Gandes Retno Rahayu

Meeting international standards: A cultural approach in implementing the mini-CEX effectively in Indonesian clerkships

Abstract Background: Medical schools all over the world try to adapt their programs to meet international standards. However, local culture might hamper innovation attempts. Aims: To describe challenges in implementing the mini-CEX in Indonesia and investigate its effect on students’ clinical competence. Methods: The study was conducted in the Internal Medicine and Neurology departments of the Universitas Gadjah Mada, Indonesia. Implementing the mini-CEX into the existing curriculum, while taking the Indonesian culture into account, implied a shift from group to individual feedback. We compared students’ final clinical competence before (Internal Medicine n = 122, Neurology n = 183) and after (n = 183 and 186, respectively) the implementation of the mini-CEX, using a modified Objective Structured Long Examination Record (OSLER). The Mann–Whitney test was used to analyze the data. Results: We took power distance and individualism into account to facilitate the implementation process. After implementing the mini-CEX, the OSLER results were significant higher in Internal Medicine (p < 0.05). However, no differences were found in Neurology. Conclusion: By managing the innovation process carefully and taking culture and local context into account, the mini-CEX can be implemented without changing the underlying concept. The shift from group to individual feedback seems to have a positive effect on student learning.

Is there a relationship between personal reflection ability and moral reasoning ability in Indonesian medical students

Objectives To determine the relationship of personal reflection ability and moral reasoning ability of medical students of the Faculty of Medicine Universitas Gadjah Mada (UGM). Methods A cross-sectional study was conducted by distributing questionnaires to 293 medical students in Year-3 at the Faculty of Medicine, Public Health, and Nursing after obtaining their agreement to participate in this research by signing an informed consent form. Personal reflection ability was measured by the Groningen Reflective Ability Scale (GRAS) questionnaire; moral reasoning ability was measured by the Defining Issues Test (DIT) questionnaire. Descriptive statistics, T-test, and regression analysis were used to analyze the anonymized results. Results The mean GRAS score of all students was 89.59 (SD = 6.80) (GRAS score ranged 0-110) which showed a high level. The mean score of Principled Morality Score (P) DIT of all students was 32.39 (SD=11.04), ranging between 28-41 which indicated a moderate level. In general, personal reflection ability scores of all students were positively correlated with their moral reasoning ability score. However, this correlation was not significant statistically (r=0.080, p=0.239). Conclusions Personal reflection ability of medical students was correlated positively with their moral reasoning ability, however, statistically it was not significant . The high level of personal reflection ability needs to be maintained. The moderate moral reasoning ability needs some efforts to improve it. Further studies are necessary to assess other factors which influence the moral reasoning ability so that appropriate interventions can be developed.

A national collaboration to improve OSCE delivery.

this concept, they can begin to identify more leadership moments and how they plan to implement lessons learned. What was tried? Throughout their first year, University of Michigan medical students write down leadership learning opportunities (large or small; personal or professional). To facilitate student reflection on their leadership activities, we adopted Borton’s framework to guide their insightful capacity, using the What? So what? Now what? framework. The What? section asks what took place. The So what? section asks what the significance of the activity was. The Now what? section asks for both synthesis and behaviour change through goal setting. This framework was applied in the following examples.

How does feedback in mini-CEX affect students' learning response?

Objective This study was aimed to explore students’ learning response toward feedback during mini-CEX encounter. Methods This study used a phenomenological approach to identify the students’ experiences toward feedback during mini-CEX encounter. Data was collected using Focus Group Discussion (FGD) for all students who were in their final week of clerkship in the internal medicine rotation. There were 4 FGD groups (6 students for each group). All FGD were audio-taped and transcribed verbatim. The FGD transcripts were analyzed thematically and managed using Atlas-ti (version 7.0). Results Feedback content and the way of providing feedback on mini-CEX stimulated students’ internal process, including self-reflection, emotional response, and motivation. These internal processes encouraged the students to take action or do a follow-up on the feedback to improve their learning process. In addition, there was also an external factor, namely consequences, which also influenced the students’ reaction to the follow-up on feedback. In the end, this action caused several learning effects that resulted in the students’ increased self-efficacy, attitude, knowledge and clinical skill. Conclusions Feedback content and the way of providing feedback on mini-CEX stimulates the students’ internal processes to do a follow-up on feedback. However, another external factor also affects the students’ decision on the follow-up actions. The follow-ups result in various learning effects on the students. Feedback given along with summative assessment enhances learning effects on students, as well. It is suggested that supervisors of clinical education are prepared to comprehend every factor influencing feedback on mini CEX to improve the students’ learning response.