Clinical Education Model Development Based On Rural General Practice Resilience

NICHOLAS EDWIN H, Prof. dr. Gandes Retno Rahayu, M.Med.Ed., Ph.D.; Prof. dr. Mora Claramita, MHPE, Ph.D.; Prof. Lambert Schuwirth, Ph.D; A/Prof. Julie Ash, Ph.D., BMBS, Bsc.Hons.

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar belakang. Konsep resiliensi dipahami sebagai komponen kunci dari kesejahteraan (well-being) dan merupakan faktor penting dalam pendidikan kedokteran untuk membantu dokter belajar menghadapi kesulitan. Mahasiswa kedokteran perlu belajar untuk menjadi resilient untuk dapat hidup dan berkembang di daerah tertinggal. Penelitian ini bertujuan untuk memahami perkembangan resiliensi dokter daerah tertinggal dan mencerminkannya dalam pendidikan klinik. Methode. Penelitian ini menggunakan desain mixed-method yang terdiri dari 3 tahap penelitian. Tahap pertama mengadaptasi kuesioner resiliensi yang ada ke konteks rural Indonesia. Kemudian, tingkat resiliensi dokter diukur menggunakan kuesioner hasil adaptasi dan dianalisis hubungannya dengan retensi mereka di daerah. Terakhir, beberapa dokter daerah tertinggal diwawancara dan tanskrip hasil wawancara dianalisis secara kualitatif menggunakan Richardson Resilience Framework oleh 2 orang peneliti untuk memahami bagaimana mereka mengembangkan resiliensi mereka. Hasil. Terdapat perbedaan yang bermakna pada dimensi endurance dan comfort-zone antar grup dokter dengan perbedaan pengalaman kerja di daerah > 10 tahun. Meskipun menghadapi stresor yang sama, respon partisipan dengan tingkat resiliensi tinggi berbeda dari partisipan dengan tingkat resiliensi rendah. Respon yang muncul tergantung pada persepsi mereka terkait makna (meaningfulness) dan perasaan mampu mengatasi stresor tersebut (manageability). Kesimpulan. Terkait dengan keterbatasan waktu dalam pendidikan klinik, upaya pengembangan resiliensi sebaiknya fokus pada membantu mahasiswa untuk menemukan makna (meaningfulness) dan mengembangkan perasaan mampu mengatasi masalah (sense of manageability) dengan cara menyadari, mengembangkan, mengumpulkan, dan mengelola faktor-faktor pelindung (protective factor) dan menyingkirkan faktor resiko (risk factor).

Background. The concept of resilience is recognized as a key component of well-being and is an important factor in medical training to help doctors learn to cope with adversities. Medical students ought to learn to be resilient to survive and thrive in rural practice. This study aimed to understand the development of rural doctors resilience and mirror it in the clinical education setting. Methods. This study employed a mixed-method design in three steps of the study. First, an existing resilience questionnaire was adapted to the rural Indonesian context. Then, the rural doctors resilience level was measured using the adapted questionnaire and its association with their retention in rural areas was analyzed. Finally, representatives of rural doctors were interviewed and the interview transcripts were analyzed qualitatively through the lens of Richardson Resilience Framework by two researchers to understand how they develop their resilience. Results. The endurance and comfort-zone dimensions of resilience were significantly different between groups of rural doctors with > 10 years differences in rural practice duration. Although the same stressors were identified between the high and the low resilient participants, their responses were different depending on their perception of the meaningfulness and the manageability of the stressors. Conclusion. To deal with the time constraint of clinical education, the resilience development efforts should focus on assisting students to find meaning, to develop a sense of manageability by being aware of, develop, gather, and manage their protective factors, to be aware of, and mitigate their risk factors.

Kata Kunci : clinical education, model development, rural general practice, resiience