Transcript Quality Improvement at Gadjah Mada University School of

Quality Improvement
at Gadjah Mada University
School of Medicine
Curriculum Team
Gadjah Mada University School of Medicine
17 June 2005
170605 Titi Savitri
Faculty of Medicine GMU
170605 Titi Savitri
Implementation of PBL at
GMU School of Medicine
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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
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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
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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)
PBL Curiculum – Block/Integrated‘02/’03
skill
E2
Internship
6
INTERNSHIP
licenced
E1
5
Internal
Medicine
4
Res. Method
Biostat
Pediatric
Obgyn
Surgery
P.H
Elective
Local Exam.
MD/BSc
MD/Bsc.
Med
Rotation
Exam.
Int. Health
Manag,
New.Em.Dis
Emergency
& Trauma
Electives and
Research
Activity
Hemato Bleeding
Lymph tissue
Nephro Urology
& Body fluid
MF
DV
Rad.
Anes.
Ent.
Opt.
Ne
Psy
4 Blocks
+
Rotation
Patient – doctor Com. 3
Research Seminar
3
GPMD/GP
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
1
Learn. Comp.
& IT
Premed
Sci
Biomed
I
Biomed
II
Digestion (Gastro)
& Absorb.
(Nutrition)
Patient – doctor Com. 1
P.H. Com. Med.
Entrepr.
CVS
&
Lungs
6 Blocks
Bioethics
&
Humanities
6 Blocks
Fig.Gadjah Mada Curriculum in Basic Medical Education, Institutional Programme 2002, ( 5 years)
YEAR
knowledge
Skills Lab Curriculum
1992-now
Block 1
: Interpersonal Communication, Microscope
Block 2
: Basic Physical Diagnostic, Anthropometri
Block 3
: Vital sign, bandage
Block 4
: Lumbar Function, Aseptic Technique
Block 5
: Health survey, Health Promotion
Block 6
: Intravenous injection, Resuscitation
Block 7
: Denver Test, Neonatal Resuscitation
Block 8
: Anamnesis, Blood Smear
Block 9
: ENT Examination, Heteroanamnesis
Block 10: Neurology examination, orthopedic examination
Skills Lab Curriculum
1992-now
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Block 11
Block 12
Block 13
Block 14
Block 15
Block 16
Block 17
Block 18
Block 19
Block 20
Block 21
Block 22
: Abdominal examination, counseling
: Thorax examination, electrocardiography
: Simulated patient (anamnesis, vital sign, thorax,
abdomen,blood pressure)
: Pediatrics physical exam, minor surgery
: Physiotherapy, Ascites and Cathether
: Complete physical examination, IUD insertion
: Gynaecology exam, baby delivery
: Diagnosis, Mental statement
: Eye examination, communication on sensitive case
: Simulated patient, MEQ 3-Clinical Reasoning
: CPR (ET), simulated patient (Cs 4-6)
: Paediatric life support, message and mission
Follow Up: QA System in Place
Dean
Academic
Audit Team
Vice Dean for Academic Affairs
Education Committee:
Curr, Ass, Tutorial,
Manual Procedure
Year Coordinators
I-IV
Block Teams
I-XXII
Coordinator
For Clinical Rotation
Clinical Coordinator
11 Depts
Coord
K3M
Principles of QA
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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
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Internal Evaluation:
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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
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External Evaluation by Prof Arie Kruseman and Prof
Albert Scherpbier from Maastricht Medical School
(Feb 2004):
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Hybrid curriculum of lecture-based, subject-based and problembased 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):
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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
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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
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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 SMtutorial discussion
Follow up
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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
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To focus on improvement in assessment
system :
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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 SM
End of block written test
No
Source
Code
1
Regular, Block 4 Session 1
7 April 2004
2
Regular, Block 4 Session 2
10 April 2004
3
Regular, Block 8 Session 1
14 Des 2004
4
Regular, Block 8 Session 2
17 Des 2004
5
International, Block 4
Session 1
International, Block 4
Session 2
International, Block 8
Session 1
International, Block 8
Session 2
International, Block 15
Session 1
International, Block 15
Session 2
10 March 2004
6
7
8
9
10
12 March 2004
Number
of
Question
C1
75
60
(80%)
75
55
(73,33%)
75
57
(76%)
75
62
(82,67%)
75
56
(74,67%)
75
62
(82,67%)
75
73
(97,33)
75
61
(81,3%)
75
35
(46,67%)
75
22
(29,33)
Bloom’s Taxonomy
(n/%)
C2
C3
C4
15
(20%)
20
(26,67%)
18
(24%)
13
(17,33)
19
(25,33%)
13
(17,33)
2
(2,67)
13
(17,3%)
36
(48%)
47
(62,67%)
C5
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
It is not easy to develop questions related to discussed topic
30814
No time to develop the questions
30824
1
Low
quality of questions
(1,3%)
51515
51525
C6
4
(5,33%)
3
3
(4%)
(4%)
-
-
-
-
-
Current practice in GMU SM
End of block written test
Source
Code
1
Regular, Block 4 Session 1
7 April 2004
Number
of
Question
75
2
Regular, Block 4 Session 2
10 April 2004
75
3
Regular, Block 8 Session 1
14 Des 2004
75
No
Recall /
Application
R
A
75
(100%)
Regular, Block 8 Session 2
4
17 Des 2004
75
75
(100%)
International,
Block
4
Session
1
5
10 March 2004
75
75
(100%)
International,
Block
4
Session
2
6
12 March 2004
75
75
(100%)
It
is
not
easy
to
develop
questions
related
to
discussed
International,
Block
8
Session
1
7
30814
75
75
No time to develop the questions
(100%)
International,
Block
8
Session
2
8
30824
75
74
1
Low quality
of questions
(98,67%) (1,33)
International,
Block
15
Session
1
9
51515
75
69
6
(92%)
(8%)
International,
Block
15
Session
2
10
51525
75
69
6
(92%)
(8%)
topic
June 2005-July 2006
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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
draft
Competency-based
Curriculum 2006
For Undergraduate Medical Education
at Gadjah Mada University
School of Medicine
170605 Titi Savitri
Outcomes
(areas of competence)
Competencies
Knowledge, Skills, Attitudes
Assessment
Roles and Functions of Health Professional
Assessment
Competencies required for performance of roles/functions
Assessment
Knowledge, skills, attitudes for acquisition of competencies
Educational Strategy and Approaches –
Best Evidence Medical Education
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Learning in context
Learning to solve patient problems
Patient-Centred, Project-Based and ProblemBased
Integration and Multidisciplinary Approach
(Horizontal and Vertical; Z shape)
Collaborative Learning
Progression towards Outcome
Assessment drives students’ learning
Expertise research
Networks
Organizing memory
Context information
Information retrieval
Pattern recognition
Expertise research
Clinical Reasoning Skills
Beginner
(Novice)
Novice
Advanced
(Expert)
Expert
What it needs to become….
C ontextual
C onstructive
C ollaborative
How?
Authentic
assessment
C ontextual
C onstructive
C ollaborative
Real life
projects
Increasing
complexity
More authentic
problems
How?
C ontextual
C onstructive
C ollaborative
Portfolio
assessment;
self/peer
assessment
More demand
driven
Increasing
independent
learning
Less direction
How?
C ontextual
C onstructive
C ollaborative
Learning task =
assessment;
include group
work in
assessment
More ICT
support
Group
assignments
Smaller groups
Progression towards Outcome
Spiral Curriculum Competencies
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Increased breadth
Increased utility
Increased difficulty
Increased proficiency
Th 5
Th 4
Th 3
Th 2
Th 1
Competencies
Learning in Context
Disease/Disorder
Spectrum:
Acute, Chronic,
Emergency,
Pregnancy
Age Spectrum:
Newborn-Geriatric
Doctor-Patients
Encounters
Setting Spectrum:
Individual, family,
community
Problems Spectrum:
Clinical
Behavioural
Environmental
Steps to design
the Competency-based Curriculum
Area of Competence
Primary Care Physicians
Competency Components
Decided
At the
National
Level
Enabling Outcome
Level of Achievement
Decided at the Faculty Level
Knowledge
Skills
Decided at the Faculty Level
Attitude
Clinical
Problems
Steps to design
the Competency-based Curriculum
Enabling Outcomes are distributed
into phases/year in line with level of achievement
Identification of
Year Themes
Identification of Block Themes
and Distribution of Clinical Problems into Blocks
Blue Print
Blocks
Distribution of Knowledge, Skills, Attitude into Blocks
Tasks of the Block Team
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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
Draft Structure of the CompetencyBased Curriculum 2006
GMU School of Medicine
7 Areas of Competence – KIPDI III
Supporting area of competence:
Management of Emergency Cases
170605 Titi Savitri
Kurikulum Fakultas
Makro
Meso
Mikro
Progression towards
A Competent Medical Doctor
Areas of Competent
1
8
2
7
3
6
4
5
Th 5
Fase 3: Advanced
Th 4
Fase 2: Intermediate
Th 3
Th 2
Fase I : Beginner
3
1 2
4
Th 1
8
7 6 5
Areas of Competent
GMU SM Competency-Based Curriculum 2006
Year
Themes
1
The Human Body System
2
Life Cycle
3
Chronic disorders and Neoplasma
4
Emergency and Clinical Rotation
5
Clinical Rotation and Research
6
Internship (??)
Practice
Independent learning
Phase 1
Phase 2
Phase 3
Theory
Dependent learning
Year 1: The Human Body System
Block 1.1.
Regulatory/
Cardiovasc
ular
System
(First
Aid)
Why?
Block 1.2.
Respiratory
System
(Cough)
Block 1.3.
Digestive
Tract
System
(Diarrhoea)
Block 1.4.
Genitourina
ry System
(Disuria)
Block 1.5
Sense
Organs
(Penurunan
Visus,
Pruritus,
Ear
Discharge)
Block 1.6.
Neuromuscul
ar System
(Paralysis
and
Convulsion)
Block 1.7
Multisyste
m
(Fever)
: - 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. Block 2.3. Block 2.4.
Pregnancy Childhood Puberty
And
Childbirth
Block 2.5. Block 2.6
Adulthood Aging
Example:Block 1.2
Enabling Outcome
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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
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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:
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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
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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
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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
Integrated
Learning
Integrated
Lecture
Tutorial
Discussion
Selfdirected
Learning
Integrated
Lecture
09.00-11.00
Selfdirected
learning
13.00-15.00 Skills Lab
Tutorial
Discussion
Skills Lab
Skills Lab
Lab
Practice
Integrated
Lecture
Health
Centre
Visit
Example Student Guide Block 1.2.
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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 SM
Blueprint Assessment
Integrated

Knowledge
Five streams
Assessment
Professional
Behaviour
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
T
U
T
O
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Skills

Knowledge

Block Block Block Block
Test Test
Test
Test
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 Block Block Block Block Block
Block
Test
Test
Test
Test
Test
Test

Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
e.g.
M
C
Q
O
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S
S
A
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C
K
F
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A
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P
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P
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F
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Integrated

Knowledge
Proposal for GMU SM
Professional
Behaviour
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

Knowledge

Block Block Block Block
Test Test
Test
Test

Knowledge
• End of block written test
 Block Block Block Block Block
Block
Test
Test
Test
Test
Test
Test
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Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
e.g.
T
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T
O
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Skills
M
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Q
O
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S
S
A
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C
S
E
R
A
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I
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P
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R
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P
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T
F
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L
I
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T
E
S
T
K
F
• Practice session
Skills
• Skills lab
• Practice session
Professional Behavior
• Tutorial
•Other relevant activities
• Weighting is done within
each stream NOT across
streams
• Final mark reported consists
of 5 streams
Integrated

Knowledge
Proposal for GMU SM
Professional
Behaviour
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

Knowledge

Block Block Block Block
Test Test
Test
Test
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 Block Block Block Block Block
Block
Test
Test
Test
Test
Test
Test
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Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
Progress Test
Starting 2x / year
Portfolio
• 1x / year
• Student choose 2 best portfolio
for interview
Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
e.g.
T
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Skills
M
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Q
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C
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Integrated

Knowledge
Professional
Behaviour
Proposal for GMU SM
Academic Year 2005/2006
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
Knowledge

Block Block Block Block
Test Test
Test
Test
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 Block Block Block Block Block
Block
Test
Test
Test
Test
Test
Test
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Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
Target:
1. Improve the quality of block test
2. Modify the tutor rating form
3. Pilot project progress test
4. Socialization of portfolio
Block Block Block Block Block Block
Test
Test
Test
Test
Test
Test
e.g.
T
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Skills
M
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Q
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