Model Fasilitasi Pembelajaran REASON Untuk Meningkatkan Kemampuan Penalaran Klinik Mahasiswa Pendidikan Profesi Dokter
Yeny Dyah Cahyaningrum, Prof.dr.Gandes Retno Rahayu, MMedEd, Ph.D; dr. Yoyo Suhoyo, MMedEd, Ph.D
2025 | Disertasi | S3 Kedokteran Umum
Latar Belakang: Penalaran klinik merupakan aktivitas intelektual berupa strategi untuk mengintegrasikan informasi yang relevan dalam menentukan diagnosis, dan terapi kepada pasien. Peningkatan kemampuan penalaran klinik dapat dilakukan dengan peningkatan kualitas pembelajaran. Dosen memiliki peran yang penting dalam pembelajaran penalaran klinik, dengan beberapa keterbatasan, baik terkait dengan cara pengambilan keputusan klinis, interaksi dengan mahasiswa, dan beberapa factor yang mempengaruhi. Oleh karena itu perlu dikembangkan bentuk fasilitasi pembelajaran penalaran klinik dengan menggunakan pengalaman dosen klinis di Indonesia.
Metode: Penelitian ini merupakan penelitian dengan pendekatan perancangan dan penelitian pengembangan (design and development research) yang menekankan pada pengembangan model dan validasi model. Penelitian ini dilakukan dalam 2 tahap:
Tahap 1. Pengembangan Model, terdiri dari beberapa tahap: 1) mengetahui fasilitasi pembelajaran penalaran klinik berdasarkan literatur; 2) mengetahui pengalaman dosen klinis dalam memfasilitasi penalaran klinik pada setting klinik, dan 3) merumuskan serta melakukan validasi model pembelajaran penalaran klinik di setting klinik. Penelitian ini diawali dengan scoping review model fasilitasi pembelajaran penalaran klinik. Selanjutnya dilakukan pengambilan data kualitatif dengan indepth interview dengan dosen pembimbing klinik, focus group discussion pada mahasiswa beberapa institusi, dan validasi internal dengan pakar.
Tahap 2. Uji Coba dan Evaluasi REASON Model. Tahap penelitian dilakukan dengan pendekatan kuantitatif dan kualitatif. Penelitian kuantitatif (kuasi eksperimental with pre-post-test group design) dilakukan dengan mengimplementasikan model pada stase Ilmu Kesehatan Anak (IKA) dan Ilmu Penyakit Dalam (IPD) selama 11 minggu dengan pemberian alat ukur berupa Script Concordance Test (SCT) dan Diagnostic Thinking Inventory (DTI). Monitoring implementasi dilakukan dengan pemberian electronic logbook (E-log book) untuk melakukan self assessment terkait pelaksanaan REASON Model. Penelitian kualitatif dilakukan dengan wawancara mendalam dosen klinis dan FGD mahasiswa setelah implementasi.
Hasil penelitian: REASON Model terdiri dari beberapa tahap yaitu tahap pre interaksi (terdiri dari kesiapan (Readiness) dan lingkungan pembelajaran (learning Environment)), tahap interaksi (terdiri dari Tujuan Pembelajaran (Aim of Learning) dan Strategi (Strategy)), dan tahap post interaksi (terdiri dari penilaian (Output based assessment) dan umpan balik narasi (Narative Feedback)). Hasil implementasi menunjukkan nilai Script Concordance Test (SCT) mahasiswa setelah diberikan perlakuan (implementasi REASON Model) lebih tinggi dari pada sebelumnya (p<0>
Diskusi: Peran dosen dalam pembelajaran penalaran klinik di setting klinik membantu mahasiswa dalam percepatan penyesuaian diri mahasiswa. REASON Model memberikan intervensi dalam akselerasi peningkatan kemampuan penalaran klinik.
Kesimpulan: Terdapat beberapa pendekatan fasilitasi dosen klinis dalam menguatkan kemampuan penalaran klinik mahasiswa. REASON Model dapat membantu meningkatkan kemampuan penalaran klinik mahasiswa di setting klinik.
Background: Clinical reasoning is an intellectual activity as a strategy for integrating relevant information in determining patient diagnosis and therapy. Increasing clinical reasoning abilities can be done by improving the quality of learning. Clinical facilitators have an essential role in learning clinical reasoning, with several limitations related to how clinical decisions are made, interactions with students, and several influencing factors. Therefore, it is necessary to develop a form of facilitating clinical reasoning learning using the experience of clinical facillitators in Indonesia.
Method: This research includes design and development research, emphasising model development and validation. This research will be carried out in 2 stages:
Stage 1. Model development is used to determine the facilitation of clinical reasoning learning based on literature, determine the experience of clinical lecturers in facilitating clinical reasoning and formulate and validate clinical reasoning learning models in clinical settings. This research began with a scoping review of the clinical reasoning learning facilitation model. Next, qualitative research was conducted with in-depth interviews with clinical supervisors, focus group discussions with students from several institutions, and internal validation with experts.
Stage 2. Model Testing and Evaluation aims to implement the clinical reasoning learning facilitation model in clinical settings and evaluate its use. The research was conducted using quantitative and qualitative approaches. Quantitative research (quasi-experimental with pre-post-test group design) was carried out by testing the model at the Child Health Sciences (IKA) and Internal Medicine (IPD) stages for 11 weeks. Trial monitoring is carried out by providing an electronic logbook (E-log book) for self-assessment regarding implementing the REASON Model. After testing the model, qualitative research was conducted using in-depth interviews with clinical teaching lecturers and student FGDs.
Results: The REASON clinical reasoning facilitation model consists of several stages, namely the pre-interaction stage (in the form of preparation, consisting of capability (Capability) and learning procedures (Learning Procedure)), the interaction stage (in the form of interaction components of clinical educators and students, consisting of from Subject (Subject) and Technique (Technique)), and post-interaction stage (in the form of evaluation after interaction between lecturers and students, consisting of evaluation (Evaluation) and in-depth (Probing)). The test results showed that students' Script Concordance Test (SCT) scores after being given treatment (REASON Model trial) were higher than before (p<0>
Discussion: The role of clinical facilitators in learning clinical reasoning in clinical settings helps students accelerate student adjustment. The REASON Model provides interventions to accelerate the improvement of clinical reasoning abilities.
Conclusion: There are several facilitation approaches by clinical educators in strengthening students' clinical reasoning abilities. The REASON Model can help improve students' clinical reasoning abilities in clinical settings.
Kata Kunci : penalaran klinik, model, pembelajaran, setting klinik, dual process, cognitive load
