Kerja Sama Tim Kesehatan

Menentukan Status Kesehatan

MORA CLARAMITA
Kelompok Kerja Nasional Pengembangan Dokter Layanan Primer Indonesia
Departemen Pendidikan Kedokteran Fakultas Kedokteran Universitas Gadjah Mada
Departemen Kedokteran Keluarga dan Komunitas Fakultas Kedokteran Universitas Gadjah Mada
Curriculum Development for Medical
Education:
A Six Step Approach

David Kern
Patricia Thomas
Donna Howard
Eric Bass
John Hopkins University Press , 1998
KERN, et al. 1998, Six Steps Curriculum Development in Medical Education

Step 1 Problem Identification and General Needs Assessment

Step 2 Needs Assessment for Targeted Learners
Step 3 Goals and Objectives
Step 4 Educational Strategies
Step 5 Implementation
Step 6 Evaluation and Feedback
Step 1a problem Identification :

The first step is to identified the health problem or learning problem

that needs to be addressed in your practice. This could be a disease
state that has emerged in your population, a national epidemic, or a
well known health problem that you feel is not being satisfactorily
addressed in your current curriculum.

KERN, et al. 1998, Six Steps Curriculum Development in

Medical Education
Complete Problem Identification
Who does the problem effect:
Patient
Learners
Medical Educators

KERN, et al. 1998, Six Steps Curriculum Development in

Medical Education
What does it effect?
What does it effect
Clinical outcomes
Educational effectiveness
Educational outcomes
QOL
Other health care resources

KERN, et al. 1998, Six Steps Curriculum Development in

Medical Education
How big is the problem?
To what extent is this a problem in my practice ?
High Priority
Medium Priority
Low Priority

KERN, et al. 1998, Six Steps Curriculum Development in

Medical Education
Profil Demografi Indonesia
Pergeseran Penyakit Di Indonesia
1990 2000 2010

Penyakit Penyakit
Cedera Penyakit
menular Cedera menular Cedera menular
7% 9%
8%
33%
37% 43%
56%
49%
58%

Penyakit Penyakit tidak

tidak Penyakit
menular Penyakit
menular tidak tidak
menular menular
Sumber: Slide dr. Donald Pardede, MPPM, 2015
Indonesias Burden of Disease

Tiga penyakit katastrofik

utama yang mengancam
keuangan BPJS? ??
10
Sumber: Slide dr. Donald Pardede, MPPM, 2015
 THE NATURAL HISTORY OF A DISEASE
STIMULUS to the PALLIATIVE
HOST REACTION RECOVERY CARE
HOST
Interrelation of with or End of life care
Latent Period Symptoms,
Agent, Host and without
(Pre- Signs
Environmental Defects,
symptomatic) (Clinical)
factors Disability
PREPATHOGENESIS PERIOD OF PATHOGENESIS
Quality of
care, Quality of
Disability death, Advance
Health Promotion Early Diagnosis and Prompt
Limitation directive,
Specific Protection Treatment,
Rehabilitation Preparing the
family

PRIMARY SECONDARY TERTIARY

TREATMENT PALLIATIVE
PREVENTION PREVENTION PREVENTION
CARE
Leavell & Clark Level of Application of Preventive Medicine
 Pendekatan Pencegahan Pada Tahap Berbeda

Thomas Kuehlein, Quaternary prevention: a task of the general practitioner, http://www.primary-care.ch/docs/primarycare/archiv/fr/2010/2010-18/2010-18-368_

ELPS_engl.pdf
EVIDENCES
Four Reformation of Medical (Higher) Education

Century Generation Reformation Objective/ Process Output

20 I Informative Information/ lecture EXPERT
Curriculum Practice
Learning Examination
II Formative Idem I PROFFESIONAL
Curriculum Values
Learning Innovative/ PBL
21 III Transformative Idem II AGENT OF CHANGE
Curriculum Leadership
And have a new
Learning Management
tolerance on
New sense of bioethics
transdisciplinary attitude
IV New New sense of bioethics INSPIRING LEADER/
Transformative Tolerance on PERSON/ Model
transdisciplinary attitude

(Nicolescu B, 1997; Frenk et al, 2010; Sastrowijoto S, 2011)

Mono, Multi, Inter, Transdisciplines (subjects)
(Nicolescu B, 1999)

1).

Mono Multi Inter Trans

2) Monodisciplinary Research Used ONE methods

Multidisciplinary
Interdisciplinary
Transdisciplinary
Used the same/ ONE methods
between the disciplines
Transfer the method to the other
discipline
At once the discipline accross the
different discipline and beyond all
discipline
 WHO - DEKLARASI ALMA ATA 1978 HEALTH FOR
ALL
WHO PRIMARY HEALTH CARE IS NOW MORE
THAN EVER, 2008:
1. Reformasi kesetaraan layanan kesehatan
melalui Universal Coverage (sistem
pembiayaan kesehatan semesta)
2. Reformasi Pelayanan Kesehatan berpusat
pada individu (fokus pada keluarga dan
beriorientasi pada komunitas)
3. Reformasi Regulasi untuk mengatur publik
terkait sistem pembiayaan
4. Reformasi Kepemimpinan di bidang layanan
primer
 Primary Health Care in Indonesia
Has Recently Been Started
UU BPJS 2011 dan UU DIKDOK 2013
III
III Tertiary Care
II

Secondary Care
II

I Primary Care

Community

Current The Future 18

Priciples of Primary Care Physicians Curriculum

Caring across ages

Person-centered
Undifferentiated health problems
Comorbidity
Community-oriented
Continuity of Care
From womb to tumb
Caring more as well as cure
Person centered, family focus
Doctor patient relationship
Communication skills, cultural competence
High skilled clinicians
Community oriented
Prevention, promotion
Palliative care home care
Interprofessional collaboration
Patient, family and community advocate
Contoh
Fakta:
Angka Kematian Ibu dan Kematian BBL tertinggi di Indonesia
dibanding ASEAN
Desa Siaga, Keluarga Siaga, Suami Siaga menjadi sebuah
program
Masalah Ibu Hamil tertinggi oleh karena Anemia
Bagaimana dengan Nakes Siaga?
Contoh
Fakta:
Penyebab kematian tertinggi untuk wanita di Indonesia: Ca Cervix
Ca Cervix bisa dieradikasi dengan Vaksinasi
Ca Cervix bisa di deteksi dini dengan IVA dan Pap Smear
Angka Cakupan Pap Smear: Less than 5% women population in
Indonesia
Angka Vaksinasi? Vaksinasi Rp 700-800 ribu/ kali
CONTOH: HOSPICE PALLIATIVE CARE
Who is responsible?

Hospice affirms the concept of palliative care as an intensive program that

enhances comfort and promotes the quality of life for individuals and their
families. When cure is no longer possible, hospice recognizes that a peaceful and
comfortable death is an essential goal of health care. Hospice believes that death
is an integral part of the life cycle and that intensive palliative care focuses on
pain relief, comfort and enhanced quality of life as appropriate goals for the
terminally ill. Hospice also recognizes the potential for growth that often exists
within the dying experience for the individual and his/her family and seeks to
protect and nurture this potential.

From: National Hospice and Palliative Care Orginization

Contoh
Fakta:
Angka TB dan TB MDR di Indonesia masih sangat tinggi
TB bisa diobati dengan keteraturan dan kepatuhan minum obat
Kepatuhan minum obat bisa dibantu Kader/ PMO
Angka kesembuhan TB untuk populasi TB di Indonesia kurang dari 20 persen
Yang tidak tertdeteki TB: Fenomena gunung es
Paradigm Shifting

Physician Centered practice to Patient Centered practice

Practitioner autonomy to Team collaboration
Focus on illness & cure to Focus on health promotion
Passive patient role to Involved patients & families
Acute, episodic care to Care for chronic conditions

Aschenbrener CA, Clearning a Path Ahead for IPE

Presentation: Collaborating Across Borders II, Halifax, 2007
Institute of Medicine, Crossing the Quality Chasm (2001)
IP Competencies in Health Care
Integrate the enactment of knowledge, skills, and values/attitudes
that define working together across the professions, with other
health care workers, and with patients, along with families and
communities, as appropriate to improve health outcomes in specific
care contexts.

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an
expert panel. Washington, D.C.: Interprofessional Education Collaborative
7 Essential Elements for Collaboration Way ,
Jones & Busing (2000)

Ehpic course, June 2009 27

Inter-professional Education
More effective when:
1. Applying principles of student-centered learning (e.g. PBL
various learning methods)
2. Interactions during independent learning sessions occurs
between students from different health professionals
3. Contextual learning
4. Using different level of students-assessment (knows, knows-
how, and observation based assessment)
WHO, 2010, Sedyowinarso and Claramita, 2014
 Case studies with
real/simulated
Small group discussion
Fieldwork placement

Learning Activities
Structured practical experience

*
Interprofessional Collaborative Practice Competency Domains

Domain 1: Domain 2:
Values/Ethics for Roles/Responsibilities
Interprofessional Practice

Domain 3:
Interprofessional Domain 4:
Communication Teams and Teamwork

*
31
When I am so much younger than today
I never needed any bodys helping anyway

Help me get my feet back on the ground.

And I do appreciate you will be around,
PROBLEM BASED LEARNING