K O N S EP P EN D ID IK A N

K ED O K TER A N D A LA M
M EN G H A D A P I U N IV ER S A L
C O V ER A G E

Ova
Emilia

Konteks

Pendidi
kan

Fee for service for the rich

Marks and Spencer style managed care
for the middle classes
Safety net service for
the poor

K unci m asa depan :Kurangi

fragm entasidan integrasikom prehensif
Present State:
Fragmented Care

Future State:
Patient Centric Care

Pola layanan
RS
tersier
RS
sekund
er
Pel.
Primer
Dokter,
perawat,
bidan...

Pel.
Primer

RS
sekund
er
Pel.
primer

Pel.
primer

Bagaimana
Konsep
Pendidikan
Masa depan??

Problem sistem ik
Kompetensi tidak sesuai dengan
kebutuhan pasien dan populasi

Kerjasama tim buruk

Orientasi dominan pada RS

bukan pada pelayanan primer
Perilaku profesional menjadi
langka
Kepemimpinan lemah untuk
memperbaiki sistem kesehatan

Professional education has not kept pace

with these challenges,
largely because of fragmented, outdated,
static curricula, and improper learning
environment
that produce ill-equipped graduates.

Pengelolaan Masalah Kesehatan

Keterampilan Klinis

Landasan Ilmiah Ilmu Kedokteran

Pengelolaan Informasi

KOMPETENSI

KOMUNIKASI EFEKTIF

MAWAS DIRI DAN PENGEMBANGAN DIRI

PROFESIONALITAS YANG LUHUR

Wahana
Pendidika
n

Kompeten
si

Pembimbi
ng
an

Perub
ahan

Peserta
Pendidika
n

Wahana
Pendidika
n

Kompeten
si

Pembimbi
ng
an

Perub
ahan

Peserta
Pendidika
n

In the W orld H ealth Report2006:w orking together

for health.W H O recom m ends im m ediate action to
revitalize education strategies
Chronic disease (largest cause of death, cause

high expense, reflect health system failure)

Logic, therefore, suggests that the primary
emphasis of chronic disease management should
be centred on community health care (multiprof.
approach)
Have we prepared?
(Look the fact! Our hospital oriented education

which predominantly push specialty care and

finally push students to see specialty as the only
good choice)

Kom petensi
Pelayanan kesehatan
primer
Penyakit kronik
Bekerja dalam tim dan
sistem
Profesionalisme
Agen perubahan
(leadership)

 Old world:

Source of
knowledge is
expert opinion

New world:

Source of
knowledge is
systematic
review of
evidence

 Old world:

Clinical skills
are seen as
semi-mystical

New world:

Clinical skills
can be audited
and managed

 Old world:

Most of what
doctors need to
know is in their
heads

New world:

Doctors must
use
information
tools
constantly

 Old world:

The doctor is
smartest

New world:

Often the
patient is
smarter

Pelayanan kesehatan prim er

Konteks dalam pola

penyakit
Konteks dalam hirarki
pelayanan
Kedokteran Keluarga
Aspek promosi, prevensi,
kurasi, rehabilitasi

Penyakit kronik
Tren penyakit kronik di Indonesia
Kompetensi dalam hal

promosi,
prevensi,
kurasi,
rehabilitasi

Bekerja dalam tim dan sistem

Tidak bekerja sendiri
Keterampilan bekerja dalam

tim
Interdependece in education
(IPE)
Pemahaman tentang sistem
pelayanan kesehatan

Interdependence in Education
Interdependence is a key element in a

systems approach
Involves three fundamental shifts:
from isolated to harmonised education and health

systems;
from stand alone institutions to networks, alliances,

and consortia;
from inward-looking institutional preoccupations to

harnessing global flows of educational content,

teaching resources, and innovations

Profesionalism e
Todays culture of medicine is
hostile to altruism, compassion,
integrity, fidelity, and selfeffacement
Coulehan

Pem bim bing

Menjadi role model
Menghargai mahasiswa
Menciptakan suasana
nyaman
Menyediakan waktu
Bermotivasi
Memfasilitasi belajar

Peserta didik
Mahasiswa sebagai
partner
Belajar dari role
model staf
Bekerja dalam tim
Bekerja dalam
sistem dan
standard

Agen perubahan??
Doctors arent scientists
(How many of you are scientists?)
People are not machines: they are

complex adaptive systems

So are the families of the patients
and their social groups
So is the system within which
doctors work

Skills needed by doctors

Technical skills--mainly taught in

medical skills
Adaptive skills--tools and mindset

needed to facilitate adaptive

processes in systems--mostly not
taught

P roblem s faced by doctors

Problem and solution clear--for

example, an uncomplicated fracture

Problem clear but solution unclear--for
example, diabetes
Problem and solution unclear (very
common in medicine)

(Vote on which are the most

common)

 My medical education began three

times. What I learnt at medical

school was no use in the hospital.
What I learnt in the hospital was no
use in general practice.
Julian Tudor Hart (paraphrased)

R esult
Doctors are trying to solve unclear

problems with unclear solutions with

technical skills
Often/usually they fail
Leads to paternalism, grandiosity,
pseudoempathy, inappropriate
treatment
And burnout in doctors and
organisational problems in hospitals

Pertanyaannya
Would you prefer that a medical

student knew all about clinical

governance or hypertension in
pregnancy?

If you arent confused you

dont know whats going on.
Jack Welch, former CEO General
Electric

A ny country has
the quality of m edical
education its governm ent
deserves!