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.

The Practice of Feedback in Health Professions Education in the Hierarchical and Collectivistic Culture: a Scoping Review.

The global trend in student assessment is moving towards outcome-based assessment that requires multiple systematic data points and continuous feedback. However, in hierarchical and collectivistic cultures, one-way communication is practised more often, leading to less dialogical feedback. This scoping review explored feedback practice in Asian educational setting. Based on the 17 articles selected, the findings were categorised into four themes, i.e. inhibiting or facilitating factors of feedback, influences of cultural factors on feedback, discrepancies between students' and teachers' perceptions of feedback and impact of feedback. Hierarchical and collectivist cultural aspects, such as preference for group feedback, are pertinent to feedback practice, which likely influence the readiness for programmatic assessment.

Reaction Times among Batik Workers: The Influence of Gender and Occupational Lead Exposure.

(1) Background: Neglected occupational health and safety aspects in batik industries cause their workers to have an increased risk of lead exposure. The effect of occupational lead exposure on neurocognitive performance is inconclusive. Therefore, we conducted an observational study to examine the difference in simple reaction time between lead-exposed batik workers and non-exposed referents. (2) Methods: This cross-sectional study was conducted in seven batik enterprises in Lendah District, Indonesia, excluding workers with medical conditions impairing reaction time. Simple reaction time tests were conducted using an online tool. Two-way model ANCOVAs examined interactions between gender and job types on the mean differences in reaction time. (3) Results: After controlling for age and body mass index, we observed longer reaction times among lead-exposed batik workers than non-exposed referents with an adjusted mean difference of 0.19 (95% CI: 0.016-0.368) seconds. A more prominent detrimental effect of lead exposure on reaction time among female workers than among male workers was observed. (4) Conclusions: Our results suggest that occupational lead exposure could contribute to longer reaction time, notably among female workers. Thus, occupational health and safety precautions are vital to protect batik workers and preserve their important contributions to cultural heritage.