Existing global literature consistently recognizes that 30-40% of medical students report mental health problems. There is high prevalence of anxiety, depressive disorders, suicidal ideation, substance use disorders, as well as stress and burnout in this population; Integrating technology, such as Virtual Reality (VR), Augmented Reality (AR), Artificial Intelligence (AI), and Machine Learning (ML), into medical training enhances learning experiences and prepares students for technological adva
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Mumbai, August 18, 2024: Report of the National Task Force on Mental Health and well-being of Medical Students has been recently released by National Medical Commission. National Task Force on Mental Health of Medical Students report provides very important insights, findings and recommendations with regard to the well-being of medical students in India. The visionary leadership and unwavering guidance of Dr. B.N Gangadhar, Chairperson of the NMC, have been the driving force behind this initiative. A special gratitude has been extended to several doctors including Dr. Aruna V. Vanikar, Dr. Vijay Oza, Dr. Vijaya Lakshmi Nag, Dr. B. Srinivas, Dr. Ananda Pandurangi, Dr. Deepak B. Saxena, Dr N.S Harshavardhana, Dr. M Kishor, Dr. Prashant Kumar, and Dr. Rahul Saini and others.
Medical education is the mother of a country's healthcare system. The primary objective of a medical college is to provide education, knowledge, and skills. The provision of healthcare services is however a secondary function. This distinction is crucial, as the true essence of a medical college lies in its commitment to nurturing the next generation of compassionate and skilled healthcare professionals. Pursuing a career in medicine is a challenging yet rewarding endeavor. It requires early commitment, continuous perseverance, intense dedication, and significant emotional and financial investments. Aspiring physicians face high stakes and significant responsibilities, navigating the stringent expectations of medical colleges, society, their families, and themselves. Despite these challenges, this path is essential for shaping the future of healthcare.
Given the pervasive stressors involved in medical training, it is not surprising that medical students and doctors are at an increased risk of psychological distress and mental ill health relative to the general population. This is not merely a national phenomenon but a global one. Existing global literature consistently recognizes that 30-40% of medical students report mental health problems. There is high prevalence of anxiety, depressive disorders, suicidal ideation, substance use disorders, as well as stress and burnout in this population. Hence, a national task force was set up to assess the mental health and well-being of medical students in India and to suggest remedial measures.
National Task Force
Initially, the Task Force conducted a comprehensive review of scientific literature, which revealed a significant gap in systematic research on the risk factors and effectiveness of interventions for medical students who attempt or complete suicide. Currently, recommendations can be informed by valuable insights from broader research, including studies on the general population, high-risk groups, and individuals with pre-existing mental health conditions. Given the paucity of literature on risk factors and intervention-based studies concerning medical students, the task force employed three crucial methods to gather comprehensive data. First, in-person visits to various medical colleges were conducted, where focused group discussions were held with stakeholders such as medical college administrators, heads of departments, and students. These discussions aimed to identify best practices and challenges in providing mental health support to medical students.
Online Survey
Second, an online survey targeting undergraduate and postgraduate medical students, as well as faculty members, was conducted to collect a broad range of perspectives and insights on mental health and wellbeing. A total of 25,590 undergraduate students, 5,337 postgraduate students, and 7,035 faculty members responded to the online survey.
Third, the task force engaged and interacted with the representatives of Federation of Resident Doctors Association India (FORDA), Resident Doctors Association (RDA) and Association of Doctors and Medical students (ADAMS) for suggestions. Additionally, the task force integrated insights from several pivotal documents and engagements, including the Parliamentary Standing Committee's Report on the Quality of Medical Education in India 2024 (Report 157), the Mental Health Policy (2014), the National Suicide Prevention Strategy (2022), the National Crime Records Bureau (2023), Medical Council of India (MCI) rules, National Medical Commission (NMC) regulations, best practices from various medical colleges, and other relevant government documents.
Recommendations that are Universally Applicable Across Medical Colleges and Institutions
The environment of medical colleges is vital for fostering a healthy academic and work culture for students, faculty, and staff. A proactive and compassionate approach from the administration can significantly impact the mental health of medical students. By prioritizing mental well-being, institutions contribute to the success and resilience of future healthcare professionals.
Orientation Program at Joining
A comprehensive orientation program within four weeks for undergraduate students and two weeks for postgraduate students upon joining is essential for new entrants. This program should introduce students to the medical profession, campus resources, and the importance of physical, mental, and spiritual health. By prioritizing mental health and familiarizing students with available support systems, this initiative aims to create a supportive and well-informed environment from the outset of their medical education.
Involving Family Members
Involving family members during the induction program and periodically, at least once a year, would help them understand the expectations and stressors faced by medical students. This understanding would enable families to provide effective support and enhance the ability of students to cope with academic and clinical demands.
Anti-Ragging Measures
Strict implementation of the National Medical Commission (NMC) regulations on ragging is mandatory. Medical colleges should have active antiragging cells with strict penalties for offenders to mitigate the stress induced by ragging.
Awareness Campaigns and Education: Regular programs should educate students and faculty about mental health issues and available resources. Mental health education should be integrated into undergraduate (UG) and postgraduate (PG) curricula through lectures, workshops, and seminars. It is recommended that medical teachers, students, and administration should undergo regular training in mental health, either through periodic in-person sessions or online via the Swayam portal. The training modules should cover mental health, stress management, building resilience, prevention of substance use, gatekeeper training, and basic counselling techniques. Specific emphasis should be placed on handling confidentiality matters concerning individuals with mental illness.
Counselling Services:
Implementing a 24/7 support system, such as the TeleMANAS initiative by the Union Ministry of Health & Family Welfare, is advisable. Medical colleges should have plans for referral, evaluation, management, and follow up for students with mental illnesses. Confidential, accessible counseling services must be widely promoted. Medical colleges should consider appointing at least two counsellors for every 500 students. These counsellors should report directly to the Dean to ensure that preventive and promotive measures are actively implemented. Psychiatric referrals should only occur when the counsellors determine that a student requires psychiatric care.
Staff/Students Clinic
Medical colleges should provide free diagnostics and treatment, including medicines, for physical and mental health issues within the campus. Establishing separate wards, clinics, and investigation facilities for students ensures easy access to healthcare services.
Work Environment
Proper infrastructure and amenities are essential for maintaining the physical health and safety of medical students. This includes well maintained hostels, clean washrooms, safe drinking water, quality food, security measures, recreational facilities, and reasonable fees.
Hostel Mess
To accommodate diverse cultural, religious, and dietary preferences, hostel messes should involve students in menu planning and quality control.
Regulation of Duty Hours
The National Task Force recommends, based on feasibility, resources, and relevance, that residents work no more than 74 hours per week, with no more than 24 hours at a stretch. This includes one day off per week, a 24-hour duty, and 10-hour shifts for the remaining five days. Ensuring 7-8 hours of daily sleep for medical students is crucial for their mental and physical health. Collaborative planning of duty hours by HODs, faculty, senior residents and residents, needs to be done. It is imperative to recognize that post-graduates and interns primarily serve educational purposes rather than filling gaps in healthcare staffing. Requests for leave should be judiciously considered and not unreasonably declined. If there is an increased clinical workload, the hospital/medical college should hire more senior residents and medical officers.
Safe and Supportive Environment
Medical students should have appropriate conditions during duty hours, such as comfortable rest areas, nutritious meals, and hydration facilities. Hospitals should provide regular breaks and ensure food availability in duty rooms.
Supporting Families and Childcare
Medical colleges could consider providing onsite childcare facilities, family accommodation for married students, and daycare services. Supporting pregnant and postpartum students with academic accommodations, aligning with the Maternity Benefit (Amendment) Act 2017, is also beneficial.
Evaluation and Assessment Methods
A fair and unbiased evaluation system is essential. Institutions may offer a mix of grading systems to reduce stress and promote a collaborative learning environment.
Communication Feedback and Work Environment: Regular feedback from faculty and students enhances trust and fosters a healthy work environment. Addressing issues related to workload, hierarchy, or mistreatment is important to maintain inclusivity and respect.
Transparent and Responsive Grievance Redressal: Clear grievance redressal systems should address harassment and psychological stress. Training faculty and administrators on mentorship, accountability, and anti-harassment policies is essential. A feedback and complaint box should be available in both the Director/Dean's office and the warden's office.
E-Complaint Portal of NMC: The NMC should establish a national portal for grievance redressal, enabling secure and efficient complaint handling. A dedicated grievance redressal cell within the NMC should manage the workflow and ensure timely resolutions.
Mentor-Mentee Program: Mentor-mentee programs, as per NMC regulations, provide guidance and professional development opportunities. These programs should involve regular meetings, training for mentors, and support for mentees to promote mental health and resilience.
Removing Fees for Repetition of Semesters: Abolishing fees for repeating semesters reduces economic burdens and stress. Transparent and standardized grading systems and an independent appeals process is essential.
Teachers' Apprehension
Creating a supportive environment for teachers is crucial. Clear protocols for handling student complaints, promoting professionalism, and addressing false complaints can enhance teacher engagement and satisfaction.
Uniform PayScale, Retirement, Pension, and Rotational Headship (UPRPR): Standardizing pay scales, retirement and rotational headship policies across institutions ensures equity and attracts high-quality faculty. Prohibiting private practice for medical teachers and providing non-practicing allowances can maintain the quality & integrity of education.
Uniform PayScale for Medicos (UPS for Medicos):
In alignment with UGC pay scales and AICTE pay scales regulations, we propose AIIMS, New Delhi pay scale for all medicos. A uniform AIIMS, New Delhi pay scale structure for interns, postgraduate students, super-specialty students, and medical college teachers ensures equity and fairness in compensation, promoting job satisfaction and attracting high-quality faculty and students.
Uniform Retirement Policy (URP): The current retirement policy for medical faculty is inconsistent and disorganized. A standardized retirement policy nationwide, adopting the AIIMS, New Delhi retirement policy to be implemented. Uniform Pension Scheme for all Medical Teachers: The implementation of a Uniform Pension Scheme for all medical teachers is essential to ensure their financial security post-retirement. Such a scheme will enable them to dedicate their efforts towards teaching, mentoring, and research without concerns about
their future. Therefore, it is imperative to introduce a New Pension Scheme across all medical colleges. Uniform Policy of Rotation of Headship (URH): Implementing a rotational headship system for department heads is essential to introduce new ideas and practices, and prevent toxic environments under inefficient leadership.
Reducing Access to Means for Suicide: Implementing measures to limit access to dangerous means can prevent impulsive self-harm. Evaluating high-risk areas and enhancing security measures are essential. Family Vacation: Medical colleges could consider granting a ten-day vacation at least once a year to both undergraduate and postgraduate medical students on a rotational basis. This vacation would allow students to meet their family members and foster family bonding.
Gate-Keeper Training Program: A Gatekeeper Training Program in medical colleges aims to establish a proactive network for identifying at-risk individuals and connecting them with professional help. This program involves comprehensive training for participants to recognize warning signs and refer students to mental health services. With the support of the Department of Psychiatry, local protocols should be developed, and the gatekeeper training program should be initiated across the campus, involving all stakeholders. This initiative is crucial for fostering a supportive environment and enhancing mental health awareness within the medical college community
Increasing the Number of Postgraduate and Super-speciality Seats: Expanding postgraduate medical seats addresses healthcare needs, enhances specialist care, and reduces student migration.
Employing Adequate Number of Senior Residents: Medical colleges should hire more senior residents based on workload and patient care demands.
Policy Adjustments Regarding Bonds: Abolishing seat leaving fees/bonds and a compulsory rural service bond is imperative. Medical students who abandon their seats after admission should be prohibited from applying to medical colleges for twenty-four months from the date of leaving. Additionally, medical colleges can fill the vacated seat (UG/PG) in the same category (Government/Management Seat) as the student belonged to in the next upcoming calendar year.
Trial Observership/Externships/Residency: A trial observership or residency period provides firsthand experience of the college and department environment, helping students make informed decisions about their choice of field and institution.
Use of Technology in Training Medical Students: Integrating technology, such as Virtual Reality (VR), Augmented Reality (AR), Artificial Intelligence (AI), and Machine Learning (ML), into medical training enhances learning experiences and prepares students for technological advancements in healthcare.
Library Facilities: Digitizing library facilities and creating online access systems support academic development. Establishing reading rooms in hostels and extending library hours accommodate diverse study preferences.
Value-added Optional Courses: Introducing optional courses in various subjects allows students to explore diverse interests and develop multidisciplinary skills, thereby enhancing their academic and professional growth. These courses can be credited or non-credited and may be accredited by the medical college, university, State Medical Council, or NMC, New Delhi. This approach aligns with the principles of the New Education Policy.
Invited Guest Faculty: Inviting part-time faculty from various fields enriches the educational experience by providing diverse perspectives and mentorship without administrative burdens.
Clinical Linguistic Language Proficiency Policy: A comprehensive policy for linguistic proficiency ensures effective communication with local clinical populations, enhancing patient care and professional development. Supplementary Exams: Introducing supplementary exams reduces academic pressure and anxiety, providing a fairer assessment system and supporting student well-being.
Announcing Exam Results Using Roll Numbers: Using roll numbers to announce exam results enhances privacy, reduces stress, and promotes a fair academic environment.
Addressing the 'Ghost Faculty' Problem: Enhanced verification processes, regular inspections, and stringent penalties can address the ghost faculty issue, ensuring the integrity of medical education.
Centre for Training of Medical Teachers (CTMT): A comprehensive teacher training centre at both the national and regional levels is essential to elevate medical faculty into exemplary educators proficient in pedagogy, andragogy, online teaching, and various methods of imparting skills. Training medical teachers in stress management, mental illness, substance use, mental health first aid, and basic counselling techniques is essential.
Career Counselling and Campus Recruitment: Expanding career counselling to include diverse professional guidance and facilitating campus recruitment ensures medical students are well-prepared for various career paths.
Establishing Health Universities: Dedicated health universities or departments within general universities can ensure the effective implementation of NMC regulations and address the unique needs of medical education.
Establishment of the Centre for ICARED: A Centre for Innovation, Collaboration, Accelerator, Research, Entrepreneurship, and Medical Device Development (ICARED) fosters a culture of innovation and practical learning, preparing students for leadership in healthcare.
Liaison with Local Organizations: Medical colleges should liaise with professional organizations and community groups to develop a support network for students, enhancing their academic, professional, and personal development.
Yoga in Promoting Mental Health: Integrating yoga into students' lives can reduce stress, prevent mental illness, and develop resilience, promoting overall well-being.
Specific Suggestions for Medical Students, Families, and Faculty: Effective time management, social support, self-awareness, mindfulness, regular exercise, healthy habits, and seeking professional help are essential for maintaining good mental health. Family involvement and faculty support play crucial roles in student well-being.
Mental Health and Wellbeing Committee - At the national level, the Permanent Member of the National Medical Commission's (NMC) Ethics and Medical Registration Board (EMRB) should serve as the nodal person. At the medical college level, the Mental Health and Well-Being Committee needs to be structured as follows: the Dean must serve as the Chair, the Head of the Department (HOD) of Medicine, Surgery, Obstetrics and Gynaecology (OBG) to be designated as the Co-Chairs (three co-chairs), and the HOD of Psychiatry to act as the Member Secretary. Additionally, the HODs of each department should be members of this committee to ensure the implementation of these recommendations.
Enhancing Physical Fitness and Sports Activities: It is recommended that the college organize and maintain diverse sports activities, overseen by a sports Committee, with dedicated time allotted for physical activities.
Sāmājika Sanskriti Campus Council: The Sāmājika Sanskriti Campus Council aims to reduce social isolation and enhance well-being by supporting diverse social groups and activities within medical colleges. Headed by senior faculty and student representatives, it allocates resources for various cultural, recreational, and festival events. Regular evaluations and a quarterly newsletter foster community, making the educational environment more inclusive and engaging.
Recommendation for High-Risk Group Identification and Referral Implementing periodic faculty training and informal methods for early detection of at-risk students ensures timely intervention and support, enhancing student well-being and academic success.
Peer Support System: Task force proposes a comprehensive Peer Support Model in medical colleges, leveraging senior students to support juniors, aiming to improve mental health, provide academic and emotional support, and prevent suicide. The program includes safe spaces, anonymous reporting, professional support integration, mental health awareness campaigns, and suicide prevention workshops. Regular feedback and evaluations will ensure effectiveness and inform adjustments.
Deaddiction Services: Students dependent on substances should be encouraged to seek help while maintaining confidentiality rather than be reprimanded. This policy focuses on health and recovery, acknowledging that substance dependence is a health issue requiring professional intervention. Ensure that de-addiction services are readily accessible to students on campus will help address the problem in its initial stages.
Recommendation for Students with Mental Illness or Attempted Suicide
Supportive and Inclusive Environment: Every medical college must establish a Department of Psychiatry with sufficient psychiatrists, counsellors, nurses, and support personnel. A crisis intervention strategy shall be in place to inform and involve immediate family members during mental health crises such as attempted suicide and mental health emergencies. Creating a supportive environment with accessible mental health services, family involvement, and academic accommodations promotes the recovery and well-being of students with mental health issues. Offer necessary academic accommodations and support structures to assist students with mental health challenges.
Fitness to Practice Protocol: Medical Students with Mental Illness: Establishing a clear protocol for evaluating fitness to practice for medical students with mental illness ensures, patient safety and supports student well-being. An evaluation Committee should be formed to assess fitness to practice. The committee should comprise the following members: the Dean (as Chair), a psychiatrist, a faculty member from forensic medicine, the Head of the Department (HOD) of the concerned department, and a female faculty member. An appeal panel also needs to be established. There should be an aim to balance the rights and well-being of medical students with mental health issues against the imperative to maintain patient safety and quality care at the medical college. Mandatory Reporting of Suicidal Attempts and Death by Suicide: Enforcing mandatory reporting of suicide attempts and deaths by suicide ensures data collection, accountability, and the development of targeted interventions for mental health support. By implementing these recommendations, medical colleges can create a supportive, inclusive, and effective environment that enhances the mental well-being and academic success of medical students, ensuring a healthier future workforce.
