A team of ten doctors from the beautiful mountainous state of Uttarakhand, representing their respective districts arrived in NIMHANS, Bengaluru on the evening of 14th March, 2018 to commence their ten day on-site training program at NIMHANS.

They included – Dr. Ajay, Dr. Lalit, Dr. Himanshu, Dr. Rajeev, Dr. Mani Bhushan, Dr. Amit, Dr. Aashish, Dr. Akhilesh and Dr. SD Barman.

Doctor full name

Workplace

District

Dr. Amit Rai

District Hospital

New Tehri

Dr. Rajeev Gairola

District Hospital

Rudraprayag

Dr. Lalit Bhatt

Primary Health Care centre

Igyardevi

Dr. Sumit Deb Barman

District Hospital

Uttarkashi

Dr. Akhilesh Yadav

District Hospital

Almora

Dr. Mani Bhushan Pant

Community Health centre

Gairsain

Dr. Rajesh Kumar Gupta

District Hospital

Champawat

Dr. Himanshu Kandpal

Primary Health centre

Dhari

Dr. Ajay Kumar

District Hospital

Haridwar

Dr. Ashish Gusain

Community Health centre

Ghandiyal

Day 1 – 15th March 2018

The program began with registration in the morning at 9 AM and the doctors received their training kits. An introduction to the training programme was given by Dr. BM Suresh and Dr. Naveen Kumar. Subsequently, the doctors visited the screening OPD to receive a live demonstration of psychiatric history-taking and mental state examination, demonstrated by Dr. N Manjunatha and Dr. Malathesh. This was followed by lunch and an introduction to the Clinical Schedules for Primary Care Psychiatry (CSP) presented by Dr. N Manjunatha. The doctors participated with sincerity and enthusiasm. The last session for the day was an overview of history-taking and MSE in psychiatry, a didactic presented by Dr. Guru S Gowda.

Day 2 – 16th March, 2018

The morning session was a review of the previous day’s training. This was followed by another live demonstration in the OPD by Dr. Karishma and Dr. Malathesh. The doctors also participated in patient assessment, identification of symptoms and making diagnosis using CSPCP. The doctors were provided with sample prescription which they could use for guiding treatment and follow-up plans. This was followed by inauguration programme presided over by the Director, NIMHANS Dr. BN Gangadhar and the Dean of Behavioural Sciences, Dr. SK Chaturvedi. Also in attendance were Dr. Pratima Murthy, I/C Head of the Department of Psychiatry and Dr. Prabhat Chand, Additional Professor. A video-conferencing link was used to connect with Dr Abhay Kumar, NHM Coordinator from Uttarakhand. This was followed by lunch and a didactic on depressive disorders along with a video demonstration of symptoms of depression and examination by Dr. Karishma.

Day 3 – 17th March, 2018

The morning session once again started with the previous day’s review. A live demonstration was performed in the Centre for Addiction Medicine OPD by Dr. Narasimha, Dr. Guru and Dr. Malathesh. The doctors were trained in assessment of substance use disorders – particularly alcohol and tobacco dependence along with brief interventions, detoxification and follow-up for the same.

This was followed by lunch and a didactic session on alcohol, cannabis and tobacco use disorders by Dr. Prabhat Chand and adaptation to primary care by Dr. Manjunatha. The day’s training ended with positive feedback by the doctors.

Day 4 – 18th March, 2018

Sunday – The day was used by the doctors to take a trip to Mysore to explore the historical city. The doctors then geared to complete one full week’s training from Monday.

Day 5 – 19th March, 2018

Once again, a review of the previous day’s training was performed. This was followed by in-person on-consultation training at the first contact OPD by Dr. Guru and Dr. Malathesh. The doctors had increasing confidence in the process of eliciting symptoms, making diagnosis and starting appropriate treatment. This was followed by lunch and then a didactic on Anxiety disorders in Primary Care by Dr. Manjunatha in which doctors participated enthusiastically asking lots of interesting and relevant queries to the speaker. A video demonstration of the examination was performed by Dr. Soumitra Das to end the day’s training.

Day 6 – 20th March, 2018

Following the previous day’s training review, a live demonstration of the on-consultation training using video-conferencing for training of primary care doctors in Mandya district was performed with two parallel sessions by Dr. Shashidhara, Dr. Vinay and Dr. Guru, Dr. Malathesh. Uttarakhand doctors are also had discussion with Mandya district doctors about nature of Tele-OCT and its benefits even discussed about technical /connectivity issue of videoconference. Lunch followed by a didactic on bipolar disorder by Dr. Prabhu Jadhav and schizophrenia and other psychoses by Dr. Naveen Kumar to cover severe mental disorders.

Day 7 – 21st March, 2018

On the seventh day, following review and feedback for the previous day’s training, the doctors had another in-person on-consultation training cum live demonstration in the follow-up OPD by Dr. Guru and Dr. Malathesh. This was followed by lunch and a teaching session on Perinatal Psychiatry by Dr. Sundarnag. The day ended with feedback session.

Day 8 – 22nd March, 2018

A group photo was taken in the morning with the doctors, the resource-persons and the Head of Department, Dr. Prabha Chandra. This was followed by field trip to Ramangara where doctors were accompanied by Dr. Karishma. On the way to Ramanagara, the doctors visited a PHC in Bidadi called Byramangala. They met and interacted with the Ramanagara DMHP team comprising of psychiatrist Dr. Adarsha, social worker, Mrs. Padmarekha and clinical psychologist, Ms. Sowmya. They also interacted with the PHC MO Dr. Raju for checking change in attitudes towards mental illness, referral system, treatment cards for patients, pharmacy, essential drugs available, mental health promotion and awareness etc. This was followed by a trip to district health office where Dr. Adarsha presented challenges in day-to-day functioning of DMHP along with innovative mechanism of overcoming them. The doctors interacted with the Ramanagara team and discussed problems and challenges unique to their state and manpower development needs to be focussed on was the conclusion reached by all. Subsequently the doctors visited the DMHP Unit OPD at the District Hospital of Ramanagara. This was followed by lunch at Janpada Loka in Ramanagara where the doctors had traditional north Karnataka meals. The day ended with return to NIMHANS.

Day 9 – 23rd March, 2018

The doctors received exposure and training in emergency psychiatry and physical treatments with live demonstration of ECT procedure by Dr. Milind, postdoctoral fellow in Non-Invasive Brain Stimulation. Live demonstration of emergency services was done by Dr. Harshit. Emergency addiction psychiatry was discussed by Dr. Lekhansh. 

This was followed by lunch and then a didactic on somatisation disorders in primary care followed by video demonstration of the same. A didactic on forensic and disaster psychiatry was presented by Dr. BM Suresh in the evening session which helped doctors to gain valuable insights into how to manage medicolegal cases as well as the new Mental Healthcare Act of 2017.

Day 10 – 24th March, 2018

Following review of the previous day’s training program, a didactic on child psychiatry was presented by Dr. Rajendra Madegowda, a DM resident in child and adolescent psychiatry. This was followed by valedictory function in which the doctors received their certificates from the Head of Department Dr. Prabha Chandra for successfully completing the ten days on-site training programme. A discussion on the reality of DMHP in Karnataka was presented by Dr. Rajani and final feedback was provided. The doctors expressed their feedback also and the on-site program having come to an end, further training over one year period was discussed. The doctors were then ready to return to Uttarakhand with fresh perspective to make a start to the DMHP there to be supported by NIMHANS for one year.

EVALUATION CRITERIA FOR THIS CERTIFICATE COURSE

Following evaluation criteria for each doctor to receive course completion certificate at the end of on year (tentative) are arrived with consensus of doctors

1. One case conference (collaborative & verified)

  1. One seminar (collaborative & verified)
  1. Twenty Five collaborative video consults
  1. Weekly patients audit of total and psychiatric disorders (TAP DAS)
  1. Weekly prescription audit of psychiatric medications
  1. Five cases of follow-up for at least 6 months
  1. Substantial attendance for v-CSD module
  1. Tele-OCT evaluation sessions at end of training and subsequently every 3-4 months (at least 3 evaluations)
  1. Delivery of at least One public initiative
  1. Designing at least One public education material.

TEAM BUILDING ACTIVITIES (Optional depend on ground reality)

  1. One more doctor referral from each trained doctor of their nearby place to encourage to participate for the three online modules especially women doctors which we believe reduce of burden to trained doctor and more number of doctors are trained.
  1. 4-5 v-CSD sessions are planned to key Pharmacists and Nurses of each doctors about psychiatry and psychiatric medications for maximising support to respective doctors

MANDATORY TECHNICAL REQUIREMENTS FOR ONLINE PARTICIPATION OF REMAINING THREE MODULES ARE

  1. A fully functional laptop with a printer
  1. Uninterrupted High speed broadband internet
  1. Free time to participates in these 3 modules especially v-CSD module on every/ fortnightly session from their place of convenience
  1. Encourage key pharmacists and nurses of each doctor to v-CSD sessions about psychiatry and psychiatric medications.
  1. Official letter (if implemented) on team building activities to participate in v-CSD session of their respective pharmacist and nurses
  1. Official letter (if implemented) on team building activities such as one more referral doctor and their pharmacist and nurses
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