“To obey or not to obey” - Medical students’ response towards professional dilemmas in a hierarchical and collectivist culture

Background Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma. Aims This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses. Method A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups. Results We identified the impact of dilemmas on students’ emotions and concerns, students’ responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas. Conclusion This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students’ ability to learn from professional dilemma experienced in the workplace for developing their professional identity.

Accelerated Implementation of a Virtual Neurology Clerkship Amid a Global Crisis

The standard neurology clinical experience in medical school focuses primarily on bedside patient encounters; however, the limitations of the clinical environment due to the current COVID-19 pandemic have accelerated the need for virtual curriculum development. To provide guidance to Neurology clerkship directors during this unprecedented time, the American Academy of Neurology (AAN) Undergraduate Education Subcommittee (UES) formed a workgroup to develop an outline for a ‘virtual curriculum’, provide recommendations, and describe models of integrating virtual curricula into the neurology clerkship.In this overview, we discuss different methods of virtual instruction, hybrid models of clerkship training and the challenges to its implementation, professionalism issues, and modification of feedback and assessment techniques specific to the virtual learning environment. We also offer suggestions for implementation of a hybrid virtual curriculum into the neurology clerkship.The virtual curriculum is intended to supplement the core neurology in-person clinical experience and should not be used for shortening or replacing the required neurology clinical clerkship.

BAKTI KESEHATAN PADA LANJUT USIA DI SASANA TRESNA WERDHA RIA PEMBANGUNAN CIBUBUR

Elderly groups, including the elderly in nursing homes, are vulnerable to transmission of Covid-19, so efforts are needed to improve the health of the elderly in nursing homes through health promotion, namely counseling related to clean and healthy lifestyles. Counseling activities at the Tresna Werdha Ria Development Center of Cibubur during the Covid 19 pandemic are rarely carried out and the Faculty of Medicine of Tarumanagara University is collaborating with the Tresna Werdha Ria Development Center of Cibubur in the learning process of Geriatric clinical clerkship students. Healthy and Clean Life Behavior in the elderly who live in Sasana Tresna Werdha Ria Pembangunan Cibubur. This health service activity is carried out with the aim that the elderly at Sasana Tresna Werdha Ria Pembangunan Cibubur know about PHBS and have an impact on the implementation of PHBS in their daily lives. The introduction of PHBS counseling for the elderly at Sasana Tresna Werdha Ria Cibubur development is a series of health service activities that have been well organized on Saturday, October 16, 2021. The activity is carried out offline which stipulates implementing health protocols in its implementation, attended by 60 participants. Counseling related to PHBS is important and the application of Clean and Healthy Living Behavior needs to be considered in daily life, so that further health service activities are needed to assess that counselingparticipants have increased insight regarding clean living behavior and the stages of hand washing. Kelompok lanjut usia termasuk lansia pada Panti Werdha rentan terhadap penularan Covid-19 maka perlu upaya untuk meningkatkan kesehatan lansia di Panti Werdha melalui promosi kesehatan yaitu penyuluhan terkait Perilaku Hidup Bersih dan Sehat. Kegiatan penyuluhan di Sasana Tresna Werdha Ria Pembangunan Cibubur selama pandemi Covid 19 jarang dilakukan serta Fakultas Kedokteran Universitas Tarumanagara bekerja sama dengan Sasana Tresna Werdha Ria Pembangunan Cibubur dalam proses pembelajaran mahasiswa kepaniteraan klinik Geriatri, maka tim pengabdian fakultas kedokteran Universitas Tarumanagara melakukan bakti kesehatan dengan penyuluhan mengenalkan Perilaku Hidup Sehat Dan Bersih pada lansia yang menetap di Sasana Tresna Werdha Ria Pembangunan Cibubur. Kegiatan bakti kesehatan ini dilakukan dengan tujuan lansia di Sasana Tresna Werdha Ria Pembangunan Cibubur mengetahui tentang PHBS serta berdampak penerapan PHBS dikehidupan sehari-hari. Pengenalan tentang penyuluhan PHBS pada lansia di Sasana Tresna Werdha Ria Pembangunan Cibubur merupakan rangkaian dari kegiatan bakti kesehatan telah terselenggara dengan baik pada hari Sabtu 16 Oktober 2021. Kegiatan dilakukan secara luring yang tetapkan menerapkan protokol kesehatan dalam pelaksanaannya dihadiri 60 peserta. Penyuluhan terkait PHBS penting dilakukan serta penerapan tentang Perilaku Hidup Bersih dan Sehat perlu diperhatikan dalam kehidupan sehari-hari, sehingga perlunya kegiatan pengabdian kesehatan selanjutnya untuk menilai bahwa peserta penyuluhan telah bertambah wawasan terkait perilaku hidup bersih serta tahapan cuci tangan.

Professional identity formation-oriented mentoring technique as a method to improve self-regulated learning: A mixed-method study

Introduction: Previous studies indicate that professional identity formation (PIF), the formation of a self-identity with the internalised values and norms of professionalism, may influence self-regulated learning (SRL). However, it remains unclear whether a PIF-oriented intervention can improve SRL in clinical education. The aim of this study was to explore whether a PIF-oriented mentoring platform improves SRL in a clinical clerkship. Methods: A mixed-methods study was conducted. Forty-one students in a community-based clinical clerkship (CBCC) used a PIF-oriented mentoring platform. They articulated the values and norms of professionalism in a professional identity essay, elaborated on future professional self-image, and reflected on their current compared to future selves. They made a study plan while referring to PIF-based self-reflection and completed it. The control group of 41 students completed CBCC without the PIF-oriented mentoring platform. Changes in SRL between the two groups were quantitatively compared using the Motivated Strategies for Learning Questionnaire. We explore how PIF elements in the platform affected SRL by qualitative analysis of questionnaire and interview data. Results: A moderate improvement in intrinsic goal orientation (p = 0.005, ε2 = 0.096) and a mild improvement in critical thinking (p = 0.041, ε2 = 0.051) were observed in the PIF-oriented platform group. Qualitative analysis revealed that the PIF-oriented platform fostered professional responsibility as a key to expanding learning goals. Gaining authentic knowledge professionally fostered critical thinking, and students began to elaborate knowledge in line with professional task processes. Conclusion: A PIF-oriented mentoring platform helped students improve SRL during a clinical clerkship.

Analisis Unit Cost dan Biaya Kepaniteraan Klinik Mahasiswa Profesi Kedokteran Gigi Universitas Udayana dengan Metode Activity Based Costing

Udayana University (UNUD) School of Dentistry (PSSKGPDG) is one of the dental school in Bali that has problems in analyzing the education cost. Based on previous financial reports, the calculation of the unit cost has been made using the activity based costing (ABC) method for the undergraduate phase. This study was aimed to determine the unit cost and the amount of clinical clerkship education costs that would be proposed using the ABC method. This was a mixed method study using a combination of quantitative and qualitative approaches. The quantitative approach used secondary data of financial statements for the 2019/2020 academic year analyzed by using the ABC method. Meanwhile, the qualitative approach was conducted through in-depth interviews with five informants selected by purposive sampling and then was analyzed thematically. The results showed that the unit cost per semester for PSSKGPDG FK UNUD students was Rp. 61,635,692 which was greater than the unit cost previously calculated by the study program of Rp. 22,319,000. Often the unit costs that had been prepared were not below the budget plan (RAB) due to the lack of detail in budgeting by the study program. In conclusion, although PSSKGPDG prepared RAB by applying the ABC method, in the end its implementation was not fully realized due to urgent activities or budgets that exceeded the ceiling. Periodic training is needed, therefore, employees can be more thorough and detailed in preparing a budget.Keywords: activity based costing method; unit cost; dentist clinical clerkship Abstrak: Program Studi Sarjana Kedokteran Gigi dan Profesi Dokter Gigi (PSSKGPDG) Fakultas Kedokteran (FK) Universitas Udayana (UNUD) merupakan salah satu institusi pendidikan dokter gigi di Bali yang memiliki permasalahan dalam analisis biaya pendidikan. Berdasarkan laporan keuangan sebelumnya, perhitungan satuan biaya pendidikan sudah dibuat dengan metode Activity Based Costing (ABC) untuk fase sarjana. Penelitian ini bertujuan untuk mengetahui besaran biaya satuan (unit cost) dan besaran biaya pendidikan kepaniteraan klinik yang akan diusulkan dengan metode ABC. Penelitian ini menggunakan mixed method yaitu kombinasi pendekatan kuantitatif dan kualitatif. Penelitian kuantitatif menggunakan data sekunder laporan keuangan periode tahun ajaran 2019/2020 yang dianalisis menggunakan metode ABC. Penelitian kualitatif dilakukan melalui wawancara mendalam terhadap lima informan yang dipilih secara purposive sampling dan dianalisis secara tematik. Hasil penelitian menunjukkan bahwa unit cost per semester mahasiswa PSSKGPDG FK UNUD sebesar Rp. 61.635.692 yang lebih besar dibandingkan unit cost yang telah dihitung sebelumnya oleh prodi sebesar Rp. 22.319.000. Seringkali unit cost yang telah disusun tidak sesuai dengan rencana anggaran biaya (RAB) dikarenakan kurang detailnya prodi membuat anggaran. Simpulan penelitian ini PSSKGPDG menyusun RAB dengan menerapkan prinsip ABC, meskipun pada akhirnya dalam penerapannya tidak terealisasikan dengan sempurna karena adanya kegiatan atau anggaran mendesak yang seringkali melebihi pagu. Pelatihan secara berkala sangat diperlukan sehingga pegawai dapat lebih teliti dan detail dalam menyusun suatu anggaranKata kunci: metode activity based costing; unit cost; kepaniteraan klinik

Redefining Student Learning Objectives for the General Medicine / Primary Care Clinical Clerkship ~ The Way to Implement Community Based Medical Education

Background: Mie University is one of the first medical schools to initiate a community-based clinical clerkship in general medicine. The curriculum was developed over fifteen years ago based on the personal expertise of the general medicine faculties. The purpose of this project is to update and revise the curriculum and learning objectives by integrating the ideas of community primary care physicians and university faculties involved in clinical clerkships.Methods: We have conducted semi-structured interviews with community primary care physicians. The interviews were based on keywords extracted from the preliminary research. Two researchers independently reviewed the free-coded interview transcripts, organized them into thematic units using thematic analysis, and then discussed and merged them into one list between the two researchers. This list was shared and discussed among the four researchers to create a new curriculum and learning objectives.Results: Nine primary care physicians participated in group interviews and 11 participated in individual interviews. The following themes were identified: 1.role of primary care 2.contextual care 3.hospital-clinic collaboration 4.multidisciplinary care/inter-professional work 5.work-life balance 6.health economics 7.health promotion 8.health policy 9.common problems/common diseases. Conclusion:We have redefined the learning objectives of the general medicine clinical clerkship. The abstracts have been made more specific, which will be more helpful for both teachers and learners.

IMPLICATIONS OF CORONAVIRUS DISEASE-19 ON CLINICAL CLERKSHIP AND HOSPITAL POSTINGS

The coronavirus pandemic hit the world sweeping through all parts of the world, crumbling economies, and overwhelming health systems. Undergraduate medical education has been totally disrupted and put to a stop. As Nigeria braces to open on medical schools and clinical rotation about to begin, the palpable panic that accompanies patients-students spread of the virus will definitely affect undergraduate medical education in Nigeria. At present, little is known in Nigeria about the long-term effects of Coronavirus disease-19 on clinical clerkship and undergraduate medical education and adaptations to juxtapose future pandemics with medical education. This review accesses risks, plans, and policies in place and how they will affect undergraduate medical education.

The Relationship between Perceptions of the Availability of Hospital Facilities and Infrastructure to the Level of Fire Disaster Preparedness among Clinical Clerkship Students in Zainoel Abidin Hospital

Clinical clerkship students are one of the communities who are always in the hospital environment and have been provided with fire disaster management materials through training and simulations. The hospital has provided complete fire disaster management facilities and infrastructure. However, the problem is that there is no information about clinical clerkship student preparedness for fire disasters in hospitals. The purpose of this study is to determine the relationship between perceptions of the availability of hospital facilities and infrastructure to the level of fire disaster preparedness among clinical clerkship students in the Zainoel Abidin Hospital. This study used an analytical method with a cross-sectional design. The sample of this study was the clinical clerkship students of the Faculty of Medicine, Syiah Kuala University, who were taken by proportional stratified random sampling, totaling 117 people. The data was collected using an online questionnaire that has been tested for its validity and reliability. Data analysis was performed univariate and bivariate using the chi-square test. The results showed that the clinical clerkship student had a good perception regarding facilities and infrastructure in the hospital (68.4%), while the attitude of preparedness to face fire disasters in the hospital showed a high level (80.3%). The Chi-square test results showed that there was a significant relationship between the clinical clerkship student perception regarding facilities and infrastructure in hospitals and fire disaster preparedness (p = 0,000). The conclusion of this study showed that the good perceptions of clinical clerkship students about the availability of fire disaster management facilities and infrastructure increase fire disaster preparedness in the hospital. This study recommends the importance of training and fire disaster management simulation to be continuously carried out on clinical clerkship students to improve the quality of disaster preparedness communities.