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The profession of medicine is a challenging one considering the pace with which medical knowledge continues to expand on a daily basis. The purpose of the current review was to explore the significance of workplace learning from the perspective of different stakeholders. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines, and a total of 26 articles were selected based on their suitability with the current review objectives. Keywords used in the search include workplace learning and medical education in the title alone only. The workplace offers an opportunity for medical students to apply their acquired knowledge and participate in the process of patient care. Workplace learning gives a platform for medical students to not only participate in patient care but also gradually move forward on the path to becoming an effective member of the health workforce. We must realize that it is not only the students who derive benefits from workplace learning but also the teachers who can optimize their teaching and facilitation skills. To conclude, acknowledging the scope and merits attributed to workplace learning for different stakeholders, there is a definitive need to strengthen the overall process. Medical teachers have a crucial role to play in the strengthening and reinforcement of workplace learning in different contexts, and thus, they should be supported in their task to eventually improve the quality of medical doctors that we are producing.

Background: The definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context. Methods: The focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective. Results: We identified four themes representing actual interactional communication and its ‘meaning’ or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection. Conclusions: This study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of ‘feedback as a dialogue’ requires further effort and research to develop communication strategies in feedback that consider the national culture and context.

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.

Background: Indonesian society assume spirituality as an important aspect in life especially in sickness. Spiritual care can restore patients’ quality of life by providing them comfort, strength, and compassion. Because lack of education about spiritual care, doctors often feel not fully equipped. Reflection has proven to increase awareness of spiritual care, but the impact of this method still needs further research. This study aims to explore the impact of reflection on student awareness about spiritual care. Methods: This study used Interpretative Phenomenological Analysis with reflective writing and in-depth interview. Nine clinical medical students divided into four groups which was facilitated by clinical teacher. Intervention were three reflective writings interspersed with two small group discussion. The writings were analyzed using Transtheoretical Model to identify behavioral change then content analysis for the transcript to explore the study’s impact and the feasibility. Results: Five students increased their awareness because clinical experience, time-management, writing volume, and reflective thinking. Three students increase faster because learning from peers, engage with patient, and role-model. Two students increase slower because lack understanding of reflection and incorrect facilitators’ feedbacks. Two students stable because lack understanding of discussion and low engagement with patient. One student experienced a decrease because lack of task-commitment and interest. One student did not get awareness because difficulty interpreting emotions. Conclusion: Reflection method can be used to teach spiritual care to clinical medical students by considering several factors that might play a role. Further research with improvement to the method is still needed. Keywords: Spiritual care; spirituality; reflection; clinical medical student

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

Background: Facebook has been acknowledged as an alternative media in supporting traditional learning activities. However, its potential in enhancing students’ cognitive engagement on flipped-classroom’ activities is still not much known. This study aims to measure undergraduate medical students’ cognitive engagement changes after joining an ocular trauma flipped-classroom’ Facebook group. Methods: This pre-experimental study was involving 45 third-year undergraduate medical students of Muhammadiyah Surabaya' University who were joining the ocular trauma flipped-classroom' Facebook group. Three cognitive engagement variables were measured before students were joining the group and after the flipped-classroom’ face to face session ended. Finally, metrics data of the group members’ activities, which had been collected using Facebook Insight, used to shown changes between the active and passive user. Results: All users’ (n = 45) cognitive engagement were rising significantly after join the Facebook group (motivation, p = 0,000; self-directed learning readiness, p = 0,000; knowledge towards ocular trauma topic, p = 0,000). Increase in average active user knowledge was 11.09 points higher than passive users. Self-efficacy aspect of the students’ learning motivation and self-management aspects of the students’ self-directed learning readiness were the most increased sub-components. Conclusion: Facebook group has the potential to improve students’ cognitive engagement on ocular trauma’ flipped classroom.

The number of patients with diabetes in Indonesia reach 19,47 million in 2021, mostly is caused by the adoption of sedentary and unhealthy lifestyles. Continuous self-management is important in diabetes care. It requires optimal coordination and communication between patients, families, and health care provider. The use of communication technology could be solution to the problem. This study aims to initiate an android-based mobile apps technology as a tool for patient, family, and healthcare provider to optimize patient with T2DM treatment. This study will be conducted in Public Health Centers (PHCs) in Yogyakarta using an exploratory sequential mixed-methods design which is divided into three phases. The first phase will use qualitative descriptive methods. Patients with T2DM, families, nurses, physicians and Health Social Security Agency officers in Indonesia will be involved in a focus group discussion (FGD) and in-depth interviews to understand their needs in optimizing the treatment. The second phase will be the development of an android-based application on the first phase results. The apps will be usability tested by involving experts (heuristic evaluation) and users (think aloud method) to ensure that the apps really meet targeted user’s need. In the third phase, we will collect feedback from user after using this apps for three months. The effectiveness of the apps will be measured by self-management improvement and glycemic control of patients with T2DM. The non-equivalent control group design will be applied using a pre-repeated post-test control group. The result of this study will be an Android-based Application which will be called Integrated Diabetes Self-Management (IDSM) app to optimize the implementation of diabetes self-management which can improve glycemic control of patients with T2DM as one of the indicators of the Indonesian Chronic Disease Management Program at PHCs.

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

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 impactful 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 less 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.

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

Background: Problem-based Learning (PBL) is a new strategy on a learning system. There are four basic theories regarding PBL such as constructive, self-directed, collaborative, and contextual learning. The success of the implementation of PBL in one institution can be measured by the implementation of its four basic theories. Faculty of Medicine UGM (FM UGM) has been implementing PBL as their curriculum since 2002, however there have not been any conducted research that measure the implementation of PBL in FM UGM towards its 4 (four) basic theories. The objectives of this study are to validate instrumen developed by Romauli et al8 that can measure the implementation level of PBL towards its 4 basic theories, to measure the implementation level of PBL in FM UGM towards its 4 basic theories, and to compare the implementation level of PBL based on students’ academic level and regular/international program. Method: This research used quantitative non-experimental research with cross-sectional design. 321 students from 2nd (2008) and 3rd (2007) students’batch regular and international program filled the questionnaire developed by Romauli et al (2009) which had been reliable (Alpha Cronbach) and validated (Pearson Moment Product) twice previously. The data were analyzed using mean analysis to measure the implementation level of PBL towards its four basic theories. This research also compared the implementation level of PBL based on students’ academic level and regular/international by using Independent Sample t-test. Results: Instrument developed by Romauli et al8 had high validity and reliability level (á=0,01 and r=0,931). The implementation level of PBL in FM UGM towards constructive, self-directed, collaborative, and contextual learning were in moderate level (1,72±0,28;min 0 & max 3). There were not any significant differences of the implementation level of PBL among 2007 & 2008 batch (p>0,05). There were any significant differences of the implementation level of PBL among regular & international students regarding constructive & contextual learning (p0,05). Conclusion: Instrument developed by Romauli et al (2009) had high validity and reliability. The implementation level of PBL were in moderate level. There were not any significant differences of the implementation level of PBL among two different students’ batch. There were any significant differences of the implementation level of PBL among reg

Background: Mini-CEX was developed to assess the clinical skills of students through direct observation and constructive feedback on student achievement. To test Mini-CEX well as assessment methods, it is necessary to evaluate the implementation of Mini-CEX as Mini-CEX assessment methods and benefits of the learning process, as well as the professional development of students as future doctors, in the form of assessment of students’ perceptions of the Mini- CEX implementation. The objective of this study are to validate an instrumen for measuring the level of student perceptions in the implementation of Mini-CEX in Faculty of Medicine, Universitas Gadjah Mada’s clerkship program, to know the student’s opinions about the implementation of Mini-CEX as a method of assessment in clerkship program and benefits to student learning and professional development, to know the relationship students’ Mini-CEX point to student’s perception in the implementation of Mini-CEX in clerkship program medical faculty of GMU, and to compare the perceptions of students in Mini-CEX implementation in clerkship program Medical Faculty of GMU based on the characteristics of the department. Method: Research was conducted with a cross sectional study design. The research utilized closed questionnaires, each contained 5 likert scales. The questionnaires were given to the students who conducted clerkship in Faculty of Medicine, Universitas Gadjah Mada during the period of September 2010–March 2011. A total number of 103 students who become subjects in this study, which are consisted of 72 students in Internal Medicine Department and 32 students in Neurology Department. The correlation between student perception and Mini-CEX score was analyzed by using spearman correlation test. Mann-Whitney test was used to analyze the differences student perception between both Departments. Results: Students who are conducting clerkship program in Internal Medicine Department and Neurology Department Faculty of Medicine Universitas Gadjah Mada agree that Mini-CEX can be as assessment and learning tools, and promote the development of student professionalism. Perceptions of students towards the implementation of Mini-CEX in clerkship are not associated with Mini-CEX score. There was no significant difference in students’ perceptions towards the implementation of Mini-CEX between Internal Medicine Department students and Neurology Department students. Conclusion: Students perceived the Mini-CEX to be a practical assessment tool with a positive impact on their learning and professionalism development during clerkship.

Background: Mini-CEX was developed to assess clinical skills by direct observation. Mini-CEX as a clinical skills assessment tool had to fulfill four requirements: validity, reliability, effects on students, and practicality. The purpose of this study is to understand validity, reliability, and feasibility of Mini-CEX as a clinical skills assessment tool in medical core clerkship program at Faculty of Medicine Universitas Gadjah Mada. Method: Seventy four clerkship students from Internal Medicine and 42 clerkship students from Neurology Department were asked to do an observed Mini-CEX encounter for minimum amount of four in Internal Medicine and two in Neurology Department in the period of September 2010 to January 2011. The validity was analyzed with Kruskal-Wallis method for Internal Medicine, and Mann-Whitney Method for neurology Department, reliability was analyzed based on G coefficient, and feasibility was analyzed using descriptive statistic. Results: Mini-CEX’s validity is shown by p < 0,001 in Internal Medicine and p = 0,250 in Neurology Department, G coefficient for Internal Medicine and Neurology Department is 0,98 and 0,61 respectively. Feasibility in Internal Medicine and Neurology Department is 79,7 % and 100% respectively. Conclusion: Mini-CEX is valid and reliable in Internal Medicine but not in Neurology Department. Feasibility is good for both Internal Medicine and Neurology Department.

Innovation in medical education is essentially a reaction towards various demands and changes in the medical education institutions environment. The innovation of educational strategy is a part of the effort. Innovation in medical education should consider the feasibility level, resources needed, time and duration of implementation, scale and degree, that failure can occur, obstacles faced and the pattern of innovation that will be done. Considering the current condition of medical education institutions that are known through self-evaluation and strategic plan, and a growing trend in medical education at this time, severalinnovation can be proposed. SPICES approach can be taken as a guide in designing innovation in medical education.

This study aimed to develop and test a student self-assessment instrument based on the programmatic assessment (PA) components. We applied a series of psychometric research methods by (a) conducting a literature study to find PA constructs, (b) developing the students' self-questionnaires, (c) ensuring content validity, (d) testing face validity, and (e) conducting reliability tests that involve medical students, medical teachers, medical educationalist, and an international PA expert. Face validity (readability test) was conducted with 30 medical students from an Indonesian university who were in their last year of pre-clinical education and had average scores above or equal to their classmates. The confirmatory factor analysis (CFA) was used to report the instruments' validity and reliability. The final instrument was tested on 121 medical students with excellent GPAs from another medical school with a middle-level accreditation. The PA consists of five components: 'learning activities', 'assessment activities', 'supporting activities', 'intermediate evaluations', and 'final evaluations'. These components are conveyed through 41 relevant statements with a four-point Likert scale and three yes/no statements. According to the respondents, there was a lack of 'supporting activities' and 'intermediate evaluation' components in the PA in their universities. This study has developed and tested a five-component evaluation instrument based on medical students' perceptions regarding PA implementation. [ABSTRACT FROM AUTHOR]