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REVIEW ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 3  |  Page : 242-245

Prioritizing training of undergraduate medical students in mental health competencies


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission27-May-2021
Date of Acceptance14-Sep-2021
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE), Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_62_21

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  Abstract 


Mental health has been acknowledged an integral component of maintenance of optimal health of individuals and communities. The purpose of the current review was to explore the teaching practices for mental health competencies and strengthen the same in undergraduate teaching period. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 19 articles were selected based on their suitability with the current review objectives. Amid the shortage of trained psychiatrists, it becomes an indispensable need that undergraduate medical students are trained in specific competencies in the subject so that they are empowered to manage basic psychiatric illnesses, especially at the primary level of health care. If we can train our medical undergraduate students, it will turn out to be the most cost-effective and feasible approach to meet the needs of the rural and remote sections of the society. As the imparted mental health training is grossly inadequate or incomplete, it is a must that we take specific steps to improve the existing scenario. In conclusion, psychiatry is an essential and integral component of medical training in the undergraduation period. However, the subject lacks the desired attention under the present circumstances, and thus there is an indispensable need to improve the training and assessment of psychiatric competencies so that students become competent in discharging their future clinical roles.

Keywords: Mental health, psychiatry, undergraduate medical education


How to cite this article:
Shrivastava SR, Shrivastava PS. Prioritizing training of undergraduate medical students in mental health competencies. J Sci Soc 2022;49:242-5

How to cite this URL:
Shrivastava SR, Shrivastava PS. Prioritizing training of undergraduate medical students in mental health competencies. J Sci Soc [serial online] 2022 [cited 2023 Jan 31];49:242-5. Available from: https://www.jscisociety.com/text.asp?2022/49/3/242/365175




  Introduction Top


Mental health has been acknowledged an integral component of maintenance of optimal health of individuals and communities, as it significantly impacts the ability to function, remain productive, and foster congenial association with different people.[1] However, it is a fact that the prevalence of mental disorders continues to rise, which, in turn, accounts for a remarkable impact on health status, realization of fundamental rights, and the financial growth of the nation as a whole.[1] For instance, depression has been reported among more than 264 million people worldwide.[1] Moreover, mental illnesses augment the risk for acquisition of infectious and lifestyle disorders and significantly contributes toward disability and impairment in the quality of life of the patients.[2] The purpose of the current review was to explore the teaching practices for mental health competencies and strengthen the same in undergraduate teaching period.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Relevant research articles focusing on undergraduate medical education and psychiatry/mental health published in the period 2004–2020 were included in the review. A total of 21 studies similar to current study objectives were identified initially, of which 2 were excluded due to the unavailability of the complete version of the articles. Overall, 19 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include undergraduate medical education, psychiatry, medical education, and mental health in the title alone only (namely, mental health [ti]; mental health [ti] AND undergraduate medical education [ti]; mental health [ti] AND medical education [ti]; psychiatry [ti] AND medical education [ti]). Articles published only in the English language were included for the review [Figure 1]. The collected information is presented under the following subheadings, namely Ground reality, teaching psychiatry to medical undergraduates: The need, anticipated outcomes of imparted training, Global pattern and recommendations, Mental health competencies required for undergraduates, Way Forward, Implications for practice, and Implications for research.
Figure 1: Flowchart for selection of studies

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Ground reality

As a matter of fact, we cannot rule out the possibility of underestimated evidence of these illnesses, as they often go unreported, either due to lack of awareness or failure to diagnose the illness owing to the shortage of trained mental health-care personnel.[3] In addition, we must remember that there is a significant unmet need for mental health care in the society as most of the specialists are working in the private sector.[4],[5] At the same time, even if the services are available, there is poor utilization owing to the lack of awareness or the stigma attributed to mental illnesses.[3],[6] The number of postgraduate mental health specialists produced each year is quite less and no way they can bridge the existing disparities in the number of specialists per total population they are supposed to cater.[2],[3],[7],[8]

Teaching psychiatry to medical undergraduates: The need

Amid the shortage of trained psychiatrists, it becomes an indispensable need that undergraduate medical students are trained in specific competencies in the subject so that they are empowered to manage basic psychiatric illnesses, especially at the primary level of health care.[3],[8],[9],[10],[11] The medical undergraduates who are not trained in psychiatry-related domains either fail to diagnose the existing condition or inappropriately manage the patient or are very much shorter in confidence to take decisions.[9],[10] Inability to demonstrate clinical competence significantly impacts their performance in their clinical practice.[12],[13] Further, we must realize that regardless of the stream in which a doctor is working, it is not unusual to find patients with mental conditions, and thus, we should be ready to address their needs.[8],[14]

In addition, training on the basic psychiatric conditions and behaviors will help the medical students to effectively function as a leader and member of the health-care team in the future.[3] These acquired traits will also help the doctors in establishing and maintaining a healthy relationship with patients and identification of the issues, which the patient might not be comfortable to open up easily.[3],[4],[14] If we fail to train the undergraduate medical students in psychiatric competencies, we do not do justice to our global vision which is to attain universal health coverage and meet the targets set under the Sustainable Development Goals.[1],[2],[12],[15] Further, we will fail to preserve the available scarce resources, and directly, the delayed management of these illnesses will result in a massive burden on the health-care delivery system.[2],[5]

Anticipated outcomes of imparted training

If we can train our medical undergraduate students, it will turn out to be the most cost-effective and feasible approach to meet the needs of the rural and remote sections of the society.[3],[9],[11],[16] These trained professionals will act as the bridging factor in improving the access, quality of the offered services, and the overall outcome of the mental illnesses by minimizing the suffering attributed to these conditions.[8],[14],[16] Further, the training offered will instill humanistic values in them, which will improve their competence levels in empathizing with their patients within their social contexts, and thereby enables the medical students to effectively communicate and respond to the needs in a professional manner.[3],[8],[14]

Global pattern and recommendations

In the medical training imparted to the undergraduate students in nations such as the United States of America, Denmark, and the United Kingdom, psychiatry as a specialty has been given immense importance.[2] In fact, specific norms have been set with regard to the number of teaching hours within the entire curriculum, and to ensure that the learning has taken place, in most of these nations, a specific qualifying exam is also being conducted. Even in nations such as Sri Lanka and Nepal, it is expected that medical undergraduate students should clear the psychiatry summative examination to become eligible to get their final degree.[2] Amid all the recent developments in terms of the trend of mental illnesses and the fact that many people have started to voice out their views on the very much existence of mental illnesses, psychiatry has become an integral component of the medical curriculum.[2],[3],[8]

Mental health competencies required for undergraduates

As the imparted mental health training is grossly inadequate or incomplete, it is a must that we take specific steps to improve the existing scenario.[3],[8] This has to start with the formulation of specific competencies to which a student should be exposed during the medical training period. A set of learning areas has been identified, including ability to identify clinical features of common psychiatric conditions, understanding about the nature and development of normal human behaviors, and ascertaining developmental delays.[2] In addition, the students should be exposed to recognize the interaction between physical and psychological attributes, the common drugs to be used in the management of psychiatric illnesses, and counseling skills to comfort patients or their relatives.[2],[3]

Further, the students should be sensitized about legislative and educational provisions pertaining to psychiatric illnesses. Moreover, they should be able to develop a helping and humanistic approach toward the psychological and behavioral concerns of the patients.[3],[14] Finally, the training should prepare the medical undergraduate students to effectively discharge mental health services at the primary level of health care.[2],[3],[8],[17] A thorough curriculum mapping should be done to identify which competencies will be when (namely theory sessions, clinical postings session, electives, and internship), teaching–learning method (including simulation-based teaching) to be employed, and the assessment method to be employed to assess the learning progression.[11],[13],[14],[18],[19]

Way forward

In the process to impart training and assessment of medical undergraduate students with regard to psychiatric competencies, a lot of work needs to be done. This has to start with strengthening the number of teaching faculty in the psychiatry department so that they can impart the desired training. It is quite essential that research is encouraged in the field to precisely estimate the magnitude of different mental illnesses, which will also act as evidence for helping the policymakers and regulatory body to take evidence-based decisions.[2],[3] Further, the undergraduate students have to be sensitized about the scope and utility of psychiatry as a discipline and the ways in which the subject can make them better and competent in their clinical practice.[3]

To make the learning experience enriching, interesting cases can be shown to the students and a wide range of educational methods including cinema education can be employed.[14],[20] Efforts should be taken to merge psychiatry with other clinical specialties so that students can understand the dynamics of psychiatric illness in the causation or aggravation of other medical ailments.[2],[3] Further, students should be trained in soft skills (namely stress management, time management, and communication skills), which plays an important role in enhancing professional growth. Finally, students should be assessed using standard assessment methods in an objective manner and they should be given appropriate feedback to make them understand about the areas that need improvement.[2],[3],[8]

Implications for practice

The faculty members of the department of psychiatry, in association with the members of the curriculum committee and the medical education unit, should aim to perform thorough curriculum mapping. The idea is to effectively cover all the specified competencies across the entire duration of medical training, instead of targeting them only in the final professional year. There is a definite need for support from the administration to ensure that the planned training can be done effectively. Further, the teachers should look to employ standardized patients, case conferences, online modules, etc., as a learning as well as an assessment tool while imparting training.

Implications for research

Research will be the backbone for implementing various curricular innovations in the field of psychiatry in undergraduate medical education. The first priority of research can be an estimation of the prevalence or incidence of various mental illnesses so that we can create adequate evidence about the need that psychiatry needs to be given due importance. In addition, it will be an encouraging step to assess the comfort and skills of medical students who are trained in various psychiatric domains while dealing with patients with mental illnesses. There is a definite scope to evaluate the overall program so that specific modifications can be made based on the feedback received from the different stakeholders.


  Conclusion Top


Psychiatry is an essential and integral component of medical training in the undergraduation period. However, the subject lacks the desired attention under the present circumstances, and thus, there is an indispensable need to improve the training and assessment of psychiatric competencies so that students become competent in discharging their future clinical role.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Mental Disorders – Key Facts; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/mental-disorders. [Last accessed on 2021 Jul 26].  Back to cited text no. 1
    
2.
Kallivayalil RA. The importance of psychiatry in undergraduate medical education in India. Indian J Psychiatry 2012;54:208-16.  Back to cited text no. 2
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3.
Ghodse H. Psychiatry for tomorrow's doctors: Undergraduate medical education. Int Psychiatry 2004;1:1-2.  Back to cited text no. 3
    
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Sinha SK, Kaur J. Need to increase psychiatry training in graduate medical education. Indian J Psychiatry 2013;55:206-7.  Back to cited text no. 4
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Bandeira ID, Mendoza J. Medical education and leadership: A call to action for Brazil's mental health system. Int J Med Educ 2018;9:170-2.  Back to cited text no. 5
    
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Bynum WE 4th, Sukhera J. Perfectionism, power, and process: What we must address to dismantle mental health stigma in medical education. Acad Med 2021;96:621-3.  Back to cited text no. 6
    
7.
Ballester DA, Filippon AP, Braga C, Andreoli SB. The general practitioner and mental health problems: Challenges and strategies for medical education. Sao Paulo Med J 2005;123:72-6.  Back to cited text no. 7
    
8.
Sood M, Sharan P. A pragmatic approach to integrating mental health in undergraduate training: The AIIMS experience and work in progress. Natl Med J India 2011;24:108-10.  Back to cited text no. 8
    
9.
Flajsman AM, Degmecic D, Pranjkovic T, Rogulja S, Bošnjak D, Kuzman MR. Medical education changes students' attitudes on psychiatry: Survey among medical students in Croatia. Psychiatr Danub 2017;29 Suppl 4:859-65.  Back to cited text no. 9
    
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Hofmann M, Harendza S, Meyer J, Drabik A, Reimer J, Kuhnigk O. Effect of medical education on students' attitudes toward psychiatry and individuals with mental disorders. Acad Psychiatry 2013;37:380-4.  Back to cited text no. 10
    
11.
Wilkins KM, Wagenaar D, Brooks WB. Emerging trends in undergraduate medical education: Implications for geriatric psychiatry. Am J Geriatr Psychiatry 2018;26:610-3.  Back to cited text no. 11
    
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Sethi S, Kataria D, Srivastava V. Competency-based medical education: Relevance to psychiatry. Indian J Psychiatry 2021;63:189-91.  Back to cited text no. 12
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Fage B, Abadir AM, Boyle M, Fefergrad M, La Croix E, Poynter B, et al. Competency-based medical education: Objectives for a foundational emergency psychiatry experience. Acad Psychiatry 2018;42:519-22.  Back to cited text no. 13
    
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Joshi A, Haidet P. Time for a change? How rethinking delivery of undergraduate medical education in psychiatry may add value to healthcare systems. Acad Psychiatry 2018;42:552-4.  Back to cited text no. 14
    
15.
Mullins D, Jabbar F, Fenlon N, Murphy KC. The digital age: Is this the future of medical education? A cross-sectional study to assess medical students' opinions about e-learning in psychiatry undergraduate medical education. Ir J Psychol Med 2014;31:89-96.  Back to cited text no. 15
    
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Dale JT, Bhavsar V, Bhugra D. Undergraduate medical education of psychiatry in the west. Indian J Psychiatry 2007;49:166-8.  Back to cited text no. 16
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Sawyer MG, Giesen F, Walter G. Child psychiatry curricula in undergraduate medical education. J Am Acad Child Adolesc Psychiatry 2008;47:139-47.  Back to cited text no. 17
    
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Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation training in psychiatry for medical education: A review. Front Psychiatry 2021;12:658967.  Back to cited text no. 18
    
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Coggins A, Marchant D, Bartels J, Cliff B, Warburton S, Murphy M, et al. Simulation-based medical education can be used to improve the mental health competency of emergency physicians. Australas Psychiatry 2020;28:354-8.  Back to cited text no. 19
    
20.
Kuhnigk O, Schreiner J, Reimer J, Emami R, Naber D, Harendza S. Cinemeducation in psychiatry: A seminar in undergraduate medical education combining a movie, lecture, and patient interview. Acad Psychiatry 2012;36:205-10.  Back to cited text no. 20
    


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