Background

Early clinical exposure of medical students is supposed to improve preparation for prospective clinical rotations. Hence, students prepared exclusively in a skills laboratory were compared with peers for whom part of their skills training programme was substituted by training in a primary health centre (PHC).

Summary of work

Over a 5-week period 153 fourth-year (pre-clinical) medical students trained clinical skills exclusively in a skills lab; 59 of their peers received a mixed programme of laboratory trainings and practice in PHC. Students’ perception of preparedness and clinical skills achievement were assessed through the Preparation for Hospital Practice Questionnaire (PHPQ) and a 9-station OSCE exam.

Summary of results

Students taking the mixed programme felt significantly better prepared for clinical rotations than exclusively skills lab-trained peers. Mean OSCE scores of both groups did not differ significantly. Students’ preparedness scores did not correlate with their General Point Average (GPA) and OSCE scores.

Conclusion

Adding clinical skills training in a PHC setting to skills lab trainings improved students’ perception of preparedness for clinical rotations. However, this mixed programme did not improve students’ clinical and academic performance. Take home message Early clinical encounters may improve students’ perception of preparedness for clinical rotations. However, tangible impact on clinical and academic performance remains to be demonstrated.

Accepted As: Oral Presentation

in OTTAWA Conference 2010, Miami, Florida, US

further information, please contact: widyandana@yahoo.com

¹ Dept. Medical Education & Skills Lab, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

²Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Keywords:

Clinical skills training, preparation, undergraduate students, primary care, attachment program

Introduction

Undergraduate medical students’ can practice their clinical skills in a skills laboratory when a school has this facility. Finishing pre-clinical phase, the students enter clinical rotations in real clinical setting. Current studies show that transition process from campus into real clinical setting can cause problems for students, they often feel anxious and not prepared enough to face real patients in reality. Integrating skills training between skills laboratory and primary health care setting could be a solution for this problem.

Objective

To show the effects of clinical attachment program with integrated skills training in Primary Health Care (PHC) settings on student’s level of preparedness to enter clinical rotation.

Method

59 undergraduate medical students in Faculty of Medicine, Gadjah Mada University, Indonesia, randomly choosen to practice their clinical skills in PHC setting before entering clerkship for 5 weeks (11 days). Preparation for Hospital Practice Questionnaire (Hill et al, 1998) will be used for pretest and post test to assess student’s level of preparedness entering clerkship, that consists of interpersonal skills, confident, collaboration, management, science, prevention, holistic care, and self directed learning. The clinical supervisor assesses students’ improvements 5 times during attachments program in PHC.

Result

Finishing clinical attachment in PHCs, students have significant improvement in their sense of preparedness entering clinical rotations (p<0.05). Average score from the teacher also support that result, scores from clinical supervisors indicate that students have significant improvement (p<0.05) in all eight areas of preparedness during practice in PHC settings.

Conclusion

Undergraduate students are more and better prepared for entering hospital clerkship after having clinical attachments in PHC settings.

Published in 7th APMEC Conference 2010, NUS, Singapore

as Poster Presentation. This study conducted as apart of PhD study in Maastricth University.

Further Information,  please contact: widyandana@yahoo.com

Awarded as BEST ORAL PRESENTER

¹ Dept. Medical Education & Skills Lab, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

²Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Keywords:

Comparison, clinical environment, cases, facility, clinical supervisor, medical students

Introduction

Current studies show the importance of early clinical experiences for undergraduate medical students. It improves motivation for learning and prepares them entering clinical rotations. Skills laboratory needs to collaborate with clinical settings to give skills training program for students before entering clerkship.

Objective

To compare three clinical settings (primary health care (PHC), secondary health care (SHC) and tertiary health care (THC)) environment for undergraduate skills training program .

Method

Questionnaires were send to 272 clerkship students in Faculty of Medicine Gadjah Mada University, Indonesia. The students were practicing in three different clinical settings. This survey using modified DREEM questionnaire that already has been validated, and followed by semi structured interview to the clinical supervisors from those settings (n:45).

Result

In general, clerkship students shows that primary health care environment have highest score compare with SHC and THC settings (p<0.05). The clinical supervisors from the hospital settings (SHC and THC) indicate that they are willing to teach, but having difficulties on managing time to supervise students. Beside of that, teaching hospital (THC) is already overloaded with residents, clerkship and other students. This situation is different in PHC, students are welcome, teachers more concern about education, and they have enough time to supervise students. Moreover, facilities and variety of cases in those settings proved to be sufficient for teaching basic knowledge and clinical skills for undergraduate student’s level.

Conclusion

Primary health care settings are feasible as a partner of skills laboratory for undergraduate skills training program. It can provide enough supervision, facilities and availability of cases that suitable for student’s level of competency.

Awarded as BEST ORAL PRESENTATION

in APMEC Conference 2010, NUS, Singapore

will be Published in Medical Education Suplement 2011

Further information, contact widyandana@yahoo.com

Community, education, clinical experience, first year, primary care

Background: Recent studies show the importance of “early clinical experience” for medical students, it can motivate them to study and prepare before entering clerkship. Those clinical exposures should be introduced earlier according to student’s level of competence. Faculty of Medicine, Gadjah Mada University (FM GMU) has been implementing a Community Based Education (CBE) program, in which send first year medical students to Primary Health Care (PHC) settings to observe and interview staff members regarding their activities, facilities, and management in primary care.

Objective: to explore first year medical students and PHC supervisors opinions on their first experiences having interaction in PHC settings as an early part of CBE program.

Method: Survey using questionnaire to all first year medical students in FM GMU (n: 272) and interview to 5 supervisors in PHC DIY. Data were analyzed qualitatively using content analysis.

Result: The response rate was 86%. Most of the students and PHC supervisors give positive responses on their first experiences having interaction in PHCs settings. CBE activities give better understanding to student’s future profession and reality of health service system in primary care settings. Some areas that students do not like are the report writing, lack of time, limited facilities in PHCs, and unpleasant transportation. Students and supervisors suggest that those activities should be prepared well and scheduled more in the curriculum.

Conclusion: First year students and supervisors realize the importance and advantages of CBE program. This program is acceptable and feasible to continue longitudinally in the curriculum.

Presented as Oral Presentation

in AMEA Conference, Bandung, Indonesia 2009

Further discussion, contact: widyandana@yahoo.com

Kurikulum Problem Based Learning (PBL)??

Kurikulum Berbasis Kompetensi (KBK)??

Ini adalah ajang diskusi, mana yang paling baik dari tiga kurikulum tersebut? Apakah anda tahu bedanya? Apakah anda benar-benar mengerti kelebihan dan kekurangan masing2?

Mari berdiskusi, agar pemahaman kita semua lebih baik lagi.. bisa lewat Blog ini atau lewat email; widyandana@yahoo.com

ACMER

This is My picture with international friends after join Advance Course in Medical Education Research, Maastricht, Netherlands, 2008.

Tentu saja kita harus menyadari bahwa ternyata pencapaian kompetensi bagi mahasiswa kedokteran tidaklah mudah, perlu ada proses belajar yang terintegrasi, dan sistem yang baik untuk mencapainya. Oleh karena itu, untuk saat ini banyak institusi melakukan inovasi pendidikan, termasuk didalamnya; pengembangan kurrikulum, penambahan/ pengurangan masa study, dan bahkan perubahan metoda pembelajaran yang semua itu untuk dapat mencapai kompetensi tersebut. Sehingga saat ini di Indonesia sedang marak istilah-istilah PBL (Problem Based Learning), KBK (Kurrikulum Berbasis Kompetensi), Skills Lab, dll.

Penyusunan kurikulum pendidikan kedokteran ini tidaklah mudah, karena kita tahu bahwa komponen kompetensi terdiri dari banyak hal, harus terintegrasi mengenai sisi teori, keterampilan, perilaku, maupun nilai-nilai professional dalam kurikulum tersebut. Ada beberapa prinsip dasar yang harus kita pegang, ketika menyusun kurrikulum KBK, yaitu:

- Kita cermati Standar Kompetensi Dokter Indonesia, dan kita usahakan untuk dapat mengintegrasikan sisi Knowledge, Skills dan Professional Behavior dalam suatu kerangka kurikulum yang terintegrasi, baik dilevel makro, meso, maupun mikro kurikulum.

- Integrated Horizontally, semua materi yang di intergasikan dalam suatu block harus dalam satu konteks yang sama. Topik block, kuliah, materi diskusi tutorial, materi untuk keterampilan medis di Skills lab, dan praktikum sebaiknya terintegrasi secara baik dalam suatu block. Perlu dihindari beban dalam block yang berlebihan, atau sebaliknya, serta perlu di perhatikan materi-materi yang sebenarnya dipaksakan masuk dalam block padahal relasinya jauh dari topik.

- Integrated Vertically, semua materi yang ada harus teintegrasi dari satu block, dengan materi block sebelum dan sesudahnya. Materi yang diajarkan dalam satu block, sudah semestinya melanjutkan materi yang sebelumnya sehingga dimulai dari yang paling sederhana, ditingkatkan level kesulitannya, sampai nantinya mempelajari suatu hal yang bersifat lebih kompleks. Penyusunan materi dari simple ke kompleks ini tentu saja harus dibuat secara luas sehingga dapat di integrasikan dengan baik.

- Integrated Longitudinally, semua materi yang diajarkan dalam suatu kurikulum, sebaiknya berkelanjutan dari awal sampai akhir harus terlihat garis benang merahnya. Tidak disarankan pemberian materi yang terpisah-pisah, dalam satu atau dua block saja, tanpa ada kelanjutan dengan block lainnya. Susunan yang baik, materi dapat selalu diajarkan berkelanjutan, dengan derajat yang selalu ditingkatkan dalam suatu kurikulum KBK, baik dari sisi teori maupun prakteknya. Selain itu perlu dipikirkan bahwa level pembimbingan juga harus dikurangi seiring dengan meningkatnya kompetensi mahasiswa. Untuk mahasiswa yang masih awal harus banyak dibimbing, namun untuk mahasiswa yang tingkat lebih tinggi harus di support untuk berani bertindak lebih mandiri.

- Integrated Spirally, ini berarti bahwa materi-materi yang tersusun dalam block-block di kurikulum KBK harus diberikan pengulangan-pengulangan dengan integrasi yang baik. Pengulangan ini penting dilakukan, karena kita sadar bahwa secara normal seseorang akan lupa terhadap materi yang sudah lama diajarkan dan tidak pernah diulang kembali. Sedangkan, pengulangan disini tidak boleh hanya mengulang, tetapi tetap harus dibuat suatu inovasi dimana pengulangan tersebut tidak bersifat membosankan dan tetap menarik bagi mahasiswa untuk belajar dan berlatih. Harus ada variasi latihan dan metoda pembelajaran untuk membuat tetap menarik.

Dapat disimpulkan bahwa penyusunan kurrikulum KBK tidaklah mudah, harus dipikirkan integrasi yang menyeluruh untuk teori, keterampilan, maupun perilaku professional dengan kaidah-kaidah diatas. Pemetaan kurikulum baik di level makro, meso maupun mikro sebaiknya dilakukan dengan sebaik-baiknya. Untuk itu memang perlu di pelajari teori-teori ilmiah dalam keilmuan medical education, atau dibantu seorang yang mengerti konsep ilmu pendidikan kedokteran dalam melaksanakan penyusunan kurikulum tersebut.

References
• General Medical Council (GMC). (2003). Tomorrow’s Doctors Recommendations on undergraduate medical education. UK: General Medical Council.
• Remmen, R., Scherpbier, A., van der Vleuten, C., Denekens, J., Derese, A., Hermann, I., Hoogenboom, R., Kramer, A., van Rossum, H., van Royen, P., and Bossaert, L. (2001). Effectivenes of basic clinical skills training programes: a cross-sectional comparison of four medical schools. Medical Education, 35, 121-128.
• Lynagh, M., Burton, R., Fisher, R.S. (2007). A systematic review of medical skills laboratory training: where to from here?. Medical Education, 41, 879-887.
• Van Marrienboer JJG, Clark RE, de Croock MBM. Blueprints for complex learning: The 4C/ID-model. ETR&D. 2002; 50: 39-64
• Stark, P. and Fortune, F. (2003). Teaching clinical skills in developing countries: Are Clinical Skills Centres the answer?. Education for Health, 16, 3, 298-306.

Contact:
dr. Widyandana, MHPE
Staff Skills lab dan Bagian Pendidikan Kedokteran FK UGM
Mahasiswa S3 Maastricht University bidang Medical Education
Email: widyandana@yahoo.com