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
Cedera
2000
Penyakit menular
7%
2010
Penyakit Cedera menular
Cedera
Penyakit menular
9%
8%
33%
37%
43% 56% 49%
Penyakit tidak menular
Penyakit tidak Penyakit menular tidak menular
58%
Penyakit tidak menular Sumber: Slide dr. Donald Pardede, MPPM, 2015
Indonesia’s Burden of Disease
Tiga penyakit katastrofik utama yang mengancam keuangan BPJS…? ?? Sumber: Slide dr. Donald Pardede, MPPM, 2015
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THE NATURAL HISTORY OF A DISEASE STIMULUS to the HOST Interrelation of Agent, Host and Environmental factors
HOST REACTION Latent Period (Presymptomatic)
PREPATHOGENESIS
Health Promotion Specific Protection
PRIMARY PREVENTION
Symptoms, Signs (Clinical)
RECOVERY with or without Defects, Disability
PALLIATIVE CARE End of life care
PERIOD OF PATHOGENESIS
Early Diagnosis and Prompt Treatment,
SECONDARY PREVENTION
TREATMENT
Disability Limitation Rehabilitation
TERTIARY PREVENTION
Quality of care, Quality of death, Advance directive, Preparing the family
PALLIATIVE 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
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I
Informative • Curriculum • Learning
• • •
Information/ lecture Practice Examination
EXPERT
II
Formative • Curriculum • Learning
• • •
Idem I Values Innovative/ PBL
PROFFESIONAL
III
Transformative • Curriculum • Learning
• • • •
Idem II Leadership Management New sense of bioethics
AGENT OF CHANGE
New Transformative
• •
New sense of bioethics INSPIRING LEADER/ Tolerance on PERSON/ Model transdisciplinary attitude
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IV
Reformation
Objective/ Process
Output
And have a new tolerance on transdisciplinary attitude
(Nicolescu B, 1997; Frenk et al, 2010; Sastrowijoto S, 2011)
Mono, Multi, Inter, Transdisciplines (subjects) (Nicolescu B, 1999)
1).
Mono
Multi
2) Monodisciplinary Research Multidisciplinary Interdisciplinary Transdisciplinary
Inter
Trans
Used ONE methods 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 I
Primary Care
Community
Current
The Future
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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 Practitioner autonomy Focus on illness & cure Passive patient role Acute, episodic care
to Patient Centered practice to Team collaboration to Focus on health promotion to Involved patients & families 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
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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, knowshow, 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 Interprofessional Practice
Roles/Responsibilities
Domain 3: Interprofessional Communication
Domain 4: Teams and Teamwork
*
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When I am so much younger than today I never needed any body’s helping anyway Help me get my feet back on the ground…. And I do appreciate you will be around,
PROBLEM BASED LEARNING
