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Gandes Retno Rahayu, Prattama Santoso Utomo, Rilani Riskiyana, Rachmadya Nur Hidayah Department of Medical Education and Bioethics, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, IndonesiaCorrespondence: Rilani Riskiyana, Radioputro Building 6th Floor, Jl. Farmako Sekip Utara, Yogyakarta, 55281, Indonesia, Tel +62274562139, Email rilani.riskiyana@ugm.ac.idPurpose: 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.Keywords: medicine, teaching, undergraduate, pandemic, opportunities, challenges

Indonesia has applied for a national competency exit examination for medical graduates since 2014. This examination has an impact on students. There is limited literature that describes the impact mechanism of the national examination. This study aimed to identify the determinant factors of the learning behavior of medical students in the national medical competency examination during the COVID-19 pandemic in Indonesia. This qualitative study was conducted using semi-structured in-depth face-to-face interviews with 13 medical students from the Faculty of Medicine Universitas Islam Malang and online interviews with 13 medical students from the Faculty of Medicine Universitas Gadjah Mada, Indonesia. Theoretical sampling was carried out by including three medical students from a faculty of medicine in east Indonesia. Semi-structured in-depth interviews with respondents from FK Unisma were conducted offline with strict health protocols. Meanwhile, communications with respondents from FK-KMK UGM and the eastern Indonesia medical faculty were conducted online by telephone or through Zoom meetings. Transcribed interviews were coded openly. Themes were finalized through discussion to reach a consensus. The extracted concepts from our study were classified into 10 categories that describe the determinant factors of learning behavior and two categories of learning behavior. These categories include task value, goal orientation, weakness, impact failure, benefits of passing the examination, self-efficacy, beliefs, barriers to learning, environment factors, and test anxiety. The learning behavior itself consists of two categories: quality of learning and regulation of learning. The conclusion is determinant factors consisting of internal and external factors. Internal factors include task value, goal orientation, weakness, benefits of passing the examination, self-efficacy, belief, and test anxiety. The external factor includes the environmental factor. These factors determine the medical student learning behavior in the national medical competency examination during the COVID-19 pandemic in Indonesia, both in quality and regulation of learning. The impact of failure only determines the regulation of learning, while the barrier to learn only determines the quality of learning.

Introduction: Objective Structured Clinical Examination (OSCE) examiners come from various backgrounds. This background variability may affect the way they score examinees. This study aimed to understand the effect of background variability influencing the examiners’ score agreement in OSCE’s procedural skill. Methods: A mixed-methods study was conducted with explanatory sequential design. OSCE examiners (n=64) in the Faculty of Medicine Universitas Kristen Duta Wacana (FoM-UKDW) took part to assess two videos of Cardio-Pulmonary Resuscitation (CPR) competence to get their level of agreement by using Fleiss Kappa. One video portrayed CPR according to performance guideline, and the other portrayed CPR not according to performance guidelines. Primary survey, CPR procedure, and professional behaviour were assessed. To confirm the assessment results qualitatively, in-depth interviews were also conducted. Results: Fifty-one examiners (79.7%) completed the assessment forms. From 18 background categories, there was a good agreement (>60%) in: Primary survey (4 groups), CPR procedure (15 groups), and professional behaviour (7 groups). In-depth interviews revealed several personal factors involved in scoring decisions: 1) Examiners use different references in assessing the skills; 2) Examiners use different ways in weighting competence; 3) The first impression might affect the examiners’ decision; and 4) Clinical practice experience drives examiners to establish a personal standard. Conclusions: This study identifies several factors of examiner background that allow better agreement of procedural section (CPR procedure) with specific assessment guidelines. We should address personal factors affecting scoring decisions found in this study in preparing faculty members as OSCE examiners.

Objectives: In this study, we summarize current evidence on learning health behaviors through modeling, thereby offering greater insight into the predictors of modeling's effectiveness on health behavior change. Methods: We searched 5 electronic bases (PubMed, ProQuest New Platform, EBSCOHost, ERIC, and ScienceDirect) drawing on articles from January 1986 to April 2018. In addition, we performed follow-up searches of unique citations from identified articles. Results: Overall, our search identified 3339 articles. Based on inclusion and exclusion criteria, we reviewed 20 qualifying articles across 4 conditions of role modeling: attention, retention, motor reproduction, and motivation. Characteristics of role models and observers, use of technology to promote the modeling of health behavior, and use of peers as role models emerged as predictive factors related to attention; types of information and adherence to a specific timeframe were related to retention. Opportunity to practice a modeled health behavior and a specific timeframe to perform what was observed were key elements for motor reproduction. Support by significant others, self-efficacy, self-regulation, and policy incentives were predictive of sustained motivation. Conclusions: This review highlights several predictive factors in each situation in learning healthy behavior through role modeling. Identification and application of these factors may increase health behavior adoption.

Objectives This study aimed to identify the factors that support or inhibit medical teachers as healthy role models in medical school to conduct healthy behavior. Methods This qualitative study involved semi-structured in-depth interviews with medical teachers categorized as healthy role models in a medical school from a previous survey. Ten medical teachers were selected using purposive sampling. Three medical teachers were interviewed by direct meetings, and the remaining were phone interviewed, with one interview facilitated by chat using WhatsApp. Transcribed interviews were coded openly. Themes were finalized through discussion and debate to reach a consensus. Results Two themes were identified: perceived facilitators and perceived barriers, which were classified into four categories and 13 subcategories: intrinsic facilitators (motivation, conscious awareness, having physical limitations, knowledge, and economic reasons); extrinsic facilitators (the impact on doing a particular job, feedback, time, and environment); intrinsic barriers (the lack of self-motivation and having physical limitations); and extrinsic barriers (the burden of responsibilities for being medical teachers and environment). Conclusions Factors that support and inhibit medical teachers as healthy role models in medical school are influenced by intrinsic and extrinsic factors. This result could be used by medical schools to design appropriate interventions to help medical teachers as healthy role models in conducting healthy behavior. More studies are needed to explore other factors that influence medical teachers to conduct healthy behavior. During the COVID-19 pandemic, healthy role models in medical schools are vitally important and significantly contribute to the overall health of a nation.

Introduction Producing healthy physicians who act as a "healthy role-model" in their environment must be one of the concerns of medical schools today in response to the global movement of "health-promoting university" by the WHO (1995). However, no publications explained the "healthy role-model" in medical school. This study aimed to fill this gap by exploring the definition and characteristics of a "healthy role-model" for medical teachers. Methods We used a grounded theory approach with in-depth interviews and e-mail communications to 48 medical teachers from various backgrounds of "health professions education," "health education and behavior"/'health education and promoter,' "general practitioners/family medicine," "adolescent health," "internal medicine," and "cardiology-vascular medicine." The medical teachers were from Indonesia, one other developing country (Bangladesh), and five developed countries (United States of America, Canada, Netherlands, Australia, and United Kingdom). We also invited 19 medical students from Indonesia for three focus group discussions. Results We identified four categories to define a "healthy role-model" for medical schools as persons who are seen: 1) "physically," "socially," "mentally", and "spiritually" healthy; 2) internalized healthy behaviors; 3) willing to promote healthy lifestyles; and, 4) a life-long learner. In each category, there are several characteristics discussed. Conclusion Our study provides some insights to define a "healthy role-model" of medical teachers by using the characteristics of healthy people and adult learners. The first category describes the characteristics of healthy people, but cultural issues influence the perspectives of medical teachers to define a "healthy role-model" for medical schools.

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 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.

Background: Health professionals in carrying out clinical practice are known to use various combinations of knowledge and skills, such as critical thinking, clinical reasoning, clinical judgment, problem-solving, and decision-making. Most of these skills are acquired during undergraduate education, clinical training and honed through professional practice. Aims: This study aims to observe the clinical reasoning patterns of undergraduate dental students when solving oral health problems from hypothetical cases. Furthermore, assessing their structure of knowledge through a concept map defined by a SOLO taxonomy. Material and method: This qualitative study employed the think-aloud method and the result was assessed through verbal protocol analyses. Five respondents from the final year dental undergraduate student were agreed to participate. A unique hypothetical clinical scenario was used as a trigger. The audio data were transcribed, interpreted, and categorized as a clinical reasoning pattern; and the concept maps created were assessed by SOLO Taxonomy as knowledge structures. Result: A hypothetico-deductive, an elaborated hypothetico-deductive, and an inductive or deductive reasoning model were found to be applied by the participants when solving problems. The reasoning used reflects the knowledge possessed. The variability of the structure of knowledge assessed by the concept map reflected the acquired knowledge during the pedagogical stage, which in turn have an effect on clinical reasoning patterns.Conclusion: It concluded that undergraduate dental student applies clinical reasoning patterns according to their level of knowledge structure. It is suggested to improve dental education, whether curriculum, teaching and learning methods, instructional methods, or dental environment, which emphasize critical thinking and clinical reasoning in order to provide optimal dental health services.

Objectives To determine the relationship of personal reflection ability and moral reasoning ability of medical students of the Faculty of Medicine Universitas Gadjah Mada (UGM). Methods A cross-sectional study was conducted by distributing questionnaires to 293 medical students in Year-3 at the Faculty of Medicine, Public Health, and Nursing after obtaining their agreement to participate in this research by signing an informed consent form. Personal reflection ability was measured by the Groningen Reflective Ability Scale (GRAS) questionnaire; moral reasoning ability was measured by the Defining Issues Test (DIT) questionnaire. Descriptive statistics, T-test, and regression analysis were used to analyze the anonymized results. Results The mean GRAS score of all students was 89.59 (SD = 6.80) (GRAS score ranged 0-110) which showed a high level. The mean score of Principled Morality Score (P) DIT of all students was 32.39 (SD=11.04), ranging between 28-41 which indicated a moderate level. In general, personal reflection ability scores of all students were positively correlated with their moral reasoning ability score. However, this correlation was not significant statistically (r=0.080, p=0.239). Conclusions Personal reflection ability of medical students was correlated positively with their moral reasoning ability, however, statistically it was not significant . The high level of personal reflection ability needs to be maintained. The moderate moral reasoning ability needs some efforts to improve it. Further studies are necessary to assess other factors which influence the moral reasoning ability so that appropriate interventions can be developed.

Background: Professionalism is a skills area that should be mastered by medical graduates. The period of formal education is essential for the formation of professionalism. The involvement of internal factors, such as academic motivation, and external factors, such as the learning environment, might play a role in the development and learning of professional identity. Aim: To determine the profiles of academic motivation and its relationship between student professional identity during their degree courses. Methods: This cross-sectional study included 531 medical students in the early, mid, and late phases of their courses in the Gadjah Mada University Faculty of Medicine. The Academic Motivation Scale of Vallerand was used to assess academic motivation, and the Professional Identity Scale of Adams to assess professional identity. Results: The mean scores of academic motivation domains including intrinsic, extrinsic, and lack of motivation among medical students in the Gadjah Mada University Faculty of Medicine were 5.02 ± 0.87, 4.86 ± 0.88, and 1.83 ± 0.96 (mean ± standard deviation), respectively. No significant differences were found between the intrinsic and extrinsic motivation scores among students in the three phases of education, while the scores on lack of motivation among students in earlier phases were lower than students in the mid and late phases (P

Background: Medical students in Indonesia are required to pass a national licensing examination (e.g., UKMPPD) as a requirement of graduation and to obtain their certificate of competence. Medical schools prepared their students based on their needs and capacity. The preparation might use different teaching approaches. Undergraduate medicine program in Universitas Gadjah Mada conducts a national licensing examination preparation program facilitated by both faculty members and peer tutors. The peer tutors are newly graduated medical doctors who were recruited and trained. The use of trained peer tutors in a structured program to prepare high-stake examination such as a national examination is considered novel. This paper aims to describe a peer-assisted learning (PAL) approach used to prepare medical students in facing a national licensing examination.Case Discussion: A preparation program using faculty and peer tutors was deployed to prepare final-year medical students for facing the Indonesian national licensing examination. The ratio of sessions facilitated by faculty to peer tutors was 1:2. The preparation included CBT and OSCE training. Sessions with faculty used a medium to large class approach while sessions with peer tutors used a small to medium group approach. Through February 2020, 147 students have participated in the program. A questionnaire was developed to measure agreement that the program was successful and if the tutees were satisfied with various aspects of the program. The tutees responded with high rates of satisfaction to most items on the questionnaire (responses for all but one item ranged between 72.1% and 90.5% in favorable agreement or satisfaction). The one exception was CBT preparation where the level of satisfaction was lower (54.4% rated CBT favorably). Participants highly valued the involvement and the performance of peer tutors.Conclusion: The use of near-peer assisted learning for national licensing examination preparation has strong potential. Further study is required to investigate the impact of the peer-assisted national licensing examination preparation program on students’ achievement and clinical practice.

Background: Rational prescribing is an important skill for medical doctors. Many graduates still feel insufficiently prepared to make rational prescribing and fail to demonstrate the related clinical reasoning after graduation. For these reasons, it is important to improve the medical student teaching of rational prescribing. The aim of this study is proving the effectiveness of experiential learning methods to improve rational prescribing skills of medical students.Methods: This study used a one-group pretest-posttest design. Rational prescribing courses use experiential learning methods for 6 year medical students. Every student provided evaluation of rational prescribing and clinical reasoning through pretest and posttest, and we analyzed the results by paired t test.Results: The change in the rational prescribing skill of the students is significant between pretest and posttest. However, in the hypertension case the scores are not significant between pretest and posttest. Also, the scores of clinical reasoning based on drug interaction and evidence based methods are not significant in the hypertension and otitis media cases.Conclusions: Experiential learning methods can enhance rational prescribing skill in medical students but the students were still not able to choose appropriate medications based on drug interaction and evidence based approach.

Background: A medical teacher as a healthy role-model has a critical role in supporting health promotion effectiveness in medical school. However, an instrument to measure the characteristics of the medical teacher as a healthy role-models is unavailable. This study aimed to develop and validate a questionnaire to evaluate these characteristics by analyzing a model from previous grounded theory. Methods: A total of 442 medical teachers at the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, were invited to participate. We used hierarchical component models (HCMs) to develop our path model. A partial least squares structural equation modeling (PLS-SEM) were then used to analyze this model. Results: Twenty-six items from seven constructs supports our model. The construct of socially healthy (SH) has the most substantial effect on constructing healthy people's characteristics (H). The constructs of healthy role-models (HRM) in medical schools are mainly influenced by healthy people characteristic (H). Conclusion: A questionnaire with 26 items grouped in these seven constructs showed good reliability and validity. Seven constructs have relevance to the characteristics of a healthy role-model in the medical school model.

Background: Medical students who experience failure in the final exam are around 10%. In Indonesia, there are students who failed to pass the competency test for medical profession program students (UKMPPD) until 14 times. The impact of this failure is the occurence of mental health disorder. Students need support more than guidance on clinical knowledge and skills. This study aimed to identify the motivation and support needed by the UKMPPD retaker students in the effort to achieve graduation Methods: This research is a qualitative research with phenomenological approach, the data was obtained by in-depth interview and focus group discussion (FGD). This research was followed by 16 respondents. The data analysis was conducted by thematic analysis method. Results: Identified intrinsic motivation predictor originated from learning independence, relation, and low competence. The extrinsic motivation predictors are originated from external regulation, that is UKMPPD regulation. The motivation predictor is originated from anxiety and study period limit. The support needed by the respondents from medical schools are in the form of psychological approach, absolving the retaker students from selection tests, providing form of selection tests that compatible with the blueprint and rules of UKMPPD multiple choice question, also giving the opportunity to pass with other exam methods. Conditions of motivation can change with the factors that influence it. Changes in motivational conditions that may occur are an increase in motivational conditions, decreased motivational conditions, or persistent motivational conditions. Conclusion: The motivation condition of retaker students is amotivated and motivated (external and internal motivation). Support from medical school that can increase motivation is given to students to keep their motivation level.

Objective This study was aimed to explore students’ learning response toward feedback during mini-CEX encounter. Methods This study used a phenomenological approach to identify the students’ experiences toward feedback during mini-CEX encounter. Data was collected using Focus Group Discussion (FGD) for all students who were in their final week of clerkship in the internal medicine rotation. There were 4 FGD groups (6 students for each group). All FGD were audio-taped and transcribed verbatim. The FGD transcripts were analyzed thematically and managed using Atlas-ti (version 7.0). Results Feedback content and the way of providing feedback on mini-CEX stimulated students’ internal process, including self-reflection, emotional response, and motivation. These internal processes encouraged the students to take action or do a follow-up on the feedback to improve their learning process. In addition, there was also an external factor, namely consequences, which also influenced the students’ reaction to the follow-up on feedback. In the end, this action caused several learning effects that resulted in the students’ increased self-efficacy, attitude, knowledge and clinical skill. Conclusions Feedback content and the way of providing feedback on mini-CEX stimulates the students’ internal processes to do a follow-up on feedback. However, another external factor also affects the students’ decision on the follow-up actions. The follow-ups result in various learning effects on the students. Feedback given along with summative assessment enhances learning effects on students, as well. It is suggested that supervisors of clinical education are prepared to comprehend every factor influencing feedback on mini CEX to improve the students’ learning response.

Despite the average life expectancy of Indonesian people increasing from 63.63 in 1990 to 71.69 in 2016, the gap of life expectancy and healthy age life expectancy also increased from 7.49 to 8.72. RISKESDAS (2018) further highlighted that the proportion of Indonesian people with a healthy diet was poor. These data challenged us to implement an outreach program, Community and Family Health Care – Interprofessional Education (CFHC-IPE), involving our medicine, nursing and nutrition students for assisting families and communities with an aim of improving the population health status. Thus, we assessed their baseline status, in particular, people’s dietary habits. We attached batch 2015 and 2016 students to 465 households with 1,254 family members. We deployed them to 15 different sub-villages in Sleman Regency, Yogyakarta. Students surveyed the families and put the data in family folders during field visits in 2018 – 2019. Our focus was to seek eating patterns of the families and performed descriptive analysis of socio-demographic aspects within those with certain dietary habits using chi-squared tests. Of the 1,254 family members, those who routinely consume fried, sweetened, contained preservatives and grilled foods were 70.14%, 61.00%, 38.13%, and 20.08%, respectively. We found the adults tend to consume more sweetened foods and beverages along with grilled foods compared to the elderly, and the differences of proportions are statistically significant. The CFHC-IPE program partner families were often not realizing that a combination of their dietary habits, in particular, the consumption of fried and sweetened meals might result in threats to the family members’ health. Fried foods were the most routinely consumed followed by sweetened food, grilled foods and foods containing preservatives. These patterns were also the same in both urban and rural settings.

Implementing large-scale multi-site objective structured clinical examination (OSCEs) for national competency examination in a low resource country is challenging.To describe the first national OSCE for national competency examination of medical doctors in Indonesia and evaluate the reliability, validity, feasibility, acceptability, and educational impact.We collected electronically the OSCE scores from 49 out of 73 medical schools that participated to assess reliability and validity. We conducted electronic survey to examiners, examinees, SP trainers, and OSCE coordinators to assess feasibility, acceptability, and educational impact.The Cronbach's alpha coefficient across station was 0.79. There was strong correlation between rubric and global rating scores in each station (coefficient correlation ranges from 0.705 to 0.82). The content validity ratio was 0.97. The coefficient correlation between OSCE and MCQ was 0.335 (p = 0.00). All 49 medical schools were able to conduct OSCE simultaneously. Examiners, examinees, SP trainers, and OSCE coordinators had good perception regarding feasibility and acceptability of OSCE. Both examiners and examinees indicated good educational impact of OSCE application. The cutting score based on the borderline regression method was 61.96%. There were 67.39% of the examinees achieved similar or above the cutting score.With 12 stations 15 min each, the reliability coefficient across station is intermediate. Content validity is good. It is feasible and acceptable to implement large-scale multi-site OSCEs in Indonesia. Examiners and examinees perceive good educational impact on OSCE implementation.

Several studies have been conducted to evaluate the implementation of interprofessional education (IPE) across the globe. By looking at the timeline of each previous study, it can be inferred that the implementation of IPE has been improving continuously. However, the effectiveness of IPE still cannot be easily generalized due to misconceptions regarding how interprofessional collaboration capabilities should be evaluated. This study aims to generalize the learning outcomes that were produced by IPE in a global context and analyse the contributing factors. A systematic review was conducted within seven online databases as well as paperback periodical publications to search for the intended articles. A set of four criterions were assigned prior to the study using the standard Population-Intervention-Context-Outcome (PICO) model to ensure the included articles matched the study objectives. The quality of studies were appraised using the Medical Education Research Study Quality Improvement (MERSQI). Each included article was analysed using the narrative method to obtain the relevant information. Sixteen articles included in this study showed that IPE improved interprofessional collaborative knowledge, skills, and behaviour based on objective measurements. Complexity of the learning material, appropriateness of the program design, and referral to a specific standard of competence were assumed to play significant role towards the effectiveness of interprofessional education. This study results in several recommendation for future development of IPE, including a specific suggestion for its development in Asia region.

Objective: to explore factors that was being a challenge and an encouragement for lecturers in writing MCQ questions.Methods: This was a content analysis qualitative research. Determination of the research subject was done with a maximum variation purposive sampling that was choosing faculty of medicine at states university with an A accreditation, and faculty of medicine at private university with a B accreditation. Then research subjects was selected from each of these institutions with variations in teaching time, clinical and non-clinical lecturers, active and not active in writing MCQ questions. The amount of research subject was 16. The results of the interview were transcripted and conducted with an open coding using Open Code 4.3 program by a researcher and a research assistant. Coding results were analyzed using a thematic analysis approach.Results: Results from the qualitative analysis showed factors that was being an encourage for lecturers in writing MCQ questions were the fulfillment of basic needs such as an autonomy, competence, relatedness, and religiosity. While the factors that was being a challenge for lecturers were not fulfilling these basic needs.Conclusions: Autonomy, competence, relatedness, and religiosity were basic needs that was influence lecturers in writing MCQ questions. If the institutions aimed to conducted appropriate development programs for lecturers, they must pay attention to the basic human needs of life such as autonomy, relatedness, competence and religiosity.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 120-127

The aims of this study were to assess students' perceptions of their educational environment and approaches to learning, and determine if perceptions of learning environment associates with approaches to learning. A survey was conducted to collect data from a regional private university in Indonesia. A total of 232 nursing students completed two questionnaires that measured their perceptions of educational environment and approaches to learning. The measurement was based on Dundee Ready Education Environment Measurement (DREEM) and Approaches and Study Skills Inventory for Students (ASSIST). Five learning environments dimensions and three learning approaches dimensions from two measures were measured. The overall score of DREEM was 131.03/200 (SD 17.04), it was in the range considered to be favourable. The overall score is different significantly between years of study (p value = 0.01). This study indicated that the majority of undergraduate nursing students' adopt strategic approach (n = 139. 59.9%). The finding showed that perceived educational environment significantly associated with approaches to learning. This study implicated the need to maintain conducive learning environment. There is also a need to improve the management of learning activities that reflect the use of student-centered learning.

Background: Constructive feedback is an essential component of learning for medical undergraduate. Communication culture of high-power distance and collectivism might have influence in shaping students' perception of the benefit of feedback. Aim: This study is aimed to identify feedback characteristic which associated with students' perception of learning benefit, and further explored the mechanism feedback influence on students learning process. Method: This is a mixed method study, with explanatory sequential approach. The setting is first-year medical undergraduate students at FK UKDW who enrolled in skill lab class (pulmonary physical examination). The first phase is a quantitative study using questionnaire on feedback characteristics and student’s perception of feedback benefits, further analysed with linear regression methods. The next phase is an interview study on selected students with semi-structured questions, and further analysed with thematic analysis. Result: There are 82 students who returned the questionnaire. Quantitative analysis showed that feedback including comparison to standard (B=2,26; p = 0,003) and follow-up planning (B=3,47; p < 0,001) are associated with perceived benefit by students. Further interview of 11 students discovered that students have received clear and concise outline through the feedback process. On the other hand, the communication culture, poor execution of feedback process, and interconnectedness between each characteristic may influence the students' perception of benefits. Conclusion: Feedback is beneficial for medical undergraduate students in high power distance and collectivist culture, specifically feedback with comparison to standard and follow-up planning.

The Government of Republic of Indonesia launched Healthy Indonesia Program with Family-Centered Approach (PIS-PK). This program intended to improve public health in commons beneath the management of public health care. However, it remains challenging for public health care to reach all families in the working area. Active participation from volunteers or cadres to encourage the implementation of this program is required. Gabugan Tourism Village is an educational tourism village in a vision to develop the concept of "healthy tourism village". Determination from the local government to achieve healthy tourism village taken by joining collaboration with Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada (FK-KMK UGM).Together with interprofessional students from the campus, local government arranged training for cadre and assist during program implementation. This study aimed to identify the Healthy Family Index (HFI) of residents in the Gabugan Tourism Village and evaluate the cadre’s level of knowledge before and after training sessions. This was action research with a quantitative descriptive method. Data collected from August 4th, 2018 to September 7th, 2018. Research subjects were family and health cadres. Sample of 50 families from 100 families population surveyed to discover Healthy Family Index (HFI), while cadres were receiving training session related to "healthy tourism villages". Pre-test and post-test followed by cadres during the training session. Survey results analyzed using quantitative descriptive, meanwhile, Wilcoxon tests set to compare pre-test and post-test scores. From 50 families an HFI average of 0.810 obtained. The highest indicator of healthy family index was access to clean water facilities and the use of healthy latrines. The lowest index found at hypertension patients taking regular medication. The results of pre-test and post-test cadres indicated rising average with value of 3,823 and p = 0,000. Families in Gabugan Tourism Village generally in the healthy group. Training program involving interprofessional students proven to significantly increase the knowledge of health cadres.

Top-quality maternal health care requires midwifery and medical students to work together in multidisciplinary interprofessional education (IPE). Achieving IPE learning competencies requires interprofessional assessment methods; one such is portfolio. Study on portfolio as interprofessional assessment is limited. To evaluate interprofessional core competencies illustrated by IPE portfolios. A qualitative design using content analysis to evaluate portfolios of midwifery and medical students attending three weeks’ interprofessional learning in an Indonesian university. Sixty portfolios were analyzed for four IPE core competencies. Fifteen open-ended questionnaires were collected to confirm the data and further explore issues. Four interprofessional core competencies were illustrated in portfolios. While only three portfolios contained objective evidence of learning, over two-thirds of students could plan appropriate, concrete work based on interprofessional learning. The results indicate that the portfolio assesses interprofessional learning with student reflections that illustrate the achievement of four IPE core competencies. The validity of this competency achievement is also supported and confirmed by the evidence of learning and subsequent learning plans. Furthermore, portfolios also can encourage the students to prepare a concrete and appropriate work plan or study plan for students’ interprofessional learning.

Introduction:Emergencies and disasters need inter-discipline and inter-professional approaches because many problems in a disaster are due to poor coordination and collaboration. The disaster events during a decade in Indonesia highlighted the limitations of the healthcare system in responding to large-scale public health problems. Disaster health preparedness is the key to an effective response to any problems in community and family. Thus, education for health students has become a priority.Aim:Preparing fourth-year health students to be aware of disaster health problems in family and community with an inter-professional approach.Methods:Faculty of Medicine, Public Health, and Nursing UGM were prepared for the fourth year undergraduate health students through a semester “Emergency and Disaster Course” under Community Family and Healthcare with the Inter-professional Education Program, first given in 2016 for four hundred students. Mix method between class lecture, training skill, and simulation. The course goals are to (1) educate students on disaster health management, (2) understand the health preparedness and disaster family kit, and (3) define the principle of health worker’s role and collaboration in disaster.Results:The course was well received and at the 2017-2018 session was improved based on students and faculty feedback. Disaster knowledge of students changed. However, they still had a problem in communication between professions. And addition, they became aware of the function and each role of health profession competency during a disaster.Discussion:A course for fourth-year health students about emergency and disaster health management is extremely relevant because they will be health workers soon. They must have good awareness, knowledge, and attitude to cope with disaster health problems in the future.

Background: Clinical education in some countries applies a hospital-based learning approach where each student rotates to one division to another division (call of shifting). However, for clinical midwifery education in Indonesia each student remains in a community midwifery clinic (call of nonshifting). Because of the differences in the shifting system used, the question of “How is feedback in the nonshifting context of the clinical midwifery education being given?” needs to be explored. Materials and Methods: This was a mixed methods study and was carried out in a School of Midwifery in Indonesia during 2014 and 2015. We explored the supervisors’ and students’ perception on the feedback delivery. Students’ perceptions were collected through focus group discussions whereas supervisors’ perceptions were recorded through interviews. The quality of feedback was observed using a checklist. Qualitative data were analyzed using Atlas Ti and quantitative data were analyzed using a descriptive statistic method. Results: From the qualitative data, students and supervisors perceived their feedback as “more intensive.” They reported authenticity in the monitoring and feedback from the day-to-day delivery of patient care with their supervisors. Students and supervisors also described their feedback as “more integrated.” The feedback process stimulated students to value history taking, physical examination, and midwifery care. On the other hand, quantitative data from observations presented that “intensive and integrated feedback” were not supported by the quality of the feedback based on literature of the theory of facilitating learning (the mean was 4.67 on a scale of 0–9). Conclusions: The nonshifting clinical midwifery education can be a better alternative for facilitating the process of providing integrated and intensive feedback. To improve the quality of the feedback, training on providing feedback in a nonshifting context is fundamental in Indonesia.

Background: Role modeling is known as one of the most effective methods in learning professionalism, especially in the workplace. Each role model shows a different substantial values of professionalism, therefore the 'positive' or 'negative' role model criterion are difficult to set. This study aims to understand how students identify 'professional behavior’ (positive role model) and ‘unprofessional behavior’ (negative role model). Method : The design was a qualitative with case study approach. The sample was 20 students of undergraduate medical school at one university in Indonesia, selected by purposive sampling using maximum variation strategy. Gender, GPA, origin, and clinical rotation are used as key dimensions. Data collection used two methods, written narrative and focus group discussion. While the steps of qualitative analysis refers to Miles and Huberman. Results: This study found four themes as ‘behavioral identification’, namely: 'self-principle', 'self-standard of professionalism', 'normative standard of professionalism' and 'subjectivity'. Conclusion: Differences in identification are a reflection of students’ cognitive maturity. The outcome of learning professionalism can be improved from ‘valuing’ to ‘organizing’ and ‘internalizing’ through role model exposure and facilitation that provides the opportunity to explore and to reflect on professional values, before the student chooses them independently. This is part of the development of internal belief systems that are closely related on how students build their professional identity.

Background: The physician who reflects critically will interpret the experience, aware of its limitations, and will become life long learner. When implementing reflection learning in medical education, it is necessary to assess the ability of learners to help improve the ability of reflection. The objective of the research is to know the students 'reflection ability by giving feedback and different of reflection ability between intervention group and control group. Method: Research using pre and post control group design. The subjects of the study were 62 students medical students of Faculty of Medicine UGM year II who had collected narrative reflection to Gamel (n = 176 students) and willing to participate, divided into 2 groups with simple random sampling. Intervention of treatment group are giving feedback based on the result of narrative reflection from Gamel followed by narrative reflection assignment. The subjects' narrative reflection was assessed using the REFLECT rubric, and analyzed by Wilcoxon and Mann-Whitney tests. Results: The results showed that students' pre and post test reflection ability is in the reflection stage. Giving feedback once does not increase the ability from reflection stage to the critical reflection stage. This result may be due to several things: critical reflection does not occur without significant / dramatic experience that shifts perspective resulting in transformative learning, feedback is given regularly, lack of trustworhty to instructors who are not university lecturers. Another result of a decrease in the ability of reflection in general after 6 months indicates the need to do reflection activity / assignment in each semester to maintain and improve the ability of reflection. Conclusion: Increased reflection ability from reflection stage to critical reflection stage does not occur with single feedback. If reflection is not done regularly, it can cause a decrease in reflection ability.

Background : Clinical Skills is a fundamental ability that must be mastered by the newly graduated nurses. Therefore, assessment of clinical competence is essential to be considered by educators and education managers. It needs a valid assessment instrument, which is reliable and impact ful on learning the process by giving a structured feedback so that qualified graduates can be produced. Some assessment instruments in the clinical nursing education have l ess evidence of validity and reliability and less feasible, so it requires a development of clinical assessment instruments. This study aims to develop a clinical assessment instrument in the nursing clinic and to test the content validity. Method : This study used a qualitative research design that includes drafting through literature review and expert review by the expert panel. Results : The process of drafting and reviewing produces a rubric named Nursing Clinical Exercise (NCEx) made of six domains consisting the assessment of subjective data, physical examination, diagnosis formulation, treatment planning formulation, communication and interpersonal relationships, and professionalism. The value of content validity is good (CVR of the entire domain = 1) Conclusion: The NCEx Rubric consists of six domains and has good content validity.

Background: In the teaching process at medical faculty, there are many measuring devices have been used to evaluate the clinical reasoning ability. Each measuring device has the advantage and disadvantage. MCQ and SCT are the clinical reasoning measuring device. In the previous study, both methods have been validated. SCT is a more recent method to measure clinical reasoning compared to MCQ. This study aims to evaluate the concurrent validity between MCQ and SCT. Method: Forty-three students who had already passed the Paediatric clinical rotation were asked to complete 100 items of MCQ. The next day, they did 100 items of SCT. The concurrent validity is measured using correlation analysis. Results: Concurrent validity between MCQ and SCT did not show strong correlation (coefficient of rank spearman correlation= 0.291 with the probability = 0.058). Conclusion: Concurrent validity between MCQ and SCT do not have strong correlation in evaluating the clinical reasoning. SCT is used as complement to evaluation of clinical reasoning in order to be more specific and close to real setting.

Professional Behavior (PB) is an observable behavior which reflects professional values, proven by behavior, speech and appearance that can increase patients‟ confidence of their doctor. PB is a component of professionalism which receives a lot of attention by the institution of medical education in Indonesia, with special reference to its pluralism, multicultural and multiethnic diversity. This qualitative study was conducted to identify the PB attributes adjusted for the Indonesian context. The data collection included: 1) literature study; 2) in-depth interviews and 3) Focus Group Discussions (FGD). Participants interviewed were the chairman of the Center for Pancasila Study (PSP), chairman of center for religious cross cultural studies (CRCS) , artists and Catholic, Hindu and Muslim religious leaders. Participant selection was purposeful, based on their links with the characteristic aspects of Indonesia. The FGD participants were the pertinent stakeholders and experts associated with the Medical and Health sciences education, health practitioners and physicians. Total of 26 FGD participants were grouped into 3 groups. Following analysis by the researchers, the qualitative data transcripts from FGD and interviews were randomly verified by other researchers. The qualitative data on the PB attributes from the literature and the interviews and FGDs were classified and categorized in three stages to avoid overlap, and collated to obtain the final PB attributes. The results of this study indicated the presence of 34 of 133 identified PB attributes. The five PB attributes found in all sources were: 1) respect, 2) honesty; 3) integrity; 4) responsibility and 5) altruism. There were attributes only obtained from the Indonesian sources, namely a faith or belief in God Almighty. All PB could be realized best when based on the faith in the Lord as internal motivation. Amanah, Siddiq, Tablig, and Fathonah have long been important teachings for one of the biggest religions in Indonesia (Islam) in which honesty, integrity and responsibility are implied within it, three attributes of the five essential attributes gained from this research.

Background: OSCE is one of the assessments used in the Faculty of Medicine of Universitas Gadjah Mada, Yogyakarta since 1993. The uses of the OSCE as assessment tool have been widely proven. However, it also had limitations such as the presence of anxiety of the students and the high complexity of resources. This study aimed at finding out the impact of the OSCE on learning and its catalytic effects on the first, second and third year students of the Faculty of Medicine of Universitas Gadjah Mada. Method: In a qualitative method, data was collected using focus group discussion. There were 25 participants assigned to 3 groups, which were the group of the first year students, that of the second year students and that of the third year students. Samples were drawn using purposive sampling technique. The data was collected once the students have followed the OSCE. Analysis was made using Atlasti verion 6 and intercoding was conducted along with medical and health education experts. Results: The impacts of the OSCE were the learning strategy of the students more focused on clinical skills and their learning motivation increase. The OSCE caused anxiety of the students and they needed constructive feedback. The catalytic effects of the OSCE in the study were: It made the students more aware of the necessity to more diligently learn, to actively look for learning sources, to more creatively learn, to learn in a more integrated and comprehensive manner. Conclusion: The impact of the OSCE on learning was influenced by its organization and students’ characteristics. The positive catalytic effect of the OSCE on the students was that they needed standard OSCE. The study must be continued using other methods for example survey, cross-sectional or mixed methods.

Background : For two years implementation of PBL in Faculty of Medicine Islamic University of Sumatera Utara several phenomenon should be evaluated such as various performance of tutor in facilitating PBL and student’s self study not much. This research aimed to evaluate the relationship between tutor performance and student’s self study and reporting process in PBL. Method: This was observational analytical research, cross sectional study with population of all students of Faculty of Medicine Islamic University of Sumatera Utara. Primary data was collected from June to August 2009. Instrument used were tutor performance evaluation questionnaire, self learning activity evaluation questionnaire and student’s self study and reporting process in PBL questionnaire with Likert scale. Kruskall Wallis test was used to assess the relationship between tutor and student performance. Results : Average score of tutor performance on first year was higher compared to the second year students (p=00,32). There is significant difference in student’s self study and report process in PBL between high and moderate tutor performance’s group (p=0,000; p=0,000), high and low tutor performance’s group (p=0.007, p=0,008), but not significant difference between moderate and low tutor performance’s group (p=0,111, 0,280). Conclusion: Tutor performance is related to higher level of student’s self study and report process in PBL.

Background: Besides knowledge and clinical skills, nursing students should have professional behavior as an essential component of competences as a side of knowledge and clinical skills. One aspect of professionalism is academic integrity. Lecturer should know about students’ perception of academic integrity and behavior, to make a good way to detect and prevent the deviant behavior. The objective of this study is to describe nursing students’ perception and behavior on academic integrity. Method : Survey was conducted in a nursing school in Yogyakarta. The subject were 230 nursing students who were taken by proportionate stratified random sampling. The data were analyzed with descriptive analysis. Results : There were many deviant or unacceptable behaviors which were not considered as an academic misconduct (by 5.2%-61.3% students). Peer students’ percentage who had done an academic misconduct with 10 of the highest percentage was 50%-82.2% and the behavior ever done by students was 28.7%-68.7%. The intention to do the behavior in the future was 3-38.7%. Conclusion : Perceptions of nursing students on academic integrity varied widely. Many of the actual behaviors were not considered as academic misconduct. Nursing students had different opinions about the behavior that violated academic integrity. Students’ perceptions about the behavior and the behavior of a peer friend were in accordance with the students’ own behavior. Therefore, there is a need for a shared perception between institutions and students about behaviors that violate academic integrity.

Background: Clinical supervision has a vital role in the learning process of undergraduate medical education because it may improve the student’s clinical performance of the students. Supervision is a complex activity and covers wide variety of applications. Medical faculty of Islamic Sultan Agung University has 15 affiliated hospitals for its clinical education. To assure the quality of the clinical program, an evaluation on the quality of clinical program is required. This study was conducted to assess the effectiveness of the clinical supervision among the 12 affiliated hospitals.Design and Methods: This study involved 181 students of clinical internship of the year 2003, 2004 and 2005 of medical faculty of Islamic Sultan Agung University having the clinical rotation at the stage of surgery, obsgyn, pediatrics, internal medicine, ENT, neurology, dermatology and venerology, psychiatry, across the affiliated hospitals. The subject were divided into groups based on the hospital they were placed. Clinical Teaching Effectiveness Instrument (CTEI) adapted in bahasa Indonesia was used. The Descriptive and Kruskal-Wallis test were applied for the data analysis.Results: Means of the effectiveness of clinical supervision for 12 affiliated hospitals ranged from 3.25 to 4.02. Kruskal-Wallis test resulted in the value of Chi-S=13.32 and p=0.27.Conclusion: Over all the clinical supervision for the 12 affiliated hospitals is perceived good and shows no significant difference. However the practice of clinical supervision varies among the hospitals (Sains Medika, 3(2):135-149).