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"Latar Belakang: Kompetensi "mengambil keputusan terhadap dilema etika yang terjadi pada pelayanan kesehatan individu, keluarga dan masyarakat" tercantum dalam SKDI 2005 sehingga harus ada dalam kurikulum dan dilaksanakan di dalam modul. Penerapan proses pengambilan keputusan etis (PKE) berkaitan dengan manajemen pasien, karena itu pembelajaran pada tahap klinis pendidikan kedokteran menjadi keharusan. Penelitian ini dilakukan untuk mengetahui proses pembelajaran pengambilan keputusan etis di tahap klinispendidikan kedokteran di FKUI. Metode: Penelitian merupakan penelitian deskriptif kualitatif dengan mengidentifikasi komponen Buku Kurikulum, Buku Rancangan Pengajaran modul praktik klinik, dan dokumen lain; wawancara mendalam pengelola program studi, pengelola modul, staf pengajar; serta Focus Group Discussion (FGD) pada mahasiswa. Hasil: Tidak ada modul praktik klinik yang lengkap mencantumkan PKE dalam dokumen. Pengelola modul kurang memahami kompetensi PKE SKDI 2006. Sebagai klinisi, staf pengajar mampu mengidentifikasi dan mengambil keputusan penyelesaian dilema etika. Mahasiswa memahami PKE dan menemukan kasus berdilema etika dalam proses pembelajaran tahap klinik. Mahasiswa mendiskusikan dilema etika yang ditemui dengan residen dan/atau dokter penanggungjawab kasus. Mahasiswa memiliki prior knowledge yang didapat pada tahap preklinik. Kesimpulan: Proses pembelajaran pengambilan keputusan etis di tahap klinis merupakan hidden curriculum.Perlu dilakukan peningkatan kapasitas staf pengajar di bidang teori etika kedokteran dan penyusunan modul agar PKE menjadi komponen tertulis dalam kurikulum.

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Background: Ethical Reasoning is one of competency component stated in the ?2006 Indonesian Medical Doctor Competencies Standard? therefor it has to be taught in medical faculties. The competency should be stated in all documents related to the curriculum. The learning of ethical reasoning should be done in clinical years since it is related to patient's managements. This research was done to evaluate the ethical reasoning learning process in the clinical stage medical education in Faculty of Medicine University of Indonesia.

Method: This is a descriptive qualitative research which identifies the component of curriculum inside the curriculum documents; indepth interview to the module developer, module organizer, and teachers; and focus group discussion with clinical year medical students.

Result: Ethical Reasoning Competency was not written as the aim of any module, as seen in the Instructional Design of all documents. The module developer did not recognize this competency despite their daily practice of ethical reasoning. The students learnt ethical reasoning in clinical stage by observing the medical staff during their interaction with patient with ethical dilemma. The student were able to identify the cases based on their prior knowledge from previous stage.

Conclusion: Ethical reasoning learning process in clinical stage is part of hidden curriculum.Capacity building for faculty members in medical ethics theory and module development for the faculty member are needed to make the ethical reasoning process as a part of the curriculum."

"Latar belakang: Strategi problem based learning pada kurikulum berbasis kompetensi didasari atas adult learning theory, dimana salah satu ciri dari adult learning adalah self directed learning. Kemampuan self directed learning perlu diberikan dan dilatih, agar siswa kelak lulus nanti dapat mengembangkan keilmuannya. Melihat pentingnya self directed learning, maka perlu adanya suatu gambaran bagaimana penerapan self directed learning pada kegiatan mandiri oleh para siswa kita serta faktor yang berhubungan dengannya. Metoda: Penelitian ini menggunakan disain potong lintang. Subyek dari penelitian ini adalah 266 mahasiswa semester 3 FK UKRIDA. Instrument yang dipakai untuk pengumpulan data terdiri dari 3 kuesioner, yaitu: kuesioner penerapan self directed learning, motivasi dan pemanfaatan waktu pada kegiatan mandiri. Hasil data yang diperoleh dianalisis dengan menggunakan chi square lest. Hasil: Penerapan self direcled learning didalam PBL diterapkan oleh 68% mahasiswa, 71,8% mahasiswa mempunyai motivasi baik, tetapi hanya 28,2% yang memanfaatkan waktu pada kegiatan mandiri. Kesimpulan: Adanya hubungan yang bermakna antara mahasiswa yang menerapkan self directed learning dengan motivasi belajar, pemanfaatan waktu pada kegiatan mandiri.

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Background: Problem based learning strategy in competency based curriculum was based on adult learning theory which is characterized by self directed learning. Student should be trained self directed learning. so after graduation they could develop their knowledge. Due to the importance of self directed learning, it is necessery to know the process of self directed learning and factors related to it.

Method: A cross sectional design has been conducted among 266 third semester medical student at University of Ukrida. Three questionaires were used to collect data related to self directed learning, motivation and time management. Data were analize using chi square test.

Result: Self directed learning in the PBL session was done by 68% of students, 71,8% has a good motivation, however only 28.2% used the time allocated in the PBL.

Conclusion: Motivation, time management were found significantly related to self directed learning."

"[ABSTRAKLatar Belakang: Masalah relasi orangtua-anak dapat berdampak fatal, tapi seringdisepelekan. Penanganannya mencakup psikofarmaka dan psikoterapi, khususnya analisistransaksional (AT). Penelitian ini bertujuan untuk mendapatkan data kebutuhan pelatihanaplikasi AT, sebagai dasar pembuatan modul aplikasi AT tingkat dasar (AATD) yangvalid dan reliabel. Penelitian juga bertujuan mendapatkan model pelatihan efektifmeningkatkan pengetahuan dan keterampilan AATD untuk penyelesaian masalah relasiorangtua-anak, menggunakan pendekatan pendidikan berbasis kompetensi agar dapatmenghasilkan luaran psikiater yang kompeten.Metode: Disain studi adalah mixed methods, terdiri atas: (a) penelitian potong-lintanganalisis kebutuhan pelatihan aplikasi AT melalui survai kepada 54 psikiater dan 53 calonpsikiater di Indonesia yang terpilih secara acak; (b) pembuatan modul AATD; (c) ujivaliditas dan reliabilitas modul AATD; (d) penelitian kuasi eksperimental keefektifanmodel pelatihan untuk pencapaian kompetensi AATD pada dua kelompok residenpsikiatri; (e) studi kasus implementasi AATD untuk penyelesaian masalah relasiorangtua-anak, yang dilakukan masing-masing 2 orang dari kedua kelompok tersebut.Hasil: Seluruh subjek (total 107) menyatakan membutuhkan modul pelatihan AT.Penilaian modul AATD adalah valid dengan rerata nilai di atas 90 (kategori baik sekali).Penilaian reliabilitas menggunakan Bland-Altman Plot menunjukkan semua penilaianberada dalam rentang batas judgment agreement (SB ±1,96). Pada kelompok latihdidapatkan perbedaan bermakna peningkatan pengetahuan AATD (RR=2,54; IK 95 %1,12-5,75; p <0,001), dan peningkatan keterampilan AATD (RR 4,37; IK 95 % 1,81-10,54; p<0,001) dibandingkan dengan kelompok baca. Implementasi AATD padapenyelesaian masalah relasi orangtua-anak menunjukkan cukup efektif dengan rentanghasil perbaikan dari social control sampai pada tahap transference cure.Simpulan dan Saran: Modul AT dan pelatihannya dibutuhkan oleh psikiater dan calonpsikiater. Modul AATD valid, reliabel, dan efektif untuk penyelesaian masalah relasiorangtua-anak. Model perlakuan latih lebih efektif secara bermakna meningkatkankompetensi pengetahuan dan ketrampilan AATD. Pengembangan modul aplikasi ATtingkat lanjut diperlukan untuk penanganan kasus yang lebih kompleks;

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ABSTRACTBackground: The parent-child relationship problems can cause fatal effects if theywere not managed properly. Managements of parent-child relationship problems requirepharmacotherapy and psychotherapy, also transactional analysis (TA). The aims of thisstudy are to obtain data on the training needs of TA applications, which are used as thebasis for the application of basic transactional analysis (ABTA) which is valid andreliable, also capturing the effective training model to improve the knowledge and skillsof ABTA, as well as evaluating its effectiveness in managing the parent-childrelationship problems. The module approach is competency-based on education in orderto produce psychiatrists who are competent in providing optimal health care.Method: The design of this study was a mixed methods, comprising: (a) cross-sectionalstudy of needs training analysis for the TA application by survey on 54 psychiatrists and53 psychiatrist candidates in Indonesia which were chosen randomly; (b) ABTA modulemaking along with the tools; (c) validity and reliability test of ABTA module; (d) quasiexperimentalstudy about the effectivity of training module in order to achieve theABTA competency in two groups of psychiatrict candidates; (e) case studies of ABTAimplementation in managing the parent-child relationship problems.Result: The whole subjects (total 107) declared the needs of ABTA training modules;demonstrated the validity of the ABTA module was valid, with a mean value of all is theabove 90 (excellent value category) and reliability assessment judgment using the Bland-Altman Plot indicates that all within the range limits of agreement (± 1.96 SD). In thetraining group, a significant difference about the improvement of TA knowledge wasfound (RR=2.54; 95 % CI: 1.12-5.75; p<0.001), and the improvement of ABTA skill(RR=4.37; 95 % CI: 1.81-10.54; p<0.001) compared with the reading group. Theimplementation of ABTA indicated that the use of ABTA module was effective enough,with the results of improvements ranging from the social control to the transference curestage.Conclusion and Recommendation: The TA module and its training is needed by bothpsychiatrists and psychiatrist candidates. The ABTA module is valid, reliable, andeffective in managing the parents-child relationship problems. ABTA training module ismore effective and significant to improve the knowledge and skills competency ofABTA. Development of advanced application module TA is necessary in managingmore complex cases.;Background: The parent-child relationship problems can cause fatal effects if theywere not managed properly. Managements of parent-child relationship problems requirepharmacotherapy and psychotherapy, also transactional analysis (TA). The aims of thisstudy are to obtain data on the training needs of TA applications, which are used as thebasis for the application of basic transactional analysis (ABTA) which is valid andreliable, also capturing the effective training model to improve the knowledge and skillsof ABTA, as well as evaluating its effectiveness in managing the parent-childrelationship problems. The module approach is competency-based on education in orderto produce psychiatrists who are competent in providing optimal health care.Method: The design of this study was a mixed methods, comprising: (a) cross-sectionalstudy of needs training analysis for the TA application by survey on 54 psychiatrists and53 psychiatrist candidates in Indonesia which were chosen randomly; (b) ABTA modulemaking along with the tools; (c) validity and reliability test of ABTA module; (d) quasiexperimentalstudy about the effectivity of training module in order to achieve theABTA competency in two groups of psychiatrict candidates; (e) case studies of ABTAimplementation in managing the parent-child relationship problems.Result: The whole subjects (total 107) declared the needs of ABTA training modules;demonstrated the validity of the ABTA module was valid, with a mean value of all is theabove 90 (excellent value category) and reliability assessment judgment using the Bland-Altman Plot indicates that all within the range limits of agreement (± 1.96 SD). In thetraining group, a significant difference about the improvement of TA knowledge wasfound (RR=2.54; 95 % CI: 1.12-5.75; p<0.001), and the improvement of ABTA skill(RR=4.37; 95 % CI: 1.81-10.54; p<0.001) compared with the reading group. Theimplementation of ABTA indicated that the use of ABTA module was effective enough,with the results of improvements ranging from the social control to the transference curestage.Conclusion and Recommendation: The TA module and its training is needed by bothpsychiatrists and psychiatrist candidates. The ABTA module is valid, reliable, andeffective in managing the parents-child relationship problems. ABTA training module ismore effective and significant to improve the knowledge and skills competency ofABTA. Development of advanced application module TA is necessary in managingmore complex cases., Background: The parent-child relationship problems can cause fatal effects if theywere not managed properly. Managements of parent-child relationship problems requirepharmacotherapy and psychotherapy, also transactional analysis (TA). The aims of thisstudy are to obtain data on the training needs of TA applications, which are used as thebasis for the application of basic transactional analysis (ABTA) which is valid andreliable, also capturing the effective training model to improve the knowledge and skillsof ABTA, as well as evaluating its effectiveness in managing the parent-childrelationship problems. The module approach is competency-based on education in orderto produce psychiatrists who are competent in providing optimal health care.Method: The design of this study was a mixed methods, comprising: (a) cross-sectionalstudy of needs training analysis for the TA application by survey on 54 psychiatrists and53 psychiatrist candidates in Indonesia which were chosen randomly; (b) ABTA modulemaking along with the tools; (c) validity and reliability test of ABTA module; (d) quasiexperimentalstudy about the effectivity of training module in order to achieve theABTA competency in two groups of psychiatrict candidates; (e) case studies of ABTAimplementation in managing the parent-child relationship problems.Result: The whole subjects (total 107) declared the needs of ABTA training modules;demonstrated the validity of the ABTA module was valid, with a mean value of all is theabove 90 (excellent value category) and reliability assessment judgment using the Bland-Altman Plot indicates that all within the range limits of agreement (± 1.96 SD). In thetraining group, a significant difference about the improvement of TA knowledge wasfound (RR=2.54; 95 % CI: 1.12-5.75; p<0.001), and the improvement of ABTA skill(RR=4.37; 95 % CI: 1.81-10.54; p<0.001) compared with the reading group. Theimplementation of ABTA indicated that the use of ABTA module was effective enough,with the results of improvements ranging from the social control to the transference curestage.Conclusion and Recommendation: The TA module and its training is needed by bothpsychiatrists and psychiatrist candidates. The ABTA module is valid, reliable, andeffective in managing the parents-child relationship problems. ABTA training module ismore effective and significant to improve the knowledge and skills competency ofABTA. Development of advanced application module TA is necessary in managingmore complex cases.]"

"ABSTRAKPelayanan intensif ditujukan untuk memberikan terapi intensif dan perawatan intensif. Biaya pelayanan yang sangat tinggi membutuhkan rasionalisasi pelayanan ini agar dapat memenuhi hak setiap orang yang membutuhkan. Penelitian ini ditujukan untuk mendapatkan pedoman rasionalisasi pelayanan intensif untuk mempertajam peraturan perundang-undangan yang telah ada. Desain penelitian adalah penelitian kombinasi concurrent transformative strategy. Data kuantitatif diperoleh melalui studi longitudinal retrospektif dari rekam medis pasien yang mendapatkan layanan intensif selama tahun 2015 dan dihitung nilai diagnostik dari metode skoring APACHE II dan LODS serta dengan menghitung risiko relatif dan analisis kesintasannya. Data kuantitatif juga diperoleh melalui kuesioner Moral Distress Scale-Revised dan Hospital Ethical Climate Survey. Data kualitatif diperoleh melalui FGD dan wawancara mendalam terhadap tenaga medis dan perwakilan pasien. Skor APACHE II dan LODS hari pertama tidak bermakna sebagai metode diagnosis untuk memasukkan pasien ke dalam ICU. Skor LODS hari ketiga memiliki area di bawah kurva ROC yang lebih baik sebesar 66,6 95 IK: 50,5 ndash;82,7 . Analisis kesintasan menunjukkan adanya penurunan kesintasan sekitar 30 dan peningkatan risiko terhadap terjadinya kematian sebesar 40 . Usia tua usia > 45 tahun meningkatkan risiko terjadinya kematian sebesar 1,6 kali 95 IK: 1,1 ndash;2,5 dibanding usia dewasa. Enam kategori yang dibahas dalam penelitian kualitatif adalah kebebasan, indikasi masuk dan keluar ICU, kesempatan, kesesuaian, ketersediaan, dan wewenang memutuskan perawatan ICU. Konsep pedoman ICU disusun dengan menitikberatkan pada aspek futilitas tindakan kedokteran yang ditunjukkan dengan skor LODS hari ketiga lebih besar atau sama dengan 12,5. Selanjutnya diperlukan case conference dengan semua pihak dengan mempertimbangkan keenam faktor nonmedis. Kriteria distribusi pelayanan intensif yang adil adalah menjamin ketersediaan tempat di ICU secara proporsional dan melakukan diskursus translasional dengan setiap pihak. Kata Kunci: keadilan distributif, pelayanan intensif, rasionalisasi.

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ABSTRACTThe purposes of intensive care are providing intensive treatment and monitoring. The just enjoyment of this high cost services could be achieved through a thorough rationalization. The goal of this study is to acquire an ICU guidance as an addition to the present regulation. Mixed methods with concurrent transformative strategy was used as study design. Quantitative data were collected from 2015 ICU medical records. Longitudinal retrospective study was used to measure the diagnostic value of the first day APACHE II and first and third day LOD score. Survival analysis and relative risks were also measured. Moral Distress Survey Revised and Hospital Ethical Climate Survey questionnaire were used to measure the moral hazard in intensive care. Qualitative data were obtained from FGD and in depth interview of persons who were involved in intensive care. First day APACHE II and LOD score were found not significant as diagnostic tools. The area under the ROC curve for third day LOD score was 66.6 95 CI 50.5 ndash 82.7 . Survival analysis found a 30 decrease in survivability and a 40 increase in hazard in the third day treatment. Older patient has a 1.6 times higher risk 95 CI 1.1 ndash 2.5 of developing death in intensive care. Six categories were found in qualitative study namely the freedom, in and out indication, opportunity, appropriateness, availability, and the authority to decide. The ethicolegal concept of ICU guidance was developed by emphasizing the medical futility which was shown from the measurement of third day LOD score equal or higher than 12.5. The next step was case conference, considering the six non medical categories.The criteria for distributing a just intensive care are by proportionally guaranteeing the availability of the service and performing the translational discourse with every person involved. Keywords distributive justice, intensive care, rationalization."