LONG hours, heavy workloads and workplace bullying are often cited as harsh realities faced by doctors.
In light of recent media reports of medical practitioners being overwhelmed by such challenges, experts stress the need for a comprehensive approach to help medical students transition to housemanship.
According to Health Minister Datuk Seri Dr Dzulkefly Ahmad, over 6,000 doctors had resigned from the Health Ministry (MOH) over the past five years.
He said this included 3,200 contract medical officers who left for permanent roles, with some transitioning to academia and continuing to contribute to public health.
“I admit and am fully aware that the ministry lacks staff, resulting in some MOH personnel having to bear the burden of duties more than other colleagues.
“Despite all the existing constraints, I will make sure all issues facing the ministry on the ground will be dealt with in my second term as minister,” he said in a Facebook post on Dec 21.
The pressures faced by the profession have also led to tragic outcomes.
On Aug 29, Dr Tay Tien Yaa, a pathology specialist at Hospital Lahad Datu in Sabah, was found dead in her rental unit amid allegations of workplace bullying.
Earlier, on June 27, Dr Ch’ng Hooi Ping, a doctor at Seberang Jaya Hospital in Penang, was found dead in her car at the hospital parking lot, reportedly due to fluid in her lungs. Her sister attributed the death to overwork and exhaustion.
As young doctors face the challenge of adapting to high-stress environments, experts emphasise the importance of a medical curriculum that bridges the gap between clinical teaching and real-world practice, equipping them to better handle workplace demands.
Bridging the gap
Universiti Putra Malaysia (UPM) Faculty of Medicine and Health Sciences dean Prof Dr Normala Ibrahim said the transition from medical student to house officer involves a steep learning curve.
“Medical school emphasises theoretical knowledge and clinical skills through lectures and supervised clinical exposure, while housemanship shifts to practical experience with increased responsibility, including direct patient care, administrative tasks, and communication within multidisciplinary teams.
Prof Muhammad Yazid“Doctors must adjust to real-world responsibilities, make critical decisions under time pressure and with limited information, and cope with long hours and high stress, which can lead to burnout,” she told StarEdu.
Agreeing, Universiti Malaya (UM) Faculty of Medicine deputy dean of undergraduate studies Prof Dr Muhammad Yazid Jalaludin noted that medical students learn in a protected and supervised environment.
“In real-world practice, graduates are expected to function independently as safe and competent practitioners from day one of housemanship.
“Adaptation and assimilation are essential,” he said.
Strategies in place
To address this gap, Universiti Kebangsaaan Malaysia (UKM) Faculty of Medicine deputy dean of undergraduate studies Assoc Prof Dr Jemaima Che Hamzah shared that UKM has introduced a special module called Personal and Professional Advancement.
“This module complements the teaching of basic medical sciences, clinical skills in simulation laboratories, and bedside teaching in wards, clinics and operation rooms.
“It exposes our medical students to soft skills such as personal and interpersonal skills during the preclinical years, followed by professionalism and medical ethics in the clinical years.
“Leadership skills are developed through organising team members for project-based learning, such as problem-based learning sessions or co-curricular activities. Students also learn about administration, handling responsibilities and time management,” she said.
At UPM, the focus is on skill development and practical skill integration to address gaps upon graduation, according to Prof Normala.
“Key activities for skill development include orientation and transition programmes like Medic Orientation Week (MeOW) for first-year students, Medic Camp for third-year students transitioning from preclinical to clinical years, and the Clinical Skills Immersion programme for fifth-year students preparing for housemanship.
“Course integration for practical skills includes clinical pathology, humanitarian leadership experiences, community engagement, and research projects. These foster administrative, communication, social responsibility, and research skills,” she said.
Prof NormalaProf Normala added that to promote a healthy work-life balance during medical studies and early careers, UPM provides flexibility through independent learning during clinical years.
“This allows students to balance academic performance with other life priorities while developing healthy work habits.
“Students receive guidance from academic advisers and have access to university counselling and mental health services.
“Additionally, extracurricular activities and Personal and Professional Development courses foster self-awareness, stress management, self-care and resilience through structured reflection and wellness practices,” she said.
At UM, Prof Muhammad Yazid said medical students are encouraged to take on leadership roles from their freshman year, such as chairing problem-based learning sessions, managing portfolios in student-led societies, and representing the university in various activities.
“They are supported by academic advisers and clinical mentors throughout their education, with hands-on experience in clinical rotations where they engage with patients and healthcare professionals.
“Time management is emphasised as a key skill, developed gradually through consistent exposure to diverse tasks and responsibilities during their training,” he said.
The experts, however, conceded that certain challenges remain in preparing medical students for housemanship.
Dr Jemaima explained that skills like taking blood and conducting deliveries can only be further honed during house officer training.
“A major challenge is exposing students to on-call duties adequately while not compromising their well-being for educational activities the following day.
“Students are given on-call duties until 10pm, unlike the shift duties during house officer training or the long hours of on-call duties faced by medical officers,” she added.
Prof Muhammad Yazid shared that burnout remains a pressing issue due to real-life situations in healthcare facilities, as junior doctors deal with heavy workloads, stress, hospital bureaucracy, bullying and harassment.
“Providing mentorship through clinical academic staff has helped to some extent in bridging the gap by preparing students for real-world scenarios.
“Clinical rotations also provide debriefing sessions, which encourage students to process their emotions by discussing their experiences with supervisors and peers after stressful clinical situations,” he said.
Candidate assessment
Prof Normala shared that offering psychological screenings to new medical students, such as the Depression, Anxiety and Stress Scale and the Stress Inventory, can identify mental health concerns early, while academic advisers provide ongoing support for both academic and personal challenges.
She added that multiple mini interviews (MMIs) during the admissions process help assess applicants’ communication skills, emotional intelligence, and ability to handle challenging scenarios.
“The structured format allows us to evaluate interpersonal capabilities and professional attributes that contribute to successful medical training and practice.
“However, concerns exist about potential stigmatisation and discrimination if applicants with psychological issues are identified early, necessitating further evaluation by mental health professionals,” said the clinical psychiatrist.
Dr Jemaima, however, asserted that MMIs are not a tool for detecting mental health issues but can provide insights into candidates’ ability to handle stress and their interpersonal skills.
“Candidates may practise MMIs before the actual sessions so that they become more comfortable with the format and better at articulating their thoughts under pressure.
“On the other hand, psychometric tests may be more useful in detecting mental health issues, but they are costly for candidates or institutions, as no single psychometric test can predict mental health issues,” she said.
Evaluating performance
Dr JemaimaDr Jemaima added that continuous assessment provides opportunities to prepare clinical-year students to make sound decisions in high-stakes, high-pressure situations by evaluating their learning and performance over time, rather than relying solely on a final examination or project.
“This includes multiple work-based assessments conducted during the clinical years, such as observed long cases, objective structured clinical examinations, direct observation of procedural skills and case-based discussions.
“The students receive feedback from their supervisors and mentors, along with opportunities for self-reflection, to help them improve and build confidence in their clinical abilities,” she said.
Prof Muhammad Yazid said assessments require students to demonstrate clinical competence under time constraints, mirroring the types of emergencies or complex cases they might encounter as house officers.
“For example, during the Acute Care end-of-posting examination, each student is assessed using real-life emergency scenarios,” he said.
Student support
For students unable to cope with the high academic pressure and stress, Prof Muhammad Yazid said they will be called for counselling sessions and given opportunities to switch to other courses offered by the university.
“Reasons for dropout often stem from parental pressure to join the medical programme when the student has other aspirations.
“Our student dropout rate has been low, perhaps one to two students at most within the first year of the programme or during the first year of clinical exposure, because of our robust selection process,” he said.
Dr Jemaima added that UKM’s medical programme has a monitoring system where the academic performance of each student is discussed in meetings at least three times a year – before and after examinations, as well as during the middle and end of each semester – to identify students who are weaker academically.
“We alert the mentors of students at risk for advice and support.
“Professional counselling services are available to help students manage stress, anxiety, and other emotional challenges,” she said.
With the evolving expectations of young doctors upon graduation, Dr Jemaima explained that the effectiveness of UKM’s medical curriculum in preparing students for medical practice is constantly evaluated for further improvements.
“Our curriculum is measured by various factors, such as the rate of passing final professional examinations, on-time graduation, monitoring and examination meetings, and feedback from students, graduates, lecturers, alumni and the MOH.
“The medical programme follows the Standards for Undergraduate Medical Education set by the Malaysian Medical Council and the Malaysian Qualifications Agency, which provides guidelines listing the core competencies a medical student must be exposed to in the clinical world, ensuring the quality of graduates and protecting patient safety, which is the utmost priority,” she said.
Dr Wong Zhi Yong, 24, a medical graduate at Universiti Malaya, is a participant of the BRATs Young Journalist Programme run by The Star’s Newspaper-in-Education (Star-NiE) team. For updates on the BRATs programme, go to facebook.com/niebrats.
