Indian Journal of Social Psychiatry

DEBATE/PERSPECTIVE/VIEWPOINT
Year
: 2022  |  Volume : 38  |  Issue : 2  |  Page : 114--117

Should psychiatrists in India engage in more research? Lessons from the West


Sanju George1, TS Jaisoorya2, Valsraj Menon3,  
1 Rajagiri Centre for Behavioural Science and Research, Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India
2 Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
3 Psychiatric Intensive Care Unit, South London and Maudsley NHS Foundation Trust, London, UK

Correspondence Address:
Prof. Sanju George
Rajagiri Centre for Behavioural Science and Research, Rajagiri College of Social Sciences (Autonomous), Rajagiri P.O., Kalamassery, Kochi - 683 104, Kerala
India

Abstract

To explore if psychiatrists in India carry out less research as opposed to psychiatrists of Indian origin working in the United Kingdom (UK), we carried out a small-scale survey of psychiatrists practicing in India and psychiatrists of Indian origin working in the UK. In light of the findings of this survey and from the three authors' experience of teaching, training, working, and engaging in research in India and the UK, we try to answer questions such as “why do psychiatrists in India carry out less research? Should it change, and if so how? What can one learn?” Here, we do not assume or advocate that one system (East or West) has all the answers. We merely wish to discuss the place of research in psychiatric training and psychiatric practice.



How to cite this article:
George S, Jaisoorya T S, Menon V. Should psychiatrists in India engage in more research? Lessons from the West.Indian J Soc Psychiatry 2022;38:114-117


How to cite this URL:
George S, Jaisoorya T S, Menon V. Should psychiatrists in India engage in more research? Lessons from the West. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Aug 16 ];38:114-117
Available from: https://www.indjsp.org/text.asp?2022/38/2/114/327826


Full Text



 Introduction



It is a common observation of the authors that psychiatrists in India publish less, possibly implying that they carry out less research, as opposed to psychiatrists of Indian origin working in the West (especially the United Kingdom [UK]). To verify this, we carried out a small-scale survey of psychiatrists practicing in India (n = 30) and psychiatrists of Indian origin working in the UK (n = 32). We chose a purposive sample of psychiatrists (in India and the UK), and they were asked to complete a simple questionnaire, with mostly yes/no questions and some open-ended questions. To minimize cross-cultural bias, we did not include British psychiatrists and only included Indian psychiatrists who had immigrated to the UK and were working there as psychiatrists. It is in light of the findings of this survey that we try to answer the questions – why do psychiatrists in India carry out less research? Should it change, and if so how? What can one learn? It is to be noted here that all the three authors have experience of working as psychiatrists in the UK and India [Table 1]. Our discussion is based on, apart from, our survey's results and the authors' experience of teaching, training, working, and engaging in research in India and the UK.{Table 1}

Although our study was limited to psychiatrists, the points being debated may be equally applicable across various medical specialties and its practitioners. We do acknowledge, at the very start, that direct comparisons between psychiatric practice in India and the West are fraught with limitations because of differences in medical and postgraduate education and training, working conditions, structure of psychiatric health care and its delivery, number of psychiatrists to population ratio, and so on. While thinking through the issue of psychiatry and psychiatric practice in India and the UK, it is worth noting the significant difference in workforce resources between the two countries: India has approximately 9000 psychiatrists at 0.75/100,000,[1] whereas the UK has 12,000 psychiatrists at 18/100,000.[2]

In this paper, we are not assuming or advocating that one system has all the answers. We merely wish to set fire to a debate on the place of research in psychiatric training and psychiatric practice, and to generate interest in ongoing research and develop a cadre of clinical researchers.

One of the most unambiguous findings of our survey was that very few psychiatrists in India as compared to the UK had engaged in research as principal investigator (PI) or co-PI (2–4/30 vs. 26–29/32). Consequently, psychiatrists in the UK had also published more papers (28–30/32 vs. 2–3/30). In our opinion, what was disheartening was that, despite the above observation, only five out of the thirty psychiatrists in India said that they would like to do more research and that psychiatrists (in general) should do more research, in contrast to all 32 psychiatrists in the UK. The common themes emerging from both groups of psychiatrists for answers to the question – what can encourage you to do more research – seem to be time and support, perhaps very simple yet the most pragmatic of solutions to the main question posed in our study.

 Why Don't Psychiatrists in India Engage in More Research?



In line with the findings of this survey, a quick glance at the psychiatric journals in India and/or the West makes it evident that very little research is being published by psychiatrists in India. Exceptions are psychiatrists working in the select few premier national academic institutions in the country and the top-ranked medical colleges.

Often-cited reasons for the above include lack of time, lack of support from management, competing priorities, high patient load, limited exposure to research during postgraduate training, and an overall “environment” in the work setting that is not conducive to good-quality research.

In our opinion, one key factor here is that the requirement to carry out research, and the support and incentives for it is very much an integral part of the job description of psychiatrist in the UK and in the West generally. This is further aided in the UK by the fact that almost all (with very few exceptions) psychiatrists work in the government sector (the National Health Service), often with affiliations to a local university or a medical school. This means the availability of “protected” and dedicated time set aside for research. Contrast this to a busy psychiatrist in India who has to work at least 6 days a week and run outpatient clinics on all days seeing around fifty patients a day. Dedicated time set aside for research and ensuring that this time and space is “protected” from clinical and administrative work is an almost alien concept in India. Just like, a 5-day working week is!

Other possible answers as to why psychiatrists in India carry out little research are discussed in the section on “what can be done to encourage psychiatrists in India to do more research?”

 Psychiatrists in India Carry Out Very Little Research: Should this Change?



Logic dictates that all psychiatrists should engage in more research because research drives learning, it quenches one's scientific curiosity, research enhances one's knowledge, it helps psychiatrists offer better quality of care to their patients, and so on. That said, the large majority (25/30) of psychiatrists in India answered NO to the question – “would you like to carry out more research?” This is interesting but disappointing too and could be dismissed as the collective mindset of those psychiatrists who have been part of a “system” has never been research conducive.

But being pragmatic and dispassionate, it is worth considering an alternative viewpoint, which is counterintuitive to the logic mentioned above. That is, to conclude that research is not every psychiatrist's cup of tea, nor is it necessary for all psychiatrists to engage in research. It may then be concluded that it is best to reserve research to a few academics who have the time, interest, and expertise, and can be given the support. Maybe it is time to consider a special interest group in psychiatry – “researchers in psychiatry.”

 How Can Psychiatrists in India Be Encouraged to Carry Out More Research?



Although we put forward the argument above that research should only be engaged in by those with a genuine interest and passion, this may not be possible for all as those working in medical colleges have mandatory requirements to carry out research and to publish scientific papers.[3] It is almost always the case that if matters are made compulsory, short cuts will be identified and quality can suffer as a result. Even in medical colleges in both the government and private sectors, there is no “protected” time to do research in spite of the expectation for publications to progress up the faculty “ladder.” Doctors in medical colleges not being enthusiastic about carrying out research is not for want of clear vision by the Government of India: to encourage research by medical professionals, a new Department of Health Research was set up in 2007. Later, in 2009, the Medical Council of India, made it mandatory that doctors have research papers for their career progression, and issued further clarification on the matter in 2015.[4],[5]

Some practical measures that could help change the present scenario are discussed briefly below. First and foremost, attempts to inculcate interest in research have to start early – at best, during undergraduate medical education and, at worst, during postgraduate training in psychiatry. Although it is presently mandatory for every postgraduate trainee in psychiatry to carry out research and to write up a dissertation, this is not always embraced heartily, nor does all such research translate into publications. Measures such as workshops on doing research and writing/publishing, training programs on research methodology, the ethics of research, writing research grant/fund applications, and courses on basics of statistics will be helpful. Right from the time of postgraduate training, a research-friendly atmosphere ought to be created in psychiatric settings including the provision of time, space, and facilities for research; support and guidance from senior academics; encouragement to network locally, nationally, and internationally; and opportunities to travel to conferences and meetings are some examples. A research-friendly postgraduate trainee is likely to turn into an academic in future, who then promotes research.

In our view, what is perhaps most important to have psychiatrists do more research is to provide them with the time and space to do so. There will always be severe and continuous pressure on a psychiatrist's time, but if quality research is to be done, “protected” time to do so is a must. How this can be done is for the psychiatrist to negotiate with the local administration and with colleagues in the department. No research is possible if a psychiatrist in busy carrying out clinical work 7 days a week! Research involves much more than finding time to write – it requires thinking time, reading time, networking time, traveling time, and time to collect and analyze data. This is a key difference between the West and India. Such dedicated time for research needs to be built into the weekly timetable of psychiatrists.

No one psychiatrist can carry out research in isolation; it is very much a team effort. It requires more than one individual, often needing teams from several institutions/centers across the state, country, and beyond. For this reason, it is a good idea to have a group/network/team of psychiatrists (with or without interested experts from relevant disciplines) working in research projects. Such like-minded professionals, with a good skill mix, can support each other and can enhance the overall piece of work. It is our experience that such a “culture” of work is uncommon in India.

Our experience in the UK leads us to believe that provision of incentives for research (including publications) can encourage more psychiatrists to do more research. This system of incentives is called the clinical excellence awards (CEAs) in the UK.[6] Here, financial rewards are awarded annually to consultants who carry out work that is considered “over and above what is expected of them.” Research is one category, in addition to innovative service development and service delivery, and teaching and training, that is specifically offered rewards. CEAs, more than being a financial reward scheme for exceptional work, are also seen as peer acceptance and recognition, with both these offering significant positive reinforcement.

Our survey had several limitations including its small sample, limited scope, and multiple cross-cultural differences. Nevertheless, to our knowledge, it is the first attempt at systematically exploring the topic of and comparing psychiatrists carrying out research in India and the UK.

 Conclusion



We are by no means claiming to have provided satisfactory or comprehensive answers to the questions addressed in this paper. Instead, we have merely highlighted some key issues and suggested possible ways forward. Despite the above, we hope to stimulate debate on the topic of should psychiatrists in India carry out more research. We close our “case” by emphasizing that it may be unfair to expect all psychiatrists to be enthusiastic about research. Although ultimately it ought to be one's personal choice and responsibility to engage or not in research, the wider psychiatric training “system” and “environment” need to be more research friendly in India. Despite the transcultural differences in the training and practice of psychiatry between India and the West, there are some ideas in the Western system that India could adapt and adopt. Let East meet West to facilitate cross-fertilization of research ideas and research projects, and more than that a “culture” of research during psychiatric training and psychiatric practice.

Acknowledgments

We thank all psychiatrists who took part in our survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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