Addressing unmet needs of young psychiatrists: A focus on Asia

Figure 1. Unmet educational needs in young psychiatrists in Asia, as identified from the workshop and pre-workshop survey.
A compilation of information about unmet educational needs highlighted by experts in psychiatry (n = 15) from Hong Kong, India, Indonesia, Malaysia, Pakistan, the Philippines, Singapore, Taiwan and Thailand (see Reference 2 for further information on participating experts) and gathered through pre-workshop. 

Among the unmet needs, acquiring skills of leadership, management and teaching were consistently mentioned as important areas for further improvement in education.1,2

“In Indonesia, despite the presence of 10 faculties of medicine with residents in psychiatry, some gaps in knowledge competency are still present among young psychiatrists in areas such as psychotherapy, forensics, and child and adolescent psychiatry, due to the lack of, and uneven distribution of, specialists and lecturers in this field.”
Prof. Dr Nurmiati Amir
(Psychiatrist at the Department of Psychiatry in Ciptomangunkusumo National General Hospital, Vice-chairman of the Section on schizophrenia of the Indonesian Psychiatric Association [IPA] and Scientific Coordinator on the bipolar disorder section of IPA)

Leadership
Training young psychiatrists in leadership skills facilitates their work in several areas. This include the engagement of staff in their daily task of patient care, and bringing forth talent and initiative in the people with whom they work.1 The wider impact, particularly pertinent in countries with few psychiatrists in practice, includes the ability to engage key stakeholders in programmes, and to leverage opportunity to participate in developing public health approaches to psychiatric issues and networks of care for mentally ill patients.1,2

Management
Skills in management are often not an element of formal teaching. These skills are usually acquired through experiential learning when psychiatrists are entrusted with leading team(s) and managing multiple tasks concurrently.1 Skills training supplemented by observational learning from seniors or teachers who are good managers would significantly support young psychiatrists entering or newly entered into clinical practice.1 

Teaching
Psychiatrists are expected to supervise trainee psychiatrists, train medical students and other staff, and educate family and/or care givers about living with a person with mental health issues.

“Young psychiatrists will become senior teachers in several years. They need to be equipped with better presentation skills and broader scope of knowledge in psychiatry. As such, any task or effort which could improve these two main targets will be highly appreciate by junior psychiatrists.” 
Prof. Dr Yan Kuang Yang
(Distinguished Professor at National Cheng Kung University & Hospital)

Teaching is a skill that, once acquired, has many valuable outcomes relevant to the future of psychiatry.1 Among them is the capacity to change the image of psychiatry and to attract students to select psychiatry as their profession – a task of great importance in view of the lack of psychiatrists in Asia, as highlighted by Professor Sartorius.1

Bridging the gap

There is a clear need to address the gap that remains in formal training. However, given the diversity in education in Asia, the first and foremost necessity is for Asian key leaders in psychiatry to drive and prioritise the standardisation of competences for young psychiatrists, as highlighted by both Dr Edgardo Juan L. Tolentino Jr, Chief of the Section of Psychiatry at Makati Medical Center and Immediate Past President of the Philippines Psychiatric Association, and Dr Chan Herng Nieng, Consultant at the Department of Psychiatry in Singapore General Hospital.

It is clearly important to provide skills training in areas that are currently not addressed through formal education. Discussions with therapy area experts indicated that the curriculum should be tailored to train young psychiatrists using skills that will help them to practice.2 These can be knowledge updates (as opposed to refresher courses), skills in the management of mental illnesses pertinent to the region, skills of appraisal in the critical evaluation of literature and social networking.2 The curriculum should equip young psychiatrists with skills in leadership, management and teaching.2 Furthermore, education should continue after these clinicians start their practice, to make certain that they are well supported.2 

To ensure the success of these educational initiatives, they should be engaging/interactive – leveraging the use of multimedia and technology – have a structured delivery and, importantly, provide participating psychiatrists the opportunity to accumulate CME points.2 Additionally, insights from Associate Prof. Dr Pornjira Pariwatcharakul, Associate Professor at Mahidol University, Thailand, revealed that the involvement of young psychiatrists in the delivery of educational initiatives has resulted in the development of more relevant content, better performance in all of their tasks, indicating the value of this approach. Experts also suggested that networking opportunities should be given special attention because it helps in continuing education, prevents burnout and would further encourage participation.2 

Support after the end of formal education maintains motivation and improves the performance of services. Education initiatives should therefore include future opportunities to meet and learn and connect young psychiatrists with their peers through initiatives such as collaborative research or interactions via an online platform.2

Working with industry to fill the gap: How can we best do it?

During the workshop, experts indicated that countries are generally open to potential educational collaborations with the pharmaceutical industry; however, there are country-specific restrictions and/or prerequisites that need to be met in order for this to work (see Reference 2 for further information on participating experts). Of interest was the fact that in a country like Thailand, the governing bodies of medical education appear to be more amenable to industry-supported education initiatives targeted at young clinicians versus trainees.2 It suggests that in some countries, there may be room for potential collaboration of professional societies and/or educational institutes with the pharmaceutical industry for education after the completion of formal training. 

Furthermore, discussions underlined concerns about the ability to achieve a balanced perspective with respect to education content.2 Industry-driven educational initiatives may focus on topics that are solely ‘LEADERS’-orientated (Leader, Educator, Advocate, Diagnostician, Expert, Researcher and “Social change agent”) or disease-oriented, and not drug-focused; the remaining educational needs should be achieved through industry-independent medical education initiatives.2 This highlights significant room for potential collaborations between professional societies, educational institutes and the pharmaceutical industry for the development of initiatives centred particularly on areas such as soft skills, research and publication – noteworthy unmet needs of young psychiatrists in the region. 

It is likely that useful and continuing education will best be achieved through collaborative and/or complementary initiatives from well-rounded professional societies, educational institutes and the pharmaceutical industry.2

References
  1. Norman Sartorius. Unmet medical education needs for young psychiatrists and trainees: a global perspective. Presented at Progress In Mind (Lundbeck Institute)-initiated workshop ‘Unmet needs in medical education for young psychiatrists’. 2 November 2016, Kaoshiung, Taiwan.
  2. Progress In Mind (Lundbeck Institute). Unmet needs in medical education for young psychiatrists. 2 November 2016, Kaoshiung, Taiwan.
    Participating experts from Asia
    Hong Kong:  Dr Tat-Lam Lo, William (Hospital Chief Executive, Kwai Chung Hospital; Chairman, The Mental Health Association of Hong Kong)
    India:  Dr Debashis Ray (Senior Consultant Psychiatrist, Apollo Gleneagles Heart Centre, Kolkata, India; Founder member of The Society of Bipolar Disorder [India])
    Indonesia: Prof. Dr Nurmiati Amir, Prof. (Psychiatrist, Department of Psychiatry, Ciptomangunkusumo National General Hospital; Vice-chairman, Section on schizophrenia of IPA; Scientific Coordinator on bipolar disorder section of IPA); Dr Margarita Maramis, PhD (Psychiatrist, Department of Psychiatry, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia; Chairman, Section on Bipolar and Mood Disorder of IPA)
    Malaysia: Prof. Dr Nor Zuraida Zainal (Head, Psychological Medicine Research Group of University of Malaya (PARADIGM); President, Malaysian Psychiatric Association; Editorial member, Malaysian Journal of Psychiatry)
    Pakistan:  Dr Fareed Aslam Minhas (Professor of Psychiatry, Head, Institute of Psychiatry, Rawalpindi General Hospital; Director, WHO Collaborating Centre Rawalpindi, Pakistan)
    Philippines:  Dr Josefina Tan Ly-Uson (Clinical Associate Professor and Attending Psychiatrist, Department of Psychiatry and Behavioral Medicine, University of the Philippines, College of Medicine and Philippine General Hospital); Dr Edgardo Juan L. Tolentino Jr (Makati Medical Center; Immediate Past President, Philippines Psychiatric Association)
    Singapore:  Dr Chan Herng Nieng (Consultant, Department of Psychiatry, Singapore General Hospital); Assistant Prof. Mok Yee Ming (Consultant and Chief, Department of Psychiatry, Institute of Mental Health)
    Taiwan: Prof.  Dr Yan Kuang Yang (Distinguished Professor, Department of Psychiatry and Institute of Behavioral Medicine, National Cheng Kung University & Hospital; The Society of Psychiatry, ROC [Taiwan]); Prof.  Dr Yuan Hwa Chou (Chief, Section of Community Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Clinical Professor, National Defense University; Vice President, 2nd Asian collegiums of Neuropsychopharmacology); Prof. Te-Jen Lai (Professor, Department of Psychiatry, Chung Shan Medical University & Hospital, Taichung, Taiwan; President of the Taiwanese Society of Psychiatry; Co-Chair of the PRCP 2016 organizing committee)
    Thailand: Prof.  Dr Manit Srisurapanont (Professor, Chiang Mai University, Department of Medicine; Executive Member, Royal College of Psychiatrists of Thailand); Associate Prof.  Dr Pornjira Pariwatcharakul (Associate Professor, Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University).
  3. Union Européenne des Médecins Spécialistes (UEMS). UEMS Section and Board of Psychiatry – Competency framework for psychiatry. 2009. Available at: http://uemspsychiatry.org/wp-content/uploads/2013/09/2009-Oct-EFCP.pdf (accessed January 2017).
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