Abstract
Background:
Psychiatric problem is as common as among the 25% of the general population and 15% patients attending specialty clinic. Majority of the cases are dealt by primary care physician at the first contact, but there is only 2 weeks of clinical posting and 20 h of theory classes during MBBS course. Earlier studies have reported low attendance during the posting and theory classes. There are few studies on this aspect. On this background, the present study was planned.
Methodology:
One hundred 8th semester students of MBBS from two medical colleges (Group A government aided college and Group B from Private college under autonomous university) from the same locality of Central Maharashtra were selected for the study after due approval by the Institutional Ethical Committee. Questionnaire was prepared by the psychiatric faculty of both institutes and administered to the individual students. The data were analyzed using suitable statistical methods (Chi-square test and t-test).
Results:
Only 27% of the students in Group A attended 25%–30% of clinical posting, whereas none of them attended a single theory class. While in Group B, 1/3rd of students attended 30%–40% of clinical posting and 20%–25% of theory class. No separate examination in the subject (88%–94%) and adjustment of attendance in the other major subjects (64–86%) were cited as main reasons for nonattendance among the majority of the students in both the groups.
Conclusion:
Strict adherence to the attendance by the institutional authority, increase in the training hours and separate examination in the subject at undergraduate level may help in improving the attendance and change in attitude of the students toward psychiatry.
Keywords: India, psychiatric training, undergraduate
Mental health is a component of overall health status of an individual and society, which occupies a major portion in the World Health Organization (WHO) definition for the health. Mental health affects the individual's ability to function productively and to maintain a healthy relationship in the society. Hence, it is called “there is no health without mental health.” Approximately 14% of global burden of the disease is attributed to neuropsychiatry disorders. Among those, chronic disabling illness such as depression, substance abuse, and psychosis cover the major chunk. Mental illness increases the risk for communicable and noncommunicable diseases. Several physical health conditions also increase the risk for mental illness and influence in the process of diagnosis and prognosis.[1] 20%–40% burden of disability is contributed by mental illness, which affects 1 out of 5 persons each year. Mental illness can interfere in the treatment outcome of other illness and contribute to several noncommunicable diseases such as diabetes, cardiovascular disorder, and malignancies.[2]
The progress of mental health care worldwide is a developing process. The WHO report 2001 described the changes in the mental health care over the last centuries. The model of mental health care has changed from institutionalization care to community care approach supported by the availability of beds in General Hospital Psychiatric Unit for acute cases.[3]
The Bhore Committee in 1946 emphasized on the need for training and social aspect of medicine to boost India's minimal mental health resources. Also recommended setting up of psychiatric departments in every general hospital to enhance the existing curriculum and training in psychiatry for medical undergraduates (UGs).[4]
In an editorial in the Indian Journal of Psychiatry in 1998, late Prof. J. K. Trivedi highlighted that “the basic purpose of teaching and training at UG level is to prepare medical graduates to serve better at primary health care. The patients with physical illness have concomitant emotional problems requiring professional handling.[5] Knowledge in behavioral sciences and mental health equips the students to deal with various difficult and complex situations during the medical practice. Psychiatric problems are common among 25% of the patients seen in general practice and about 15% of patient's attending specialty clinic. Hence, a proper training psychiatry during UG course will definitely make a student a better doctor to deal with day-to-day issues during their practice.[6] The Medical Council of India (MCI) recommended 2 weeks of clinical posting and 20 theory classes during the 6th semester. In spite of that, studies have reported low attendance in theory classes and clinical posting in psychiatry. Various reasons have been cited toward that. The general attitude among the students is that they will not take a subject seriously unless there is an examination in the subject.[7,8,9] On this background, the study was carried out in two medical colleges of Central Maharashtra.
METHODOLOGY
This is a cross-sectional, single assessment, observational study conducted at two different medical colleges of Maharashtra. One is government aided (Group A), other is a private institution under an autonomous university (Group B). The participants were the 8th semester students of MBBS, who have completed their 2 weeks of clinical posting and 20 theory classes in psychiatry as per the MBBS curriculum. The present study was conducted between December 2018 and May 2019. The Institutional Ethical Committee approval was obtained. A semi-structured pro forma and questionnaire which was prepared and validated by the teachers of psychiatry from both the colleges, was given to 100 students of each college after obtaining their written consent to participate in the study. To minimize the group bias, the pro forma was given to the individual students separately. They were explained that this will not affect their attendance or will not have any implication toward their eligibility for appearing the examination. Study was kept confidential keeping the name of the students optional in the pro forma. Their attendance in the class and clinics was confirmed from the departmental attendance register. Data obtained were analyzed using the suitable statistical test, namely Chi-square and t-test.
RESULTS
From Group A and B, there were 96 and 92 completed forms were obtained. The mean age in the Group A was 21.6 ± 0.65, and in Group B, it was 21.2 ± 0.58. The percentage of male and female in Group A was 44% and 56%, respectively, with male: female 1:1.2. In Group B, it was 48% and 52%, respectively, with Male: Female 1:1.09 [Table 1]. In Group A, only 27% of the students attended 25%–30% of clinical posting and none of the students attended a single theory class. In Group B, only 1/3rd of students attended 20%–25% of theory classes and 30%–40% of clinical posting [Table 2]. Majority of the students in Group A (94%) and in Group B (88%) cited nonattendance in the theory class toward not having a separate examination in the subject. Second common reason for nonattendance (86% and 64%, respectively) was adjustment of attendance in the other subjects toward eligibility for appearing in examinations. Scheduling of class immediately after the postlunch period was attributed as one of the reason for the absence in 44% students in Group A [Table 3]. The main reason for the absence from clinical posting was attributed toward no separate examination in the subject by 93% of students in Group A and 84% in Group B. The other common reasons for the absence were adjustment of attendance in other subjects and clinics were scheduled during the examination period [Table 4].
Table 1.
Sociodemographic characteristics of study participants
| Group A (n=96), n (%) | Group B (n=92), n (%) | P | |
|---|---|---|---|
| Mean age in years | 21.6±0.65 | 21.2±0.58 | 0.2748* |
| Sex distribution | |||
| Male | 42 (44) | 44 (48) | 0.5749# |
| Female | 54 (56) | 48 (52) | |
| Male:female | 1:1.2 | 1:1.09 |
*t-test, #Chi-square test
Table 2.
Attendance in theory class and clinic
| Group A (n=96) | Group B (n=92) | P* | |
|---|---|---|---|
| Attendance in theory | Nil | 0.0001 | |
| No of students | 34 | ||
| Percentage of class | 20-25 | ||
| Attendance in clinic | 0.409 | ||
| No of students | 28 | 32 | |
| Percentage of class | 25-30 | 30-40 |
*Z test for proportions
Table 3.
Reason for not attending theory classes
| Group A (n=96), n (%) | Group B (n=58), n (%) | P* | |
|---|---|---|---|
| Attendance adjusted against other subjects | 82 (86) | 37 (64) | 0.002 |
| No separate exam in subject | 90 (94) | 51 (88) | 0.208 |
| Classes during examination period | 33 (34.3) | 16 (28) | 0.381 |
| No interest in the subject | 31 (32) | 15 (25) | 0.398 |
| Classes held immediately postlunch | 40 (42) | _ |
*Z test for proportions
Table 4.
Reason for not attending clinic
| Group A (n=68), n (%) | Group B (n=60), n (%) | P* | |
|---|---|---|---|
| No separate examination | 63 (93) | 50 (84) | 0.102 |
| Attendance adjusted | 60 (88) | 38 (64) | 0.001 |
| Classes schedule during examination | 38 (56) | 26 (44) | 0.156 |
| No interest in the subject | 23 (34) | 16 (27) | 0.380 |
*Z test for proportions
DISCUSSION
The present study was aimed at finding the common causes for the absence of UG students from psychiatric teaching through the attendance in theory classes and clinical postings. The present study revealed at least 30% of students in private run medical colleges attend the classes and clinics in psychiatry in comparison to none of the students attending the theory classes in a government-aided college. One of the factors, which made the students of private-run college to attend 20%–30% of theory classes, may be due to strict attendance policy. Similar finding was noted in the study carried out by Gulati et al. in a government medical college of Northern India and by Lingeswaran in South India.[8,9] Gulati et al. in their study found out that only 5% of interns had attended 50% of theory lecturers during their UG period. On further evaluation, the reasons for not attending the classes among the students of government-aided college were attendance in psychiatry classes was not mandatory and they were adjusted against the attendance in medicine. The most common explanation of not attending the clinics was that there is no separate examination in the subject and only 10 marks in the internal assessment during the prefinal examination to which no importance was given. Similar finding was observed in the study by Gulati et al. and Chawla et al.[8,10] Roy Abraham in one of his seminal paper in the subject quoted that “General attitude among the student is that they will not take the subject seriously unless there is an examination in the subject.”[7] A similar finding was attributed by Lingeshwaran.[9] A recent article by Sharma et al. on the attitudinal changes toward psychiatry by the UG students following 2 weeks of psychiatry posting reported, 2 weeks of clinical posting was not sufficient for any change in attitude.[11]
CONCLUSION
The study findings suggest the importance of mandatory attendance in the clinics and theory classes of psychiatry. Psychiatry has to be made a separate examination subject at the UG level, till then at least 30% of marks in the theory and practical examination of final MBBS medicine paper may be allotted toward psychiatry and that has to be assessed by the psychiatrist as one of the internal examiner. Awaiting the long-pending demand of making psychiatry as an independent examination subject. Increasing only 5 h for theory classes in psychiatry and no competence on the subject in the new curriculum of MCI may not change the present scenario much.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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