|Year : 2012 | Volume
| Issue : 2 | Page : 144-147
Does psychiatry rotation in undergraduate curriculum bring about a change in the attitude of medical student toward concept and practice of psychiatry: A comparative analysis
Raaj Konwar1, PK Pardal1, Jyoti Prakash2, Rythem1
1 Department of Psychiatry, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India
2 Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Web Publication||9-Oct-2013|
Department of Psychiatry, Armed Forces Medical College, Pune-411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: To assess the attitude of MBBS student toward concept and practice of psychiatry between groups of students exposed to psychiatry rotation versus those not yet exposed to. Materials and Methods: A cross-sectional analytical study was carried out. Anonymity and confidentiality of the respondent was emphasized. Attitude was measured with 30-item "attitude toward psychiatry" scale. Results: Attitude toward psychiatry was found to be better in groups of medical students exposed to 2 weeks clinical rotation in psychiatry . However, the same reached statistical significance in only 36.7% of the questions. Conclusion: Clinical rotation in Psychiatry in undergraduate has a favorable effect on the attitude of medical students toward concept and practice of psychiatry. Better curriculum and more hours in psychiatry may yield better gain.
Keywords: Attitude, education, medical, psychiatry
|How to cite this article:|
Konwar R, Pardal P K, Prakash J, Rythem. Does psychiatry rotation in undergraduate curriculum bring about a change in the attitude of medical student toward concept and practice of psychiatry: A comparative analysis. Ind Psychiatry J 2012;21:144-7
|How to cite this URL:|
Konwar R, Pardal P K, Prakash J, Rythem. Does psychiatry rotation in undergraduate curriculum bring about a change in the attitude of medical student toward concept and practice of psychiatry: A comparative analysis. Ind Psychiatry J [serial online] 2012 [cited 2020 Jul 11];21:144-7. Available from: http://www.industrialpsychiatry.org/text.asp?2012/21/2/144/119630
Psychiatry disorders are becoming more prominent and frequent over the years. According to a World Health Organization report, neuropsychiatric disorders alone contributes to 33% of the years lived with disability (YLD) and four of the six leading causes are neuropsychiatric. (depression, alcohol use disorder, schizophrenia and bipolar disorder).  Various studies have shown that up to 30-50% of the patients seen by general physician in hospital and primary health-center either have a primary or co-existing psychiatric condition.  In India, the prevalence of serious mental illness is 6.5%, which is roughly estimated to be 71 million people but the country still lacks personnel trained in mental-health to cater to such a large population of the mentally ill. Literature suggests the deficit to be 77.66% compared to ideal number of 1 per 100,000 populations. , As a result of this, caring of these mentally-ill patients is mostly ignored or rests primarily with the general practitioner. Psychiatry remains a stigmatized subject. Few students take up the subject as a specialty. Medical students, being member of a large community, may also have negative prejudice about mental illness.  The stigma may be due to poor knowledge about the psychiatric science or rare interaction with the patient with mental illness. It is important that the students develop appropriate attitude toward psychiatry as a medical discipline,  because graduating as doctors with negative attitude toward psychiatry has far reaching consequences. The integration of psychiatry in the curriculum has been found to have a significant effect of positive nature on the attitude of students toward the practice of psychiatry and the patients. Studies have suggested better clinical experience in psychiatry has been most influential in changing the attitude of these students. Specific factors that have been found to be important are the experience of direct involvement in care of patients, watching patients responding favorably to the treatment and the student having a satisfactory interaction with staff and patients at psychiatric center. However, there is absence of any direct evidence suggesting the link between these specific components of psychiatry attachments to improved attitudes.  Does present training in psychiatry impact a change in attitude in our medical students toward the concept and practice of psychiatry? Does it equip our undergraduate students better to identify and understand psychiatric patients? With this background and queries we conducted this study to understand the impact of 2 week psychiatry rotation; which is conducted in accordance with Medical Council of India guidelines; on the attitude of medical undergraduate students toward the concept and practice of psychiatry.
| Materials and Methods|| |
A cross-sectional analytical study was conducted. Fourth year medical undergraduate students pursuing their education at an established medical institution were selected for the study. The study group A consisted of students who had already undergone a 2 week clinical rotation in psychiatry and the study group B consisted of those who are yet to undergo the rotation. The psychiatry rotation included exposure to psychiatry ward and patients, assisting in in-patient care, counseling of the caregiver and evaluating outcome of the management. We distributed questionnaires to all consenting students. Anonymity and confidentiality was emphasized to overcome the possible tendency of the students to give answers perceived as acceptable to the investigator rather than the respondent's true opinion. It was explained that their response would not have influence on their grade or examination. To avoid peer group influence, students were barred to discuss their statements among themselves. Attitude to psychiatry (ATP) was measured using the 30-item ATP (ATP-30) scale.  The scale measures attitude using a 5-point Likert scale with questions about ATP patients, psychiatrists, psychiatric institute, teaching, knowledge, and carrier choice. The difference of the scores was interpreted question wise in the light of available literature between students those exposed to rotation in psychiatry versus those not exposed. It generates a global score of 30-150. A score of more than 90 indicates a good ATP. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 17.0.
| Results|| |
Total numbers of respondent were 119. Of these, nine were excluded for giving multiple or incomplete responses. Of the remaining 110 included in the study, 41 (37.27%) were males and 69 (62.72%) were females. There was no difference in ATP score between male and female students (mean ATP male = 82; female ATP = 83, P > 0.05). The age distribution ranged from 17 to 28 years. 41 (37%) students had completed their clinical rotation in psychiatry while 69 (63%) had not completed their clinical posting in psychiatry. [Table 1] shows better attitude in exposed group toward psychiatry and mental illness. Difference was statistically significant in 5 out of 11 questions. [Table 2] shows better attitude in exposed group toward psychiatric patients and treatments. [Table 3] records better attitude in exposed group toward psychiatrists and psychiatric institution and [Table 4] shows better attitude in those exposed toward psychiatric teaching and psychiatry as a career. Though, the difference was statistically significant in only 11 questions out of total of 30 questions (36.7%); better attitude was noted across the board in all the other questions.
|Table 1: Attitude to psychiatry and mental illness (attitude to psychiatry 30)|
Click here to view
|Table 3: Attitude to psychiatrist and institution (attitude to psychiatry 30)|
Click here to view
|Table 4: Attitude to psychiatric teaching and as carrier (attitude to psychiatry 30)|
Click here to view
| Discussion|| |
Our study found better attitude toward psychiatry in students who were exposed to 2 weeks clinical rotation in psychiatry. Though, there was better attitude in those exposed in all the 30 ATP questions; the same was not statistically significant in 63.3% of the questions. Tharyan et al.  in his study also found out that the psychiatric rotation did bring change in attitude. The change in attitude was statistically significant in more than 45.4% of questions in scale dealing with psychiatry and mental illness [Table 1]. However, statistical improvement did lag behind in questions dealing with psychiatric patients and treatment; psychiatrist and institution and psychiatric teaching and career [Table 2],[Table 3] and [Table 4]. This stresses the requirement of further exposure of students to psychiatric patients and nature of treatments. This also emphasizes the importance of psychiatrist to be a role model, easily approachable and socially responsible to tackle with the negative attitude involving the psychiatrists and the psychiatric institution. Attitude toward psychiatric teaching and career will further enhance with more structured curriculum, increased number of classes in psychiatry, better research in the biological underpinnings of the various aspects of psychiatry, and formal guideline toward the practice of psychiatry. McParland et al. found out that the change in attitude and career intentions were dependent on the actions of the teachers. 
Acknowledging the fact that India faces shortage of mental-health professionals; mental-health care in India is far below desired. , Psychiatrists are less and located mostly in cities, while majority of the India reside in rural areas. Hence, the onus of mental-health-care of a large population lies with the general practitioners. A negative attitude to psychiatry among the undergraduates eventually will affect the quality of mental-health-care provided at the primary health-center. It is time to review the present curriculum, which somehow does not succeed enough to bring about adequate positive attitude toward psychiatry among the undergraduate MBBS students. Studies have shown that a 4 week attachment in psychiatry improves attitude toward psychiatry , but not 2 weeks,  which is in practice as per Medical Council of India. Further study with larger sample will help in reaching more definitive conclusion.
| Conclusion|| |
The study has found that psychiatry rotation during undergraduate training has in general a favorable effect on the medical student's attitude toward the concept and practice of psychiatry. More exposure to psychiatry is required to have a robust and significantly positive change in the attitude of the medical students toward this subject.
| References|| |
|1.||Investing in Mental Health. Department of Mental Health and Substance Dependence, Noncommunicable disease and Mental Health. World Helath Organization. Geneva. 2003. p. 8. |
|2.||Murthy RS, Kuruvilla K, Verghese A, Pulimood BM. Psychiatric illness at general hospital medical clinic. J Indian Med Assoc 1976;66:6-8 |
|3.||Thirunavukarasu M, Thirunavukarasu P. Training in psychiatry. Indian J Psychiatry 2010;52:S30-5 |
|4.||NCMH Background paper. Burden of disease in India. National Commission of Macroeconomics and Health, Ministry of Health and Welfare, Government of India, New Delhi, 2005. |
|5.||Murthy RS, Khandelwal S. Undergraduate training in Psychiatry: World perspective. Indian J Psychiatry 2007;49:169-74. |
|6.||Issa BA, Adegunloye OA, Yussuf AD, Oyewole OA, Fatoye FO. Attitude of medical students to psychiatry at a Nigerian medical school. Hong Kong J Psychiatry 2009;19:72-7. |
|7.||McParland M, Noble LM, Livingston G, McManus C. The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career. Med Educ 2003;37:447-54. |
|8.||Burra P, Kalin R, Leichner P, Waldron JJ, Handforth JR, Jarrett FJ, et al. The ATP 30 - A scale for measuring medical students' attitudes to psychiatry. Med Educ 1982;16:31-8. |
|9.||Tharyan P, John T, Tharyan A, Braganza D. Attitudes of 'tomorrow's doctors' towards psychiatry and mental illness. Natl Med J India 2001;14:355-9. |
|10.||Tharyan A, Datta S, Kuruvilla K. Undergraduate training in psychiatry an evaluation. Indian J Psychiatry 1992;34:370-2. |
|11.||Rajagopalan M, Kuruvilla K. Medical students' attitude to psychiatry: The effect of a four weeks posting. Indian J Soc Psychiatry 1987;3:238-59. |
|12.||Rajagopalan M, Kuruvilla K. Medical students' attitudes towards psychiatry: Effect of a two week posting. Indian J Psychiatry 1994;36:177-82. |
[Table 1], [Table 2], [Table 3], [Table 4]