It has been thirteen years since I walked in the corridors of the psychiatry ward as a junior resident. Back then, psychiatry training happened while walking back and forth from the psychiatry ward to the OPD. There were no specified competencies at that point in time. You learned psychiatry, as Albert Bandura once postulated in his theories of learning. By observing your seniors and faculty.
We clerked endlessly. And while doing so patient’s findings blurred into one another. Learning depended more on us. Rounds began early morning. Many times, it was I, as a first-year junior resident, who woke patients up from their slumber. There was no checklist of what I had to learn. Communication skills, risk assessment skills, and managing aggressive patients all had to be picked up by noticing seniors. We picked up most of the things eventually, sometimes late.
With the introduction of the competency-based medical education (CBME) by the National Medical Commission (NMC), postgraduate psychiatry training is at an important transition point. While the intention of this much-appreciated reform is progressive, several structural gaps continue to challenge residents and threaten the quality of training.
Training Amid Service Overload
In most of the government medical colleges across India, psychiatry residents function as the backbone of the departmental clinical services. High outpatient volumes, emergency psychiatry duties, inpatient care, consultation-liaison work, and medico-legal responsibilities are often taken care of with limited manpower. Although clinical exposure is essential for competency development, excessive service obligations might come in the way of structured learning, reflective practice, and academic engagement as envisioned by the CBME. Hence, translating this into practice requires clearer demarcation between service delivery and training responsibilities, along with strengthening human resources.
Resident Well-being
While CBME focuses on structured learning, it will explicitly require learner well-being as a prerequisite for effective training. Residents, including those in psychiatry, are routinely exposed to severe mental illness, suicidality, and complex psychosocial stressors. To the top of this, institutional mechanisms for emotional support remain limited, and stigma often discourages help-seeking.
For such an initiative to be successful, strong confidential mental health services, mentorship programs, and supervision become even more essential.
Psychotherapy Training: Aligning Curriculum with Competence
For us at that time, psychotherapy training happened in the margins. And whatever training happened was even more unstructured and limited. With a huge clinical load in government setups, files to finish, and admissions to be managed, thinking of psychotherapy at the time felt like a luxury.
I feel envy as the NMC curriculum reiterates the biopsychosocial model and focuses on minimum hours of supervised psychotherapy in the training. However, psychotherapy training largely remains uneven across institutions due to a lack of trained supervisors, limited protected time, and service pressures. Initiatives across various institutions are being undertaken to develop psychotherapy skills across the country. It still remains a challenge to be overcome with time.
“Why Didn’t You Take Medicine?”
It was a question that followed me everywhere. At family functions, with friends, and in the neighbourhood. Being a woman, the questions were even heavier about whether I would be able to deal with aggressive patients. Some friends would often make casual jokes about how I would find myself unhinged in the coming years.
Despite its growing relevance, psychiatry continues to face stigma within the medical system. Greater integration of psychiatry into undergraduate teaching, horizontal and vertical integration are the things that I believe are going to help psychiatry in the coming years. Recently, a colleague shared on one of the groups that psychiatry has become the second most popular branch in the UK. We must work together to help it get its due recognition in India as well. And it can be said that investing in psychiatry residents is ultimately an investment in India’s mental health system.
Dr. Ruchi Soni
Associate Professor
Department of Psychiatry
Gandhi Medical College, Bhopal
