Opportunity Amid Crisis in Medical Education: Teaching During the Pandemic of COVID-19.

Purpose: The pandemic of COVID-19 had reinforced adaptations in medical education. It was challenging, especially for developing countries where resources were scarce. This study examined the implementation of teaching and learning adaptation during the pandemic in a low-resource country as perceived by teachers. We also present the opportunities that arise from the adaptation process. Participants and Methods: The participants of this study (n=24) were teachers in an undergraduate medical program. This study employed a qualitative approach using focus group discussions (FGDs) to collect the teachers' perceptions. Thematic analysis was performed to analyse the data. Results: Teachers' perceptions were categorized into 19 subthemes and were accentuated into four general themes; learning facilitation, assessment during the pandemic, learning resources, and competence achievement. We discovered both challenges as well as opportunities in each theme due to the shifting of learning from offline to online learning. Flexibility and innovation were regarded as the most important opportunities and were perceived to hold potential for medical education in the future. Knowledge acquisition was most benefited from this adaptation. Facilitating skill acquisition and burnout were the major challenges. Conclusion: Despite the challenges, including burnout, skills acquisition, and risk in academic integrity, innovations in medical education were strengthened during the pandemic of COVID-19. They also provided a positive influence regarding achievement in the cognitive aspect. Faculty development programs need to be encouraged to improve teachers' capacity in the future.

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.

Stakeholders' Views and Confidence Towards Indonesian Medical Doctor National Competency Examination: A Qualitative Study.

INTRODUCTION: Indonesia is a huge country consisting of 33 provinces with different characteristics. There are 83 medical schools across Indonesia with different accreditation statuses. The Indonesia Medical Doctor National Competency Examination (IMDNCE) has been established to control the quality of medical school graduates. The implementation of IMDNCE needed to be evaluated to determine its impact. To date, there has not been any research in Indonesia that explores the stakeholders' perceptions toward IMDNCE. This study aimed to explore how the stakeholders in Indonesia perceived the impact of IMDNCE towards performances of medical school graduates in clinical practice. METHODS AND STUDY PARTICIPANTS: A qualitative study with phenomenological approach was conducted to investigate perceptions of stakeholders including representatives from consumer organizations, the National Health Coverage, the Ministry of Health, the Indonesian Medical Association, employers (hospital and health center directors), clinical supervisors as well as patients across Indonesia. Data were obtained through focus group discussions (FGDs) and interviews. The study used thematic analysis methods to obtain the results. RESULTS: A total of 90 study participants participated in the study including 10 representatives of consumer watchdog organizations, the National Health Coverage, the Ministry of Health, the Indonesian Medical Association, 31 employers, 32 professionals, and 17 patients. The study found three general themes which represent the perceptions of the stakeholders towards performances of medical school graduates in clinical practice: IMDNCE as an effort to standardize doctor graduates in Indonesia, the results of IMDNCE as a mean to reflect the quality of medical education in Indonesia, and IMDNCE as an effort to improve health services in Indonesia through the quality of graduates. CONCLUSION: In general, the stakeholders perceived that the IMDNCE was able to standardize medical school graduates from various medical schools across Indonesia. However, the IMDNCE needs to be further developed to maximize its potential in improving the competences of Indonesian medical students.

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.

Interprofessional communication in a socio-hierarchical culture: development of the TRI-O guide.

OBJECTIVES: Interprofessional education (IPE) and collaborative practice are essential for patient safety. Effective teamwork starting with partnership-based communications should be introduced early in the educational process. Many societies in the world hold socio-hierarchical culture with a wide power distance, which makes collaboration among health professionals challenging. Since an appropriate communication framework for this context is not yet available, this study filled that gap by developing a guide for interprofessional communication, which is best suited to the socio-hierarchical and socio-cultural contexts. MATERIALS AND METHODS: The draft of the guide was constructed based on previous studies of communication in health care in a socio-hierarchical context, referred to international IPE literature, and refined by focus group discussions among various health professionals. Nominal group technique, also comments from national and international experts of communication skills in health care, was used to validate the guide. A pilot study with a pre-posttest design was conducted with 53 first- and 107 fourth-year undergraduate medical, nursing, and health nutrition students. RESULTS: We developed the "TRI-O" guide of interprofessional communication skills, emphasizing "open for collaboration, open for information, open for discussion", and found that the application of the guide during training was feasible and positively influenced students' perceptions. CONCLUSION: The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.