The Evolution of Psychiatric Education at CMC, Vellore
The establishment of Mental Health Centre (MHC) at Christian Medical College (CMC), Vellore, in 1957, started a quiet revolution. A mental asylum within a residential college campus, open wards, and facilities for families to live with people with mental illness were unheard of in the 1950s.
Clinical exposure to people with mental illness and their families provided them context for the medical education and resulted in its training programs being regarded as excellent. In the late 1990s, some faculty realised that doctors trained by CMC did not seem to have adequate skills in managing psychiatric problems encountered in medical practice. Faculty members recommended changed formats, which centred on training them in general medical settings using physicians’ perspectives. These concepts published in the National Medical Journal of India (NMJI) in 1998 were dismissed as being utopian, both locally and nationally.
They volunteered to provide psychiatric services in CHAD Hospital. They identified the mismatch between specialist theory and the needs of psychiatric services in medical practice, developed and published protocols to bridge of the gap in over 60 papers and 15 chapters in books. A book titled “Psychiatric presentations in general practice: A guide to holistic management”, first published in 2010 is now in its second edition. Its 10-step protocol (which reiterates good medical practice) to manage common psychiatric presentations is easy to employ in busy medical and surgical settings, and has gained acceptance both as a tool for education of trainees and for the management of patients. The steps include acknowledging distress, understanding patient perspectives, identifying presentations, ruling out medical illness, symptomatic treatment, discussing alternative explanations for symptoms, exploring stress and its reduction, and developing a shared management plan. Over the last 15 years, these modules have been used for teaching medical students and interns and physicians enrolled in the distance education program in family medicine and secondary hospital medicine. Five hundred copies of the first edition of the book were distributed, free of cost, to all mission hospitals in CMC’s network.
The centenary of medical education at CMC, Vellore, and the institutional exercise of curriculum renewal provided an ideal opportunity to take forward its ideas and practices, initiated 20 years ago. The department revamped psychiatric education by changing the setting of its training from a tertiary care to CHAD Hospital and the Low Cost Effective Care Unit and emphasizing physician perspectives over the past 2 years. A program, which was initially implemented patchily, is now uniformly employed across the whole department. Student and faculty feedback on the program has been extremely positive.
The recognition that the theory and practice of tertiary care (while satisfying the emotional needs of specialists) are inappropriate (even in their diluted forms) for primary and secondary medical care was a major insight shifting the onus on faculty members to change their approach and teaching methods. The department’s conceptual arguments (“Theorizing medical practice for India”), its approach to clinical practice and medical education (“Reimagining psychiatric education for physicians”) and its curriculum (“Psychiatric curriculum for physicians”) have been published/accepted (in press) by the NMJI.
The pursuit of excellence in MHC’s and CMC’s journey in medical education supports the thesis that sustainable changes require constant evolution, which eventually result in quiet revolutions. Opportunities always favour the prepared mind; rather, prepared minds utilize all their opportunities.