ORIGINAL ARTICLE
Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry Prannay Gulati, Subhash Das, B. S. Chavan
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
ABSTRACT
Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross‑sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire‑12 (GHQ‑12), opinion about mental illness (OMI) scale, and attitude to psychiatry‑29 (ATP‑29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi‑square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry. Key words: Attitude, interns, mental illness, psychiatry, undergraduate students
INTRODUCTION The World Health Organization reported in 2001 that about 450 million people worldwide suffer from some form of mental disorder or brain condition, and that one in four persons meet criteria for mental disorder at some point in their life.[1] Opinion about mental illness (OMI) plays a vital role in long‑term care of patients with mental illness. Stigmatizing attitudes toward people with mental illness are widespread and people tend to react in a very discriminating way toward those with mental illness.[2‑7] Address for correspondence: Dr. B. S. Chavan, Head of Department, Department of Psychiatry, Government Medical College and Hospital, Sector 32, Chandigarh, India. E‑mail: [email protected]
How to cite this article: Gulati P, Das S, Chavan BS. Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry. Indian J Psychiatry 2014;56:271-7.
Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
The treatment gap that exists in treating the persons with mental illness, due to an inadequate number of mental health professionals, especially psychiatrists, can be narrowed if the newly trained doctors have the acumen to spot those having a mental illness.[8] The knowledge and the attitude of the undergraduate medical students toward mental health and psychiatric disorders is of great importance as these individuals are going to be involved in the care of these patients either directly or indirectly during the course of their careers. Studies carried out to find out undergraduate medical students’ OMI and their Access this article online Quick Response Code Website: www.indianjpsychiatry.org
DOI: 10.4103/0019-5545.140640
271
Gulati, et al.: Impact of psychiatry training
knowledge toward psychiatry have shown ignorance about scientific facts related to psychiatry, psychiatric patients, and treatment methods.[9,10] Medical graduates considered psychiatry to be imprecise, and unscientific and had unfavorable attitude toward considering psychiatry as a career option.[11] However, providing clinical training in psychiatry during undergraduation seems to improve the attitude toward people with mental illness.[12‑15] However, psychiatry as a subject has not been given its due importance at the undergraduate level, which is reflected in the number of theory lectures and hours of psychiatry clinical posting.[8] Until recently, even during the internship posting, psychiatry used to be an optional subject as compared to compulsory posting in surgery, medicine, gynecology, among other branches.[8] Medical Council of India (MCI) had recently suggested to increase the number of hours for psychiatry into the curriculum of psychiatry for undergraduate MBBS course, but until date, only decision regarding internship has been implemented.[8] There have been few studies in the past, all of which have assessed attitude of undergraduates toward mental illness/ mentally ill or psychiatry separately, except one study from South India by Lingeswaran, which assessed both of these in a single study.[11] However, these studies have many limitations. First, these studies were carried out when psychiatry posting during internship was still optional, so the exposure to psychiatry could have been different amongst participants limiting their comparison. Second, presence of mental illness among the participants or their relatives was not ruled out, which would have an impact on their attitudes. Hence, the current study was planned to assess and compare the attitude of medical students and interns in a medical college toward mental illness and toward psychiatry. The author also attempted to assess the impact of psychiatric training on their attitude toward the mentally ill person and mental illness. SUBJECTS AND METHODS This was a cross‑sectional, single assessment study conducted at a tertiary hospital in North India. The participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry as per MBBS curriculum, and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Data were collected between June 2012 and November 2012. Students of 1st and 2nd year MBBS were approached as a group in their respective lecture theaters, whereas interns were approached individually on the last day of their psychiatry posting. After explaining them the aim of the study and obtaining their informed consent, participating students and interns were individually administered sociodemographic performa, General Health 272
Questionnaire (GHQ‑12),[16] OMI scale,[17] and attitude to psychiatry‑29 (ATP‑29) scale.[18] Names and roll numbers of the participants were omitted from the proforma to maintain the confidentiality. Inclusion criteria • 1st and 2nd year students of MBBS course • Interns who have completed their psychiatry posting as per curriculum. Exclusion criteria • Students and interns having first or second degree relatives with current psychiatric disorder • Students and intern undergoing treatment for mental health problems. • Students and interns whose first or second degree relative were psychiatrist • Students and interns who refused to participate. Tools • Demographic data was collected using a standard proforma being used routinely in the department and contained details such as age, gender, and socioeconomic status • Each subject was administered the following scales. • GHQ‑12:[16] Score >15 was taken as an evidence of distress and score >20 suggested severe problems and psychological distress • OMI scale:[17] The OMI scale investigates attitudes toward mental illness and consists of 51 items, in Likert format, with six alternative answers ranging from strongly agree to strongly disagree. Items define five factors, that is: Authoritarianism (A), benevolence (B), mental hygiene ideology (C), social restrictiveness (D), and interpersonal etiology (E) • ATP‑29 scale:[18] This scale measures attitudes using a four‑point Likert type self‑rated scale, with questions about attitude to psychiatric patients, illness and treatment, psychiatrists, psychiatric institutions, teaching, knowledge, and career choice. Statistical analysis Standard descriptive statistics (mean, percentage) were used to analyze the characteristics of participants. The differences between the students and interns were assessed using Chi‑square test. RESULTS In total, 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Of the 100 students in 1st and 2nd year, five students could not be approached due to their absence from classes on medical ground. All interns who had Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
Gulati, et al.: Impact of psychiatry training
completed their psychiatry posting participated in the study. The percentage of male and female in each batch of students was: 1st year (male 48%, female 52%); 2nd year (male 28%, female 72%) and interns (male 52%, female 48%). The socioeconomic status was mostly upper middle class (102) and upper class (33) [Table 1].
between interns and other students were observed for certain items [Table 5]. DISCUSSION The present study was carried out in a Medical College in North India to assess the impact of psychiatry training on attitude of medical students and interns toward mental illness and psychiatry. Physical and psychological well‑being of the participants was also assessed using standardized questionnaires. Students of 1st and 2nd year, who didn’t have any exposure to psychiatry as yet, and interns who had completed their psychiatry posting were included in the study. In addition to internship posting, interns were supposed to attend 20 theory lectures during their 6th semester of MBBS as part of the curriculum. However, after checking the department attendance register, it was found that only 5% (2 out of 40) of the interns had attended 50% or more of theory lectures. The study highlights the fact that the majority of the students do not attend psychiatry theory lectures as the attendance in psychiatry classes is not mandatory and there is no separate examination in psychiatry. The findings support the long pending demand of making psychiatry an independent examination subject. Alternatively, if attendance in the subject of psychiatry is made compulsory like in other major subjects and more weightage is given to theory and practical examination in psychiatry as part of medicine examination, the students may be more attentive and have a better understanding of the subject.
The mean GHQ score was 14.03 for the entire sample. The group scores were as follows: 1st year (11.7), 2nd year (12.8), and interns (16.2). None of the participant had score >20, which ruled out any severe psychological problems in the study sample. 30 interns had a score of >15 when compared to 1 and 2 in 1st and 2nd year students, respectively. Responses obtained on OMI scale were modified to agreed or disagreed to improve statistical significance to responses. No statistical differences were found between 1st and 2nd year students. Statistically significant differences between interns and other students were found on certain items [Tables 2‑4]. Some of the items, pertaining to exposure to psychiatry during MBBS curriculum, were not applicable to 1st and 2nd year students and they were omitted from the analysis. No difference between 1st and 2nd year students was statistically significant. Statistically significant differences Table 1: Demographic data n Mean age (in years) Sex distribution (male:female) In percentage (male:female) Socioeconomic status Upper middle Upper
1st year
2nd year
Interns
48 18.3 23:25 48:52
47 19.5 13:34 28:72
40 23.1 21:19 52:48
36 12
35 12
31 9
The GHQ scores revealed better scores for 1st and 2nd year students than that of interns, indicating deterioration of psychological well‑being with progression of MBBS course. None of the participant had score >20, which ruled out severe psychological and physical problems in the study sample.
Table 2: Items reflecting positive attitude of both students and interns (OMI scale) Item Anyone who tries to better himself deserves the respect of others If our hospitals had enough well‑trained doctors, nurses, and aides, many of the patients would get well enough to live outside the hospital The best way to handle patients in mental hospitals is to keep them behind locked doors The patients in mental hospitals should be allowed more privacy If a patient in a mental hospital attacks someone, he should be punished so he doesn’t do it again People (both veterans and nonveterans) who are unable to work because of mental illness should receive money for living expenses Regardless of how you look at it, patients with severe mental illness are no longer really human Our mental hospitals should be organized in a way that makes the patient feel as much as possible like he is living at home All patients in mental hospitals should be prevented from having children by a painless operation
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
75 75
25 25
80.8 78.7
19.2 21.3
67.5 70
32.5 30
35.4
64.6
34
66
25
75
54.2 43.7
45.8 56.3
61.7 36.2
38.3 63.8
70 27.5
30 72.5
62.5
37.5
72.3
27.7
82.5
17.5
33.3
66.7
38.3
61.7
30
70
79.2
20.8
78.7
21.3
82.5
17.5
35.4
64.6
40.4
59.6
27.5
72.5
OMI – Opinion about mental illness
Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
273
Gulati, et al.: Impact of psychiatry training
Table 3: Items reflecting negative attitude of both students and interns (OMI scale) Item
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
72.9
27.1
74.4
25.6
72.5
27.5
70.8 54.2
29.2 45.8
70.2 61.7
29.8 28.3
75 65
25 35
37.5
62.5
42.5
57.5
30
70
66.7
33.3
63.8
36.2
65
35
68.7
31.3
74.4
25.6
65
35
33.3 68.7
66.7 31.3
48.9 59.6
51.1 40.4
32.5 65
67.5 35
62.5
37.5
68.1
31.9
60
40
60.4
39.6
65.9
34.1
62.5
37.5
Although some mental patients seem all right, it is dangerous to forget for a moment that they are mentally ill Most patients in mental hospitals don’t care how they look The mental illness of many people is caused by the separation or divorce of their parents during childhood Many mental patients are capable of skilled labor, even though in some ways they are very disturbed mentally People who have been patients in a mental hospital will never be their old selves again A heart patient has just one thing wrong with him, while a mentally ill person is completely different from other patients Patients in mental hospitals are in many ways like children There is something about mental patients that makes it easy to tell them from normal people People who are mentally ill let their emotions control them: Normal people think things out It is easy to recognize someone who once had a serious mental illness OMI – Opinion about mental illness
Table 4: Items reflecting difference in attitude between students and interns (OMI scale) Item Mental illness is an illness like any other Most patients in mental hospitals are not dangerous Although patients discharged from mental hospitals may seem all right, they should not be allowed to marry Even though patients in mental hospitals behave in funny ways, it is wrong to laugh about them Most mental patients are willing to work The small children of patients in mental hospitals should not be allowed to visit them People with mental illness should never be treated in the same hospital with people with physical illness A woman would be foolish to marry a man who had a severe mental illness, even though he seems fully recovered If the children of mentally ill parents were raised by normal parents, they would not become mentally ill Our mental hospitals seem more like prisons than like places where mentally ill people can be cared for If the children of normal parents were raised by mentally ill parents, they would probably become mentally ill Every mental hospital should be surrounded with a high fence and guards Sometimes mental illness is punishment for bad deeds One of the main causes of mental illness is a lack of moral strength or will power There is little that can be done for patients in a mental hospital except to see that they are comfortable and well‑fed Many mental patients would remain in the hospital until they were well, even if the doors were unlocked
P value
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
50 50 66.7
50 50 33.3
51.1 44.7 68.1
48.9 55.3 31.9
77.5 72.5 45
22.5 27.5 55
0.004 0.007 0.015
43.7
56.3
48.9
51.1
65
35
0.047
37.5 41.7
62.5 58.3
51.1 38.3
48.9 61.7
65 20
35 80
0.027 0.025
56.3
43.7
59.6
40.4
30
70
0.003
81.2
19.8
80.8
19.2
50
50
0.000
66.7
33.3
63.8
26.2
52.5
47.5
0.045
35.4
64.6
44.7
55.3
20
80
0.025
60.4
39.6
48.9
51.1
30
70
0.009
50 68.7 52.1
50 31.3 47.9
53.2 68.1 61.7
46.8 31.9 38.3
30 32.5 37.5
70 67.5 62.5
0.021 0.000 0.040
56.2
43.8
51.1
48.9
30
70
0.012
56.2
43.8
53.2
46.8
25
75
0.002
OMI – Opinion about mental illness
Of the 40 participating interns, 30 had GHQ score of >15, indicating significant distress among interns, which is an area of concern. Similar findings of increasing stress among interns was also reported in a recent study.[11] Reasons for increasing level of psychological distress among the interns could be diverse, including academic stress for preparing for entrance examinations for postgraduation, fatigue due to internship postings, issues pertaining to personal life, financial issues, etc. 274
Opinion about mental illness Authoritarianism It includes authoritarian submission and anti‑intraception and reveals a view of people with mental illness as an inferior class requiring coercive handling and also indicates a belief that people with mental illness are inferior to normal individuals.[17] In our study, 1st and 2nd year students were found to have a negative view, when compared to interns on Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
Gulati, et al.: Impact of psychiatry training
Table 5: Items reflecting difference in attitude towards psychiatry (ATP‑29 scale) Item
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
50 41.7 45.8 45.8 64.6
50 58.3 54.2 54.2 35.4
55.3 48.9 53.2 48.9 68.1
44.7 51.1 46.8 51.1 31.9
75 70 77.5 25 35
25 30 22.5 75 65
Psychiatry is a rapidly expanding frontier of medicine Psychiatric consultation for medical or surgical patients is often helpful Psychiatric treatment is helpful to most people who receive it Psychiatry is not a genuine and valid branch of medicine Psychiatrists frequently abuse their legal power to hospitalize patients against their will
P value 0.016 0.009 0.003 0.016 0.001
ATP‑29 – Attitude to psychiatry‑29
most of the questions. Approximately, 68% of the students felt that persons with mental illness should not be treated in the same hospital with people with physical illness and considered a mental illness as punishment for bad deeds, etc., Majority of the interns (70%) were against mental hospitals being surrounded by a high fence and guards, whereas students had mixed opinion. However, most of the students (65.3%) and interns (75%) were against keeping such patients behind locked doors. Both students (60%) and interns (72.5%) were also against punishing them in case they attacked someone in order to prevent future attacks. Most of the participants felt that people with mental illness were easy to recognize, and were different from patients suffering from other illness, e.g. a heart patient. Benevolence It reflects an orientation toward care in general.[17] Interns were of different, but favorable opinion toward people with mental illness than the students, as they considered that it was wrong to laugh over people with mental illness, and that more can be done for these patients except feeding them and keeping them comfortable (P
Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry Prannay Gulati, Subhash Das, B. S. Chavan
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
ABSTRACT
Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross‑sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire‑12 (GHQ‑12), opinion about mental illness (OMI) scale, and attitude to psychiatry‑29 (ATP‑29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi‑square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry. Key words: Attitude, interns, mental illness, psychiatry, undergraduate students
INTRODUCTION The World Health Organization reported in 2001 that about 450 million people worldwide suffer from some form of mental disorder or brain condition, and that one in four persons meet criteria for mental disorder at some point in their life.[1] Opinion about mental illness (OMI) plays a vital role in long‑term care of patients with mental illness. Stigmatizing attitudes toward people with mental illness are widespread and people tend to react in a very discriminating way toward those with mental illness.[2‑7] Address for correspondence: Dr. B. S. Chavan, Head of Department, Department of Psychiatry, Government Medical College and Hospital, Sector 32, Chandigarh, India. E‑mail: [email protected]
How to cite this article: Gulati P, Das S, Chavan BS. Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry. Indian J Psychiatry 2014;56:271-7.
Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
The treatment gap that exists in treating the persons with mental illness, due to an inadequate number of mental health professionals, especially psychiatrists, can be narrowed if the newly trained doctors have the acumen to spot those having a mental illness.[8] The knowledge and the attitude of the undergraduate medical students toward mental health and psychiatric disorders is of great importance as these individuals are going to be involved in the care of these patients either directly or indirectly during the course of their careers. Studies carried out to find out undergraduate medical students’ OMI and their Access this article online Quick Response Code Website: www.indianjpsychiatry.org
DOI: 10.4103/0019-5545.140640
271
Gulati, et al.: Impact of psychiatry training
knowledge toward psychiatry have shown ignorance about scientific facts related to psychiatry, psychiatric patients, and treatment methods.[9,10] Medical graduates considered psychiatry to be imprecise, and unscientific and had unfavorable attitude toward considering psychiatry as a career option.[11] However, providing clinical training in psychiatry during undergraduation seems to improve the attitude toward people with mental illness.[12‑15] However, psychiatry as a subject has not been given its due importance at the undergraduate level, which is reflected in the number of theory lectures and hours of psychiatry clinical posting.[8] Until recently, even during the internship posting, psychiatry used to be an optional subject as compared to compulsory posting in surgery, medicine, gynecology, among other branches.[8] Medical Council of India (MCI) had recently suggested to increase the number of hours for psychiatry into the curriculum of psychiatry for undergraduate MBBS course, but until date, only decision regarding internship has been implemented.[8] There have been few studies in the past, all of which have assessed attitude of undergraduates toward mental illness/ mentally ill or psychiatry separately, except one study from South India by Lingeswaran, which assessed both of these in a single study.[11] However, these studies have many limitations. First, these studies were carried out when psychiatry posting during internship was still optional, so the exposure to psychiatry could have been different amongst participants limiting their comparison. Second, presence of mental illness among the participants or their relatives was not ruled out, which would have an impact on their attitudes. Hence, the current study was planned to assess and compare the attitude of medical students and interns in a medical college toward mental illness and toward psychiatry. The author also attempted to assess the impact of psychiatric training on their attitude toward the mentally ill person and mental illness. SUBJECTS AND METHODS This was a cross‑sectional, single assessment study conducted at a tertiary hospital in North India. The participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry as per MBBS curriculum, and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Data were collected between June 2012 and November 2012. Students of 1st and 2nd year MBBS were approached as a group in their respective lecture theaters, whereas interns were approached individually on the last day of their psychiatry posting. After explaining them the aim of the study and obtaining their informed consent, participating students and interns were individually administered sociodemographic performa, General Health 272
Questionnaire (GHQ‑12),[16] OMI scale,[17] and attitude to psychiatry‑29 (ATP‑29) scale.[18] Names and roll numbers of the participants were omitted from the proforma to maintain the confidentiality. Inclusion criteria • 1st and 2nd year students of MBBS course • Interns who have completed their psychiatry posting as per curriculum. Exclusion criteria • Students and interns having first or second degree relatives with current psychiatric disorder • Students and intern undergoing treatment for mental health problems. • Students and interns whose first or second degree relative were psychiatrist • Students and interns who refused to participate. Tools • Demographic data was collected using a standard proforma being used routinely in the department and contained details such as age, gender, and socioeconomic status • Each subject was administered the following scales. • GHQ‑12:[16] Score >15 was taken as an evidence of distress and score >20 suggested severe problems and psychological distress • OMI scale:[17] The OMI scale investigates attitudes toward mental illness and consists of 51 items, in Likert format, with six alternative answers ranging from strongly agree to strongly disagree. Items define five factors, that is: Authoritarianism (A), benevolence (B), mental hygiene ideology (C), social restrictiveness (D), and interpersonal etiology (E) • ATP‑29 scale:[18] This scale measures attitudes using a four‑point Likert type self‑rated scale, with questions about attitude to psychiatric patients, illness and treatment, psychiatrists, psychiatric institutions, teaching, knowledge, and career choice. Statistical analysis Standard descriptive statistics (mean, percentage) were used to analyze the characteristics of participants. The differences between the students and interns were assessed using Chi‑square test. RESULTS In total, 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Of the 100 students in 1st and 2nd year, five students could not be approached due to their absence from classes on medical ground. All interns who had Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
Gulati, et al.: Impact of psychiatry training
completed their psychiatry posting participated in the study. The percentage of male and female in each batch of students was: 1st year (male 48%, female 52%); 2nd year (male 28%, female 72%) and interns (male 52%, female 48%). The socioeconomic status was mostly upper middle class (102) and upper class (33) [Table 1].
between interns and other students were observed for certain items [Table 5]. DISCUSSION The present study was carried out in a Medical College in North India to assess the impact of psychiatry training on attitude of medical students and interns toward mental illness and psychiatry. Physical and psychological well‑being of the participants was also assessed using standardized questionnaires. Students of 1st and 2nd year, who didn’t have any exposure to psychiatry as yet, and interns who had completed their psychiatry posting were included in the study. In addition to internship posting, interns were supposed to attend 20 theory lectures during their 6th semester of MBBS as part of the curriculum. However, after checking the department attendance register, it was found that only 5% (2 out of 40) of the interns had attended 50% or more of theory lectures. The study highlights the fact that the majority of the students do not attend psychiatry theory lectures as the attendance in psychiatry classes is not mandatory and there is no separate examination in psychiatry. The findings support the long pending demand of making psychiatry an independent examination subject. Alternatively, if attendance in the subject of psychiatry is made compulsory like in other major subjects and more weightage is given to theory and practical examination in psychiatry as part of medicine examination, the students may be more attentive and have a better understanding of the subject.
The mean GHQ score was 14.03 for the entire sample. The group scores were as follows: 1st year (11.7), 2nd year (12.8), and interns (16.2). None of the participant had score >20, which ruled out any severe psychological problems in the study sample. 30 interns had a score of >15 when compared to 1 and 2 in 1st and 2nd year students, respectively. Responses obtained on OMI scale were modified to agreed or disagreed to improve statistical significance to responses. No statistical differences were found between 1st and 2nd year students. Statistically significant differences between interns and other students were found on certain items [Tables 2‑4]. Some of the items, pertaining to exposure to psychiatry during MBBS curriculum, were not applicable to 1st and 2nd year students and they were omitted from the analysis. No difference between 1st and 2nd year students was statistically significant. Statistically significant differences Table 1: Demographic data n Mean age (in years) Sex distribution (male:female) In percentage (male:female) Socioeconomic status Upper middle Upper
1st year
2nd year
Interns
48 18.3 23:25 48:52
47 19.5 13:34 28:72
40 23.1 21:19 52:48
36 12
35 12
31 9
The GHQ scores revealed better scores for 1st and 2nd year students than that of interns, indicating deterioration of psychological well‑being with progression of MBBS course. None of the participant had score >20, which ruled out severe psychological and physical problems in the study sample.
Table 2: Items reflecting positive attitude of both students and interns (OMI scale) Item Anyone who tries to better himself deserves the respect of others If our hospitals had enough well‑trained doctors, nurses, and aides, many of the patients would get well enough to live outside the hospital The best way to handle patients in mental hospitals is to keep them behind locked doors The patients in mental hospitals should be allowed more privacy If a patient in a mental hospital attacks someone, he should be punished so he doesn’t do it again People (both veterans and nonveterans) who are unable to work because of mental illness should receive money for living expenses Regardless of how you look at it, patients with severe mental illness are no longer really human Our mental hospitals should be organized in a way that makes the patient feel as much as possible like he is living at home All patients in mental hospitals should be prevented from having children by a painless operation
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
75 75
25 25
80.8 78.7
19.2 21.3
67.5 70
32.5 30
35.4
64.6
34
66
25
75
54.2 43.7
45.8 56.3
61.7 36.2
38.3 63.8
70 27.5
30 72.5
62.5
37.5
72.3
27.7
82.5
17.5
33.3
66.7
38.3
61.7
30
70
79.2
20.8
78.7
21.3
82.5
17.5
35.4
64.6
40.4
59.6
27.5
72.5
OMI – Opinion about mental illness
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Gulati, et al.: Impact of psychiatry training
Table 3: Items reflecting negative attitude of both students and interns (OMI scale) Item
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
72.9
27.1
74.4
25.6
72.5
27.5
70.8 54.2
29.2 45.8
70.2 61.7
29.8 28.3
75 65
25 35
37.5
62.5
42.5
57.5
30
70
66.7
33.3
63.8
36.2
65
35
68.7
31.3
74.4
25.6
65
35
33.3 68.7
66.7 31.3
48.9 59.6
51.1 40.4
32.5 65
67.5 35
62.5
37.5
68.1
31.9
60
40
60.4
39.6
65.9
34.1
62.5
37.5
Although some mental patients seem all right, it is dangerous to forget for a moment that they are mentally ill Most patients in mental hospitals don’t care how they look The mental illness of many people is caused by the separation or divorce of their parents during childhood Many mental patients are capable of skilled labor, even though in some ways they are very disturbed mentally People who have been patients in a mental hospital will never be their old selves again A heart patient has just one thing wrong with him, while a mentally ill person is completely different from other patients Patients in mental hospitals are in many ways like children There is something about mental patients that makes it easy to tell them from normal people People who are mentally ill let their emotions control them: Normal people think things out It is easy to recognize someone who once had a serious mental illness OMI – Opinion about mental illness
Table 4: Items reflecting difference in attitude between students and interns (OMI scale) Item Mental illness is an illness like any other Most patients in mental hospitals are not dangerous Although patients discharged from mental hospitals may seem all right, they should not be allowed to marry Even though patients in mental hospitals behave in funny ways, it is wrong to laugh about them Most mental patients are willing to work The small children of patients in mental hospitals should not be allowed to visit them People with mental illness should never be treated in the same hospital with people with physical illness A woman would be foolish to marry a man who had a severe mental illness, even though he seems fully recovered If the children of mentally ill parents were raised by normal parents, they would not become mentally ill Our mental hospitals seem more like prisons than like places where mentally ill people can be cared for If the children of normal parents were raised by mentally ill parents, they would probably become mentally ill Every mental hospital should be surrounded with a high fence and guards Sometimes mental illness is punishment for bad deeds One of the main causes of mental illness is a lack of moral strength or will power There is little that can be done for patients in a mental hospital except to see that they are comfortable and well‑fed Many mental patients would remain in the hospital until they were well, even if the doors were unlocked
P value
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
50 50 66.7
50 50 33.3
51.1 44.7 68.1
48.9 55.3 31.9
77.5 72.5 45
22.5 27.5 55
0.004 0.007 0.015
43.7
56.3
48.9
51.1
65
35
0.047
37.5 41.7
62.5 58.3
51.1 38.3
48.9 61.7
65 20
35 80
0.027 0.025
56.3
43.7
59.6
40.4
30
70
0.003
81.2
19.8
80.8
19.2
50
50
0.000
66.7
33.3
63.8
26.2
52.5
47.5
0.045
35.4
64.6
44.7
55.3
20
80
0.025
60.4
39.6
48.9
51.1
30
70
0.009
50 68.7 52.1
50 31.3 47.9
53.2 68.1 61.7
46.8 31.9 38.3
30 32.5 37.5
70 67.5 62.5
0.021 0.000 0.040
56.2
43.8
51.1
48.9
30
70
0.012
56.2
43.8
53.2
46.8
25
75
0.002
OMI – Opinion about mental illness
Of the 40 participating interns, 30 had GHQ score of >15, indicating significant distress among interns, which is an area of concern. Similar findings of increasing stress among interns was also reported in a recent study.[11] Reasons for increasing level of psychological distress among the interns could be diverse, including academic stress for preparing for entrance examinations for postgraduation, fatigue due to internship postings, issues pertaining to personal life, financial issues, etc. 274
Opinion about mental illness Authoritarianism It includes authoritarian submission and anti‑intraception and reveals a view of people with mental illness as an inferior class requiring coercive handling and also indicates a belief that people with mental illness are inferior to normal individuals.[17] In our study, 1st and 2nd year students were found to have a negative view, when compared to interns on Indian Journal of Psychiatry 56(3), Jul‑Sep 2014
Gulati, et al.: Impact of psychiatry training
Table 5: Items reflecting difference in attitude towards psychiatry (ATP‑29 scale) Item
1st year (n=48) (%)
2nd year (n=47) (%)
Interns (n=40) (%)
Agree
Disagree
Agree
Disagree
Agree
Disagree
50 41.7 45.8 45.8 64.6
50 58.3 54.2 54.2 35.4
55.3 48.9 53.2 48.9 68.1
44.7 51.1 46.8 51.1 31.9
75 70 77.5 25 35
25 30 22.5 75 65
Psychiatry is a rapidly expanding frontier of medicine Psychiatric consultation for medical or surgical patients is often helpful Psychiatric treatment is helpful to most people who receive it Psychiatry is not a genuine and valid branch of medicine Psychiatrists frequently abuse their legal power to hospitalize patients against their will
P value 0.016 0.009 0.003 0.016 0.001
ATP‑29 – Attitude to psychiatry‑29
most of the questions. Approximately, 68% of the students felt that persons with mental illness should not be treated in the same hospital with people with physical illness and considered a mental illness as punishment for bad deeds, etc., Majority of the interns (70%) were against mental hospitals being surrounded by a high fence and guards, whereas students had mixed opinion. However, most of the students (65.3%) and interns (75%) were against keeping such patients behind locked doors. Both students (60%) and interns (72.5%) were also against punishing them in case they attacked someone in order to prevent future attacks. Most of the participants felt that people with mental illness were easy to recognize, and were different from patients suffering from other illness, e.g. a heart patient. Benevolence It reflects an orientation toward care in general.[17] Interns were of different, but favorable opinion toward people with mental illness than the students, as they considered that it was wrong to laugh over people with mental illness, and that more can be done for these patients except feeding them and keeping them comfortable (P
