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| EXPERT COMMENTARY |
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| Year : 2016 | Volume
: 2
| Issue : 1 | Page : 100-102 |
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Selection process for psychiatry residents in India: Does it need reorganization?
Siddharth Sarkar
Department of Psychiatry and NDDTC, All Institute of Medical Sciences, New Delhi, India
| Date of Submission | 09-Nov-2015 |
| Date of Acceptance | 05-Dec-2015 |
| Date of Web Publication | 2-Jun-2016 |
Correspondence Address:
Siddharth Sarkar
Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2455-5568.183321
The selection process for Psychiatry Residency Training Programmes in India is quite different from Western developed nations. The Indian medical graduates are required to take a multiple-choice question based competitive entrance examination that covers all undergraduate subjects for entry to all postgraduate specialties. Residency position allocation is conducted through “counseling” based upon the rank or percentile secured in this examination. This process of resident selection is fraught with certain risks which are discussed. The alternative possible selection systems are also evaluated for their advantages and potential concerns. Residency selection procedure needs are constrained by the practicalities of local resources, social structure, and system of medical education. And changes, if any should be implemented after careful and cautious consideration.
The following core competencies are addressed in this article: Systems-based practice, Professionalism, Interpersonal skills and communication. Keywords: India, medical education, psychiatry, residency, selection
How to cite this article:
Sarkar S. Selection process for psychiatry residents in India: Does it need reorganization?. Int J Acad Med 2016;2:100-2 |
The selection process for Psychiatry Residency Training Programmes in India is quite different from Western developed nations. While an extensive resident matching program is used in the USA, Indian postgraduate aspirants typically undertake an entrance examination to secure entry to scarce residency positions. Indian medical graduates are required to take a multiple-choice question (MCQs) based competitive entrance examination that covers all undergraduate subjects to enter a postgraduate specialty. Residency position allocation is conducted through “counseling” based upon the rank or percentile secured in this examination. Students who score higher on this common entrance examination are able to secure admission to an institution and specialty of their choice for continued postgraduate education. The annual number of residency positions in India is far less than the number of students completing their basic medical training, resulting in a backlog of students who are forced to prepare again, emigrate to other countries, or settle without a specialization despite intending to do one. Except for a handful of psychiatry training centers, selection for most psychiatry residency positions in India are conducted by this method.
The situation described above results in residents being forced to choose a specialty based solely upon their performance in the common entrance examination. Such a system leads to three types of anomalies in student selection. First, aspiring psychiatry residents may not be able to secure a position because of the inability to score the adequate number of marks on the MCQ-based examination. The entrance examination system may be justified in selecting students who display a certain level of competence, but a solely MCQ-based examination is unlikely to assess other characteristics required for excelling in the field of choice. The second anomaly occurs when students are “forced” to take up psychiatry when they demonstrate sparse inclination toward the specialty and demonstrate more interest towards another field like internal medicine or orthopedics. Such a situation occurs when the student has secured a rank adequate to get a psychiatry residency position, but not a more desirable residency position. Hence, some students land up in the residency training program just to leave it subsequently for another lucrative specialization during re-counseling or by preparing again for the entrance examination. The third anomaly occurs when a student who otherwise desires a psychiatry residency secures a very high rank, but then is influenced by external opinion to opt for another specialization. Though some candidates would take up a residency in psychiatry irrespective of the rank, the vicissitudes of Indian society and family pressures do deter a few otherwise interested students from opting for psychiatry after securing a very high rank. These issues in the current resident selection process can result in disinclined students needing to develop an interest in psychiatry to pursue it as a career while keeping out interested students because of inability to secure a good rank in the common entrance examination.
Given this situation, it might be worthwhile to consider alternative selection systems that can be thought about. One obviously is a comprehensive matching program where the residency directors interview students in their own institutions and submit their preferences based upon their own personal assessment of the student. Recommendations may be based upon multiple facets including personal attributes of the students. Translating such a system to India with a varied and difficult to regulate medical education system, however, is fraught with the concerns of nepotism and corruption influencing the selection process. This is coupled with the additional financial and time burden on the students for applying and traveling to various places to attend interviews. Another selection procedure would be a standard panel interview and/or an essay for interested potential candidates to assess for personal inclination and suitability for the specialization. However, English language proficiency and interview skills are likely to determine success in such a selection process, which might not be reflective of a resident's ability to provide patient care. Again, such a panel might be inundated by a large number of applicants if they are to provide an assessment on a national basis. Another solution to the selection process would be to have a separate examination for entrance to psychiatry residency programs, for example, as is being conducted by the National Institute of Mental Health and Allied Sciences, Bengaluru. The advantage of having a separate examination is that only those candidates who wish to take up psychiatry as a career would apply. However, one can speculate that separate national examinations for each postgraduate discipline would make selection process cumbersome for students especially if they have an undecided interest in two or more specializations. The examination schedules for more than one specialization may coincide and lead to students being forced to choose one specialization. Yet, another approach would be to introduce a separate additional paper assessing one or two specializations of choice along with the present common MCQ based paper covering all medical graduate subjects. This would force a candidate to choose selected specialization fields a-priori and prepare accordingly, and then take up the residency program at a place of their choice based upon the performance in the examination. This would enable residency programs to get residents who are interested in a particular field. The promises and caveats of various options of resident selection are enumerated in [Table 1]. | Table 1: Selection system of psychiatry residents in India: Present and alternatives
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Selection of students in psychiatry or any other specialization in the best scenario should not only assess knowledge, skills, and attitudes, but also other characteristics of the individual such as motivation, integrity, and ingenuity. A comprehensive assessment of all attributes is a utopian dream, constrained by practicalities of feasibility and impartiality. Selection of the best candidate for a resident position is a recursive question due to the lack of consensus of what constitutes the “best.”[1] The best candidates for specialization can be viewed from the perspectives of clinical care, academic teaching, research, administration, and advocacy. The ideal candidate for each role may be different, resulting in confusion about a common minimum set of desired attributes. Program directors around the world contemplate about an ideal resident selection process, without approaching completely satisfactory answers.[2] Moreover, selection procedures are indicative of potential, but not actual achievement.[3] The formative years of residency can also have a profound impact on the direction of career choices and experiences in the field. Hence, attention is required for devising an appropriate selection system.
Residency selection procedures need also to consider the practicalities of the local resources, social structure, and system of medical education. The selection process into medical education in India is entrenched in a competitive, score-based entrance examination to secure a position in government-funded medical schools, without needing to show “recommendations” or extra-curricular aptitude. This mindset continues to the completion of undergraduate medical training, and students often seek specialized coaching to crack the postgraduate competitive entrance examinations. A change from the present selection process of psychiatry residents in India would need a well-reasoned alternative approach that demonstrates the feasibility and promises better health-care providers. Such a scenario is unlikely to be encountered in the near future with the present alternatives previously discussed. Until then, a complete overhaul of the present selection process despite its limitations seems difficult to justify.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Provan JL, Cuttress L. Preferences of program directors for evaluation of candidates for postgraduate training. CMAJ 1995;153:919-23.  |
| 2. | Green M, Jones P, Thomas JX Jr. Selection criteria for residency: Results of a national program directors survey. Acad Med 2009;84:362-7. |
| 3. | Dawkins K, Ekstrom RD, Maltbie A, Golden RN. The relationship between psychiatry residency applicant evaluations and subsequent residency performance. Acad Psychiatry 2005;29:69-75. |
[Table 1]
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