|Year : 2015 | Volume
| Issue : 2 | Page : 137-141
A comparative study of Indian and Indian origin foreign medical graduate interns' attitude towards psychiatry
Kuldip Kumar, Raghu Gandhi
Department of Psychiatry, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
|Date of Web Publication||13-Jul-2015|
Dr. Kuldip Kumar
Associate Professor and Consultant, Department of Psychiatry, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Context: Evidence suggest that medical students' attitudes towards psychiatry are determined by multiple factors like previous experiences, training in medicine and psychiatry, globalization of education, medical school experiences, including influence of faculty, friends and family members. No previous work on Indian origin foreign medical graduate interns has been done in this area in India. Aims: To study the difference in attitude towards psychiatry among Indian and Indian origin foreign medical graduate interns. Settings and Design: Cross sectional study, conducted in a central government teaching hospital. Materials and Methods: Study was done on 261 medical interns who did their medical schooling in India and abroad during a period of one year. Balon et al. questionnaire was administered for attitude assessment. Statistical Analysis: Statistical package for social sciences (SPSS) for windows 20th revision was used. Descriptive statistics was used for analyzing discrete and continuous variables. Chi square test applied for comparing categorical variables. Results: Ninety five percent of FMG interns (N = 66) were from China and Russia. IMG interns considered teaching of psychiatry at their medical school to be interesting and good quality as compared to FMG interns. Both groups admit that family and friends discouraged them from entering psychiatry. Conclusions: Good training in psychiatry during medical school has overall positive effect on the attitude towards psychiatry. Internship is the appropriate period when the specific needs of the FMG interns to be addressed for their better integration into the Indian medical system.
Keywords: Attitude, Indian origin foreign medical graduate, interns, psychiatry
|How to cite this article:|
Kumar K, Gandhi R. A comparative study of Indian and Indian origin foreign medical graduate interns' attitude towards psychiatry. Muller J Med Sci Res 2015;6:137-41
|How to cite this URL:|
Kumar K, Gandhi R. A comparative study of Indian and Indian origin foreign medical graduate interns' attitude towards psychiatry. Muller J Med Sci Res [serial online] 2015 [cited 2021 Jan 15];6:137-41. Available from: https://www.mjmsr.net/text.asp?2015/6/2/137/160683
| Introduction|| |
Medical students' attitudes towards psychiatry are determined by a number of factors  such as personality,  previous experiences,  training in medicine and psychiatry,  medical school experiences, including influence of faculty members  and globalization of medicine. In many countries there has been an increasing concern regarding the low number of medical students choosing psychiatry as a career after graduation.  For example, U.S. studies have pointed out a steadily decreasing trend in recruitment for many years. Specifically, since the mid-1970s enrolment has been generally decreasing, from 5.9% in 1978 to 4.2% in 2012  Medical students have been shown to have different stigmatizing attitudes toward mental illness which they hold onto in their professional lives. Opinions of Spanish students about the bio-psycho-social concept of illness, salary, social pressure, and respect from non-psychiatry staff were different than those of U.S. students , Similarly the stigma of medical students against psychiatry and psychiatrists was stronger in Ghana than in the United States, but with less discouragement from families and fellows. 
Indian origin foreign medical graduates (FMG) interns who receive training from outside India after coming back to India, have to pass Foreign Medical Graduates Examination (FMGE) conducted by Medical Council of India (MCI) The test is one of the mandatory requirements for an Indian citizen who has a medical degree from a college outside India, and wants to practice medicine in the country. The other requirement is a compulsory one-year internship at an Indian teaching hospital recognised by MCI. 
FMG interns' study in different countries with diverse ethnic and cultural background and with different education systems and methods, we hypothesized them to have divergent attitude. The present study aims to investigate the attitude differences between FMGs and Indian Medical Graduates (IMG) interns towards the various aspects of psychiatry, shaped during their medical training.
| Materials and Methods|| |
This was a cross sectional study conducted in department of psychiatry, Vardaman Mahavir Medical College (VMMC) and Safdarjang hospital after taking approval from the Institute Ethical Committee. VMMC and Safdarjang Hospital is one of the large multi-disciplinary tertiary care hospital in Delhi where foreign medical graduates come to do compulsory rotatory internship. Here they work with fellow interns referred as IMG interns who did medical graduation from VMMC and other Indian medical colleges. Interns population of VMMC is heterogeneous and from various part of country apart from the city of Delhi.
Both IMG and FMG interns were evaluated on the very first day of their compulsory rotatary internship posting in the department of psychiatry during one year representing a full batch. A well informed written consent was taken from each intern and complete anonymity of the each intern and confidentiality of all their responses were kept. Balon et al. questionnaire  was used to assess the attitude which is a self administered questionnaire consists of 39 questions, of which 29 questions were used which examined the attitudes of medical students towards psychiatry and psychiatrist. It explores the six main domains:
- Overall merits of psychiatry,
- Role definition and functioning of psychiatrists,
- Possible abuse and social criticism,
- Career and personal reward and
- Specific medical school factors.
Forced multiple-choice responses to each item were defined as: "strongly agree", "moderately agree", "moderately disagree" and "strongly disagree" The questionnaire was supplemented with socio-demographic details and country of medical graduation.
The statistical package for social sciences (SPSS) for windows 20 th revision was used for statistical analysis. Descriptive statistics was used for analyzing discrete and continuous variables. Chi square test was used for comparing categorical variables.
| Results|| |
Out of total 266 interns posted on rotational internship in department of psychiatry from 1 st Jan. 2013 to 31 st Dec. 2013, 261 interns consented to participate in the study. Number of FMG interns was 66 which constituted 25.28% of the total sample. Male interns were predominantly represented, being 69.23 % and 63.36 % in IMG and FMG interns groups respectively [Table 1]. More than 95% FMG interns graduated from Russia and China [Table 2].
Most of IMG interns (n = 130) and FMG interns (n = 48) agree that psychiatry is rapidly expanding frontier of medicine. Fifty four percent of FMG interns (n = 36) disagree that psychiatry has made good strides in advancing care of major mental disorders while seventy two percent of IMG interns believed in efficacy of psychiatry. Majority of interns believed that psychiatric consultation for medical and surgical patients was often helpful [Table 3].
|Table 3: Comparative merits, efficacy of psychiatry and role of psychiatrists|
Click here to view
[Table 4] depicts more FMG interns (18%) than IMG interns (7%) believed that psychiatrist frequently abuse their legal power to hospitalize patients against their will (P > 0.003). Seventy eight percent of IMG interns and sixty two percent of FMG interns believed that psychiatry had low prestige among general public. But more IMG than FMG interns admitted that their family discouraged them from entering psychiatry. Both group differed statistically in all the items except their opinion about non psychiatry and house staff respectful of psychiatry [Table 5].
|Table 4: Social criticism and career reward, attitude towards psychiatry|
Click here to view
| Discussion|| |
To the best of authors' knowledge, this is the first comparative Indian study about Indian origin foreign medical graduates interns reported from India. The mean age of FMG interns is 2-3 years more than IMG interns because they usually take one or two attempts to get admission in medical colleges in India before joining for foreign study and also due to time lost in migration process. In our sample the maximum number of FMG interns are from china because of cheaper medical education. 
Both IMG and FMG interns differ to the overall merits of psychiatry [Table 3]. While IMG interns believe that psychiatry has made good strides in advancing care of major mental disorders, FMG interns disagree. The difference can be because of comparatively better structured training in psychiatry available in Indian settings. In India total 40 hours exposure to psychiatry is in the form of lectures, tutorials seminars, integrated teaching and self directed teaching. There is compulsory two weeks clinical posting to psychiatry department during third year of medical school.  The academic factors that have been verified as especially important to the improvement of students' attitudes towards psychiatry are the knowledge acquisition, the awareness of the therapeutic potential of psychiatric interventions and the direct contact with patients  Both the groups are of opinion that psychiatry is rapidly expanding frontier of medicine and both disagreed that psychiatry is unscientific and imprecise The psychiatry is now seen as progress making branch of medicine and as a helping discipline. Earlier studies have shown similar, mixed or even contradictory findings . Recently a study by William et al.  reported positive attitudes towards psychiatry, openness with regard to psychiatric services and respect for psychiatric patients among medical students in China. On the issue of the efficacy of psychiatry both group believes that psychiatric consultation for medical or surgical patient is helpful and psychiatric treatment is helpful to those who receive it. Another similarity between the two groups is on the role definition and functioning of psychiatrists, psychiatry is a genuine and valid branch of medicine, psychiatrists are clear and logical thinkers and have authority. On earning part FMG interns are of opinion that psychiatrist make much less money as compared to other physicians.
Further FMG interns believe that psychiatrist frequently abuse their legal power to hospitalize patients against their will and psychiatry has low prestige among general public and among other medical disciplines. IMG interns are of opinion that people who could not obtain a residency position in other specialities eventually enter psychiatry. This finding is accordance with previous study by Balon  where medical students in America perceived psychiatry as having low status among other disciplines, with lower incomes compared with other physicians. FMG interns are more positive and believe that psychiatry is a prestigious specialty among general public and other medical disciplines. However, both IMG and FMG interns agree that there family, friends and fellows discouraged them from entering psychiatry. Balon et al.  also stated that effort to increase recruitment may be doomed to failure when societal and peer pressures discourage entry into the discipline. Psychiatry is considered as wasted time by family members though medical education to some extend can overcome this. 
As far as teaching of psychiatry in medical schools is concerned FMG interns are not satisfied and do not consider psychiatry residents and attendings as good role models. Our finding is supported by recent article in China Daily  which reported that students don't see psychiatry as popular as cardiology or endocrine medicine, in our sample more than 50% of FMG interns studied in China so they share the common belief system. FMG interns further added that although they were interested in psychiatry, no effort was made to encourage those becoming psychiatrists at their medical school. IMG interns, on the contrary said that during psychiatry rotation they were encouraged to enter in psychiatry.
| Conclusions|| |
The present study shows that IMG interns are more convinced about the advancing state of psychiatry and the competence of psychiatrist as well as teaching of psychiatry, at their medical school to be interesting and good quality as compared to FMG interns. "Psychiatrists make much less money", "Psychiatry has low prestige", "Psychiatry is not my preferred choice" are some of the valid concerns of FMG interns. Internship is an important period in a doctor's training, as it is the transition period between being a medical student to obtaining full registration as a doctor. , Clearly we need to define and understand the specific needs of interns particularly FMG interns in order to healthily integrate them in to the Indian medical system.
However, we need to mention here that both groups admit that family and friends have discouraged them from entering psychiatry indicating social stigma still prevalent in psychiatry and global in nature. And sadly research aimed at reducing stigma of psychiatry and psychiatrist is limited. 
Our study has few limitations. FMG interns sample represents only those who qualified FMGT and hospital selection procedure to work as interns, hence difficult to generalise to all FMG interns' population working in India. A multi-centred study could yield more specific results. As both IMG and FMG were from India, our study mainly explores attitude differences shaped during their medical graduation. Moreover cross-sectional design of study and using a questionnaire for obtaining multi-dimensional personal opinion have its own short-comings.
| Acknowledgement|| |
The authors would like to thank all the interns who participated gave their consent for the completion of this study.
| References|| |
Buchanan A, Bhugra D. Attitude of the medical profession to psychiatry. Acta Psychiatr Scand 1992;85:1-5.
Walton HJ. Personality correlates of a career interest in psychiatry. Br J Psychiatry 1969;115:211-9.
Alexander DA, Eagles JM. Attitudes of men and women medical students to psychiatry. Med Educ 1986;20:449-55.
Ghadirian AM, Engelsmann F. Medical students′ attitude to psychiatry: A ten-year comparison. Med Educ 1982;16:39-43.
Eagle PF, Marcos LR. Factors in medical students′ choice of psychiatry. Am J Psychiatry 1980;137:423-7.
Balon R, Franchini GR, Freeman PS, Hassenfeld IN, Keshavan MS, Yoder E. Medical students′ attitudes and views of psychiatry: 15 years later. Acad Psychiatry 1999;23:30-6.
Pailhez G, Bulbena A, López C, Balon R. Views of psychiatry: A comparison between medical students from Barcelona and Medellin. Acad Psychiatry 2010;34:61-6.
Pailhez G, Bulbena A, Coll J, Ros S, Balon R. Attitudes and views on psychiatry: A comparison between Spanish and U.S. medical students. Acad Psychiatry 2005;29:82-91.
Laugharne R, Appiah-Poku J, Laugharne J, Shankar R. Attitudes toward psychiatry among final-year medical students in Kumasi, Ghana. Acad Psychiatry 2009;33:71-5.
Alexander DA, Eagles JM. Changes in attitudes towards psychiatry among medical students: Correlation of attitude shift with academic performance. Med Educ 1990;24:452-60.
Williams JA, Liu N, Afzal K, Cooper B, Sherer R, Morgan I, et al
. Positive attitudes towards psychiatry among Chinese medical students. Int J Soc Psychiatry 2014;60:21-9.
Cutler JL, Harding KJ, Mozian SA, Wright LL, Pica AG, Masters SR, et al
. Discrediting the notion "working with ′crazies′ will make you ′crazy′ ": Addressing stigma and enhancing empathy in medical student education. Adv Health Sci Educ Theory Pract 2009;14:487-502.
Hongyi W. Country′s Mental Health Services Lacking: China Daily. Available from: http://www.chinadaily.com.cn
. [ Last accessed on 2012 May 16].
Brown J, Graham D, Chapman T. Factors influencing teaching and learning in the preregistration year. Hosp Med 2003;64:740-2.
Evans DE, Wood DF, Roberts CM. The effect of an extended hospital induction on perceived confidence and assessed clinical skills of newly qualified pre-registration house officers. Med Educ 2004;38:998-1001.
Sartorius N, Gaebel W, Cleveland HR, Stuart H, Akiyama T, Arboleda-Flórez J, et al
. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2010;9:131-44.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]