P.G. Curriculum

              M.D. Psychiatry  Index

 

1. Goals
2. Objectives
3. Syllabus
4. Teaching Program
5. Posting
6. Thesis 
7. Assessment
8. Job Responsibilities
9. Suggested books
10. Model Test Papers

 

 

PG Curriculum 

MD Psychiatry

 

• The infrastructure and faculty will be as per MCI guidelines.

1. Goals

The goal of Post graduation (MD) course in Psychiatry is to produce a competent psychiatrist:

•  To equip the trainee with basic skills in psychiatry and scientific foundations in behavioral sciences.
•  Has acquired the competencies pertaining to psychiatry that are required to be practiced in the community and at all levels of health care system;
•  Is aware of the contemporary advances and developments in medical sciences as related to  mental health;
•  Is oriented to principles of research methodology; and
•  Has acquired skills in educating medical and paramedical professionals.

2. Objectives

At the end of the MD course in Psychiatry, the student should be able to :

•  Recognize the key importance of mental health in the context of the health priority of the country;
•  Practice the specialty of Psychiatry in keeping with the principles of professional ethics;
•  Identify social, economic, environmental, biological and emotional determinants of mental health, and institute diagnostic, therapeutic, rehabilitative, preventive and promotive measures to provide holistic care to patient;
•  Take detailed history, perform full mental status examination including detailed neurological  examination of the patient and make clinical diagnosis;
•  Perform relevant investigative and therapeutic procedures for the psychiatric patient;
•  Interpret important imaging and laboratory results;
•  Diagnose illness in patient based on the analysis of history, physical examination and investigative work up;
•  Plan and deliver comprehensive treatment for illness in psychiatric patient using principles of rational drug therapy;
•  Plan rehabilitation of psychiatric patient suffering from chronic illness 
•  Manage psychiatric emergencies efficiently;
•  Recognize the emotional and behavioral characteristics of patients, and keep these fundamental attributes in focus while dealing with them;
•  Demonstrate empathy and humane approach towards patients and their families and respect their sensibilities;
•  Demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities;
•  Develop skills as a self-directed learner, recognize continuing educational needs; use appropriate learning resources, and critically analyze relevant published literature in order to practice evidence-based psychiatry;
•  Demonstrate competence in basic concepts of research methodology and epidemiology;
•  Facilitate learning of medical/nursing students, practicing physicians, paramedical health workers and other providers as a teacher-trainer;
•  Play the assigned role in the implementation of national health programs, effectively and responsibly;
•  Organize and supervise the desired managerial and leadership skills;
•  Function as a productive member of a team engaged in health care, research and education.

3. Syllabus

3.1 Theory 

• General Guidelines. During the training period effort are always made that adequate time is spent in discussing mental health problems of public health importance in the country  The Patient – Doctor Relationship :
•  Human Development Throughout the Lifecycle
• Normality, Embryo, Fetus , Infant , and Child , Adolescence , Adulthood , Late Adulthood (Old Age), Death , Dying  , and  Bereavement .
•  The Brain and Behavior
•  Functional and Behavioral Neuroanatomy, Neurophysiology and
•  Neurochemistry, Neuroimaging, Electrophysiology, Psychoneuroendocrinology, , Psychoneuroimmunology , and
•  Chronobiology., Neurogenetics. 
•  Contributions of the Psychosocial Sciences
•  Jean Piaget , Attachment Theory , Learning Theory , Aggression , Sociology and Ethology , Anthrology and Cross-Cultural Psychiatry, Epidemiology and Biostatistics. 
•  Clinical Neuropsychological Testing
•  Clinical Neuropsychological Testing of Intelligence and Personality., Clinical Neuropsychological Assessment of Adults. 
•  Theories of Personality and Psychopathology
•  Sigmund Freud: Founder of Classic Psychoanalysis., Erik Erikson , Schools derived from Psychoanalysis and Psychology. 
•  Clinical Examination of the Psychiatric patient 
•  Psychiatric History and Mental Status Examination, Interviewing Techniques with Special Patient Populations, Physical Examination of the Psychiatric Patient., Laboratory tests in Psychiatry. Medical Record and Medical Error.
•  Signs and Symptoms in Psychiatry
•  Classification in Psychiatry
•  Psychiatric Classification ,  International Psychiatric Diagnosis 
•  Delirium, Dementia, and Amnestic and Other Cognitive Disorders and
•  Mental Disorders Due to a General Medical Condition
•  Cognitive Disorders Introduction and Overview , Delirium , Dementia ,  Amnestic Disorders Other Cognitive Disorders and Mental Disorders Due to a General Medical Condition 
•  Substance-Related Disorders
•  Substance-Related Disorders Introduction and Overview  , AlcoholRelated Disorders ,  Amphetamine (or Amphetamine-like)related
• Disorders  , Caffeine-Related Disorders  , Cannabis-Related Disorders ,
•  Cocaine-Related Disorders  , Hallucinogen-Related Disorders  , InhalantRelated Disorders ,  Nicotine-Related Disorders , Opioid-Related
•  Disorders ,  Phencyclidine (or Phencyclidine-like)related Disorders ,
• Sedative-, Hypnotic-, or Anxiolytic-Related Disorders ,  AnabolicAndrogenic steroid abuse
•  Schizophrenia and Other Psychotic Disorders
• Concept of Schizophrenia ,  Schizophrenia Scope of the Problem ,  Schizophrenia Genetics ,  Schizophrenia Environmental Epidemiology 
• Developmental Model of Schizophrenia  Neuroimaging in Schizophrenia Linking Neuropsychiatric Manifestations to Neurobiology  Schizophrenia Neuropathology  Schizophrenia Clinical Features and Psychopathology
• Concepts  Schizophrenia Cognition  Schizophrenia Sensory Gating Deficits and Translational Research  Schizophrenia Psychosocial
• Treatment  Schizophrenia Somatic Treatment  Psychiatric Rehabilitation 
• Schizophrenia Integrative Treatment and Functional Outcomes ,
• Schizophrenia Spectrum Pathology and Treatment , Other Psychotic Disorders , Acute and Transient Psychotic Disorders and Brief Psychotic
• Disorder , Schizophreniform Disorder , Delusional Disorder and Shared
• Psychotic Disorder , Schizoaffective Disorder , Postpartum Psychosis , Culture-Bound Syndromes with Psychotic Features , Psychosis Not
• Otherwise Specified , Treatment of Other Psychotic Disorders
• ,Schizophrenia and Other Psychotic Disorders Special Issues in Early Detection and Intervention 
• Mood Disorders
• Mood Disorders Historical Introduction and Conceptual Overview ,Mood
• Disorders Epidemiology , Mood Disorders Genetics , Mood Disorders
• Neurobiology , Mood Disorders Intrapsychic and Interpersonal Aspects , Mood Disorders Clinical Features  Mood Disorders Treatment of Depression , Mood Disorders Treatment of Bipolar Disorders , Mood Disorders Psychotherapy 

 Anxiety Disorders

• Anxiety Disorders Introduction and Overview , Anxiety Disorders Epidemiology , Anxiety Disorders Psychophysiological Aspects , Anxiety
• Disorders Neurochemical Aspects , Anxiety Disorders Neuroimaging , Anxiety Disorders Psychodynamic Aspects , Anxiety Disorders Clinical
• Features , Anxiety Disorders Somatic Treatment , Anxiety Disorders Cognitive-Behavioral Therapy   Somatoform Disorders

 Factitious Disorders

 Dissociative Disorders

•  Normal Human Sexuality and Sexual and Gender Identity Disorders
• Normal Human Sexuality and Sexual Dysfunctions , Homosexuality, Gay and Lesbian Identities, and Homosexual Behavior , Paraphilias , Gender
•  Identity Disorders , Sexual Addiction 

 Eating Disorders 

 Sleep Disorders

•  Impulse-Control Disorders Not Elsewhere Classified

 Adjustment Disorders

 Personality Disorders

•  Psychological Factors Affecting Medical Conditions
•   History of Psychosomatic Medicine , Gastrointestinal Disorders , Obesity,  Cardiovascular Disorders ,Respiratory Disorders , Endocrine and Metabolic Disorders , Psychocutaneous Disorders , Musculoskeletal
• Disorders , Stress and Psychiatry , Psycho-Oncology , ConsultationLiaison Psychiatry 
•  Relational Problems
•  Additional Conditions That May Be a Focus of Clinical Attention
•  Malingering , Adult Antisocial Behavior, Criminality, and Violence , Borderline Intellectual Functioning and Academic Problem ,Other
•  Additional Conditions That May Be a Focus of Clinical Attention 

 Culture-Bound Syndromes

 Special Areas of Interest

• Psychiatry and Reproductive Medicine , Premenstrual Dysphoric
• Disorder , Genetic Counseling , End-of-Life and Palliative Care , Death, Dying, and Bereavement , Physical and Sexual Abuse of Adults ,
• Survivors of Torture , Alternative and Complementary Health Practices ,
• Military and Disaster Psychiatry , Famous Named Cases in Psychiatry 
•  Psychiatric Emergencies
• Suicide , Other Psychiatric Emergencies 

 Psychotherapies

• Psychoanalysis and Psychoanalytic Psychotherapy , Behavior Therapy ,
• Hypnosis , Group Psychotherapy and Combined Individual and Group Psychotherapy , Family Therapy and Couple Therapy , Cognitive
• Therapy , Interpersonal Psychotherapy ,Dialectical Behavior Therapy , Intensive Short-Term Dynamic Psychotherapy , Other Methods of Psychotherapy , Evaluation of Psychotherapy , Combined Psychotherapy and Pharmacology 

 Biological Therapies

• General Principles of Psychopharmacology , Pharmacokinetics and Drug
• Interactions , Drug Development and Approval Process in the United States , Medication-Induced Movement Disorders , α2-Adrenergic
• Receptor Agonists Clonidine and Guanfacine , β-Adrenergic Receptor Antagonists , Anticholinergics and Amantadine , Anticonvulsants , Antihistamines , Barbiturates and Similarly Acting Substances ,
• Benzodiazepine Receptor Agonists and Antagonists , Bupropion ,
• Buspirone , Calcium Channel Inhibitors , Cholinesterase Inhibitors and Similarly Acting Compounds , Dopamine Receptor Antagonists (Typical Antipsychotics) , Lithium , Mirtazapine , Monoamine Oxidase Inhibitors ,
• Nefazodone , Opioid Receptor Agonists Methadone, Levomethadyl, and
•                 Buprenorphine     ,    Opioid     Receptor    Antagonists     Naltrexone    and
• Nalmefene, , Selective Serotonin Norepinephrine Reuptake Inhibitors, Selective Serotonin Reuptake Inhibitors , Serotonin-Dopamine Antagonists (Atypical or Second-Generation Antipsychotics) , Sympathomimetics and Dopamine Receptor Agonists , Thyroid
• Hormones , Trazodone , Tricyclics and Tetracyclics , Electroconvulsive
• Therapy , Neurosurgical Treatments and Deep Brain Stimulation , Other
• Pharmacological and Biological Therapies , Drug Augmentation ,
• Reproductive Hormonal Therapy Theory and Practice 

 Child Psychiatry

• Introduction and Overview, Normal Child Development, Normal Adolescence 
•  Psychiatric Examination of the Infant, Child, and Adolescent

 Mental Retardation

 Learning Disorders

• Reading Disorder, Mathematics Disorder ,Disorder of Written Expression
• and Learning Disorder Not Otherwise Specified 
•   Motor Skills Disorder Developmental Coordination Disorder

 Communication Disorders

• Expressive Language Disorder, Mixed Receptive-Expressive Disorder , Phonological Disorder , Stuttering , Communication Disorder Not Otherwise Specified 

 Pervasive Developmental Disorders

 Attention-Deficit Disorders

• Attention-Deficit/Hyperactivity Disorder, Adult Manifestations of AttentionDeficit/Hyperactivity Disorder 
•   Disruptive Behavior Disorders
•  Feeding and Eating Disorders of Infancy and Early Childhood 

 Tic Disorders

 Elimination Disorders

•  Other Disorders of Infancy, Childhood, and Adolescence
• Reactive Attachment Disorder of Infancy and Early Childhood, Stereotypic Movement Disorder of Infancy, Disorders of Infancy and Early Childhood Not Otherwise Specified 
•  Mood Disorders in Children and Adolescents
• Depressive Disorders and Suicide in Children and Adolescents, EarlyOnset Bipolar Disorders 
•  Anxiety Disorders in Children
• Obsessive-Compulsive Disorder in Children, Posttraumatic Stress
•  Disorder in Children and Adolescents, Separation Anxiety Disorder and Other Anxiety Disorders, Selective Mutism 

 Early-Onset Schizophrenia

 Child Psychiatry Psychiatric Treatment

• Individual Psychodynamic Psychotherapy , Short-Term Psychotherapies for the Treatment of Child and Adolescent Disorders , CognitiveBehavioral Psychotherapy for Children and Adolescents , Group
• Psychotherapy , Family Therapy , Pediatric Psychopharmacology , Partial Hospital and Ambulatory Behavioral Health Services , Residential and Inpatient Treatment , Community-Based Treatment , Psychiatric Treatment of Adolescents 

 Child Psychiatry Special Areas of Interest

• Psychiatric Aspects of Day Care , Adoption and Foster Care , Child
• Maltreatment , Children's Reaction to Illness and Hospitalization , Psychiatric Sequelae of HIV and AIDS , Child or Adolescent Antisocial
• Behavior , Dissociative Disorders in Children and Adolescents ,Identity Problem and Borderline Disorders in Children and Adolescents ,
• Adolescent Substance Abuse , Forensic Child and Adolescent Psychiatry 
• Ethical Issues in Child and Adolescent Psychiatry , School Consultation , Prevention of Psychiatric Disorders in Children and Adolescents
• Neuroimaging in Child and Adolescent Psychiatry , Child Mental Health
• Services Research , Impact of Terrorism on Children 

 .Adulthood

 Geriatric Psychiatry

• Overview , Assessment , Psychiatric Disorders of Late Life , Treatment of
• Psychiatric Disorders , Health Care Delivery Systems , Special Areas of Interest 
• Hospital and Community Psychiatry
• Public and Community Psychiatry, Health Care Reform, Role of the
• Psychiatric Hospital in the Treatment of Mental Illness , Psychiatric Rehabilitation 
• Psychiatric Education
• Graduate Psychiatric Education, Examining Psychiatrists and Other
• Professionals, An Anthropological View of Psychiatry 
• Ethics and Forensic Psychiatry
• :Clinical-Legal Issues in Psychiatry ,Ethics in Psychiatry , Correctional Psychiatry 
•  Psychiatry Past and Future
• History of Psychiatry, World Aspects of Psychiatry ,Future of Psychiatry 

 

3.2 Practical 

Diagnostic  Work up 

Detailed history and MSE to diagnose to patient along with   management plan. 

 ECT  

 Psychological Testing 

•  I.Q Test
•  Memory Test
•  Personality Test 
•    Psychological  Treatment   Psychotherapy
•  Behaviour Therapy 
•  Cognitive behaviour therapy
•  Neurological Examination 
•  Detailed neurological assessment   Findings of CT, MRI  E.E.G.

 

3.3. Skills

 History and examination.

•  History taking including present history, past, family, personal, psychosocial history, physical and mental status examination and application of the relevant psychiatry rating scales.

 .Bedside investigations. 

• Hemoglobin, TLC, ESR, peripheral smear staining and examination, urine: routine and microscopic examination, Viral markers, urine for screening for substances of abuse.
•  Interpretation of ECG, EEG, MRI findings; CT scan.
•  Understanding of  common EEG patterns,

Teaching Program

4.1. General Principles

• Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training is skills oriented. Learning in postgraduate program is essentially self-directed and primarily emanating from clinical and academic work. The formal sessions are merely meant to supplement this core effort.

4.2. Teaching Sessions

 Clinical case discussions :

•  PG bed side
•  Teaching rounds
•  Monthly Examination  Seminars/Journal club

 Interdepartmental Meetings

•  Others – Guest lectures/vertical seminars/Central Stat meets.

 

4.3. Teaching Schedule: 

The suggested teaching schedule is as follows:

	Item	Frequency
1	Case discussion	Once a week
2	Seminar	Once a week
3	Psychology seminar	Once a week
4	Psychopharmacology/Journal Club	Once a week

• 5       Central session (held in hospital auditorium regarding    Once a week various     topics like CPC, guest lectures, student seminars, grand round, sessions on basic sciences, biostatistics, research methodology, teaching methodology, health economics, medical ethics and legal issues) or teaching rounds at bed side.

Note: 

•   All sessions to be supervised by the faculty members. All PGs should attend the sessions except the ones posted in emergency.
•  All the teaching sessions to be assessed by the consultants at the end of session and marks considered for internal assessment.
•   Attendance of the Residents at various sessions has to be at least 75%.

 

5. Postings

• The postgraduate student rotates through emergency , O.P.D.  and  Ward posting. In addition, following special rotations are also undertaken:

Neurology  :                                              2 months 

Psychology:                                                  1 month

• During first year the resident will work under direct supervision of the 2/3 year resident/senior resident and consultant on call. S/he will be responsible for taking detailed history, examination of patients as per the file record and send appropriate investigations as advised by seniors. Initially all procedures are to be observed and then done under supervision of seniors and during 2/3 year can do procedures independently. In 2^nd year, resident should be 
• posted in special clinics also. In 3 rd year, resident is also encourged to make independet decisions in management of cases. S/he is also involved in teaching of undergraduate students.

6.  Thesis 

6.1.  Every candidate shall carry out work on an assigned research project under the   guidance of a recognized Postgraduate Teacher, the project shall be written and submitted in the form of a Thesis. 

6.2.  Every candidate shall submit thesis plan to the University within 9 months from the date of admission or as specified by the University .

6.3.  Thesis shall be submitted to the University six months before the commencement of theory examination i.e. for examination May/June session, 30^th November of the preceding year of examination and for November/December session 31^st May of the year of examination.

6.4.  The student will identify a relevant research question; (ii) conduct a critical review of literature; (iii) formulate a hypothesis; (iv) determine the most suitable study design; (v) state the objectives of the study; (vi) prepare a study protocol; (vii) undertake a study according to the protocol; (viii) analyze and interpret research data, and draw conclusions; (ix) write a research paper. 

7. Assessment

• All the PG residents will be assessed daily for their academic activities and also periodically. 

7.1. General Principles

•  The assessment is valid, objective, and reliable. 
•  It covers cognitive, psychomotor and affective domains. 
•  Formative, continuing and summative (final) assessment is also conducted in theory as well as practicals/clinicals. In addition, thesis is also assessed separately. 

 

7.2. Formative Assessment

• The formative assessment is continuous as well as end-of-term. The former is be based on the feedback from the senior residents and the consultants concerned. End-of-term assessment is held at the end of each semester (upto the 5th semester). Formative assessment will not count towards pass/fail at the end of the program, but will provide feedback to the candidate. 

7.3. Internal Assessment

•          The performance of the Postgraduate student during the training period should be monitored throughout the course and duly recorded in the log books as evidence of the ability and daily work of the student. Marks should be allotted out of 100 as followed.

                            Sr. No.                       Items                                                              Marks

  1.                     Personal Attributes                                                  20       2.                     Clinical Work                                                    20       3.                     Academic activities                                         20

4. End of term theory examination                20
5. End of term practical examination                        20         

 

1. Personal attributes:

 Behavior and Emotional Stability: Dependable, disciplined, dedicated, stable in emergency situations, shows positive approach.

 Motivation and Initiative: Takes on responsibility, innovative, enterprising, does not shirk duties or leave any work pending.

 Honesty and Integrity: Truthful, admits mistakes, does not cook up information, has ethical conduct, exhibits good moral values, loyal to the institution.  

 Interpersonal Skills and Leadership Quality: Has compassionate attitude towards patients and attendants, gets on well with colleagues and paramedical staff, is respectful to seniors, has good communication skills. 

 

2. Clinical Work:

 Availability: Punctual, available continuously on duty, responds promptly on calls and takes proper permission for leave. 

 Diligence: Dedicated, hardworking, does not shirk duties, leaves no work pending, does not sit idle, competent in clinical case work up and management.

 Academic ability: Intelligent, shows sound knowledge and skills, participates adequately in academic activities, and performs well in oral presentation and departmental tests.  

 Clinical Performance: Proficient in clinical presentations and case discussion during rounds and OPD work up. Preparing Documents of the case history/examination and progress notes in the file (daily notes, round discussion, investigations and management) Skill of performing bed side procedures and handling emergencies.

 

3. Academic Activity: Performance during presentation at Journal club/ Seminar/ Case discussion/Stat meeting and other academic sessions.

Proficiency in skills as mentioned in job responsibilities.  

 

4. End of term theory examination conducted at end of 1^st, 2^nd year and after 2 years 9 months

 

5. End of term practical/oral examinations after 2 years 9 months.

 

•   Marks for personal attributes and clinical work should be given annually by all the consultants under whom the resident was posted during the year. Average of the three years should be put as the final marks out of 20.

 

• Marks for academic activity should be given by the all consultants who have attended the session presented by the resident. 

 

•   The Internal assessment should be presented to the Board of examiners for due consideration at the time of Final Examinations. 

 

7.4. Summative Assessment

•  Ratio of marks in theory and practicals will be equal. 
•  The pass percentage will be 50%. 
•  Candidate will have to pass theory and practical examinations separately. 

 

A. Theory  Examination (Total =400)  

Title	Marks
Paper 1:  Basic sciences as applied to psychiatry	100
Paper 2:  Clinical Psychiatry	100
Paper 3:  Psychiatry Theory and   Psychiatry specialties*	100
Paper 4:  Recent advances in Psychiatry	100

B. Practical Examination and Viva voce (Total =400)

       Long Case (s) (1)   -      Psychiatry     

       Short Case (s) (2)          1 each Psychiatry & Neurology 

       Viva    

8. Job Responsibilities

OPD : History and work up of all cases and presentation to the consultants

 Indoors :Sending investigations and filling investigation forms and performing                    procedures  as Narco- analysis , Aversion therapy and E.C.T. 

Ward : History and work up of all cases

•  Examination of all patients and documentaion the files.
•  Daily Mental Status Examination of the patients
•  Applying  relevant  psychiatry rating scales
•  Completion of files 
•  Preparation of  discharge summary

 

9.Suggested Reading

9.1. Core Books

•  Comprehensive Text book of Psychiatry by Sadock & Sadock
•  Psychopharmacology by Stephen  M. Stahl
•  Fish’s clinical psychology
•  Psychology by Morgan and King.

 

9.2. Reference books

•  Textbook of Psychiatry by Wylie & Wylie
•  Organic Psychiatry by Leishman
•  Technique of Psychotherapy by Wolberg

 

9.3. Journals

•  Indian J Psychiatry            
•  British Journal of Psychiatry                 
•  American J. Psychiatry
•   Archives Journal of  Psychiatry
•  Journal of Clinical Psychiatry
•  Psychiatry Clinics of North America     

 

10. Model Test Papers