Pengembangan Instrumen Penilaian Kinerja Residen Program Pendidikan Dokter Spesialis Kulit dan Kelamin

SANDRA WIDATY, Prof. Dr. dr. Hardyanto Soebono, Sp.KK(K)

2015 | Disertasi | S3 Ilmu Kedokteran

Latar belakang Pendidikan spesialisasi membutuhkan Standar Kompetensi Pendidikan Dokter Spesialis (SKPDS) dan tatacara penilaian yang sesuai. Dalam Program Pendidikan Dokter Spesialis Kulit dan Kelamin, evaluasi keberhasilan pendidikan residen dilakukan melalui berbagai penilaian. Diperlukan suatu cara penilaian khususnya penilaian kinerja residen Program Pendidikan Dokter Spesialis Ilmu Kesehatan Kulit dan Kelamin (PPDS IKKK) yang sesuai dengan ranah kinerja dokter, SKPDS dan mudah diterapkan serta dapat digunakan oleh dosen yang berada di berbagai tempat pelaksanaan pendidikan termasuk di rumah sakit jejaring pendidikan. Tujuan Penelitian ini bertujuan untuk mengembangkan instrumen penilaian kinerja bagi residen PPDS IKKK, dinilai oleh staf pengajar, untuk menilai kinerja residen waktu melakukan praktik klinis sesuai dengan peran dan tanggung jawab yang tercakup dalam standar kompetensi yang harus dicapai sebagai keluaran pendidikan dokter spesialis Metode Penelitian dilakukan dengan menggunakan rancangan mixed methods; campuran kuantitatif-kualitatif, dominan kuantitatif, terbagi atas empat tahap. Tahap I (pembentukan konsep kinerja dokter spesialis kulit dan kelamin) melalui wawancara mendalam terhadap pemangku kepentingan pendidikan dokter spesialis kulit dan kelamin serta panel ahli dilakukan oleh staf pengajar dari berbagai Institusi Pendidikan Dokter Spesialis (IPDS) IKKK di Indonesia. Tahap II (pengembangan instrumen kinerja), tahap III (pengujian instrumen kinerja) berupa uji komparatif instrumen kinerja dan instrumen kontrol terhadap kinerja praktik klinis residen dalam bentuk video kinerja, serta tahap IV (aplikasi penilaian kinerja residen dengan instrumen kinerja) dilakukan oleh staf pengajar terhadap residen di Departemen IKKK Fakultas Kedokteran (FK) Universitas Indonesia (UI) dan Bagian IKKK FK Universitas Gadjah Mada (UGM). Hasil Penelitian dilakukan dalam 4 (empat) tahap di Departemen IKKK FK UI di Jakarta dan Bagian IKKK FK FK UGM di Yogyakarta pada tahun 2011 – 2012. Pada tahap I dihasilkan konsep instrumen kinerja melalui wawancara mendalam terhadap kelompok residen, dosen, praktisi spesialis kulit dan kelamin serta kelompok perawat dan laboran serta panel ahli yang terdiri atas para dosen yang berkecimpung dalam pendidikan spesialisasi kulit dan kelamin di beberapa perguruan tinggi di Indonesia. Pada tahap II dikembangkan instrumen penilaian kinerja yang terdiri atas sebelas komponen kompetensi dengan nilai akhir berupa angka absolut dan kesan kesemuaan kinerja praktik klinis disertai umpan balik. Pada tahap III dilakukan uji eksperimen dengan cara sepuluh orang dosen melakukan penilaian kinerja praktik klinis residen yang terekam pada empat buah film video kinerja praktik klinis. Validitas muka dan konten disimpulkan baik, reliabilitas instrumen yaitu konsistensi internal  = 0,96 dan se 0,03 dengan nilai masing-masing komponen kompetensi  > 0,90 (sangat baik). Penilaian konsistensi internal instrumen dengan metode Spearman Rank didapat nilai baik dengan nilai koefisien korelasi  > 0,70. Nilai batas lulus berdasarkan cut off point dengan kurva ROC adalah 60, nilai sensitivitas, spesifisitas, positive predictive value dan negative predictive value sebesar 95,0 %. Akurasi instrumen kinerja didapat sebesar 95,0 % sedangkan instrumen kontrol adalah 80%. Pada tahap IV dilakukan penilaian 20 orang residen oleh 10 orang dosen dengan menggunakan instrumen kinerja saat residen melakukan praktik klinis. Penilaian serentak oleh tiga orang dosen untuk setiap residen, didapat 54 penilaian dari 60 yang diharapkan. Keandalan penilaian (interrater reliability) antara penilai I-II maupun penilai I-III rendah, namun memiliki keandalan tinggi antara penilai II-III (kappa 0,81, p < 0,01) dengan korelasi signifikan (koefisien korelasi =0,79, p<0,01). Um pan balik yang diberikan pada umumnya mengenai pengetahuan dan ketrampilan dengan sedikit umpan balik mengenai perilaku. Kesimpulan dan saran Instrumen disimpulkan dapat menilai dengan akurat kinerja praktik klinis residen. Sesuai dengan perhatian pendidikan yaitu perlunya memperhatikan residen dengan kinerja yang belum memuaskan agar mencapai kompetensi yang ditetapkan maka instrumen ini dapat digunakan dan sesuai untuk pendidikan spesialisasi kulit dan kelamin di Indonesia. Saran yang diajukan adalah dilakukan pelatihan penggunaan instrumen dan aplikasi penilaian residen di berbagai PPDS IKKK FK di Indonesia.

Background. Assessment of doctors’ performance, particularly the assessment of clinical practice performance, has become a great concern and is one of research topics in medical educational program. For the Postgraduate Medical Specialist Training in Dermatology and Venereology (PMSTDV), evaluation on successful educational program of the residents is carried out through various assessments. The development of assessment instruments, especially the performance assessment of residents in medical specialist educational program should be carried out referring to current standards and criteria. An instrument of assessment is required, particularly to assess performance of residents who are participating PMSTDV. Objective. The present study was aimed to develop an instrument to assess residents’ performance of the Postgraduate Medical Specialist Training in Dermato Venereology, which was evaluated by the lecturer faculty staff, to evaluate the performance of the residents during performing the clinical practice in accordance with their roles and responsibilities, which have been included in the standard of competencies that must be achieved by them as the outcomes of the medical specialist educational program. Methods. The study was conducted using mixed methods design, a combination of quantitative and qualitative method, the quantitative method was predominant, which consisted of four stages. The first stage was the development of concept on the performance of dermatovenereology specialist through in-depth interviews with the authorities and those who were in-charge of the medical specialist educational program in dermatovenereology and an expert panel was carried out by lecturer faculty staff of various institutions of the dermatovenereology medical specialist educational program in Indonesia. The second stage was developing an instrument of performance; while the third stage included conducting a test for the performance instrument, which was a comparative test between the performance instrument and the control instrument on clinical practice performance of the residents in the form of video of performance. The fourth stage was the application of residents’ performance assessment using the performance instrument, which was carried out by the lecturer faculty staff to evaluate the residents of Dermato Venereology Department at the Faculty of Medicine University of Indonesia (FMUI) and University of Gadjah Mada (FMUGM). Results. The study was conducted in four stages at the Department of Dermatovenereology, FM UI and UGM in 2011-2012. In the first stage, we obtained a concept of performance instrument through in-depth interviews with groups of residents, lecturers, practitioners in dermatovenereology, including nurses and laboratory personnel as well as an expert panel consisted of lecturers who had great experiences in dermatovenereology medical specialist educational program at several universities in Indonesia. In the second stage, an instrument of performance assessment was developed, which consisted of 11 (eleven) competency components with a final score of an absolute grade, the overall impression of clinical practice performance and feedbacks. In the third stage, an experimental test was carried out, i.e. ten lecturers performing clinical performance assessment of residents recorded in 4 video clips. It was concluded that the face and content validity were good, while the reliability of the instrument, expressed as the internal consistence of  = 0.96 and standard error 0,03, with each component of  competence > 0.90 (very good). Evaluating reliability instrument using Spearman Rank method, we found a value of  coefficient > 0.70. The passing grade score based on cut-off point on ROC curve was 60 (sixty); while the sensitivity, specificity, positive and negative predictive value of the instrument were 95.0 %. The accuracy of the performance instrument was 95.0 %, while the controle instrument was 80% . In the fourth stage, asse ssments of 20 residents were performed by 10 lecturers using the performance instrument when the residents completing their clinical practice. The assessments were performed simultaneously by 3 lecturers for each resident. There were 54 assessments obtained out of 60 expected assessments. The inter-rater reliability between the 1st and 2nd evaluators or between the 1st and 3rd evaluators was low; however, the reliability was high between the 2nd and 3rd evaluator (kappa 0,81, p < 0.01) with a significant correlation (correlation coefficient =0,79, p < 0.01). Feedbacks were usually about knowledge and skill and some feedbacks on attitude. Conclusion and suggestion. It is concluded that the instrument can assess the clinical practice performance of the residents accurately. As a response to a great concern in medical field, which includes the necessity to pay attention to residents whose performance are poor so that they can achieved the expected competencies, the instrument can be used and relevant for dermatovenereology medical specialist educational program in Indonesia. The suggestion includes the need of training on how to use the instrument and its application to assess residents of various dermatovenereology medical specialist educational programs (PPDS IKKK) among medical faculties in Indonesia and abroad.

Kata Kunci : instrumen penilaian, kinerja, residen