Department of Psychiatry of the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah (FMHS UMS) developed a SBMHP as part of its Psychiatry Clerkship, enabling medical students to work directly with adolescents in school settings within Kota Kinabalu, Sabah. Grounded in Kolb’s experiential learning theory, this SBMHP immerses medical students in real-world mental health settings, enabling them to transform theoretical knowledge into practical skills [16]. The program followed Kolb’s learning cycle in practice. Students gained concrete experience through direct interaction with adolescents. Reflective observation occurred during peer debriefings and self-reflection. Abstract conceptualization was supported through discussions with supervisors that helped make sense of their experiences. Finally, students engaged in active experimentation by applying skills like mindfulness, motivational interviewing, and communication skills in realtime. This full cycle helped reinforce learning and build confidence in applying mental health skills.

Before participating in the program, medical students completed all psychological skills laboratory sessions that are part of the standard psychiatry clerkship at FMHS UMS. These sessions included training in communication and problem-solving skills, motivational interviewing, introductory to cognitive behavioral therapy (CBT), mindfulness, and relaxation techniques. This foundational training prepared students for real-world interaction with adolescents by equipping them with essential psychological tools and communication strategies. This program enables medical students to work directly with adolescents in school settings under the supervision of psychiatrists and school counsellors. It offers a unique opportunity to develop communication skills, enhance mental health literacy, and apply essential psychological techniques, making these experiences a vital component of holistic medical education, even if they do not specialize in psychiatry [13,17].

This study adopted a qualitative method of data collection using focus group discussion to explore medical students’ insights, attitudes, and experiential learning outcomes during the program. This method aligned with the study’s aim to understand students’ subjective experiences and the impact of such training on their clinical development.

Convenience sampling was used to select medical students (n=32) scheduled for the psychiatry clerkship and who participated in the school-based mental health initiative between November 2023 and May 2024. The medical students were then assigned to focus groups, with eight participants in each group. Data saturation was achieved after the third focus group; however, a fourth group was conducted to confirm the consistency of the identified themes and ensure comprehensive coverage of the students’ diverse perspectives [18].

The focus group discussion was developed using a semi-structured interview protocol to ensure consistency and depth. Following a five-phase process, we confirmed the appropriateness of the semi-structured interviews, reviewed relevant literature, drafted core thematic questions, pilot-tested with a small student group, and refined the guide based on feedback from the students. This systematic approach ensured reliability, objectivity, and a comprehensive framework for exploring students’ experiences [19]. At the beginning of the focus group discussion, the researchers explained the aim of the study, and each student signed a consent form.

All focus groups were held in a private setting in FMHS UMS to ensure confidentiality and create an environment where participants felt comfortable sharing openly, with each session lasting 60 and 90 minutes. All discussions were audio-recorded with the participants’ informed consent, anonymized upon transcription with participant tags of S-1 to S-32, and securely stored. Confidentiality was ensured through encryption, password protection, and restricted access. A data management plan outlined storage, future sharing, and eventual destruction of the recordings, adhering to the ethical standards of Institutional Review Board (IRB).

All data (quotes) from the transcribed verbatim were encoded using the qualitative web software, Atlas.ti Web (ATLAS.ti GmbH, Berlin, Germany). Data analysis was conducted using reflexive thematic analysis as outlined by Braun and Clarke [20], involving a six-step iterative process that engaged researchers closely. This approach was selected for its capacity to identify patterns and themes within complex qualitative data, particularly in capturing the nuanced experiences of medical students from diverse demographics. The analysis involved familiarizing with the transcribed data as researchers reviewed transcripts to develop a thorough understanding. Initial coding was conducted and organized into themes representing the study. The themes were refined to ensure they accurately represented the data set and were distinguishable. The themes were then defined, labelled, and organized into a coherent narrative. Potential biases were mitigated through reflexivity practices. Regular discussions were held to reflect on personal assumptions and interpretations, thereby minimizing subjective influences on the analysis process. This reflexive approach enabled the researchers to recognize and address potential biases, enhancing the trustworthiness and reliability of the findings.

The study protocol received ethical approval from the IRB in medical research ethics, which is the Medical Research Ethics Committee of the Faculty of Medicine and Health Sciences, University Malaysia Sabah (reference of approval no., JKEtika 3/24–4). All methods were carried out following the relevant guidelines and regulations under the IRB.

The students demonstrated significant progress in contextsensitive communication, specifically in adapting their tone, body language, and conversational approach to connect with adolescents. Techniques such as mirroring and empathetic listening were frequently applied to foster rapport. “The most important part about this clerkship experience in high school is the communication skill that I obtained in psychiatry and being able to apply effectively that’s outside a hospital and clinic setting, like paraphrasing, affirmation, active listening, and summarizing” (S-12).

The students highlighted the value of building rapport by treating adolescents as younger siblings, noting that this approach helped create a friendlier, more open environment for conversation. Similarly, one student (S-19) observed, “They talked to me in a low tone and volume, so I mirrored their way of speaking.” These reflections illustrate the students’ ability to adapt core communication skills to a non-clinical, adolescent setting.

The students experienced notable growth in empathy and emotional connection through direct engagement with adolescents. Actively listening to adolescents’ challenges allowed the students to gain insight into their struggles, fostering deeper emotional connections. As one student (S-5) noted, “Some of their situations resonated with my own experiences, which made me feel more connected.” Another student (S-27) reflected on overcoming initial doubts about empathizing, stating, “I initially doubted my ability to empathize, but hearing students’ stories and understanding their problems during the school visit helped me develop empathy and become a better listener.” These accounts demonstrate how firsthand interaction with adolescents enabled the students to cultivate empathy and listening skills, contributing to their emotional sensitivity in patient care.

Sustained engagement with adolescents during the school-based program enhanced the students’ mental health literacy and understanding of adolescent-specific issues. By interacting directly with adolescents, students gained insights into issues such as anxiety, stress, body image, family-related challenges, sports performance, and academic pressures. These interactions bridged the gap between theoretical learning and practical application, equipping students with the skills necessary to recognize early signs of mental health issues and intervene appropriately. One student (S-18) noted, “Learning directly from students about mental health issues like anxiety and stress provided me with an understanding of what we learnt in lectures and this enhances our understanding and approach.”

This engagement fostered trust and normalized mental health discussions, encouraging adolescents to share their struggles. As one student (S-3) observed, “I think they are very thankful because they never shared their stories. I feel grateful that I can help them to understand better.” These repeated interactions not only built rapport but also helped students reduce stigma and deepen their empathy.

The students also recognized the broader context of adolescent mental health, identifying the role of external stressors like family dynamics. One student (S-22) shared, “Most of their problems are due to family issues and academic performance, with I think around nine out of ten of them having family issues.” Another (S-7) shared, “Observing the long-term effects of mental health issues on his sports performance provided a perspective on the impact of mental health beyond academics.” This direct exposure allowed students to contextualize mental health challenges within psychosocial frameworks, reinforcing their ability to provide patient-centered care.

The students reported an increase in confidence and adaptability, equipping them with essential psychological tools to support adolescents while fostering their resilience. Through hands-on engagement, students bridged theoretical knowledge and practical application, gaining valuable skills for navigating fast-paced, real-world settings. One student (S-15) reflected, “The experience boosted my confidence as a medical student. During the school visit, with many school students coming over to our stations, and we had to see continuous, it felt like a clinic session.”

Frequent interactions with adolescents required students to balance empathy and efficiency, sharpening their adaptability. As another student (S-10) noted, “The number of school students coming to our stations was continuous. I had to communicate with them and show empathy at the same time. It was fast-paced.”

The integration of psychological skills, such as mindfulness, motivational interviewing techniques, and CBT, empowered students to manage both adolescent stress and their challenges. One student (S-9) remarked, “Practicing mindfulness learned during the Psychological Skills Lab proved valuable in helping students manage their stress.” These tools also demonstrated broader applicability, with students recognizing their relevance across medical fields. As one noted (S-7), “Mindfulness can be taught to most people with mental health difficulties. When we see patients in primary care or other departments, we can integrate this skill into their management plans.”

This dual focus on practical confidence and psychological resilience prepared students to address adolescent mental health while equipping them for diverse clinical environments. The initiative’s holistic approach exemplifies the value of integrating experiential learning with psychological skill-building to foster cross-disciplinary applicability of mental health skills, which aligns with the study’s goal of equipping future healthcare providers to address mental health needs in the community and primary care settings.

The program highlighted the potential of strengthening peer guidance clubs (Pembimbing Rakan Sebaya, PRS) to better support adolescent mental health in schools. Medical students recognized that while PRS networks exist, their impact could be significantly enhanced through targeted training in mental health literacy and mindfulness. One student (S-30) observed, “Secondary students often lack trusted confidants, so strengthening their peer support systems could make a significant difference.” Another proposed (S-12), “I think the PRS should not just be for extra co-curricular marks. We can train them so they can help their friends.”

Additionally, the focus on peer support fostered collaborative learning among the medical students themselves. “Working with peers allowed us to learn from each other’s strengths and weaknesses, and having a psychiatrist present gave us immediate feedback and confidence in our abilities,” one student (S-8) shared, underscoring how peer interactions and mentorship bolstered both skills and confidence. In this dual role, peer support not only enhances adolescent mental health resources but also cultivates critical teamwork and adaptability skills in medical students, reinforcing the program’s value in medical training and community mental health initiatives.