When we were students,
we had to learn medicine, surgery, obstetrics and gynecology, ophthalmology, ear-nose-throat
diseases, orthopediacs and paediatrics as separate clinical subjects. Psychiatry
was dealt with in 1-2 lectures, 15 days in the second year and about 15 days of
posting in internship. The medicine paper was supposed to have a question on
Psychiatry which was usually a short note on one of five favourite topics (which
unfortunately did not include depression).
This was 15 years ago.
Now when I meet my classmates, irrespective of speciality or area of practice
or even if some of them have switched their professions- all my classmates rue
the lack of special training in Psychiatry. Most of my non- psychiatry
colleagues have told me how a significant portion of their practice is actually
psychological intervention or psychiatric treatment. One family physician joked
to me that he will have very minimal practice left if he begins to refer
patients with psychological problems to Psychiatrists instead of treating them
himself! Considering all these experiences, it is very clear that a special
training in Psychology and Psychiatry would have been indispensible.
All things cannot be
covered in undergraduate medical education because of the vast and changing
nature of medical science. Invariably, some amount of learning happens on the
job when the doctor actually settles down to start work. So some authorities
have argued that psychology and psychiatry will be ‘automatically’ learned by
doctors when they need it. So we see a good attendance at CME programs of
medical associations when the topics are related to psychiatry. But what about
clinical skills? CME programes are only lectures and I don’t know how doctors
will learn the clinical skills of mental health care.
Unless the MCI mandates
that clinical skills have to be learned, the students will not be able to do so
during MBBS. After MBBS, even if they want to pick up these skills, who will
teach them? Technical knowledge in psychiatry can be picked up in the CMEs but
clinical skills have to be learnt during undergraduate clinical training only. So
our MCI should include testing of clinical skills in psychiatry and psychology
during exams. Then there is a higher probability that students will imbibe
these skills. Leaving market forces to create motivation for this learning is
not the right approach. I hope the MCI will oblige.
