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170605 Titi Savitri
Quality Improvementat Gadjah Mada University School of Medicine
Curriculum Team
Gadjah Mada University School of Medicine
17 June 2005
170605 Titi Savitri
Faculty of Medicine GMU
Implementation of PBL at GMU School of Medicine
1985-1992 : Community Oriented Medical Education Programme – 13 Credits from year 1-year 6
1992-2002:
- Hybrid PBL (20% of total Credits)
- 8 PBL Symptom-based Modules for 8 Semester (pain, icterus, fever, shock, etc)
QUE Project (1998-2003)Evaluation Results
Internal Evaluation by Ad Hoc Teams:- Tutorial discussions need to be improved
- Students rely on lectures External Evaluation by Dr. Roger Barton
from New Castle University UK:- Incomplete integration
- Overburdened academic staffs - Need a QA system
Follow up Implementation of FULL INTEGRATED
CURRICULUM using BLOCK System starting in 2002/2003
Using KIPDI II as the main reference to determine contents and instructional objectives
Educational Strategy: Problem-Based Learning and
Lecture-Based (60-70% of total hours)
6
Internship
E2 GP
5
Internal Medicine
Pediatric
Obgyn
Surgery
P.H
Elective
Local Exam.
E1 MD/BSc Rotation Exam.
4
Res. Method Biostat
Int. Health Manag,
New.Em.Dis
Emergency & Trauma
Electives and Research Activity
MF
DV
Rad.
Anes.
Ent.
Opt.
Ne
Psy
4 Blocks + Rotation
Research Seminar Patient – doctor Com. 3
3
Hemato Bleeding Lymph tissue
Nephro Urology
& Body fluid
Endocrine & Metabol
Reproduct Health
& Diseases
Neuro Behavior
Psychiatry
Sense organ &
Integument
6 Blocks
Patient – doctor Com. 2
2
Life – Cycle & Elderly-Geriatrics
Immuno. Inflam. Infection Trop.
Med.
Degener Regener
& Neoplasm
Locomotion
& Musculo Skelet
Digestion (Gastro)
& Absorb. (Nutrition)
CVS &
Lungs
6 Blocks
Patient – doctor Com. 1
1
Learn. Comp. & IT
Premed
Sci
Biomed
I
Biomed
II
P.H. Com. Med.
Entrepr.
Bioethics &
Humanities
6 Blocks
Fig.Gadjah Mada Curriculum in Basic Medical Education, Institutional Programme 2002, ( 5 years)
PBL Curiculum – Block/Integrated‘02/’03
knowledge
skill
YEAR
INTERNSHIP
MD/Bsc. Med
MD/GP
licenced
Skills Lab Curriculum1992-now
Block 1 : Interpersonal Communication, MicroscopeBlock 2 : Basic Physical Diagnostic, AnthropometriBlock 3 : Vital sign, bandageBlock 4 : Lumbar Function, Aseptic TechniqueBlock 5 : Health survey, Health PromotionBlock 6 : Intravenous injection, ResuscitationBlock 7 : Denver Test, Neonatal Resuscitation Block 8 : Anamnesis, Blood SmearBlock 9 : ENT Examination, HeteroanamnesisBlock 10: Neurology examination, orthopedic examination
Skills Lab Curriculum1992-now
Block 11 : Abdominal examination, counseling Block 12 : Thorax examination, electrocardiography Block 13 : Simulated patient (anamnesis, vital sign, thorax,
abdomen,blood pressure) Block 14 : Pediatrics physical exam, minor surgery Block 15 : Physiotherapy, Ascites and Cathether Block 16 : Complete physical examination, IUD insertion Block 17 : Gynaecology exam, baby delivery Block 18 : Diagnosis, Mental statement Block 19 : Eye examination, communication on sensitive case Block 20 : Simulated patient, MEQ 3-Clinical Reasoning Block 21 : CPR (ET), simulated patient (Cs 4-6) Block 22 : Paediatric life support, message and mission
Follow Up: QA System in Place
Dean
Vice Dean for Academic Affairs
Education Committee:Curr, Ass, Tutorial,Manual Procedure
Year CoordinatorsI-IV
Block TeamsI-XXII
CoordinatorFor Clinical Rotation
Clinical Coordinator11 Depts
CoordK3M
AcademicAudit Team
Principles of QA
Self-Evaluation by Vice Dean for Academic Affairs, Year Coordination Teams, and Block Teams
Independent Internal Evaluation by Academic Audit Team
External Evaluation by International Experts Improvement based on evaluation by Vice Dean
for Academic Affairs, Year Coordination Team, and Block Teams
Evaluation of Curriculum 2002
Internal Evaluation: Major problems in assessment, lectures (60-70%),
tutorial discussions, PBL management, learning resources, clinical teaching, skills lab curriculum unmatched with block themes, contents of blocks determined by departments
Caused by
Incomprehensive Planning
Evaluation of Curriculum 2002 External Evaluation by Prof Arie Kruseman and Prof
Albert Scherpbier from Maastricht Medical School (Feb 2004):
Hybrid curriculum of lecture-based, subject-based and problem-based learning
Organisation rather traditional and naturalistic and not in line with educational philosophy of student-centred (SCL) and problem-based learning (PBL)
Responsibilities of staff in strategic and operational tasks unclear
Learning objectives in curriculum outline and block books to detailed and directive
Evaluation of Curriculum 2002
External Evaluation by Prof Arie Kruseman and Prof Albert Scherpbier from Maastricht Medical School (Feb 2004):
Student evaluation focus on lectures, lecture notes and structured learning objectives mentioned in the block books
Skills lab is not an official unit with staff Majority of staff not trained in concepts and objectives of SCL and PBL.
Majority of students are also not aware of these objectives and educational power of tutorials
Programme too overloaded with (introductory) lectures, not enough time in programme for self-study
Majority of textbooks in library outdated[1] Not enough computer facilities, no free access to internet [1]
May 2004- Follow up the Evaluation
Decision for Minor Revisions -continuous: assesment, tutorial discussions, learning resources, quality of blocks, clinical teaching
Decision for Major Revisions 2005-2006:
Change the curriculum into Competency-based Curriculum
- SK Mendiknas 045/U/2002
Follow up April 2004: 4 Tim Management PBL to
Maastricht June 2004: 18 Block Coordinators and 4 Block
Coordinators sent to Maastricht (new curriculum was first designed)
October 2004: 16 Clinical Instructors sent to Maastricht
July, August, Sept: Dr Pie Bartholomeus to GMU School of Medicine – Skills Lab
Oct 2004: Dr Willem de Graff to GMU SM- tutorial discussion
Follow up Feb 2005: Prof Albert to GMU SM- PBL
Management Maret 2005: Dr. Pie Bartholomeus and Dr. Jaan
Van Dallen to GMU SM – Skills Lab May 2005: Assessment and Program Evaluation
Team To Maastricht July 2005: Dr. Erik (ass expert), Dr.Ameike
Jansen (program evaluation expert) dan Dr. Marieke (skills lab) to GMU SM
June 2005-July 2006
To focus on improvement in assessment system : Task Force on Block Exam Task Force on Progress Test Task Force on OSCE Task Force on Portfolio Task Force on Clinical Rotation and
Comprehensive Exam
Current practice in GMU SMEnd of block written test
It is not easy to develop questions related to discussed topicNo time to develop the questions
Low quality of questions
Bloom’s Taxonomy (n/%)
No Source Code Number of
Question C1 C2 C3 C4 C5 C6 1 Regular, Block 4 Session 1 7 April 2004 75 60
(80%) 15 (20%)
2 Regular, Block 4 Session 2 10 April 2004
75 55 (73,33%)
20 (26,67%)
3 Regular, Block 8 Session 1 14 Des 2004 75 57 (76%)
18 (24%)
- - - -
4 Regular, Block 8 Session 2 17 Des 2004 75 62 (82,67%)
13 (17,33)
- - - -
5 International, Block 4 Session 1
10 March 2004 75 56 (74,67%)
19 (25,33%)
- - - -
6 International, Block 4 Session 2
12 March 2004 75 62 (82,67%)
13 (17,33)
- - - -
7 International, Block 8 Session 1
30814 75 73 (97,33)
2 (2,67)
- - - -
8 International, Block 8 Session 2
30824 75 61 (81,3%)
13 (17,3%)
1 (1,3%)
- - -
9 International, Block 15 Session 1
51515 75 35 (46,67%)
36 (48%)
4 (5,33%)
- - -
10 International, Block 15 Session 2
51525 75 22 (29,33)
47 (62,67%)
3 (4%)
3 (4%)
- -
Current practice in GMU SMEnd of block written test
It is not easy to develop questions related to discussed topicNo time to develop the questions
Low quality of questions
Recall / Application
No
Source Code Number of
Question R A 1 Regular, Block 4 Session 1 7 April 2004 75
2 Regular, Block 4 Session 2 10 April 2004
75
3 Regular, Block 8 Session 1 14 Des 2004 75 75 (100%)
-
4 Regular, Block 8 Session 2 17 Des 2004 75 75 (100%)
-
5 International, Block 4 Session 1 10 March 2004 75 75 (100%)
-
6 International, Block 4 Session 2 12 March 2004 75 75 (100%)
-
7 International, Block 8 Session 1 30814 75 75 (100%)
-
8 International, Block 8 Session 2 30824 75 74 (98,67%)
1 (1,33)
9 International, Block 15 Session 1 51515 75 69 (92%)
6 (8%)
10 International, Block 15 Session 2 51525 75 69 (92%)
6 (8%)
June 2005-July 2006 To focus on improving tutorial system
(tutorial discussions, management of tutors, tutor training)
To prepare the New Competency-Based Curriculum which will be implemented starting in August 2006
170605 Titi Savitri
draft
Competency-based Curriculum 2006For Undergraduate Medical Education at Gadjah Mada University
School of Medicine
OutcomesOutcomes(areas of competence)(areas of competence)
CompetenciesCompetencies
Knowledge, Skills, AttitudesKnowledge, Skills, Attitudes
Competencies required for performance of roles/functionsCompetencies required for performance of roles/functions
Roles and Functions of Health ProfessionalRoles and Functions of Health Professional
Knowledge, skills, attitudes for acquisition of competenciesKnowledge, skills, attitudes for acquisition of competencies
AssessmentAssessment
AssessmentAssessment
AssessmentAssessment
Educational Strategy and Approaches – Best Evidence Medical Education
Learning in context Learning to solve patient problems Patient-Centred, Project-Based and Problem-
Based Integration and Multidisciplinary Approach
(Horizontal and Vertical; Z shape) Collaborative Learning Progression towards Outcome Assessment drives students’ learning
Expertise research
Organizing memory
Pattern recognition
Networks
Context information
Information retrieval
Expertise research
Novice Expert
Clinical Reasoning Skills
Beginner(Novice)
Advanced(Expert)
Contextual
Constructive
Collaborative
What it needs to become….
How?
More authentic problems
Increasing complexity
Real lifeprojects
Authentic assessment
Contextual
Constructive
Collaborative
How?
Less direction
Increasing independent learning
More demand driven
Portfolioassessment;self/peerassessmentContextual
Constructive
Collaborative
How?
Smaller groups
Group assignments
More ICT support
Learning task = assessment;include group work in assessmentContextual
Constructive
Collaborative
Progression towards OutcomeSpiral Curriculum
Increased breadth Increased utility Increased difficulty Increased proficiency
Th 1
Th 2
Th 3
Th 4
Th 5
Competencies
Competencies
Learning in Context
Doctor-PatientsEncounters
Disease/Disorder Spectrum:
Acute, Chronic, Emergency, Pregnancy
Age Spectrum:Newborn-Geriatric
Setting Spectrum:Individual, family,
community
Problems Spectrum:Clinical
BehaviouralEnvironmental
Steps to design the Competency-based Curriculum
Area of CompetencePrimary Care Physicians
Competency Components
Enabling Outcome
DecidedAt theNational Level
Knowledge Skills AttitudeClinical
Problems
Decided at the Faculty Level
Level of Achievement
Decided at the Faculty Level
Steps to design the Competency-based Curriculum
Enabling Outcomes are distributedinto phases/year in line with level of achievement
Identification ofYear Themes
Identification of Block Themesand Distribution of Clinical Problems into Blocks
Distribution of Knowledge, Skills, Attitude into BlocksBlue PrintBlocks
Tasks of the Block Team Design learning experiences for the
students based on Block Blue Prints (such as tutorial discussion, field visits, lectures, skills lab, laboratory practice, etc)
Design Scenarios or other triggers Develop Student Guide and Tutor Guide Carry out Block Assessment Plan, implement and evaluate
170605 Titi Savitri
Draft Structure of the Competency-Based Curriculum 2006GMU School of Medicine
7 Areas of Competence – KIPDI IIISupporting area of competence: Management of Emergency Cases
Kurikulum Fakultas
Makro
Meso
Mikro
Progression towards A Competent Medical Doctor
Th 1
Th 2
Th 3
Th 4
Th 5
Areas of Competent
Areas of Competent
Fase I : Beginner 1 2 34
5678
12 3 4
567
8
Fase 2: Intermediate
Fase 3: Advanced
Year Themes1 The Human Body SystemThe Human Body System
2 Life CycleLife Cycle
3 Chronic disordersChronic disorders and Neoplasma and Neoplasma
4 Emergency and Emergency and Clinical RotationClinical Rotation
5 Clinical Rotation and Clinical Rotation and ResearchResearch
6 Internship (??)Internship (??)
Practice Theory
Independent learning Dependent learning
GMU SM Competency-Based Curriculum 2006
Phase 1
Phase 2
Phase 3
Year 1: The Human Body System
Block 1.1.
Regulatory/
Cardiovascular
System
(First
Aid)
Block 1.2.
Respiratory
System
(Cough)
Block 1.3.
Digestive
Tract
System
(Diarrhoea)
Block 1.4.
Genitourinary System
(Disuria)
Block 1.5
Sense Organs
(Penurunan Visus, Pruritus,
Ear Discharge)
Block 1.6.
Neuromuscular System
(Paralysis and Convulsion)
Block 1.7
Multisystem
(Fever)
Why? : - To introduce the human body system – the foundation of medicine - Common symptoms – familiar for students – motivating students
- To introduce 8 areas of competence – Level Beginner
Year 2: Life Cycle
Block 2.1.
Cell Growth
Block 2.2.
Pregnancy
And
Childbirth
Block 2.3.
Childhood
Block 2.4.
Puberty
Block 2.5.
Adulthood
Block 2.6
Aging
Example:Block 1.2Enabling Outcome
1. (Area 1)To be able to use various elements of communication principles to establish effective doctor-patient relationship, i.e.
- listen actively - respect the patient as a person: a. Elicits and respect patients’ values b. Exhibits cultural sensitivity c. Communicates empathy 2. (Area 2) Be able to perform basic clinical examination required in dealing
with respiratory tract disorders 3. (Area 3) Understand the anatomy of respiratory system and surrounding 4. (Area 3) Understand the normal function of respiratory system 5. (Area 3) Understand the clinical consequences of respiratory tract
disorders 6. (Area 3) able to identify the type of coughs in relation to relevant disorders 7. (Area 4) able to choose appropriate treatment for the type of coughs 8. (Area 4) carry out education needed to protect individuals against
preventable respiratory tract disorders
Example: Block 1.2.Knowledge Base
Understand the anatomy of respiratory system and surrounding at cellular and organ level
- Understand the normal function of respiratory system Biologi Sel (cellular organization and structure) Molecular-celular defense against injury and disease:
Barrier defenses Cellular immune defenses Humoral immune defenses Active and passive immunity Inflamatory response
Understand Mechanism of respiratory diseases and pathophysiological response
- pharmacology of specific drugs for respiratory system disorders
Example: Block 1.2.Skills
Active Listening Examination of vital signs (pulse,
temperature, tekanan darah,) (1,2) - Examination of thorax (perkusi, palpasi,
auskultasi) (1,2) - Examination of nose and throat - Assessment of thorax (perkusi, palpasi,
auskultasi) (1,2)
Example of Block 1.2.Clinical Problems
ISPA (pharyngitis, bronchitis) Tuberculosis Asma Pertusis ???- check with the depts involved
Example Block 1.2. – Week 1
Monday Tuesday Wednesday Thursday Friday Saturday
07.00-09.0 Overview
Lecture
Self-directed
learning
Integrated
Learning
Integrated
Lecture
Self-directed
Learning
-
Lab Practice
Integrated
Lecture
09.00-11.00 Tutorial
Discussion
Tutorial
Discussion
Integrated
Lecture
13.00-15.00 Skills Lab Skills Lab Skills Lab Health Centre Visit
Example Student Guide Block 1.2. List of Block Team and Contact Address List of Experts and Contact Address Overview of Block 1.2. Enabling Outcome Time Table Scenarios Other learning activities Learning resources
Proposal for GMU SMBlueprint Assessment
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Knowledge MCQ ES S A Y KF
Skills
O S C E
Professional Behaviour
Knowledge PROGRESS TEST
Integrated
P O R T F O L I O
e.g.
T U T O R
R A T I N G
Five streams Assessment
Proposal for GMU SM
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Knowledge MCQ ES S A Y KF
Skills
O S C E
Professional Behaviour
Knowledge PROGRESS TEST
Integrated
P O R T F O L I O
e.g.
T U T O R
R A T I N G Knowledge
• End of block written test
• Practice session
Knowledge
• End of block written test
• Practice session
Skills
• Skills lab
• Practice session
Skills
• Skills lab
• Practice session
Professional Behavior
• Tutorial
•Other relevant activities
Professional Behavior
• Tutorial
•Other relevant activities
• Weighting is done within each stream NOT across streams
• Final mark reported consists of 5 streams
Proposal for GMU SM
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Knowledge MCQ ES S A Y KF
Skills
O S C E
Professional Behaviour
Knowledge PROGRESS TEST
Integrated
P O R T F O L I O
e.g.
T U T O R
R A T I N G
Progress Test
Starting 2x / yearProgress Test
Starting 2x / year
Portfolio
• 1x / year
• Student choose 2 best portfolio for interview
Portfolio
• 1x / year
• Student choose 2 best portfolio for interview
Proposal for GMU SMAcademic Year 2005/2006
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Block Test
Knowledge MCQ ES S A Y KF
Skills
O S C E
Professional Behaviour
Knowledge PROGRESS TEST
Integrated
P O R T F O L I O
e.g.
T U T O R
R A T I N G
Target:
1. Improve the quality of block test2. Modify the tutor rating form3. Pilot project progress test4. Socialization of portfolio