Panduan Kepaniteraan Klinik

STANDARD KOMPETENSI
Materi Pembelajaran
Materi Pembelajaran yang dilaksanakan dalam kepaniteraan bedah
bertujuan untuk memenuhi SKDI, terdiri dari tujuh (7) area kompetensi yaitu:
1. Komunikasi Efektif
2. Keterampilan Klinis
3. Landasan Ilmiah Ilmu Kedokteran
4. Pengelolaan Masalah Kesehatan
5. Pengelolaan Informasi
6. Mawas Diri
7. Etika, Moral, Medikolegal dan Profesionalisme Serta Keselamatan Pasien
• Seluruh dokter muda akan berlatih dan belajar di setiap stase sub
bagian bedah dengan memperhatikan ketujuh aspek area kompetensi
di atas. Di bawah ini akan dijabarkan \daftar dan tingkat
kemampuan/kopetensi penyakit dan keterampilan klinis yang akan
dicapai setiap dokter muda di bagian bedah sesuai SKDI.
A. Daftar Penyakit dan Kemampuan yang
harus dicapai
Tingkat Kemampuan dokter muda yang harus dicapai akan suatu
penyakit-penyakit (tergantung sulitnya penyakit), pada akhir
pendidikannya dibagi atas 5 tingkat pilihan:
1. Tingkat kemampuan 1
2. Tingkat kemampuan 2
3. Tingkat kemampuan 3a
4. Tingkat kemampuan 3b
5. Tingkat kemampuan 4
1. Tingkat kemampuan 1
Ia dapat mengenali dan menempatkan gambaran-gambaran klinik
penyakit tertentu ketika membaca literatur. Bila dokter menghadapi
pasien seperti itu, dokter hanya dapat menduga penyakitnya dan
segera merujuknya.

2. Tingkat kemampuan 2
Mampu mendiagnosis klinik penyakit tersebut berdasarkan anamnesa,
pemeriksaan fisik dan pemeriksaan laboratorium sederhana atau x ray,
dan merujuk pasiennya ke spesialis yang relevan.
3. Tingkat kemampuan 3a
Mampu membuat diagnosis klinik berdasarkan anamnesa, pemeriksaan fisik
dan lab sederhana serta memutuskan memberi terapi pendahuluan lalu
merujuk ke spesialis yang relevan (namun kasus tersebut bukan gawat
darurat)

4. Tingkat kemampuan 3b
Mampu membuat diagnosis klinik berdasarkan anamnesa, pemeriksaan fisik
dan laboratorium sederhana serta memutuskan memberi terapi
pendahuluan lalu segera merujuk ke spesialis yang relevan (kasus tersebut
gawat darurat)

5. Tingkan kemampuan 4
Mampu membuat diagnosis klinik berdasarkan anamnesa, pemeriksaan fisik
dan laboratorium sederhana serta memberi terapi secara mandiri sampai
tuntas.
 Tabel dibawah ini menjabarkan daftar penyakit dan kemampuan yang
harus dimiliki dokter muda (ditandai berwarna) pada akhir
kepaniteraan bedah.
Penyakit 1 2 3a 3b 4

Tromboplebitis 3a

Pneumothorax

Hemothorax

Hernia Diafragmatika

Pneumonia Aspirasi

Osteoma, Osteosarcoma, Condroma,

Cordoma
Ganglion cyst
Penyakit 1 2 3a 3b 4

Pes plavus

Genu varum-valgus

Scoliosis-kyposis

Club foot, claw foot

Osteoporosis

Ewing sarcoma

Paget’s diseases
Penyakit 1 2 3a 3b 4

osteomyelitis

Fraktur patologis

Fraktur & dislokasi tulang belakang

Fraktur, dislokasi shoulder

Fraktur humerus, radius, ulna

Mallet finger

Nail loss
Penyakit 1 2 3a 3b 4

Subungual hematomi

Fraktur clavicula

Fraktur femur

Fraktur tibia, fibula

Fraktur rib

Fraktur, dislokasi rahang

Fraktur, dan lesi kapsul, tendon dan

ligament knee
Penyakit 1 2 3a 3b 4

Fraktur pelvis, hip, dislokasi hip

Rruptur tendon achilles

Lesi meniscus

Rheumatoid arthritis

Hernia inguinalis, femoralis, insisional,

umbilicalis
Peritonitis

Ileus
Penyakit 1 2 3a 3b 4

Salphingitis

Appendicitis akut

Appendicitis abses

Gastric ulcer

Meckel’ diverticulum

Umbilical fistula, omphalocele-

Gastroschisis
choledocolitiasis
Penyakit 1 2 3a 3b 4

pancreatitis

Diverticulitis colon

Hemorrhoid

Perianal abses

Fistula, fisura ani

Atresia ani

Hirschprung disease
Penyakit 1 2 3a 3b 4

Ruptur uretra, ruptur kandung kencing

Striktur uretra

Priapismus

infertility

Paraphymosis

Hypospadia, epispadia

Undecencus testiculorum
Penyakit 1 2 3a 3b 4

Torsio testis

BPH

Prostatitis

Colic renal

Nephrolitiasis, ureterolitiasis, vesikolitiasis

Hydrocele, spermatocele, varicole

Phymosis
Penyakit 1 2 3a 3b 4

Varicocele, hidrocele

Squamous cell carcinoma

Seminoma

Karsinoma prostat

Kista tiroid

Goitre

Hypertiroid/hyperparatiroid
Penyakit 1 2 3a 3b 4

Breast Ca

Fibroadenoma mammae, fibrocystic

change
Gynecomastia

Hodgin-non hodgkin limpoma

Multiple myeloma
Penyakit 1 2 3a 3b 4

Rhabdomyosarcoma

Drowning

Poisoning

Syok hipovolemik

Whiflash

Trauma medula spinalis, complete spinal

transaction
Brown sequard syndrome
Penyakit 1 2 3a 3b 4

Cauda equine syndrome

Syringomielia

Myelopathie

HNP

Spondiilitis TB

Head injury

Cerebral hemorrhage, EDH, SDH

Penyakit 1 2 3a 3b 4

Koma

Brain dead

Anencephaly

Spina bifida

Hidrosepalus acquired

Hidrosepalus congenital

Trigeminal neuralgia
Penyakit 1 2 3a 3b 4

TIA, Cerebral infark, SAH

Brain tumor

Tuberkuloma

Carpal tunnel syndrom

Trigeminal neuralgia

Bell’s palsy

Hemifacial spasm
Daftar Keterampilan Klinis yang harus dicapai

1. Tingkat kemampuan 1
Dokter muda mengetahui dan dapat menjelaskan suatu teori
keterampilan klinis tertentu
2. Tingkat kemampuan 2
Dokter muda pernah melihat atau di demonstrasikan pembimbing
klinis keterampilan klinis tersebut
3. Tingkat kemampuan 3
Dokter muda pernah melakukan atau menerapkan keterampilan itu
dalam pengawasan supervisor
4. Tingkat kemampuan 4
Dokter muda sudah mampu melakukan secara mandiri
SURGERY
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

General physical examination

Rectal examination

Bimanual ginjal
ORTHOPAEDIC EXAMINATION
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Assessment of muscle athrophy

Determination range of motion of head
Inspection shoulder/upper extremity
Test function of shoulder joint
Test function of muscles and elbow joint
Test function of wrist joint, metacarpal and finger joints
Inspection ofposture of spine/pelvis
Inspection of scapula position
Inspection of flection and extension of back
Assessment of lumbar flexion
Palpation spine, sacro-illiac joints, back muscles
ORTHOPAEDIC EXAMINATION
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection of gait
Measurement of length oflower extremities
Hip: assessment of flexion and extention, adduction, abduction, and
rotation
Knee : assessment of cruciate ligaments, collateral ligaments
Assessment of menisci
Feet : inspection of postures and shape
Feet : assessment of dorsal/ plantar flexion, inversion, eversion
EXAMINATION OF PATIENT WITH VARICOSE
VEINS
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Trendelenburg test
Parthes
EXAMINATION OF ARTERIAL VASCULAR
DISORDER
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Posture test of arterial insufficiency

Reactive hyperaemia test of arterial insufficiency
Capillary refil
EXAMINATION OF ABDOMINAL HERNIA
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection of groin during increased abdominal pressure

Palpation of hernia

EXAMINATION OF ABDOMINAL HERNIA

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Palpation of penis, testes, epididymis spermatic duct

Transilumination of scrotum
Urethral swab
Accident and emergency
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY
First aid
Assessmenr of consciousness by means of Glasglow coma scale
External cardia message
Mouth to mouth/ nose resusitation
Mask ventilation
Intubation
Assessment and care external injuries (wounds, bleeding, burns,
distortion, dislocation, fractures)
Stop bleeding (direct pressure, pressure point, pressure bandage)

Transport of casuality
Heimlich manouvre
Apply a bandage
Fluid rescucitation
 Additional examination
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY
Radiography (plane film)
Arthrography
Arteriography
Scintiscan
CT
MRI
Ultrasound
Endoscopy
Biopsy
Uroflowmetry
Micturating cystography
Urodinamic examination
Reflex bulbocavernosus
Therapeutic skill
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Pre operation of operative field for minor sugery, asepsis, antisepsis, local
anethesia
Preparation to watch/ to assist in theatre scrub-up, gown up, put on
sterile gloves, etc)
Infiltration anaesthesia
Local nerve block
Incision and drainage abscess
Wound cleaning
Wound debridement with scalpel and scissors
Wound stiching
Wound removal of sutures
Wound care of burns
Apply a pressure dressing
Therapeutic skill
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Fracture repositioning, closed

Fracture stabilization (without plester)
Reduction of dislocation
Apply a sling
Nail bed cauterization
Nail removal
Nasogastric suction
Nasogastric insertion
Urethral catheherization in male
Urethral catheherization in female
Clean intermitten catheherization (neuropathic blader)
Therapeutic skill
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Circumcition
Dorsumcircumcision
Pungsi suprapubic
Colostomy, changing the bag
Enema
Injection of varices with sclerosant
Venous canulation
Administration of analgesics
To attend oncological patient regarding social and psychological issues
 Neurological
Cranial nerve function
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection of pupils (size and shape)

Pupilary reaction to light
Pupilary reaction of close objects
Assessment of extra ocular movements
Assessment of diplopia
Assessment of nistagmus
Corneal reflex
Assessment of visual acuity
Funduscopy assessment of facial symetry
 Neurological
Cranial nerve function
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Assessment of strength of temporal and masseter muscles

Assessment of facial sensation
Assessment of movements
Assessment of taste
Assessment of hearing (lateralization, air and bone conduction)
Assessment of swallowing
Inspection of palate
Test gag reflex
Assessment of sternomastoid and trapezius muscle
 Neurological
Cranial nerve function
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Tongue, inspection at rest

Tongue, inspection and assessment of motor system (e.g sticking out)

Neurological
The motor system

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection : posture, habitus involuntary movements

Assessment of passive stretch
Assessment of muscle strength
Assessment of strength of individual muscles
Neurological
Coordination

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection of normal gait (normal, on heels, on toes, hopping in one

place, heel to toe)
Shallow knee bend
Romberg test
Point to point testing : between index finger and nose
Point to point testing : heel on opposite knee, running down to big toe
Neurological
The sensory system

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Assessment of sense of pain

Assessment of sense of temperature
Assessment of light touch
Assessment of extinction phenomenon
Assessment of vibration
Assessment of position sense
Discriminative sensation (e.g stereognosis)
Neurological
Radicular sensation disorders

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Lasegue’s sign

Neurological
Higher function
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Assessment of level of consciousness by means of Glasglow coma scale

orientation
Neurological
Reflexes

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Physiological Reflexes
Tendon reflexes (biceps reflex, triceps reflex, knee reflex, ankle reflex)
Plantar respone
Abdominal reflexes
Cremaster reflexes
Anal reflexes
Pathological Reflexes
Hoffman-Tromner sign
 KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Plantar response (babinski group)

Primitive Reflexes

Snout Reflex

Rooting reflexes

Grasp reflex

Glabela reflex

Palmomental reflex

Detection of neck stiffness

 Neurological
Reflexes
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

X-ray skull

X-ray spine

Seldinger angiography

Myelography

Caudography

CT-scan of cerebrum

EEG

EMG, ENMG
 KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

ENG
Brain mapping
PET, SPECT
Visual evoked response examination, BAEP, SSEP
Digital substraction angiography
Duplex-scan of vessels
Biopsy of muscle
Lumbar puncture
Lumbar puncture, Queckenstendt test
MRI, MRA
Neurological
Therapeutic skills
KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Laminectomy
Therapeutic spinal tap
Opening the skull
Surgery for acoustic neuroma
Pituitary gland
Surgery for extradural haemorrhage
Surgery for subdural haemorrhage
Surgery for cerebral tumor
Surgery for carpal/ tarsal tunnel syndrome
Surgery for intra cerebral aneurysm
Neurological
The Spine

KETERAMPILAN KLINIS LEVEL OF EXPECTED ABILITY

Inspection at rest
Inspection in motion
Percussion for tenderness
Palpation for tenderness
Palpation for pain on vertical pressure
Assessment of lumbar flections
 JADWAL BIMBINGAN MORPORT

SENIN SELASA RABU KAMIS JUMAAT SABTU

dr. Monica Sp.B dr. Satria Sp.OT dr. Wendy Sp.OT dr. Satria Sp.OT dr. Robert Sp.BS dr. Monica Sp.B