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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Mental Health of Foreign Medical Graduates in Tamil Nadu, India: A Mixed-methods Study
Correspondence Address :
V Karthikeyan,
Door No. 2/23, VSKN Nagar, Kaveripattinam, Krishnagiri-635112, Tamil Nadu, India.
E-mail: karthikeyanveerabadran@gmail.com
Introduction: Over the last five years in India, there has been a three-fold increase in the number of candidates taking the Foreign Medical Graduate Examination (FMGE). Foreign Medical Graduates (FMGs) have recently experienced the Coronavirus Disease-2019 (COVID-19) pandemic and wars/internal conflicts in the countries where they study.
Aim: To assess the mental health status of FMGs and analyse the associated socio-demographic, economic, and academic factors, as well as the impact of COVID-19 on their mental health.
Materials and Methods: This explanatory mixed-method study utilised a quantitative method (Phase 1- Self-administered questionnaire GHQ-12) followed by a qualitative method {Phase 2- Focus Group Discussion (FGD)}. The study included 169 FMGs doing their internship (academic year 2022-23) at Government Medical College Krishnagiri, Tamil Nadu, India, and their colleagues/batchmates who were willing to participate in the study. Descriptive statistics and student t-test were used to analyse the variables.
Results: In the present study, 99 (58.6%) study participants were male, 130 (76.9%) were in the age group of 23-25 years, and 114 (67.5%) belonged to the upper socio-economic class. About 80 (47.3%) respondents scored higher than the overall mean GHQ-12 score, indicating mental distress. FMGs who had not yet joined the internship reported significant mental health issues compared to those currently in internship. FGD participants felt a lack of confidence in patient care, academic burden, financial burden, family bereavement, and personal health issues were the impacts of the COVID-19 pandemic on their mental health.
Conclusion: Almost half of the FMGs in the present study were under stress, which could be attributed to the financial burden in the family, lack of academic confidence, and personal loss during the COVID-19 pandemic.
Coronavirus disease-2019, Depressive disorders, Internship, Stress disorders
The World Health Organisation conceptualises mental health as a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, engage in activities, learn effectively, work well, and contribute to their community (1). Medical students, who are exposed to hectic academic activities, prolonged course durations, and highly competitive exams, are at risk of compromised mental health (2),(3). In India, the number of FMGs appearing for FMGE has been increasing over the last decade (4).
The COVID-19 pandemic had a severe impact on the education of the majority of medical students. The stress and anxiety during the pandemic were relatively higher than usual, indicating a generalised deterioration of mental health (5). FMGs who pursued the course during the COVID-19 pandemic also faced restrictions during lockdown, which in turn affected their academics. The differences in academic and assessment methods between countries might also impact their performance. The pass percentages in FMGE for the years 2021, 2020, and 2019 were 24.5%, 16.4%, and 25.7% respectively (4). Additionally, it often takes multiple attempts to clear the FMGE. All these factors warranted an assessment of the mental health of FMGs returning to India.
Research work exploring the mental health of FMGs returning to India is lacking. The present study aimed to assess the mental health status of FMGs and evaluate the socio-demographic, economic, and academic factors associated with it. The impact of COVID-19 on the mental health of FMGs was also assessed.
It was an explanatory mixed-method study conducted from September 2022 to February 2023. The study utilised a quantitative method (Phase 1- Self-administered questionnaire GHQ-12) followed by a qualitative method (Phase 2- FGD). The study participants included FMG interns of the academic year 2022-23 at Government Medical College Krishnagiri, Tamil Nadu, India, along with their willing colleagues/batchmates.
Sample size: Based on a meta-analysis by Dutta G et al., which reported a pooled prevalence of depression among Indian medical students at 50% (6), the present study determined a sample size of 169 using a prevalence of 50% and a relative error of 15%.
The study was conducted following the guidelines of the Helsinki declaration and after obtaining clearance from the Institutional Ethics Committee (EC/NEW/INST/2023/15250). Data was anonymised to ensure confidentiality, and participants were given the option to seek help for any problems identified during the study.
Inclusion criteria: FMG interns of the academic year 2022-23 were included.
Exclusion criteria: Interns from the previous academic year who had not yet completed their internship (18 members) were excluded.
Procedure
Phase 1: A pre-designed and pre-tested questionnaire, along with the 12-item General Health Questionnaire (GHQ-12), was used to assess the mental health status of 169 FMG volunteers [7,8]. This questionnaire can assess non psychotic psychiatric disorders like depression and anxiety. Each item is rated on a bimodal scale (not at all-0, no more than usual-0, rather more than usual-1, much more than usual-1). The total score ranges from 0 to 12 [8,9]. The mean GHQ score was used as a cut-off point to determine the respondents’ level of mental health, with a higher score indicating poorer mental health [7,8]. The questionnaire also included socio-demographic, economic, and academic details.
Phase 2: Based on the findings from Phase 1, guidelines for FGDs were developed. Two FGDs were conducted among 10 purposively selected FMGs to explore the impact of COVID-19 on their mental health. The selection of these 10 FMGs was based on either their personal experience or their family members’ experience with COVID-19.
Statistical Analysis
The quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 16.0. Descriptive statistics were employed to analyse the socio-demographic, economic, and academic details. The association between variables and mean GHQ-12 score was assessed using the Student t-test. The FGDs were transcribed, and manual content analysis was conducted to generate themes.
Out of 169 participants, 99 (58.6%) were male, and 70 (41.4%) were female. The majority of participants, 130 (76.9%), were in the age group of 23-25 years. Most of them, 82 (48.5%), had a family size of four. 101 (59.8%) were urban residents, while 68 (40.2%) were rural residents (Table/Fig 1).
The majority, 101 (65.1%), completed their medical graduation in the Philippines. 19 participants (11.2%) completed their medical graduation in Russia, and 14 (8.3%) completed it in China. The remaining 35 participants (20.7%) completed their degrees in countries like Armenia, Ukraine, Kyrgyzstan, Guyana, Georgia, Moldova, and Mauritius (Table/Fig 1).
About 37 participants (21.9%) reported taking more than one attempt to clear FMGE. Out of the total respondents, 10 (5.9%) have not cleared the FMGE. Around 137 (81.1%) are currently doing an internship (Table/Fig 1). A total of 125 participants (74%) reported that their academic activities were impacted by the COVID-19 pandemic. Eleven (6.5%) participants reported increased screen time. Social media and mobile games were the most commonly reported mobile usage activities (Table/Fig 1).
The overall mean GHQ score among the study participants was observed as 5.5 with a standard deviation of 3.8. Since the mean value is 5.5, the authors considered 6 as the cut-off point to determine mental health status. In the present study, 80 (47.3%) respondents scored above the cut-off point, suggesting that the mentioned percentage of respondents were in mental distress.
The mean GHQ-12 score was significantly higher (p<0.05) among those who are currently not in an internship period compared to those who are currently doing their internship. The present study could not find any significant association between other socio-demographic, economic, academic variables, and mean GHQ-12 score (Table/Fig 1).
In the present study, 43 (43.5%) male and 37 (52.8%) female respondents scored above the overall mean GHQ-12 score. About 20 (51.3%) respondents in the 26-30 years age group, 22 (56.4%) respondents in the middle class, 9 (64.3%) respondents studied in China, 7 (70%) respondents who have not cleared FMGE, and 21 (56.8%) respondents who took more than one attempt to clear FMGE scored above the overall mean GHQ-12 score, indicating that they are in mental distress (Table/Fig 2).
In the FGD, the present study aimed to explore the impact of the COVID-19 pandemic on their mental health. As they mostly completed their medical graduation through online lectures, they reported a lack of self-confidence in patient care. Academic/financial burden and family bereavement had a huge impact on their mental health. They also reported personal health issues in the post-COVID-19 period (Table/Fig 3).
In the present study, 47.3% of the respondents scored above the cutoff point for the mean GHQ-12 score (>6), indicating that they were in mental distress. Similar findings were reported in a cross-sectional study by Jafari N et al., on the mental health of medical students in Iran. In their study, 49.5% of the students scored above the threshold on the GHQ-12 (>3.5), and the level of training significantly contributed to psychological distress (9). In the present study, the mean GHQ-12 score was also significantly higher among those who were not currently in an internship period compared to those who were currently doing their internship.
Another study titled “Pattern and correlates of depression among medical students: An 18-month follow-up study” by Mohammed S et al., in Kerala, India, showed that factors such as the course not being of the student’s choice, having an unemployed parent, alcohol use, and male gender were significantly associated with depression. Other socio-demographic variables were not significantly associated with depression (10). Similarly, the present study did not find a significant association between socio-demographic, economic, academic variables, and the mean GHQ-12 score.
A meta-analysis by Dwivedi N et al., (2014-18) found that the pooled prevalence of depression among medical students in India, using a random effects model, was 40%. Girls had a slightly higher risk of depression than boys (11). However, the present study did not find a significant association between gender and psychological distress.
A systematic review by Cuttilan AN et al., on mental health issues in Asian medical students (2000-2015) showed that the pooled prevalence of depression and anxiety disorders was 11% and 7%, respectively (2). In contrast, a systematic review and meta-analysis conducted by Jia Q et al., to assess mental health among medical students during COVID-19 revealed that the pooled prevalence of depression and anxiety was 37.9% and 33.7%, respectively (12).
These variations in prevalence patterns could be attributed to increased psychological distress due to the COVID-19 pandemic.
A cross-sectional study by Sidhana S et al., among medical students in New Delhi showed that factors such as gender, type of social support, family structure, and education of parents were not significantly associated with the prevalence of depression, which is consistent with the findings of the present study (13).
A meta-analysis conducted by Puthran R et al., among medical students shows that depression affects almost one-third of medical students globally, but treatment rates are relatively low (14). Similarly, in a systematic review by Rotenstein LS et al., the estimate of the prevalence of depression or depressive symptoms among medical students was 27.2%, and the prevalence of suicidal ideation was 11.1% (15). In contrast, the present study among FMGs returning to India shows that almost half of the FMGs are under stress, which could be attributed to the COVID-19 pandemic.
A study done by Venkatarao E et al., in Orissa showed that higher scores of depression, anxiety, and stress were associated with female gender, lower semester, younger age, and non-smokers (16). Similarly, in a narrative review of previously published research conducted by Mirza A et al., female medical students were found to have a higher prevalence of depression (31.5%) (17). However, the present study shows no significant association between age, gender, and other socio-demographic variables.
About 74% of participants in the present study reported that they had an impact on their academic activities due to the COVID-19 pandemic. During the pandemic, FMGs completed their courses mostly through online lectures while adhering to COVID-19 appropriate behavior. FGD participants expressed that they lost their self-confidence in patient care as they couldn’t interact with patients and had very few bedside clinics. These findings can help teachers in devising the internship curriculum accordingly.
The National Medical Commission (NMC) has set various competencies for Indian Medical Graduates (IMGs) who are expected to fulfill roles such as clinician, leader, communicator, lifelong learner, and professional (18). FMGs returning to practice in India should also acquire these competencies to effectively serve the community. Thus, the mental health of FMGs needs to be addressed more carefully.
Limitation(s)
The majority of participants (81%) were currently doing an internship. Only 32 participants (19%) who were yet to join an internship participated in the study. This study would have been more significant if a higher proportion of FMGs who have not cleared the examination were included.
Almost half of the FMGs were found to be worried, unhappy, and agitated, highlighting a neglected aspect of psychology that requires immediate attention and care. Various factors such as the pandemic situation, prolonged course duration, highly competitive exams, financial dependence/burden on the family, personal loss, and lack of confidence in clinical skills due to the online mode of classes have contributed to mental stress. To address this morbidity, counseling services must be made available and accessible.
The authors here sincerely thank and appreciate the efforts of the Foreign Medical Graduates who actively participated in the study.
DOI: 10.7860/JCDR/2023/63162.18274
Date of Submission: Jan 30, 2023
Date of Peer Review: Mar 03, 2023
Date of Acceptance: Jul 14, 2023
Date of Publishing: Aug 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 04, 2023
• Manual Googling: Jun 08, 2023
• iThenticate Software: Jul 11, 2023 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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