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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 25
| Issue : 2 | Page : 158-159 |
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The changed psychiatric teaching landscape in the times of COVID-19
Siddharth Sarkar, Nileswar Das
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| Date of Submission | 19-Jul-2020 |
| Date of Decision | 22-Jul-2020 |
| Date of Acceptance | 12-Sep-2020 |
| Date of Web Publication | 23-Feb-2021 |
Correspondence Address:
Siddharth Sarkar
Department of Psychiatry, National Drug Dependence Treatment Centre,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmhhb.jmhhb_87_20
How to cite this article:
Sarkar S, Das N. The changed psychiatric teaching landscape in the times of COVID-19. J Mental Health Hum Behav 2020;25:158-9 |
Sir,
The COVID-19 pandemic has resulted in substantial changes in the manner in which health-care services function.[1],[2] It has also resulted in changes in the processes of medical teaching in India.[3] Social distancing, quarantines, pressing needs on health care, and re-allocation of resources have led to significant alterations in the scope and pragmatics of undergraduate and postgraduate medical teaching.[4] The initial lockdown resulted in considerable disruption of the schedules of classes and teaching activities, and subsequent efforts were made to circumvent the impediment due to the pandemic and the resultant measures. We present a few important changes that we have observed in the recent past.
The first prominent change has been online classes, as social distancing was enforced and students went home. The newer paradigm was students being “mute” unless speaking to prevent cacophony and noise feedback loops. Interactions have been distant, and teachers constrained in their abilities to engage students whose attention and interest have been wavering. However, such classes have ensured that teaching goes on, and students remain stimulated to continue with their learning pursuits. For postgraduate teaching, seminars and journal clubs also are now online, with the presenter, chairperson, and audience being in different locations, but coming together for shared learning experiences. Even the discussions related to preparation of these academics by the postgraduate students have moved online to prevent the spread of infection. Online teaching through webinars (which are often free) has given the opportunity to postgraduate students to learn from experts in the field without the need to travel to attend.
The second change has been constraints in practical and bedside teaching. The “practice” of medicine requires exposure to patients, where students can spend time with patients, understand their narratives, dissect and synthesize psychopathologies, and understand reasoning about management options. Again, social distancing and the quest to reduce exposure of trainees to the coronavirus has resulted in temporary pause or decrement of such practical teaching. Meanwhile, attempts have been made to continue the experience of postings for undergraduates through case vignettes, role-plays, or simulated patients. For example, at All India Institute of Medical Sciences, New Delhi, clinical posting of the 4th/5th or 6th/8th semesters is being temporarily being conducted online, to maintain distancing and enable learning experiences for students who went to their homes. In these replacement postings, some of the teachers have conducted online role-plays by simulating themselves as patients. This may not give the clinical bedside or field experience, but at least continues some teaching experiences. However, distance from patients or not having real patients constrains the “human touch” as a part of therapeutic processes, and may lead to a lack of experiential immersive experience of clinical teaching.
The third change has been the conduct of examinations. Postgraduate exit examinations have used case vignettes and objectively structured clinical examinations for the practicum part, with even some of the external examiners examining online being in another city due to travel restrictions. Similarly, undergraduate assessments have been successfully conducted online through viva voce.
Another unresolved challenge has been the continuation of theses as a part of the postgraduate psychiatric training. The protocol of the theses would have not anticipated the emergence of the pandemic and consequent disruptions. Hence, many of the committed theses would have become untenable due to the pandemic, as research pursuits themselves suffer through challenges.[5] The possible resolutions include altering data collection procedures, altering sample sizes, and even altering the topic or protocol altogether.
The changes brought about by COVID-19 have impacted psychiatric training significantly. As pragmatic solutions have been proposed and implemented, concerns do remain about the comprehensiveness of the training. Some of the issues faced and possible solutions as teaching moves online are presented in [Table 1]. While we move from lockdown to unlock to new normal, we may need to ponder upon ways of improving training in the circumstances. Honing information-gathering skills in a limited interaction time and training in telemedicine would be important for residents. Psychiatry does offer an opportunity of using distance care or telecare more easily than many other specialties.[6] Developing rapport with masks on either side of table would need extra efforts to follow patient's verbatim and emotional cues. Expressing empathy to build a therapeutic relationship through physical distance and covered expressions in a physical consultation scenario would be a challenge. On the other hand, mentoring interviewing and therapy skills online, demonstration through role-plays, vignette discussion to enhance reasoning skills, and assessment through simulated patients are some of the methods which can enrich learning experiences. Nonetheless, as the pandemic recedes, continued upskilling of graduated medical students and residents through workshops would add value and complement the training. This would be particularly important as some of the residents would have been retrenched into COVID-19-related duties, which, while making them more adept at taking care of patients with COVID-19, are likely to take away time from their psychiatric teaching–learning experiences. The renewed focus on mental health brought about by the pandemic calls for a renewed emphasis on psychiatric training in the medical undergraduate curriculum, and implementation of more structured, comprehensive, and socially responsive psychiatric training.[7] Continuation of previous efforts for curricular enhancement and adaptation would help to update the psychiatric teaching–learning landscape for medical undergraduates, postgraduates, and super-specialists. | Table 1: Issues faced in online psychiatric teaching and possible solutions
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
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| 4. | Kishor M, Menon V, Vinay HR, Bhise MC, Isaac M, Chandran S, et al. COVID-19 pandemic highlights the need to reconsider psychiatry training of Indian medical graduate. Int J Health Allied Sci 2020;9:104-6. [Full text] |
| 5. | Sarkar S, Mishra S, Padhy SK. How COVID-19 may impact mental health research conduct, interpretation and priorities? Asian J Psychiatr 2020;54:102245. |
| 6. | Das N, Narnoli S, Kaur A, Sarkar S, Balhara YP. Attitude to telemedicine in the times of COVID-19 pandemic: Opinion of medical practitioners from India. Psychiatry Clin Neurosci 2020;74:560-62. |
| 7. | Sagar R, Sarkar S. Psychiatry as a separate subject in the undergraduate medical curriculum: The need re-emphasized. J Mental Health Hum Behav 2016;21:88-90. [Full text] |
[Table 1]
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