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Undergraduate medical education: Psychological perspectives from India

Byline: L.S.S. Manickam, T. Sathyanarayana Rao Introduction Undergraduate medical education in India in the new century is facing more challenges than ever before. Apart from the advanced technological input that came into health-care practices, the fast-changing socioeconomic cultural scenario is also posing a grave concern in the process of producing quality physicians to meet the demands of the future. Though the number of medical colleges has increased substantially to meet the health-care needs of the country, the institutions have to compete with each other to get expert medical educationists who could impart effective training. Highly lucrative jobs that are offered to an engineering or IT professional after four years of less strenuous training shake up the medical student, as well as those who are aspiring to take up the medical profession, and make them ponder whether it is worth its effort in terms of job satisfaction and remuneration. Recent introduction of changes by the policy makers, including the compulsory service in rural areas by the newly trained doctors, could pose an added stress. This is complicated by the fact that even in rural settings, the patients, as well as their relatives, have become so increasingly better informed that they tend to question the decisions and approaches of the physicians to the extent of affecting the doctor-patient relationship. In this paper we review the present curriculum in terms of the psychology component and the probable ways in which it can be effectively implemented in order to train a physician who could be facing the challenges posed, and propose to review the current selection procedure to recruit those with good aptitude for the profession. The Present Curriculum and the Learning Objectives Related to Psychology The Kacker committee, constituted by the Medical Council of India (MCI),[sup] [1] recommended to include "humanities" in the pre-clinical phase and to examine the students in it. Accepting the suggestions, the curriculum provided by MCI[sup] [2] included knowledge content and skill related to psychology, under "psychiatry" and recommended that "Training should be integrated with the departments of Medicine, Neuroanatomy, Behavioral Sciences and Forensic Medicine." At the knowledge level, it is stipulated that the student should be able to "comprehend nature and development of different aspects of normal human behavior like learning, memory, motivation, personality and intelligence" and "recognize differences between normal and abnormal behavior." At the psychomotor or skill level, the student should be able to effectively: *Interview the patient and understand different methods of communication in patient-doctor relationship. *Identify and manage psychological reactions and psychiatric disorders in medical and surgical patients in clinical practice and in community setting. However, only a small minority of institutions are strictly adhering to what has been recommended. While teaching the core academic topics of "learning, memory, motivation, personality and intelligence" in the pre-clinical years in the early 80s at the Christian Medical College, Vellore, it was observed that the students did not evince much interest in learning the theoretical concepts of general psychology, since they were not examined in the topics taught. Moreover, the students could not relate the core subjects of general psychology to the clinical practice of medicine. However, when the same topics were dealt with during their clinical posting in psychiatry, there was more interest in learning about the different psychological tests that assessed the cognitive functions and their usefulness in diagnosing in different types of disorders, including mental retardation and dementia. Therefore, in order to achieve the learning objective of the curriculum, the psychology topics may have to be shifted to the clinical years, along with psychiatry, and may be duly examined. …