Emergency Conditions in Specialist Medical Education

The depression experienced by prospective specialist doctors shows that there are problems in the specialist doctor education system.

The depression experienced by specialist doctor candidates cannot be seen solely as a personal problem of the students. It is important to look at the education system of specialist doctor candidates.

The results of the mental health screening of specialist medical education program (PPDS) students conducted by the Ministry of Health (Kompas, 4/16/2024) has not yet revealed the cause of depression. However, with many PPDS students experiencing symptoms of depression, it is important to see how these students experience their education. What's wrong with the education system for specialist doctors at the Ministry of Health's teaching hospitals?

From a screening of 12,121 PPDS students at 28 Ministry of Health hospitals in March 2024, as many as 22.4 percent of students experienced symptoms of depression. 3.3 percent or 399 of them experienced severe symptoms of depression. They admitted to feeling better off ending their lives or wanting to harm themselves.

These figures are not small for cases of mental health in a level of education, and of course, it is not a coincidence that the students all experience depression.

Also read: Depression, 3.3 Percent of Prospective Specialist Doctors Want to End Their Lives or Injure Themselves

If we look back, the condition of these students is relevant to the news in the mass media in mid-2023. At that time, a number of media reported cases of bullying experienced by PPDS students, the perpetrators were mainly seniors at PPDS. In this regard, the Ministry of Health has also opened two channels for reporting cases of bullying through channels on the Ministry of Health's website and a telephone number (hotline).

As a result, during a press conference by the Ministry of Health which was also uploaded on the YouTube channel on July 21, 2023, Minister of Health Budi Gunadi Sadikin revealed the existence of bullying practices against PPDS students in several hospitals owned by the Ministry of Health. These PPDS students have been subjected to physical, mental, and financial pressure from their seniors.

The Ministry of Health also reprimanded three hospitals for cases of bullying against PPDS students (Kompas.id, 17/8/2023). The three hospitals are Cipto Mangunkusumo Hospital, Hasan Sadikin Hospital, and H Adam Malik Hospital.

So far, there is no information on the follow-up to the reprimand. However, what is clear is that from the mental health screening results of PPDS students, students from the Cipto Mangunkusumo and Hasan Sadikin hospitals are among those with the most indications of depression symptoms. This is certainly not a coincidence.

From that case, we cannot deny that the bullying and depression experienced by the PPDS students are related. Bullying victims, when unable to defend themselves and forced to be in that situation because seniors have a role in determining grades, are potentially experiencing depression.

This is similar to cases of bullying in general, which occur due to a power imbalance. In some cases, the most fatal ones, the bullying victim takes their own life.

From this case, we cannot deny that the cases of bullying and depression experienced by PPDS students are related.

Not only does bullying cause depression among PPDS students, it can also lead to them dropping out. In a discussion held by an online medical education platform on April 30, 2023 and broadcasted on Youtube, a doctor gave testimony that he stopped studying to become a specialist doctor because of the bullying he experienced.

He conveyed this during a question and answer session with Minister of Health Budi Gunadi Sadikin. The moderator of the event, who is also a doctor, confirmed the existence of bullying practices against PPDS students, which have been going on for decades and tend to be covered up.

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The steps taken by the Ministry of Health to immediately address students who are experiencing depression by providing treatment are commendable. This is an urgent step to prevent the situation from worsening, especially for the 339 residency program students who have admitted to contemplating suicide or self-harm. These are urgent symptoms of severe depression that need to be addressed.

Furthermore, this case shows that there is a problem with the specialist doctor education program in hospitals owned by the Ministry of Health. This case can serve as a basis for stakeholders to evaluate the specialist doctor education system in those hospitals. If the source of the problem is indeed bullying, it is an urgent issue that requires systemic handling.

Also read: Strengthen Protection of Medical Students from Bullying

Bullying anywhere and towards anyone is not acceptable, especially when it occurs in educational institutions that should uphold scientific and moral traditions. Bullying behavior is also contrary to the medical code of ethics, a collection of norms to guide doctors in Indonesia when practicing in society.

Therefore, this problem not only hampers efforts to overcome the shortage of specialist doctors, but also affects health services for society. How will doctors be able to serve the community well and optimally if they themselves also have problems, whether they are victims or perpetrators of bullying? Equal distribution of health services is also difficult to achieve because there are not enough specialist doctors.