Call for better care

MENTAL health education must be strengthened to promote mental health literacy in all medical programmes offered here.

And the social determinants of mental health should be integrated into the medical curriculum, said the Malaysian Medical Association (MMA).

Its president Dr Koh Kar Chai, who made the call, said students must be equipped with the knowledge and skills to take care of their own mental health.

This will only be possible if they are taught self-care, stress management and healthy coping skills during their undergraduate days, he said when commenting on poor mental health among medical students.In 2019, studies by Universiti Putra Malaysia (UPM) and Universiti Malaya (UM) found that medical students were prone to depression, anxiety and stress (see infographic).

The studies titled “Risks of Mental Problems Among Medical Students in a Public University in Malaysia” and the “Anxiety, Depression and Quality of Life of Medical Students in Malaysia” highlighted the worrying mental issues students were facing in the course of their studies.

Dr Koh said medical students must also be taught to spot the red flags and telltale signs of mental illness among their peers so that early intervention and support can be provided.

“Provide accessible, confidential and effective mental health support services for all students.

“Teaching hospitals should, where necessary, provide priority access to psychiatric services, and medical universities should look into establishing a psychological first aid programme.”

These measures, he told StarEdu, would help empower students to be psychological first responders to their peers, friends and family, and provide those who are more comfortable engaging with their peers an alternative to seeking professional mental health services.

Entrance exams

Suggesting that compulsory aptitude and attitude tests be introduced for those seeking admittance into medical school, MMA and Medico-Legal Society of Malaysia past president Datuk Dr N.K.S. Tharmaseelan said currently, many aspiring doctors do not have a clear idea of what they are signing up.

This, he warned, can be dangerous as applicants who are ill prepared could develop poor mental health over the course of the programme.

“It is common to see students register to study medicine without having much of an idea about the course or what they are getting into.

“Medical students often think of it as a glamorous job until they enter the programme and realise that the reality can be quite the contrary,” he said.

Aptitude and attitude tests, he added, are necessary as these will give applicants an idea of what the medical field and programme involve. The tests will ensure that only those who are genuinely interested in practising medicine are selected.

“This must be mandatory for all higher education institutions offering medical programmes.

“The tests should provide detailed descriptions of what the profession entails, including the working hours and the type of work doctors do,” he said.

Citing India as an example, he said the country requires all of its medical varsities to carry out entrance exams for prospective students. It is only after passing this exam that the students will be admitted into a private or public medical university, he explained.

Most public varsities, Universiti Kebangsaan Malaysia (UKM) Faculty of Medicine former dean and senior consultant obstetrician and gynaecologist Prof Dr Zaleha Abdullah Mahdy said, carry out their own tests and interviews to assess applicants before offering them a spot to study medicine in the university.

UKM, for example, conducts multiple mini interviews where applicants will be tested on aspects such as soft skills, resilience and ethics, she said, while some universities like UM carry out their own entrance exam known as the Biomedical Admission Test.

Malaysia should, however, gradually introduce graduate entry level medical programmes, she offered.

In countries with entry level medical programmes, those interested in medicine already have a degree in hand before they even go to medical school.

“Medical universities in the United States and Australia, for example, only take in graduates although it is not necessary that the first degree is related to medicine.

“Such a system could be beneficial if introduced here as it would result in medical students who are more mature in every aspect,” she said, adding that mature judgements are necessary in the the practice of medicine.

Deciding on diagnoses, identifying the issues that patients are faced with and how to tackle them, providing treatment options, and handling a situation where the patient does not agree with you, all require maturity, she added.

Student counsellors

A better counsellor-student system should also be implemented in medical varsities, said Dr Tharmaseelan.

Every medical school in Malaysia, he said, is required to have counsellors but the current system is flawed because students do not want to be seen going in and out of the counsellor’s room under the glare of their peers as they will be stigmatised.

“Counsellors should instead visit the students privately to protect their identities,” said Dr Tharmaseelan, who was a professor of obstetrics and gynaecology at Melaka-Manipal Medical College and former Asia Metropolitan University president and chief executive officer.

There is also a lack of a holistic support system for graduates, he noted, as it is not mandatory for medical universities to provide such assistance.“A helpline – at the very least – should be made compulsory, at least in the first two years post-graduation.

“The existing support system in medical schools can be improved but the students themselves must also learn how to be more resilient after leaving home to embark on their tertiary education,” he added.

Agreeing, UPM Faculty of Medicine and Health Sciences dean Prof Dr Zamberi Sekawi said learning how to be resilient and managing one’s stress is the key to better mental health.Anxieties and depression among medical students are a multifaceted problem, he added.

Medical universities are already doing the best they can to support the students, he said, while reminding parents not to pressure their children into a career in medicine.

“This creates a stressful environment for the students, especially if they do not want to be doctors,” Prof Zamberi, who is a consultant clinical microbiologist, said. Measures in place

Among the measures medical universities currently have in place to help medical students cope, said Dr Koh, are mentor-mentee programmes where clinicians guide and monitor their students’ academic progress, as well as personal and professional development initiatives.

Other measures include peer teaching to provide social support and informal academic support; recognising students as stakeholders and engaging meaningfully with them in developing mental health support systems and the medical curriculum; and adopting an open communication policy within the faculty to gather students’ thoughts and opinions to develop more robust and student-centred support systems.

The support system in place at public medical universities has improved greatly, Prof Zaleha noted.

In UKM, for example, career carnivals featuring speakers from various industries, including those from the Health Ministry, are held regularly.

These talks provide medical students with an idea of the many career pathways open to them upon graduation, she said.“We’ve also had the deputy director-general from the Health Ministry speak to our students about the options they have post-graduation.

“This raises awareness among students of the many job opportunities available to those who do not want to practise medicine,” she shared.

The Views . . .‘Don’t forget we are human too

’“Poor mental health can affect anybody, whether one is in medical school or not. No doubt, it is widely known that medical school is biopsychosocially straining with extensive academic credit hours and high expectations from our supervisors. Medical students may face mental health issues due to the political and hierarchical nature of the working environment.

Being at the lowest in the hierarchy as medical students, we cannot help but experience several events that may result in negativity. This could sometimes serve as a motivational push. Nevertheless, one’s mental health outcomes vary from an individual to another.

Therefore, I highly encourage medical students to not be disheartened by the backlash of opening up about mental health and more importantly, to live the year like a series of 365 episodes. Reset your day after a good night’s sleep, which is usually better after an hour of high-intensity workout.

”Final year medical student Marjorie Ong Jia Yi, 25, Universiti Kebangsaan Malaysia

”I have had the highs and lows throughout my journey in medical school. The major contributing factor for the latter is everyone else’s expectations. You’re expected to be smart and well-versed even before you become a doctor. You’re expected to be one of the most elite groups in society; therefore, you’re expected to behave a certain way.

You’re expected to be able to answer everyone’s doubts about their medical conditions. People forget that doctors and medical students are human too. What I had to learn the hard way is that you can never please everyone in life. There is always going to be someone who is not satisfied with what you do or who you are.

I have learnt to do my utmost best instead. Becoming a doctor means you’re going to have to be able to understand other people and what they feel, but that doesn’t mean you forget your own well-being. It’s okay to take breaks in between, and go on a holiday with your friends. The most important thing here is that you come back stronger. One small crack does not mean you’re broken.”

Fourth year medical student Priyanka Menon, 24, Quest International University

“The medical profession is a career that requires practice, practice and more practice. This is the only way to stay sharp and competent. This Covid-19 pandemic has affected everyone differently. To medical students from private institutions, we have not been able to practise in our designated hospitals since the beginning of the pandemic.

Quite honestly, it has compromised our practical learning. However, I am grateful that I was given opportunities such as serving the community, participating in non-governmental organisations, and providing medical care through mobile clinics and local refugee clinics. I know I am not alone in feeling down because of certain factors related to my studies. The idea of us graduating in the pandemic with limited exposure really makes me anxious.

From one medical student to another reading this, I encourage you to seek alternative opportunities; reach out to gain more clinical experience.”

Fourth year medical student Leong Kah Chun, 23, Mahsa University

The quotes above were obtained by medical student Wong Zhi Yong, who is also a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. To join Star-NiE’s online youth community, go to facebook.com/niebrats.