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"Tujuan Kemampuan penalaran kliiik odotoh salah salu kompetensi utama yang harus dimiliki oleh lulusan dokter sehingga perlu dilatih sejak mahasiswa. Akan tetapi, pembuktian kuantitatif tentangfaktor-faktor yang mempengaruhi kemampuan penalaran klinik mahasiswa masih sangat sedikit. Penelitian ini bertujuan untuk menenlukan pengaruhpengetahuan dan faktor lainnya terhadap kemampuan penalaran klinik mahasiswa sebagai bahan acuan dalam menentukan metode pembelajaran penalaran klinik.Melode Penetritian potong linlang dilakukan terhadap mahasiswa Fakuhas Kedokteran Universitas Sriwijaya program KBK semester IV Data yang diambil adalah tentang kemampuan penalaran klinik dengan faktor risikonya pada kasus sistem urogenital karena saat data diambil pada April 2008, mahasiswa baru menyelesaikan pembelajaran blokurogenilal. Kemampuan penalaran klinik dinilai dengan /es script concordance danfaktor risiko dinilai berdasarkanhasil evaluasiformatif, sumatif blok dan karakterisitk mahasiswa. Analisis data dilakukan dengan metode regresi Cox. Hasil Hasil penelitian terhadap 132 mahasiswa menunjukkan persentase kemampuan penalaran klinik yang rendah sebesar 38,694. Mahasiswa yang mempunyai pengetahuan yang rendah dibandingkan dengan yang tinggi mempunyai 63% lebih tinggi risiko mengalami penalaran klinik yang rendah (kR suaian : 1,63; 9594 interval kepercoyaan (C[): I,l0-2,42). Dibanding dengan kelompok mahasiswa yang lerampil berpikir kritis, mahasiswa yang tidak terampil berpikir ltritis lebih berisiko dua kali lebih mempunyai penalaran klinikyang rendah (M suaian: 2,30; 95% interval kepercayaan (CD: 1,55 - 3,41).Kesimpulan Dari penelitian ini dapat disimpulkan bahwa mahasiswa yang tidak terampil berpikir kritis atau memiliki pengetahuan yang rendah memiliki kemampuan penalaran klinik yang rendah.

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AbstractAim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning. Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculumof the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summativeassessments, and student characteristics. Data were analyzed by Cox regression.Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct): 1.10 -2.42). When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 9s% CI: 1.55 - 3.41).Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability."

"ABSTRAKLatar belakang: Keterampilan klinis mutlak diperlukan dokter dalam melakukan pelayanan kesehatan. Dokter yang tidak terampil melakukan keterampilan klinis tentu membahayakan keselamatan pasien. Oleh sebab itu, fakultas kedokteran Universitas Tarumanagara (FK Untar) melaksanakan pembelajaran keterampilan klinis dasar (KKD) pada tahap pendidikan pre-klinik melalui fasilitas skills lab yang memadai. Meskipun demikian, angka ketidaklulusan ujian KKD pada beberapa blok masih tinggi. Stres menghadapi ujian dianggap berperan terhadap kegagalan tersebut. Penelitian ini bertujuan mengetahui hubungan tingkat stres dalam menghadapi ujian dengan hasil belajar KKD.Metode: Penelitian ini merupakan penelitian cross sectional yang dilakukan di FK Untar dengan responden berjumlah 196 orang mahasiswa semester tujuh pada blok sistem penginderaan. Penelitian menggunakan kuesioner Westside Test Anxiety Scale untuk menilai tingkat stres dan data nilai ujian KKD untuk melihat hasil belajar KKD. Faktor lain yang berhubungan dengan hasil belajar KKD juga diteliti yaitu strategi coping dan lama waktu persiapan belajar. Analisis bivariat dilakukan dengan uji chi-square. Selanjutnya, analisis multivariat dilakukan untuk mengetahui faktor yang lebih berperan terhadap hasil belajar KKD. Kuesioner juga memuat data kualitatif tentang penyebab stres pada ujian KKD (stressor) dan cara persiapan belajar.Hasil: Tingkat stres sedang paling banyak dialami mahasiswa saat menghadapi ujian KKD (50.0%), diikuti dengan tingkat stres berat (28.1%) dan stres ringan (21.9%). Stressor yang paling banyak dilaporkan adalah ketakutan tidak lulus ujian KKD (46.9%). Belajar bersama teman merupakan cara persiapan belajar yang paling banyak dilaporkan (89.3%). Mahasiswa dengan tingkat stres berat cenderung tidak lulus ujian KKD dibandingkan mereka dengan tingkat stres ringan (nilai p= 0.019, OR= 2.809). Di antara berbagai strategi coping, active coping mempunyai hubungan bermakna dengan hasil belajar KKD (nilai p= 0.033, PR= 1.345). Lama waktu persiapan belajar tidak berhubungan dengan hasil belajar KKD (nilai p>0.05). Hasil analisis multivariat menunjukkan ketidaklulusan ujian KKD berhubungan dengan tingkat stres berat (nilai p= 0.022, OR= 2.805) dan penggunaan active coping yang rendah (nilai p= 0.025, OR= 3.590).Kesimpulan: Tingkat stres berat dan penggunaan active coping yang rendah berperan terhadap ketidaklulusan pada ujian KKD. Mahasiswa dengan tingkat stres berat berisiko lebih besar untuk tidak lulus ujian KKD dibandingkan mahasiswa dengan tingkat stres ringan. Penggunaan active coping yang rendah, dalam hal ini persiapan belajar yang kurang memadai, berisiko bagi mahasiswa untuk tidak lulus ujian KKD.

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ABSTRACT

Background: Clinical skills is an absolute necessity for doctor in conducting health services. Doctors who are not skillful in clinical skills will endanger patient safety. Therefore, the Faculty of Medicine of Tarumanagara University (FM Untar) conduct teaching and learning of basic clinical skills (BCS) at academic education level through adequate skills lab facility. Nonetheless, rate of failure in BCS exams are still high on some modules. Stress is considered as a factor that contributes to this failure. This study aims to determine the relationship of stress level and BCS learning outcomes.

Method: This is a cross sectional study, conducted in FM Untar with 196 students from the 7th semester who took sensory system module. This study use Westside Test Anxiety Scale questionnaire to assess stress level and student?s BCS test scores in order to find out the BCS learning outcomes. Other factors associated with BCS learning outcomes such as coping strategy and duration of preparation in studying are also observed. Bivariate analyses were conducted by chi-square. Multivariate analysis was also conducted to determine the factors that contribute more to the learning outcomes KKD. Qualitative data about the cause of stress (stressor) on BCS exam and preparation method in studying were also collected.

Results: Moderate stress is the stress level that students experienced the most (50.0%), followed by severe stress (28.1%) and mild stress (21.9%). The most dominant stressor is the fear of not passing the BCS exam (46.9%). In the case of preparation method in studying, it is reported that learning with friends is the most dominant (89.3%). Students with severe stress tend to fail the BCS exam than those with mild stress (p value= 0.019, OR= 2.809). Among the various coping strategies, active coping has a significant relationship with BCS learning outcomes (p value= 0.033, PR= 1.345). The duration of preparation in studying is not related to the BCS learning outcomes (p value>0.05). The multivariate analysis shows that the failure in BCS test is related to severe stress (p value= 0.022, OR= 2.805) and low usage of active coping strategy (p value= 0.025, OR= 3.590).

Conclusion: Severe stress and the low usage of active coping contribute to failure in BCS exam. Students with severe stress level have greater risk of not passing the BCS exam than students with mild stress level. Low usage of active coping, which means less preparation in studying, can cause the students to fail the BCS exam."

"Sistem Informasi telah menjadi penunjang di era modern, termasuk di dunia medis, salah satunya di bidang pendidikan kedokteran. Dalam pendididkan kedokteran, Sistem Informasi digunakan dalam membantu kelancaran pendidikan kedokteran, baik untuk pengajaran, pengujian hingga penilaian. Salah satu metoda pengujian dalam Pendidikan kedokteran yaitu OSCE (Objective Structured Clinical Examination). Dalam OSCE membutuhkan sumber daya yang besar. Sistem Informasi diintegrasikan dengan sistem audio visual diterapkan untuk meningkatkan efisiensi. Sistem Informasi dikembangkan untuk pelaksanaan OCSE di fakultas Kedokteran Unswagati. Kemudian desain yang dibuat diujicobakan untuk melihat pengaruhnya terhadap reliabilitas, validitas dan efisiensi. Hipotesis awal mengharapkan bahwa tidak ada perbedaan dalam reliabilitas dan validitas OSCE, tetapi ada perubahan peningkatan efisiensi. Hasil pengujian menunjukan bahwa dengan penerapan Sistem Informasi terintegrasi audiovisual, menjadikan pelaksanaan OSCE reliabel, valid tetapi dengan peningkatan efisiensi.

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Information system has been suppoting this modern era, including in the medical world, such as in medical education. In medical education, information system is being used to assist its fluency, such in teaching, examining and grading. One of the method to exam in medical education is called OSCE (Objective Structured Clinical Examination. OSCE requires massive resources. An information system integrated with audiovisual system is applied to enhance the efficiency.

This Information system is developed for implementation of OSCE in Medical Faculty of Unswagati. The design is tested to see the influence to its reliability, validity and efficiency. Early hypothesis is there will be no significant difference on OSCE?s Reliability and Validity, but there will be a significant improvement on efficiency. The test result shows that with implementation of Audiovisual integrated Information system, causing a reliable and valid OSCE with improved eviciency."

"Background: treatment of erythropoietin (EPO) is essential in chronic kidney disease (CKD) patients to maintain optimal hemoglobin (Hb) level. Renogen is a biosimilar epoetin-α, and Eprex is the originator epoetin-α. This study aimed to compare the efficacy and tolerance of Renogen with Eprex in CKD anemia.Methods: Renogen and Eprex were compared in a randomized (2:1), open-label study for 8 weeks, proceeded by 4 weeks adjustment (maintenance) phase, in anemic CKD patients undergoing HD in Cipto Mangunkusumo General Hospital, Jakarta, from June 2017 to October 2018.Results: a total of 45 patients (31 received biosimilar EPO and 14 received originator EPO) were included in the study. At baseline, mean (SD) Hb levels were 10,9 (0,74) g/dL and 10,9 (0,61) g/dL in biosimilar and originator EPO groups, respectively. At end of study (8 weeks), mean (SD) Hb levels were 10,5 (1,28) g/dL and 11,0 (1,13) g/dL in biosimilar EPO and originator EPO groups, respectively. The proportion of patients with Hb levels maintained within the target range (>10 g/dL) during 8 weeks randomization phase were 58,1% and 71,4% in biosimilar EPO and originator EPO, respectively (p=0,60; NS). There were no significant difference in epoetin dose between the 2 groups, and there was no drug-related adverse event in either group.Conclusion: Hb level at >10 g/dL could be maintained for 8 weeks of treatment with both originator and biosimilar EPO (more consistent with originator EPO and more fluctuations with biosimilar EPO), with similar epoetin dose and no drug-related adverse event."

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Pendahuluan: Tahap pendidikan klinik adalah fondasi penting dalam pendidikan kedokteran karena pada tahap ini pengembangan identitas profesional peserta didik terjadi. Peran pengajar klinis pun menjadi salah satu determinan penting dalam menentukan kualitas pembelajaran di tahap pendidikan klinik. Oleh karena itu, kualitas pengajar klinis harus dijaga dan ditingkatkan. Salah satu upaya yang dapat dilakukan untuk menjaga kualitas pengajar klinis adalah memahami pengembangan identitas profesional sebagai pengajar klinis. Integrasi identitas profesional pengajar klinis ke dalam identitas profesional klinisi dianggap penting dalam menjaga well-being dan resistensi dalam menjalankan peran sebagai pengajar klinis. Metode: Penelitian ini menggunakan desain penelitian kualitatif dengan pendekatan fenomenologi. Responden penelitian adalah pengajar klinis yang dipilih menggunakan strategi maximum variety sampling dengan mempertimbangkan lama menjadi pengajar klinis, jenis kelamin, peran sebagai koordinator, dan rotasi pendidikan klinik.Terdapat tiga focus group discussion dengan jumlah peserta 5-6 orang pengajar klinis untuk setiap kelompok dan tiga belas wawancara mendalam terhadap tiga belas orang pengajar klinis untuk mengeksplorasi proses pengembangan identitas profesional pengajar klinis. Hasil penelitian: Dalam penelitian ini teridentifikasi faktor-faktor yang berkaitan dengan self, situation, support, dan strategy sebagai faktor yang berpotensi mempengaruhi pengembangan identitas profesional. Diketahui bahwa kemampuan reflektif dan peran community of practice merupakan faktor esensial dalam menjalani masa transisi dan pengembangan identitas profesional. Ditemukan tiga narasi integrasi identitas profesional oleh responden, yaitu koalisi I-position pengajar klinis dan klinisi, bertahan pada I-position klinisi, serta metaposisi antara I-position profesional dan personal. Simpulan: Faktor-faktor yang terkait dengan self, situation, support, dan strategy berpotensi mendukung atau pun menghambat pengajar klinis dalam masa transisi. Selain itu gambaran proses integrasi identitas profesional pengajar klinis mencerminkan refleksi responden terhadap pengalaman dan peran mengajar.

 

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Introduction: Clinical clerkship is an important foundation in medical education because at this stage the development of students professional identity occurs. Clinical teachers play an important role in determine the quality of learning in clinical rotation. Therefore, the quality of clinical teachers should be maintained and improved. One of the strategies to maintain and improve the quality of clinical teachers is to understand the clinical teachers professional identity development. The integration of clinical teachers professional identity into clinicians identity is considered important to maintain the well-being and resistance in carry on the role as clinical teacher. Method: This is a qualitative study with phenomenological approach. Respondents were clinical teachers who were selected using maximum variety sampling strategy by considering the length of time being clinical teacher, gender, role as coordinator, and clinical rotation. There were three focus group discussion in which each group consists of 5-6 clinical teachers and thirteen in-depth interviews with thirteen clinical teachers to explore the development of clinical teachers professional identity. Result: This study identified factors related to self, situation, support, and strategy that could influence the development of clinical teachers professional identity. It was found that reflective abilities and community of practice were essential factors in undergoing a period of transition and the development of professional identity. Three narratives of integration of professional identity by respondents were found, namely the coalition of I-position as clinical teachers and clinicians, holding on to the clinicians I-position, and meta-position between professional and personal I-positions. Conclusion: Factors related to self, situation, support and strategy were identified as potential factors to support or hinder clinical teacher in transition. In addition, the narration of the integration process reflects the clinical teachers reflection upon their teaching roles and experiences.

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"Supervisi konsisten mempengaruhi kinerja perawat tetapi pelaksanaannya pada pelayanan keperawatan di Indonesia cenderung bersifat pengawasan dan kurang memberikan upaya-upaya untuk mendidik, memotivasi, melatih, dan memberi arahan. Model supervisi klinik educative, supportive and Administrative Cycle (ESA-C) dibuat untuk meningkatkan nilai positif dari supervisi. Model ini disintesa dari model supervisi Kadushin, Proctor dan mengintegrasikannya dengan teori interpersonal relationships Peplau serta nilai caratif Watson. Penelitian bertujuan menguji efektifitas model supervisi klinik ESA-C dalam meningkatkan kinerja perawat, menggunakan desain kuasi eksperimen pre-post test pada dua kelompok. Dua rumah sakit dirandom dari 5 rumah sakit umum, sampel diambil secara random sebanyak 90 perawat dan 270 pasien secara purposif. Hasil penelitian menunjukkan model supervisi klinik ESA-C mampu meningkatkan kinerja perawat secara signifikan (p Value < 0.05) pada dimensi task performance: keterampilan teknis sebesar 2%, pemberian edukasi 9%, pemberian dukungan emosionl kepada pasien 14%, dan contextual performance: pemberian bantuan bagi pasien dan keluarga 21%. Model ini disarankan digunakan pada pelayanan keperawatan terutama di rumah sakit dalam upaya meningkatkan kinerja perawat dalam memberikan asuhan keperawatan kepada pasien.

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Supervision is a consistent variable that affect to job performance. Unfortunately, the supervision that had done only just controlled rather than an effort to educating, coaching, directing, and nurse potential reinforcement. ESA-C clinical supervision model that developed is to eliminate negative side of supervision these times. Educative, supportive, and administrative cycle of clinical supervision model was a result from synthesize of Kadushin's, Proctor's, Heron's, Faugier's, and Experimental's models. The ESA-C model was synthesizing with interpersonal relationship from Peplau's and carative value from Watson's. ESA-C clinical supervision model use a group approach in an educative supervision and individual approach for supportive and administrative supervision.

The purpose of this research is to determine the effect of ESA-C clinical supervision model to increasing nurses' job performance. This research used quasi experiment design with intervention and control group. The sample of this research use a random method to 90 nurses (each group has 45 nurses) and 270 patients (each group has 135 patients).

The result of this research revealed that ESA-C clinical supervision model can increase nurses' job performance including task performance dimension (clinical skill, patient education, emotional support) and contextual job performance (assisting patient and the family). This research recommended the using of ESA-C model in hospital to increasing nurses' job performance in giving of nursing care to the patient."