Excessive duty hours pose risks to the physical and mental health of medics and also compromise patient safety, an NMC taskforce said while recommending that resident doctors work no more than 74 hours a week and get a day off every week.
Ensuring seven to eight hours of sleep daily for medical students is crucial for their mental and physical health and requests for leave should be judiciously considered and not unreasonably declined, the National Task Force on Mental Health and Wellbeing of Medical Students said in its report.
Collaborative planning of duty hours by heads of departments, faculty, senior residents and residents needs to be done and, if there is an increased clinical workload, the hospital or medical college should hire more senior residents and medical officers, it said.
"It is imperative to recognise that postgraduates and interns primarily serve educational purposes rather than filling gaps in healthcare staffing," it added.
Strict implementation of National Medical Commission (NMC) regulations on ragging is also mandatory, according to the taskforce report.
It emphasised that medical colleges should have active anti-ragging cells with strict penalties for offenders to mitigate the stress induced by ragging.
Medical colleges could consider granting a 10-day vacation at least once a year to both undergraduate and postgraduate medical students on a rotational basis, the taskforce said and unsderscored that this would allow the medics to meet their family members that could foster bonding.
It also called for appropriate conditions such as comfortable rest areas, nutritious meals and hydration facilities for medics during duty hours.
Hospitals should provide regular breaks and ensure food availability in duty rooms, it said.
The taskforce also recommended a gatekeeper training programme in medical colleges aimed at establishing a proactive network for identifying at-risk individuals and connecting them with professional help.
This programme will involve comprehensive training for participants to recognise warning signs and refer students to mental health services.
With the support of psychiatry departments, local protocols should be developed and the gatekeeper training programme initiated across the campus, involving all stakeholders, the taskforce said.
"Mental health education should be integrated into undergraduate and postgraduate curricula through lectures, workshops and seminars," it said in the report and recommended that medical teachers, students and the 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," it said.
It also called for abolishing fees for repeating semesters, saying this would reduce economic burden and stress.
Transparent and standardised grading systems and an independent appeals process are essential, it added.
For evaluation and assessment methods, it said "a fair and unbiased evaluation system is essential" and suggested that institutions could offer a mix of grading systems to reduce stress and promote a collaborative learning environment.
The task force also recommended introducing supplementary exams to reduce academic pressure and anxiety and for providing a fairer assessment system and supporting student wellbeing.
It suggested announcing exam results using roll numbers to enhance privacy, reduce stress and promote a fair academic environment.
Expanding postgraduate medical seats addresses healthcare needs, enhances specialist care and reduces student migration, the report said.
The taskforce also recommended abolishing seat-leaving fees or bonds.
Students who abandon their seats after admission should be prohibited from applying to medical colleges for 24 months from the date of leaving, it suggested.
Additionally, medical colleges can fill the vacated seat in the same category (government/management seat) in the next calendar year.
The report said a comprehensive orientation programme within four weeks for undergraduate students and two weeks for postgraduate students upon joining was essential for new entrants.
"This programme should introduce students to the medical profession, campus resources and the importance of physical, mental and spiritual health," it said and also recommended involving family members during the induction programme and periodically, at least once a year, reasoning that it would help them understand the expectations and stressors faced by medics.
This understanding would enable families to provide effective support and enhance the ability of students to cope with academic and clinical demands.
"Implementing a 24/7 support system, such as the TeleMANAS initiative by the Union Ministry of Health, is advisable. Medical colleges should have plans for referral, evaluation, management and follow-up for students with mental illnesses. Confidential, accessible counselling services must be widely promoted. Medical colleges should consider appointing at least two counsellors for every 500 students," the report said.
Medical colleges should provide free diagnostics and treatment, including medicines, for physical and mental health issues within the campus, it stated.
The taskforce also suggested that the NMC should establish a national portal for grievance redress, enabling secure and efficient complaint handling
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