Although ethics is an essential part of medical education, little attention has been paid to ethics education during the clerkship phase, where medical students observe how physicians make decisions regarding various ethical problems. Specific nuances and cultural contexts such as working in a rural setting can determine ethical issues raised. This phenomenology study aimed to explore ethical issues experienced by Indonesian students during clinical clerkship in a rural setting. In-depth interviews were used to explore students’ experiences. Participants were ten students, selected on gender and clerkship year variations. Data saturation was reached after eight interviews, followed by two additional interviews. Thematic analysis was used in this study, and trustworthiness was ensured through data and investigator triangulation, member checking, and audit trail. Three main themes found in this study were limited facilities and resources, healthcare financing and consent issues, as well as unprofessional behavior of healthcare providers. Many ethical issues related to substandard care were associated to limited resources and complexities within the healthcare system in the rural setting. Early exposure to recurrent ethical problems in healthcare can help students prepare for their future career as a physician in a rural setting.
Background Previous studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves. Methods This study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples. Results Four teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient’s rights and autonomy, and sexual harassment. Regarding teachers’ responses in general, we found three main themes: (1) being assertive, (2) being careful, (3) barriers and facilitators. Most teachers were convinced of the need to take action despite numerous barriers, which they identified, leading to doubts and concerns in taking action. Our study shows that formal education in ethics might not necessarily influence how teachers respond to alarming cases, and that their responses are mainly influenced by how they perceive their role and responsibility as teachers. Conclusions Our study suggests that teachers should carefully consider the risks and consequences before taking action upon alarming cases to prevent further harm, and that support from higher authorities might be crucial, especially in the Indonesian context. Our study also shows that taking action as a group might be appropriate in certain cases, while personal approaches might be more appropriate in other cases. Most importantly, school leaders and administrators should develop effective organisational culture and support students and teachers for their ethical responsibility commitment.
SCL (student centered learning) merupakan strategi pembelajaran yang menempatkan peserta didik sebagai subyek yang aktif, mandiri dan bertanggung jawab sepenuhnya dalam proses belajarnya. Peserta didik beserta proses belajarnya menjadi tokoh utama dalam proses pembelajaran. Semakin kompleksnya materi belajar dan tantangan kebutuhan jaman yang dinamis menuntut adanya kemampuan belajar yang mandiri. Oleh karena itu, kesiapan mahasiswa untuk belajar atas keinginan sendiri (self directed learning readiness) merupakan salah satu komponen penting dalam menentukan keberhasilan belajar. Penelitian ini bertujuan untuk mengeksplorasi karakteristik kesiapan belajar mandiri mahasiswa Kedokteran Umum. Desain penelitian ini ialah mixed methods secara analitik observasional dengan pendekatan cross sectional dan pendekatan fenomenologi untuk mendalami hasil penelitian kuantitatif. Metode pengumpulan data yang digunakan yaitu pengisian kuesioner Self Directed Learning Readiness Scale dan wawancara semi terstruktur. . Mahasiswa angkatan 2019 menunjukkan skor kesiapan belajar mandiri kategori sedang sebanyak 9.1%, tinggi 57.3%, dan sangat tinggi 33.6%. Mahasiswa angkatan 2016 menunjukkan skor kesiapan belajar mandiri kategori sedang sebanyak 17.8%, tinggi 50.5%, dan sangat tinggi 31.7%. Sedangkan mahasiswa profesi angkatan 2014 menunjukkan skor kesiapan belajar mandiri kategori rendah sebanyak 2.3%, sedang 4.5%, tinggi 56.8%, dan sangat tinggi 36.4%. Proses identifikasi kebutuhan belajar sudah baik, namun konsistensi, manajemen waktu, pengendalian diri, wawasan kinerja, dan ulasan masih perlu ditingkatkan
Introduction: In March 2020, the World Health Organization (WHO) proclaimed coronavirus disease 2019 (COVID-19) a global pandemic. Indonesia is one of the nations that is still dealing with the COVID-19 outbreak. COVID-19 has several complications, including lung abscess in extremely rare cases. We presented the first reported COVID-19 patient in Indonesia with a delayed lung abscess. Case: A 30-year-old man presented to the hospital with breathlessness and tested positive for COVID-19. Chest X-ray revealed typical COVID-19 pneumonia. He was discharged after 16 days of hospitalization and was educated on using oxygen at home lest the breathlessness recurred. We planned to evaluate the patient’s chest X-ray after 2 weeks of being discharged. The follow-up chest X-ray revealed an air-fluid level in the upper lobe of the right lung, indicating a lung abscess. The patient was treated with antibiotics for 2–3 weeks. Clinical follow-up 4 weeks after the treatment revealed no symptoms, and chest X-ray showed significant improvement. Conclusion: Lung abscess is one of the rare complications of COVID-19. It is a pulmonary infection that creates an air-fluid level by forming a cavity in the lung parenchyma. Notably, this complication manifested 2 weeks after the patient was discharged. COVID-19 can have several unexpected complications, including lung abscess. It is crucial to monitor patients after being discharged for such complications, especially if they are symptomatic.
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