CURRICULUM VITAE • Nama Lengkap : dr. Tri Wahju Astuti,MKes,Sp.P(K) • Tempat & Tanggal Lahir : Jember, 22 Oktober 1963 • Alamat : Jl. Danau Sentani Utara H2A-31 Malang • No. Tlp/Fax/HP : (0341) 712655 / 08123297361 • Alamat Kantor : SMF Paru RSU Dr. Saiful Anwar, Jl. Jagung Suprapto No 2 Malang • Pendidikan Dokter umum : FK Unibraw tahun 1989 Magister : FK Unair tahun 1997 Spesialis Paru : FK Unibraw tahun 2008 Konsultan Paru Kerja & Lingkungan : Kolegium Pulmonologi 2012 • Riwayat Pekerjaan/Pengalaman Puskesmas Sukajaya – Bogor: 1990 - 1992 Puskesmas Pasirlangu – Bandung : 1992 - 1995 Dosen FKUB : 1996 – sekarang Penyelia Pusat UKMPPD : 2013 - sekarang Ketua Program Studi Pendidikan Dokter : 2016 – Sekarang • Organisasi Profesi Persatuan Dokter Paru Indonesia Cabang Malang Ikatan Dokter Indonesia Asian Pacific Society of Respirology

Introduction of

Workplace-Based Assessment

Tri Wahju astuti

BACKGROUND

Competence: what an individual is able to do in clinical practice

Performance: what an individual actually does in clinical practice

Dimensions of medical competence including:

−The scientific knowledge base

−Professional practice elements: history taking, communication, physical examination, procedural and management skills, problem solving ability, relationships with colleagues & ethical behaviour

Peran Lulusan Dokter Spesialis Pulmonologi & Kedokteran Respirasi

Kepakaran Klinik

(Clinical Expertise

Memperlihatkan keterampilan diagnostik &

terapeutik dlm tatalaksana yg efektif

& etis pd px.

Mencari & mengikuti kemajuan informasi yg tepat & relevan u/

praktik klinik.

Memberikan pelayanan konsultatif

yg efektif sehubungan dengan tatalaksana pasien, edukasi & pendapat

legal.

Komunikator

Membina hubungan dgn px & sejawat dlm rangka

pengobatan px. Menghasilkan & mensintesis riwayat penyakit yg relevan

dari px / kolega / lingkungan , dgn mendengar &

melakukan wawancara yg efektif.

Memberikan informasi yg sesuai kpd px / tim

keluarga & tim pelayanan. Mampu mengembangkan

kemampuan berkomunikasi dengan

unsur-unsur yg bertugas di rawat inap & rawat

jalan.

Berkonsultasi efektif dengan dokter2 & profesi

kesehatan lain.

• Memberikan kontribusi yang efektif terhadap kegiatan-kegiatan tim interdisiplin

Kemampuan Bekerjasama (kolaborator)

Berkonsultasi dengan efektif dengan dokter-

dokter dan profesi kesehatan lain.

Memberikan kontribusi yang efektif terhadap

kegiatan-kegiatan tim interdisiplin

Manajer

Menggunakan & memanfaatkan

sumber daya scr efektif guna perawatan px, kebutuhan belajar,

& aktifitas diluar, secara seimbang.

Mengalokasikan sarana pemeliharaan

kesehatan yg terbatas secara bijaksana.

Bekerja secara efektif & efisien dalam suatu organisasi kesehatan.

Menggunakan TI u/ mengoptimalkan tatalaksana px,

pembelajaran yg berkesinambungan &

kegiatan2 lain

Advokator Kesehatan

Mengidentifikasi determinan

kesehatan yg penting yg mempengaruhi px.

Memberikan kontribusi yang

efektif untuk memperbaiki

kesehatan pasien dan masyarakat.

Mengenal dan menjawab

permasalahan dimana advokasi

tepat untuk dilaksanakan.

Ilmuwan (scholar)

Mengembangkan, mengimplementasikan dan memantau strategi pendidikan untuk diri

sendiri yang berkelanjutan.

Menilai secara kritis sumber-sumber informasi medik.

Memfasilitasi pembelajaran pasien,

mahasiswa kedokteran dan tenaga professional

lain.

Berkontribusi terhadap pengembangan ilmu

baru.

Professional

Memberikan pelayanan yang bermutu tinggi

dengan integritas, kejujuran, dan rasa

kasih.

Memperlihatkan perilaku personal dan interpersonal

yang baik.

Menjalankan praktik kedokteran yang etis

dan sesuai dengan kewajiban seorang

dokter

Learning Stages for Complex Cognitive Skills

1. Novice: rigid adherence to rules; poor situational perception; no experience

2. Advanced beginner: uses guidelines for action, still limited situational perception

3. Competent: better view of big picture; plans ahead; but still procedure driven

4. Proficient: holistic view and able to extract most important elements of situation; uses maxims (generalizable)

5. Expert: no longer relies on rules, guidelines or maxims; intuitive grasp and recognition of patterns for ease of decision action

Dryfus & Dryfus (1980)

Learning Domains

Cognitive: intellectual skills (facts, procedures, concepts, rules, principles)

Psychomotor: complex perceptual – motor skills

Affective: emotional control, stress – coping, attitudinal predisposition to respond

Learning Stages For Complex Perceptual Motor Learning

Cognitive: knowledge based (thinking, verbal) understanding of task and strategies

Associative: procedural (rule-based) understanding of steps or task sequence

Autonomous: (unconscious) automatic execution of skilled performance with high accuracy and precision

Fittsand Posner (1967)

Kurikulum Pendidikan Dokter Spesialis Pulmonologi & Kedokteran Respirasi

CAPAIAN PEMBELAJARAN

(LEARNING OUTCOME)

Kerangka Kualifikasi Nasional Indonesia (KKNI)

UU Pendidikan Kedokteran

(no.20/th/2013)

Standar Nasional

Pendidikan Tinggi

Standar Nasional Pendidikan Kedokteran 2018

WFME , ACGME, Global

Standards for Quality

Improvement

Standar Kompetensi

Dokter Spesialis Pulmonologi &

Kedokteran Respirasi

RENCANA PEMBELAJARAN

KURIKULUM

MAKROKURIKULUM (Peta Kurikulum; ,kompetensi disease, ketrampilan klinis)

MESOKURIKULUM (Tahapan per tahun, Divisi, Mata Ajar)

MIKROKURIKULUM (Rencana Pembelajaran Semester (RPS) per divisi per mata ajar

TUJUAN PEMBELAJARAN

Disusun per Divisi per mata ajar dalam bentuk Rencana Pembelajaran

Didasarkan pada level capaian

dalam SK DSPKR

Menjadi landasan untuk

asesmen/evaluasi belajar (blueprint)

METODE PEMBELAJARAN

Pemilihan metode pembelajaran

disesuaikan dengan tujuan pembelajaran

KOGNITIF : Diskusi ; Problem

based learning (PBL); POMR

PSIKOMOTOR : Clinical skills training (Skills lab); procedural skills; project

based learning

Profesionalism / attitude

EVALUASI PEMBELAJARAN

Menilai ketercapaian tujuan belajar

(blueprint assessment)

Evaluasi proses belajar

WFME Standard 3 (revised)

13

Does

Shows how

Knows how

Knows

Cognition

Behaviour

Miller’s pyramid: a framework for assessing clinical competence

Performance-based

testing: 360 degree,

Portfolio, Mini-CEX

Competency-based

testing: OSCE, Short

case, long case

Clinical contact-based

testing: MEQ, EMQ,

PMPs, SAQ, SEQ

Factual testing: MCQ,

Essay, Oral

Miller’s Model of Clinical Competence

Performance assessment: the assessment of skills & behaviour, both in academic & workplace setting

Performance assessment: building in a degree of complexity to Miller’s pyramid, recognising both the development of performance expertise, & the need for skills & behaviour maintenance through deliberate practice.

Through the skills complexity triangle, some of the contextual factors which impact on performance measures, both individual & systems related, including taking experience into account.

Miller’s Model of Performance Assessment

Deliberate practice Integrated

team performance

Integrated skills

Task training

Does

Shows how

Knows how

Knows

Cognitive phase

Integrative phase

Skills complexity triangle

Miller Fitts and Posner

Ericsson

ASSESSMENT

Integrated assessment 3 components:

Applied knowledge test (AKT)

Clinical skill assessment (CSA)

Workplace-based assessment (WPBA)

Each of these components is assessed independently and will assess different skills, but together the 3 components will cover the curriculum.

Knowledge is only one aspect of being a doctor how about competencies & performance in the professional practice?

Competencies can be assessed through relevant clinical tasks were often simulated & occasionally distant from the workplace

Assessment of competence – performance misses routine behavior

WPBA tools assess at the “does” level of Miller’s pyramid

WORKPLACE-BASED ASSESSMENT (WPBA)

Definition of WPBA

A form of authentic assessment testing of performance in the real environment facing doctors in their everyday clinical practice

Boursicot K, Etherridge L, et al. 2010

Assessment of day to day working practices undertaken in the working environment

PMETB Workplace – Based Assessment January 2005

The evaluation of a doctor’s performace progress over time in professional practice areas best tested in the

workplace http://www.1scp.ac.uk/Assessment/WBA/Intro.aspx

Structured & continuous: not only to form judgement on competence

Repeated assessment assessor has the opportunity for gathering documentary evidence of the student’s actual performace progression

Can identify gaps in practice allow the assessor & student to mutually plan student development needs

Helps identify difficulties, strength & weakness of student in different areas of practice e.g. technical skills, professional behaviour & teamworking

Reasons for using WPBA

Best assessment practice in medical education rather than traditional assessment allow the assessment of professional behavior aspects

Allows the assessment to get as close as possible to the real situations in which doctors work

Based on contemporary educational design

Drive learning in important areas of competency

Reasons for using WPBA.....

Assessment tools for clinical competence

Objective structure clinical examination OSCE

Objective structured long case examination record

OSLER

Objective structured assessment of technical skills

OSATS

These are undertaken outside the “real” clinical environment but have many aspects of realism of workplace incorporate into them and are assessed at the “shows how” level of Miller’s pyramid.

Mini clinical evaluation exercise Mini-CEX

Direct observation procedural skills DOPS

Case-based discussion CbD

Mini-peer assessment technique Mini-PAT

Assessment tools for clinical performance

Consultation Observation Tool COT

Patient Satisfaction Questionnaire PSQ

CWS Clinical Work Sampling