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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

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.

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.