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History of Psychiatric Education in Singapore—EH Kua 137C History of Psychiatric Education in Singapore
Psychiatry was largely a forgotten discipline in the first 75 years of the medical school. In the
last 2 decades, there has been steady progress in the extension of teaching time and clinical
postings. The focus of psychiatric education has shifted from the mental institution to the general
hospital and primary care. Psychiatric teaching emphasises not just clinical skills, but also, the
importance of communication skills in the doctor-patient relationship.

Ann Acad Med Singapore 2005;34:137C-139C
Key words: Postgraduate, Psychological medicine, Teaching, Undergraduate
While medical education in Singapore has a hundred- 1914 A psychiatry course was started for medical students year history, the teaching of psychiatry became salient only in the last quarter of the century. In the early years, medical 1920 Melanie Klein conceptualised the developmental education mainly focused on medicine, surgery, paediatrics, obstetrics and public health. Fortuitously, interest in 1928 The Mental Hospital, or Woodbridge Hospital, was psychiatry grew as a consequence of social changes or societal concerns, like drug addiction, suicide and stress.
From a few perfunctory lectures in the early years, The Second 25 Years (1930 to 1954) psychiatry has become well entrenched in the undergraduate 1938 First use of electroconvulsive therapy by Ugo Cerletti medical curriculum. In recent years, psychiatric education has expanded, with courses for the Master of Medicine 1942- Woodbridge Hospital became the Japanese Civilian (Psychiatry), Graduate Diploma for Psychotherapy, Master of Nursing (Psychiatry) and regular seminars for general 1947 Electroconvulsive therapy was first used in Milestones in Psychiatric Education
1951 Lectures in psychiatry were introduced for final- 1905 The King Edward VII Medical College, built near 1952 Delay and Deniker prescribed chlorpromazine for the site of the Lunatic Asylum at Sepoy Lines, was opened. The psychiatric patients in the asylum were transferred to another ward at Pasir Panjang.
1955 Chlordiazepoxide, the first benzodiazepine, was The evolution of psychiatric education was gradual in the early years of the medical school. There was, however, aninterest in “exotic” transcultural syndromes like “amok”.1 Chlorpromazine was introduced in Singapore.
1908 Eugen Bleuler, a Swiss psychiatrist, coined the term 1957 The first antidepressant, imipramine, was used in 1910 Sigmund Freud’s Five Lectures in Psychoanalysis 1958 Paul Janssen developed haloperidol, the first National University of Singapore, Singapore Address for Correspondence: Professor Kua Ee Heok, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road,Singapore 119074.
Email: 138C History of Psychiatric Education in Singapore—EH Kua encouraged combined teaching sessions, with related 1968 Medical students were posted to Woodbridge disciplines like neuro-anatomy, neuro-physiology, pharmacology, psychology and neurology.
2003 Publication of a study on the declining rate of elderly The Fourth 25 Years (1980 to 2005) 1980 The Department of Psychological Medicine was The first Asia Teachers’ of Psychiatry (TOP) meeting established, with Associate Professor Tsoi Wing was organised by the Department of Psychological Foo as the Head. The department was based at the Medicine, for the discussion of issues pertaining to Singapore General Hospital. The undergraduate psychiatry course included lectures, tutorials and 2- 2004 The Master of Nursing (Psychiatry) programme was week postings at Woodbridge Hospital.
1985 The first book on psychiatry for local doctors was There was a regular teaching module in psychiatry written by Tsoi Wing Foo and Kua Ee Heok.2 for general practitioners, in collaboration with the 1986 The Department of Psychological Medicine moved to the University campus at Kent Ridge. The first The Specialist Training Committee for Psychiatry psychiatric unit in a general hospital in Singapore reviewed the psychiatric traineeship programme opened at the National University Hospital in July.
and made recommendations for improvement.
A postgraduate training programme for the Masterof Medicine (Psychiatry) was started in collaboration Discussion
with the Royal College of Psychiatrists (UK). The The scope of Medicine in general and Psychiatry in Chairman of the postgraduate training programme particular is very wide. Our responsibility to the medical students is not limited to simply teaching psychiatric 1988 Prozac was introduced in North America.
syndromes, but also the broader issues of good doctoring.
1992 Publication of a 10-year follow-up study of For example, it is not only important to teach students schizophrenia in Singapore – the first long-term interviewing skills for examining patients. Communication skills, like establishing rapport and expressing empathy inthe therapeutic alliance, are just as important. These The epidemiology of dementia in elderly Chinese in communication skills will also be relevant in the future Singapore was published – the research was part of when the students work in multidisciplinary teams in 1993 Risperidone, an atypical antipsychotic medication, We introduced video feedback 15 years ago as a technique was introduced for the treatment of schizophrenia in for teaching clinical skills. This is an excellent method of learning for the students because they are able to watch 1994 The undergraduate psychiatry curriculum was their own performance, which can be replayed, and any reviewed, with an emphasis on providing a good shortcomings can be rectified through discussions with foundation for primary care physicians. The posting was expanded to a 6-week clerkship and medical Psychiatric teaching emphasises not only the biological students were exposed to a wide spectrum of common causality of an illness but also the significance of the psychiatric disorders, like depression and anxiety.
patient’s social environment, i.e., family or work, which Besides pharmacotherapy, they were also taught may precipitate or perpetuate the illness. The focus is not techniques of counselling and stress management.
just on molecular biology but also the wider aspects of A new textbook, Psychiatry for Doctors, was psychological and social factors in health and illness – a holistic approach in the totality of care. For example, an 1996 The first National Mental Health Survey was elderly man might have severe depression as a result of conducted by the Department of Psychological biochemical changes in the brain, but the medical student will have to explore other factors, like physical illness, e.g., 1999 The Graduate Diploma of Psychotherapy course stroke, or conflict in family relationships, which may was conducted by the Faculty of Medicine. This is a 1-year course for Dynamic Psychotherapy and It is impossible to teach students about the whole spectrum Cognitive Behavioural Psychotherapy.
of psychiatric disorders in their entirety. What is important 2000 The integrated curriculum of the medical school is to focus on common disorders they will encounter in History of Psychiatric Education in Singapore—EH Kua 139C primary care practice or even as specialists. For many incredulity and cynicism. Psychiatric care, then, was years, the teaching of Psychiatry in Singapore was limited sequestered in the asylum far away from the citizenry, with to just 2 weeks at Woodbridge Hospital, where students poor morale and pervasive pessimism. Psychiatry today mainly examined psychotic patients with schizophrenia or has made inroads into the general hospitals and general mania. Such isolation only provided a skewed impression practice, underlining the totality of health as not merely the of psychiatry in healthcare. Most general practitioners will absence of physical illness, but also the presence of mental probably see just 1 or 2 cases of schizophrenia in a year, but every day they see patients with the common problems ofdepression and anxiety associated with stress, or otherphysical illnesses, like cancer or heart disease. Therefore,in the last 10 years, the focus of teaching has shiftedfrom the mental institution to the general hospital and 1. Kua EH. Amok in nineteenth-century British Malay history. History of There is an emphasis on self-learning, which is crucial after graduation, when continuing medical education 2. Tsoi WF, Kua EH. Clinical Psychiatry for Family Physicians. Singapore: becomes a personal responsibility. The lecturer also 3. Tsoi WF, Kua EH. Predicting the outcome of schizophrenia ten years organises seminars where the students assume the teaching later. Aust N Z J Psychiatry 1992;26:257-61.
role and give critical analyses of medical literature, which 4. Kua EH. A community study of mental disorders in elderly Singaporean helps students to evaluate scientific reports.
Chinese using the GMS-AGECAT package. Aust N Z J Psychiatry Psychiatric education will continue to evolve – in content and pedagogy. The repertoire of skills that doctors need to 5 . Kua EH, Ko SM, Lim LCC. Psychiatry for Doctors. Singapore: Armour learn in order to treat common psychiatric disorders should 6. Fones CS, Kua EH, Ng TP, Ko SM. Studying the mental health of a not just be the judicious prescription of medications but nation: a preliminary report on a population survey in Singapore.
also counselling techniques. The relevance of psychiatry in clinical medicine today is incontrovertible, although a 7. Kua EH, Ko SM, Ng TP. Recent trends in elderly suicide rates in a multi- century ago, psychiatry as a science was perceived with ethnic Asian city. Int J Geriatr Psychiatry 2003;18:533-6.


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