精神経誌（2009 ）111 巻 10 号

1238

第回日本精神神経学会総会

シ ⃞ン ⃞ポ ⃞ジ ⃞ウ ⃞ム⃞

Postgraduate Psychiatric Training in Thailand
Woraphat Ratta‑apha, MD. , Nantawat Sitdhiraksa, MD. , Nattha Saisavoey, MD. ,M anote Lortrakul, MD. , Pichet Udomratn, M D.
1）Department of Psychiatry, Faculty of M edicine Siriraj Hospital, M ahidol University, 2）Department ofPsychiatry, Faculty of Medicine Ramathibodi Hospital, M ahidol University, 3）Department of Psychiatry,
Faculty of M edicine, Prince of Songkla University

In Thailand,after medical students graduated from medical schools,the general practitioners have to work for the government for at least three years. Then, they can enroll in
postgraduate training program. Postgraduate training usually takes three to four years. All of
the psychiatric training programs are supervised and monitored by the board of education of theRoyal College of Psychiatrists of Thailand（RCPsychT）. One of the missions of all training
institutes is to prepare residents to be the high qualiﬁed psychiatrists to serve the mental well‑being of Thai people. Additionally,they should teach the learners to be the leaders in academic
and research ﬁelds in psychiatry. Currently, there are nine psychiatric training institutions inThailand, most of which are running by university programs. The training program corecurriculum composes of the compulsory rotations such as general psychiatry, child and adolescent psychiatry, neurology, consultation‑liaison psychiatry, mental hospital psychiatry andaddiction psychiatry. Moreover, the residents also have three months for elective in eachprogram. The learning process includes practicing in an out‑patient and in‑patient unit underpsychiatric staﬀ supervision, individual and group supervision, case conference, journal club,
book club and grand round etc. Research in ﬁeld of psychiatry and social sciences is also
compulsory for board examination. The RCPsychT approved two Certiﬁcate Diplomas including Diploma of Thai Board of Psychiatry,and Diploma of Thai Board of Child and Adolescent
Psychiatry.
There are only nine psychiatric training institutes and only thirty to forty residents enrolled
in these programs in each year. The compact and collaboration of all training institutes bringabout the beneﬁts in eﬃciency programs management byregular meeting of representatives fromeach institute. They keep the standard of training program to progress in the same vision anddirection. Furthermore, residents of each training programs can exchange and request forelective rotation at the other institutes.
Key word : Postgraduate psychiatric training,the Royal College of Psychiatrists of Thailand（RCPsychT）, Diploma of Thai Board of Psychiatry

Overview of Postgraduate Psychiatricis approximately 500（around 400 general psy-Training in Thailand

chiatrists and 70 child and adolescent psychia-

The current number of Thai psychiatrists

trists）, which somehow is inadequate for basic

シンポジウム：Post‑graduate Psychiatric Training in Asia

standard psychiatric services. Comparing with1239

program in each year.

the high number of Thai population,the proportion of psychiatrists is only 8 1,000,000 popula-

Monitoring from the Board of Education,tion. Restraint of psychiatrists is one of theRCPsychT

important obstacles to improve quality ofIn Thailand, we arrange the training pro-mental health promotion in Thailand. Evengram by using the model of education, that isthough, we need more psychiatrists to improve

composed of 3 main domains; Objective,

the qualityof psychiatric care in Thailand. The

Learning,and Evaluation. The committee fromRoyal College of Psychiatrist of Thailand

the Royal College of Psychiatrists of Thailand（RCPsychT）also sees the importance of high（RCPsychT） is in charge of supervising andstandard and quality of the new psychiatrists.

monitoring the postgraduate training. （Theexecutive committee of the RCPsychT wasApplication Process

selected from the representatives from eachIn the process of specialist training intraining institute. All of the psychiatric train-

Thailand, after graduated from medical

ing programs are supervised and monitored byschools,the general practitioners have to work

the board of education of the RCPsychT）. Thefor the government for at least three years

mission of every training institute is to prepare

before they can enroll in postgraduate training

residents to become the high qualiﬁed psychia-programs. In Thailand,there are two approved

trists with good command knowledge and atti-

Diplomas including Diploma of Thai Board oftude, and to become leaders in academic andPsychiatry, and Diploma of Thai Board ofresearch ﬁelds in psychiatry. Moreover, there

Child and Adolescent Psychiatry. The general

are nine sub domains（i.e.1）mission and vision,practitioners,who are interested in enrolling in2）quality control system,3）executive plan,4）

residencytraining program,must applydirectlytraining program, 5）curriculum, 6）instructor,

to the M edical Council of Thailand. The appli-7）academic activity,8）resident,and 9 ）evalua-cants can apply up to 3 institutes from the mosttion）, that each institute must arrange theirselective to the least selective. Then the appli-own program according to the RCPsychTʼscant must have an interview with a committee

guideline.

at the selected institute. The letters of recom-monitoring and evaluation each instituteʼs mis-mendation, attitude, experience, GPA in MD

sion,vision,and objective. Currently,there areprogram, and psychological tests are alsonine psychiatric training

required in the application process at someThailand.

The RCPsychT has a regularinstitutions ininstitutes. The committee will consider thesuitable candidates for position in their own
institutes,and then the ﬁnal decision for accept-

The training program
The core curriculum（Table 2） of eaching residents at each institute will be announced

training program composes ofbased on applicantʼs prioritized list. There are1）The compulsory rotations（which includes

only thirty‑four positions for psychiatric train-

general psychiatry, child and adolescenting in general psychiatry and fourteen positions

psychiatry, neurology, consultation‑liaisonin child and adolescent psychiatric resident

psychiatry, mental hospital psychiatry and精神経誌（2009 ）111 巻 10 号

1240

addiction psychiatry）

monitored by the RCPsychT. After a surveyby2）Three months of elective in each program.

the RCPsychT committee in 2008, there wereThe learning process（Table 3） includes

some issues to develop to keep the uniﬁedpracticing in both the out‑patient and the in‑common standard for all institutions. The ﬁrst

patient unit under psychiatric staﬀsupervision,action was to revise the postgraduate training

individual and group supervisions,participating

curriculum which has been using since 2001.

in case conference, journal club, book club andWe set the curriculum revision committee se-

grand round etc. In addition, the RCPsychT

lected from the representatives from each insti-

also runs special inter‑mural core lecture andtute. First,the committee revised and rearran-case conference on a monthly basis. There are

ged the training curriculum, then they sent thealso inter‑mural technique of interview（TOI）

ﬁrst revision version of the curriculum to each

workshop and psychotherapy workshop run

institute for further comments. Feedback andregularly by the RCPsychT.

comments from each institute were reviewed,

For the competency evaluation, residents

and then the ﬁnal revised version, with thehave to pass an evaluation by the committee ofconsensus of the committee, was presented totheir own institute. For every postgraduate

the Board of education of the RCPsychT.

training year composes of knowledge,attitude,experience,and interviewing examination. The

The followings are some updates in residency training in psychiatry curriculum.

RCPsychT also runs a centralized multiple
choice examination called PRITE（Psychiatry
Residency in Training Examination）.

1. Objective
We rearranged the objective of training
into six general competencies: 1）Patient care,

The Board Certiﬁed Examination

2）Medical knowledge,3）Practice‑based learn-

For the application for examination toing and improvement, 4） Interpersonal andbecome a board certiﬁed psychiatrist, the resi-

communication skill,5）Professionalism,and 6）

dents have to

System‑based practice. We also required, in1）Fulﬁll the time requirement for compulsory

each competency, to acknowledge three basic

and elective rotations2）Submit one research thesis

components 1） knowledge, 2） skill, and 3）
attitude.

The training institute then will issue theRegarding the topic of medical knowledge,

endorsement letter of eligibility to enter thewe divided the medical knowledge into fourteen

board certiﬁed examination. The Diploma oftopics such as knowledge of major psychiatricThai Board of Psychiatry will be issued by thedisorders, knowledge of psychotropic medica-

RCPsychT for the candidate who passes thetion, knowledge of substances abuse, knowl-examination.

edge of human growth and development, andknowledge of emergency psychiatry, and etc.

Update in Postgraduate Psychiatric Training
Program : Residency Training inGeneral Psychiatry
The standard of training program is

We then categorized each topic into twogroups; must know, and should know.
By using the data from the epidemiology
and the signiﬁcance of disorder, we furtherシンポジウム：Post‑graduate Psychiatric Training in Asia

1241

Table 1 Classiﬁcation of knowledge of major psychiatric disorders
Level

Epidemiology,
SigniﬁcantLearning experience

Competency

1Common disease;
Direct interaction with Diagnosis,
M ust possess well- patients
M anagement,
known knowledge
Prevention andrehabilitation

2Common disease;
M ust known

Direct interaction withpatients orobservation or ward
round

Limited knowledgeof Diagnosis,
M anagement,Prevention andrehabilitation

3

Less common disease;should processes
minimum knowledge

Self study, Lecture

Diagnosis, Limited
knowledge inM anagement, Initialmanagement, andrefer to specialist

categorized the topics of knowledge of major

regular academic curriculum（Table 3）.

psychiatric disorders,classiﬁed by ICD‑10,into
three diﬀerent levels 1）common disease; must

3. Evaluation

possess well‑known knowledge 2） common

The evaluation process of the 2009 version

disease; must known 3）less common disease;

was mainly as the same format as the former

should possess minimum knowledge. The levelversion. We also added the other requirement ;of knowledge of major psychiatric disorders

the submission of two psychotherapy case port-then will determine the learning experience,

folios as the criterion for applying for theand competency requirement for diagnosis,

Board Certiﬁed examination for the Diploma oftreatment,prevention,and rehabilitation（tableThai Board of Psychiatry.

1).
Discussion : Strength and Weakness in
2. Learning

Post‑graduate Psychiatric Training ProgramBecause of changes in current situations ofThe compact and the close collaboration ofpsychiatric services, social context, and theall training institutes with the RCPsychT makerevised objective of training, we had to update

the strength in eﬃcient programs management.

the learning experiences in new version of theWith regular meeting and monitoring from thecurriculum. We added required rotations in

RCPsychT,the standard of psychiatric training

Community Psychiatry and Forensic Psychia-program progresses with the same mission andtry as the compulsory for at least two weeks

direction.

within three years of training, and decreased

opportunities to exchange and request for elec-

the elective to only two months（Table 2）.

tive rotations at the other training institutes.

In addition, residents could have

Furthermore, the group psychotherapy, andHowever, the compact of all institutes is

research seminar activities were required inour strength,we consider the limited number of

精神経誌（2009 ）111 巻 10 号

1242

Table 2 Training program curriculum : Residency training in General Psychiatry
Requirement experiences for
Residency training in General
Psychiatry

The 2001 Curriculum
M inimum time requirement(M onths)

The 2009 revised Curriculum
M inimum time requirement(M onths)

Compulsory

1818

General psychiatry

33

Child and adolescent psychiatry

33

Consultation-liaison psychiatry

33

Neurology

33

Mental hospital psychiatry

33

Addiction psychiatry11

Forensic psychiatryX

0.5

Community psychiatryX

0.5

Total for compulsory

3132

Elective32Total

34

34

Table 3 Requirement of Academic Activities: The 2001 version and 2009 revision version
Academic Activities ofResidency Training inPsychiatry

The 2001 version
Frequency(times, hoursweek, month)

The 2001 version
Frequency(times,hours year)

The 2009 revision
Frequency(times, hoursweek, month)

The 2009 revision
Frequency(times,hours year)

Supervision

2 hours week

90 hours year

2 hours week

90 hours year

Case Conference

2 times month

20 times year

2 times month

20 times year

Journal Club

2 times month

20 times year

2 times month

20 times year−

10 times year−

10 times year

Grand round,Inpatient conference

1 time week

40 times year1 time week

40 times year

Book club, book reading,
topic discussion, lecture

20 times week

90 times year

20 times week

90 times year

Medical audit, M orning
Noon report, Chart review

2 times week

90 times year

2 times week

90 times year

Reporting writing,
Inpatient medical record,
Progress note, OPD record

Regular

Regularregular

RegularResearch seminarXX−

10 times year

Group psychotherapyXX−

10 times year

Psychotherapy seminar,
Psychotherapy caseconferencePowered by TCPDF (www.tcpdf.org)

シンポジウム：Post‑graduate Psychiatric Training in Asia1243

training institutes, the limited number of posi-Thanand Piyasirisilp, M D.

tion for residents in training programs,and theWeerapon Unaharassamee, M D.

restraint of psychiatric training staﬀ as theSupachoke Singhakant, M D.

weaknesses of our training programs. Additionally, we need to develop the progress in
psychiatric research to serve both the mental

Thaneya Wongjongrungrueng, M D.
Nantawat Sitdhiraksa, M D. Secretary
Woraphat Ratta‑apha , M D. Assist‑Secretary（siwhr＠staﬀ1.mahidol.ac.th）well‑being of the Thai and the improvement ofthe academic activities of training program.

References1）Board of education of The Royal College ofAcknowledgements
The Japanese Society of Psychiatry and Neurology（JSPN）
Japan Young Psychiatrists Organization（JYPO）
Professor Pichet Udomratn（Chairman of the Association of Thai Psychiatrist）
Assoc. Professor M anote Lortrakul（Chairman of thecurriculum revision committee）

Psychiatrist of Thailand（RCPsychT）, Curriculum :Residency Training in Psychiatry for Diploma of theThai Board of Psychiatry, 2001
2）Board of education of The Royal College of
Psychiatrist of Thailand（RCPsychT）, Curriculum :Residency Training in Psychiatry for Diploma of theThai Board of Psychiatry, 2009

Assist. Professor Panom Ketuman（Chairman of De-3）Department of M ental Health. M ental Healthpartment of Psychiatry, Siriraj Hospital Mahidol University）

Resources（in Thai）. Available at the website of De-Pornjira Pariwatcharakul, MD.
Kanokwan Limsricharoen, MD.
My colleagues in the Department of Psychiatry,
Faculty of M edicine Siriraj Hospital Mahidol Universi-

partment of M ental Health, Ministry of Public Healthat http: www.dmh.go.th report pdf 2549mhworker.pdf（accessed 15th August 2009 ）4）M edical Council of Thailand. List of Specialists: General Psychiatry,Child and adolescent Psychia-tytry（in Thai）.Available at M edical Council of Thailand
The curriculum revision committee
Assoc. Prof. Manote Lortrakul , M D. Chairman
Assoc. Prof. Suwanna Arunpongpaisal, M D.
Assoc. Prof. Sirilak Supapitiporn, M D.
Col. Nawaporn Hirunviwatgul, MD.
Col. Pongsatorn Netrakom, M D.
Assist Prof. Sombat Zartrungpak, MD.
Assist. Prof. Sookjaroen Tangwongchai, M D.
Assist Prof. Chawanan Charnsil, MD.
Assist Prof. Arnon Wittayanon, MD.

at http: www.tmc.or.th doctor new （accessed 15thAugust 2009 ）5）M edical Council of Thailand. Residents（inThai）. Available at M edical Council of Thailand at
http: www.tmc.or.th detail doctor.php（accessed 15th
August 2009 ）6）Amin Z,Eng KH.Basics in M edical Education.
Chapter 8: Classiﬁcation of Educational Objectives.
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