HEALTH PROFESSIONAL STUDENTS
SHOULD
KNOW!
PARTICIPATING AND COLLABORATING IN HEALTH PROFESSIONAL EDUCATION SYSTEM
Center for Indonesian Medical Students’ Activities
Ministry of Education & Culture
for students, for indonesia,
HEALTH PROFESSIONAL STUDENTS
SHOULD
KNOW!
PARTICIPATING AND COLLABORATING IN HEALTH PROFESSIONAL EDUCATION SYSTEM The book is a copyright of Dikti-Kemdikbud (Ministry of Education and Culture, Republic of Indonesia). It is written as one of HPEQ Project's tools made for health professional students to promote awareness on the importance of: 1.
Students' participation in the process of policy-making
2.
Collaborative practice among health professionals or as
within health education system known as Interprofessional Education (IPE)
table of content Chapter 1 Health education system: is that even my business?
1
Chapter 2 So I should be participating? Who on earth am I?
5
Chapter 3 Alright, if I want to participate, what do I do?
11
Chapter 4 Interprofessional education (IPE): you + me = us! Together for the better!
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Chapter 5 Participation, collaboration, health education system, HPEQ..., wait, what is HPEQ?
29
Chapter 6 What can I do, like NOW?
35
Chapter 7 IT'S A WRAP! :D
38
List of Abbreviations References Acknowledgment
41 42 43
HEALTH EDUCATION SYSTEM: IS THAT EVEN MY BUSSINESS?
F
arrell, a pseudonym, was a smart medical student
with outstanding academic records. His GPA never
went below 3 of a 4.0 scale and he felt that he had
always studied well and obediently followed his campus' rules. This year he graduated as a medical doctor and he started working as a general practitioner at health centers and private clinics. In his early weeks, he had a hard time handling patients. During his study, Farrell spent most of his clinical rotations in teaching hospitals where he encountered a lot of advanced and specialistic cases. Consequently, there were times Farrell felt he knew how to diagnose an end-stage chronic kidney disease but he could be somewhat clueless about how to treat a patient with simpler cases such as common cold, eczema, or bloating. In fact, at health centers and clinics they were the kind of patients he met on a daily basis. Since he had worked, Farrell realized that there were professional competences that he should have had prioritized back when he was a medical student. However, in reality, not only once he had to be on a night shift duty where his time and energy were drained, while ironically he did not gain much of clinical knowledge and skill.
Another story came from Fitri, also pseudonym, a dentistry student who was supposed to be graduating soon. Unfortunately she was worried about not being able to sit for the final board because she could not find a patient for her clinical examination. Fitri also had a concern on the fact that she did not obtain sufficient practical skill due to inadequate number of dental chair facilities for everyone in her batch. Mischka, not a real name either, a pharmacy student having similar problem related to infrastructures. Mischka was expected to have research skill and knowledge of international standards. But on the other hand, laboratory facilities and free access to international journals were not even fully supported by her institution.
“Oh, crap. I think we made a mistake! We really should do more lab practices...�
From the three stories, we could see several differences and similarities among them. After graduating, Farrell had just realized that education system in his university was not always carried out efficiently and effectively. As a student, he was too busy studying and did not even bother to care about situations related to teaching-learning processes. A little bit different compared to Farrell, Fitri dan Mischka had actually been quite aware of what happened with their education system, but they simply did not know what to do. They did not know whom to talk to and how they should do it. Additionally, there was a slight pessimism that their voices would be heard and given beneficial responses.
I
llustrations above are only a very small part of the all problems faced by health
professional students in Indonesia. It is clear that the problems might include: Incompability issue between material being taught and competency needed in real life Ineffective learning methods which often results in energy and time-consuming activities with less to no knowledge acquisition Lack of teaching facilities
Problems faced by Farrell, Fitri, and Mischka are technical problems that might be different among each profession. But the moral of the story is: students' participation is highly needed to improve health education system. Students have to provide feedbacks, be it critiques or suggetions, towards teaching-learning processes. To get the best of it, aspiration should be conveyed appropriately. In other words, methods being used have to be effective, efficient, and intellectual. The process surely needs a good communication between students and stakeholders, i.e. teachers, institutions, and government.
“Students' participation has to be done in an effective, efficient, and intellectual way.�
4
SO, I SHOULD BE PARTICIPATING? WHO ON EARTH AM I?
P
erhaps some of you have had similar experinces with Farrell, who had been ignorant about his health education system. Or probably like Fitri and Mischka, who had been pretty conscious of the problems but felt not powerful enough to take actions? Have you ever felt that way?
Students these tend to be passive? Hmm, thatya...? right? Mahasiswa saatdays ini cenderung pasif? Hmmm, betulistidak Sejak kecil sudah ditanamkan pada anak-anak Indonesia tugas Indonesian kids have been continuously taught that thebahwa primary taskutama of a pelajar is itutoyastudy. belajar. Apakah di antara yang“Be nasehat student Is there anyada of you whoseteman-teman parents ever tell: criticalorangtuanya at school! berbunyi, “Yang kritis di sekolah ya, Nak. berikansystem masukan Always give constructive feedbacks onSelalu education to yang yourmembangun teachers, untuk guru, kepala sekolah, menteri pendidikan, kalau perlu presiden sekalian, headmaster, minister, and even better, the president!” tentang sistem belajar kalian di sekolah!”? If there are such parents, pelase tell them to join the HPEQ Project! They Kalau ada yang orangtuanya berpesan demikian, tolong ajak mereka should be registered the New7Wonders parents of that speciesmereka might beke bergabung di HPEQforProject ya! Jangan because lupa sebelumnya daftarkan even scarcer than komodos! New7Wonders karena orangtua jenis itu bisa jadi lebih langka daripada komodo.
“Education system-conscious mom! Vote for me!”
Pardon the sarcasm. But this is is the real deal. It is no longer a secret that critical thinking is not yet our home-grown culture. It is shown by teaching-learning process, from elementary school students to university ones. Now go ask yourselves. At a diri sendiri, yang kalau kuliahseats? memilih lecture, do siapa you prefer the back Do duduk di kursi belakang, kalau diberi you keep quiet when the professors tell you kesempatan bertanya diam, kalau diberi to ask a question? Do you also, keep quiet pertanyaan juga diam? Nah, hal-hal kecil when they youtidak to answer their seperti itulahtell yang menunjukkan questions? Right, if the answer is three keaktifan dalam kegiatan belajar mengajar. nods, those small things are a Tidak heran are jikatheperistiwa yangthat dialami Farrell, Fitri, Mischka juga banyak reflection of dan a passive behavior during dialami oleh mahasiswa lain di negara ini. teaching-learning processes. No wonder students of this country have problems like what Farrell, Fitri, and Mischka had.
“At the lecture. Sit at the back, ask nothing, answer nothing.”
7
Quality health professional education system is the root of quality health care system Quality product of an education process is born from appropriate education system. What is taught at school is what to apply in the field. Education system continuously changes and evolves over time. So does health professional education. Technology, disease patterns, community needs, and policy-making are some of the factors that give in a major impact in the change. This is the reason why an education systems can have expiry dates and cannot remain a lifetime standard. In short, whatever was best ten years ago might not be today. Policy making related to health professional education system is not an easy task, even for developed countries. Let alone in Indonesia, where every change in period of leadership is almost always followed by a change in teaching-learning methods. Government and institutions have tried so hard to create the best education system to produce the best health care providers. However, the component that has not yet been taken optimally is students' participation, which is actually one of key factors of needed to for successful education system. Research on the pattern of students' participation in education management system in Indonesia, which is done by team of students from HPEQ Project in 2011 showed that not all institutions involve their students in the process of planning, perencanaan, development, and accrediation. This is quite a pity because students as learners should be more encouraged to contribute in institutional policies. “Not every Lack of student participation should be institution addressed wisely by every one of us. This is time includes student for us to take more initiative to participate in the process of together in the planning of education that we live up to. planning,
development, and accreditation�
8
Students, where do we stand actually? “Every citizen is responsible for education sustainability� (Law No. 20 Year 2003 on National Education System Article 6) "People are entitled to participate in the planning, implementation, monitoring, and evaluation" (Law No. 20 Year 2003 on National Education System Article 8) Of the two articles above, it can be concluded that the students, who are part of the public, have both the responsibility and rights to participate in policymaking related to education system. Now, what would happen if towards every policy made, we can only keep silent and do not respond even though we find dissatisfaction in it? Where our responsibility towards education and the 'status of students' that we bear? We are college students, well-known for our critical thinking. It is time we jointly support the sustainability of the health education system by channeling our constructive aspirations. Dwiprahasto (2010) in Indonesian Health Professional Student Summit described that students must be active, active as a subject in determining the curriculum. Students need to change, from being reactive to being responsive. If you do not feel comfortable with the curriculum, then provide a solution. Students must also be the driving force, because changes can be made if there is a concern and a desire to change the curriculum in order to be accepted and implemented by all parties. Moreover, students can actually act as public pressure that internally understand the issues and take part in decision-making. Participation also means collusion, merging the strength of the parties that have the same interests. In this case, we should work together among health professions students towards integrated education system. Collusion that should be taken seriously are synergies between students' expectation and that of relevant stakeholders'. Students' Declaration: Time to take the role! Aren't we grateful that there are still many health professional students in Indonesia who have stronger critical ways of thinking and more willingness to act than Farrell, Fitri, and Mischka do?
9
This is the day when we made the history!
Inspired by the awareness of the importance of students' participation, at Indonesian Health Professional Student Summit, November 19th 2010, eight students organizations from seven health professions which are Center for Indonesian Medical Students' Activities (CIMSA), Ikatan Senat Mahasiswa Kedokteran Indonesia (ISMKI-medicine), Ikatan Lembaga Mahasiswa Ilmu Keperawatan Indonesia (ILMIKI-nursing), Persatuan Senat Mahasiswa Kedokteran Gigi Indonesia (PSMKGI-dentistry), Ikatan Mahasiswa Kebidanan Indonesia (IKAMABI-midwifery), Ikatan Senat Mahasiswa Farmasi Seluruh Indonesia (ISMAFARSI-pharmacy), Ikatan Senat Mahasiswa Kesehatan Masyarakat Indonesia (ISMKMI-public health), dan Ikatan Lembaga Mahasiswa Ilmu Gizi Indonesia (ILMAGI-nutrition science) formulate a declaration on the importance of their role as future leaders to get involved actively in policy-making related to education system in their home institution as well as the respective forms of cooperation which are well intertwine between one profession with another. Students Participation in Other Nations? Finland's success as a developed country in the world of education is inseparable from its student participation. Finland emphasizes the University as a scientific concept that emphasizes community partnership with its student rather than a rigid school. The position of students in the educational system is as “full participation�. Students from various universities in Finland developed its own system of feedback in his education. For example, the University of Oulu meet with its student annually to collect opinions & criticism of the students about learning system. Collected opinions then processed and continued discussion of problem-solving oriented along with the staff of educators. In addition, there are teams of developers that involve students (4-5 people) as the members, even there are some teams that are chaired by students. (ENQA workshop report, 2006)
10
“
“
If you want happiness for a lifetime - help the next generation. -Chinese proverbs
ALRIGHT, IF I WANT TO PARTICIPATE WHAT DO I DO?
C
ongratulations! If you have reached this chapter, you are one step ahead of Farrell. You are now aware of the importance of students' participation a policymaking process in education system. Now let's invite Fitri and Mischka to read this section so that they know what they are supposed to do: ADVOCACY.
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ADVOCACY? Err, sounds like a fancy word to me...
Wait, wait, don't close the book yet! It's okay if you're not familiar with that term (yet). It's okay, This is why the book was written!
According to the dictionary advocacy means “defense”. The more comprehensive meaning is the submission of opinions aimed at shaping public perceptions in order to achieve a change. In this context, advocacy can be interpreted as the right method for conveying aspirations to the stakeholders in the world of health professional education. Advocacy = the art of “let's sit together and talk it out”? “Study hard, graduate soon. Don't go down the roads creating riots!” Indonesian college students are notorious for their mass demonstration habit. Although mass demonstration is often perceived as sporadic and anarchistic act, a well-organized, civilized demonstration is actually a part of advocacy. However, in this section, we will further discuss about other forms of advocacy.
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A critical thinking, an open-mind, a broad vision, and a high committment Those are the basics needed to do a good advocacy. During their participation in policy making at least students will meet with: The institution people: such as a lecturers and the head of faculty or 1 university The government: such as Ministry of Health and Ministry of Education 2and Culture, or the professional councils In the world of education, they are our parents. Generally, compared to their on age and experience, students are inferiorly-positioned. Approach to the senior people are certainly different from his peers. Local customs and Eastern values did make us have to pay extra attention to attitude and manners, but it doesn't mean we have to blindly follow everything “our parents� want, without using our critical thinking. High commitment is needed because once we decide to start doing advocacy; it means less time for studying, resting, and leisuring. Advocacy sure takes a lot of your time! For many people, this is a sacrifice, and with such a busy college life, not all students are willing to do so. Therefore, when we decide to do this, make sure we have a strong commitment that each step is not executed halfheartedly. I have those basic principles. Now what? Start from ourselves. If we say we are ready do nothing but to wait for 1 others, we are never going anywhere.
2
Have a really good understanding of what actually happens. Misleading perception is catastrophic. Stakeholders would think we are just a bunch of premature know-it-alls who do not actually understand the situation. In the end, our advocacy would just go to waste.
As the initial steps, we can get ourselves involved in students' activities, for example, attending a forum, finding out about campus organizations and campus policies. To dig deeper into the problem, we can do simple research or preliminary surveys to add references.
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In search of information, we should be proactive because the policy makers are often less open in the socialization of some information to the students. Avoid making "people say..."-kind of arguments. Always use a legitimate source of information and can be trusted. Usually the source is written in black and white, such as the rule b o o k fo r s t u d e n t , o f f i c i a l curriculum guidelines, and the results of research that have been widely published
“When attempting to advocate the need of a teaching hospital for nursing students, ILMIKI (nursing student organization) conducted a survey at the institutional level. This turns out to be pocitively accepted and responded by the AIPNI (professional council).”
One of the materials on basic principles of higher education for health professionals you can learn in the e-book provided by HPEQ Project. E-book can be downloaded for free from the website HPEQ. Want to know the website domain? Keep reading... ;) BE A SOCIAL CREATURE! We should be with someone or the 3 mass who share the same vision with us. More importantly, we should maintain a good relationship with “our parents”. Nothing near advocacy success is created without great coordination and cooperatiom. Learn from the past. We should know how much advocacy 4 attempts towards an issue have made previously. Ask our seniors/alumni who had similar experiences, what are the hurdles, what are the tips and tricks. Do not make the same mistake twice. Set a target! We are heading to nowehere without sorting out aims 5 and indocators beforehand. Clear aims and indicators would help us how far we have made it and what else to fight for.
15
Determine and analyse targets and the stakeholders' profiles. Please 6 bear in mind that stakeholders and we are not always in the same page.
7
There are different visions and prespectives. Analyse their characters. Learn about how is our position in front of them, what to do to be accepted in their circle of power. Relationships among stakeholders ar important to understand too. They can be either supportive or gettin in your way. Planning is everything! Problem identification, target determination, resource analysis, strategies design, roles and responsibilities sharing Each plan should be carried out with the SWOT analysis (strength, weakness, opportunity, and threat). That way, we can establish some alternative strategies as well as anticipation for everything that might happen. One Good Example! The effort of midwifery students from Universitas Sebelas Maret (UNS) to have a decent library is a good practice of advocacy. Before spreading out their opinions, they made a cost-benefit anaylisisof the library was ever to be built? Morever, they shared possible advantages not only for students but also for the institution, such as improvement of accreditation score. In the end, the campus agreed to build a library and even distributed forms to ask students what books they needed the most.
Create clear messages. The messages do not have to be sophisticated. It 8 should communicate our vision clearly to others. Start from the general ideas to the specific ones. Underline every keypoint or give further explanation so it could give a better impact. One thing to remember: before formulating the advocacy ideas, be insightful. Do the messages really represent what we actually need?
Do enem n't create ies mess ! Send th e ende ages in a aring way!
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Good advocacy messages are not solely demanding but also solutionproviding. Showing possible advantages for stakeholders earns us extra points! Arrange the tactics before go to the battle. The strategies can be 9 designed based on what we have collated in the previous points. Furthermore, consider also the influence of the bureaucracy. Are our strategies to deal with the existing bureaucracy good and appropriate enough? Share the roles and responsibilities! Although Advocacy is strongly 10 related to communication, does not mean it will only work for those who have good public speaking skill. Translate the plans into job descriptions. Not everyone has to go on stage and do the talk. Behind the screen work such as strategy making, research, media/IT menagement, funding, even adminisitrative tasks including cashflow record and photocopy are parts of advocacy. Everyone can contribute according to his/her ability. Timing. Pay attention to time and situation. No matter how good your 11advocacy plan is, sometimes it would damage your victory if it is done in the wrong time. For instances, when stakeholders are at their busiest days, or there are more urgent issues to solve. Camera, light.., ACTION! In advocacy, never be afraid of making the first 12 step! We are only entitled to fear if our strategies are not well-planned. Follow up! This is very typical. Lack of evaluation and follow-up is 13 advocacy's story of life. Often people stop fighting especially after everything has failed. Opinion channeling is no longer done. While in fact, a failure should be evaluated together to create nextfurther actions. Sometimes it is not a failure, but the process is not completed yet. Good advocacy is done gradually. It's almost impossible to expect an instant result.
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a sustainable advocacy. Do not let every effort go to waste. 14 DoEstablish not make we cannot stay in campus forever, don't we want to graduate? Make sure our advocacy is not limited to certain people and period. Alumni can still contribute. Moreover if they work somewhere close to stakeholders. Even better if there are alumni associations that are able to contribute in providing support especially for their juniors in developing professional education in the institution. Work hard pray hard! (And don't be sad when things don't work out). 15 Nobody says advocacy is easy. We should be proud for having tried. Becoming education system-conscious is an amazing achievement. Nah sebagai contoh, inilah yang seharusnya dilakukan Farrell semasa koass! Seandainya Farrell sudah menyadari hal ini selagi dia masih di bangku kuliah, barangkali keadaannya akan berbeda. Mungkin dulu dia bisa:
Be more proactive. Guide book for medical competencies are already 1 provided by Indonesian Medical Council. Surprisingly, not every student knew it ever existed. Many of them realize that eight before of even after they sit for national competency board. Farrell should have known this so he could prioritize what he should learn better during his clinical years. Talk to academic advisors. Good, communicative, and caring teachers are an 2 important channel toadvocacy. They can help conveying students' aspiration to stakeholders.
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Get feedbacks from his colleagues about problems concerning teaching3 learning method. Make a mini survey on the efficacy of night shift duty. He can coordinate with student councils or representatives. So when he has to talk to stakehoders, he can present an objective data. Formulating problems and offering solutions. Example of problem: many 4 students feel that 24-hr night shift duty is not effective. It makes them exhausted and sleepy the following day and cannot study well. Moreover, sometimes the skills are not worth the pain. Like vital signs and urine output monitoring. Example of solution: adjusting the schedule. Probably more frequent but shorter period. So nobody has to sacrifice his/her biologic clock. Maintain a good relationship with teachers. Students who talk a lot but show 5 poor academic records are not going to win faculty's heart. Farrell has the potential as a good student, he just needs to make the best out of it.
Because Farrell cannot turn back time, what he can do now is:
1 2
19
Maintain a good relationship with his juniors. As an alumnus, Farrell must have known better than them. So he can act as an advisor if their juniors want to start advocating. Write a letter or help students to talk to the faculty. One of the causes of students' hesitations about talking to “parents� is a concern of possible conflicts with institutions that might later affect their college life, including grades or other academic matters. For alumni like Farrell, that is not a burden because they do not have such dependency. They have more freedom to convey their aspiration.
A NOT-TO-DO LIST: Public provocation with anger and emotional drive. This is not a win-win solution and can backfire your plans.
1 2 3 4
Complaining in social media. Watch your words on Twitter, Facebook, blogs, and perhaps newspaper. If possible, solve the problem internally before going public.
Blackmailing. It is immature and coward. Anonimity is not leading anywhere, because it is difficult to make follow-ups and the responsibility is questioned.
Making up false data to support our ideas. Spreading rumors based on assumptions and subjective opinions of certain group of people.
Using harsh word in arguments. Maybe in western countries, freedom of speech allows young people to have discussion with older people without having to go through awakward moments. In Indonesia, it is slightly different. Always adjust ourselves when talking to seniors. Use polite and dignified words and keep our emotion stable.
5 6 7
Putting professional ego over public's priorities. Sometimes it's difficult to synchronize opinions between students. Different perspectives and professional backgrounds lead to various judgments. And it's okay! If it's not possible to achieve an agreement, it's important that we respect other people opinions. Violence and abuse behaviours. It is pointless to create riots, burn down the buildings, or use voodoos or black magic.
“Witch, please put this snake inside my dean’s tummy. He never listens to students!”
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“
“Each finger has different shape and size. But they work together and complete each other.”
-Arsitawati P. Rahardjo
“
“
The health care we want to provide for the people we serve—safe, high-quality, accessible, personcentered—must be a team effort. No single health profession can achieve this goal alone. These new competencies will build a path to a collaborative health care workforce and the improved care that we all desire.”
“
-Carol A. Aschenbrener, M.D. Executive Vice President Association of American Medical Colleges
INTERPROFESSIONAL EDUCATION (IPE): YOU + ME = US! TOGETHER FOR THE BETTER!
“I
have once received a wrong therapy because of a m i s co m m u n i cat i o n b et we e n doctors, nurses, and its pharmacist.” - Mrs. Mercedes (not a real name), 30, patient. “Lots of people don't know what's the difference between dietitian and nutritionist, including some of my colleagues from another health professions.” - Mr. Boy (not a real name either), 23, a 3rd year student in nutrition sciences.
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Does what Mrs. Mercedes said above sound familiar to you? Or have you ever heard a story about a surgeon who amputated the wrong leg? Such cases are the examples of iatrogenic error, which often happens due to the lack of coordination between health workers rather than lack of clinical ability. What Mr. Boy was tying to say is, many health workers are unaware of their colleagues from another profession. To be honest with ourselves, sometimes we as health professional students do not realize who are working with us at the hospital, what their tasks are, and how we should work with them. Each health profession has specific roles and responsibilities. That is why, collaboration among health professions is very important.
1
What is Interprofessional education (IPE)? Interprofessional education is the application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, organisational, and interorganisational relations and processes of professionalisation”. -Hugh Barr, United Kingdom Center for the Advancement of Interpersonal Education (CAIPE).
3
“Interprofessional education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care”. -CAIPE, 2002 Based on those two definitions, we can conclude that IPE occurs when the students from various health professions discuss the concept of health care and how they can improve the quality of care for the sake of the community. Specifically, IPE can be utilized to address the health issues as well as specific cases in the community to find applicable solutions through discussions.
2 Why does the world need IPE? WHO Framework of Action on Interprofessional Education and Collaborative Practice stated that fragmented health systems have caused many countries
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to fail in their efforts to fulfill their health needs. Health problems are in fact related to many aspects of life, and these problems can not be solved by depending solely on a uniprofesional approach. Contributions from various study disciplines are needed to make a positive impact in eliminating health problems..
3
How could IPE make benefits to the development of medical practice? “Building a regional network to support interprofessional collaboration not only ensured there was no competition for let between projects, it also made it possible for all interprofessional projects to share best practices, challenges and opportunities.� -Regional Health Leader (WHO, 2010). In the world of health professional education, IPE will help prepare students to be able to get involved and contribute positively in the active collaborative practice when they work as health workers in the future.
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IPE plays an important role as a bridge to the implementation of collaborative practice. Through IPE, students are trained on how to take part in a team, how they could make their contributions, respect others' arguments, give opinions, not only to colleagues from the same profession but also with students of other professions. The WHO Framework of Action on Interprofessional Education and Collaborative Practice shows research results from 42 countries about the impact of collaborative practice to health. The results of the researches turn out to be very promising. According to the researches, collaborative practice may improve: Access to of health care Use of specific clinical resources Clinical outcome of chronic disease patients Service and safety of patients In addition, the collaborative practice may decrease: Number of complications Length of stay/hospitalization Tension and conflict between service providers (caregivers) Staff turnover Hospital costs Number of clinical errors Mortality
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This is Cool! University of Western Ontario was one of the institutions that are aware of the role of IPE in developing health professional education. This can be seen from the website of the Office of Interprofessiobal Education and Research (http://www.ipe.uwo.ca/). There, we can find health professional students doing simulation to solve medical cases. Similar activities are also carried out by the University of Toronto, the University of Minnesota, and some other institutions.
4
How should the concept of IPE be developed in Indonesia? As in rest of the world, IPE has also been recognized in Indonesia. More and more people and institutions now realized that IPE is a promising new model of learning, especially for health professionals. However, many aspects in Indonesian health professional education system are still fragmented, while application of IPE demands an integrated system. Therefore, to put IPE into the standard of health professional education which applies nationally, there should be new policies related to the health system. This will be a challenge for all stakeholders involved, namely policy makers and the students themselves. According to the WHO, the application of IPE in a country can be done via two mechanisms, namely the educator mechanism and curricula mechanism. In educator mechanisms, we need:
a.·Supportive institutional policies b.·Good communication between the participants c. ·Enthusiasm to run IPE d.·Shared vision and understanding about the benefits of introducing a new curriculum e.·Person in charge as the coordinator of educational activities who can identify barriers or obstacles in implementing IPE
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Harmony among students of health professions can be seen from the HPEQ project activities! CIMSA President, General Secretary of PMSKGI, General Secretary of ISMKI, General Secretary of IKAMABI, General Secretary of ILMIKI, General Secretary of ISFARMASI, General Secretary of ISMKMI, the representative of AMSA, and 11 representatives of those student organizations, discuss issues of their education in a forum named HPEQ Student.
Meanwhile, in the curriculum mechanism, we need: learning principles such as problem-based learning or action learning sets Learning methods which can reflect real practice A good interaction between students
a.Suitable b. c.
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How can students get involved in IPE? Student is an important element in the IPE as well as a moving factor to start collaborative practice in a country. Therefore, students must first understand the concept and benefits of IPE so that students are motivated to embody IPE in their learning proces. In general, IPE contains some of the following elements, which are important for its implementation.
1. Colaboration 2. Respectful communication
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3. Reflection 4. Implementation of knowledge and skills 5. Experience in interprofessional team This concept should be implanted on the students' mind since the beginning of education. to be able to introduce IPE as possible in health professional education system in Indonesia. And when students understand the required elements for the implementation of IPE they would be able to equip themselves with the elements. The abilities can be obtained through various means, such as taking part in student organization activities, learning good communication techniques, and maximizing their professional skills.
A long journey starts with a small step: Example of IPE implementation in Indonesia It's been 2 years since health study programs in the UMM (Universitas Muhammadiyah Malang) first implemented a system of integrated courses between medical, pharmaceutical, and nursing students with the aim to improve team coperation, both in clinical and non-clinical settings. The method applied was a case study in small group discussions, which would be reviewed based on the specialties of each profession.
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“
Education is a slow-moving but powerful force. -William Fulbright
PARTICIPATION, COLLABORATION, HEALTH EDUCATION SYSTEM, HPEQ WAIT, WHAT IS HPEQ?
“Y
ou've been mentioning HPEQ Project throughout this book. But actually, I'm not too familiar with that thing...” Someone, 20 years old, purely fictional
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Health Professional Education Quality (HPEQ) Project is a program of Directorate General of Higher Education of the Ministry of Education and Culture of the Republic of Indonesia which aims to improve the quality of health care in Indonesia by improving the quality of health institutions and their students, which would later become the strategic health care providers. The HPEQ Project was established at the end of 2009 and it will end in December 2014. In improving the quality of health professional education, the HPEQ Project involved a variety of stakeholders. They are the Government as policy makers, educational institutions as producers of health workers, as well as students as the user of education system. To achieve the goal, the HPEQ Project works through its 3 components: Component 1: Strengthening Policies and Procedures for School Accreditation, Component 2: Certification of Graduates Using a National Competency-based Examination, and Component 3: Results-based Financial Assistance Package (FAP) for Medical Schools.
Masalah : tuntutan masyarakat akan tingginya kebutuhan pelayanan kesehatan
Problem: the high demand of health service from the society
Component 1: Accreditation to create standardized quality of educational institutions Component 2: National Competencybased examination to produce certified graduates from medical schools
Solution: New education institutions establishments (especially from private sectors) Problem: health education institutions quality assurance Result: Increase number of health workers Problem: The graduates quality assurance
Expected outcome: Sufficient amount of qualified health workers
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Component 3: Financial Assistance Package for improving medical schools
Programs and activities run by the three components are aligned to the national program mandated by the Ministry of Education and Culture; that is to reduce disparity in quality of educational institutions and their graduates, through improvement of the accreditation system, competency exam and certification systems, as well as partnerships and coaching from well-established institutions to new growing institutions. And because the HPEQ Project has also given space for students' participation, this is the right time to prove how the students as the agent of change can contribute to make sustainable improvement! Hmmm... Then what is HPEQ Student? To support the success of the three components above, the HPEQ Project facilitates students to be involved actively in the policy making of education system. Because there are so many activities in the project, to make it easier to recognize, students' programs that are facilitated by HPEQ often referred to as HPEQ Student programs. Student activities in HPEQ Project begins with the Indonesian Health Professional Student Summit: Students' Role in Health Professional Education held on 19 November 2010 at the Faculty of Medicine University of Indonesia. At that summit, health professional student organizations made a declaration which expressed students' commitment to take part actively in health professional education improvement, as well as commitment to support the sustainability of interprofessional collaboration. Right now, student representative from 7 health professions joined the HPEQ project to work together on the follow-up of the declaration. Some of the activities already carried out are, research on health professional students' participation in the governance of health professional education in Indonesia, and survey and focused group discussion (FGD) to assess the readiness of teachers and students forIPE. This activity involved nearly 50 teachers and 200 students from various universities. Previously, more than 6000 students have filled the questionnaire related to the same study. This set of activities was a successful first step to realize the concept of participation and collaboration in the improvement of health professional education system in Indonesia.
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Now the question is, to be able to participate in the activities of the HPEQ Project, is there any special procedure? Do I have to be the representative of student organizations first? Do I have to pay the registration fee? Is there any member-get-member system? Or do I have to send an SMS like REG <space> JOIN?
Of course not! HPEQ Project is not a multi level marketing business. HPEQ Project is neither an exclusive group who works only with certain students. â&#x20AC;&#x153;Where should I look for information about HPEQ?â&#x20AC;? To know more about HPEQ Project and HPEQ Student, you guys can ask your student organization representatives or education coordinators in your campus.
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Another way? Just Google it or go to the next page and read this book until the end ;)
To find out more about HPEQ, you can go to www.hpeq.dikti.go.id & www.worldbank.org/indonesia
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“
Small things make perfection, but perfection is no small thing.
-Sir Frederick Henry Royce, pioneering car manufacturer of the Rolls-Royce company.
“
Optimism is the faith that leads to achievement, nothing can be done without hope and confidence. -Helen Keller
“
“
N
ow that we have reached this chapter, perhaps we think, â&#x20AC;&#x153;Although seems simple, turns out doing participation and collaboration is not as easy as we thought...â&#x20AC;?
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That is correct! This is a very long, long road and the results will not come instantly. However, don't let these facts bring us down.
So this is what we can do within the next 30 minutes! 1 Start writing. It does not have to be a long, serious essay. But it is a good way to keep our ideas in a piece of paper, or a draft in your e-mail. Whenever we have time, we can develop those ideas. Remember, unheard ideas are plain wastefulness. Nowadays, there are easy access to social media and places to share. Writing is a good way of aspiration conveying. 2 Yo u h a v e y o u r i d e a s w r i t t e n a l r e a d y ? S e n d t h e m a w a y t o contact@hpeqstudent.org ! 3 Follow us @hpeqstudent on twitter and get yourself updated with the latest issue on Indonesian health education! 4 Not a twitter user? Visit HPEQ website at http://hpeq.dikti.go.id! Provide us your input and feel free to join the discussions! 5 Take a visit to websites that are written in this book. Broaden our knowledge on education system! 6 Spread this information! The more students who are aware of the concept of collaboration, participation, and HPEQ Project, we are getting closer to reaching our goals! â&#x20AC;&#x153;That's it? Will my actions ever give a positive impact? I don't feel like I have contributed enough to the health professional education system in our beloved country...â&#x20AC;? If human beings never have faith in themselves, we should have gone extinct million years ago, just like the dinosaurs. Put aside all the negativity. As the young generation, we still have a lot to do. No matter how hard it is to fight for our idealism, we should believe that every genuine effort we give in, no matter how small, is going to make a positive change in the future. So don't give up, let's work it out together!
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â&#x20AC;&#x153;
One generation plants the trees, and another gets the shade -Chinese proverbs
â&#x20AC;&#x153;
Y
ay! This is the kind of response that we are waiting for! The book you are holding now is made to build critical thinking and awareness of health professional students towards their education
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With all the limitation of time, energy, and resources, this book surely has flaws here and there. That is why the book is designed with a unique concept of â&#x20AC;&#x153;growing the seedâ&#x20AC;?, meaning that it is prepared to keep improving as a guide for students to enchance the quality of their education system. We hope this book is getting a lot of improvement from the readers within the upcoming years, and continues to give something positive even when HPEQ Project has ended. Therefore, we are very happy if any of you could be inspired and encouraged to make this book better. So don't hesitate to contact us, send your ideas, and make some changes!
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list of abbreviations
ACKNOWLEDGEMENT We, the team of writers: 1. Lhuri D. Rahmartani (medical doctor, Universitas Indonesia) 2. Samuel Josafat Olam (medical doctor, Universitas Indonesia) 3. Puspita Hapsari (medical student, Universitas Indonesia) 4. Yosephine D. Hendrawati (pharmacy student Universitas Sanata Djarma) 5. Gentur Adiprabawa (nutrition student, Universitas Gajah Mada) 6. Vera Rakhmawati (nursing student, Universitas Indonesia) 7. Rufita Ismu Astania (medical student, Universitas Gajah Mada)
Would like to thank: 1. Illah Sailah (Project Manager) 2. Arsitawati P Raharjo (Executive Secretary) 3. Aprilia Ekawati Utami (Research and Development Team) 4. HPEQ Student team 5. Representatives of health professional: CIMSA, ISMKI, ILMIKI, PSMKGI, IKAMABI, ISMAFARSI, ISMKMI, dan ILMAGI 6. Everyone who has contributed to the development of this book
REFERENCES