2011)

SS12

Psychiatry Postgraduate Program in M alaysia :

Tailoring Training to Service Needs
Umi Adzlin Silim , Suarn Singh
1Psychiatrist, Department of Psychiatry & M ental Health, Hospital Kajang, Selangor,
2Consultant Psychiatrist and Director, Hospital Bahagia Ulu Kinta, Perak,
3National Technical Advisor for Psychiatry, M inistry of Health, M alaysia,
4National Conjoint Board for Postgraduate Psychiatry, M inistry of Health, M alaysia

Postgraduate training for psychiatry in M alaysia has gone through many stages since the
past 4 decades. A signicant development took place in year 2000 when a Conjoint Program
was established between three leading universities and the M inistryof HealthM OH. Being the
main mental healthcare provider, M OH participation is instrumental in shaping the nation s
future psychiatrists. As the mental healthcare system develops towards more balanced care in
the community with the expansion of many subspecialties; the Conjoint Program ensures a
standardized module, being revised 5-yearly as a continuous eort to tailor the training to the
current service needs. This 4-year program covers basic medical sciences, basic psychiatry,
clinical psychiatry and research. Training on psychodynamic and cognitive behaviour therapy
is provided hands-on for the trainees to conceive ideas and techniques relevant and applicable
to the culture and local practice. Besides general psychiatry,clinical rotations are structured to
give adequate exposure and to cultivate interest in the prioritized subspecialties such as community, geriatric, forensic, child, liaison, neuromedicine and addiction psychiatry. Components of
administrative psychiatry and research are emphasized. Supervision by designated psychiatrists
is complemented by continuous assessment done via case protocols on psychiatric disorders,
supervisors report and log book on clinical experience; all are the prerequisite for examinations. Succeeding M OH 3-year sub-specialization program will also be described. Throughout
this discussion,the strengths and the challenges in the training of the nation s future psychiatrist
who must be competent and independent enough to full the growing service needswill be
highlighted.
Key words: postgraduate training, psychiatry, subspecialty training

Introduction
Country Background
M alaysia is a developing country, with a
multi-ethnic population approaching 28 million.

ernment through the Ministry of Health

MOH
.
Funding and Legislative Provision
The funding for mental health system

Health care in M alaysia is provided byboth the

comes mainly from the government .

public and private sectors, steered by the gov-

might be resulted from the Mental Disorder

This

Post-graduate Training Programs to Curve a Good Psychiatrist

SS13

Ordinance 1952 which limited private sector

in function. Based from these hospitals, com-

involvement, particularly in inpatients treat-

munity care is developed to cater for acute

ment. More participation of the private sectors

home care,assertive community treatment and

is anticipated following the implementation of

follow-up services for patients with complex

the new Mental Health Act,eective from June

needs. Having said that, in April 2010, out of

2010. The new act promotes cooperation be-

5506 psychiatric beds in the MOH facilities,

tween government agencies and the private

459083.4%are still in the mental institutions

sector for the establishment of psychiatric hos-

while only 91616.6%are in the mainstream

pitals, nursing homes and community mental

hospitals. There are more to be done to for the

health centres .

advancement of mental health care in

Services

Malaysia .

The M OH is in the process of integrating

Workforce

psychiatric care with the mainstream general

One of the main challenges in this process

hospital and primary health care services .

is workforce limitation . As of April 2010,

One of the main agendas is to move forward

there are only 224 psychiatrists in Malaysia,

from the custodial care in the past to care in

with psychiatrist to population ratio of 1 to

the community at present and in the future.

122,000. It is still far beyond the recommended

This movement involves downsizing of the

ratio by the World Health Organization

psychiatric institutions and providing care near

WHOof 1 to 50,000. Of theses, 109 psychia-

to home.

Psychiatric care should be made

trists are in the MOH, 2 in the Ministry of

available in the health clinics for the outpa-

Defence,69 in the Universities and 43 in private

tients and in the general hospital for the inpa-

practice. Among the MOH psychiatrists, 31%

tients. This expansion of services and outreach

have subspecialty psychiatry training in Child,

to a larger population is made possible by a

Forensic, Community, Liaison, Neuropsy-

well structured National M ental Health Frame-

chiatry, Psycho - g eriatric,

work .

Epidemiology and Addiction. Overall there is

Facilities

also a shortage of trained paramedical and

As a result, in 2005, a total of 763 Health

Clinical

allied health stas .

Clinics88.9%already oered mental health

services in the community such as promotion of
mental health, long term management for sta-

Training Future Psychiatrist

Notably, inadequate human resource is

ble cases, and defaulter tracing . As in April

one well-established barrier to scaling-up of

2010, the government facilities providing psy-

mental health services . Mental health profes-

chiatric care include 37 general government

sionals, particularly psychiatrists are the

hospitals, besides the existing 4 psychiatric

leaders for mental health services and mental

Setting-up of new psychiatric

health development in most parts of the world.

institutions.

services in the general hospitals is a consistent

In the world which is rapidly changing,technol-

eort being carried out surely and eciently.

ogy which is advancing faster, mental health

In a 3 year period from 2007 to April 2010,there

problems are in a constant increase. World-

were 11 new psychiatric services started to be

wide, training future psychiatrists is always an

2011)

SS14

important agenda because trainees being

gram is now better known as the Conjoint

trained today are tomorrows leaders in psychi-

Program .

atry.
Although it is very obvious that the press-

The Conjoint Board was established between three leading universities oering post-

ing need in M alaysia is to increase the number

graduate training and the M OH. Being the

of psychiatrists,the quality must come togeth-

main mental healthcare provider,M OH partici-

er with the quantity being aimed for. Quality

pation is instrumental in shaping the nation s

is subjective but we can be assured that we are

future psychiatrists. The Conjoint Board devel-

in the right direction if we understand what we

oped a standardized curriculum, reviewed the

need and work to full those needs. Therefore

curriculum regularly, selected suitable candi-

training program has to be tailored to the needs

dates for the program, coordinated the pro-

of the country, achieved by understanding the

grams both in the universities and in the accred-

countrys background, the evolution of the

ited M OH training hospitals, and carried out

mental health system, the strengths and the

assessment and examinations.

limitations.

Since its establishment, the Conjoint Program for Postgraduate Training appeared to be

Postgraduate Program for Psychiatry

During the earlier era,doctors were sent to

a very innovative strategy. First, it works to

tailor training to the service needs. Second, it

the western countries for specialization train-

is carried out with a full understanding of the

ing and theyreturned home to develop psychiat-

limitations in the country, not to compromise

ric services in Malaysia. Since 1970s, psychia-

what we want to achieve,but to utilize,synerg-

trists have been trained locally to meet the

ize and optimize anyavailable resources for the

increasing demand in the country. The rst

best outcome possible.

local postgraduate training in psychiatry was

In terms of needs of the service, the Con-

pioneered by University Malaya with a small

joint Boardconsisted of experts from the

number of trainees. There was a slow increase

universities and senior consultants from the

in the number of trainees throughout the years

MOHsat together to develop a standardized

until about the year 2000 when a substantial

curriculum for the whole country. The analogy

number of candidates applied for the psychiat-

that can be applied is that if psychiatrists are

ric course and the course became more compa-

the products then MOH is the main consumer

rable to other popular branches of medicine .

of these products , therefore, the voice of the

As in April 2010, there are 81 trainees in the

consumers, followed by active participation in

postgraduate program for psychiatry .

the design and evaluation of the products will

generate an excellent outcome.

Conjoint Program : An Innovative Strategy

A signicant development took place in

The rst conjoint curriculum was ready by

2003 and immediatelybeing implemented bythe

year 2000 with the establishment of a profes-

three universities. The curriculum is reviewed

sional body at the national level, namely The

5-yearly, with inputs from the experts in the

Conjoint Board for Postgraduate Training in

conjoint board and feedback from the trainees.

Psychiatry. The postgraduate training pro-

It is a very important step,again to ensure that

Post-graduate Training Programs to Curve a Good Psychiatrist

SS15

the curriculum is always relevant and always

managing the department,budgeting of medica-

advanced to cater to the vision of mental health

tion, handling stas, and organizing activities

services. The rst review in 2008 brought in

related to mental health. Second, the govern-

changes related to the current service needs.

ment hospitals are the place where most people

For example, more structured syllabus for ad-

go for services. The trainees are exposed to a

ministrative psychiatry was planned and addi-

very rich clinical experience,and again it famil-

tional rotation of addiction psychiatry was

iarizes them to the type of cases commonly

formally included.

presented and the practical clinical manage-

As in April 2010, there are only 3 universi-

ment.

ties oering postgraduate program. Lining up,

In terms of academic advantages, trainees

there are 4 more universities preparing to oer

from dierent universities may reside together

the program. The conjoint curriculum contrib-

in a similar government hospital and this may

utes to expedite this process by being readily

encourage exchange of knowledge and informa-

available for implementation.

tion. Open-system learning promotes a good

The Conjoint Program, therefore, can be

networking between future psychiatrists as

seen as a collaborated eort taken by all psy-

well as between other disciplines in medicine in

chiatrists in M alaysia in training the future

the MOH setting. Open-system also provides

psychiatrists. Training program expands be-

training all over the country thus encourage

yond the universities and carried out all over

more enrolment of candidates.

the country. Roles of teachers and supervisors

The disadvantage is that the open-system

are not restricted to the lecturers in the univer-

is usually perceived as tougher bythe trainees,

sities but also being taken by psychiatrists in

compared to the close-systemfull-time in the

the mainstream service.

university
. The trainees are expected to work
full-time in busy hospitals; while studying,

Open-System Learning : A Way to Go

Besides the conjoint program,special men-

accomplishing assignments, taking examinations and conducting research. Adequate sup-

tion has to be given to this open-system

port from the head of department and other

method of learning. This method had been in

stas,excellent time management and perhaps

place even before the Conjoint Program,howev-

good negotiation skills are of paramount impor-

er, the function is further strengthened by the

tance for the trainees to survive the program.

Conjoint Program.

Given the countrys background and the

In the open-system learning, government

future direction that we are heading, open-

hospitals fullling standard criteria are being

system is the way to go. In the near future,the

accredited as training hospitals. There are a

available close-system may be revised and a

lot of advantages of the open-system learning.

rotational system may be proposed to ensure a

First, training takes place in the setting where

good balance of exposure in training for all

the trainees will work as psychiatrists in the

trainees.

future, thus trainees become familiar with the

organizational system.

Trainees can learn

hands-on on administrative skills such as

Conjoint Curriculum
The general objective of the curriculum is

2011)

SS16

Table 1 The 3 phases of the curriculum structure

Phase

Content

Placement

Basic Sciences and Basic Psychiatry 6 months in university

6 months in general hospital

Clinical Psychiatry& Research

1 year in university
1 year in general hospital

Consultant in Training & Research

1 year in general hospital

to impart knowledge and skills to candidates of

be capable to lead and cooperate with

the 4-year Postgraduate Programme in Psychi-

other sta members, for example the

atry, enabling them to function independently

clinical psychologist,medical social work-

as safe and competent psychiatrists. Being able

to function independently and competently is a

er, occupational therapist and others,

show good attitudes and a sense of respon-

very important objective because a new psychi-

sibility while discussing with colleagues

atrist graduated from the program may be sent

and while treating patients,

to work on their own. They may be required to

be skilful in handling discussions and in

set up a new psychiatric service in a new gener-

communicating with patients and their

al hospital single-handedly. M ore of them are

family members,

expected to develop a more sub-specialized

be capable in advancing themselves in the

service such as community service or addiction

current knowledge in psychiatryand keep-

service in the existing general psychiatric ser-

ing abreast with the latest developments

vices available.

in the eld of medicine in general,

The specic objectives outline what are

expected from a candidate throughout the
training process. It encompasses elements of

be able to undertake research activities in

psychiatry,
have the ability to function as a consult-

personal growth and leadership ability besides

ant who is eective in raising the levels of

academic and clinical competency. The candi-

expertise, practice and mental health

dates should :

standards in society.

have thorough knowledge in the eld of

psychiatryincluding basic sciencesand
sucient knowledge in the psychiatric
sub-specialities,
have broad knowledge in the elds of

Curriculum Structure
In order to achieve the objectives, the program consists of 3 phasesRefer to Table 1.
This 4-year program covers basic medical sci-

psychopathology, aspects of etiology,

ences, basic psychiatry, clinical psychiatry and

symptomatology, treatment and manage-

research.

ment,
be capable of taking a detailed history,

Basic Sciences are inclusive of topics on

Biostatistics and Epidemiology, Genetics, Im-

and carry out physical and mental state

munology, Neuroanatomy, Neurochemistry,

examination,

Neuroimaging, Neuropathology, Neuro-

Post-graduate Training Programs to Curve a Good Psychiatrist

physiology and Pharmacology. Basic psychiatry covers topics on Classication in Psychia-

Table 2 Academic& clinical posting and

the duration

try, History of Psychiatry, Phenomenology,

Phase

Psychiatric interview, Psychological assess-

Academic& Clinical Posting

Duration

Basic Sciences:
Basic Psychiatry:
General Psychiatry

1 year

General Psychiatry
Community& Rehabilitation
Forensic
Psychogeriatric
Addiction
Child Psychiatry
Neuromedicine

32 weeks
12 weeks
12 weeks
6 weeks
6 weeks
16 weeks
12 weeks

General Psychiatry
Consultation-Liaison
Elective

36 weeks
12 weeks
4 weeks

ments, Psychopathology, Transcultural Psychiatry, Communication skills, Psychological Sciences, Medical ethics, Medical Sociology and
Ethology.
Clinical rotations are structured to give
adequate exposure in clinical skills in general
psychiatry and subspecialties such as community, geriatric, forensic, child, liaison, neuromedicine and addiction psychiatry. The dura-

SS17

tion of the rotation varies according to the

weighed importance in their relation to the
current service needs Refer to Table 2
.

earlier,a freshly graduated psychiatrist may be

Exposures to prioritized subspecialties are

required to set-up new psychiatric services,

hoped to cultivate interests for future undertak-

therefore knowledge and skills in administra-

ings.

tive psychiatry are essential.

Besides the above, the curriculum covers

The syllabus

include topics on history, structure and or-

other components which are important to pro-

ganisation of dierent psychiatric settings,

vide the trainees with skills very relevant to

leadership and managerial roles as administra-

their future practice. These include training in

tor, networking skills, stadevelopment, plan-

psychotherapy, administrative psychiatry and

ning of psychiatric services, quality assurance,

research.

program evaluation, accreditation and regula-

Psychotherapy

tion of psychiatric facilities, budgeting and

Training on psychodynamic and cognitive

nancing of psychiatric services. A candidate is

behaviour therapy is provided hands-on for the

expected to apply the knowledge of administra-

trainees to conceive ideas and techniques rele-

tive psychiatry in planning and delivery of a

vant and applicable to the culture and local

high quality psychiatric service,to have compe-

practice. A candidate must conduct at least 10

tence in managing their future organization

sessions of each type of psychotherapy under

while handling administrative and clinical work

supervision. Following that,the candidate must

and develop good attitude and respect for all

write-up the sessions and submit as case proto-

categories of sta. Teaching methods include

cols.

seminar series, hands-on experience and

Administrative Psychiatry

involvement in departmental administrative

Following the rst review of the curricu-

activities. Assessment will be done continuous-

lum in 2008, components of administrative psy-

ly by the supervisors; and through the Consul-

chiatry are further emphasized based on the

tation Viva examination.

feedback from the trainees.

As mentioned

2011)

SS18

Research

skills, a candidate must develop professional

As it is now, the MOH psychiatrists being

qualities, managerial and leadership skills as

very inadequate in number are very much oc-

well as demonstrate the ability to become self-

cupied with the demand of clinical and adminis-

directed learners who are motivated to continu-

trative work.

ally improve their performance.

However, having a research

culture is very much a desired vision.

An

Therefore,the assessment tools used in the

emphasis on research work in the training of

program are devised to assess dierent areas of

future psychiatrists is hoped to cultivate this

competencies; consisting of supervisors re-

culture. Candidates are equipped with research

port, log book, case protocols and dissertation.

skills by attending intensive courses in research

The assessments are the prerequisite for exami-

methodology, application of software statistics

nations, or the prerequisite to proceed to the

and scientic writing before conducting their

following year in the year without examination.

own research. Submission of dissertation is to

The supervisors report must be submitted

be done at the end of the training program,

in a regular interval of 5 months,in a standard-

followed by oral thesis defence as the nal

ized format,giving a continuous assessment on

examination.

both professional development and personal

endeavour of a candidate.

Supervison

The case protocols must be written based

Supervision is fundamental in any training

on patients being managed and followed up by

program,especially when open learning method

the candidate for at least three months. The

is applied. A supervisor has two major roles:

case protocols cover important topics as fol-

1to establish a relationship that will help a

lows: 1schizophrenia,2anxiety disorder,3

trainee to be a self-directed learner and a

organic brain disorder, 4 mood disorder, 3

highly motivated individual; 2to objectively

forensic psychiatry 4 community psychiatry,

evaluate a candidates performance using ap-

5psychodynamic psychotherapy 6cognitive

propriate methods of assessment . The candi-

psychotherapy 7child and adolescent psychia-

dates are supervised by academicians or lectur-

try and 8addiction psychiatry.

ers in the universities when they are in the

Ultimately passing examination is an im-

universities; or specialists working in the

portant milestone in any educational process.

M OH when they are doing the rotational post-

There are 3 end-of-phase examinations con-

ing in the M OH hospitals or mental institutions.

ducted to evaluate a candidate, inclusive of

Accreditation of consultants or specialists in

theoretical and clinical componentsRefer to

the MOH is based among others on their com-

Table 3
.

mitment to teaching plus evidence of teaching

activities at departmental and hospital levels.

Award of Master of MedicinePsychiatry

Master of Psychological Medicine

Assessment and Examination

Assessment and examination are impor-

Award of M aster of MedicinePsychiatryMaster of Psychological Medicinedepen-

tant tools to validate a candidate s acquirement

ding on universitieswill be bestowed upon the

of skills and knowledge. Apart from clinical

successful completion of the course and on

Post-graduate Training Programs to Curve a Good Psychiatrist

SS19

Table 3 Assessment & Examination

Phase

Year

Supervisors Report
Log book
2 Case Protocols

Part I
Theory: M CQ, short notes
Clinical: 2 short cases

Supervisors Report
Log book
4 Case Protocol

Supervisors Report
Log book
4 protocols
Submission of research proposal

Part II
Theory: Essays,Critical Review Paper,
Short notes
Clinical: 1 long case, 2 short cases

Supervisors Report
Log book
Submission of dissertation

Part III
Thesis defence
Consultation Viva

Assessment

Examination

fullment of all the requirements of the Con-

subspecialist with for 2 years locally and often

joint Board and the university. In the end,with

followed by additional exposure in overseas for

the master degree, a M alaysian doctor is

a duration of 1 year .

qualied to hold a position as a psychiatrist in

Malaysia.

The Fellowship Training Program provides an advanced training for specialists to

acquire more expertise and prociency in re-

Subspecialty Training for Psychiatrists

As for subspecialty training, psychiatrists

spective subspecialties. To facilitate this,each

medical specialty under MOH establishes its

who wish to pursue in subspecialty must rst

own committee to be responsible in the plan-

full a few criteria. Theymust possess a recog-

ning, organization and supervision of the pro-

nized postgraduate qualication in psychiatry,

gramme. The members of the committee con-

have at least 4 years of supervised training in

sist of senior consultants in the subspecialties

psychiatry of which at least 1 year is after the

being oered.

postgraduate qualication and have a good

Training in the subspecialty areas can only

report from 2 senior psychiatrists or referees

be undertaken in approved posts in accredited

pertaining to their suitability in terms of inter-

training centres. Training must be supervised

est, experience and attitude. Lastly, the sub-

by ocially appointed supervisors who must

specialty being applied must be available and

ensure trainees obtain increasing responsibility

recognized.

and varied exposure in all areas of the sub-

The Subspecialty Training Program or

also known as the Fellowship Program for

specialty.
At present, subspecialties being oered in

specialists including psychiatrists in the

psychiatry are child, community, psychoger-

MOH is directly organized by the M OH. A

iatric, forensic, neuropsychiatry, consultation-

specialist wishing to further specialize under-

liaison and addiction psychiatry. As in April

goes supervised training under a consultant

2001, there are 11%n12psychiatrists from

2011)

SS20

2Hussain,H.,M uhsin,A.Z.: Training for future

the M OH in the subspecialty training, both

locally and in other countries .

psychiatrists: Postgraduate training in psychiatry in

M alaysia.A viewpoint from M alaysia.ASEAN Journal

Conclusion
While M alaysia has taken what can be
considered as a concerted eort towards developing a comprehensive program of postgraduate psychiatry training ; the process is

of Psychiatry, 9Supplement 1: 31, 2008

3Lancet Global M ental Health Group : Barriers
to improvement of mental health services in low-income and middle-income countries. Lancet,2007; Published OnlineSeptember 4,2007DOI : 10.1016 S0140-6736
07
61263-X

dynamic, evolving and in need of continuous

4M alaysia Country Report : Asia Pacic Com-

improvement. M eanwhile, expansion of train-

munity M ental Health Project Development.Asia-Aus-

ing to encompass subspecialtyareas is foreseea-

tralia M ental HealthAAM H, 2008

5M ental Health Act 2001. M alaysia

ble in order to keep pace with the advancement

6M inistry of Health Malaysia : National M en-

of psychiatry worldwide. Finally, we can be

assured on the training of the future psychiatrists in Malaysia,as long as we strategize to be

tal Health Framework 2001

7M inistry of Health M alaysia : The Annual
Report 2005

relevant to our needs; as well as realistic and

practical based on our strengths and limita-

8M inistry of Health Malaysia : The 20 Annual

M eeting of Psychiatrists. Ipoh, 2010

tions.

9 M inistry of Health : Fellowship Training Program. 2010http: medicaldev.moh.gov.my v2 uploads

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