Predicting medical graduates' clinical performance using national competency examination results in Indonesia.

BACKGROUND: Indonesia has applied a national competency exit-examination for medical graduates since 2014, called The Indonesia Medical Doctor National Competency Examination (IMDNCE). This examination is administered to ensure the competence of medical graduates from at present 83 medical schools in Indonesia. Although many studies reported their evaluation on medical licensing examinations, there are not many studies performed to evaluate the correlation of a national licensing examination to the graduates' clinical practice. AIMS: This research aimed to evaluate the performance of new medical doctors in Indonesia in their internship period after the IMDNCE completion, and whether it might become a predictive indicator for the new medical doctors' clinical performance. METHODS: An observational cross-sectional study was performed in November-December 2017 on 209 doctors who were new medical graduates. Thirty-one senior doctors from a range of regions in Indonesia who were recruited and trained previously participated in the observation. The Clinical Performance Instrument (CPI) tool was developed as an evaluation tool of the new doctors' clinical competence to be observed for three weeks. The obtained data were analysed using descriptive statistics and correlated to the IMDNCE scores. RESULTS: The mean (95% CI) of the CPI for all participants was 83.0 (80.8-85.2), with no correlation of CPI score with IMDNCE results in domains of communication, professionalism and patient safety (p > 0.05). However, the mean total of the CPI observation scores from doctors who graduated from public medical schools was higher than those graduating from private medical schools. Also, there were differences in scores related to the institution's accreditation grade (p < 0.05). CONCLUSION: There is no difference between CPI and national competency examination results. There was no statistical correlation between the clinical performance of new medical doctors during their internship to CBT and OSCE scores in the national competency examination. New doctors' performance during internship is affected by more complex factors, not only their level of competencies.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study.

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital. Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.