Promoting medical student's clinical reasoning during COVID-19 pandemic.

PURPOSE: The development of students' clinical reasoning skills should be a consideration in the design of instruction and evaluation in medical education. In response to the coronavirus disease 2019 (COVID-19) pandemic, several changes in the medical curriculum have been implemented in promoting clinical reasoning. This study aims to explore medical students' perceptions and experiences with the clinical reasoning curriculum during the COVID-19 pandemic and determine their skills development. METHODS: The study used a mixed-method design with a concurrent approach. A cross-sectional study was conducted to compare and examine the relationship between the outcomes of the structured oral examination (SOE) and the Diagnostic Thinking Inventory (DTI). Then, the qualitative method was used. A focus group discussion using a semi-structured interview guide with open-ended questions was conducted, then the verbatim transcript was subjected to thematic analysis. RESULTS: There is an increase in SOE and DTI scores between second-year to fourth-year students. The diagnostic thinking domains and SOE are significantly correlated (r=0.302, 0.313, and 0.241 with p<0.05). The three primary themes from the qualitative analysis are perceptions regarding clinical reasoning, clinical reasoning activities, and the learning component. CONCLUSION: Even if students are still studying throughout the COVID-19 pandemic, their clinical reasoning skills can improve. The clinical reasoning and diagnostic thinking skills of medical students increase as the length of the school year increases. Online case-based learning and assessment support the development of clinical reasoning skills. The skills are supported in their development by positive attitudes toward faculty, peers, case type, and prior knowledge.

Stakeholders' Views and Confidence Towards Indonesian Medical Doctor National Competency Examination: A Qualitative Study.

INTRODUCTION: Indonesia is a huge country consisting of 33 provinces with different characteristics. There are 83 medical schools across Indonesia with different accreditation statuses. The Indonesia Medical Doctor National Competency Examination (IMDNCE) has been established to control the quality of medical school graduates. The implementation of IMDNCE needed to be evaluated to determine its impact. To date, there has not been any research in Indonesia that explores the stakeholders' perceptions toward IMDNCE. This study aimed to explore how the stakeholders in Indonesia perceived the impact of IMDNCE towards performances of medical school graduates in clinical practice. METHODS AND STUDY PARTICIPANTS: A qualitative study with phenomenological approach was conducted to investigate perceptions of stakeholders including representatives from consumer organizations, the National Health Coverage, the Ministry of Health, the Indonesian Medical Association, employers (hospital and health center directors), clinical supervisors as well as patients across Indonesia. Data were obtained through focus group discussions (FGDs) and interviews. The study used thematic analysis methods to obtain the results. RESULTS: A total of 90 study participants participated in the study including 10 representatives of consumer watchdog organizations, the National Health Coverage, the Ministry of Health, the Indonesian Medical Association, 31 employers, 32 professionals, and 17 patients. The study found three general themes which represent the perceptions of the stakeholders towards performances of medical school graduates in clinical practice: IMDNCE as an effort to standardize doctor graduates in Indonesia, the results of IMDNCE as a mean to reflect the quality of medical education in Indonesia, and IMDNCE as an effort to improve health services in Indonesia through the quality of graduates. CONCLUSION: In general, the stakeholders perceived that the IMDNCE was able to standardize medical school graduates from various medical schools across Indonesia. However, the IMDNCE needs to be further developed to maximize its potential in improving the competences of Indonesian medical students.