MBBS students are battling despair and depression in medical colleges

NEW DELHI: Following recurring incidents of suicides among medical students and young doctors, the National Medical Commission’s (NMC) anti-ragging cell, in April 2024, formed a 15-member national task force on the mental health and well-being of medical students. This was at the behest of various student and doctors’ associations regarding mental health in the medical education space.

The taskforce is conducting an anonymous online survey among medical students and young doctors to learn more about the issue. They are to submit a report by May 31.

Although students’ associations welcome the steps taken by the National Medical Commission so far, they insist on a more structured approach to looking after students’ mental health. A big priority, they say, is dealing with the “toxic workplace” created by senior doctors and faculty. They also said that most of the onus falls on medical colleges which remain a place of “exploitation”.

Medical student suicides

Suicide rates among medical students have been increasing over the past few years. The NMC, in reply to RTI activist Vivek Pandey’s queries in February 2024, said that 119 medical students have died by suicide in the past five years across 512 government medical colleges. This includes 64 undergraduate students and 55 postgraduate students. The NMC also said that over 1,100 medical students also dropped out of college during this time frame.

The National Human Rights Commission India (NHRC), in a meeting held on April 25, even called attention to the “long working hours and continuous shifts, lack of proper restrooms, hygiene, lack of rest” of doctors.

Medical interns and postgraduate doctors are often forced to work for 16-18 hours a day which, depending on the department they are working in, can even stretch to 48 hours of continuous work without sleep.

“The Indian Medical Association (IMA) had done a study among young doctors about the people afflicted with mental health [problems]. We found that the number one reason for mental health problems is departmental toxicity, humiliating students in front of patients, and long working hours,” said KM Abdul Hasan, former national chairperson, IMA Junior Doctors Network (JDN).

Depression is also common among students who work away from their home states due to bond policy. Several states enforce a mandatory rural service for medical graduates, including those from other states, in turn for letting them study in highly-subsidised medical seats. This mandatory service can range from three months to several years depending on the state.

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“States like Jharkhand, Chhattisgarh where the doctors are not available in rural areas follow the bond policy seriously. So what happens is that junior doctors who come from other states have to work there. Doctors from the state will go home but the ones from other states will be alone and they’re the ones that are facing a lot of issues.” said Hasan.

Organisational efforts, such as the counselling helpline created by the IMA JDN plays its part but medical students have been calling for more structured efforts.

“Since IMA JDN launched a 24x7 helpline for undergraduate and postgraduate students in December last year, we have received 22 calls for help from students that were facing serious issues such as suicidal tendencies. There were also countless other less serious cases,” said Hasan.

Medical Interns: Toxic workplace

Experts agree that one of the immediate problems that needs addressing is the bullying and harassment of young doctors at the hands of faculty or senior doctors.

“Senior doctors in India have a huge responsibility in ensuring that the next generation is mentally healthy. In the NHRC meeting, young doctors were criticising senior doctors and accusing them of bullying. Which is a reality. From IMA we have given guidelines to faculty to not bully and put pressure on students. NMC is also thinking about this,” said Hasan.

“I think this needs to be addressed as a priority because in a country like ours with 1.3 billion people, often the patient load will be high. So, a smile or a pat on the back from the senior doctor goes a long way rather than enduring the toxicity that they give off,” said Rohan Krishnan, national chairperson, Federation of All India Medical Association (FAIMA).

This also extends to sharing of work.

Organisations have been calling for senior doctors to put their hand up and take up their share of work so as not to overburden medical interns and postgraduate doctors.

“In major hospitals senior doctors only spend a little time, they come and make rounds and go. But the
interns and postgraduates are working 24x7. So, sharing work is very important. In private medical colleges work is shared between seniors and juniors but this is not the case in government colleges,” said Hasan.

The right direction

Medical professionals see the anonymous survey as a step in the right direction and one that they have been asking for years. The anonymity also ensures that students will be more open to sharing their troubles with the NMC.

“The good thing is that the anonymity of the students is maintained because usually what happens is that students have issues with their own professors and deans. This is also the disadvantage of the anti-ragging committee. In the anti-ragging committee, the members are usually faculty members of the same college,” said Krishnan.

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“We hope that proper examination of the records is done by the NMC and all the records are taken seriously. I also hope that NMC makes more collaborations with the medical organisations and other systems so that this can be more student friendly,” said Krishnan.

By the time the report is released on May 31, student organisations are hoping for more than mere guidelines.

“There should be a suicide prevention and mentorship programmes and these have to be structured at the medical college level. You cannot sit in Delhi headquarters and give directions, it has to be implemented and not just on paper. They should focus on streamlining medical education which is currently totally unstructured and totally confusing. There was a one-month foundation course that was started a few years back but has now been done away with more or less. There were also sports activities across colleges which are now abolished or removed,” said Shalabh Gupta, national president of IMA Medical Students Network (MSN).

Onus on medical colleges

Ultimately, all of this boils down to how colleges implement guidelines. Experts pointed out that NMC has many guidelines, including limiting the duty hours of medical interns to eight hours, that are not followed anywhere.

“NMC prescribes eight-hour duty for interns. But this is not followed in most colleges. Students fear they will be denied completing certificates if they don’t obey the colleges. So, they continue to work. This has to be strictly implemented but the ground reality is that this is not being followed. Currently, a kind of exploitation is happening in these colleges. The colleges see the students as under their control. It is also difficult for the NMC to deal with this,” said Hasan.

The responsibility falls on the deans and directors of the medical colleges to ensure a student-friendly workspace.

“Faculty need to self-improvise and check themselves. The colleges need to ensure that the faculties are in line because at the end of the day the NMC is just a body and there are more than 250 medical colleges with more than 1 lakh MBBS students and more than 50,000 postgraduate students. So, obviously the onus is on colleges,” said Krishnan.