however , studies have shown that there is a strong negative attitude among both fresh entrants to medical school as well as students who have completed their medical training . indian students have rated psychiatry significantly lower in regards to financially rewarding , enjoyment , work satisfaction , intellectual challenge , scientific basis , future prospects , etc . a study has shown that as medical students undergo training in psychiatry , their attitude toward it becomes less negative . however , this varies according to the intensity of training and exposure to psychiatry wards and procedures . paramedical students , especially nursing students are reported to have a significant negative attitude toward psychiatry ( atp ) and mental illness , which gradually improved in successive years of training in psychiatry . in india , there are only 22 theory lectures ( each of 1 h ) and 15 days clinical postings . psychology is not included in their curriculum and there is no separate exam in psychiatry . a study by rajagopalan and kuruvilla has found that this little exposure of mbbs students does not have much impact on their atp . on the other hand , physiotherapy ( bpth ) students have more intense training of full 1-year psychiatry and psychology as a separate subject along with clinical postings and separate exam paper for psychiatry . the present study was done to explore the difference in the attitude of students of these two different courses having significantly different training programs in psychiatry . to ascertain and compare the positive and negative atp in final year mbbs students and final year physiotherapy ( bpth ) students who have completed their respective psychiatry curriculum . to ascertain and compare the positive and negative atp in final year mbbs students and final year physiotherapy ( bpth ) students who have completed their respective psychiatry curriculum . the study was conducted in march 2015 at mgm 's medical college and hospital , aurangabad , maharashtra , with intake capacity of 100 mbbs students . there is an institute of physiotherapy in the same campus with intake capacity of 90 bpth students . we planned to approach all the final year undergraduate medical students and equal number of final year physiotherapy students for participation in the study . hence , our target sample was of 100 final year mbbs and 100 final year bpth students ( we also recruited those students who had failed in final year exam and are in odd batch , repeating the course ) , who have completed their respective psychiatry curriculum . out of these , we could recruit only 94 medical and 94 physiotherapy students on three different visits to their class rooms due to absenteeism of remaining ( both regular and odd batches ) . for both the groups , same teachers in the psychiatry department of a medical college in aurangabad impart theory and clinical training as per schedule by the university . mbbs students had undergone 22 h of theory teaching in psychiatry and 15 days ( 3 h each ) of clinical posting in psychiatry wards during their 6 and 7 semesters , whereas physiotherapy students had undergone 30 h of theory teaching in medical psychology in 1 year bpth and 32 h of theory teaching in psychiatry in 2 year bpth along with 15 days ( 3 h each ) of clinical posting in psychiatry ward . another important difference in two courses is physiotherapy students have to pass exam in psychology in 1 year and psychiatry in 2 year whereas medical students do not have psychiatry as a separate exam subject and even with internal medicine exam , only a short note is asked which is optional to solve . medical students ' attendance of psychiatry theory and clinics is clubbed with medicine and allied subjects for fulfilling minimum attendance criteria for appearance in examination , while for physiotherapy students , being a separate subject minimum attendance criteria applies exclusively to psychiatry and hence there is higher likelihood of them attending training in psychiatry . we visited classrooms of these students in between two lectures with prior permission from concerned teachers taking lectures . written informed consent was taken from each participant with promise of keeping their personal details anonymous . all the participants were provided with the predesigned and pretested questionnaire to record sociodemographic variables . it is a 30-item questionnaire covering the following eight dimensions of atp : ( 1 ) psychiatric patients , ( 2 ) psychiatric illness , ( 3 ) psychiatrists , ( 4 ) psychiatric knowledge , ( 5 ) psychiatry as a career choice , ( 6 ) psychiatric treatment , ( 7 ) psychiatric institutions and ( 8) psychiatric teaching . the questionnaire has a combination of both positively and negatively phrased statements with scoring in the likert format of 5 options ranging from 1  strongly agree to 5  strongly disagree . positively phrased items ( numbers 4 , 5 , 912 , 14 , 15 , 18 , 20 , 23 , 25 , and 2729 ) are reversed by subtracting the score from 6 . based on prior surveys in medical students , atp-30 total score of 90 is considered as neutral , score of < 90 suggests negative attitude , and score above 90 shows positive atp . this questionnaire has high face , concurrent , and construct validity with split - half reliability comparable to most of the attitudinal scales . nonparametric methods were used for statistical analysis as data were not normally distributed . for class variables , chi - square test or fisher 's two - tailed exact whitney / wilcoxon two - sample test ( kruskal  wallis test for two groups ) was used to assess differences between two groups . wallis h ( equivalent to chi - square ) was calculated and p value was set at 0.05 . we planned to approach all the final year undergraduate medical students and equal number of final year physiotherapy students for participation in the study . hence , our target sample was of 100 final year mbbs and 100 final year bpth students ( we also recruited those students who had failed in final year exam and are in odd batch , repeating the course ) , who have completed their respective psychiatry curriculum . out of these , we could recruit only 94 medical and 94 physiotherapy students on three different visits to their class rooms due to absenteeism of remaining ( both regular and odd batches ) . for both the groups , same teachers in the psychiatry department of a medical college in aurangabad impart theory and clinical training as per schedule by the university . mbbs students had undergone 22 h of theory teaching in psychiatry and 15 days ( 3 h each ) of clinical posting in psychiatry wards during their 6 and 7 semesters , whereas physiotherapy students had undergone 30 h of theory teaching in medical psychology in 1 year bpth and 32 h of theory teaching in psychiatry in 2 year bpth along with 15 days ( 3 h each ) of clinical posting in psychiatry ward . another important difference in two courses is physiotherapy students have to pass exam in psychology in 1 year and psychiatry in 2 year whereas medical students do not have psychiatry as a separate exam subject and even with internal medicine exam , only a short note is asked which is optional to solve . medical students ' attendance of psychiatry theory and clinics is clubbed with medicine and allied subjects for fulfilling minimum attendance criteria for appearance in examination , while for physiotherapy students , being a separate subject minimum attendance criteria applies exclusively to psychiatry and hence there is higher likelihood of them attending training in psychiatry . we visited classrooms of these students in between two lectures with prior permission from concerned teachers taking lectures . written informed consent was taken from each participant with promise of keeping their personal details anonymous . all the participants were provided with the predesigned and pretested questionnaire to record sociodemographic variables . it is a 30-item questionnaire covering the following eight dimensions of atp : ( 1 ) psychiatric patients , ( 2 ) psychiatric illness , ( 3 ) psychiatrists , ( 4 ) psychiatric knowledge , ( 5 ) psychiatry as a career choice , ( 6 ) psychiatric treatment , ( 7 ) psychiatric institutions and ( 8) psychiatric teaching . the questionnaire has a combination of both positively and negatively phrased statements with scoring in the likert format of 5 options ranging from 1  strongly agree to 5  strongly disagree . positively phrased items ( numbers 4 , 5 , 912 , 14 , 15 , 18 , 20 , 23 , 25 , and 2729 ) are reversed by subtracting the score from 6 . based on prior surveys in medical students , atp-30 total score of 90 is considered as neutral , score of < 90 suggests negative attitude , and score above 90 shows positive atp . this questionnaire has high face , concurrent , and construct validity with split - half reliability comparable to most of the attitudinal scales . nonparametric methods were used for statistical analysis as data were not normally distributed . for class variables , chi - square test or fisher 's two - tailed exact whitney / wilcoxon two - sample test ( kruskal  wallis test for two groups ) was used to assess differences between two groups . wallis h ( equivalent to chi - square ) was calculated and p value was set at 0.05 . mean age of medical ( mbbs ) students was 21.9 ( standard deviation [ sd ] = 0.7 ) years whereas that of physiotherapy students was 20.6 ( sd = 0.8 ) years . in medical students sample , 52 ( 55.4% ) were males and 42 ( 44.6% ) were females whereas that for physiotherapy , 11 ( 11.7% ) were males and 83 ( 88.3% ) were females . mean atp-30 score for medical students was 91.9 ( sd = 7.0 ) and that of physiotherapy students was 105.8 ( sd = 9.7 ) ; this difference in two groups was highly significant ( kruskal  wallis h = 81.3 , df = 1 , p < 0.001 ) . based on a neutral score of 90 , students were grouped into those with total score < 90 ( negative atp ) and those with total score more than 90 ( positive atp ) . of all medical students , 36 ( 41.4% ) had negative attitude while only 2 ( 2.1% ) of the physiotherapy students had negative atp (  = 41.7 , p < 0.001 ) . boys were 2.6 times more likely to have negative atp than girls ( relative risk = 2.6 , p = 0.005 ) . difference in the attitude of medical and physiotherapy students remains highly significant even when weighed for gender (  = 86.3 , p < 0.001 ) . there were significant differences in the attitude of two groups across the eight domains that atp-30 covers table 1 . mean scores of statements in atp-30 questionnaire for final year mbbs and final year physiotherapy students in general , physiotherapy group had higher scores ( indicating positive attitude ) on statements in each domains except on those related to psychiatric treatments where they had lower scores than medical group on a statement  psychiatric treatment causes patients to worry too much about their symptoms .  on a domain of  psychiatry as career choice ,  both groups had lower scores indicating negative attitude for psychiatry as the career option . we cross - checked the attendance of both groups for theory and clinical postings and found that majority of the medical students had attendance between 30 and 50% with very few above 80% , while most of the physiotherapy students had fulfilled required attendance criteria of 75% and 80% for theory and practical and had got their attendance signed by the head of the psychiatry department , which was sent to the university before exams . amount of training , designation as a separate subject for exam , and need to meet minimum attendance criteria are few factors that differed among the two study groups . negative attitude for psychiatry has been reported among both fresh entrants as well as those who have completed their medical curriculum . earlier studies have shown that attitude improves with training in the subject . in the present curriculum , medical students ' attendance in psychiatry training is affected by the fact that psychiatry does not have a separate subject exam , and there is no minimum attendance criteria specific for psychiatry . this has been reported to be an important hindrance in developing positive attitude toward mental illness as well as psychiatry . it has been reported that only 5% of the medical students have attended 50% or more of their allotted psychiatry training . the same study also found that this negative attitude does not change much even after completion of posting in the psychiatry department during internship . mental health needs of society in our country can not be met solely by specialists in the field . general practitioners and other specialists should have basic knowledge of psychiatry and psychiatric illnesses so that their attitude toward mental illness and mental health improves . our doctors of future if harbor such negative atp even after completion of their training , they may not be able to do justice to the mentally ill in society in general and patients in their own specialty in particular , as psychological factors play an important role in physical disorders . negative attitude for psychiatry as a career choice and toward scientific basis of psychiatry are also important findings replicated from previous studies . even those students with career interest in psychiatry were concerned about low career and social rewards in psychiatry . had reviewed the current status of psychiatric undergraduate training in india and suggested important changes in teaching methodology and assessment process . incorporation of these in training of medical students may improve their interest in subject to some extent . findings of the present study are good argument for positive impact of more detailed psychiatry curriculum with status as an exam subject for the undergraduate medical students which is a long - standing demand of the indian psychiatric society . it is interesting to see that medical humanities , medical ethic , and other subjects are being considered to be incorporated in medical curriculum , but not yet psychiatry . physiotherapy students , who hardly will be involved in direct mental health care , have psychiatry as a separate exam subject ( since 20142015 , psychiatry and psychology have been clubbed as one exam subject ) , then why not medical students will be an integral part of mental health care delivery in country ? our study highlights the importance of differences in training on attitude of students toward psychiatry . a well - planned psychiatry curriculum with separate exam in the subject definitely plays a role in developing positive attitude toward psychiatry . small sample size , involvement of single center , and cross - sectional study design are the obvious limitations of the present study . attitude is shaped by many variables such as sociocultural factors and upbringing , which have not been assessed in the present study . we tried to minimize informant bias by keeping pro forma anonymous and by using atp-30 which has a mix of positive and negatively framed questions . small sample size , involvement of single center , and cross - sectional study design are the obvious limitations of the present study . attitude is shaped by many variables such as sociocultural factors and upbringing , which have not been assessed in the present study . we tried to minimize informant bias by keeping pro forma anonymous and by using atp-30 which has a mix of positive and negatively framed questions .
background : negative attitude toward psychiatry ( atp ) among medical students is a serious concern . 
 some studies have concluded that after training in the subject , attitude changes toward positive side . 
 currently in india , medical students have a less intense course without separate exam or binding to attend training whereas physiotherapy students have more intense course with separate subject exam and binding to attend training in psychiatry.objective:to ascertain and compare the positive and negative atp in final year mbbs students and final year physiotherapy ( bpth ) students who have completed psychiatry curriculum.methods:this is a cross - sectional study with semi - structured pro forma for sociodemographic variables and atp-30 questionnaire to evaluate atp of 94 medical and physiotherapy students each . 
 nonparametric methods were used for statistical analysis with appropriate tests of significance and p value was set at 0.05.results:mean atp-30 score for medical students was 91.9 ( standard deviation [ sd ] = 7.0 ) and that of physiotherapy students was 105.8 ( sd = 9.7 ) , this difference in two groups was highly significant ( kruskal  wallis h = 81.3 , df = 1 , p < 0.001 ) . of all medical students , 36 ( 41.4% ) had negative attitude while only 2 ( 2.1% ) of the physiotherapy students had negative atp ( 2 = 41.7 , p < 0.001 ) . 
 boys were 2.6 times more likely to have negative atp than girls ( relative risk = 2.6 , p = 0.005).conclusions : physiotherapy students with intense and planned training in psychiatry as an exam subject have significantly more positive atp than medical students .