What to Teach and How to Teach Medical Students in the Middle of COVID-19? Guidance for Teachers in Psychiatry

The second wave of the COVID-19 pandemic has already hit India, disrupting the medical teaching–learning in most parts of the country. Until the last week of May 2021, nearly 3.5 million people had died worldwide because of COVID-19, and India had the highest number of active cases with over 300,000 new cases every day. The COVID-19 outbreak is an unprecedented humanitarian crisis that India had to face in recent times. ¹ Education of medical students, who, in turn, are key human resources during times of a pandemic, is severely affected in this time. Most medical educational institutions have not been fully functioning since the lockdown of March 2020. While most have moved to the online platform, with the second wave, it is time for teachers, students, and medical education institutions to reflect and look at the continuity of education in the current scenario.

Teachers of psychiatry play an important role in national public health services. ² They must learn to balance the standard of psychiatry education with other duties related to COVID-19 care. The new medical education curriculum implemented in 2019 has raised the need for faculty training. ³ The pandemic module for Indian medical graduates released has major lacunae, with exclusion of mental health, and was duly criticized. ⁴ The new module has incorporated necessary changes. More importantly, an increased need for mental health services during the pandemic has indeed highlighted the necessity for psychiatry training of Indian medical graduates, which the psychiatry teachers should emphasize at all times. ⁵

Enthusiastic psychiatry teachers find joy in teaching irrespective of the hurdles they face. Learning new methods of online teaching is one of them. For responsible students, there is a real need to learn. In India, in the first wave of COVID-19, there have been media reports about students who committed suicide because of unaffordability to access digital teaching–learning programs. ⁶

There is a great need for the teaching-learning process to make up for the lost time. Also the teachers have to bear in mind that COVID-19 pandemic has been unpredictable with multiple waves across the world, including India. Psychiatry teaching–learning in Indian undergraduate medical education is a time-dependent process of listening, assimilation, practice, and application of knowledge; in the process forty hours have been allotted for theory and four weeks to clinical posting. The pandemic has taken away the valuable time allocated for the subjects. There is a need for psychiatry teachers to urgently reflect upon how each phase of psychiatry education can be completed in the middle of the COVID-19 pandemic.

Information technology is booming, and virtual communication has accelerated during the pandemic. It has heralded a new era of teaching, including psychiatry teaching–learning; teaching programs can now be attended from anywhere and anytime. For students, this can be truly called “Selfie” time, an age for self-learning of all subjects, including psychiatry. Although there are concerns related to the technology issues such as network problems and the issue of internet addiction, the young medical students of India are tech-savvy, and online learning thus is expected to be a positive development. Psychiatry teachers may have to speed up and learn adapting to technology-enabled online teaching methods.

The teaching in medical schools that was formal, with actual classes in the physical presence of students, may not be possible during the COVID-19 pandemic. The informal pattern of an online class that is streamed live and/or stored at web portals or mobile application shall be the new norm or alternative for some time. Mobile-application-based learning has not been evaluated, but it does give flexibility to students, and in self-learning mode, they can decide when to learn and what to learn. It is important to consider how psychiatry education can continue. The pandemic is a time when the entire psychiatry curriculum of each phase of MBBS or each section can be effectively carried out by dividing it into components that are predominantly the knowledge or cognitive domain, affective domain or communication skills, and the psychomotor domain. Psychiatry teachers and undergraduate students can together decide which aspect of the topic falls into which section. It is important to customize the selection of psychiatry topics based on the necessity and priority in the current pandemic: For example, the teaching of depression, anxiety disorders, suicide prevention, alcohol dependence syndrome, and sleep disorders may be considered more relevant in the context of COVID-19. Prioritizing the topics to be covered will ease the process of designing the teaching plan in the available time frame. If the topic for psychiatry teaching selected is alcohol-dependence syndrome, the knowledge or cognitive domain will include prevalence, etiology, clinical criteria for diagnosis, etc. The affective component can be “How to elicit alcohol dependence syndrome as per WHO-ICD (World Health Organization International Classification of Diseases)?” The psychomotor domain shall involve steps in the examination of the patient (or virtual/simulation) such as observation, palpation, percussion, and auscultation in relation to signs of alcohol withdrawal, alcoholic liver disease, and cerebellar dysfunction. Psychiatry teachers can carefully design specific-learning objectives for each session. With active feedback, the teachers and students can make the teaching–learning interesting and interactive.

Learning in the knowledge or cognitive domain is considered easy for students, as they can read and learn by themselves. To read, comprehend, and recall the information is the focus of the cognitive process. Information is available from recommended medical textbooks or online sources that psychiatry teachers can list out. The psychiatry teacher has a minimal role in cognitive learning, and that can be reserved for providing guidance and clarity when the students need it and for highlighting the key aspects or relevant additions. Psychiatry teachers can facilitate peer-to-peer interaction for learning and self-evaluation, such as mock examination. In a pandemic, contact classes can be avoided, and only limited online theory classes can be held. Thus, they should be more interactive and provide a recap of clinically relevant aspects. Teachers can bring in predetermined methods of rewards that can be incorporated in the total marks during the assessment, if any.

Psychiatry teachers can spend more time in the affective and psychomotor domains. A psychiatry teacher conducts a demonstration first on developing rapport and elicits alcohol dependence, for example. The teacher later facilitates the learning through role-play carried out by the students, through the online platform. Role-play with normal people (non-COVID),with safety methods, can also be incorporated. The process can be streamed live or recorded video clips can be made available. While learning an affective or psychomotor component, the students should repeatedly perform it to master the skill. They can perform the method with the help of family members or friends (with their consent). Once the students start appreciating the process in any skill domain, the other steps in learning are much easier. With the least exposure to infection, modified clinical sessions can also be carried out in small groups. The skill acquisition can be monitored online by the teacher evaluating each student individually or through peer-to-peer evaluation. Wherever or whenever patients are available in a safe environment for examination (e.g., patients with alcohol-dependence syndrome or depression), teachers can use the “Fish Bowl” teaching methodology. The basic idea is that the psychiatry teacher conducts a coaching session with an individual student and the other students observe and learn vicariously. Problem-based learning, flip classroom, and other teaching–learning methods can be incorporated as feasible.

Psychiatry teachers may have to break the old methods and discover newer ways that may be needed during a pandemic. Assessments, if any, need to be carefully planned and pilot tested, and novel ideas of assessment can be incorporated. Digital student assessments such as those using Google Forms or Microsoft Teams can be utilized.

In institutions where the pandemic has adversely affected the teachers or where resources are constrained, professional organizations such as the Indian Psychiatric Society can provide free access to teaching–learning on online platforms.

In this time of a pandemic, there is an urgent need for psychiatry teachers to innovate efforts for continuity of psychiatry teaching–learning in medical institutions so that upcoming doctors are reasonably competent in psychiatry and ready to serve the society with the required psychiatric knowledge and skills.

Enthusiastic psychiatry teachers and medical students can join hands to ensure the continuity of people-centric learning. Learning should never stop; however, “how” we learn needs to change.