Challenges and opportunities in cultivating medical students' competencies: Participatory action research from a hierarchical cultural setting.

BACKGROUNDS: Research concerning student-centered learning (SCL) recommends a comprehensive assessment of medical students' competencies including their personal and professional characters. Accordingly, nurturing future doctors should be in a continuous mentorship program. However, in a hierarchical culture, communication is one-way with limited feedback and reflection. We aimed to explore challenges and opportunities for SCL implementation in medical schools in this cultural setting necessary for a globally interdependent world. METHODS: Two cycles of participatory action research (PAR) were conducted, involving medical students and teachers in Indonesia. A national conference on SCL principles was conducted between the cycles, also the SCL modules were developed for each institution and feedback was shared. Twelve focus group discussions were conducted (before and after the module development), with 37 medical teachers and 48 medical students from 7 faculties of medicine across Indonesia at various levels accreditation. Following verbatim transcriptions, a thematic analysis was conducted. RESULTS AND DISCUSSIONS: In cycle 1 PAR, some challenges in implementing SCL were identified: lack of constructive feedback, overloaded content, summative-based assessment, hierarchical culture environment, and teachers' dilemma of committed time between patient-care and education. In cycle 2, several opportunities to approach the SCL were proposed: a faculty development program on mentorship, students' reflection guides and training, a more longitudinal assessment system, also a more supportive government policy on the human resources system. CONCLUSIONS: The main challenge of fostering student-centered learning revealed in this study was a teacher-centered learning tendency in the medical curriculum. The weighting towards summative assessment and the national educational policy drive the curriculum like a 'domino effect', away from the expected student-centered learning principles. However, using a participative method, students and teachers could identify opportunities and articulate their educational needs, i.e., a partnership-mentorship program, as a significant step toward student-centered learning in this cultural context.

Application of Failure Mode and Effects Analysis in Managing Medical Records for Accuracy of INA-CBGs Health Insurance Claims in a Tertiary Hospital in Indonesia.

Objective: Awareness of the importance of social security systems continues to grow in Indonesia, as mandated by the amendment of the 1945 Indonesian Constitution Article 34 paragraph 2, which states the obligation of the Indonesian government to develop and implement a social security system for all Indonesian people. This study aims to evaluate the effectiveness of applying failure modes and effects analysis (FMEA) in managing inpatient medical records at the Dr. M. Djamil Padang Central General Hospital. Material Methods: This is a comparative research study that uses a retrospective approach and compares the data between 2017 and 2018 inpatient National Health Insurance (NHI) patient medical records. Study samples include randomly selected 24,005 files. Results: The results showed a decrease in problematic claims by 13 percent and an increase in receipt of claims paid by 87 percent. There is a significant difference between the data in 2017 and 2018 in problematic claim decrease (p=0.000) and claim acceptance increase (p=0.000). Discussion: It was found that the redesign process of the formation of hospital claims will make hospitals more organized, precise, effective, and efficient, therefore positively impacting hospital income. In addition, the redesign was carried out because of the large number of Social Security Administrator for Health patients; thus, it greatly affected hospital income. Implication for Health Policies: The FMEA medical record flow process is very effective and can thus be implemented in hospitals.

Empowering adolescents as peer-educators for early prevention of non-communicable diseases: Through existing 'POSBINDU' program in Indonesia.

BACKGROUND: Human lifestyles, including sedentary activities, obesity, and smoking, are associated with a high risk of non-communicable diseases that are a leading cause of death globally. Accordingly, health promotion should be done as early as possible in the adolescent period. AIMS: This study explores the efficacy of a peer-educator program in promoting the healthy habits of adolescents, via an existing Indonesian community initiative program called 'POSBINDU' (Integrated Counseling Post), led by the general practitioners. METHODS: Twenty-week 'experiential learning' approach with mixed-method was designed to: 1) Train 10 GP trainers, 2) Recruit and observe the 10 group-1 and 50 group-2 peer-educators in a high school; 3) Develop modules on health lifestyles by the GPS and peer-educators, and 4) Implement the POSBINDU program at the high school. RESULTS: Both GPs and students' perceptions significantly increased before to after the intervention (p > 0.05). The participants also expressed they experienced increased comprehension of NCDs and the importance of healthy habits. CONCLUSIONS: The existing POSBINDU community's initiative program can potentially be improved by appropriate interventions to empower school students towards better healthy habits to prevent the early progression of NCDs.