“Internship” Dokter & Peran Organisasi Profesi Kedokteran Sukman T Putra, SpA(K),FACC,FESC
MPPK Ikatan Dokter Indonesia
PIT2 PDUI 2011
Curriculum Vitae Dr. Sukman Tulus Putra,SpA(K),FACC,FESC Kepala Divisi Kardiologi,Dep Ilmu Kes Anak FK.UI/RSCM Jakarta
Pendidikan:
Dokter Umum – FK.UI 1977
Spesialis Anak – FK.UI 1987
Ped.Cardiology Fellow, Children’s Hosp.Melbourne,Australia, 1990-1991
Fellow of American College of Cardiology (FACC) - 2003
Fellow of European Society of Cardiology (FESC) – 2004
Organisasi:
Ketua Umum Pengurus Pusat Ikatan Dokter Anak Indonesai ( IDAI )
Wakil Ketua Umum II Pengurus Besar Ikatan Dokter Indonesia ( IDI )
General Secretary ASEAN Pediatrics Federation
International member of American Academy of Pediatrics (AAP)
Council member Asia Pacific Pediatric Cardiology & Pediatric Cardiac Surgery Society
Patients need Good Doctors •Care of their patients their first concern •Keep their knowledge and skills up to date •Maintain good relationships with patients & colleagues •Honest & trustworthy •Act with integrity PIT2 PDUI, 2011
Professionalism& Medical Association MEDICINE is, in essence, a moral
enterprise, and its professional associations should be built on ethically sound foundations.
At very least, when physicians form associations,such occasions should promote the interest of those they serve Pellegrino ED. JAMA 1999;282(10):984-986
Professionalism & Medical Association This, sadly has not case.
always been the
economic, commercial and political agendas so often take precedence over ethic obligation. When
Pellegrino ED. JAMA 1999;282(10):984-986
Medical Association ......When physicians form associations, they should make this promise collectively.............................. Whithout such commitment, they are
easily degenerate into self-serving
trade association, lobbies or
unions
OUTLINE What is doctor & what does doctor do? Professionalism in Medicine Internship in Medicine The Role of Medical Association Medical Internship in Indonesia Summary
• MEDICINE is more than the sum of our knowledge about disease. • Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moment of fears, anxiety and doubt…. Stern DT. Measuring Medical Professionalism (2006)
PIT PDUI, 2011
What is a Doctor & What does a Doctor do ? A century ago : “ the role of doctors was clear & simple” …to acquire facility in the art of diagnosis
clinical judgment … to appreciate the relative value of symptoms … to grow in
and the physical signs … to give the patients and his friends the
prognosis … to conduct the treatment that the patients forecast or
may be restored t health
Prof. William Osler (Oxford) MJA 2005;183:560-561
What is a Doctor & What does a Doctor do ?
One hundreds years on…. ...... .......... Things has changed MJA 2005;183:560-561
7 Physician Role Medical Experts
Applying medical knowledge, clinical skills & professional attitude
Communicators
Fascilitating effective doctors-patients relationship
Collaborators Managers
Achieve optimal patients care by effective tem work
Health Advocators
Influencing advancement of health and well being individuals, communities,population
Scholars
Demonstrating lifelong commitment of learning, application & translation medical knowledge
Professionals
Applying ethical practice, profession ledregulation,high personal standards of behavior
Contriobuting in health care organization and the effcetive health care system
CanMEDS physician competency framwork (2005)
Doctors are often portrayed as: • • • • • • • •
Poor communicators Arrogant Defensive Too quick to use jargon Resistant to change Self-interested Operating in an exclusive Highly paid club culture
Doctors in Society : Medical Professionalism in changing world Royal College of Physicians (2005))
What is a Doctor & What does a Doctor do ? The medical profession is built around a networks of relationships created between the doctor and “other people” not only “sick people”
Not all who visit DOCTORS are sick or Patients DOCTORS always remain for EVERYONE The Good Doctor ( 2002 )
What is Profession? An occupation whose core elements is work, based of mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning , or practice of an art founded on it is used in the service of others.
Its members profess a commitment to competence, integrity, morality ,altruism and the promotion of public goods within their domain
What is Professionalism?
People think of professionalism in three main ways : the mastery of technical knowledge and skills strong ethical principles and values such as
honesty, respectfullness and reliability notions of calling of service, in which altruism comes before anythings else
Professionalis m in Medicine
Measuring Medical Professionalism (2006)
Accountability of the physician Private Payerrs
Patient
Government • Proffessional competence • Legal and ethical conduct • Adequacy of access
• Proffessional competence • Financial performance • All six domains
Lawyers And Courts
• Proffessional competence • Legal and ethical conduct • Adequacy of access
Physician
• Proffessional competence • Legal and ethical conduct • Adequacy of access • Public health promotion
Professional Associations
• Proffessional competence • Legal and ethical conduct • Financial performance
Hospitals
• Proffessional competence • Financial performance
Employers
• Financial performance
• Proffessional competence • Legal and ethical conduct • Financial performance
Investors
Managed Care Plants
Modified from Emanuel, E. J. et. Al. Ann Intern Med 1996;124:229-239
Professionalism & Medical Association
Medical Association
.....Association should be aware of the dangers of focusing attention on the economic concerns of their members at the expense of their of more important public and professional responsibilities................. Pellegrino ED,RelmanAS. JAMA 1999;282(10):984-986
The Role Medical Professional Organization
Education Licensing Regulation Representation
Academic VS Professional BASIC Medical Education (S Ked)
Inernship in MEDICINE
Master of MEDICINE (S2)
Medical Doctor (MD)
DOCTOR of Phylosophy (PhD) /S3
Residency ( Specialty)
Fellowship (SUB-Specialties)
What is “Internship” in Medicine ? A transitional training period for newly graduated doctors starting their carreers.(1940) One-year in different clinical placement “Interns” as active learners, practice based learning. Physician in training who has completed medical school but DOES NOT have full license to practice Medicine unsupervised
Education Educational standards and curriculum : undergraduates (medical students, internship and residency training) Continuing medical education (CME) and continuing professional development (CPD)
Licensing For practice of medicine in the areas of expertise The requirement for licensure may vary significantly by country or region. In some countries separate license is required in each region
The Challenges of Medical Associations at Present
Bioterrorism
Explosion technology
Changing market Forces
Problems in health care delivery
Globalisation Medical professinalism in millenium : a physician charter, MJA (2002)
Health Care in the Late 19th and 20th Century
Patients Physician
Medical Associations
Emmanuel EJ. What is accountability in health care. Ann Intern Med.1996;124:229-239
A set of Professional Responsibilities Commitment to: 1. 2. 3. 4.
Professional competence Honesty with patients Patients confidentiality Mainataining appropriate relationship with patients 5. Improving quality of care
Maintaining Trust by managing Conflict of Interest Threatening personal- organisation ineraction with for-profit industries (pharmaceutical, devices company)
Physician have an obligation to recognize, disclose to general public, and deal with
conflict of interest that arise in the course of their professional
INTERNSHIP DOKTER di INDONESIA (2009) Stakeholder : Departemen Kesehatan Institusi Pendidikan Kedokteran KD/KDDKI (IDI) RS Pendidikan Penyelenggara: • Komite Internship Dokter Indonesia (Pusat dan Propinsi)
The Role of Perofessional Medical Association
Professional School of Medicine
Medical Education
CME/CPD
Tujuan INTERNSHIP Memberikan kesempatan kepada dokter baru, lulusan Program Studi Pendidikan Profesi Dokter berdasarkan kurikulum berbasis komtensi (KBK) Menerapkan serta mempraktikkan kompetensi yang diperoleh selama pendidikan dalam rangka penyelarasan antara hasil pendidikan dan praktek di lapangan
Wahana Pelayanan Kedokteran Dilaksanakan di wahana pelayanan kesehatan primer (pemerintah/swasta) yang telah memenuhi syarat internship
Rumah Sakit Puskesmas :dengan atau tanpa perawatan Klinik layanan primer lainnya
Pendampingan Setiap peserta ‘internship” mendapat pendampingan/ disupervisi oleh seorang dokter yang memenuhi kriteria: • Bersedia menjadi pendamping internship • Masih praktik aktif minimum 2 tahun dengan rekam jejak yang baik • Memiliki SIP yang masih berlaku • Telah mengikuti pelatihan menjadi pendamping.
Permasalahan/Kendala Kewenangan dokter ‘intern” dalam hal penanganan pasien perlu diperjelas. Interaksi antara dokter “intern” dan dokter spesialis yang ada belum berjalan baik, sehingga transfer of knowledge &skills tidak optimal. Peran dokter pendamping perlu diperjelas termasuk rewards Proses administratif (penerbitan STR dan SIP sementara lambat. Tempat tinggal tidak disediakan oleh RS wahana
Permasalahan/Kendala Peran KIDI (Komite Internship Dokter Indonesia) di tingkat propinsi kurang berperan IDI Wilayah di beberapa tempat belum mengambil peran yang optimal, bahkan terkesan mempersulit dalam rekomendasi SIP/STR ? RS wahana belum mersakan pentingnya kehadiran dokter “intern” dalam peningkatan kualitas pelayanan kesehatan.
MASALAH/ TANTANGAN YANG KITA HADAPI SEKARANG
DESENTRALISASI
SISTEM YANDOK
TRUST MENURUN
MASALAH/ TANTANGAN DOKTER
GLOBALISASI
UUPK UUSISDIKNAS
INDONESIA
KESEJAHTERAAN
PENDIDIKAN DU/Spes.
AKB/AKAB TINGGI
UU RS UU KES.
Kesimpulan & Saran “Intership” merupakan proses pendidikan professional yang penting bagi sorang dokter dalam meniti jenjang karir di masa depan. Oleh karena ‘internship” adalah suatu sistem jenjang pendidikan profesi yang berlaku global maka perlu segera diadakan evaluasi untuk perbaikan oleh pemegang otoritas masalah ini. Peran Perhimpunan Profesi (ditingkat cabang/ wilayah) perlu ditingkatkan dalam pembekalan pengetahuan dan keterampilan dokter ‘intern”
