On 2 November 2016, experts in psychiatry from Hong Kong, India, Indonesia, Malaysia, Pakistan, the Philippines, Singapore, Taiwan and Thailand (see Reference for further details on participating experts) gathered for a workshop entitled Unmet needs in medical education for young psychiatrists, conducted by Progress In Mind (Lundbeck Institute) at Kaohsiung, Taiwan, to discuss the unmet needs of young psychiatrists, particularly in Asia. Professor Norman Sartorius, President of the Association for the Improvement of Mental Health Programmes, delivered a keynote address to the workshop which consisted of presentations and group discussions supported by data obtained through pre-workshop surveys completed by participating clinicians. The following are highlights from this workshop.
The current content for postgraduate training in psychiatry consists mainly of theoretical and practical instruction on diagnostics and rules of classification, and the treatment, of mental disorders.1 This is supplemented by observational learning via shadowing of teachers and senior psychiatrists on day-to-day activities, and contact and incidental learning from health service staff.1 This spectrum of knowledge and skills development training is commonly observed in countries around the world, including Asian countries such as Hong Kong, India, Indonesia, Malaysia, the Philippines, Pakistan, Thailand, Taiwan and Singapore.1,2 In fact, this is extended to post-completion of training as a form of continuing medical education (CME).1,2
"There is a residency training for board certification for psychiatry trainees, and a Clinical Fellowship in Child and Adolescent Psychiatry and overseas training/education post-completion of training"
Prof. Dr Manit Srisurapanont (Professor at the Chiang Mai University and Executive Member of the Royal College of Psychiatrists of Thailand)
"We have a 5-year programme with inpatient and outpatient rotations, rotations at the psychotherapy clinics, continuity clinics, and in all the major sub-specialities of psychiatry, including forensic, addiction, child and adolescent, CL, psychogeriatrics, community psychiatry, emergency psychiatry. Rotations in general medicine and neurology are mandatory. Psychiatry trainees will need to take intermediate (MMed (Psychiatry) and/or MRCPsych) and exit exams. Following completion of training, there is on-the-job training, peer-review learning, participation in journal clubs, grand ward rounds and other CME activities."
Associate Prof. Dr Mok Yee Ming
(Consultant and Chief at the Department of Psychiatry, Institute of Mental Health, Singapore)
However, are young psychiatrists truly prepared for what they will face entering into clinical practice? Are they fully supported over time with the skills they need for their day-to-day activities?
In 2009, the Union Européenne des Médecins Spécialistes (UEMS) described the profile of psychiatrists as experts in their therapy area, clinical decision-makers, communicators, managers, health advocates, scholars and professionals.3 This accurately sums up the expectation of these clinicians, reflecting their daily tasks and responsibilities.1 Psychiatrists are expected to (1) possess a sufficient level of knowledge as a specialist and as a member of the medical profession, (2) have positive attitude concerning their profession and tasks and (3) possess the ‘skills of the trade’, including listening, social networking, leadership, managerial skills and treatment skills, a number of which may not necessarily be provided by their formal training.1 Professor Norman Sartorius, President of the Association for the Improvement of Mental Health Programmes, stated that “Skills on areas such as how to be a leader and manager, and how to network are lacking in the formal training curriculum”. The survey and discussion conducted with experts in this workshop further affirm this gap in the region.2
“We need to train young psychiatrists/psychiatry trainees to be advocating stakeholders, that is to know how to deliver ideas and they can get accepted.”
Dr Margarita Maramis, PhD
(Psychiatrist at the Department of Psychiatry, University of Airlangga, Surabaya, Indonesia)
“Leadership training and training of trainers (supervisors) in psychiatry are some areas for further improvement for medical education of young psychiatrists/psychiatry trainees”
Prof. Dr Nor Zuraida Zainal
(Head of the Psychological Medicine Research Group of University of Malaya [PARADIGM], President of the Malaysian Psychiatric Association, and Editorial member of the Malaysian Journal of Psychiatry)
In essence, trainees in psychiatry may chance upon a teacher who has the ‘gift of teaching’, or a senior psychiatrist with good management skills during the course of their training, but may not necessarily know how to replicate these skills without being provided with training relevant for these tasks and the tools that help their performance. Ways of teaching others and good management skills are examples of things that are currently taught through imitation or not at all.1 This underscores a critical unmet educational need of young psychiatrists today.
Unmet needs of young psychiatrists in Asia
Asia is a part of the world characterised by its great diversity. This is no different with respect to the specific needs of young psychiatrists in this region. Contributions from experts during the workshop revealed needs for training in soft skills for young psychiatrists that are not provided in formal training, such as subspecialty training and skills for research, literature reading and publishing (Figure 1).2