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BackgroundCesarean section (CS) rates in Indonesia are rapidly increasing for both sociocultural and medical reasons. However, there is limited understanding of the role that social media plays in influencing preferences regarding mode of birth (vaginal or CS). Social media provides a platform for users to seek and exchange information, including information on the mode of birth, which may help unpack social influences on health behavior. ObjectiveThis study aims to explore how CS is portrayed on Instagram in Indonesia. MethodsWe downloaded public Instagram posts from Indonesia containing CS hashtags and extracted their attributes (image, caption, hashtags, and objects and texts within images). Posts were divided into 2 periods—before COVID-19 and during COVID-19—to examine changes in CS portrayal during the pandemic. We used a mixed methods approach to analysis using text mining, descriptive statistics, and qualitative content analysis. ResultsA total of 9978 posts were analyzed quantitatively, and 720 (7.22%) posts were sampled and analyzed qualitatively. The use of text (527/5913, 8.91% vs 242/4065, 5.95%; P

Introduction Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women’s preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women’s preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth.Methods We conducted a longitudinal qualitative study using in-depth interviews with 28 women accessing private and public health facilities in Jakarta, the region with the highest CS rates. Interviews were conducted two times: during the woman’s third trimester of pregnancy and in the postpartum period, between October 2022 and March 2023. We used a reflexive thematic approach for analysis.Results We generated three themes: (1) preferences about the mode of birth, (2) decision-making about the mode of birth and (3) regrets about the actual mode of birth. Most women preferred vaginal birth. However, they were influenced by advertisements promoting enhanced recovery after CS (ERACS) as an ‘advanced technique’ of CS, promising a comfortable, painless and faster recovery birth. This messaging influenced women to perceive CS as equivalent or even superior to vaginal birth. Where women’s preferences for mode of birth shifted around the time of birth, this was primarily due to the obstetricians’ discretion. Women felt they did not receive adequate information from obstetricians on the benefits and risks of CS and vaginal birth and felt disappointed when their actual mode of birth was not aligned with their preferences.Conclusion Our study shows that despite rising CS rates, Indonesian women prefer vaginal birth. This highlights the need for better communication strategies and evidence-based information from healthcare providers. Given the rising popularity of ERACS, more work is urgently needed to standardise and regulate its use.

ProblemThe Indonesian Healthcare Program starting in 2014 enabled access to healthcare delivery for large population groups. Guidance of usage, infrastructure and healthcare process development were the most challenging tasks during the implementation period. Due to the high social impact obstetric care and related quality assurance require evidence-based developmental strategies. This study aims for analysis of outcome and maternal health care utilization, as well as differences related to demographic and economic subgroups.MethodsFor univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants.ResultsSpecialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; pConclusionsImprovement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.

Abstract Background Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice.

Introduction: Performance assessment of residents should be achieved with evaluation procedures, informed by measured and current educational standards. The present study aimed to develop, test, and evaluate a psychometric instrument for evaluating clinical practice performance among Dermatology and Venereology (DV) residents. Methods: This is a qualitative and quantitative study conducted from 2014 to 2016. A pilot instrument was developed by 10 expert examiners from five universities to rate four video-recorded clinical performance, previously evaluated as good and bad performance. The next step was the application of the instrument to evaluate the residents which was carried out by the faculty of DV at two Universities. Results: The instrument comprised 11 components. There was a statistically significant difference (p < 0.001) between good and bad performance. Cronbach’s alpha documented high overall reliability ( = 0.96) and good internal consistency ( = 0.90) for each component. The new instrument correctly evaluated 95.0% of poor performance. The implementation study showed that inter-rater reliability between evaluators range from low to high (correlation coefficient  =0.79, p < 0.001). Conclusion: The instrument is a reliable and valid instrument for assessing clinical practice performance of DV residents. More studies are required to evaluate the instrument in different situation.

Abstract Background Indonesia has the highest maternal mortality rate in South East Asia, that a third of the mortality is caused by hypertensive disorders of pregnancy (HDP), including preeclampsia and eclampsia. Research suggests that maternal deaths from HDP are avoidable with appropriate initial management in primary care. However, little is known regarding the exact way HDP management is conducted in Indonesian primary care. This research aims to explore the way HDP management is provided, including its barriers and facilitators in Indonesian primary care settings. Methods This research applied a practical qualitative methodology using interviews with a topic guide. It is guided by the implementation science framework of the Medical Research Council (MRC) framework and Practical Robust Implementation and Sustainability Model (PRISM) to design and evaluate complex healthcare interventions. Primary care key stakeholders from Yogyakarta province were recruited from May–December 2018. The interviews were conducted in face-to-face, telephone, and teleconference interviews. Data from the interviews were analysed thematically using a mix of inductive and deductive approaches. Results A total of 24 participants were interviewed, consisting of four general practitioners, five midwives, three nurses, three obstetricians, a cardiologist, five policymakers and three women with a previous history of HDP. Referrals are the usual management performed for HDP women in primary care and the primary care providers’ practice is challenged by three identified themes: (i) providers’ limited confidence to perform HDP management, (ii) fragmented continuity of care, and (iii) community beliefs. Many participants also desired to have more focused guidance to improve HDP management in primary care practice. Conclusion Even though Indonesian antenatal care and referrals are generally accessible, there are many challenges and fragmentation of HDP management. The most prominent challenge is the primary care providers’ lack of confidence in performing the management and the ‘elephant’ of an urgent need of practice guidelines in primary care that has never been appropriately described in the literature. Further development of an evidence-based primary care-focused guidance will potentially improve primary care providers’ skills to perform optimal HDP management and provide appropriate education to their patients.

Background: One of the competencies that must be mastered by health workers is therapeutic communication. Effective communication can increase patient satisfaction but on the contrary communication failure can cause poor information exchange, misdiagnosis, decreased participation and stressors in patients, and even death. Poor communication can be caused by low self efficacy. Bedside teaching learning through preseptor modeling can affect self efficacy in communication. The study aimed to determine the effectiveness of bedside teaching learning method towards the self-efficacy of therapeutic communication in midwifery students in clinical practice. Method: This research is a quantitative descriptive study. The research sample was all midwifery students in the fifth semester who had clinical practice at PKU Muhammadiyah Hospital of Gamping, and Queen Latifa Hospital as many as 20 students. The sampling technique used saturated features. The research instrument used SE-12 and the preceptor’s assessment in bedside teaching. The bivariate analysis used paired t-test and independent t-test. Results: The results showed that the self-efficacy analysis of prior and after bedside teaching therapeutic communication in the certified group obtained mean different of 19.50 and those in the non-certified group obtained mean different of 5.13. There were differences, but not statistically significant with p-value of 0.153. Conclusion: Bedside teaching effectively increased the self-efficacy of midwifery student communication taught by certified preceptors compared to non-certified preceptors. The stages of bedside teaching in the certified group had a better level of preceptor competence than the group that had not been certified. Clinical advisors are suggested to follow preceptors certification to increase knowledge.

Abstract Background Cultural differences might challenge the acceptance of the implementation of assessment formats that are developed in other countries. Acceptance of assessment formats is essential for its effectiveness; therefore, we explored the views of students and specialists on the practicality and impact on learning of these formats. This study was conducted to explore Indonesian students’ and specialists’ appreciation of the implementation of the Mini-Clinical Evaluation Exercise (Mini-CEX) in Indonesian clerkships. Methods This study was conducted at the Universitas Gadjah Mada, Indonesia. Participants were 52 students and 21 specialists in neurology and 78 students and 50 specialists in internal medicine. They were asked to complete a 19-item questionnaire that covered the characteristics of the mini-CEX such as its practicality, and the impact on learning and professional development. We used a Mann-Whitney U test to analyse the data. Results In total, 124 students (46 from neurology and 78 from internal medicine) and 38 specialists (13 from neurology and 25 from internal medicine) participated in this study. Students and specialists were positive about the practicality of the mini-CEX and the impact of this assessment format on learning and on professional development. The Mann-Whitney U test showed that there were no significant differences between students’ and specialists’ opinions on the mini-CEX, except for 2 items: specialists’ appreciation of direct observation (mean rank = 93.16) was statistically significantly higher than students’ appreciation of it (mean rank = 77.93; z = 2.065; p

Purpose This study was designed to develop an evaluation tool for assessing professional behavior and clinical competencies from the graduates’ perspective. Methods This study employed mixed method in a sequential exploratory design. The semi-structured interviews were conducted with three graduates from different cohorts. The qualitative analysis of the interviews found six emerging themes for professional behavior and clinical competencies development. These themes were then developed into a 55-item questionnaire. The questionnaire was then distributed to 84 medical graduates for exploratory factor analysis (EFA) from February to April 2019. The quantitative data were analyzed using IBM SPSS ver. 21.0 (IBM Corp., Armonk, USA) for principal axis factoring. After conducting EFA, we proceeded with confirmatory factor analysis (CFA) with another 120 graduates to validate the tool. Results Eighty-four graduates completed the questionnaire for EFA. Upon completion of EFA, 35 out of 55 items of the questionnaire were found to be valid and reliable. The most appropriate fit was seven factors, which explained 58.18% of variance between them after 15 iterations with Cronbach’s α of 0.916. The personal satisfaction factor was noted to be weak. It was therefore added to patient management factor due to its similar intention. The final EFA factor after the modification was six. The CFA found that 34 out of 35 items was valid and reliable that representation of the latent variables. Conclusion The questionnaire has achieved the desired construct validity score and can be used as an evaluation tool to assess professional behavior and clinical competencies from the graduates’ perspective.

Pengetahuan tentang proses persalinan sangat penting diketahui ibu hamil trimester III, agar ibu dapat memberdayakan dirinya dalam menjalani proses persalinan. Tujuan penelitian adalah mengetahui tingkat pengetahuan ibu hamil trimester III mengenai persalinan. Desain penelitian deskripsi kuantitatif, jumlah responden 98 ibu hamil trimester III yang diambil menggunakan teknik consecutive sampling. Analisis data menggunakan analisis univariat. Hasil penelitian didapatkan bahwa tingkat pengetahuan ibu hamil trimester III dengan proses persalinan dalam kategori baik sebanyak 94,9%. Tidak ada ibu hamil yang memiliki tingkat pengetahuan buruk. Disimpulkan ibu hamil trimester III memiliki pengetahuan yang baik mengenai persalinan.

Abstract Background Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings. Methods We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of ‘medical education’ and ‘primary care’, to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results. Results We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment. Conclusions We designed a ‘CBE-tree’ model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.

Abstract Background National and international guidelines for the management of hypertensive disorders of pregnancy (HDP) are available in developing countries. However, more detailed clinical pathways for primary care settings are limited. This study focuses on Indonesia, where 72% of women who died from HDP and its complications had received less appropriate treatment according to international guidelines. There is an urgent need to develop primary care focused pathways that enable general practitioners (GPs), midwives and other relevant providers to manage HDP better. Objectives This paper describes a study protocol for the development of HDP management pathways for Indonesian primary care settings. Methods This study design is informed by Implementation Science theories and consists of three phases. The exploratory phase will involve conducting semi-structured interviews with key Indonesian primary care stakeholders to explore their experiences and views on HDP management. The development phase will apply evidence from the literature review and results of the exploratory phase to develop HDP management pathways contextualised to Indonesian primary care settings. Consensus will be sought from approximately 50 experts, consist of general practitioners (GPs), midwives, obstetricians, nurses and policy makers using Delphi technique survey. The evaluation phase will involve a pilot study to evaluate the pathways’ acceptability and feasibility in a sample of Indonesian primary care practices using mixed methods. Discussion The implementation science frameworks inform and guide the phases in this study. Qualitative interviews in the exploratory phase are conducive to eliciting opinions from key stakeholders. Using Delphi technique at the development phase is suitable to seek participants’ consensus on HDP management in primary care. Observations, focus group discussions, interviews as well as analysis of patients’ medical records at the evaluation phase are expected to provide a comprehensive investigation of the implementation of the pathways in practice settings.

Background: Resident has a significant role and time allocation as a clinical teacher in the learning process of medical students at the clerkship stage in clinical settings. Unfortunately, residents were often not formally asked to be involved in the teaching process. Residents’ role in medical students’ learning process in clerkship is still ill defined. The aim of this study was to explore the perceptions of resident and medical students on residents’ role as a teacher in clerkship using cognitive apprenticeship model. Methods: This study used quantitative descriptive, cross sectional design. Samples taken with total sampling were 153 students (68.3%) and 214 resident (60.6%) of the total population. Respondents were asked to fill The Maastricht Clinical Teaching Questionnaire (MCTQ), and the results were analyzed using ANOVA and independent t-test. Results: Results of quantitative analysis showed a difference of perception between students and residents in modeling (p = 0.008) and overall performance (p = 0.002) factor, in which students placed a higher point than the resident. These results were consistently found in three departments. While in three other, students gave a lower point than the resident. In addition, differences also found in the exploration factor based on residents’ study period and residents’ preferences for teaching. Conclusion: Residents’ role as a clinical teacher in clerkship is very important, especially as a role model for students. Taking into account of time allocations spent between students and the residents, improvement and optimalization of residents’ role as a clinical teacher appears to be an important requirement.

Background: Premature Rupture of Membranes (PROM) causes morbidity and mortality complications in both maternal and perinatal. Pregnancy with anemia where low hemoglobin level which is less than 11.1 g / dL can be the cause of PROM through biological mechanisms and mechanisms of disease. Objective: This study aims to compare the risk of PROM between anemic maternal mothers and non-anemic maternal mothers. Methods: A case-control study was conducted on the maternal mothers at KerthaUsadaSingaraja Bali Hospital, with 106 cases and 106 controls, using maternity medical records data in January-December 2016. The cases and controls were adjusted to the parity. The data were collected using questionnaires consisting of 2 parts: the first part was about the demographic characteristics, and the second part was about the time of membrane rupture and hemoglobin level at the delivery. The obtained data were analysed using descriptive and analytic statistics on the computer program. Result: On univariable analysis, the prevalence of PROM equalled to 28.3% in maternal anemia group. In bivariableanalysis, the risk factors of were anemia status, maternal activity, and maternal age (p

Prolaps organ panggul merupakan salah satu bentuk disfungsi dasar panggul pada perempuan. Disfungsi dasar panggul adalah keadaan terganggunya fungsi dasar panggul merupakan salah satu kondisi kesehatan yang banyak dikeluhkan perempuan. Lebih dari 46% perempuan dengan riwayat persalinan vaginal mengalami disfungsi dasar panggul,dan peningkatan jumlah paritas berkorelasi dengan peningkatan kejadian prolaps organ panggul. Tujuan penelitian ini adalah untuk mengetahui gambaran karakteristik faktor risiko prolaps organ panggul pasca persalinan vaginal di wilayah Daerah Istimewa Yogyakarta. Penelitian dilakukan pada Januari–Maret 2018. Hasil penelitian didapatkan 51 subjek penelitian dengan persalinan vaginal yang dapat dilakukan pemeriksaan POPQ pada 3 bulan pascapersalinan. Prolaps organ panggul didapatkan pada sebagian besar pasien pascasalin, yaitu sejumlah 46 orang, prolaps uteri 33 orang, sistokel 44 orang, serta rektokel pada 46) orang. Hanya 5 orang yang tidak memiliki gambaran prolaps organ panggul pada 3 bulan pascapersalinan.Dari penelitian ini dapat disimpulkan bahwa faktor risiko prolaps organ panggul pascapersalinan vaginal di Daerah Istimewa Yogyakarta terdiri atas faktor intrinsik (usia ibu, panjang genital hiatus maupun perineal body), dan ekstrinsik (paritas, indeks massa tubuh overweight dan obes, kenaikan berat badan selama hamil >15 kg, serta dilakukan episiotomi dan terjadi robekan perineum). Upaya pencegahan terutama edukasi, perbaikan gaya hidup, pengendalian indeks massa tubuh, pengaturan diet, olahraga penguatan otot dasar panggul, pembatasan jumlah kehamilan dan persalinan, serta pertolongan persalinan sesuai Asuhan persalinan normal. Kata kunci: Disfungsi dasar panggul, faktor risiko, persalinan vaginal, prolaps organ panggul

The etiology of Low Birth Weight (LBW) in Murung Raya is still unclear. This study aimed to find out the relationship between environmental and health behavior risk factors of LBW in Murung Raya. 150 women were recruited through the incidence data 2013- 2014, and the questionnaires, medical records, and geographic data were measured by McNemar, ANOVA, logistic, IRR, MI, z (Gi), and NNI tests. Bivariate analysis showed significant correlation of LBW with TBA care OR= 10, drinking popa OR= 5, smoking OR= 6.1, and accessibility OR = 2.3, with adjusted OR for TBA care OR= 32.78, ANC OR= 27.52 revealing trend lines with ANOVA F=49, and clustering RR=7, MI >0 (four clusters), z (Gi) >1 (two high clusters), and NNI>1 (two high clusters). The spatial analysis provided greater statistical power to detect an effect that was not apparent in the case-control study. This study suggests that preventions, interventions and treatment for LBW not only be conducted by the current epidemiology approach but also by new modern geographic positioning analysis.

Abstract Background Feedback is essential for workplace learning. Most papers in this field concern individual feedback. In collectivistic cultures, however, group feedback is common educational practice. This study was conducted to investigate the perceived learning value and characteristics of individual and group feedback in a collectivistic culture. Methods During two weeks, on a daily basis, clerkship students (n = 215) from 12 clinical departments at Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia, recorded individual and group feedback moments by using a structured form: the providers, focus and perceived learning value of feedback. Data were analysed with logistic regression and multilevel techniques. Results Students reported 2687 group and 1535 individual feedback moments. Group feedback more often focused on history taking, clinical judgment, patient management, patient counselling, and professional behaviour (OR ranging from 1.232, p

Latar belakang: Pengetahuan akan gaya belajar sangat dibutuhkan oleh mahasiswa. Pada saat belajar mandiri, mahasiswa memiliki kebebasan untuk untuk dapat mengidentifikasi kebutuhan belajarnya yang akan dijabarkan dalam bentuk tujuan belajar, setelah itu menyiapkan rencana belajar, mencari sumber daya yang dibutuhkan dan melaksanakan rencana belajar tersebut serta diakhir dengan evaluasi hasil dan proses belajar. Dalam proses belajar inilah gaya belajar dapat menjadi katalisator untuk pembelajaran yang efektif. Salah satunya adalah gaya belajar Visual, Aural, Read/write, Kinestetik (VARK). Metode: Penelitian deskriptif dengan pendekatan kuantitatif terhadap mahasiswa tahun pertama FK Unismuh di TA 2013/2014. Tahap pertama dengan menyebarkan kuesioner VARK untuk mendapatkan data gaya belajar mahasiswa. Selanjutnya mahasiswa diberikan buku harian belajar mandiri untuk diisi sesuai apa yang mereka lakukan saat belajar mandiri. Hasil: Berdasarkan analisis data diperoleh gaya belajar unimodalitas mahasiswa yaitu Visual 1.4%, Aural 29%, Read/write 24.6%, Kinestetik 32%, dan multimodalitas 13%. Dari kelompok unimodalitas hanya sebesar 10% yang mengaplikasikan gaya belajar sesuai karakteristik gaya belajarnya sedangkan dari kelompok multimodalitas sebesar 77.7%. Simpulan: Gaya belajar yang paling dominan adalah gaya belajar kinestetik dan kelompok multi modalitaslah yang paling banyak mengaplikasikan gaya belajar sesuai dengan karakteristik gaya belajarnya. Background: Knowledge of learning styles is needed by the student. At the time of self -learning, students have the freedom to be able to identify learning needs to be spelled out in the form of learning objectives, and then prepare a lesson plan, look for the resources needed to learn and implement the plan as well as the end of the evaluation results and the learning process. In this learning process learning styles can be a catalyst for effective learning. One of which is the Visual, Aural, Read / write, Kinesthetic (VARK). Methods: Descriptive study with a quantitative approach. The population was freshman FK Unismuh in school year 2013/2014. The data were taken byquetionnaire s to obtain data VARK learning styles of students. Then, students are given self-learning diary filled according to what they do when the independent study. Result: Learning style is Visual 1.4%, 29% Aural, Read / write 24.6%, Kinesthetic 32%, 13% and multimodality. Of group unimodalitas only 10% who apply learning style according to the characteristics of learning styles while multimodality group at 77.7%. Conclusion: The most dominant learning style is kinesthetic but group multimodality most widely applied according to the learning style characteristics.

Background: Reflection is one of important skills to be possessed by medical professional, which should be developed while studying at medical faculty. In clinical stage of medical education in many medical schools in Indonesia, a reflection-learning model has not developed yet. This often make clinical teacher confuse, how to facilitate the reflection learning correctly. Methods: We developed the reflection-learning model for clinical stage of medical education. The model development was started with a blueprint and a model’s draft development, which referred by reflection learning theory. The next step was a clinical teacher panel discussion and in-depth interviews of medical education experts. After these process, a reflective clinical learning model were developed and six clinical teachers were involved in the models’ trial. They adopted the model in their learning sessions. In-depth interviews were used to explore clinical teachers’ experience when they implemented the model. Result: a six-step clinical reflection learning model developed, consists of (1) case selection, (2) case presentation, (3) self-evaluation, (4) peers’ feedback, (5) teachers’ feedback and (6) reflection writing. The implementation problem is that students and lectureres have not been accustomed to reflective learning and lecturers’ limitation of time. Conclusion: This study shows that the six steps clinical reflection learning model could be used as an alternative learning method of reflection learning. However, in practice, both clinical teachers and students should have sufficient understanding about the model, and clinical teacher should provide sufficient time in the learning process.

Abstract: Various efforts can be made to overcome the symptomsand complaints that occur in menopausal women, one of themwith aerobic low impact exercise. The aim of research to determinethe effect of aerobiclow impact exercise to improvement the qualityof life of menopausal women. This type of research quasyexperiment with non-equivalent pretest and posttest control groupdesign. The sampling technique used purposive sampling methodwith a sample size of 56 respondents. The analysis used is theindependent t test and paired sample t test with significance levelof 95%. The results of research shows that there is an increasedquality of life scores menopausal women who do aerobic low impactexercise than those who do not do aerobic low impact exercise,with p value< 0.05.Keywords: quality of life, menopause, aerobic low impact exercise

Background: Medical education research has been flourished in the past two decades in Indonesia. It is highly important to study results of medical education researches in Indonesia to provide future direction for medical education. Six published literature in medical education from Asian context was used as the basis of this study. Method: We used the narrative review in which quantitative data were interpreted qualitatively. All national and international publication and the unpublished research in medical education from Indonesia between 2000 - 2013 were collected with multiple methods based on 8 criteria of inclusion/ exclusion. We also grouped the articles into quantitative and qualitative groups based on each method in each study. Results: Total articles interpreted was 151 and grouped into 17 areas of interest and level of evidences from ‘very rarely’ to ‘very frequently’ studied. Studies in the area of understanding problem–based learning (PBL) are still dominating the area of interest including the student-assessment within PBL program. Other areas are still rarely done, especially research in health professions education other than medical doctors. Conclusion: Research in medical education in Indonesia should be more stimulated; in terms of numbers and quality, more importantly to strive for future agent of culture, socio-economic and political changes based on the actual community problems in the universal coverage era toward solid interprofessional team work to accomplish patient safety.

Abstract Background Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students’ perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on power distance. This study was conducted to validate the influence of five feedback characteristics on students’ perceived learning value of feedback in an Indonesian clerkship context. Methods We asked clerks in Neurology (n = 169) and Internal Medicine (n = 132) to assess on a 5-point Likert scale the learning value of the feedback they received. We asked them to record whether the feedback provider (1) informed the student what went well, (2) mentioned which aspects of performance needed improvement, (3) compared the student’s performance to a standard, (4) further explained or demonstrated the correct performance, and (5) prepared an action plan with the student to improve performance. Data were analyzed using multilevel regression. Results A total of 250 students participated in this study, 131 from Internal Medicine (response rate 99%) and 119 from Neurology (response rate 70%). Of these participants, 225 respondents (44% males, 56% females) completed the form and reported 889 feedback moments. Students perceived feedback as more valuable when the feedback provider mentioned their weaknesses (β = 0.153, p

The patient is an essential stakeholder within the medical healthcare system and an important stakeholder of the medical education program. The patients should be able to assess the performance of junior doctors in general practitioner residency to ensure their competency. Some instruments of patient assessment are available, but they do not adapt to local needs and context. This study aims to validate newly developed evaluation instruments from the patient’s perspective against the performance of a junior doctor in a teaching hospital. Fifty patients from outpatient clinics of internal medicine of two teaching hospital Faculty of Medicine Universitas Islam Bandung were selected to fill out the questionnaire in September–October 2018. The tool consists of 20 items and used a 4-point Likert scale of strongly disagree, disagree, agree, and strongly agree. The SPSS version 21 have used to extract the data as the principal axis factoring of analysis. Oblimin rotation method was applied with Kaiser normalization to simplify and describe the data structure. The detailed analysis identified five factors based on the initial eigenvalue >1. Patient perception instruments of junior doctor performance (PIJDP) showed that five constructs extracted explained 81.27% of the variance of them. Constructs were namely: humanism, responsibility-accountability, communication-empathy, altruism, and pleasant manner. Construct validity achieved after the PIJDP run fifteen times, and consistency internal with Cronbach’s alpha was 0.95. In conclusions, the PIJDP could be used to assess the performance of junior doctors and could make a novel contribution to the development of medical education. VALIDASI INSTRUMEN PERSEPSI PASIEN TERHADAP KINERJA DOKTER MUDA: SEBUAH ANALISIS FAKTOR Pasien merupakan stakeholder kunci dalam sistem pelayanan kesehatan dan stakeholder penting dalam program pendidikan kedokteran. Pasien dapat menilai kinerja dokter muda dalam pemagangan umum untuk memastikan kompetensi mereka. Beberapa instrumen penilaian pasien sudah dibuat, namun mereka tidak diadaptasi terhadap kebutuhan dan konteks lokal. Penelitian ini bertujuan memvalidasi instrumen evaluasi yang baru dikembangkan menurut perspektif pasien terhadap kinerja dokter muda di rumah sakit pendidikan. Lima puluh pasien dari klinik rawat jalan penyakit dalam dua rumah sakit pendidikan Fakultas Kedokteran Universitas Islam Bandung dipilih untuk mengisi kuesioner pada September–Oktober 2018. Kuesioner berisi 20 item yang menggunakan Skala Likert empat poin dari sangat tidak setuju, tidak setuju, setuju, dan sangat setuju. SPSS versi 21 digunakan untuk menganalisis data melalui principal axis factoring. Metode rotasi oblimin dengan normalisasi Kaiser diaplikasikan untuk menyederhanakan dan menjelaskan struktur data. Hasil analisis mengidentifikasi lima faktor berdasar atas eigenvalue awal >1. Instrument persepsi pasien terhadap kinerja dokter muda (PIJDP) menggambarkan 5 construct yang diekstraksi sebesar 81,27% dari varian indikator dapat dijelaskan oleh faktor yang terbentuk. Faktor tersebut adalah humanisme, tanggung jawab-akuntabilitas, komunikasi-empati, altruisme, dan sifat menyenangkan. Kesahihan construct dicapai setelah PIJDP diulang lima belas kali dan konsistensi internal dengan Cronbach’s alpha sebesar 0,95. Simpulan, PIJDP dapat digunakan untuk menilai kinerja dokter muda dan dapat memberi kontribusi baru dalam pengembangan pendidikan kedokteran.

Background: Medical faculty has to make sure that the students meet the minimal competence needed using apropriate exam. While the exam itself should facilitate students to learn. Oral examination has known for its ability to facilitate students learn but low in validity and reliability. Medical faculty of Lampung University (FK Unila) apply the student oral case analysis (SOCA) exam as one of block assessment component, as with MCQ, tutorial, and laboratory exam. This study aimed to evaluate validity and reliability of SOCA examination at FK Unila Method: Video of 65 students doing SOCA examination and 28 question rubrics had taken when odd semester exam year 2014-2015 has been carying out at FK Unila. Video and question rubrics were assessed by 5 panelis and analysed using Lawshe's content validity ratio (CVR) to determinate its content validity. Students performance on the video were re-assessed by another assessor to see inter-rater reliability, than analysed using kappa Cohen. Two expert in medical education assessed the cognitive comlpexity of the question rubrics. Data of SOCA's student's mark from year II, III, and IV were analysed for construct valdity and internal consistency. Results: 93,7% of the overall question in 65 video were valid (CVR>99%) and 71,8% question number in 28 question rubrics also valid according to 5 panelis. SOCA cognitive complexity were at level of analyse, know how and 4a. Inter-rater reliability analysis showed 0,549 (moderate agreement) kappa value. Mann Whitney analysis for construct validity showed no significant difference of all year. Cronbach alpha analysis showed internal consistency at the point 0,575. Conclusion: FK Unila's SOCA of odd semester examination year 2014-2015 has sufficient content validity, sufficient cognitive complexity and sufficent inter-rater reliability but lack in construct validity and internal consistency. Keywords: SOCA, validity, reliability

Background Over the last twenty years, higher education, par- ticularly pediatric residency training, has changed dramatically. A question arises whether the pediatric residency training conducted in Indonesia today has been set up to meet the changing as well as the community needs. Objective To evaluate whether the pediatric residency training program in Indonesia today has met the changing as well as the community needs. Methods Twelve centers with pediatric training program in Indone- sia were involved in this study. Each institution had various number of respondents, with a total of 42 respondents. A structured ques- tionnaire with open responses was selected to ensure the variety and flexibility of responses.The questionnaires included statements which encompassed areas such as curriculum, training and educa- tional system, and alumni achievement of educational objectives. Continuous content analysis of the responses was made. Results Coverage was considered adequate by 80% of respon- dents and was suggested to be continuously updated to be in line with existing national problems but not yet considered international standard. Additional knowledge and competence proposed by the respondents are mollecular biology, genetics, generic skills, com- munication skills, and introduction to sophisticated instruments. The length of the existing program was appropriate. Graduate knowl- edge was sufficient and fulfilled pediatric standards. Current pro- gram was different from that of the past. The objectives are compre- hensible. The placement of trainees enabled them to follow each division in a spiral fashion (at least three times during the training). Conclusion The curriculum content of the training process was continuously updated to be inline with existing national problems. Additional knowledge, and competence, and the present length of study was considered appropriate. Graduate knowledge is sufficient and fulfills pediatric standards. Furthermore, the objec- tives of the current program are clearer and placement of train- ees enables them to follow each division at least three times

Background: Most clinical students still have difficulties in clinical reasoning process. Previous study mentioned that reflection and metacognition are factors could influence clinical reasoning. This study aimed to measure the effect of reflection, metacognition, age, sex, duration of clinical rotation, duration of undergraduate program taken by students, and students’ final remark on undergraduate program to students’ clinical reasoning. Method: This study was a quasi-experimental pretest postest control group design, conducted at RSUD Dr Moewardi Surakarta. We selected 185 clinical students by purposive sampling technique. The study used the Metacognitive Awareness Inventory (‘the MAI’), Motivation scale on Motivated Strategies for Learning Questionnaire (‘the MSLQ’), and Script Concordance Test as instruments. The analyses used multiple linier regressions. Results: The intervention of reflection learning increased clinical reasoning 1,11 unit (p=0,319); The increase of 1 unit score metacognition decreased clinical reasoning 0,01 score (p=0,806), increasing one semester duration of undergraduate program decreased clinical reasoning 1,17 score (p=0,297), increasing students’ final remark on undergraduate program increased clinical reasoning 15,98 score (p=0,006), female students had 1,97 lower score of clinical reasoning than male (p=0,103), increasing one month of duration clinical rotation increased clinical reasoning 0,01 score (p=0,958), increasing one score of motivation increased clinical reasoning 0,01 score (p=0,529). Conclusion: Clinical learning and metacognition can not influence clinical reasoning significantly. Clinical teacher and clinical students should be familiarized with reflection learning. Further researches are needed to exploring influencing factors to clinical reasoning.

Background: Clinical education in outpatient settings acknowledged as a challange for clinical instructors, which they had to provide efficient and qualified service to the patients while also including educational components that significantly handful for clinical students. We recognized many learning strategies to encounter those challanges, but only few of them that had been evaluated. This systematic review were provided to compare various clinical learning strategies which are useful in outpatient setting. Method: Literature searching has done according PubMed database that related in topics such the impact of clinical education in outpatient setting on learning, outcome, and also efficiency of the outpatient clinics. There were no boundary setting that cone in this systematic review. Results: There were two learning strategy: “One Minute Perceptor” (OMP) and SNAPPS has been showed to be effective in increasing educational-learning process and service outcome. Another two strategies such as “Aunt Minnie” pattern recognition and “Active Demonstration” were also promising but hadn’t been sufficiently studied. There weren’t any of those strategies showed their impact in outpatient clinic setting efficiency. Conclusion: OMP and SNAPPS may be used for clinical mentoring in outpatient settings to increase learning process and learning outcome, while pattern recognition and activated demonstration hadn’t show any promising evidence.

Sebagian kecil mahasiswa fakultas kedokteran adalah mahasiswa dengan riwayat pernah mengikuti program akselerasi ditingkat pendidikan dasar dan menengah, dan kelompok ini disebut sebagai akseleran. Akseleran merupakan siswa berbakat dan memiliki inteligensi serta kemampuan akademik yang tinggi, namun, akseleran umumnya imatur baik sosial, emosional maupun fisik. Dengan demikian dapat diprediksi akan mengalami penurunan kompetensi ketika berada pada tahap rotasi klinik. Tujuan penelitian ini adalah untuk melakukan evaluasi kinerja akseleran dalam pencapaian kompetensi di rotasi klinik. Penelitian ini menggunakan rancangan penelitian campuran, dengan pendekatan kualitatif lebih dominan. Responden penelitian ialah mahasiswa fakultas kedokteran di semester tujuh dan delapan dengan riwayat pernah mengikuti program akselerasi. Hasil penelitian ini mendapatkan bahwa kemampuan dasar akseleran berada pada skala baik dan baik sekali; sikap kerja cukup hingga baik, sedangkan kepribadian pada komponen stabilitas emosi serta daya tahan stres berada pada skala kurang hingga cukup. Nilai median kompetensi klinik akseleran sedikit lebih tinggi dibandingkan non-akseleran, tetapi secara satistik perbedaannya tidak bermakna. Kesimpulan penelitian adalah, kinerja akseleran dalam rotasi klinik cukup baik, namun akseleran menghadapi masalah non-akademik terutama aspek kepribadian yang dapat memengaruhi nilai akademik. Perlu pertimbangan seleksi calon mahasiswa kedokteran terhadap akseleran dengan menggunakan pemeriksaan psikologik untuk menilai kematangan kepribadian. Kata kunci: akseleran, kompetensi klinik, seleksi calon mahasiswa

Background: A large number graduates of midwife even now accompanied with low competency isues in associated with quality of clinical learning. Now implementation of clinical learning with caseload model has problems. Clinical learning model in clinical practice that student, teacher and clinical midwife experienced provide greater insight to develop an effective clinical teaching strategy in midwifery education. The main objective of this study was to investigate student midwife, teacher and clinical midwife’ insight about an ideal clinical learning model in midwifery education. Method: A qualitative study by Focus Group Discussion (FGDs). By selected randomly, this study was conducted 32 from 76 final year midwifery students at Estu Utomo Boyolali Midwifery Academy, 14 lecturer and 13 clinical midwife who involve in Estu Utomo Boyolali Midwifery Academy clinical practice program at 2013-2014. There are 4 groups of student midwife, 2 groups of lecturer and 2 groups of clinical midwife. FGDs were arranged in 3 session differently between students, lecturer and clinical midwife. FGDs were facilitated by researcher and 3 research assistant. Data were analyzed using Atlas.Ti 6.1 software to support the coding process and identifying the main categories from verbatim transcripts. Results: Six themes emerged from the focus group data, “student caseload”, “duration of clinical practice”, “clinical placement”, “clinical mentorship”, “documentation”, and “clinical assessment”. From the sixth themes, demonstrated that an ideal clinical learning model in midwifery education to design preparation clinical learning should consider about that components. An ideal clinical learning model in midwifery education should give priority to quality than quantity especially to suggest decreasing student caseload. Conclusion: This study showed that midwife student, teacher and clinical midwife suggest that clinical learning model should give priority to quality than quantity to gain midwifery care competence. Clinical learning model therefore applied with student case loading that each student have different need. They are suggest that midwifery clinical learning should be consistent with the midwifery care philosophy “women center care” that provide midwifery continuity of care.

Background: In term of health service duty, physicians unprofessional behavior, than their lack of knowledge or skills, are more likely to cause some problem. The issues of professionalism can be identified when student are still in the process of education. There are several things associated with the development of professionalism, such as self-reflection and the ability to understand (insight) the incidents around them in this study professional behavior was mainly connected with responsibility. This study aimed to examined the relationships between UMI medical students (SRI) and perception of professionalism (responsibility) Method: It is a quantitative study using cross sectional approach. The participants were UMI students of batch 2009-2011 who are still studying at the university data were obtained from the questionnaires SRI scale and perceptions scale. Descriptive statistics, t-test and ANOVA-test and Pearson correlation test were used to analyze the data. Results: In general, students SRI score were LOW (M=2,46), as well as students’ perceptions of responsible behavior (M= 2,25). Based on students characteristics, significant difference in SRI was only found in the high school of origin (p = 0,043) and in the perception was found in father’s occupation (p = 0,018). Correlation analysis found a significant relationship between SRI and perceptions of professionalism (p = 0,0001). Conclusion: Self-reflection and insight of UMI medical students were still low and they were aligned with students’ perceptions of professional conduct (responsibility) which were also low. These values varied by students characteristics but for all intents and purposes, the differences were not significant.

Background: Education providers in many ways short of expectations. Education strategy is essential in teaching and learning activities. Student who has motivation and learning strategies tends to devote all their ability to get the optimal learning results according to the expected goals. Understanding student motivation and learning strategies will help institution to facilitate students for their study success. This study aimed of determine differences in student motivation and learning strategies at Faculty of Dentistry, University of Hasanuddin among students with collaborative learning and problem-based learning educational strategies. Method: This was quantitative research with observational analytic cross-sectional study design. The subjects were all students of class 2007 and 2008 data were collected using Motivated Strategies for Learning Questionnaire (MSLQ). Descriptive analysis and Mann-Whitney test were used to analysis the data. Results: The subjects consisted of 84 students of class 2007 and 79 students of class 2008. The mean score of learning motivation and learning strategy were higher among students with PBL than students with collaborative learning. There we are significant differences in learning strategies with different education strategies except in organization (p=0,369) and anxiety (p=0.058). Conclusion: There are differences in the learning motivation and learning strategies in students with collaborative learning and problem based learning education strategies, except in organization and anxiety component. Learning motivation and learning strategies in problem based learning students are higher than collaborative learning students.

Background: Caring in nursing is a very basic component, as the heart of profession, Which means that caring is a fundamental component, and central and unique focus of nursing. Caring, which is a core of nursing practice, must grow from self and deepest heart to help other people since being a nursing student so that caring in nursing education, must be placed as main competency in nursing education. The aim of this research to evaluation the efficacy of caring training in improving understand cognitive, affective and psychomotor competencies of caring, among students during clinical period Method: This research used quasi experiment non-randomized control group pretest-posttest design. Respondents of research were nursing students of Poltekes Palangka Raya, Semester V, regular class, X-A period, with total of 37 respondents as intervention group and regular class of X-B period with total of 35 respondents as control group. Results: Data were analyzed using descriptive and inferential statistical analyses. Results of research indicated that cognitive, affective and psychomotor competencies of caring in nursing students with caring training did not show significant effect (cognitive: p-value = 0,21, affective: p-value = 0.58, psychomotor: p-value = 0.07); however, the average scores were higher among student received caring training The caring behavior showed no difference between male and female students. Conclusion: There is insignificant difference between students with caring training and students without caring training. The training should be modified as suggested in the paper.

Background: OSCE is known as a skills examination method with high level of objectivity and reliability. Many efforts explore to increase OSCE achievement. Increasing the underlying knowledge of medical skills prior to a skills training proven to improve the skills achievement. A lecture delivered using concept maps, are considered better than the conventional lecture. The objective of this study is to find out that a lecture using concept maps before splinting skills training will increase the OSCE scores. Method: A quasi-experimental post test only study was conducted among 151 students of the Faculty of Medicine, General Achmad Yani University studying trauma at the fourth semester. The 74 students of the experiment group got a trauma lecture using concept maps, the 77 students of the control group got a trauma lecture without concept maps. The result of the splinting OSCE scores of the two groups were compared and statistically analyzed. Results: The average value of the OSCE score of the experiment group was significantly higher (89.10) than the control group (84.93). There were no differences in OSCE score among different gender, grade point average value, and the expertise of the instructors. Conclusion: Lecture in trauma before splinting skills training using the concept map that explains on the conceptualization (i.e. indication, contraindication, and how to prevent, identify and treat the splinting complications), will increase the score of OSCE. Demonstration of cases according to the theme of the subject involving a group of students, will enhance student understanding of the lecture topics.

Background: Clinical Audit is one of the formative evaluations that conducted to maintain and increase behavior and performance of the Radiation Oncology students, as an effort to maintain radiotherapy services and grant the quality of education. The objective of this study is to evaluate the role of clinical audit in improving students’ behavior. Method: This was a quasi-experimental research time series. We have done audit to the medical record chart of the residences at Policlinic I, II, III and stay at semester 3, 4, 5 in FK UI/RSUPNCM between September 2010 and December 2011 (T0). Audit had done by the author and one of the lectures. After analyzing the audit report, the reports were sent to the students one by one through email followed by forwarding it to the lecturer involved in this research. Then we continue the audit by performing the second clinical audit (T1) from January until March 2011. We used the mean score from the two auditors. The score divided into 4 groups as follows: hospital clinical record, treatment prescription, simulation and planning also evaluation during treatment. After that the author compared the audit score before and after intervention with t-test. Results: There were 16 Oncology Radiation students with 163 cases (To) and 156 cases (T1) who worked at Policlinic I, II and III. Behavior mean score is 1.9229 (T0), standard deviation 0.0514 and mean score after first intervention is 1.9764, standard deviation 0.0479 with p= 0.006. Conclusion: The students’ behaviors and performance are changed significantly after intervention.

Background: Earlier data showed that the mean of achievement index at first year students in Environmental Health Polytechnic of Maluku were decreased for the last 3 years, from 2,9 at year 2008, become 2,6 at year 2010. Students presence rate in the first semester for science and skills subjects such as basic of environmental health, microbiology, patophysio-anatomy, and health entomology also decreased from 89,09% at 2008 to 77,04% at 2010. Several studies and experts concludes that both quality and quantity of student’s learning are influenced by some factors like achievement motivation, attention, and cognitive process. The decrease on that factors may influence quality and quantity of learning process. The objective of this study is to identify the correlations between achievement motivation and attention to student’s cognitive process at first year students of Environmental Health Polytechnic of Maluku. Method: This was a quantitative study using survey to 80 first year students academic year 2010/2011. It is used modified instrument Archer’s Health Professional Motivation Survey to assess achievement motivation, Attention Deficit/ Hyperactivity Disorder to assess attention, and Cognitive Processing Inventory to assess cognitive process. Correlation significance between factors analyzed by using Pearson Correlation. Results: There were significant correlations between achievement-motivation oriented to mastery learning and performance towards cognitive process. Attention factor also correlated to the cognitive process. Conclusion: Early stimulations of learning motivation and profession explanation are needed to the first year students. Learning methods that stimulate students engagement are important to improve the quality of student’s learning process.

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: Clinical education requires competent supervisor to guide student. Supervisory competency should be trained and closely monitored to ensure quality learning process taking place. The aim of this study is to evaluate the effect of micro-skill supervisory model to improve the supervision quality among nursing student. Method: The research used quantitative approach with quasi experimental design. Subject consisted 91 students of the third year Nursing students at Magelang Health Polytechnic. Students were divided into two groups: intervention group (44 students) and control group (47 students) using purposive sampling. Research questionnaire consisted of 21 items which were derived from 5 micro skill domains was used. Intervention was supervision using micro-skill model during 2 weeks in a rotation of clinical practice. Results: There was no difference of quality clinical supervision was used in the control group while in experiment group the pre and post test score was significantly different. The experiment group had higher quality of supervision. The study showed that only 9 items showed significant improvement of supervision and 12 items did not show any improvement. Conclusion: Clinical teaching using micro skill model is more effective in improving the quality of nursing student clinical supervision compare to the conventional method.

Background: Early Clinical Experiences (ECEs) is a learning strategy that helps students integrate their knowledge through clinical learning in classes easily from their initial semester of study. Advantages have been earned by both students and lecturers; nevertheless, obstacles in the implementation have frequently emerged. Ideally, lecturers and students should know their own perception on ECEs for the sake of creating good communication and expected learning results in order to improve preclinical education. The purpose of this study is to find out different perceptions between students and lecturers on ECEs in nursing undergraduate program. Method: This was a descriptive study using quantitative and qualitative approaches (mix method). Subjects comprised students in the year of 2007 and 2008 as many as 71 nursing students and 21 lecturers, consisting of 11 academic advisors and 10 clinical advisors. Qualitative method was done with Focus Group Discussion for students groups and in-depth interview to academic advisors and clinical advisors. Quantitative analysis used descriptive analysis and comparative analysis used One Way Anova analysis. Qualitative analysis used content analysis that included identification, coding, categorization, and synthesis. In the end, the result of quantitative analysis was integrated with the result of qualitative analysis. Results: Mean score of students’ perception on ECEs was 3.11 (SD 0.24) which was lower than that of academic advisors (3.27 (SD 0.28)) and of clinical advisors (3.30 (SD 0.25)), (F score of 3.18 and p

Background: Integration between preclinical basic science education, skills training program in the laboratory setting and real clinical setting is recommended. This study explores clinical setting which suitable for undergraduate skills training program. The purpose of this study is to compare 3 different clinical settings (Sardjito Hospital, Klaten Hospital, and Puskesmas), which is appropriate for undergraduate clinical skills training. Method: This was a descriptive quantitative study, using cross sectional method. Data collection used self administrated questionnaire comprised of clerkship students who pooled of Sardjito Hospital, Klaten Hospital and Puskesmas (Primary Health Centre). Data analysis was done using ANNOVA test. Results: The Puskesmas scored the highest mean compared to Sardjito Hospital and Klaten Hospital for an overall learning environment and also in the scales for autonomy, social support, and role clarity. Sardjito Hospital scored the highest mean for the scales of supervision, workload, emphasis on teaching and learning and variety. There is a positive correlation between the learning environment and skills practice opportunity. Conclusion: Puskesmas as primary health centers is a better overall clinical learning environment compared to Sardjito Hospital and Klaten Hospital, but scored low means in domains such as emphasis on teaching and learning and variety. There is a positive correlation between the learning environments and skills practice opportunity with different features for each setting. There is no correlation between skills practice opportunity and gender or marital status.