Download semester 5 - 6

COMMUNITY AND FAMILY HEALTH CARE
WITH INTERPROFESSIONAL EDUCATION
cover
CFHC-IPE MATERIAL BOOK
YEAR 3
SEMESTER 5 - 6
Year 3 topic: “WELL-PREPARED FAMILY”
(KELUARGA SIAGA)
Focus of study:
Specific abilities:
Reducing maternal and infant mortality risks and increasing
life expectancy
Community Diagnosis and Program Planning
The Shares Information and Shared Decision Making
Community Empowerment
Community and Family Health Care Program - Interprofessional Education (CFHC-IPE)
Faculty of Medicine
Universitas Gadjah Mada
Yogyakarta
2016
1
CURRICULUM CONTRIBUTORS
dr. Mora Claramita, MHPE, Ph.D
Department of Medical Education
Department of Family, Community Medicine
and Bioethics
Faculty of Medicine UGM
Dra. RA Yayi Suryo Prabandari, M.Si, Ph.D
Department of Public Health
Faculty of Medicine UGM
Co-contributors
dr. Fitriana Murriya, MPHC - Department of Family, Community Medicine and Bioethics
dr. Hikmawati Nurrakhmanti, MSc – Department of Medical Education
dr. Fitriana - Department of Family, Community Medicine and Bioethics
Fitrina M Kusumaningrum, SKM., MPH - Department of Health Promotion
Lastdes Cristiany Friday, S.Gz., MPH - Department of Health Nutrition
dr. Noviarina MSc – Department of Medical Education
CFHC – IPE YEAR 3 COORDINATORS
Dr.rer.nat. dr. BJ Istiti Kandarina - Department of Public Health
Akhmadi, S.Kp., Ns., M.Kep, S.Kom – Department of Nursing
Dr.Susetyowati, M.Kes – Department of Nutrition
dr. Mahar Agusno, Sp.KJ(K)
2
PREFACE
CFHC-IPE program is designed to stimulate undergraduate students within faculty of medicine to
understand the practice of health professionals (doctors, nurses and dieticians). They are attached in a family
as a group and advocate their health issues during their study periods in the faculty. With this program, the
students are expected to understand the importance of continuing and comprehensive advocation in a family.
When the family faces a health issue, the students may detect the underlying cause and propose a systematic
approach to overcome the problem.
This CFHC-IPE is an interprofessional and multiple approach program. It needs some essential skills
as visualized in Figure 1. The three groups students from undergraduate medical degree, nursing and health
nutrition program study should perform their unique skills with Family and community health approach. To
apply those skills, the students should master some supporting curricula: Interprofessional Education (IPE),
Evidence Based Medicine (EBM), Professional Behavior (PB), as well as Skills Lab (SL) training.
Figure 1. Matrix of CFHC-IPE program
Year Coordinators
3
CONTENTS
Contents
COVER .............................................................................................................................................................1
CURRICULUM CONTRIBUTORS .......................................................................................................................2
CFHC – IPE YEAR 3 COORDINATORS ...............................................................................................................2
PREFACE..........................................................................................................................................................3
CONTENTS ......................................................................................................................................................4
BACKGROUND ................................................................................................................................................5
ANNUAL MATRIX CFHC-IPE ............................................................................................................................6
ACTIVITIES.......................................................................................................................................................7
Learning Objectives: (semester 5 to 6) .......................................................................................................7
General activities ........................................................................................................................................8
LESSON PLAN ..................................................................................................................................................9
RESOURCES .................................................................................................................................................. 12
REFERENCE .................................................................................................................................................. 27
BLUE PRINT ASSESSMENT............................................................................................................................ 29
Appendix 1. General PPT format ................................................................................................................. 31
Appendix 2. Portfolio Format ...................................................................................................................... 32
Appendix 3. Portfolio Assessment............................................................................................................... 34
Appendix 4. Checklists of Inter-professional collaboration ........................................................................ 36
Appendix 5. Feedback card/form ................................................................................................................ 37
Appendix 6. Skenario tutorial C1 – C6 berbasis kegiatan di komunitas (kegiatan CFHC-IPE) ..................... 44
Appendix 7. Tutor-guide for Scenario which was based on community settings (CFHC-IPE settings) ....... 52
4
BACKGROUND
There is an outgrowing health issues around community problems such as the high
prevalence of infectious as well as non communicable diseases such as diabetes and
hypertension. Those diseases need a collaborative management from not only the doctors but
also the nurses and dieticians.
Faculty of Medicine UGM has three undergraduate health study programs: undergraduate
medical degree, nursing program and health nutrition program. With the CFHC-IPE program, we
expect that those students could perform and train their interprofessional collaboration in the
community.
The aims of CFHC-IPE Semester 5 to 6:
1. The students can establish a hypothesis of the family as well as community health problem
(community diagnosis)
2. The students can apply the informed and share decision making skills together with the
individual, family or community (informed and shared decision making skills)
3. The students can propose a health problem solving for example: education, advocation,
health promotion and prevention (program planning and community empowerment)
5
ANNUAL MATRIX CFHC-IPE
YEAR 1
- Example of care study: water and sanitation
Healthy Family
- Students introduce themselves to their attached community
Year 2
Community health awareness
- Example of case study: the danger of smoking habits
- Students identify the health risk in the family and community
- Students can perform a simple health promotion
Year 3
Well-prepared family
- Example of case study: maternal and child problem
- Students assess a more individual problem, plan a simple individual health
conseling and evaluation
Year 4
Disaster preparedness
(Village Awareness)
- Students identify any possible problem during disaster event
- Students propose a disaster simulation and community training
6
ACTIVITIES
Learning Objectives: (semester 5 to 6)
1. Students can learn and perform communication skills in community setting
2. The students can establish a hypothesis of the family as well as community health
problem (community diagnosis):
Students are able to perform an advanced intervention with 5A Phase: Ask-AssessesAdvice (Semester 5) and Assist dan Arrange Follow up (Semester 6)  ASK and ASSESS
are for community diagnosis purposes
3. The students can propose a health problem solving for example: education,
advocation, health promotion and prevention (program planning and community
empowerment):
Students are able to perform an advanced intervention with 5A Phase: Ask-Assesses
Advice (Semester 5) and Assist dan Arrange Follow up (Semester 6)  ADVICE –
ASSIST ARRANGE FOLLOW UP are for program planning purposes
4. The students can apply the informed and share decision making skills together with
the individual, family or community (the informed and shared decision making skills)
 these skills are for community empowerment purposes
5. Students are able to perform a screening and discussion about non communicable
diseases comprehensively and interprofessionally
7
General activities
1. Lecture
a. Overview of CFHC in semester 5
b. Guideline to think select the major problem within family/personal health
Time allocation: 100 minutes
2. Practical work
Covers these topic of discussions of approaches in changing behavior:
a.
b.
c.
d.
e.
f.
Self - introduction: the introduction of students’ role and function as a volunteer
Ask-phase: Health problem exploration should be done together with community members
using various types of methods, such as:

PRA Method (Participatory Rural Appraisal)

Rapid Assessment Procedure

Interview

Observation

Live-In (if possible one or two days)
Assess-phase: from the existing problems, to select which will becomes the priority (should
be done together with community).
Advice-phase: Plan shared activity by involving the community (emphasizing the shares
information and shares decision with individual , family or community)
Assist-phase: Assist the activity by involving the individual, family or community
Arrange follow up / monitoring program
Time allocation: field-work
3. Fieldwork
a. Screening within community
b. Discussion of changing health behaviour using 5A guidelines
Time allocation: 600 minutes
4. Feedback session
a. Faculty lecture feedback
b. Fieldwork feedback
Time allocation: 300 minutes
8
LESSON PLAN
For detail information in each activity (ASK-ASSESS-ADVICE-ASSIST-ARRANGE FOLLOW UP) please refer to these following tables:
Table 1. Detailed Lesson Plan Semester 5
Block
C1
Activities
Lecture
Practical work
Fieldwork
Feedback
C2
Fieldwork
Feedback
C3
Fieldwork
Feedback
Final report and evaluation
Overview of CFHC in Semester 5
Cases identification guided with faculty
supervisors/facilitators
Attachment in Family/Community
using 5 A guide: ASK
Presentation
with
the
faculty
supervisor (DPF)
Attachment in Family/Community
using 5 A guide: ASSESS
Presentation with faculty supervisor
(DPF)
Attachment in Family/Community
using 5 A guide: ADVICE
Presentation with faculty supervisor
(DPF)
Presentation and evaluation with
fieldwork supervisor (DPL)
Time Allocation
100 minutes
100 minutes
Location
On campus
On campus
200 minutes
Community
100 minutes
Puskesmas / Family
doctors’ clinics
Community
200 minutes
100 minutes
200 minutes
100 minutes
100 minutes
Puskesmas / Family
doctors’ clinics
Community
Puskesmas / Family
doctors’ clinics
On campus
9
Table 2. Detailed Lesson Plan Semester 6
Block
C4
Activities
Lecture
Practical work
Fieldwork
Feedback
C5
Fieldwork
Feedback
C6
Fieldwork
Feedback
Final report and evaluation
Overview of CFHC in Sem 6
Case identification guided with faculty
supervisors/facilitators
Attachment in Family/Community
using 5 A guide: ADVICE
Presentation with faculty supervisor
(DPF)
Attachment in Family/Community
using 5 A guide: ASSIST
Presentation with faculty supervisor
(DPF)
Attachment in Family/Community
using 5 A guide: ARRANGE FOLLOW UP
Presentation with faculty supervisor
(DPF)
Presentation and evaluation with
fieldwork supervisor (DPL)
Time Allocation
100 minutes
100 minutes
Location
On campus
On campus
200 minutes
Community
100 minutes
Puskesmas / Family
doctors’ clinics
Community
200 minutes
100 minutes
200 minutes
100 minutes
100 minutes
Puskesmas / Family
doctors’ clinics
Community
Puskesmas / Family
doctors’ clinics
On campus
10
Table 3: Role of students and supervisors during each activities
No
Campus Activities
Role of faculty supervisors
Student’s Task
1
Facilitate students reflection
process concerning medical
learning in primary care
setting
2
Facilitate reflection using
constructive feedback
emphasized the informed and
shared decision making skills
(ASK-ASSESS-ADVICE-ASSISTARRANGE FOLLOW UP)
3
Discussion, feedback and
reflection as scheduled with
faculty supervisor on campus
Activities during fieldwork
Role of fieldwork supervisor
Student’s Tasks
Write diary and portfolio on
reflection forms provided after
field visit for five phase: ASKASSESS-ADVICE-ASSIST-ARRANGE
FOLLOW UP
Discuss reflection in discussion
session with faculty supervisor on
campus
Facilitate observation process of
GMU students concerning real
community health problems based
on approval of attendance
Follow approval of
attendance schedule, by
fulfilling target
Allow students to join for
example, PHC programs or NGO
programs related with health
promotion
Receive feedback reflectively
(understand their positive sides
and those that need to be
improved)
Facilitate students reflection
verbally concerning real
community health problems
1. Join and participate
activities suggested by
field instructor
individually or in
together with
community members
2. Propose a program of
educating the patients/
community in which
have a high
sustainability
Receive feedback
responsively (understand
local community needs)
11
RESOURCES
EDUCATION AND COUNSELING
The Shares Information and Shares Decision Making Skills
with a Community – Based Approach
Mora Claramita
Yayi Suryo Prabandari
Third year students should have an ability to educate and counsel the patients by applying shares
information and shares decision-making skills. One of way is to “DISCUSS” the care-plan with patients.
However, many facts prove that student’s communication skills capacity, are limited on cognitive aspects
rather than application. Students’ inflexible communication affects their professionalism. Students usually
focus on disease’s perspective rather than communicating with the patients. Moreover, so far, skills lab
has limitation in providing opportunities for students to engage in real setting directly. Direct exposure to
community has been proven in many studies to improve knowledge transfer mechanism into an
applicable, flexible and professional competence (Dornan et.al, 2010). Therefore, a community based
approach is used to introduce students in learning education and counseling skills by discussing with the
patients, involving the patients’ perspectives, sharing information and sharing clinical decision making
with patients (individual, family or community).
12
Targets:
Students explores individual/ family/ community’s health problems through series of
“self introduction, ask and assess” methods in the real learning settings.
For detail skills please refer to UGM doctor-patient communication skills guideline in Tabel 1:
THE GREET AND INVITES rows.
Targets:
Students shared decision with individual/ family/ community about a particular health
problem that needs intervention of series of “advices, assist and arrange follow up”
methods.
For detail skills please refer to UGM Doctor-Patient Communication Skills Guideline in Tabel 1:
THE DISCUSS row.
13
Pedoman Komunikasi UGM: SAPA – AJAK BICARA - DISKUSI
Taken from: Claramita M, Susilo AP, Kharismayekti M, Van Dalen J, Van der Vleuten C. Introducing a partnership doctor-patient communication guideline to
teachers in a culturally hierarchical context of Indonesia. Educ for Health 2013; 26 (3): 147-55
Struktur
Deskripsi Isi Ketrampilan
Komunikasi
Keterampilan Komunikasi
Latar Belakang Budaya
Indonesia
Keterampilan Komunikasi yang
sebaiknya diperkuat
SAPA
Kemampuan membina
sambung rasa dan
hubungan interpersonal
yang dilandasi perhatian
dan keinginan untuk
menolong masalah
kesehatan pasien selama proses konsultasi
kesehatan berlangsung
1. Menyapa dan menyambut
pasien dengan hangat yang
menunjukkan perhatian
terhadap masalah
kesehatannya
2. Menggunakan kata-kata
yang memperlihatkan
perhatian secara verbal
3. Menunjukkan sikap dan
bahasa tubuh alamiah yang
memperlihatkan perhatian
secara non-verbal
4. Melakukan obervasi dan
merespon pernyataan
pasien (verbal dan nonverbal) mengenai
perasaannya dan
harapannya. Hal ini
dilakukan sebagai kontrak
awal agenda pertemuan hari
ini.
5. Melakukan refleksi atas
harapan pasien
Pasien di Indonesia baik dari
kalangan pendidikan tinggi
maupun rendah, secara
umum mengharapkan
kedudukan yang setara
dengan dokter.
Kemampuan untuk menyapa dan
menyambut pasien seperti anggota
keluarga sendiri (dengan
memperhatikan hubungan antar
keluarga sesuai masing-masing
budaya daerah) dengan harapan
agar lebih akrab dengan pasien.
1. Mempersilakah dan
memfasilitasi pasien
mengutarakan keluhannya
sampai selesai (ekplorasi
penyakit dari sudut pandang
pasien)
2. Menggunakan pertanyaan
terbuka di awal
3. Menggunakan pertanyaan
tertutup untuk
mengklarifikasi sesuatu
4. Menyimpulkan apa yang
menjadi permasalahan
pasien dan mengecek
kembali pengertian/ persepsi
sakit dengan pasien
5. Menggunakan pertanyaan
tambahan secara efektif
6. Menanyakan adakah
masalah lain yang ingin
disampaikan
7. Meminta persetujuan lisan/
tertulis akan agenda
konsultasi hari ini (sudah
tersebut di SAPA, bisa
diulangi untuk hal yang
spesifik).
Biasakan menggali keluhan
pasien dari sudut
pandangnya dulu (termasuk
mengekplorasi latar
belakang pasien, keluarga,
lingkungan, dan budaya),
kemudian baru dilakukan
penggalian keluhan dari
sudut pandang medis untuk
klarifikasi (e.g. Identitas,
keluhan utama, RPS, RPD,
RPK, RPSosial, Ax sistem)
Eksplorasi yang baik dapat menggali
seluruh riwayat penyakit – hanya
dengan satu-dua pertanyaan
terbuka.
Waspadai perbedaan
hierarki antara pasien
dengan dokter, bahwa dokter
biasanya dipandang lebih
tahu tentang suatu penyakit
daripada pasien.
”Apa yang bisa saya bantu?”
Kepercayaan dan
rasa nyaman dari
pasien yang
didapatkan dari
proses sambung
rasa dengan
dokter, akan
mendorong
pasien untuk
menceritakan
keluhannya
secara terbuka.
AJAK BICARA
Ekplorasi dan
observasi yang
adekuat oleh
dokter terhadap
masalah
kesehatan pasien
dan latar
belakangnya
akan membantu
proses
penegakkan
diagnosis dan
rencana
penatalaksanaan
(terapi/ edukasi)
Kemampuan memulai dan
menstruktur pembicaraan
tentang masalah
kesehatan pasien
Prinsip berikut dianut:
-
Kesetaraan
Kepercayaan
Komunikasi dua arah
Dokter perlu bersikap Semanak
(“Friendly” - disesuaikan budaya
setempat): “Ibu, Bapak, Mas, Dik, “
(Iragiliati, 2006)
Nama panggilan sesuai yang
diinginkan pasien perlu disebutkan
sebagai klarifikasi.
Salah satu contoh ekplorasi keluhan
pasien menggunakan pertanyaan
terbuka:
”Gimana, Pak (ceritanya)...?”
”Ada keluhan apa, Bu?”
”Rasanya bagaimana hari ini, Pak?”
”Datang sendiri atau ada yang
mengantar, Bu?”
( masuk ke eksplorasi keluarga)
”Di rumah sehari-hari..?” (masuk ke
ekplorasi daily activity)
”Oh, mengapa kira-kira bisa seperti
itu, Bu? Apa ada perubahan
aktivitas? (tunggu respon),
Perubahan pola makan? (tunggu
respon),..” (masuk ke ekplorasi
14
RPS,RPD,RPK dari sudut pandang
pasien)
Memahami sudut pandang
pasien terhadap
penyakitnya
1.
2.
DISKUSI
Pengambilan
keputusan klinik
secara bersamasama oleh pasien
dan dokter
dengan cara
menyamakan
persepsi terlebih
dahulu diikuti
dengan
memberikan
penjelasan dan
mendiskusikan
rencana
selanjutnya
Kemampuan
informasi
membagi
1.
(Shares information)
2.
3.
4.
Kemampuan mencapai
persetujuan (bersama
antara pasien dan dokter)
(Shares decision making)
1.
2.
Menanyakan peristiwa
hidup, lingkungan, dan
komunitas di mana
pasien tinggal yang
mungkin mempengaruhi
kesehatannya
Menanggapi harapan
pasien terhadap penyakit
dan akibat dari
penyakitnya terhadap
kehidupannya sehari-hari
Menyamakan persepsi
antara pasien dan dokter
tentang pengertian
penyakit maupun
rencana terapi
Penghargaan terhadap
harapan/ persepsi pasien
lebih lanjut (Harapan
mengenai penyakit dan
akibat penyakit itu thd
kehidupan pasien seharihari dan masa depannya
serta harapan akan
proses diskusi dalam
agenda pertemuan hari
ini)
Menginformasikan
penjelasan sesuai
standar pengetahuan
dokter yang tertinggi –
dalam bahasa awam
Selalu berusaha
komunikasi dua arah
Eksplorasi segala
kemungkinan yang
cocok/ sesuai untuk
keputusan klinik yang
diambil
Eksplorasi kemungkinan
pasien mematuhi
rencana terapi
Pasien di Indonesia
mempunyai sikap yang
sangat khas yang
membutuhkan fasilitasi dan
bukan diabaikan oleh dokter:
a. Keterlibatan keluarga/
masyarakat sekitar pasien
amat berperan (Dengan
catatan: bila pasien setuju
akan keterlibatan mereka
dan bila pasien dianggap
cukup dewasa memberikan
informasi – Bukan anak
dibawah 5 tahun dan
penderita dengan
gangguan bicara/
pendengaran)
b. Pasien di Indonesia secara
umum ingin bersikap
sesopan dan sehormat
mungkin pada dokter. Ini
bukan berarti pernyataan
”Ya” berarti setuju.
c. Penggunaan obat/jamu
tradisional atau
pengobatan alternatif
menjadi suatu kebiasaan
yang sulit dihindarkan baik
di kalangan pendidikan
tinggi maupun rendah
Selalu waspada akan sistem
hirarki di Indonesia, yang
kental. Dokter secara umum
dipandang lebih tinggi
statusnya daripada pasien.
Hal ini membuat pasien tidak
nyaman untuk berdiskusi 
kembali lagi ke kemampuan
SAPA dan AJAK BICARA
Kemampuan menyamakan persepsi
sebagai salah satu usaha bahwa
dokter ingin berada dalam satu level
yang sama dengan pasien, (level
informasi):
”Apa yang sudah Ibu ketahui tentang
penyakit ini?”
(Nada suara – tidak menyalahkan,
tidak menguji)
Penjelasan yang efektif untuk
pasien di Indonesia adalah
yang:
Selalu pertimbangkan partisipasi
keluarga dalam proses edukasi
pasien (bila pasien setuju):
1.
Contoh diskusi antara dokter dan
pasien:
Mengikutsertakan
keluarga/ masyarakat
sekitar
(Dengan catatan: bila
pasien setuju akan
15
keterlibatan mereka
dan bila pasien
dianggap cukup
dewasa untuk
mengambil keputusan –
Bukan anak-anak dan
usia lanjut)
Perkembangan lebih lanjut
tentang shares decision
termasuk didalamnya adalah
kemampuan untuk
-
-
-
”Nanting”
Menyampaikan
Badnews (misal pengobatan
terus menerus untuk
penyakit kronis)
Persuasi  Kental dg
stigma

contoh
comunal-test utk HIV
lebih berhasil daripada
individual test
Konseling  kental
dengan hub keluarga dan
dukungan sebaya
2.
3.
Waspada akan sinyal
non-verbal dari pasien
yang mungkin saja
kurang setuju
Mendiskusikan
penggunaan obat
tradisional (Kelebihan
dan Kekurangan harus
diketahui dan
disepakati bersama
antara dokter dan
pasien)
“Seandainya Ibu menggunakan obat
tradisional, mohon saya diberitahu,
saya ingin belajar lebih banyak
tentang obat tradisional.. Setelah itu
mungkin kita bisa mengamati
bersama sejauh mana obat
tradisional
bermanfaat
pada
penyakit Ibu.” (Beri kesempatan
diskusi).
Catatan:
Pasien yang mengatakan ”nderek”
atau
”manut” bisa berarti
persetujuan tercapai. Tapi selalu
cek non verbal dan verbal pasien,
atas pengertian yang diterima pasien
 kembali ke kemampuan SAPA
Ingat bahwa ”Ya” di konteks
Indonesia bukan selalu berarti
persetujuan maupun kepatuhan
Kemampuan
menyelesaikan
pembicaraan
1.
2.
3.
Menanyakan masalah
yang belum dimengerti
pasien dan berikan
kesempatan bila pasien
ingin menyampaikan
sesuatu
Menyimpulkan hasil
pertemuan hari ini dan
rencana ke depan
Mengucapkan terima
kasih
Tanggap apabila pasien ingin
mengutarakan sesuatu
(biasanya terlihat secara nonverbal).
Mem-verbalkan undangan untuk
bertanya akan sangat membantu
pasien:
”Ada yang mau ditanyakan lagi, Bu?
Segala informasi tertulis
sederhana (Misal panduan
untuk penderita DM) akan
sangat menjembatani
komunikasi verbal yang
terbatas antara pasien dan
dokter di Indonesia
”Masih ada yang mau disampaikan,
Mas?
”Kalau ada apa-apa segera kontrol/
hub saya?
Menghantarkan pasien untuk keluar
ruangan
akan
memperjelas
penghargaan dokter terhadap
pasien.
16
PATIENT EDUCATION
Nowadays medical education has been focused on factual medical knowledge and medical problem
approach based on medical sciences. Almost all processes of study are held in classroom, laboratory, and
university network hospitals. Therefore, graduates of medical faculty know little about common
community problems and are unprepared to work in regional areas (Magzoub, 2000). Community-based
study is a way of showing complexity of health, environment and social problems in the community.
Enhancing collaboration between community and university is necessary to find appropriate education
models for student’s education and society empowerment (Flicker, 2007).
Recently many medical faculties have been trying to enhance their curriculum to be community oriented
by implementing community-based education program (Kristina, 2005). This is being tested by medical
faculty of GMU. Using community-based education, at the beginning of education process, students are
exposed to community health problems (Magzoub, 2000). This education program will assist them in
enhancing their experiences, community services, and community research. According to Davenport
(2000), student’s knowledge will be more meaningful when they have to deal with reality. Facing facts will
enable them to help certain community based on community’s need.
Feletty (2000) stated that community observation is a way of understanding community problems.
Students can utilize their communication skills to recognize such problems. By community involvement,
students have many opportunities to work together as a team and apply their knowledge in real
community setting, not only in a demonstration or with simulated patient (Hamad, 2000). Recognizing
communities problems, students can implement appropriate health approach to the community
(Webber, 1990) holistically and multidisciplinary (magzoub, 2000). Moreover, students will also be able
to learn local cultures and their impacts to community health perspective when they live and work within
certain community (Hamad, 2000). Students who engage themselves in certain community can help them
learn more about health. They have lots of models to educate the community. Verbal communication with
community involvement, community discussion on certain interesting issues, booklet, videos, all can help
them understand more about health (Webber, 1990).
Community-based education has positive impacts not only for students but also for the academic
institution and primary health services. Involvement of academic institution in a community setting help
strengthening relationship among institutions, particularly medical faculty GMU, in various areas such as
government, community institutions, and international organizations (Magzoub, 2000). With
multidisciplinary relation, it is expected that community-based education can contribute in the
improvement of health system in Indonesia.
17
A study by Claramita et al, 2009 shows that some points require observation when students conduct skills
training in community setting:
Benefits of conducting medical skills training in community setting are as follow:
1. Experiential learning enhanced awareness and reflection on patients’ background
2. Responsiveness of community health problems to gain their trust
3. Initiation of two ways exchange information based on patients’ perspective
4. Awareness and initiation of community empowerment
5. Awareness on the dilemma of using evidence-based medicine and using traditional medicine –
applying negotiation skills
6. Awareness of the non-verbal atmosphere of politeness
Obstacles
Student’s obstacles during medical skills training in community setting are as follow:
1. Students tend to over communicate about their experiences in the community, and carried out
by their own stories – lack of time to reflect on communication theories.
2. Students’ lack of depth in exploration. They tend to focus on statements or problems that arise
initially.
3. Students are incapable to respond others’ emotion
4. Students have problems in share thinking skills
5. Some believe that doctor-patient communication skills are genetic and related to personality.
Dilemma
Dilemma between laboratory and community settings felt by students during medical skills training in
community setting.
”Is health promotion part of students’ expectation? Community expectation? Or community needs?”
From the study, it is extremely important to provide opportunities for students to engage directly in the
community adjacent to where they study or Medical Faculty GMU.
18
COUNSELING
Introduction
Beginning in the year 1970 most people agreed that counseling is beneficial and should made more widely
available (Tyler, 1969, cit. Hershenson, Power & Waldo, 1996). Not only people in the mental health area
use counseling, but also other areas, including general health areas. Doctors, nurses, midwives and other
health providers start learning and implementing counseling in the last three decades. As the
development of customer oriented climate and patient right, it is important for doctors to enhance their
counseling skills, not only their medical skills.
What is counseling?
The central purpose of counseling is to facilitate wise choice and decisions. However, some professionals
also give other definition, ‘counseling can be used to promote adjustment or mental health’. To give more
understanding on the definition, counseling is meant by assisting an individual, family or group through
the client counselor relationship:





To develop understanding of intrapersonal and interpersonal problems
To define goals
To make decisions
To plan a course of action reflecting the needs, interests and abilities of the individual, family or
group
To use informational and community resources, as these procedures are related to personal,
social, emotional, educational and vocational development and adjustment
What is the difference between counseling and psychotherapy?
Psychotherapy implies adherence to a medical model, which views the person seeking help (the patient)
as ill and the goal of intervention as curing that illness. Counseling, while it can have therapeutic effects,
focuses instead on promoting healthy development by assisting the person seeking help (the client) to
learn to cope effectively with problems of living. Thus, the goal of psychotherapy is the elimination of
psychopathology (phobia, severe depression or anxiety), whereas the goal of counseling is to empower
the client to achieve healthy growth (Hershenson, Power & Waldo, 1996, page 4)
19
Counseling process
As written in the skills laboratory manual, a counseling process may summarized as GATHER:
G
•Greet, give warm greeting to client
A
•Ask. Ask clients what happened to them
T
•Tell. Tell client alternatives
H
•Help. Help client in choosing
E
•Explain. Explain to the client about the chosen alternatives
R
•Return. Ask the client to return for follow up
Besides GATHER, two things that facilitate the counseling process should be considered:
20
C
L
•Clarifying. Clarify
the patient's
problem
E
•Listening.
Always perform
as a good
listener
•concentrate
•Keep eye
contact
•Show interest
body language
•Encourage
client to talk
•Ask client to
explain
•Re check use
paraphrase
•Leave your
opinion
•Stay calm
•Encouraging.
Encourage
patients to
express their
emotions and
explain their
problems
A
R
•Asking for
feedback. After
you gave your
interpretation
and alternatives,
ask patients for
their opinion
about your
interpretation or
alternatives
•Repeating.
Encourage
patients to apply
the alternatives
they choose and
ask them to
return
R
•Relaxing. Maintain a relax situation when conducting a
counseling
O
•Opening up to client, disclosure your self as counselor and
show your honest acceptance of the diversity
L
•Leaning toward client. Always see to the client’ problem
and show your “interest and motivated” body language
E
•Eye contact. Establish eye contact during the counseling
process
S
•Smiling and sitting squarely
21
Counseling principles
The process of counseling should follow principles below:
 Acceptance
Counselor should accept clients as they are, and understand the diversity
 Individual
Except for the group counseling, individual counseling should implemented individually and the
client should be seen as an unique person.
 Confidentiality
The confidentiality of client’ problem should be kept
 The client is the decision maker
Counselor should let the clients to make their own decision
 Emotion control
Whatever the reaction or behavior of clients, counselor should stay calm
 Avoid judgment
Although client has “un manner” behavior, counselor should stay in the neutral way and avoid
judging the client
Communication skills that should be mastered in counseling process

Relating
Maintain a good and relax relationship between counselor and counselee

Observing
During the counseling process, counselor should observe the clients’ body language or non-verbal
language

Listening
As noted previously, counselor should maintain its listening behavior

Questioning
The way for asking client should perform adequately. It is suggested that counselor should use
open question

Attending behavior
Acceptance of client is important. Counselors should show their non verbal language that show
an acceptance and readiness to help

Talking
Use appropriate language and stay calm, avoid of giving judgment or blaming the client
22




Summarizing & paraphrasing
Sometimes counselor need to make summary or paraphrase (repeat the client’ talk with your own
language)
Interpreting
Counselors also needs to make their own interpretation of the problem or emotion of the clients
Giving interpretation
The interpretation of the main problem and its emotion should be given to the clients.
Researches regarding counseling – a smoking cessation case
Several researches have been conducted for helping the smokers to quit. Some of them use
the behavioral treatment, whereas the others use NRT (Nicotine Replacement Therapy) (Tang,
Law & Wald, 1994; Fowler, 1994) and combining of behavioral treatment (counseling) and NRT
(Gourlay, Forbes, Marriner, Pethica & Mc Neil, 1995).
Considering that stop smoking needs hardly effort, even though innovation strategies have
been conducted, some studies involving medications or combining medications and behavioral
treatments are still implemented. Fowler (1994) conducted randomized trial using nicotine patch
to help the people stop smoking. His study showed that 19.4% out of 842 subjects, who used
patches were quit at 12 weeks, compare to 11.8 % out of 844 in the placebo patch group. The
number of people who were quit decreased after 12-52 weeks, 10.8 % out of 842 in the patch group
and 7.7% out of 844 in the placebo group.
Gourlay and his colleagues (1994) added brief counseling at monthly visits besides giving
twelve transdermal nicotine for relapsed smokers. This study indicated that 6.7% (21 out of 315
subjects) had stopped smoking compared with 1.9% (6 out of 314) allocated in placebo. After 26
weeks the percentage of people who had stopped smoking were 6.4% (20 out of 315), whereas in
the placebo only 2.6% (8 out of 314).
Brief counseling for helping patients stops smoking – an example
A brief counseling for assisting patients stop smoking has been developed in the USA. The process of brief
counseling as below:
23
ASK
ASSES
ADVICE
ASSIST
ARRANGE
FOLLOWUP
ASK



Take the tobacco use as ”vital sign” (always ask smoking behavior)
Place smoking status in chart
Enter smoking status in problem list (if yes)
ASSESS


Assess the willingness of clients to stop smoking
Assess the motivation of quitting smoking
ADVISE





Praise patient for trying or planning to stop smoking
Link smoking to present symptoms/visit
Discuss health, short-term benefits
Give clear cessation message
Ask all tobacco users “if we give you some help, are you willing to try to stop?”
ASSIST
For those who say YES  Ready to stop now:
 Provide motivational and self-help
 Map out plan with patient
 Set date for stopping
For those who say NO  Not ready to stop



Provide motivational literature
Ask about barriers to stop
Encourage – reconsideration in future; offer ongoing support
ARRANGE FOLLOW UP



Mention that you will follow up at next visit
Arrange follow-up date for those ready now as appropriate
Telephone/personal contact on quit date
24
Final remark
Counseling is one of communication skills. For mastering this counseling skill, students should practice
and practice. Use your day life social interaction as a field for practicing. Helping friends’ problem is one
example to practice your counseling skill. Enjoy your practice, good luck!
SHARES INFORMATION AND SHARES DECISION SKILLS
The goal of Patient Education and Counseling skills is the SHARES INFORMATION AND SHARES DECISION
skills with patients (individual, family or community). We should remind ourselves that doctor-patient
communication does not stop after the information is delivered by the doctors. This should be two-way
communication as we have learned during the Active Listening skills in Block 1.1. The two-way
communication in which involve discussion with the patients should be maintained during the whole
consultations until a care-plan was decided and agreed by the doctors and the patients. Most of medical
compliance increases when the patients understood the background of a clinical decision making. The
shares information and shares decision skills is vital when it comes to chronic diseases such as diabetes
mellitus, hypertension, asthma, or tuberculosis that needs extra cooperation from the patients to
maintain their health condition. It is the central duty of general practitioners to help the patients
preventing their chronic diseases from falling into further “levels of prevention” in the natural history of
diseases. This is the fundamental reason why education and counseling skills as well as health promotion
skills is necessary for general practitioners to be.
The shares information and shares decision making skills is not only useful for chronic diseases but also
for other diseases that require extra prevention and promotion e.g. malaria, dengue fever, typhoid fever,
etc. Without adequate exploration on individual or community’s’ NEED and WANT, health professionals
may falls into a health promotion program which not fully understandable by the patients. Therefore, an
optimal health promotion program may not be reached. Education and counseling skills related to health
promotion skills is the central challenge of health promotion system in Indonesia.
More about shares information and shares decision skills was provided in the UGM Doctor-Patient
Communication Skills Guideline in Table 2, particularly on the “Discuss” row. To proceed into a partnership
discussion with patients, students should master the “Greet and Invites” skills in which already learned
during the first and second year of medical education in Faculty of Medicine UGM.
25
The UGM Guideline on communication skills “Greet-Invites and Discuss” was validated during July 2010
and will be registered as a patent - trademark soon. The invention of the UGM guideline was emerged
from series of studies conducted in the Skills Lab FM UGM 2006-2010 (Claramita, et al, 2010).
Evaluation:
1. Feedback will be given orally by every field instructor, communication instructor and physical
examination instructor in every occasion (field or skills lab)
2. Professionalism assessment will be given by field instructor using approval of attendance
26
REFERENCE
Claramita, M, Susilo AP, van Dalen J, 2010, Workshop on UGM Doctor-Patient Communication Skills
Guideline, Faculty of Medicine Gadjah Mada University, February 2010.
Claramita, M, Utarini A, Soebono H, van Dalen J, van der Vleuten C, 2010, Doctor-patient communication
in Indonesia: The conflict between ideal and reality, Advances in Health Sciences Education, onlinepublished, September, 2010
Claramita M, Prabadari Y, van Dalen J, van der Vleuten C, Developing and validating doctor-patient
communication skills guideline for a hierarchical context, less verbally expressed style of
communication and communal society, a poster presented at 7th APMEC conference Singapore, 2010.
Claramita, M. and Widyandana, 2007, Skills Laboratory, Faculty of Medicine Gadjah Mada University,
Yogyakarta.
Claramita, M, Kharisma Yekti M, and Prabandari YS, Proposal for Junior Teacher Research Grant 2009:
Learning Clinical Skills in the Community Setting, Faculty of Medicine, GMU, Yogykarta
Prihatiningsih TS and Widyandana Proposal for Senior Teacher Research Grant 2009: Transferability of
Procedural Skills in the Community Setting, Faculty of Medicine, GMU, Yogykarta
Davenport, BA., 2000, Witnessing and the Medical Gaze: How Medical Students Learn to See at a Free
Clinic for the Homeless, Medical Anthropology Quarterly 14(3):310-327.
Feletti, G., Ja’afar, R., Joseph, A., dkk, 2000, Implementation of Community-Based Curricula, Handbook of
Community-Based Education: Theory and Practices, hal.11-26, Network Publication, Maastricht.
Flicker, S., Savan, B., McGrath, M., dkk, 2007, ‘If you could change one thing...’ What community-based
researchers wish they could have done differently, Community Development Journal Vol 43 No 2;
April 2008 pp. 239–253.
Hamad, B., 2000, What is Community-Based Education? Evolution, definition and rationale, Handbook of
Community-Based Education: Theory and Practices, hal.11-26, Network Publication, Maastricht.
Kristina, TN., 2005, Generic objective for Community-Based Education in Undergraduate Medical
Programmes: the prespective from developing countries, Disertasi S3, Diponegoro University press,
Semarang.
Magzoub, M., 2000, Some Principles Involved in Community-Based Education, Handbook of CommunityBased Education: Theory and Practices, hal. 27-38, Network Publication, Maastricht.
Patton, MQ., 1990, Qualitative Evaluation and Research Method, 2nd edition, Sage Pub, London.
Webber, GC., 1990, Patient Education, A review of the issues, Medical Care 1990;28:1089-1103.
27
American Medical Association. 1992 How to Help Stop Smoking. USA: National Cancer Institute, Centers
for Disease Control and Prevention, American Society of Addiction Medicine
Fowler, G. (1994) Randomised trial of nicotine patches in general practice: results at one year. BMJ COM,
308:1476-1477, dowload 12/26/01
Gourlay, S.G., Forbes, A., Marriner, T., Pethica, D., & McNeil, J.J. (1995) Double blind trial of repeated
treatment with transdermal nicotine for relapsed smokers. BMJ COM, 311:363-366, download
12/26/01
Herhshenson, DB., Power, PW., & Waldo, M. 1996 Community Counseling – Contemporary Theory and
Practice. Boston: Allyn and Bacon
Tang, J.L, Law, M., & Wald, N. (1994) How effective is nicotine replacement therapy in helping people to
stop smoking. BMJ COM, 308: 21-26, download.
28
BLUE PRINT ASSESSMENT
The students’ assessment would have several types i.e. checklist from both teachers/supervisors
during fieldwork and faculty supervisor (DPL/DPF), feedback, and portfolio.
Formative assessment:
Your peers’ feedback (360 degrees feedback from teachers, friends,
health workers, community) would contribute on your portfolio i.e. as
a formative assessment.
Summative assessment:
1.
2.
40%: The checklist from teachers would contribute 40 percent for the end of your
mark. The checklist distributed in your activities such as presentation with your field
teachers (DPL) or while discussion session - tutorial with your faculty teacher (DPF).
60%: Your portfolio will have 60 percent contribution for your mark.
The checklist is representative of competencies which should be mastered by the students. Below
are the third year competencies for CFHC-IPE:
29
Table 4. List of third year competencies of CFHC-IPE:
Year 3
Theme: Well prepared Family (Men's, Women's, Children's Health)
Manage ethical dilemmas specific to interprofessional patient/ population centered care
situations.
Maintain competence in one’s own profession appropriate to scope of practice.
Use the full scope of knowledge, skills, and abilities of available health professionals and
healthcare workers to provide care that is safe, timely, efficient, effective, and equitable.
Engage in continuous professional and interprofessional development to enhance team
performance.
Use unique and complementary abilities of all members of the team to optimize patient care.
Use respectful language appropriate for a given difficult situation, crucial conversation, or
interprofessional conflict.
Engage other health professionals—appropriate to the specific care situation—in shared
patient-centered problem-solving.
Integrate the knowledge and experience of other professions— appropriate to the specific care
situation—to inform care decisions, while respecting patient and community values and
priorities/ preferences for care.
Apply leadership practices that support collaborative practice and team effectiveness.
Reflect on individual and team performance for individual, as well as team, performance
improvement.
Use process improvement strategies to increase the effectiveness of interprofessional
teamwork and team-based care.
Demonstrate high standards of ethical conduct and quality of care in one’s contributions to
team-based care.
Applying bio-psycho-socio-cultural communication
Being able to identify and analyse any health problems in the community
Assess and taking notes on individual as well as family and community health problems during
fieldwork
Establish any hypothesis of individual, family and community health problems
Suggest any solution for the health problems (such as education, councelling, advocation, or
any prevention procedures
Understand any related health system analysis
Understanding professionalism from social construct
Leadership
Compromised solution
Note: The list was taken from the Grand Design of CFHC-IPE Learning objectives for the fouryear-basic medical education (via several workshops on synchronization curriculum of
CFHC-IPE in 2015 with Skills Laboratory, Family Medicine, Public Health and Bioethics
longitudinal curriculum).
30
APPENDICES
Appendix 1. General PPT format
Instruction: Each small group of field group should make a Ppt and submitted via game
Time of Ppt submission:
After the end of Semester 5 and 6 (scheduled presentation with the fieldwork supervisor)
Ppt format-Guide set:
a. At minimum font 20
b. Title page contains group members, name of DPF and DPL, Village name, head of the
village name
c. Content : preface/introduction, body, conclusion, problems during fieldwork
d. Equipped with supporting pictures, quotation and video whenever possible
e. Purposes of presentation: all process from the learning objectives for each semesters,
to show what you have done and what you have learned from the field-work activities
and gaining feedback from the fieldwork supervisors
Abilties should be mastered:
All the list of the third-year competencies of CFHC-IPE (Table 4)
Assessors:
This presentation will be assessed by Dosen Pembimbing Lapangan (Family Doctor/ Puskesmas Doctor)
based on the list of competencies on Table 4.
31
Appendix 2. Portfolio Format
Reflection Form
Instruction: Each students should write according to these question-guides below and submit it via Gamel
Time of portfolio submission:
After each of community-activity (1 activity in 1 block – week 3) and before Feedback Session with the
Faculty Supervisor/ DPF
Question-Guide set:
Self-Assessment:
1. Details of what I’ve done:
Describe events, experiences, feelings, difficulties and dilemma towards the events in a
narrative way (unlimited words)
2. The new experiences from the activity:
Describe what you have learnt from the experiences, what are new to you, what are usual
things, what things should be changed to be better? (Unlimited words)
3. The problems I encounter during the activity :
Tell what do you think you should know more about a particular skills/ knowledge/
attitude; in which you feel that you are lack of mastery on it (unlimited words – try to
grouped your problems into a more specific groups for each problem)
Plan of Action:
4. Plan of action for improvement (according to the problems mentioned before):
Tell what your plans of action to master more on the problems that you encounter. Try
to respond to your problems mentioned above.
32
Attached Evidence: (Should be attached)
5. The evidence of what I did for improvement (can be a note taken during expert discussion/paper
read/ article read/ video recording of re-practice):
Prove that you already try to collect information to respond to your plan of actions above.
The information should be valid and reliable (e.g. journals, textbooks, interview, etc.), in
which you show that you read/ re-do it, by e.g. summarizing, highlighting, note-taking, videorecording. Construct all of the above into a portfolio. Show that you are trying to learn from
various evidences and show that you have learn most of the skills and knowledge of this
phase of CFHC.
33
Appendix 3. Portfolio Assessment
Portfolio is a continuous assessment method when the students analyze their own study through
guidance and feedback of self-assessment and action plan. In this module, students have to fulfill
their portfolio and collecting them in a binder. Scoring will be done by DPF concerning students’
performance from the quantity and quality (each range 1-6) and will contribute 60% of the final
mark of particular semester.
Quantity of the portfolio consists of the length of time of study, number of pages and resources.
Quality of the portfolio concentrates on students’ written reflection and individual action plan .
Topics of Reflection to be
assessed
Objectives 1
Objectives 2
Dan seterusnya
What will be assessed
Quantity 50%
Quality 50%
Rigorous resources and
compiled documents by
students
Self assessment and
reflection
25%
Action Plan
25%
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Scale 1 to 6
Mean of scale 1 to 6 of 2 observers will be the final score.
Scale 1:
Scale 2:
Scale 3:
Scale 4:
Scale 5:
Scale 6:
Poor performance
Under expectation
About expectation
Meet expectation
Above expectation
Excellent
E (Fail)
D
C
B
A/B
A
Quantity (Rigorous resources and compiled documents by students)
1.
2.
3.
4.
5.
6.
Only providing 1 variation of documentation* of learning process
Providing 1 variation of documentation* of learning process and 1 variation of resource** (article/journal/text book)
Providing 1 variation of documentation* of learning process and 2 variations of resources** (article/journal/text book)
Providing 1 variation of documentation* of learning process and 3 variations of resources** (article/journal/text book)
Providing 2 variations of documentations* (photos/interviews/observations/artifacts*) of learning process and 3
variations of resources (article/journal/text book)
Providing 3 variations of documentations* of learning process and 3 variations of resources**
34
*Documentation variation
Photos
Result of Observation
Result of Interviews
Artifacts (forms, guidelines)
**Resources variation
Article
Textbook
Journal
Quality (Self Assessment and Reflection)
1.
2.
3.
4.
5.
6.
Self Assessment and Reflection is limited, only reporting to events
Self Assessment and Reflection is medium and including self-introspection
Self Assessment and Reflection is adequate with sufficient reflection of difficulties or dilemmas
Self Assessment and Reflection is good with presentation of detail critical reflection on certain topics (analysis and
reflect on experiences)
Self Assessment and Reflection is clear and specific, dynamic (capturing growth and change throughout the program)
with reflection using reliable references.
Self assessment is clear, specific, dynamic, able to establish correspondence between program activities and life
experiences, reflection using reliable references (transformational learning)
Quality (Action Plan)
1.
2.
3.
4.
5.
6.
Not able to formulate a clear and specific action plan regarding their development during the program
Able to formulate a clear but not specific action plan regarding their development during the program
Able to formulate a clear and specific action plan regarding their development during the program
Able to formulate a clear and specific action plan based on a poorly defined purpose and goals, regarding their
development during the program.
Able to formulate a clear and specific action plan based on a clearly defined purpose and goals
Able to formulate a clear and specific action plan based on a clearly defined purpose and goals, not only regarding
their development during the program, but to be later used in real-life situation.
Portfolio assessment =
𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑠𝑐𝑜𝑟𝑒 𝑓𝑟𝑜𝑚 3 𝑎𝑠𝑠𝑒𝑠𝑠𝑜𝑟𝑠
18
𝑋 100%
35
Appendix 4. Checklists of Inter-professional collaboration
This checklist will be used by DPL and DPF (for the 40% of summative assessment) and by Peers for
formative assessment
Students name
activities
No
:
:
Competencies
0
1
2
3 (max, the student is able to....)
1.
1
Value or ethics for
Interprofessional Practice
2.
3.
1.
2
Role and responsibilities
2.
3
Interprofessional
Communication
1.
2.
1.
4
Team and teamwork
2.
1.
2.
5
Community competency
3.
4.
Place the interests of patients and populations at the center of
interprofessional health care delivery.
Manage ethical dilemmas specific to interprofessional patient/ population
centered care situations.
Maintain competence in one’s own profession appropriate to scope of
practice.
Use the full scope of knowledge, skills, and abilities of available health
professionals and healthcare workers to provide care that is safe, timely,
efficient, effective, and equitable.
Engage in continuous professional and interprofessional development to
enhance team performance.
Menerapkan ketrampilan komunikasi biopsikososial spiritual.
Use respectful language appropriate for a given difficult situation, crucial
conversation, or interprofessional conflict.
Integrate the knowledge and experience of other professions—
appropriate to the specific care situation—to inform care decisions, while
respecting patient and community values and priorities/ preferences for
care.
Demonstrate high standards of ethical conduct and quality of care in one’s
contributions to team-based care.
Mengidentifikasi dan menganalisis permasalahan kesehatan dalam
komunitas
Menilai masalah kesehatan individu, keluarga dan masyarakat di daerah
binaan.
Menegakkan diagnosis hipothesis pada tingkat individu, keluarga dan
masyarakat
Memberikan usulan pemecahan masalah(misalnya edukasi, pendampingan
management kasus, advokasi dan promosi dan pencegahan)
Yogyakarta,............................................
Sign
Total = .......... x 100
15
observer: ..............
36
Appendix 5. Feedback card/form
This card will be used by supervisor/ peers for formative assessments:
1. Any activitiesd done by each students willl be assessed by supervisors (Dosen Pembimbing
Lapangan (DPL) and Dosen Pembimbing Fakultas (DPF) or their peer students.
2. Whenever the supervisors are unable to give any feedbacks, students are expected to ask
feedbacks from their peer students.
3. Students are required to get 3 feedbacks, whatever from the combination of DPL , DPF or from
their peer students. Please note your feedbacks in these pages and get their verification from your
DPL/DPF.
37
Semester 5
C1
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
38
Semester 5
C2
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
39
Semester 5
C3
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
40
Semester 6
C4
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
41
Semester 6
C5
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
42
Semester 6
C6
No.
Assessment
Activities (Semester, year):
Feedback
Verification
Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun):
Feedback
Verification
Saran
2.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
3.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
Verification
Suggestion
4.
DPL/DPF*
Name:
Activities (Semester, year):
Feedback
5.
Verification
Suggestion
DPL/DPF*
Name:
43
Appendix 6. Skenario tutorial C1 – C6 berbasis kegiatan di
komunitas (kegiatan CFHC-IPE)
TUGAS BELAJAR MAHASISWA:
SKENARIO 5 – KASUS PASIEN yang dijumpai mahasiswa dari Seting Belajar di Komunitas
Kriteria untuk skenario dari seting belajar di Komunitas:
1. Kasus merupakan pengalaman nyata mahasiswa ketika menjumpai pasien di seting belajar
komunitas (ketika CFHC, ketika di Puskesmas, ketika penugasan blok, pasien yang ditemui di dekat
tempat tinggal)
2. Kasus telah dipilih dan disepakati oleh TKT-TKB dengan kata kunci yang telah diumumkan dalam
blok
3. Kasus dapat berbeda untuk masing-masing kelompok mahasiswa, asal kata kuncinya sesuai
dengan arahan dari TKB
4. Setiap kelompok mahasiswa harus sudah mendiskusikan kasus ini, belajar mandiri selama 2 jam
sesuai waktu yang disepakati kelompok (Pertemuan I Mandiri: sebelum minggu ke-2) untuk
mengisi format kasus di bawah ini, sesuai arahan, secara bersama-sama.
5. Mahasiswa menunjuk pemimpin diskusi dan satu sekretaris dalam Pertemuan I Mandiri
6. Setiap kelompok kemudian menyepakati kasusnya dan setelah belajar mandiri, mendiskusikan
kasus ini bersama dengan tutor (Pertemuan II terjadwal dengan Tutor). Jadwal akan dikeluarkan
secretariat TKB.
7. Tutor adalah pemimpin diskusi di Pertemuan II terjadwal
8. Teknik Pengumpulan kasus: Kasus harus sudah dikumpulkan mahasiswa dengan format
(terlampir), maksimal minggu ke-2 blok berjalan ke sekretariat TKB tahuan 3 atau 4. Hal ini untuk
memastikan kesiapan mahasiswa.
9. Keluaran pada saat Pertemuan II dengan Tutor adalah: Rumusan masalah (maksimal 2 hal) terkait
dengan kasus yang dibicarakan.
10. Rumusan masalah ini diketik dan diserahkan pada skeretariat TKB sebagai bahan Diskusi Panel
dengan beberapa pakar di akhir Blok.
11. Selalu ingat tentang level of evidence, bahwa informasi dari pakar adalah level ke-4. Dengan
demikian jangan abaikan proses SELF-STUDY
44
MEDICAL RECORD GUIDE
- for any cases brought by students from community settings –
Tutorial Group: Year……………..Group………….Block………………………….
Keywords from the Block coordinators/ TKB: (1)
(2)
(3)
We met the patient during this learning experience: (Coret yang tidak perlu):
Puskesmas/ CFHC/ or else – please filled in………………………………………
1. WHO IS THE PATIENT?
Write a rich summary of patient’s personal identity, occupation, daily habits, lifestyle, patients’
family, home environment, etc. Write any reason of why this patient is so important to your
group?
Example:
We met the patient name: Siti Halimah, 68 year-old lady, during a home visit at CFHC activity year
2. She was the grandmother of the family that we visit regularly. Bu Siti, or we should call her ‘Mbah
Siti’ is 68 year-old who lives with her daughter’s family in a small village called: Desa Sukamaju.
Mbah Siti helps her daughter takes care of her grandsons, 7 and 1 year-old and during the day she
still goes to the rice field. Her husband died of stroke attack 5 years ago. Her daughter and son in
law are school teachers nearby the village. Mbah Siti still prepares meals like rice, tempe bacem,
sayur lodeh, and other typical traditional Javanese food. They live all together in a small house
made from bamboo, Joglo style, ground floor made from partly land and partly cement, almost no
window in their house so sunlight is impossible to reach the main hall. When it is rainy season, the
house felt like sauna steem room, which was very hot and humid.
This patient is very important to our group because we met her for the first time when we visit
this family. She is a humble and generous lady…bla-bla….and we remember her because we
concern about her elderly life as well as her grandchildren early life, considering the impact of this
illness….
45
2. WHAT IS THE HEALTH PROBLEM?
Write a rich summary of patient’s history of illnesses accompanied by physical examination and
supportive examination needed
Example:
The health problem of Mbah Siti was coughing for more than…..days with blood and difficulty in
breathing……(write the summary of the history taking, current history, past history and family
history)……
This result is supported by physical examination: (write a rigorous physical examination – format
below only served as a general guideline. Students may adjust if necessary)
Vital signs:
Head and Neck:
Heart:
Lungs:
Abdomen:
Extremity:
Supportive examination: labs, X-Ray, etc:
Routine Blood exam:
X-Ray:
BTA:
Did you feel the need to check the blood sugar in elderly patients?
46
3. WHAT IS THE POSSIBLE DIAGNOSIS AND TREATMENT OF THIS PATIENT?
Write any possible differential diagnosis and diagnosis:
1.
2.
3.
4.
5.
Write any possible treatment for this patient:
a) Treatment of non-pharmacology:
b) Treatment of pharmacology:
47
4. WHAT ARE POSSIBLE PATIENT’S PROBLEMS – based on patients’ perspectives?
Write a rich summary of what patient might perceive as her problem, regarding the diagnosis
and treatment that we proposed and how do you approach that as a health professional?
Patients’ problem may be rather different with doctors’ problem, however, if we start from
what the problem is perceived by the patients, we may help the patients better, because we
start with thinking as they think. Patients usually think about: FEAR – HOPE – EXPECTATIONS –
WORRY – IMPACT OF ILLNESS ON DAILY LIFE (keywords for patients’ perception)
Example:
The exact diagnosis of lung tuberculosis in an elderly patient seems obvious because it is
supported by physical findings and laboratory findings. Also the treatment was based on guideline
of treating TB patient from……….and …….(references)
However, the patient may be reluctant intaking medication on daily basis because of these
possibilities:
1. She may feel comfortable after 1 month medication so she felt that the medication
should be stopped
2. She may feel embarrassed and therefore she takes herbal medicine instead of pills
3. She does not understand the importance of taking TB-drug package
Any effort from the students to approach patients’ perspective:
Example:
We did regular home visit to mbah Siti’s family and we tried to talk to her, the importance of the
medication and it will prevent other family members to get the disease. We try to explain the
duration of the TB treatment that will last more than 6 months. We understand that it will be
boring, however……..etc…..etc…………..
During taking medication, she also has to continue to take care little grandsons…it had made her
guilty because she did not want her family to expose the same illness. It is kind like a dilemma for
the patient because…………bla…………….bla………………..bla
48
5. WHAT DO YOU PLAN TO LEARN FOR CARING THIS PATIENT?
During taking care of this patient, what kind of problem that you found, what are learning
objectives that you think it is important and how do you seek information to overcome your
problems?
Our problems with this particular patient-care are: (LEARNING OBJECTIVES)
1.
2.
3.
4.
5.
6.
Obtaining blood sample for BTA test which was very difficult because of bla…..bla….bla
Health provider as well as other patients’ family safety, due to infectious disease like TB
Educating patient on the importance of not stopping medication for more than 6 months
What about MDR TB?
How many is TB in Indonesia? (Epidemiology?)
How much is it related to Diabetic Mellitus problem?
SELF STUDY:
Results of this SELF STUDY should be ready when there is a schedule to discuss with a tutor/
attached
1. We checked the references on obtaining gold standard diagnosis for TB
2. We checked the references on patient and provider safety due to TB
3. We had checked the method for educating chronic illnesses and patient-empowerment for
a specific disease like TB
4. We had checked the references on MDR TB
5. We had checked the references on TB Patients with Diabetic
Results of SELF STUDY are attached
49
6. IF YOU MEET ANOTHER PATIENT JUST LIKE HIM/HER, WHAT WOULD YOU DO DIFFERENTLY NEXT
TIME?
Please discuss this questions with your friends and write a list of what would you do better next
time. Please consider general issues like:







Epidemiology of this case world-wide, in Indonesian context, and in Yogyakarta
Patient and provider safety
Inter-professional or team work
Clinical practice guidelines or consensus
Medical ethics and law (Undang-Undang. Peraturan Daerah, Regulasi dll)
Patient education and counseling
Other issues
Example:
We think that people like Mbah Siti who suffers from both TB and DM type II are a lot in Indonesia.
During home visit with Mbah Siti, we did not get adequate chance to talk with her because during the
day she mostly work in the rice field and we do not have much time in the evening to visit. However,
next time we will try to talk to her in a convenient time for her so she could undertand
comprehensively about treatment of TB.
It is also important to check and educate other family members at the same house, due to…..bla-blabla………….
As one of MDGs’ target in Indonesia, TB is uneasy to eradicate because of bla-bla bla…………….as a
health professional we may do better next time in………..bla………….bla………….bla.
Other references that we would like to know are:
TB guidelines, TB consensus, etc……………
50
7. IF THERE ARE EXPERTS OF THIS PROBLEM, WHAT WOULD YOU LIKE TO LEARN FROM THEM?
Discuss with your friends on what do you want to learn from the experts in order to comprehend this
particular patient-care better (maximum 2 problem formulation). Remember that experts’ opinion
are listed as number 4th as level of evidences, so please not to neglect any self study.
Example:
What we would like to learn from the experts regarding this case are:
1. The MDR TB are still very high in Indonesia, how we deal with that and where is exactly the
problem lied? Is it on the treatment formula? Is it with the patients’ adherence? Or else?
2. How to put into practice the DOTS program in reality?
Note: You must submit these two problems to TKB Secretariat once this discussion is finished.
51
Appendix 7. Tutor-guide for Scenario which was based on
community settings (CFHC-IPE settings)
Panduan untuk Tutor Skenario dari seting belajar di Komunitas:
1. Tutor memfasilitasi mahasiswa dalam 1 sesi tutorial saja
2. Mahasiswa sudah membawa kasusnya dalam format yang kami sediakan dan sudah
melakukan Sesi SELF STUDY sebelum tutorial.
3. PANDUAN PERTANYAAN TUTOR dalam diskusi tutorial dengan masalah dari seting belajar
komunitas (terlampir)
4. Hal yang kritikal adalah perlunya upaya belajar sepanjang hayat oleh mahasiswa dengan
cara:
a. TAHAP BELAJAR: Memahami bahwa proses belajar mengenai penetapan diagnosis
banding, diagnosis, maupun terapi pada tahap pendidikan ini adalah tahap
belajar. Dengan demikian semua hasil diskusi mahasiswa tidak harus selalu benar.
Tugas tutor adalah membantu mengarahkan pola pikir/ penalaran klinik
mahasiswa agar mahasiswa selalu berusaha belajar dari keterbatasannya
b. KETERBATASAN DIRI: Penekanan pada ‘uncertainty’ dan keterbatasan diri sangat
penting, meskipun seorang dokter telah merasa bahwa diagnosis yang akan
ditegakkannya sudah dapat dipastikan. Kewaspadaan pada keterbatasan diri dan
berbagai kemungkinan-kemungkinan lain, menjadi bekal dari seorang dokter
untuk selalu meningkatkan diri, belajar sepanjang hayat, berinisiatif melakukan
up-date ilmu, bertanya pada kelompoknya, seniornya, dan selalu mengikuti
perkembangan ilmu kedokteran.
c. RELASI DOKTER-PASIEN: Penekanan pada relasi/ hubungan dokter pasien sangat
penting agar mahasiswa memahami bahwa dalam pengelolaan masalah
kesehatan, hanya dengan menegakkan diagnosis dan memberikan terapi begitu
saja tidak cukup bagi keluaran kesehatan.
52
d. ETIKA PROFESI: Pembahasan mengenai hal dilematis antara kenyataan yang
dihadapi mahasiswa ketika belajar di seting komunitas yang sangat mungkin tidak
se-ideal teori-teori medis yang dipelajari di kampus, perlu ditekankan dengan
prinsip-prinsip: Menghormati sejawat sesama dokter, semangat memperbaiki diri,
semangat sebagai pemimpin perubahan ke arah yang lebih baik (seandainya
mahasiswa nanti bekerja di seting layanan kesehatan yang tidak ideal, ia akan
selalu berupaya memperbaiki diri dan bukan menyalahkan orang lain,
menyalahkan sistem kesehatan, standar prosedur, atau apapun), dan tetap
mendasarkan perilaku profesinya pada bukti ilmiah terkini, keselamatan pasien
dan petugas kesehatan, etika, hukum dan perilaku professional serta komunikasi
yang efektif.
53
PANDUAN PERTANYAAN UNTUK TUTOR pada sesi belajar dengan kasus dari komunitas
(CFHC-IPE):
(1) WHO IS THE PATIENT?
Write a rich summary of patient’s personal identity, occupation, daily habits, lifestyle, patients’ family,
home environment, etc. Write any reason of why this patient is so important to your group?
(2) WHAT IS THE HEALTH PROBLEM?
Write a rich summary of patient’s history of illnesses accompanied by physical examination and supportive
examination needed
(3) WHAT IS THE POSSIBLE DIAGNOSIS AND TREATMENT OF THIS PATIENT?
Write differential diagnosis, diagnosis, treatment of pharmacological and non pharmacological
(4) WHAT ARE POSSIBLE PATIENT’S PROBLEMS (based on patients’ perception)?
Write a rich summary of what patient might perceive as her problem, regarding the diagnosis and treatment
that we proposed and how do you approach that as a health professional?
Patients’ problem may be rather different with doctors’ problem, however, if we start from what the
problem is perceived by the patients, we may help the patients better, because we start with thinking as
they think. Patients usually think about: FEAR – HOPE – EXPECTATIONS – WORRY – IMPACT OF ILLNESS ON
DAILY LIFE (keywords for patients’ perception)
(5) WHAT DO YOU PLAN TO LEARN FOR CARING THIS PATIENT?
During taking care of this patient, what kind of problem that you found, what are learning objectives that you
think it is important and how do you seek information to overcome your problems?
 Learning objectives are:
 SELF STUDIES are: (results of self study should be reported her, during this tutorial session)
(6) IF YOU MEET ANOTHER PATIENT JUST LIKE HIM/HER, WHAT WOULD YOU DO DIFFERENTLY NEXT TIME?
Please discuss this questions with your friends and write a list of what would you do better next time. Please
consider general issues like:






Epidemiology of this case world-wide, in Indonesian context, and in Yogyakarta
Patient and provider safety
Inter-professional or team work
Clinical practice guidelines or consensus
Medical ethics and law (Undang-Undang. Peraturan Daerah, Regulasi dll)
Patient education and counseling or other issues
(7) IF THERE ARE EXPERTS OF THIS PROBLEM, WHAT WOULD YOU LIKE TO LEARN FROM THEM?
Discuss with your friends on what do you want to learn from the experts in order to comprehend this
particular patient-care better. Remember that experts’ opinion are listed as number 4 th as level of
evidences, so please not to neglect any self study.
Write maximum 2 problem formulation
Students must submit these two problems to TKB Secretariat once this discussion is finished
54
15 FEBRUARI – 17 JUNI 2016
NO
KEGIATAN
1
2
Overvew CFHC-IPE Th. 3
PERSIAPAN:
1. Pertemuan dengan DPF dan persiapan kelompok
turun ke keluarga dampingan
2. Pembahasan Informed and Shared Decision Making
(Panduan Informed and Decision Making dan
pemberdayaan masyarakat)
3. Pembahasan Tabel 4 dan Appendix 4 penilaian IPE
PENUGASAN LAPANGAN I
Eksplorasi dari intervensi lanjutan yang telah dilakukan
Intervensi program penanggulangan PTM (Panduan
umpan balik 5A Fase ASSESS & ADVICE)
Presentasi laporan dengan DPL
Mahasiswa mengisi portfolio untuk fase terkait (upload
GAMEL) sebagai bahan sesi Umpan Balik dg DPF (Gunakan
appendix 2: Format Portfolio – upload beserta bukti-bukti
belajar)
Mahasiswa dari kelompok tutorial yang sama merumuskan
scenario berbasis komunitas yang akan di gunakan untuk
tutorial di Blok C.5 Key Word : Ederly (degenerative : DM,
Hypertensi, gout, Demensia, PPDK, Asma, Osteoporosis,
Osteo Atritis, Mata, Ngompol)  Gunakan apendix 6 dan
format MR scenario komunitas
UMPAN BALIK
Umpan balik Informed and Shared Decision Making dan
pemberdayaan masyarakat (Panduan umpan balik 5A
Fase ASSESS & ADVICE, Tabel 4 dan Appendix 4 penilaian
IPE)
3
4
5
6
7
MINGGU
II
BLOK
C.4
WAKTU
HARI & TANGGAL
Selasa, 16 Februari
KETERANGAN
JAM
15.00-16.00
R. Kuliah 3, 4 dan 5
15.00-17.00
Praktikum
II
C.4
Kamis - Jumat
25, dan 26
Februari
III
C.4
Sabtu, 27 Februari
07.00-11.50
Lapangan
III
C.4
Sabtu, 27 Februari
12.30-14.00
Praktikum
IV
C.4
Senin – Jumat (sebelum melakukan umpan balik)
Pertemuan
mandiri
IV
C.4
Jadwal menyusul
Submit skenario berbasis
komunitas ke sekretariat TKB
C5 maksimal tanggal…X
Praktikum
55
NO
KEGIATAN
8
PENUGASAN LAPANGAN II
Eksplorasi dari intervensi lanjutan yang telah dilakukan
Intervensi program penanggulangan PTM (Panduan 5A
Fase ASSIST & ARRANGE FOLLOW UP)
Presentasi laporan dengan DPL
Mahasiswa mengisi portfolio untuk fase terkait (upload
GAMEL) sebagai bahan sesi Umpan Balik dg DPF (Gunakan
appendix 2: Format Portfolio – upload beserta bukti-bukti
belajar)
Mahasiswa dari kelompok tutorial yang sama merumuskan
skenario berbasis komunitas yang akan di gunakan untuk
tutorial di Blok C.6 (sesuai kata kunci oleh TKB C6: Life style
– dalam konfirmasi)
9
10
11
12
13
UMPAN BALIK
Umpan balik Informed and Shared Decision Making,
pemberdayaan masyarakat (Panduan 5A Fase ASSIST &
ARRANGE FOLLOW UP, Tabel 4 dan Appendix 4 penilaian
IPE))
PERSIAPAN PENGABDIAN MASYARAKAT
di akhir semester
MINGGU
BLOK
WAKTU
HARI & TANGGAL
III
C.5
Sabtu, 9 April
07.00-11.50
Lapangan
III
C.5
Sabtu, 9 April
12.30-14.00
Praktikum
IV
C.5
IV
KETERANGAN
Senin – Jumat (sebelum melakukan umpan balik)
C.5
Pertemuan
mandiri
C.5
Jadwal menyusul
C.5
JAM
Submit skenario berbasis
komunitas ke sekretariat TKB
C6 maksimal tanggal…X
3 Jam
Praktikum
Usulan TOR
pengabdian
masyarakat oleh
mahasiswa
(aturan menyusul)
56
NO
13
14
15
16
17
18
19
KEGIATAN
MINGGU
BLOK
WAKTU
HARI & TANGGAL
II
C.6
Sabtu, 14 Mei
07.00-11.50
Lapangan
II
C.6
Sabtu, 14 Mei
12.30-14.00
Praktikum
III
C.6
III
C.6
Jadwal menyusul
C.6
Pemenang TOR
Grant Pengabdian
Masyarakat akan
melaksanakan
kegiatan ini
C.6
Jadwal menyusul
C.6
Mandiri
PENUGASAN LAPANGAN III
Eksplorasi dari intervensi lanjutan yang telah dilakukan
Intervensi program penanggulangan PTM (Panduan 5A
Fase ASSIST & ARRANGE FOLLOW UP)
Presentasi laporan dengan DPL
Mahasiswa mengisi portfolio untuk fase terkait (upload
GAMEL) sebagai bahan sesi Umpan Balik dg DPF
UMPAN BALIK
Umpan balik Informed and Shared Decision Making
(Panduan umpan balik 5A Fase ASSIST & ARRANGE
FOLLOW UP, Tabel 4 dan Appendix 4 penilaian IPE)
PENGABDIAN MASYARAKAT
Kegiatan bakti sosial, promosi kesehatan massa
Penilaian oleh DPL
Presentasi hasil laporan kegiatan dan evaluasi (DPL) 
Format ppt di Appendix 1 dan penilaian IPE Tabel 4 dan
Appendix 4)
Mahasiswa memperbaiki portfolio untuk seluruh fase
ADVICE, ASSIST, ARRANGE FOLLOW UP (upload GAMEL)
sebagai bahan penilaian portfolio oleh DPF
Penilaian oleh DPF
Penilaian Portfolio Laporan Aktivitas Belajar Mahasiswa
Semester VI (Oleh DPF)  Panduan penilaian portfolio
Appendix 3
IV
IV
C.6
JAM
KETERANGAN
Senin – Jumat (sebelum melakukan umpan balik)
3 jam
Praktikum
Pemenang grant mendapatkan
sertifikat dan grant pengabdian
masyarakat
3jam
Penilaian terjadwal
Penilaian terjadwal
Mbak Berlin, mohon yang blok kuning dijadwalkan dan TIDAK Hari Sabtu
57
58