Community Medicine Clerkship amidst COVID-19 Pandemic: Re-designing, Implementation, and Evaluation

Clerkship on primary care and family medicine is multi-elemental and was very challenging during the COVID-19 pandemic. Some medical students postponed their graduation because the clerkship at the health center could not be carried out in a pandemic situation. This article aims to describe the community medicine clerkship (CMC) module and its implementation amidst the COVID-19 pandemic. This module was delivered by online and offline activities from 10th August to 13th September 2020. A total of forty students, twelve faculty mentors, and fifteen Primary Health Care (PHC) preceptors from ten PHCs in the Tangerang District, Indonesia were involved. Students could carry out activities and fulfil assignments given in the midst of a pandemic with a re-designing of the CMC module. The one-sample t-tests were employed to compare the difference between the study values and the values before the COVID-19 pandemic. The study showed that the scores of students participating in CMC module during the COVID-19 pandemic were significantly different from the scores before the pandemic in terms of both individual and group scores. The findings of the study clearly indicated that all clinical clerkship modules must be redesigned to suit the current conditions. Modifications and variations of various learning methods, guidance techniques, monitoring and coordination are all factors that must be considered in implementing changes to these modules. © 2023 Dwi Tyastuti, Risahmawati Risahmawati, Marita Fadhillah, Fika Ekayanti, Sity Kunarisasia & Ahmad A. Habibi.

Correlation Between Pre-clinical Medical Students' Self-adjustment During Hybrid Learning and Students' Test Scores

Introduction: The more controlled Covid-19 pandemic conditions had made face-to-face learning activities possible with emphasizes the implementation of health protocol. Students needed to adjust to the new learning method transition, which was originally a fully online learning, to a hybrid learning. This condition is likely to be correlated to student learning outcomes. The study aims to determine the correlation between students' self-adjustment during hybrid learning and students' test scores. Methods: This research was a correlation study. Participants were the second-year pre-clinical students who underwent the hybrid learning for the first time. Self-adjustment was measured using a self-developed questionnaire by the investigators. The instrument was a YES or NO questionnaire consisting of 23 questions. Learning outcomes were measured based on summative and practical test scores. Results: Eighty-eight participants had completed the data (response rate 79%). Participants consist of 18 males and 70 females. Most of them were in the range of 15-19 years of age. Majority of the student was in good self-adjustment (55;62.5%). Median self-adjustment score was 16 (range:2-23). The average score of the summative and practical exams were 58± 8.1 and 61±13.1, respectively. There was no significant positive correlation between self-adjustment and summative test (r=0.076;p=0,482). There was no significant positive correlation between self-adjustment and practical test (r=0,044;p=0.683). Conclusion: Most of students have good self-adjustment to this learning method transition. Therefore, it has no impact on test scores. The institution needs to pay more attention to the students who have adapting difficulties. © 2022 UPM Press. All rights reserved.

Implication Between RT-PCR's Cycle Threshold (CT) Value and Clinical Insight in COVID-19

Introduction: Coronavirus disease 2019 (COVID-19) is a contagious with speed transmission and cause pandemic around the globe. A real-time polymerase chain reaction (RT-PCR) has become the major diagnostic method for COVID-19. Some believe that releasing patient from isolation or evaluating clinical progression could be made based on cycle threshold (CT) values. Here, we aimed to compare CT-value to the clinical insight using three different PCR's kit. Method: We collected 48 patients with confirmed COVID19 positive, then we divided into three groups that were (1) pneumonia, (2) non-pneumonia and (3) asymptomatic. The specimens came from nasopharyngeal and oropharyngeal swabs, were extracted using the same matrix column method and then detected by RT-PCR using different kit. The kits were commercially that detect Orf1ab, E gene (kit A);Orf1ab, N, E gene (kit B) and Orf1ab, N gene (kit C). Thus, we compared the result using comparation analysis based on CT-value and clinical groups by using SPSS 20.0 Result: From those patients there were 23 asymptomatic (48%), 9 symptomatic non-pneumonia (19%) and 16 pneumonia cases (33%) respectively. The mean difference of CT-values within three kits were wide and convergence. There were also significantly different (Kruskal-Wallis Test) between clinical course and CT-value in three PCR's kit even from the same detected gene (p< 0.005). Conclusion: This study conclude that CT-value cannot be the only determination to exclude patient from the isolation or to predict the clinical manifestation in COVID-19 since it has wide variation within same sample in different PCR kits. © 2022 UPM Press. All rights reserved.

Epidemiological Assessment of COVID-19 Clinical Symptoms and Its Associated Factors from Banten Districts: The Role of Gender Aspects

Objectives: The symptoms of COVID-19 resemble those of a variety of mild to severe clinical conditions. Having epidemiological knowledge of the clinical symptoms of COVID-19 and associated factors may help health workers to diagnose and manage the disease. Assessment of COVID-19’s clinical symptoms is therefore necessary to support health workers in Banten, Indonesia. Materials and Methods: In this descriptive cross-sectional study, we purposively analysed 1492 medical records from our online COVID-19 database. All data were analysed in a consecutive manner and were shown as percentages or significances. Results: Medical records revealed that 577 patients (39%) were male and 915 (61%) were female. Our sample contained 106 patients (7%) who tested positive for COVID-19. Among these 106 patients, 70 were asymptomatic (66%) while the rest (34%) had single or multiple clinical symptoms. The most common symptom was fever (16%), followed by cough (15%), fatigue (11%), headache (11%), dysphagia (10%), rhinorrhoea (8%), nausea (7%), dyspnoea (4%) and diarrhoea (2%). Subsequently, gender differences were found to be significantly associated with positive cases (p<0.05), the appearance of clinical symptoms (p<0.05), and decision whether to hospitalize or self-isolate (p<0.05). Conclusion: Fever, cough and fatigue predominated in the COVID-19 symptoms reported by our patients. Additionally, gender differences should be carefully considered in developing better management processes.