I have just returned from Harvard Medical School’s Leadership in Medicine: Asia Pacific (LIM AP) programme, which ran two tracks: clinical leadership and faculty development.
Much of what I heard in both applies directly to Malaysian hospitals and clinics, which are under strain and struggling to keep the young doctors they train.
Start From How Work Really Happens
Hospital policies describe “work as imagined”. The faculty showed us research on “work as done”. In one Australian observational study, emergency physicians were interrupted 7.9 times an hour, rising to 9.4 an hour while prescribing.
An interruption mid-prescription almost tripled the error rate, and below-average sleep was linked to a far larger rise.
We have our own warning signs. Malaysia’s National Medication Error Reporting System received 265,194 reports between 2018 and 2022, about 145 a day. Reporting is healthy, but the volume shows how much rides on tired, interrupted people doing complex tasks.
This matters now because the Ministry of Health (MOH) is going digital. In early 2025, only 14 per cent of MOH hospitals and 18 per cent of health clinics had electronic medical records (EMR), and 128 hospitals and 893 clinics still ran on paper. The target is full coverage by 2028.
Leaders who choose and sign off these systems should spend time on the wards first. A system built around the imagined workflow will be worked around, and workarounds bring new risks.
Count The Cost Of Safety Rules
I came home with a useful term: “safety clutter”. It describes the policies, forms, and checks that pile up after each incident, add little protection, and eat into staff time.
Our case study was double-checking of medication administration, a near-universal rule whose benefit is surprisingly hard to prove.
Few of us ever retire a policy. Before adding one, we should ask what problem it solves and how we will know it works.
Every hour spent on a duplicate form is an hour taken from patients, in a ministry whose doctor headcount fell by 1,444 in 2024.
Bullying Is A Safety Issue
Australian data from 5,178 staff in seven hospitals found that 38.8 per cent faced bullying at least weekly, and about half said it harmed patient care or service quality. Our numbers are no better.
In the 2022 Healthcare Work Culture Improvement Task Force survey, 4,692 of 20,633 MOH supervisors, about 23 per cent, admitted to bullying. A CodeBlue poll in January 2023 found that 41 per cent of house officers who responded had been bullied.
It Is Also A Teaching Problem
Much of what trainees learn is in no syllabus. They watch how we speak to nurses, how we talk about patients once the curtain is drawn, and how seniors treat juniors when things go wrong.
This hidden curriculum teaches the next generation to repeat what they endured. A consultant who owns up to a mistake on ward rounds teaches more about safety than any lecture on incident reporting.
Change Is Possible
A culture-change programme in Australian hospitals, combining speak-up training, a reporting channel and peer messengers, cut the odds of frequent bullying by 24 per cent within three years.
Malaysia has had task forces and statements. What we need now are programmes like this, properly evaluated.
Train The People Who Teach
Malaysian specialists and medical officers teach every day, on ward rounds, in clinics and in theatre. Very few of us were trained to do it, so we teach the way we were taught.
The stakes are high. MOH says the public sector needs 22,435 specialists by 2030 but had 9,040 at the end of 2025, a gap of more than 13,000, and at current rates we will close less than half of it.
Our medical schools produce about 4,000 graduates a year, yet only 529 reported for 5,000 housemanship slots offered in January 2026. We need more good teachers, and teachers who make young doctors want to stay.
Use Simulation For Systems, Not Only Skills
At one Boston teaching hospital, every provider must show sterile technique for central line insertion in the simulation centre before doing it on a patient.
The hospital also runs unannounced drills to test whether alarms sound, whether security responds and whether equipment can be reached quickly, and it re-enacts near misses to find what needs fixing.
Debrief Well And Help Those Who Struggle
Adults learn from experience followed by reflection. A structured debrief in a psychologically safe setting turns a messy resuscitation into a lesson rather than a source of shame.
We also worked through a framework for struggling learners and struggling faculty: identify early, diagnose the cause, then agree on a goal-oriented plan. This matters here.
Between 2009 and 2016, the share of Malaysian house officers finishing within two years fell from 85 to 15 per cent, and about a third were extended each year. A knowledge gap, burnout and a family crisis can look alike from outside but need very different responses.
Treat Mentoring As Essential
Mentoring is different from coaching, sponsorship and supervision. Each has its place, and our young doctors need all four. We were urged to write mentoring plans with clear goals, boundaries, and mutual accountability, and to build a “personal board of advisors” across disciplines and cultures.
With 377 specialists and 359 permanent medical officers resigning from MOH in 2023, good mentoring is also a retention strategy.
Take Home Messages
Go and see: Watch frontline work regularly before redesigning it, especially before signing off an EMR system.
Prune before you add: Review safety policies for evidence of benefit, and retire those that only add paperwork.
Treat workplace bullying as a patient safety risk, with speak-up training, safe reporting and visible follow-through. Trainees copy what we model.
Teaching is a skill: Every clinician who supervises trainees should get basic training in how adults learn, and should design sessions with a simple framework such as Kern’s six steps.
Use simulation to test systems and rehearse rare emergencies, not only to train students.
Diagnose before you remediate: A struggling learner needs a plan, not just an extension.
Give every junior doctor a mentor, and give mentors the time to do it.
Most of this needs no large budget. It needs leaders willing to look, and hospitals that give clinicians protected time, training in education, and credit for teaching when promotions are decided.
Faculty development should not rest on a handful of enthusiasts. It should be part of how every teaching hospital works.
Prof Dr Long Chiau Ming is from the Faculty of Medical and Life Sciences, Sunway University.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
