Post graduate training in medical colleges of India: Resident Physicians’ perspective

Statistical analysis

The data were organized in MS Excel file. The responses were analyzed and expressed as percentages. These percentage values were used to derive results. Likert scale (1-Strongly agree; 2-Agree; 3-Neutral; 4-Disagree; 5-Strongly disagree/1-Happy and satisfied, 2-Satisfied to some extent, 3-Not sure, 4-Unsatisfied, 5-Extreme stress/suicidal thoughts/1-Very Motivated, 2-Motivated, 3-Not Sure, 4-Sometimes motivated, 5-Not motivated at all/1-Very Safe, 2-Safe, 3-Not sure, 4-Some safety, 5-Not safe at all/1-Very much equipped, 2-Equipped, 3-Not sure, 4-Some equipped, and 5-Not at all) was used to access student’s perceptions on some issues [Tables 1 and 2, Appendix A].

Demographic details

The survey was taken up by 274 postgraduate students. Of these, 55.5% were males, 44.2% were females, and rest 0.3% belonged to others. The age group of respondents varied from 24 to 44 years with mean age of 29.5 ± 4.1 years. Most of these respondents (80.6%) were pursuing postgraduation course from medical colleges located at urban areas whereas 16.9% students were studying in medical colleges located in small townships. The rest were pursuing the courses in colleges located in rural areas.

The students were pursuing various postgraduation courses, namely – 61.3% were pursuing MD, 24.8% had taken up MS, 2.9% and 2.6% were enrolled for DM and MCh courses, respectively. Of these, 4.4% were pursuing diploma courses, 3.3% were registered for DNB courses, and the remaining were pursuing MSc, Senior residency, observership, and fellowship programs and private practice. About 47.8%, 27%, and 18.2% respondents were in 3^rd year, 2^nd year, and 1^st year junior residency program, respectively. Rest had completed their junior residency and were working as senior residents or pursuing super specialization, fellowship courses. Of these, majority of students (42.7%) were enrolled in government owned medical colleges and institutes. These respondents were in colleges which were run by central government (39.4%) and state government (21.9%). Some of these students were registered in autonomous institutes (10.6%) or affiliated to university (13.5%) or in private medical schools (12.4%). About 0.4% respondents were enrolled in defense institute.

Marital status results revealed that 54.7% of these students were unmarried or single whereas 43.8% were married and 1.5% were divorced/separated/widowed. Further 77.9% of them responded that they had no children and 22.1% of the candidates had children.

Academic information

Academic activities were organized at departmental level in majority of the medical colleges as accepted by 79.9% respondents whereas 20.1% students declared that there were no academic activities held in their departments. These activities were organized daily as reported by 25% students, on weekly basis as agreed by 34.9% students and on every month in case of 12.9% respondents. Of these, 9.6% students accepted that these activities were organized once in many months and rest responded that the activities are organized once in fortnight or over a period of 3 weeks in some cases. According to 67.8% respondents, journal clubs were organized by their department whereas 86.8% agreed that regular seminars were medium of post graduate academic activities. About 74.4% students voted for case presentation and 42.5% reported for group discussions as a part of their academic activities. The remaining participants responded that lectures, tutorials, mortality meets, clinical meets, bedside teaching, grand rounds, clinic-pathologic meets, classroom teaching, cadaveric dissection, and slide seminars were a regular part of their training. Of these, 3.3% students accepted that there were no post graduate academic activities organized by their departments. The teaching activities were in the form of didactic lectures (38.5%), small group teachings (62.3%) whereas 24.2% agreed for peer based learning as the main academic activity and 45.8% agreed that they were not taught by anyone and were self-taught.

Further, 72.8% respondents agreed that they were able to get enough exposure to cases as a part of their practical training whereas 17.3% could get some exposure and 9.9% students did not get any exposure. During practical sessions 68.4% respondents agreed that they were able to get enough hands-on opportunities (with patients) to learn and use their skills, 15.2% could get some opportunity whereas 16.4% of them did not receive any hands on experience during their training.

During their postgraduate training curriculum, the students are often exposed to multiple skill sets. 62.4% respondents agreed that they have frequent laboratory or unit rotations, 39% have been exposed to peripheral postings, 25.8% reported that they visit various labs, and 17% reported that they do not have any such exposure. Some of the remaining respondents accepted that they have rotations in other departments, OPD, OT, FNAC procedures, and visit to other reputed institutes in country.

Assessment was conducted quarterly as reported by 45.1% respondents, monthly as reported by 17.6% respondents, only at the time of completion of the course as reported by 25.6% participants. These included both subjective and objective pattern of assessment as replied by 44.1% participants, only subjective assessments were conducted according to 45.2% respondents whereas 6.3% students replied that they had only objective assessment. Practical assessments were in form of full experiments or cases as confirmed by 55.1% respondents, structured OSCE as replied by 40% students.

Emphasis on soft skills and ethics were laid during their training period according to 60.4% participants, 19.2% responded that they were sometimes emphasized on this part whereas 20.4% did not get any guidance on this aspect.

Mentor-mentee and faculty interaction

Receiving adequate supervision from faculty was reported by 56.8% participants, 23.6% participants answered that they could get guidance only sometimes whereas 19.8% were not supervised at all by their faculty during their training. Similarly, 58.6% of the participants reported they were comfortable while interacting with faculty and clarifying doubts at all times, 23.1% could interact only sometimes whereas the rest did not interact with the faculty. Of these, 48.9% participants responded that their supervisors demonstrated new techniques and skills, 28.9% agreed that they were sometimes demonstrated newer techniques whereas 22.2% did not learn new techniques from their mentors. In similar veins, 52.9% got appropriate and adequate feedback from their supervisors, 25% received feedback only sometimes while the remaining did not get feedback.

Research activities

Research activities are inseparable component of postgraduate training; however, only 54.1% participants were satisfied with the fact that they got adequate and appropriate guidance from the faculty for their thesis research and writing, 21.1% students were somewhat satisfied but 24.8% were not satisfied on this aspect. About 66.9% participants affirmed that they were taught basics of statistics and research methodology in their institute, whereas 33.3% students were not taught these basics and were either taught by their peers or they tried to study by themselves.

Further 77.8% of these participants agreed that they were encouraged to publish their research study in professional journals whereas 22.2% participants answered that they were not encouraged for the same. Similarly, 68.6% students were encouraged to participate in conferences/workshops/ training programs, 18.1% were allowed to participate in some selected events only and the rest were not encouraged for participating. As reported by 37.3% candidates that their department conducted CMEs regularly, 41.7% reported that their departments conducted such events once in a while and 21% stated that their departments did not conduct such events at all.

Institutional facilities

Adequate institutional amenities play an important role in postgraduate training. Financial support for promoting research activities in institute may help postgraduate students to pursue their thesis work. To this issue, 54.4% participants replied that they did not receive any grant, 30.1% students did not need funds for their thesis project, and 12.9% received funds and the remaining either had no idea of such facility or had applied for grants or did not start with their thesis work. Further, 75.5% respondents agreed that their institute has no provision for travel grants/funding to support their participation in academic events such as conferences, workshops, and trainings, 16.1% students received travel grants from their institutes, and 8.9% respondents were not sure about such grant support.

Institutional library facility were available in most of the institutes as responded by 82.2% participants; however, 17.8% participants answered that they could not avail the library facilities. In continuation, 45.8% agreed that their institute library had abundant electronic media/journals/ books available, 38.4% agreed that although they had such facility but in limited manner, and 15.9% responded their institute library did not have such facility.

Extracurricular activities act like a rejuvenating medium for students overburdened with their coursework assignments. However, only 44.3% participants accepted that their institutes encouraged such activities among students and faculty and 55.7% responded that their college did not promote such programs.

Mental health of students and employees is a key to success for any institute. Surprisingly only 20.7% respondents answered that their institute has deputed student counselor to take care of their emotional concerns whereas 51.5% responded on a negative note and the remaining had no clue or were not sure of such initiative from their colleges.

Further 46.5% participants confirmed existence of Resident’s Association in their institute to take care of issues faced by the residents whereas 45.8% participants answered that there were no association for addressing their problems and subsequently the remaining respondents were not sure about the existence of association.

The participants responded that they were entitled to 21.3 ± 10.8 leaves in a year on an average which included casual leaves, academic leaves, earned leaves, and medical leaves. Of these, only 56.5% respondents agreed that they could avail the entitled leaves, 32% answered they could avail the leaves sometimes whereas the rest responded that they were not allowed to avail their leaves and some stated that their pay was deducted for their leave.

Department facilities

About 67.2% participants stated that their departments have enough equipment for teaching and patient care whereas 20.3% accepted that they have the facility to some extent and 12.5% reported that their departments are not well equipped. Further, 69.4% accepted that their departments provide them with a proper place to work whereas in case of remaining participants they did not have proper working areas in their department. Interestingly, 60.1% agreed that newer technologies are used in their departments, and 36.2% did not agree with the same and remaining students responded that most of the equipment are not used or they need repair and have not been upgraded.

Efficiency of a department and its outcome is dependent on adequate manpower. However, only 25.2% participants strongly agreed and 26.6% agreed that their departments have adequate manpower, whereas 20.3% opted for a neutral response, 14.7% disagreed, and 13.3% strongly disagreed with the availability of adequate manpower in their departments [Table 1 and Figure 1].

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Figure 1:

Graphical representation of responses on work culture/ psychosocial factors.

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Further, 24.4% respondents strongly agreed and 28% agreed that their departments foster team work and healthy interaction; 25% of the respondents were neutral on this issue; however, 12.5% disagreed and 10% strongly disagreed about presence of such team work and interaction [Table 1 and Figure 1].

The postgraduate students were working 42–168 h/week on an average. About 51.8% study participants were of the view that the working hours/shift duties were managed efficiently by their departments, 19.1% voted that duties were managed to some extent by their departments but 29.1% were against such view and stated that their working duration was not adequately managed by their departments. Further, only 44.2% students could get adequate rest/sleep to be able to perform their duties effectively, 38.2% could get rest to some extent, and 16.6% could not get enough rest or sleep.

Other facilities

About 95.6% respondents replied that they were able to manage their financial requirements through the stipend earned during their training while 4.4% students did not receive any financial support during training. Institutional hostel accommodation facilities were utilized by 64.8% participants whereas 27% students were staying in rented apartments, 2.2% were staying in private hostels or as paying guests, and remaining were living in their homes. Furthermore, 63% students accepted that their institute have adequate food facilities, 28.1% responded that their institute have cafeterias which are not well maintained and the remaining students replied that there was either poor arrangements or no canteens available in their college premises. Similarly 65.7% students agreed that there are adequate sanitation facilities in their institute, rest replied that there are inadequate sanitation facilities in their premises.

Work culture/Psychosocial factors

Eustress promotes achievement of best performance in life. Similarly during postgraduate training period little stress along with a supportive working environment helps to improve a trainee’s output in practice. The results of the survey were disturbing on this aspect. Hardly 15.5% strongly agreed and 23.2% agreed that they were in a happy and satisfied mental state during postgraduation. Of these participants, 36.9% chose for a neutral response, whereas 18.1% disagreed and 6.3% strongly disagreed with the fact that they were satisfied and happy in their postgraduation period, instead they were under extreme stress [Table 1 and Figure 2].

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Figure 2:

Graphical representation of responses on work culture/ psychosocial factors.

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On a similar note, 27.7% strongly agreed and 31% agreed with the fact that they felt motivated towards their profession. About 17.3% of the participants gave a neutral reply to this whereas 15.1% disagreed and 8.9% strongly disagreed with their counterparts and did not feel motivated [Table 1 and Figure 2].

In addition to these, only 32.1% students strongly agreed and 29.5% agreed that they feel safe and comfortable in their work environment. Contrary to this, 14.4% students disagreed and 10.3% strongly disagreed about feeling safe while working whereas 13.7% students chose for a neutral reply [Table 1 and Figure 3].

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Figure 3:

Graphical representation of responses on work culture/ psychosocial factors.

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Further, 17% students strongly agreed and 22% agreed that they were able to maintain work life balance during postgraduation. Similar percentage (21.5% disagreed and 16.5% strongly disagreed) of students were not in coherence regarding this issue. Remaining 23% students chose for a neutral response on the subject [Table 1 and Figure 1].

Interestingly, 23.6% respondents strongly agreed and 29.2% agreed that they felt equipped to pursue their future career independently, whereas 12.5% disagreed and 11.1% felt that they are unequipped for practicing independently after their postgraduation. About 23.6% respondents had neutral opinion [Table 1 and Figure 3].

The survey revealed numerous suggestions for improvement from the respondents like number of faculty must be increased; there should be more interaction on one to one basis and in groups with faculty along with regular formative assessments. New equipment must be procured by departments to train the trainees and infrastructure must be strengthened. It was also emphasized that the students should be taught like MBBS students. There should be more involvement of faculty for postgraduate teaching. They also suggested for integrated CME with other departments so that knowledge sharing can improve their training. Students also suggested that faculty must trust students and not bully or humiliate them. The respondents suggested for a lighter environment among the consultant and residents. Residents should get the required support from the administration and consultants. It was also emphasized that facility for personal counseling must be made available for students. There must be safe environment to work without fear and faculty must show empathy to them and encourage them. Further mess, hostel and library facilities need to be improved as suggested by some respondents.