In India Post Graduate Psychiatry Training: Guidelines
In India Post Graduate Psychiatry Training: Guidelines
In India Post Graduate Psychiatry Training: Guidelines
FOR
POST GRADUATE
PSYCHIATRY TRAINING
IN INDIA
JANUARY 1, 2013
59
Guidelines for Post Graduate Psychiatry Training in India 2013
Indian Psychiatric Society
TASK FORCE
Chairman: Members:
Dr Mohan K Isaac Dr PSVN Sharma
Professor of Psychiatry (Population Mental Health) Professor and Head,
School of Psychiatry and Clinical Neurosciences Department of Psychiatry,
The University of Western Australia, Perth Kastuba Medical College, Manipal
1
Indian Psychiatric Society- Executive Council (2012-13)
East Zone:
Dr UK Sinha
Dr T Sudhir
North Zone:
Prof BS Chavan
Prof RK Solanki
South Zone:
Prof NN Raju
Dr G Prasad Rao
West Zone:
Dr Kishor Gujar
Dr Kaushik Gupte
2
Table of Contents
1. Background ................................................................................................................ 7
3
Message from the President, Indian Psychiatric Society
Dear Colleagues
The publication of this document, “Guidelines for Post- Graduate Psychiatry Training
in India is a landmark event. The most widely referenced document so far, was the
previous one published 11 years back in 2002. This was prepared by a task force
headed by Mohan Isaac and Pratima Murthy and was made available in printed format
as a book and was extensively circulated. Another document “Recommendations for
Minimum Standards of Competency Based Training in Psychiatry” was prepared by
Prof RC Jiloha and Prof Shugangi Parker for the IPS Psychiatric Education Committee
in 2010, although this was not published in book format.
We could see, there was exponential growth in the number of PG Centres and PG
seats in Psychiatry in India during the last 2-3 years. Besides, the views expressed
in the two documents of IPS needed to be streamlined and updated. Hence the
IPS Executive Council decided to appoint a task force and entrust this job to them.
It may be important to mention that the first M.D. Psychiatry course in India was
started by Medical College, Patna in 1941 and the first M.D. Candidate was late
Prof. L.P. Verma, a Past President of I.P.S. and Past Editor of Indian Journal of
Psychiatry and Neurology (Sharma et al 2010)
We are grateful to the task force headed by Prof Mohan Isaac and Prof Pratima
Murthy for having taken up this arduous task. They have completed the assignment
within the time of six months allotted to them. They have sent questionnaires to
all PG Centres and got their feedback. This is a most comprehensive work done
on PG Training in India. We are sure, this will be a valuable document, which will
considerably enhnace the standards of training and teaching in the country. Let
me offer our heartiest congratulations to all the members of the task force.
Yours in IPS,
4
Letter of IPS President to all Fellows & Members dated July 20, 2013
5
This appointment is in acknowledgement of their expertise in this area as
well as the significant contributions they have made to IPS. We are confident,
the task-force will make a remarkable contribution to PG medical teaching
in India.
We request you to send your suggestions and views to this task force at
the earliest, latest by August 31, 2012. The task force has been asked to
submit the draft Guidelines by December 31, 2012 for consideration by our
Executive Counicl. Once approved by EC, it will be published as the IPS
official document.
Yours in IPS,
Prof Roy Abraham Kallivayalil
President, Indian Psychiatric Society
6
IPS Task Force Guidelines for
Post Graduate Psychiatry Training in India 2013
1. Background 1
Formal post graduate Diploma training in Psychiatry started at the All India
Institute of Mental Health in 1955 and at the Central Institute of Psychiatry in
Ranchi in 1962. Until 1967, there were only 6 institutes in the country offering
post graduate psychiatry training.1 During the last 4 decades, there has been a
significant increase in post graduate training throughout the country.
The 2002 IPS Guidelines recognised that there were many small departments of
psychiatry that had just begun post-graduate training programs and thus set out to
establish basic requirements and training programs as a minimum guideline upon
which institutions could build to improve training. It was suggested that constraints
in meeting these minimum guidelines could be overcome through posting trainees
to larger centers for training, having guest faculty to conduct workshops and
expose the students to the CME programs of the Indian Psychiatric Society. A
specific suggestion at the Workshop on Post Graduate Education at the ANCIPS
2001 was the preparation of a common set of training and resource materials for
use at different centres.
In 2010, there were 112 Medical Colleges and Postgraduate Institutes which
admitted 266 M.D. degree students in Psychiatry each year and 55 medical colleges
with training facilities for 124 D.P.M. students. In addition 50 to 60 Postgraduates
appeared for D.N.B. of the National Board of Examination. Presently, as per the
official website, there are 141 MD psychiatry centers with 358 seats 37 DNB
centres with 60 seats.4,5
In September 2012, a task force was established to modify these guidelines in the
light of radical changes in post graduate psychiatry training all over the world, as
well as the fact that there has been a significant increase in post graduate training
centres in India.
The Task Force had invaluable inputs and recommendations from academicians
and luminaries from all over the world. We gratefully thank the following persons
for their ideas and suggestions which have all helped in modifying the 2002
guidelines.
3 Indian Psychiatric Society. Guidelines: for post graduate training in psychiatry, 2002
4 http://www.mciindia.org/InformationDesk/CollegesCoursesSearch.aspx?N=47 (accessed 29/12/12)
5 www.natboard.nic.in (accessed 29/12/12)
8
Drs Alok Sarin, Anand Pandurangi, Anil Shah, Arabinda Chowdhury, D Basu,
SK Chaturvedi, Dilip Patel, DS Goel, Henal Shah, Himanshu Gupta, Kaustav
Chakraborty, Mathew Yaltho, Nalini Juthani, D Natarajan, Nirmala Srinivasan,
Ponnudorai, Prabha Chandra, Prabhakar Korada, KS Shaji, Smitha Ramadas, R
Sreenivasa Murthy, JK Trivedi, Vikram Patel.
Drs Abhay Matkar, Amar Bavle, Anil Prabhakaran, Anurag Srivastava, Aparajeet
Baruah, Asim Kumar Mallick, PS Bhat, BS Chavan, Christina George, PK Dalal,
Daniel Saldanha, Deepa Ramaswamy, Deepak Kumar, Dilip Kumar Mondal, HA
Gandhi, PD Garg, Gunugurti Prasad Rao, Harihar Chilikuri, Harish Arora, Hemangi
S Dhavale, John P Mathai, GD Koolwal, SM Manohari, DG Mukherjee, Murali
Thyloth, Mushtaq A Margoob, Nilesh Shah, Om Prakash Singh, NM Patil, Pradeep
Sharma, Praveen Khairkar, G Raghunathan, R Raguram, Rajat Ray, Rajiv Gupta,
MSVK Raju, TSS Rao, Ravi Philip Rajkumar, Ravindra Kamath, Roy Abraham
Kallivayalil, Sandip Shah, Sanjeev Jain, Satheesh Rao, V Satheesh, Savita
Malhotra, KS Shaji, DK Sharma, PSVN Sharma, Shivananda Kattimani, Shubangi
R Parkar BS Sidhu, Smita N Deshpande, Sudhir Kumar, Sunita Simon, Sushil
Kerada, Thirunavukarasu M, Varghese Punnose, Vijaya Mahadevan, Vishal Indla,
Yousuf Matcheswala.
While regulatory bodies like the MCI set uniform standards for training and
monitoring, it should be the responsibility of professional bodies in different
specializations like the IPS to evolve guidelines for training. The professional body
can play an important role in assisting post-graduate centers set up training facilities
that meet the essential requirements for training. They can assist the regulatory
bodies in monitoring adherence to standards, be closely involved in evaluation of
trainees’ fulfillment of training requirements and participate in evaluation of the
trainee’s competence to fulfill his/her obligations as a specialist in the area.
9
Between September and December 2012, the IPS constituted a Task Force to
revise the 2002 guidelines as relevant to the present times.
In order to fulfill its obligations, the Task Force carried out the following:
10
2. International review of
post graduate training 1
Training in psychiatry is evolving all over the world and is becoming more formal.
In many developed countries with many years of such training, the program is
much more evolved and structured. The following table compares training in the
United States of America, the United Kingdom, Australia and New Zealand. The
references for these are provided at the end of the accompanying table.
11
clinical neu- (subspecialties old age psychia- old age, forensic,
rophysiology, include: liaison, try, psychiatric Research/Aca-
pain medicine, substance aspects of sub- demic, adult, CL,
sleep medicine, misuse, and stance misuse, Psychotherapies -
and hospice rehabilitation), developmental indigenous, rural
and palliative learning dis- psychiatry (CAP, and any other as
medicine. ability, learning difficul- specified by the
psychotherapy, ties and mental board for 2 yrs
CAP, forensic, handicap) and
and forensic psy-
Geriatric psy- chiatry.
chiatry. The training
program can
include not more
than 1 year of
flexible training
(e.g. research or
other subjects
to be approved
by the head of
training).
Core com- Patient Care, Medical Expert, Medical Ex- Medical expert/ Medical expert,
petencies Medical Communicator, pert, clinical decision- communicator,
Knowledge, Collaborator, Communicator, maker, commu- collaborator, man-
Practice-Based Manager, Collaborator, nicator, collabo- ager, health advo-
Learning and Health Advo- Manager, rator, manager, cate, scholar and
Improvement, cate, Scholar Health Advo- health advocate, professional
Interpersonal and Profes- cate, Scholar scholar and pro-
and Com- sional and Profes- fessional
munication sional
skills, Profes-
sionalism, and
System Based
Practice
12
Training Yes Yes Yes Yes Yes
curriculum
and teach-
ing meth-
ods
Evalua- Evaluation after WPBA and ITER (and Annual assess- Work place based
tion of the each rotation ARCP, FITER at the ment of the assessments
training (usually Weekly CBDG end of train- trainee’s prog- (WPBA); Entrust-
360-degree), in first year; ing), annual ress (clinical, able Professional
patient SAPE used for Oral examina- thory), training Activities (EPAs);
logs, annual psychotherapy tions, log books, final Supervisor In-
PRITE and evaluation, including STA- evaluation in the Training Assess-
CSV exams, Case report or CER in the form of a written ment (ITA) forms
Psychotherapy small final year, report and reports;
evaluation, literature re- Psychotherapy Scholarly Project;
view in the evaluation, Psychotherapy
Core Psychia- Long Case;
try training;
13
ABPN certifi- original re- RCPSC certifi- Theory exami-
cation search re- cation nation; clinical
examination quired examination examination by
in year 4-6, OCIP and OSCE
MRCPsych ex-
aminations
Certifica- ABPN certifi- MRCPsych ex- RCPSC exam, national require- Fellowship certifi-
tion cation, Part I aminations consisting of ments for psy- cation by – Fellow
(written)and consisting of written and chiatry training of Royal Aus-
Part II (clinical) three written oral (OSCE) should be com- tralian and New
examination components patible with the zealand college of
papers and UEMS Board of psychiatrists
CASC clinical Psychiatry
examination
QA/QI: Quality Assessment and Quality Improvement; CSVs: Clinical Skills Verification
Exams; ITERs: In-Training Evaluation Reports; FITER: Final In-Training Evaluation
Report; WPBA: Workplace-Based Assessments; ARCP: Annual Review of Competence
Progression; MRCPsych: Membership of Royal College of Psychiatrists; OSCE: Objective
Structured Clinical Examinations; CASC: Clinical Assessment of Skills and Competencies;
FTE – Full Time Equivalent; OCIP - observed clinical interview and presentation; OSCE -
observed structured clinical examination; CL Psych – Consultation Liaison Psychiatry; CAP
– Child and Adolescent Psychiatry; CT – core training; ST- specialist training. 6,7,8,9,10,11,12,13
(accessed 29/12/2012)
6 American Board of Psychiatry and Neurology, Inc: 2010 Information for Applicants-Initial Certification
in Psychiatry; available at http://www.abpn.com/downloads/ifas/IFA_Cert_Psych_2010.pdf
7 European Union of Medical Specialties European Board of Psychiatry. European framework for
competencies in psychiatry. October 2009. (www.uemspsychiatry.org)
8 The Royal Australian and New Zealand College of Psychiatrists. Competency based Fellowship
Program. The Royal Australian and New Zealand College of Psychiatrists, 2012. (http://www.
ranzcp.org/Pre-Fellowship/2012-Fellowship-Program/About-the-training-program.aspx)
9 The Royal College of Physicians and Surgeons of Canada: Information by Specialty or
Subspecialty. The Royal College of Physicians and Surgeons of Canada, 2012. (http://rcpsc.
medical.org/information/?specialty=165&submit=Select)
10 A Competency Based Curriculum for Specialist Core Training in Psychiatry. Royal College of
Psychiatrists, London, 2010. (http://www.rcpsych.ac.uk/pdf/CORE%20CURRICULUM%20
October%202010%20(Mar%2012%20Update).pdf )
11 Royal College of Psychiatrists. Revalidation guidance for psychiatrists. Royal College of
Psychiatrists, London, 2012. (http://www.rcpsych.ac.uk/files/pdfversion/CR172.pdf)
12 American Board of Psychiatry and Neurology. Maintenance of Certiciation Program.
ABPN, 2011(http://www.abpn.com/downloads/moc/moc_web_doc.pdf).
13 Royal College of Physicians and Surgeons of Canada. Maintenance of Certification Program
(MOC). Royal College of Physicians and Surgeons of Canada, 2011 (http://www.rcpsc.org).
14
There are regulatory bodies in most countries which certify and regulate training.
However, as evident in the accompanying table, the professional body plays a
key role in many countries in developing and monitoring training, as well as in
the certification. Sub-specialisation receives a greater focus in these countries,
which already have much better psychiatrist to population ratios, better grounding
in mental health care issues in medical school and a very close involvement of
professional bodies in developing standards of care and monitoring training.
The techniques popularly used for training as summarised in the table include
didactic teaching, problem based learning, diagnostic interviewing, on call
supervision, supervision for psychotherapy, assignments, grand rounds, debriefing,
periodic feedback and resident evaluation of faculty teaching. For each training
program, the resident psychiatrist receives a formal orientation, instruction regarding
responsibilities for patient care and record maintenance, details of teaching and
reading references in the area.
15
the training, monitoring of regular attendance at teaching programs, regular
evaluation by education and training committees, evaluation of log-books
maintained by residents. These have variously been referred to as formative
assessments, summative assessments and 360 degree assessments. Satisfactory
completion of the program is a pre-requisite for board eligibility or appearance for
the qualifying examination.
The evaluation for the board certificate consists of two parts, one is the ongoing
clinical work performance and another consists of the final evaluation. The final
evaluation consists of the theory and practical examination. Depending on the
board the number of theory papers varies. (E.g., Royal College of Psychiatrists
consists of 3 papers). The practical examinations basically assess the core areas
of clinical skills in a structured format as shown in the earlier table.
While psychiatric training has really evolved in the countries mentioned earlier,
these form an exception. A collaborative survey on psychiatric training by the
WHO and WPA in 143 national medical societies from 171 countries, revealed
a general deficiency and a marked variability in training around the world. Many
developing small- to medium-sized countries have either no training facilities or
cater to a very small number of trainees, and the content and quality of training
vary considerably14. Recently, the WPA has come up with guidelines for resident
training which states that ‘in regions where very few psychiatrists exist, there must
be broader resident training experiences in preparation for roles in developing,
implementing and evaluating all aspects of mental health care and policy locally,
regionally, and nationally.” 15
14 WHO Atlas Psychiatric Education and Training across the World 2005, WHO Geneva 37,
Switzerland, 2005.
15 Tasman A, Kay J, Udomratn P, Alarcon R, Jenkins R, Lindhardt A, Fahrer R, Gureje O, Hirayasu
Y, Dusica Lecic Tosevski DL, Stein D. WPA template for undergraduate and graduate psychiatric
education, 2011 (http://www.wpanet.org/uploads/Education/Template_for_Undergraduate_and_
Graduate/WPA-Template-rev.pdf)
16
3. In-country review 3
The growth in centers offering post graduate training in India is obvious. Till 1967,
only 6 institutes offered postgraduate psychiatric training. This has substantially
increased in the last twenty years. 16 A survey of postgraduate centers in India in
198517 found a marked variability in the course duration, content of curriculum,
clinical postings and research requirements. Since then, there have been several
reviews of post graduate training.18,19 In 2010, the Indian Psychiatric Society made
recommendations to the Government of India and Medical Council of India for
Minimum Standards of Competency Based Training in Psychiatry.20 A recent review
of training and training centers in psychiatry in India21 provides an exhaustive
review of both undergraduate and postgraduate training and related issues. What
is clear is a wide variation in the syllabi and modes of training in postgraduate
courses throughout the country. There are variations in the eligibility examinations,
with separate central entrance examinations, state entrance examinations and
separate examinations of central institutions. Very few centers offer specialised
training in sub-specialties through post doctoral fellowships, DM in the subspecialty
or PhD programs. Existing training methods consist predominantly of lectures and
seminars. The need to focus on learner centered learning and evaluate programs
16 Sharma S, op cit.
17 Kulhara P. Postgraduate psychiatric teaching centers: Finding of a survey. Indian J Psychiatry
1985; 27:221-6.
18 Channabasavanna SM. Editorial, Psychiatric education. Indian J Psychiatry 1986; 28:261.
19 Agarwal AK, Katiyar M. Status of Psychiatric Education at Postgraduate Level. Postgraduate
Psychiatric Training in India-I. In: Agarwal SP, editor. Mental Health: An Indian Perspective 1946-
2003. New Delhi: Elsevier; 2005.p218-20.
20 Jiloha, Parker S. Recommendations of the Indian Psychiatric Society for minimum standards of
competency based training in psychiatry, 2010.
21 Rao TSS (Ed). Psychiatry in India: Training and Training Centers. 2011.
17
from both trainee and trainer perspectives has been highlighted22 There have been
positive experiences with techniques like OSCE23 and the role of self-evaluation of
trainees in seminars.24
22 Murthy P, Chaturvedi SK, Rao S, Learner centerd learning or teacher led teaching: a study at a
psychiatric center. Indian J Psychiatry 1996:38,3:133-136.
23 Chandra PS, Chaturvedi SK, Desai G. Objective standardized clinical assessment with
feedback: Adapting the objective structured clinical examination for postgraduate psychiatry
training in India. Indian J Med Sci. 2009; 63:235-43.
24 Goswami K, Chandra P, Desai G, Thennarasu K, Chaturvedi SK. Do I Know What I Do Not
Know? Self-Evaluation of Performance in Student-Run Seminars by Psychiatry Trainees in
India.
18
4. Survey of post graduate
training departments 4
As earlier mentioned, a survey questionnaire on current post graduate training was
designed and sent by email to heads of post graduate training centers. Contact
details were available for 87 centers, and the head of departments of these
centers were sent out questionnaires by email and 60 responses were received,
indicating a response rate of 69%.Three departments had not yet started a post-
graduate program as they were still awaiting approvals, and filled questionnaires
were received from 57 centers. Responses were obtained from 28 government
centers and 29 private centers. Forty seven centers were psychiatry departments
in general hospital settings and 10 were psychiatric hospitals. With respect to
State/Union Territory, the responses received were as follows: Andhra Pradesh-4,
Assam-1, Chandigarh-2, Delhi-3, Gujarat-2, Haryana-1, Jammu and Kashmir-1,
Karnataka-10, Kerala-6, Maharashtra-8, Madhya Pradesh-1, Pondicherry-1,
Punjab-3, Rajasthan-4, Tamil Nadu-4, Uttar Pradesh-2 and West Bengal-4.
Many centers have newly started post graduate courses. Eighteen (31.6%) centers
have started the course in the last 5 years or less. Seventeen centers (29.8%)
have been running the course for 20 years or more.
19
The median number of beds was 40. A significant number (33 centers, 58.9%) had
only 1 clinical unit and the median number of specialty clinics run was 4.
Services
Regulations
36 (63.2%) centers selected postgraduate trainees through the All India Entrance
examination, 31 (54.4%) centers through the State entrance examination and 10
(17.5%) centers through the university entrance examination. Some of the centers
follow more than one pattern of intake of intake.
Course Structure
There is a lot of variation in the post graduate course structure. The median
number of postings during the course duration are 6 in MD, 4 in DPM and 5 in
DNB. A majority (60-90%) of the centers have neurology or medicine as special
postings. However, postings in psychiatric sub-specialty areas like Child Psychiatry,
Addiction Psychiatry, Community Psychiatry and Psychology occurs in only 20-
40% of centers. Ten centers (17.5%) report special postings to Radiology.
25 Medical Council of India. Guidelines for competency based post graduate training programs for
MD psychiatry, 2002.
20
a mandatory psychotherapy supervision program. Centers that reported a
psychotherapy supervision program with a median of 60 hours of mandatory
therapy during the course
There is a high reliance on external postings for training in specialities like neurology,
radiodiagnosis and child psychiatry, with minimal input from the center itself. Very
few centers offer specialised training in consultation and liaison psychiatry (CLP),
and where it is recorded as provided (26% and 33% of centers respectively), it is
acquired through ‘on call duties’.
A high percentage of centers (30-52%) have reported that they do not provide
any specific inputs to post graduates in many sub-specialties including medical
law ethics (45%), CLP (38%), radio-diagnosis (52%) and neuropsychology (48%),
addiction medicine (35%).
21
Traditional teaching methods such as lecture, seminars and student presentation
still seem to be the most commonly existing and preferred teaching methods (in
40% and 70% of centers respectively), though many centers (40%) have expressed
need for OSCE and OSPE based methods of assessment. Though 90% of the
respondents agreed that imparting skills for clinical interview were very important,
none of the centers reported use of teaching methods like video demonstrations or
faculty demonstrations. Bedside clinical rounds remain the only source of learning
these skills by passive observation. Only 55.6% and 45.8% centers reported that
they were satisfied with the current teaching methods and assessment methods
respectively.
Median number of journals (electronic and hard copy) available across centers is
5 each. 30% of center had access to less than 5 journals and 7 centers (12.3%)
reported no access at all to journals.
Research requirements
Forty four centers (77.2%) reported that they had a mandatory research requirement
– students were expected to present 1 paper, 1 poster and publish 1 paper as per
MCI norms. Dissertation is currently mandated under MCI regulations.
Assessment methods
50% of centers did not have system of assessment during the course, for example,
at end of posting or semester.
There was a great uniformity in the final assessment methods, with 95% of centers
having 4 theory papers in the final year. The broad areas examined included basic
sciences related to psychiatry, psychology and sociology, psychiatry, psychiatric
specialties, neurology and medicine related to psychiatry and recent advances in
psychiatry. One center each 3 papers and another had 5 papers as part of the final
examination.
Practical/Viva
Two thirds of the centers (66%) report using multiple methods for end of course
assessment including case discussion and viva. The commonest pattern for the
22
practical examination carried out in 37 centers (64%) is 1 long case and 1 short
case in psychiatry, 1 case in neurology. A few centers (20, 36%) have 2 short
cases in addition to the others. Almost all the centers have 2 internal and 2 external
psychiatry examiners. Only one center has an external neurology examiner and
another center has a psychology examiner.
23
Specific suggestions on
modification of the 2002
5 guidelines
Program attributes
24
Areas of training
Most of the suggestions were specific to training content and modalities and
include:
Assessments
A common suggestion was the need for periodic assessments throughout the
course. Other suggestions included training log to monitor progress.
25
Other areas:
Suggestions included the need to train young faculty in training methods, a focus
on continuing professional development and for postgraduate research outputs to
feed into a central repository
26
IPS Guidelines on
Postgraduate Psychiatry
Training in India: 6
2013 revision
Introduction
Psychiatry has traditionally been a bridge between medicine and the humanities. A
core skill of the psychiatrist continues to be his or her ability to synthesize information
from various domains, including the biological, psychological, social and cultural, in
order to make a diagnosis and formulate a plan of management tailored to the needs
of the individual patient. 26 This involves a highly developed capacity for scientific
thinking as well as considerable interpersonal skills. While the role of psychiatrists
as consultants to other medical and allied health practitioners is likely to increase,
a substantial component of direct clinical work is essential for the psychiatrist to
maintain his or her clinical skills and credibility. In addition, the explosion in the
understanding of human behavior and psychiatric disorders, emergence of newer
treatments and the sea of information currently available, makes it necessary for the
psychiatrist in training to keep abreast not only of traditional approaches, but also be
aware of recent advances in the area of mental health.
Psychiatric training has undergone major development over the past decades and
scientific developments in the field of molecular biology, neurobiology, genetics,
cognitive neurosciences, neuroimaging, psycho-pharmacology, psychiatric
epidemiology and many other related fields have contributed to the increasing
growth of psychiatry as a medical discipline.27 There are constant tensions
26 Adler R. Through the Glass Darkly: Toward Options for Training, Examination and Continuing
Education. The Royal Australian and New Zealand College of Psychiatrists. College Statements.
2001
27 Rubin EH, Zorumski CF. Psychiatric education in an era of rapidly occurring scientific advances.
Acad Med 2003;78(4):351-4.
27
between keeping abreast of the knowledge and its translation into more effective
clinical care on the one hand, and ensuring the delivery of basic psychiatric care in
the community on the other. This is particularly relevant in India where there is an
acute shortage of trained psychiatrists and other mental health professionals. 28
Teaching methods in general have moved in the direction of interactive and active
learning rather than passive modes of learning. While the shift in training towards
a competency based, and learner led program is clear in spirit, and reflected in the
MCI guidelines, translating this into action involves consistent and collaborative
effort. While the MCI sets a broad mandate for all postgraduate programs, there
is a need for training guidelines to be essential yet aspirational, pragmatic yet
directed towards improvement, focused on present learning, yet moving the
trainee in the direction of lifelong learning.
Post graduate training cannot occur in a vacuum. It can be effective only when
placed in an appropriate training environment, which focuses on a strong
undergraduate grounding in psychiatry and is complimented with opportunities
in the form of specialised training through post doctoral programs and
superspecialisation.
The guidelines for the 3 year training program have been modified keeping the
overall objectives of training and competencies expected to have been achieved
by the end of training. It is recommended that a single postgraduate course is
conducted, rather than multiple courses, in order to maintain uniform standards in
post graduate training.
28
be formally trained in teaching and mentoring, as well as in administrative skills.
They should regularly participate in programs of continuing professional education
and workshop on teaching and evaluation.
1. Eligibility :
2. Selection Procedure
29
At the end of the course, the candidate should be able to:
The candidate, at the end of the post graduate training course is expected
to have competencies in the following areas:
30
2. Formulate of a comprehensive treatment plan that includes pharmacological
and psychosocial management, rehabilitation, aftercare and engagement
of care givers
3. Be able to manage psychiatric emergencies
4. Communicate effectively with patients and care givers
5. Learn the use of Evidence-Based Medicine (EBM) which refers to the
process of making medical decisions that are consistent with evidence
from relevant research and envisages a therapeutic alliance between
research-evidence, clinicians and patients.
31
whether the evidence from research can be trusted29.
3. Ability to develop research ideas, carry out a review, plan a protocol,
carry out a research study or clinical audit, carry out statistical analysis,
write a report, present and publish original work or reviews
4. Exposure and opportunities to train in areas of recent advances
such as neuroimaging, molecular genetics, neuropsychological
assessments, newer psychotherapeutic interventions and other
specialised areas
5. Acquisition of teaching experience through involvement in postgraduate
and undergraduate teaching as well as teaching of mental health and
health personnel
Training faculty to be effective and objective examiners, Faculty need to be
provided training and specific guidelines on how to carry out the examination, how
to select cases, how to mark the candidate, and how to retain objectivity.
o Reductionistic to holistic.
o Discipline oriented to problem oriented.
o Disease oriented to patient oriented.
o Theory oriented to skill acquisition oriented.
o Teacher taught to student led learning.
• The course should inculcate in the trainee a spirit of learning and enquiry
which the trainee retains as a quest for lifetime learning.
• The subjects should be addressed in an integrated manner in the 3
year course with the trainee being able to solidify his / her identity as a
psychiatrist in their third year as well as anticipate their future role in a
career and practice.
29 Tharyan P. Evidence-based Medicine. Can the evidence be trusted? Indian J Medical Ethics
(editorial) 2011, 7, 4: 201-207
32
• The training will occur through the three years of the MD course. The MCI
guidelines suggest a semester system of six months duration each. Thus
each year will comprise of two semesters. Each center may organize the
teaching suggested during the year within two semesters, based on its
resources.
To:
• Acquaint students with the history of psychiatry
• Instruct them in clinical skills in their daily work with patients through small
group teaching Provide introductory courses in investigations, treatment
and research methodology in psychiatry
• Encourage students to critically review a topic of interest, to find
a research supervisor and by the end of the first year, to produce
an outline proposal for research
• Orient the trainee in making a presentation, appropriate use of audiovisual
aids, performing a net search.
6.2. Postings
6.4.1. Organisation
6.4.2. Content:
Technique of Training
Organic disorders
Schizophrenia and related disorders
Mood disorders Anxiety disorders
Personality disorders
Other behavioural disorders
Substance use disorders
Stress related disorders
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6.5. Sciences basic to psychiatry
Techniques
Broad content
The focus of teaching in basic sciences should be on applied aspects of the topics
to psychiatry. While the broad content under the basic sciences are outlined for
convenience, integrated teaching would be more useful: eg. Prefrontal cortex:
anatomy, connections, neurochemistry and role in psychiatric disorders. Wherever
feasible, it would be desirable to incorporate topics from allied disciplines such as
neurophysics (e.g. Cybernetics, signal processing, computational brain models)
6.5.1. Neuroanatomy
Modular Teaching
6.5.2. Neurochemistry
6.5.3. Neurophysiology
6.5.5. Sociology
• Psychiatric epidemiology
• Descriptive Statistics
• Analytical Statistics
• Qualitative Research methodology
• Research Design
• Critical review of statistical procedures
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• Meta-analysis and systematic reviews
• Evidence Based Research
• Commonly used statistical packages
• How to read / write a research paper
6.5.7. Genetics
Postings to specialities:
• Child Psychiatry
• Medicine / liaison psychiatry
• Neurology
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• Addiction Psychiatry
• Geriatric psychiatry
• Family Psychiatry
• Rehabilitation
• Forensic Psychiatry
• Community Psychiatry
• Psychology
• Psychiatric hospital*
As this is also the year of data collection and analysis for the dissertation, it is
desirable that the trainee have an optional posting to a clinical unit, community,
or if the trainee is undertaking is undertaking biological work, for a posting to the
laboratory.
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• Psychopharmacology in children
• Adult outcome of child psychiatric disorders
• Liaison with teachers, schools, child care institutions
7.3.3. Neurology
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• Assessment and biopsychosocial management of addiction
• Specific focus on motivational interviewing and relapse prevention
• Self help groups
• Comorbidity
• Prevention strategies
• Legal issues relating to substance use
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• Liaison with legal services authority, handling mental health and
substance use in prison and other correctional settings.
7.3.8. Rehabilitation
7.0.9. Psychology
7.3.10. Psychotherapy
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• A working knowledge of group therapy and specific therapies in
different disorders
• Supervised psychotherapy employing one or more models of
psychotherapy
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Note *** The duration of specialty postings and type of posting keep in mind local constraints
and are advisable guidelines. Mandatory postings are in adult psychiatry, neurology, and child
psychiatry. In centers with specialized clinical facilities / training resources, such training may
be advanced into the first 3 months of Year III or begin in the last 3 months of Year I. In all
centers, however, it must be ensured that some form of training is provided in all the specialties.
** - where feasible, training in neurology may include one month in clinical neurology,
and 15 days each for orientation to neuroradiology and other investigations in
neurology including EEG.
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10. Common Training Program during the 3 year training
10.1. Objectives:
10.2. Modalities
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• It must be emphasized that small group activities which are learner led
are very effective ways of learning. Larger programs, while necessary,
may therefore by kept at the minimum.
10.2.2. Seminars
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10.2.4. Journal Review
This forum can also be used to review work carried out by the center.
During each semester, at least one joint conference involving allied disciplines,
either the brain science disciplines, medical disciplines or the social science
disciplines would be useful in enlarging the scope and purview of the topic. For
eg. Inviting a urologist for a discussion on managing a case of sexual dysfunction,
inviting a neurologist for a case of movement disorder, involving the psychiatric
social worker for a discussion on social case work in a homeless mentally ill
person.
The faculty and senior residents can present the research work done at the
center on a once a month basis. Clinical audits should also be periodically
presented. This would help the trainees become familiar with the work being done
at the center and learn some of the practical aspects of planning and conducting
research. It would also stimulate entrants into the post graduate course to think
about potential areas for their own dissertation.
This could occur in two ways. In large departments, trainees may be allotted
in small groups to psychotherapy supervisors, with whom they would discuss
psychotherapy cases on a weekly basis throughout the training period. In smaller
departments with fewer faculty, trainees in turn could present a psychotherapy
case for discussion by rotation, as in a case conference. Each student must
undertake a minimum of 50 hours of supervised psychotherapy. He / she should
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submit one case seen in therapy for evaluation as part of the internal assessment
in the final year.
Although the dissertation is mandated by the MCI, a lot of variability in the quality
of dissertation has been noticed and in many cases, this exercise is carried out
as a coercive exercise rather than stimulating the student’s interest in research.
The Task Force thus recommends serious rethinking about the usefulness of
the dissertation and considering other alternatives like carrying out systematic
reviews, audits, qualitative studies, formulating a proposal, and other such tasks
suitable for publication and dissemination as alternatives.
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12. Continuing Evaluation and Feedback
Objectives:
Modalities
These include monitoring of regularity in teaching programs, regular
evaluation by education and training committees and evaluation of log
books.
The trainee should maintain a work diary and record his / her participation in training
programs conducted by the department. The log book should be provided by the
department. In addition to performance in adult psychiatry posting, performance
and attendance to the specialty postings, teaching modules and departmental
programs must be assessed. The assessment must be made by the concerned
supervisor, desirably in discussion with the trainee, thus providing a feedback of
trainee’s strengths and weaknesses, and suggestions for improvement.
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The log book should be reviewed by the Head of the Department / his or her
designee at the end of each semester. The evaluation may be made out of 50
marks at the end of each semester based on the aggregate of assignments
carried out. The total out of 300 marks may be reduced to a total out of 50 and
this score be provided during the examination.
Regular feedback must be obtained from the trainees regarding adequacy, format,
and content of training. This must include clinical teaching, modular programs or
specialised topics, as well as departmental programs. Suitable modifications may
be undertaken in consultation with a larger body.
Trainees can be under significant stress during their course, both from the
professional demands of work and training, and personal stress, as well as
inadequate support. It is important to provide guidance and easily accessible
professional support.
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A system of trainee mentoring must be in place. Each trainee must be assigned
to a faculty co-ordinator/senior resident for individual supervison and precepting
throughout the course.
Trainee misconduct must be viewed seriously and each center must have
guidelines for reporting trainee misconduct.
13.1. Objective:
13.3. Theory
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Paper I Basic Sciences as related to Psychiatry* 100 marks
Paper II Clinical Psychiatry 100 marks
The traditional approach has been to have two long essay questions and six short
notes. It would be desirable to change the format to only short notes to enable a
greater coverage of topics and minimise examiner bias in topic selection. There
should be a focus on recent advances in each of the papers.
A list of potential cases must be prepared by the examination center. Case allotment
must be done in the presence and with the approval of the external examainers
to allow neutrality. Given the plurality of languages and language competencies
of the trainees and patients, this aspect must be given due consideration in case
allotment.
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Time for history taking
The trainee may be given 45 minutes for evaluation, including history taking,
mental state examination and relevant physical examination.
An additional 15 minutes may be given for the trainee to organise the presentation.
The examiners may interview the patient in this time, or ask the trainee to
elicit specific phenomena / clarify specific aspects during the viva.
Duration: 30 - 40 minutes
Case selection:
The trainee may be given 45 minutes for history taking and clinical examination
and an additional
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Viva for Neurology Case
History: 10 marks
Clinical examination: 15 marks
Diagnosis:10 marks
Management: 10 marks
Discussion:15 marks
Total: 50 marks
Duration of neurology discussion: 30 minutes (10 minutes for presentation and
20 minutes for discussion)
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iv. Final Viva
Objective: to test the trainee’s ability to interpret findings, analytical ability and
formulating ability. It is desirable that a uniform pattern is followed. It could include.
• Case vignettes
• CT/MRI films for interpretation
• EEG for interpretation
• Videos to demonstrate phenomena/clinical conditions can also be
used
• Questions on commonly used instruments in psychiatry
• Practice based questions in psychiatric subspecialities
• Recent advances
• Pass in theory
• Acceptance of dissertation/research assignment
• Pass in clinical examination
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