Undergraduate psychiatry education in India: Where do we stand on the crossroads?

Sir,

Psychiatry got separated from the mainstream of general medicine and has created its own identity as an independent discipline more than half a century back. Pediatric was also separated from the main stream as aseparate discipline during the same period. However, there is gross disparity in the growth of both the disciplines. Psychiatry is an ignored medical discipline. The stigma associated with psychiatry is not confined to general public; its root is deeply seated among the medical professionals as a result of which most medical students think psychiatry to be less important and only very few students chose psychiatry as a career during postgraduation.[1]

Since last few years, there is a movement to make psychiatry as a compulsory subject and the Indian Psychiatric Society is leading this movement.[2] Efforts are being taken to convince the “Medical Council of India (MCI)” to revise the undergraduate medical (i. e., Bachelor of Medicine, Bachelor of Surgery (MBBS)) curriculum and make psychiatry a compulsory subject.[2] This movement is quite encouraging and will definitely increase mental health awareness among medical professionals. It will also help in reducing discrimination of the discipline. But there are many hurdles on the way. At this point of time, a big question is—are we prepared enough to nurture psychiatry as a compulsory and independent subject in undergraduate medical curriculum?

Currently in India there are nearly 4,000 psychiatrists, of which many are in various private and corporate sectors.[2] Psychiatrists attached to medical colleges and other teaching medical institutions seem to be quite inadequate. With this scarcity of psychiatrists in teaching institutions, developing psychiatry as an independent and compulsory subject for undergraduate medical students seems difficult. The importance of undergraduate psychiatric education was realized in India just before independence of India (i. e., 1946) and Bhore committee (1946) had recommended the establishment of psychiatry units in every general hospitals and encouraged to update the undergraduate psychiatry training.[34]

MCI had recently focused to augment the undergraduate curriculum for psychiatry by:

Increasing the hours of psychiatry teaching and clinical posting

Increasing the marks of psychiatry in the theory examination of general medicine for undergraduate students as well as mandatory internal assessment in psychiatry

Mandatory internship posting in psychiatry.

Unfortunately, these things are not monitored properly and many things are yet to be implemented. A major drawback is that psychiatrists are not involved in setting questions, evaluating the paper of theory examinations and internal assessments.

Hence, at this crossroads, the immediate focus should be implementing and augmenting the existing MCI recommended curriculum for undergraduate psychiatry with strict monitoring. Developing psychiatry as a compulsory subject should be the long-term goal. Before that it needs to be ensured that each teaching institute has the basic teaching infrastructure in psychiatry. To meet the need of teaching faculty and enhance the teaching manpower, MCI should focus on increasing the postgraduate seats (both Doctor of Medicine (MD) and Diplomate of National Board (DNB)) in psychiatry.