 4 | 350 |
| Jharkhand | 3 | 190 |
| Karnataka | 32 | 3 585 |
| Kerala | 15 | 1 650 |
| Madhya Pradesh | 8 | 830 |
| Maharashtra | 39 | 4 995 |
| Manipur | 1 | 100 |
| Orissa | 4 | 421 |
| Pondicherry | 4 | 375 |
| Punjab | 6 | 520 |
| Sikkim | 1 | 50 |
| Tamil Nadu | 22 | 2 315 |
| Tripura | 1 | 100 |
| Uttar Pradesh | 13 | 1 262 |
| Uttaranchal | 2 | 100 |
| West Bengal | 9 | 1 105 |
| Total | 233 | 25 374 |
The undergraduate curriculum of the MCI gives meagre representation to psychiatry. Undergraduate medical students are exposed to psychiatry for only 15–20 hours by way of didactic lectures during the entire course of their medical education, which spans 4.5 years! The clerkship in psychiatry lasts only 2 weeks. During the 1-year compulsory internship, the psychiatric rotation is optional, and in any case that, too, lasts only 2 weeks. Furthermore, psychiatry has no prominence in the final examinations.
At organisational level, many medical schools even today do not have independent departments of psychiatry but rather psychiatry is catered for within the department of medicine; for those schools that do have a psychiatry department the staffing situation is generally poor. Moreover, training in psychiatry is perfunctory and tends to address the cognitive aspects rather than the psychomotor or affective aspects of mental disorder. Undergraduate students do not gain the clinical competence they need to deal with common mental disorders. There is no quality assurance in the training given. Since psychiatry has no significant place in the final examinations, most students pay only lip service to a posting in psychiatry and absenteeism during postings in psychiatry is high.
Postgraduate training
MD in psychiatry
There are only 49 medical schools in the whole country that are recognised by the MCI for training at postgraduate level for the award of an MD in psychiatry. These medical schools admit about 240 medical graduates every year for the 3-year degree course.
The MCI is the regulatory authority for postgraduate courses. It prescribes the curriculum in a broad sense. The universities to which medical schools are affiliated are the examining authorities. There is no uniformity in teaching, and training varies from university to university. Even the examination system is not uniform. This leads to wide variation in standards.
Diploma in Psychological Medicine
There are 29 medical institutions in the country that provide training that leads to the award of the Diploma in Psychological Medicine (DPM). Their combined yearly intake is 89 students.
The MCI is the regulatory authority and the university to which the medical institution is affiliated is the examining authority. The duration of the DPM course is 2 years. Again, the standards of teaching for the DPM across the country are variable and there is no uniformity in the conduct of examinations.
Training in psychiatry for general practitioners
Little information is available about the needs of general practitioners (GPs) vis-à-vis psychiatry. It is felt that they need more psychiatric expertise and that they should be thoroughly conversant with psychological medicine.
Felt need: the national perspective
For the huge population of India and its needs for mental health infrastructure and professional resources, the current training base is not sufficient. At the present rate, it will take a long time to establish a healthy ratio between the population and the number of psychiatrists serving it. Looking at this dismal scene, it is obvious that undergraduate training in psychiatry needs to be strengthened, postgraduate psychiatric training needs to be improved and GP training programmes in psychiatry need to be expanded.
Stumbling blocks
All levels of training in psychiatry – undergraduate, postgraduate and GP – lack a competence-based curriculum. This can be rectified only if policy and decision-makers recognise the importance of psychiatry, not only in medical education but in all healthcare. Unfortunately, the representation of psychiatrists at the higher levels (the MCI, university senates and university syndicates) is marginal. Furthermore, psychiatry has a very thin slice of the medical curriculum ‘cake’. Therefore, the profession as a whole will have to exert pressure on others to give psychiatry its due recognition.
The Royal College of Psychiatrists
The Royal College of Psychiatrists is known for its integrity, high standards and professionalism. Its training programmes, system of accreditation and examinations are highly regarded. For these reasons, the College could make substantial contributions to psychiatric education in low- and middle-income countries such as India. However, while the College has the professional base to do so, it does not necessarily have the resources to undertake such a mammoth task. None the less, what can be achieved is suggested as follows.
Psychiatric education in India and links with the College
India has a shortage of teachers and trainers in psychiatry. Links with the College at undergraduate, postgraduate and GP levels could be of great benefit in this respect. In relation to the teaching and training of GPs, the College could develop links with the Indian Psychiatric Society and the Indian Medical Association. At the undergraduate and postgraduate levels, links could be fostered with the existing medical schools, the universities and the Indian Academy of Medical Sciences, and so on.
What could be developed?
To overcome the shortage of teachers in psychiatry in India, a system of visiting teachers could be initiated. A large number of eminent College Members and Fellows are of Indian origin. They could be asked to provide some teaching and training in India. The logistics of operating such a system – by whom, for how long and how much – needs to be worked out through the good offices of the institutions mentioned above, as would the financial support required. Material support to the visiting faculty (costs of travel within India, board and lodging) could be provided with relative ease at institutional level. A pool of visiting professors and teachers from the membership of the College could be established and a group from this pool could visit India for variable lengths of time to provide the requisite teaching and training. With the help of the visiting faculty from the College, special programmes in continuing medical education could be developed for both psychiatrists and GPs. Links could be fostered by developing ‘memoranda of understanding’, initially between the Indian Psychiatric Society and the College, and later with the medical schools.
Is this feasible or is this a figment of our imagination? We believe that, given the will, this can be achieved.
Further reading
- Agarwal, A. K. & Katiyar, M. (2004) Postgraduate psychiatric training in India. II: Status of psychiatric education at postgraduate level. In Mental Health: An Indian Perspective, 1946–2003 (ed. Agarwal S. P.). Directorate General of Health Services, Ministry of Health and Family Welfare. [Google Scholar]
- Kulhara, P. (2004) Postgraduate psychiatric training in India. I: Current status and future directions. In Mental Health: An Indian Perspective, 1946–2003 (ed. Agarwal S. P.). Directorate General of Health Services, Ministry of Health and Family Welfare. [Google Scholar]
- Srinivasan, K. (2004) Undergraduate psychiatric education reforms and training of general practitioners in primary level mental health care. In Mental Health: An Indian Perspective, 1946–2003 (ed. Agarwal S. P.). Directorate General of Health Services, Ministry of Health and Family Welfare. [Google Scholar]