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ByWidyandana

Innovating web-based pre-test and post-test to motivate students’ learning during clinical skills training session in Skills Laboratory

Authors: Widyandana, N. Kurniawati

Backgrounds: Pre-test and post-test in clinical skills training session are necessary to motivate students’ to study before practicing skills in skills laboratory. Nowadays, e-learning has become a trend in medical education for its benefits. E-learning is considered fun for the students, easy to access, and 24-hours open.

Objectives: To compare the effectiveness of paper-based to web-based pre-test and post-test in motivating students’ learning in skills laboratory. To explore students’ and instructors’ opinions on the effectiveness of pre- and post-test in clinical skills training.

Methods: An experimental study is done by giving undergraduate students an instruction to take pre- and post-test in “Advanced Life Support” skills training topic. Seventy-eight of 4th-year medical students in Faculty of Medicine, Universitas Gadjah Mada and seven clinical skills teachers were randomly recruited in this study. The students were divided into 3 groups; the web-based test group (WB,n=30), paper-based test group who were given notification before test (PN,n=18), and paper-based test group who were not given notification (PWN,n=30). The test scores were analyzed using Paired Sample T-test and One Way ANOVA. The qualitative data were collected using survey questionnaire from the students and teachers. The result of which were analyzed using Inductive Content Analysis by two coders.

Results: Significant differences (p<0.05) were found in the pre and post-test scores between WB with PN and PWN. No significant difference found between PN with PWN. However, the significant difference between pre-test and post-test within the same group was only found in WB (p<0.05). Based on survey questionnaire, students and instructors suggested that pre- and post-test should be continued to be used in skills training because they think it improves students’ motivation to study before practicing skills, increases students’ focus during practice, and increase the effectiveness of the training. However, the test still needs to be improved, e.g. improve the suitability of questions with the guide-book, administer more questions about technical skills rather than theoretical aspect, increase the accessibility of the web and the speed of internet connection, and also add some clinical skills training video to make the test more interesting.

Conclusion: The use of web-based pre- and post-test in clinical skills training in Skills Laboratory of FM UGM has been observed to be able to motivate students’ learning.  The test can be given with or without notification before the test. Somehow it should be continuously improved to increase the effectiveness.

Keywords: web-based, paper-based, pre/ post-test, clinical skills training, undergraduate students

Presented in the Institute of Medical and Health Science Education, 2013, at University of Hongkong

ByWidyandana

Medical Students’ Perception toward Inter Professional Education

Authors: Lestari, R. Stalmeijer, D. Widyandana*, A. Scherpbier

Introduction

Poor interprofessional relationships among health professions have been reported in the literature and to overcome this problem, an Interprofessional Education (IPE) has been suggested as a way to help remedy the situation. Concerning that, Faculty of medicine together with other faculties of health allied of Sultan Agung Islamic University Indonesia has prepared a program of community based IPE and a village of a rural area has been arranged for conducting the program. Therefore, this study aimed to explore medical students’ readiness for and perception toward IPE.

Methods

Final year students of medical programs of Sultan Agung Islamic University (n=240) were asked to complete the ‘Readiness for Interpofessional Learning (RIPL)’ (Parsel& Bligh, 1999) questionnaire. A focused group discussion (FGD) with students from low-moderate and high RIPL scored students was conducted to gain a more in depth understanding of the reasons behind the RIPL finding.

Summary of result

The results revealed that 208 out of 240 students took part the study. Among them, 63 (30.3%) students obtained low-moderate score of RIPL. Chi square analysis indicated that there was a correlation between students’ GPA and readiness for IPE (p=0.009). The FGD reported that those who have positive perception stated that sharing knowledge with other health professions in a team can solve patients’ problem quickly, they can learn from each other professions, health services should be done comprehensively, and roles and responsibility of each professions can be discussed in IPE classroom to limit role conflict. The disagree group stated that they were less confidence, IPE program should be given in clinical rather than in preclinical year and they were reluctant to the role conflict concerning health practice in Indonesia.

Conclusion

Majority of medical students’ has good readiness and positive perception toward Inter Profesional Education program. This readiness for IPE has  a correlation with students’ GPA. Students’ perceptions toward IPE varies between positive and negative based on their responds to role conflict concerning health practice in Indonesia.

Keywords: IPE, medical students, perceptions, readiness

Accepted as poster presentation in The Network: Towards Unity for Health (TUFH) 2013, Thailand

ByWidyandana

Comparing clinical attachments in primary and secondary health center to prepare medical students entering clinical rotation: a quantitative study

Author:  Widyandana, MD, MHPE

Introduction

Recent studies recommend that medical education institution should prepare their pre-clinical students entering clinical rotation using early clinical exposures in real clinical settings. Therefore, this study aimed to compare the effectiveness of clinical attachment in primary health centers (PHC) with secondary health center (SHC) to prepare students entering clinical rotation.

Methods

Clerkship preparation program is five weeks clinical attachment in real clinical environments to prepare students entering clinical rotation. This study randomly recruited 59 fourth year pre-clinical students from Faculty of Medicine Gadjah Mada University, Indonesia which have clerkship preparation program in PHC, compare with 46 students from Faculty of Medicine, Muhammadiyah Jakarta University, Indonesia which have the same program conducted in SHC. Data collection using “Preparation for Hospital Practice Questionnaire (PHPQ)” by Hill et al. (1998) and analyzed using Mann Whitney test and Bonferroni correction to compare student’s level of preparedness entering hospital clerkship

Summary of Result

There are no significant difference (p<.008) between students’ clerkship preparation scores after having clinical attachments in PHC and SHC settings based on 8 areas of PHPQ questionnaire; interpersonal skills (.008), confidence (.567), collaboration(.174), management (.319), science (.073), prevention (.015), holistic care (.023), self directed learning (.091).

Conclusion

Clinical attachments in primary care environment able to prepare pre-clinical students entering clinical rotation equal with hospital environment.

Accepted as oral presentation in WONCA Conference 2011, Cebu, Philippines

ByWidyandana

INTEGRATING CLINICAL SKILLS TRAINING IN SKILLS LABORATORY AND PRIMARY HEALTH CARE SETTINGS TO PREPARE MEDICAL STUDENTS ENTERING HOSPITAL CLERKSHIP

March 3, 2010 at 1:37 am
1D. Widyandana, 2G.D. Majoor, 2A.J.J.A. Scherpbier

1 Dept. Medical Education & Skills Lab, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

2Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Keywords:

Clinical skills training, preparation, undergraduate students, primary care, attachment program

Introduction

Undergraduate medical students’ can practice their clinical skills in a skills laboratory when a school has this facility. Finishing pre-clinical phase, the students enter clinical rotations in real clinical setting. Current studies show that transition process from campus into real clinical setting can cause problems for students, they often feel anxious and not prepared enough to face real patients in reality. Integrating skills training between skills laboratory and primary health care setting could be a solution for this problem.

Objective

To show the effects of clinical attachment program with integrated skills training in Primary Health Care (PHC) settings on student’s level of preparedness to enter clinical rotation.

Method

59 undergraduate medical students in Faculty of Medicine, Gadjah Mada University, Indonesia, randomly choosen to practice their clinical skills in PHC setting before entering clerkship for 5 weeks (11 days). Preparation for Hospital Practice Questionnaire (Hill et al, 1998) will be used for pretest and post test to assess student’s level of preparedness entering clerkship, that consists of interpersonal skills, confident, collaboration, management, science, prevention, holistic care, and self directed learning. The clinical supervisor assesses students’ improvements 5 times during attachments program in PHC.

Result

Finishing clinical attachment in PHCs, students have significant improvement in their sense of preparedness entering clinical rotations (p<0.05). Average score from the teacher also support that result, scores from clinical supervisors indicate that students have significant improvement (p<0.05) in all eight areas of preparedness during practice in PHC settings.

Conclusion

Undergraduate students are more and better prepared for entering hospital clerkship after having clinical attachments in PHC settings.

Published in 7th APMEC Conference 2010, NUS, Singapore

as Poster Presentation. This study conducted as apart of PhD study in Maastricth University.

Further Information, please contact: widyandana@yahoo.com

ByWidyandana

Comparison of three clinical environments for undergraduate clinical skills training program; availability of case, facilities, and clinical supervisor

March 3, 2010 at 1:20 am (articles, research and publications)
1D. Widyandana, 2G.D. Majoor, 2A.J.J.A. Scherpbier

1 Dept. Medical Education & Skills Lab, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

2Institute for Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Keywords:

Comparison, clinical environment, cases, facility, clinical supervisor, medical students

Introduction

Current studies show the importance of early clinical experiences for undergraduate medical students. It improves motivation for learning and prepares them entering clinical rotations. Skills laboratory needs to collaborate with clinical settings to give skills training program for students before entering clerkship.

Objective

To compare three clinical settings (primary health care (PHC), secondary health care (SHC) and tertiary health care (THC)) environment for undergraduate skills training program .

Method

Questionnaires were send to 272 clerkship students in Faculty of Medicine Gadjah Mada University, Indonesia. The students were practicing in three different clinical settings. This survey using modified DREEM questionnaire that already has been validated, and followed by semi structured interview to the clinical supervisors from those settings (n:45).

Result

In general, clerkship students shows that primary health care environment have highest score compare with SHC and THC settings (p<0.05). The clinical supervisors from the hospital settings (SHC and THC) indicate that they are willing to teach, but having difficulties on managing time to supervise students. Beside of that, teaching hospital (THC) is already overloaded with residents, clerkship and other students. This situation is different in PHC, students are welcome, teachers more concern about education, and they have enough time to supervise students. Moreover, facilities and variety of cases in those settings proved to be sufficient for teaching basic knowledge and clinical skills for undergraduate student’s level.

Conclusion

Primary health care settings are feasible as a partner of skills laboratory for undergraduate skills training program. It can provide enough supervision, facilities and availability of cases that suitable for student’s level of competency.

Awarded as BEST ORAL PRESENTATION

in APMEC Conference 2010, NUS, Singapore

will be Published in Medical Education Suplement 2011

Further information, contact widyandana@yahoo.com

ByWidyandana

First Year Medical Student Experiences in Primary Heath Care Settings as a part of Community Based Education Program

March 3, 2010 at 1:16 am
Keywords:
Community, education, clinical experience, first year, primary care

Background: Recent studies show the importance of “early clinical experience” for medical students, it can motivate them to study and prepare before entering clerkship. Those clinical exposures should be introduced earlier according to student’s level of competence. Faculty of Medicine, Gadjah Mada University (FM GMU) has been implementing a Community Based Education (CBE) program, in which send first year medical students to Primary Health Care (PHC) settings to observe and interview staff members regarding their activities, facilities, and management in primary care.

Objective: to explore first year medical students and PHC supervisors opinions on their first experiences having interaction in PHC settings as an early part of CBE program.

Method: Survey using questionnaire to all first year medical students in FM GMU (n: 272) and interview to 5 supervisors in PHC DIY. Data were analyzed qualitatively using content analysis.

Result: The response rate was 86%. Most of the students and PHC supervisors give positive responses on their first experiences having interaction in PHCs settings. CBE activities give better understanding to student’s future profession and reality of health service system in primary care settings. Some areas that students do not like are the report writing, lack of time, limited facilities in PHCs, and unpleasant transportation. Students and supervisors suggest that those activities should be prepared well and scheduled more in the curriculum.

Conclusion: First year students and supervisors realize the importance and advantages of CBE program. This program is acceptable and feasible to continue longitudinally in the curriculum.

Presented as Oral Presentation

in AMEA Conference, Bandung, Indonesia 2009

Further discussion, contact: widyandana@yahoo.com

ByWidyandana

Clinical skills training in primary care settings improves perception of preparedness for clinical rotations without impacting on skills assessment

March 3, 2010 at 1:47 am (articles)
Authors: D Widyandana, G D Majoor, A J J A Scherpbier

Background

Early clinical exposure of medical students is supposed to improve preparation for prospective clinical rotations. Hence, students prepared exclusively in a skills laboratory were compared with peers for whom part of their skills training programme was substituted by training in a primary health centre (PHC).

Summary of work

Over a 5-week period 153 fourth-year (pre-clinical) medical students trained clinical skills exclusively in a skills lab; 59 of their peers received a mixed programme of laboratory trainings and practice in PHC. Students’ perception of preparedness and clinical skills achievement were assessed through the Preparation for Hospital Practice Questionnaire (PHPQ) and a 9-station OSCE exam.

Summary of results

Students taking the mixed programme felt significantly better prepared for clinical rotations than exclusively skills lab-trained peers. Mean OSCE scores of both groups did not differ significantly. Students’ preparedness scores did not correlate with their General Point Average (GPA) and OSCE scores.

Conclusion

Adding clinical skills training in a PHC setting to skills lab trainings improved students’ perception of preparedness for clinical rotations. However, this mixed programme did not improve students’ clinical and academic performance. Take home message Early clinical encounters may improve students’ perception of preparedness for clinical rotations. However, tangible impact on clinical and academic performance remains to be demonstrated.

Accepted As: Oral Presentation

in OTTAWA Conference 2010, Miami, Florida, US

further information, please contact: widyandana@yahoo.com