Deeper look into feedback practice in an Indonesian context: exploration of factors in undergraduate clinical settings / 한국의학교육

Purpose@#The practice of feedback is influenced by the characteristics of students, teachers, and the clinical environment. Most studies on feedback have been conducted in Western settings with different sociocultural backgrounds to Indonesia. This study explores feedback in Indonesian clinical clerkship using a sociocultural lens and aims to provide an exemplar of adaptive practice relevant to non-Western settings. @*Methods@#This qualitative study was conducted using an interpretive phenomenology approach. Data were collected through focus groups with students and teachers and interviews with program coordinators. Data were transcribed verbatim and grouped according to data sources, coded, and analyzed thematically. @*Results@#Themes identified from the focus group discussions and interviews were categorized as student, teacher, and environmental factors. Student factors include dependence on feedback, tendencies to use a group approach, difficulties recognizing social rules, a perceived lack of resilience, and tendencies to doubt praise. Factors related to teachers include a high level of expertise, being extremely busy, having a strong commitment, and being unsure of students’ acceptance of feedback. Clinical environment factors influence interactions between teachers and learners and include high power distance and collectivistic values. A safe environment is needed to ensure effective feedback interactions. @*Conclusion@#High power distance, collectivism, and generational characteristics of students likely impact feedback practice in clinical settings. Designing a safe environment is essential for effective feedback practice.

Cardiology residents’ attitudes towards clinical supervision: a multi-centered study / 한국의학교육

Purpose@#Residents’ gender, residency level, and hospital types might influence their attitudes towards clinical supervision (CS); however, reports of its impact on cardiology residency are nonexistent. We explore the effect of gender, residency level, and hospital location’s effect on Indonesian cardiology trainees’ attitudes towards CS. @*Methods@#A multi-centered, cross-sectional study was conducted. We invited 490 Indonesian cardiology residents in September– October 2019 to complete the Cardiology CS Scale. Residents’ attitudes, gender, university, and residency year were expressed using descriptive statistics. A Mann-Whitney test analyzed the gender and university location effect on residents’ attitudes. Training year and university’s impact were subjected to the Kruskal-Wallis test; a p-value of <0.05 reflected a significant result. @*Results@#A total of 388 residents agreed to participate (response rate=79.18%). Most of them were male (n=229 [59,02%]), attended universities in Java Island (n=262 [67,52%]), and were in their 2nd–3rd year of training (n=95 [24.48%], each). There were no significant differences in residents’ attitudes between genders (U [Nmale=229, Nfemale=159]=17,908.50, z=-0.27, p=0.78). Generally, their attitudes were significantly affected by the university (H(7)=47.38, p<0.01). However, the university location (located in Java Island or outside Java Island) does not affect residents’ attitude towards CS (U [NJava=262, Nnon-Java=126]=15,237.00, z=-1.23, p=0.22). In addition, the residents’ training year also affected the residents’ response (H(2)=14.278, p<0.01). @*Conclusion@#Cardiology residents’ attitudes towards CS are significantly influenced by training year and university but not gender or university location. The results might provide insightful information for further improvement of CS in cardiology training and guide further evaluation.

Adaptation of internet-based multiple mini-interviews in a limited-resource medical school during the coronavirus disease 2019 pandemic / 한국의학교육

The coronavirus disease 2019 pandemic has affected many aspects of life, including medical education. The selection of students using multiple mini-interviews (MMI) should be adapted promptly as internet-based MMI (iMMI) in the current setting. The current transition from MMI to iMMI is supported by experience in conducting conventional MMI in previous years; hence, the station and assessor preparation could be completed without significant issues. The greater challenges to the use of iMMI are due to technical issues, including poor internet connections and adaptations necessary for assessing candidates’ nonverbal expressions. This paper aims to describe the experience of conducting iMMI in the current pandemic situation, with further highlights on contextual challenges in a limited-resource setting.

Stereotypes among health professions in Indonesia: an explorative study / 한국의학교육

Purpose@#Effective and efficient health services require efforts to increase collaboration among health professionals. One of the barriers to effective collaboration is stereotypes. Stereotypes represent perceptions or perspectives about a person or group of people. This study aims to explore the perceptions of health professional students and practitioners regarding stereotypes. @*Methods@#This was a qualitative study using a phenomenology approach. A sample of health professions students from both preclinical and clinical stages, as well as health practitioners, was selected using a maximum variation sampling method. Primary data collection was conducted through focus group discussions. Data obtained were analyzed using thematic analysis. A total of nine focus group discussions were conducted. @*Results@#Four themes were identified from this study, including the types of stereotypes, factors affecting stereotype formation, the implications of stereotypes, and how to overcome stereotypes. Stereotype formation was affected by the lack of understanding of other health professions’ roles, hierarchical culture, personal experience in receiving healthcare, and community view. Stereotypes among health professionals created obstacles to healthcare team communication and reduced self-confidence in certain health professionals. These stereotypes may be overcome through competency development and knowledge sharing among professionals as well as through education on other health care professionals’ roles and competencies so that each profession possessed similar goals for patient safety. @*Conclusion@#Both positive and negative stereotypes negatively affected collaboration. Stereotypes were greatly affected by multifactorial causes. Therefore, understanding other professions’ roles and conducting interprofessional education are important to overcome stereotypes.

Adaptation of internet-based multiple mini-interviews in a limited-resource medical school during the coronavirus disease 2019 pandemic / 한국의학교육

The coronavirus disease 2019 pandemic has affected many aspects of life, including medical education. The selection of students using multiple mini-interviews (MMI) should be adapted promptly as internet-based MMI (iMMI) in the current setting. The current transition from MMI to iMMI is supported by experience in conducting conventional MMI in previous years; hence, the station and assessor preparation could be completed without significant issues. The greater challenges to the use of iMMI are due to technical issues, including poor internet connections and adaptations necessary for assessing candidates’ nonverbal expressions. This paper aims to describe the experience of conducting iMMI in the current pandemic situation, with further highlights on contextual challenges in a limited-resource setting.

Stereotypes among health professions in Indonesia: an explorative study / 한국의학교육

Purpose@#Effective and efficient health services require efforts to increase collaboration among health professionals. One of the barriers to effective collaboration is stereotypes. Stereotypes represent perceptions or perspectives about a person or group of people. This study aims to explore the perceptions of health professional students and practitioners regarding stereotypes. @*Methods@#This was a qualitative study using a phenomenology approach. A sample of health professions students from both preclinical and clinical stages, as well as health practitioners, was selected using a maximum variation sampling method. Primary data collection was conducted through focus group discussions. Data obtained were analyzed using thematic analysis. A total of nine focus group discussions were conducted. @*Results@#Four themes were identified from this study, including the types of stereotypes, factors affecting stereotype formation, the implications of stereotypes, and how to overcome stereotypes. Stereotype formation was affected by the lack of understanding of other health professions’ roles, hierarchical culture, personal experience in receiving healthcare, and community view. Stereotypes among health professionals created obstacles to healthcare team communication and reduced self-confidence in certain health professionals. These stereotypes may be overcome through competency development and knowledge sharing among professionals as well as through education on other health care professionals’ roles and competencies so that each profession possessed similar goals for patient safety. @*Conclusion@#Both positive and negative stereotypes negatively affected collaboration. Stereotypes were greatly affected by multifactorial causes. Therefore, understanding other professions’ roles and conducting interprofessional education are important to overcome stereotypes.

Faculty development in medical education: an environmental scan in countries within the Asia pacific region / 한국의학교육

Purpose@#In recent years, faculty development (FD) research is more noticeable within an inter-professional context and in allied health education. However, there is a paucity of published literature on FD medical education programs in Asia. With the formation of the Asia Pacific Medical Education Network (APME-Net) in 2015, a scoping review of an environmental scan of FD medical education programs in main institutions in South East Asia and Australia in 2018 was conducted. @*Methods@#A survey was developed to collect data on FD in medical education after several rounds of discussion with APME-Net members. The representatives from nine countries in Asia and Australia were invited to partner in this research project. They sent the questionnaire to the Dean of all different medical schools after ethical clearance. The data collected was analyzed using descriptive statistics. @*Results@#Only institutions in four countries responded to the questionnaire. The medical/health professions education center/department/unit has been established in most educational institutions in these countries. These centers/departments/units mostly carry out FD programs to improve the teaching and learning skills of trained participants, particularly clinical teachers via workshops and seminars. Staffing issues and participant buy-in are the current key priorities of the center/department/unit in terms of FD. Lastly, research related FD program has not been well-supported in these countries, hence, the lack of publication in this area. @*Conclusion@#Collaboration between countries to address key areas of interest and develop more standardized and productive FD medical education is required especially in research.

The relationship between gender and coping mechanisms with burnout events in first-year medical students / 한국의학교육

PURPOSE: First-year students are susceptible to experiencing burnout if the coping mechanism being used is inadequate; therefore, employing effective coping mechanisms could help students to minimize burnout. Coping mechanisms are divided into five groups: problem-focused, emotion-focused, dysfunctional coping, adaptive, and maladaptive coping. The burnout dimension includes emotional exhaustion, cynicism, and decreased academic performance that may be influenced by gender. This study aims to elaborate on the relationship between gender and coping mechanisms with burnout events in first-year medical students. METHODS: This is a cross-sectional study using a total sample of first-year students from a medical school. RESULTS: A total of 167 respondents (response rate 98.9%) completed a Brief Coping Orientation to Problems Experienced Questionnaire and Maslach Burnout Inventory-Student Survey. The results showed that there was no significant relationship between gender and burnout (p>0.05). On the contrary, maladaptive/dysfunctional coping had a significant positive correlation with emotional exhaustion (r=0.403, p<0.001) and cynicism (r=0.372, p<0.001). Adaptive coping had a significant negative correlation with cynicism (r=-0.165, p=0.033) and a significant positive correlation with perception of personal accomplishment (r=0.417, p<0.001). CONCLUSION: In conclusion, there was no significant relationship between gender and burnout. However, maladaptive/dysfunctional coping had a positive correlation with emotional exhaustion and cynicism. On the other hand, adaptive coping had a negative correlation with cynicism and a positive correlation with perception of personal accomplishment.

The relationship between empathy and stress: a cross-sectional study among undergraduate medical students / 한국의학교육

PURPOSE: Empathy is critical for medical doctors, as it enables them to conduct good patient-centred care. Medical students are expected to learn this ability as part of their education and training. METHODS: Using a cross-sectional design, the present study was conducted to identify whether the empathy levels of medical students are affected by their stress levels. A translated version of the Perceived Stress Scale-10 was used to measure the students’ stress levels, while the Jefferson Scale of Physician Empathy was used to measure their empathy levels. RESULTS: A total of 464 students from one medical school in Indonesia participated in the study. Stress levels among medical students peak in their first year of study and maintain a downward trend over the following years. The students’ empathy levels increased during their first 3 years, declined significantly upon entering the first clinical year, and increased during the second clinical year. However, no correlations were found between stress level and empathy level. CONCLUSION: These findings suggest that there may be other underlying factors that contribute to empathy decline among medical students upon entering their first clinical year. Further research should be conducted to identify these factors. The bounced-back of empathy level to a higher level in the second year highlights the importance of student adaptation in the clinical learning environment and the support system.

The relationship between empathy and stress: a cross-sectional study among undergraduate medical students / 한국의학교육

PURPOSE@#Empathy is critical for medical doctors, as it enables them to conduct good patient-centred care. Medical students are expected to learn this ability as part of their education and training.@*METHODS@#Using a cross-sectional design, the present study was conducted to identify whether the empathy levels of medical students are affected by their stress levels. A translated version of the Perceived Stress Scale-10 was used to measure the students’ stress levels, while the Jefferson Scale of Physician Empathy was used to measure their empathy levels.@*RESULTS@#A total of 464 students from one medical school in Indonesia participated in the study. Stress levels among medical students peak in their first year of study and maintain a downward trend over the following years. The students’ empathy levels increased during their first 3 years, declined significantly upon entering the first clinical year, and increased during the second clinical year. However, no correlations were found between stress level and empathy level.@*CONCLUSION@#These findings suggest that there may be other underlying factors that contribute to empathy decline among medical students upon entering their first clinical year. Further research should be conducted to identify these factors. The bounced-back of empathy level to a higher level in the second year highlights the importance of student adaptation in the clinical learning environment and the support system.

The relationship between gender and coping mechanisms with burnout events in first-year medical students / 한국의학교육

PURPOSE@#First-year students are susceptible to experiencing burnout if the coping mechanism being used is inadequate; therefore, employing effective coping mechanisms could help students to minimize burnout. Coping mechanisms are divided into five groups: problem-focused, emotion-focused, dysfunctional coping, adaptive, and maladaptive coping. The burnout dimension includes emotional exhaustion, cynicism, and decreased academic performance that may be influenced by gender. This study aims to elaborate on the relationship between gender and coping mechanisms with burnout events in first-year medical students.@*METHODS@#This is a cross-sectional study using a total sample of first-year students from a medical school.@*RESULTS@#A total of 167 respondents (response rate 98.9%) completed a Brief Coping Orientation to Problems Experienced Questionnaire and Maslach Burnout Inventory-Student Survey. The results showed that there was no significant relationship between gender and burnout (p>0.05). On the contrary, maladaptive/dysfunctional coping had a significant positive correlation with emotional exhaustion (r=0.403, p<0.001) and cynicism (r=0.372, p<0.001). Adaptive coping had a significant negative correlation with cynicism (r=-0.165, p=0.033) and a significant positive correlation with perception of personal accomplishment (r=0.417, p<0.001).@*CONCLUSION@#In conclusion, there was no significant relationship between gender and burnout. However, maladaptive/dysfunctional coping had a positive correlation with emotional exhaustion and cynicism. On the other hand, adaptive coping had a negative correlation with cynicism and a positive correlation with perception of personal accomplishment.