Center for Indonesian Medical Students’ Activities

HEALTHPROFESSIONALSTUDENTS

SHOULDKNOW!

PARTICIPATING AND COLLABORATINGIN HEALTH PROFESSIONALEDUCATION SYSTEM

Center for Indonesian Medical Students’ Activities

HEALTHPROFESSIONALSTUDENTS

SHOULDKNOW!

PARTICIPATING AND COLLABORATINGIN HEALTH PROFESSIONALEDUCATION SYSTEM

Ministry of Education & Culture

for students,for indonesia,

HEALTHPROFESSIONALSTUDENTSSHOULDKNOW!PARTICIPATING AND COLLABORATINGIN HEALTH PROFESSIONALEDUCATION SYSTEMThe book is a copyright of Dikti-Kemdikbud (Ministry of Education

and Culture, Republic of Indonesia). It is written as one of HPEQ

Project's tools made for health professional students to promote

awareness on the importance of:

1. Students' participation in the process of policy-making

within health education system

2. Collaborative practice among health professionals or as

known as Interprofessional Education (IPE)

table ofcontent

Chapter 1

Health education system: is that even my business?

Chapter 2

So I should be participating? Who on earth am I?

Chapter 3

Alright, if I want to participate, what do I do?

Chapter 4

Interprofessional education (IPE): you + me = us! Together

for the better!

Chapter 5

Participation, collaboration, health education system,

HPEQ..., wait, what is HPEQ?

Chapter 6

What can I do, like NOW?

Chapter 7

IT'S A WRAP! :D

List of Abbreviations

References

Acknowledgment

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HEALTHEDUCATIONSYSTEM:IS THAT EVEN MY BUSSINESS?

Farrell, a pseudonym, was a smart medical student

with outstanding academic records. His GPA never

went below 3 of a 4.0 scale and he felt that he had

always studied well and obediently followed his campus'

rules. This year he graduated as a medical doctor and he

started working as a general practitioner at health centers

and private clinics. In his early weeks, he had a hard time

handling patients. During his study, Farrell spent most of his

clinical rotations in teaching hospitals where he

encountered a lot of advanced and specialistic cases.

Consequently, there were times Farrell felt he knew how to

diagnose an end-stage chronic kidney disease but he could

be somewhat clueless about how to treat a patient with

simpler cases such as common cold, eczema, or bloating. In

fact, at health centers and clinics they were the kind of

patients he met on a daily basis. Since he had worked, Farrell

realized that there were professional competences that he

should have had prioritized back when he was a medical

student. However, in reality, not only once he had to be on a

night shift duty where his time and energy were drained,

while ironically he did not gain much of clinical knowledge

and skill.

From the three stories, we could see several differences and similarities among

them. After graduating, Farrell had just realized that education system in his university was not

always carried out efficiently and effectively. As a student, he was too busy studying and did not

even bother to care about situations related to teaching-learning processes. A little bit

different compared to Farrell, Fitri dan Mischka had actually been quite aware of what

happened with their education system, but they simply did not know what to do. They did not

know whom to talk to and how they should do it. Additionally, there was a slight pessimism that

their voices would be heard and given beneficial responses.

Another story came from Fitri, also pseudonym, a dentistry student who was

supposed to be graduating soon. Unfortunately she was worried about not being able to sit for

the final board because she could not find a patient for her clinical examination. Fitri also had a

concern on the fact that she did not obtain sufficient practical skill due to inadequate number

of dental chair facilities for everyone in her batch.

Mischka, not a real name either, a pharmacy student having similar problem related

to infrastructures. Mischka was expected to have research skill and knowledge of international

standards. But on the other hand, laboratory facilities and free access to international journals

were not even fully supported by her institution.

“Oh, crap. I think we made a mistake!

We really should do more lab practices...”

From the three stories, we could see several differences and similarities among

them. After graduating, Farrell had just realized that education system in his university was not

always carried out efficiently and effectively. As a student, he was too busy studying and did not

even bother to care about situations related to teaching-learning processes. A little bit

different compared to Farrell, Fitri dan Mischka had actually been quite aware of what

happened with their education system, but they simply did not know what to do. They did not

know whom to talk to and how they should do it. Additionally, there was a slight pessimism that

their voices would be heard and given beneficial responses.

Another story came from Fitri, also pseudonym, a dentistry student who was

supposed to be graduating soon. Unfortunately she was worried about not being able to sit for

the final board because she could not find a patient for her clinical examination. Fitri also had a

concern on the fact that she did not obtain sufficient practical skill due to inadequate number

of dental chair facilities for everyone in her batch.

Mischka, not a real name either, a pharmacy student having similar problem related

to infrastructures. Mischka was expected to have research skill and knowledge of international

standards. But on the other hand, laboratory facilities and free access to international journals

were not even fully supported by her institution.

“Oh, crap. I think we made a mistake!

We really should do more lab practices...”

Problems faced by Farrell, Fitri, and Mischka are technical problems that might be

different among each profession. But the moral of the story is: students' participation is

highly needed to improve health education system. Students have to provide feedbacks, be

it critiques or suggetions, towards

teaching-learning processes. To get the

best of it, aspiration should be conveyed

appropriately. In other words, methods

being used have to be effective, efficient,

and intellectual. The process surely needs

a good communication between students

and stakeholders, i .e . teachers,

institutions, and government.

I llustrations above are only a very small part of the all problems faced by health

professional students in Indonesia. It is clear that the problems might include:

Incompability issue between material being taught and competency needed in real

life

Ineffective learning methods which often results in energy and time-consuming

activities with less to no knowledge acquisition

Lack of teaching facilities

“Students' participation

has to be done in an effective, efficient, and intellectual

way.”

4

SO,I SHOULD BEPARTICIPATING?

erhaps some of you have

had similar experinces with Farrell,

who had been ignorant about his

health education system. Or

probably like Fitri and Mischka,

who had been pretty conscious of

the problems but felt not powerful

enough to take actions? Have you

ever felt that way?

WHO ON EARTH AM I?

P

Mahasiswa saat ini cenderung pasif? Hmmm, betul tidak ya...?

Sejak kecil sudah ditanamkan pada anak-anak Indonesia bahwa tugas utama pelajar itu ya belajar. Apakah ada di antara teman-teman yang nasehat orangtuanya berbunyi, “Yang kritis di sekolah ya, Nak. Selalu berikan masukan yang membangun untuk guru, kepala sekolah, menteri pendidikan, kalau perlu presiden sekalian, tentang sistem belajar kalian di sekolah!”?

Kalau ada yang orangtuanya berpesan demikian, tolong ajak mereka bergabung di HPEQ Project ya! Jangan lupa sebelumnya daftarkan mereka ke New7Wonders karena orangtua jenis itu bisa jadi lebih langka daripada komodo.

diri sendiri, siapa yang kalau kuliah memilih duduk di kursi belakang, kalau diberi kesempatan bertanya diam, kalau diberi pertanyaan juga diam? Nah, hal-hal kecil seperti itulah yang tidak menunjukkan keaktifan dalam kegiatan belajar mengajar. Tidak heran jika peristiwa yang dialami Farrell, Fitri, dan Mischka juga banyak dialami oleh mahasiswa lain di negara ini.

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7

Students these days tend to be passive? Hmm, is that right?

Indonesian kids have been continuously taught that the primary task of a

student is to study. Is there any of you whose parents ever tell: “Be critical at school!

Always give constructive feedbacks on education system to your teachers,

headmaster, minister, and even better, the president!”

If there are such parents, pelase tell them to join the HPEQ Project! They

should be registered for the New7Wonders because parents of that species might be

even scarcer than komodos!

“Education system-conscious mom! Vote for me!”

Pardon the sarcasm. But this is is the real deal. It is no longer a secret that critical

thinking is not yet our home-grown culture. It is shown by teaching-learning process,

from elementary school students to university ones. Now go ask yourselves. At a

lecture, do you prefer the back seats? Do

you keep quiet when the professors tell you

to ask a question? Do you also, keep quiet

when they tell you to answer their

questions? Right, if the answer is three

nods, those are the small things that are a

reflection of a passive behavior during

teaching-learning processes. No wonder

students of this country have problems like

what Farrell, Fitri, and Mischka had.

“At the lecture. Sit at the back, ask nothing, answer nothing.”

Mahasiswa saat ini cenderung pasif? Hmmm, betul tidak ya...?

Sejak kecil sudah ditanamkan pada anak-anak Indonesia bahwa tugas utama pelajar itu ya belajar. Apakah ada di antara teman-teman yang nasehat orangtuanya berbunyi, “Yang kritis di sekolah ya, Nak. Selalu berikan masukan yang membangun untuk guru, kepala sekolah, menteri pendidikan, kalau perlu presiden sekalian, tentang sistem belajar kalian di sekolah!”?

Kalau ada yang orangtuanya berpesan demikian, tolong ajak mereka bergabung di HPEQ Project ya! Jangan lupa sebelumnya daftarkan mereka ke New7Wonders karena orangtua jenis itu bisa jadi lebih langka daripada komodo.

diri sendiri, siapa yang kalau kuliah memilih duduk di kursi belakang, kalau diberi kesempatan bertanya diam, kalau diberi pertanyaan juga diam? Nah, hal-hal kecil seperti itulah yang tidak menunjukkan keaktifan dalam kegiatan belajar mengajar. Tidak heran jika peristiwa yang dialami Farrell, Fitri, dan Mischka juga banyak dialami oleh mahasiswa lain di negara ini.

7

7

Students these days tend to be passive? Hmm, is that right?

Indonesian kids have been continuously taught that the primary task of a

student is to study. Is there any of you whose parents ever tell: “Be critical at school!

Always give constructive feedbacks on education system to your teachers,

headmaster, minister, and even better, the president!”

If there are such parents, pelase tell them to join the HPEQ Project! They

should be registered for the New7Wonders because parents of that species might be

even scarcer than komodos!

“Education system-conscious mom! Vote for me!”

Pardon the sarcasm. But this is is the real deal. It is no longer a secret that critical

thinking is not yet our home-grown culture. It is shown by teaching-learning process,

from elementary school students to university ones. Now go ask yourselves. At a

lecture, do you prefer the back seats? Do

you keep quiet when the professors tell you

to ask a question? Do you also, keep quiet

when they tell you to answer their

questions? Right, if the answer is three

nods, those are the small things that are a

reflection of a passive behavior during

teaching-learning processes. No wonder

students of this country have problems like

what Farrell, Fitri, and Mischka had.

Quality health professional education system is the root of quality

health care system

Quality product of an education process is born from appropriate education system. What is taught at school is what to apply in the field. Education system continuously changes and evolves over time. So does health professional education. Technology, disease patterns, community needs, and policy-making are some of the factors that give in a major impact in the change. This is the reason why an education systems can have expiry dates and cannot remain a lifetime standard. In short, whatever was best ten years ago might not be today.

Policy making related to health professional education system is not an easy

task, even for developed countries. Let alone in Indonesia, where every change in

period of leadership is almost always followed by a change in teaching-learning

methods. Government and institutions have tried so hard to create the best

education system to produce the best health care providers. However, the

component that has not yet been taken optimally is students' participation, which is

actually one of key factors of needed to for successful education system.

Research on the pattern of students' participation in education

management system in Indonesia, which is done by team of students from HPEQ

Project in 2011 showed that not all institutions involve their students in the process of

planning, perencanaan, development, and accrediation. This is quite a pity because

students as learners should be more encouraged

to contribute in institutional policies.

Lack of student participation should be

addressed wisely by every one of us. This is time

for us to take more initiative to participate

together in the planning of education that we live

up to.

“Not every institution includes student in the process of planning, development, and accreditation”

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Students, where do we stand actually?

“Every citizen is responsible for education sustainability” (Law No. 20 Year 2003 on National Education System Article 6)

"People are entitled to participate in the planning, implementation, monitoring,

and evaluation" (Law No. 20 Year 2003 on National Education System Article 8)

Of the two articles above, it can be concluded that the students, who are part of the public, have both the responsibility and rights to participate in policy-making related to education system.

Now, what would happen if towards every policy made, we can only keep

silent and do not respond even though we find dissatisfaction in it? Where our

responsibility towards education and the 'status of students' that we bear? We are

college students, well-known for our critical thinking. It is time we jointly support the

sustainability of the health education system by channeling our constructive

aspirations.

Dwiprahasto (2010) in Indonesian Health Professional Student Summit

described that students must be active, active as a subject in determining the

curriculum. Students need to change, from being reactive to being responsive. If you

do not feel comfortable with the curriculum, then provide a solution. Students must

also be the driving force, because changes can be made if there is a concern and a

desire to change the curriculum in order to be accepted and implemented by all

parties. Moreover, students can actually act as public pressure that internally

understand the issues and take part in decision-making. Participation also means

collusion, merging the strength of the parties that have the same interests. In this

case, we should work together among health professions students towards

integrated education system. Collusion that should be taken seriously are synergies

between students' expectation and that of relevant stakeholders'.

Students' Declaration: Time to take the role!

Aren't we grateful that there are still many health professional students in Indonesia who have stronger critical ways of thinking and more willingness to act than Farrell, Fitri, and Mischka do?

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Inspired by the awareness of the importance of students' thparticipation, at Indonesian Health Professional Student Summit, November 19

2010, eight students organizations from seven health professions which are Center

for Indonesian Medical Students' Activities (CIMSA), Ikatan Senat Mahasiswa

Kedokteran Indonesia (ISMKI-medicine), Ikatan Lembaga Mahasiswa Ilmu

Keperawatan Indonesia (ILMIKI-nursing), Persatuan Senat Mahasiswa Kedokteran

Gigi Indonesia (PSMKGI-dentistry), Ikatan Mahasiswa Kebidanan Indonesia

(IKAMABI-midwifery), Ikatan Senat Mahasiswa Farmasi Seluruh Indonesia

(ISMAFARSI-pharmacy), Ikatan Senat Mahasiswa Kesehatan Masyarakat Indonesia

(ISMKMI-public health), dan Ikatan Lembaga Mahasiswa Ilmu Gizi Indonesia

(ILMAGI-nutrition science) formulate a declaration on the importance of their

role as future leaders to get involved actively in policy-making related to education

system in their home institution as well as the respective forms of cooperation which

are well intertwine between one profession with another.

This is the day when we made the history!

Students Participation in Other Nations?

Finland's success as a developed country in the world of education is

inseparable from its student participation. Finland emphasizes the University

as a scientific concept that emphasizes community partnership with its

student rather than a rigid school. The position of students in the educational

system is as “full participation”.

Students from various universities in Finland developed its own system of

feedback in his education. For example, the University of Oulu meet with its

student annually to collect opinions & criticism of the students about learning

system. Collected opinions then processed and continued discussion of

problem-solving oriented along with the staff of educators. In addition, there

are teams of developers that involve students (4-5 people) as the members,

even there are some teams that are chaired by students. (ENQA workshop

report, 2006) 10101010

“ “If you want happiness for a lifetime - help the next generation.

-Chinese proverbs

“ “If you want happiness for a lifetime - help the next generation.

-Chinese proverbs

ongratulations! If you have reached this chapter, you are one step ahead of Farrell. You are now aware of the importance of students' participation a policy-making process in education system. Now let's invite Fitri and Mischka to read this section so that they know what they are supposed to do: ADVOCACY.

C

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ALRIGHT,IF I WANT TOPARTICIPATEWHAT DO I DO?

ADVOCACY? Err, sounds like a fancy word to me...

According to the dictionary advocacy means “defense”. The more

comprehensive meaning is the submission of opinions aimed at shaping public

perceptions in order to achieve a change. In this context, advocacy can be

interpreted as the right method for conveying aspirations to the stakeholders in

the world of health professional education.

Advocacy = the art of “let's sit together and talk it out”?

“Study hard, graduate soon. Don't go down the roads creating riots!”

Indonesian college students are notorious for their mass demonstration habit.

Although mass demonstration is often perceived as sporadic and anarchistic act, a

well-organized, civilized demonstration is actually a part of advocacy. However, in

this section, we will further discuss about other forms of advocacy.

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Wait, wait, don't close the book yet! It's okay if

you're not familiar with that term (yet). It's okay,

This is why the book was written!

14

A critical thinking, an open-mind, a broad vision, and a high

committment

Those are the basics needed to do a good advocacy. During their

participation in policy making at least students will meet with:

The institution people: such as a lecturers and the head of faculty or

university

The government: such as Ministry of Health and Ministry of Education

and Culture, or the professional councils

In the world of education, they are our parents. Generally, compared to

their on age and experience, students are inferiorly-positioned. Approach to the

senior people are certainly different from his peers. Local customs and Eastern

values did make us have to pay extra attention to attitude and manners, but it

doesn't mean we have to blindly follow everything “our parents” want, without

using our critical thinking.

High commitment is needed because once we decide to start doing

advocacy; it means less time for studying, resting, and leisuring. Advocacy sure

takes a lot of your time! For many people, this is a sacrifice, and with such a busy

college life, not all students are willing to do so. Therefore, when we decide to do

this, make sure we have a strong commitment that each step is not executed half-

heartedly.

I have those basic principles. Now what?

Start from ourselves. If we say we are ready do nothing but to wait for

others, we are never going anywhere.

Have a really good understanding of what actually happens. Misleading

perception is catastrophic. Stakeholders would think we are just a bunch

of premature know-it-alls who do not actually understand the situation.

In the end, our advocacy would just go to waste.

As the initial steps, we can get ourselves involved in students' activities, for

example, attending a forum, finding out about campus organizations and

campus policies. To dig deeper into the problem, we can do simple research or

preliminary surveys to add references.

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In search of information, we should

be proactive because the policy

makers are often less open in the

socialization of some information

to the students. Avoid making

"people say..."-kind of arguments.

Always use a legitimate source of

information and can be trusted.

Usually the source is written in

black and white, such as the rule

b o o k fo r s t u d e nt , o f f i c i a l

curriculum guidelines, and the

results of research that have been

widely published

One of the materials on basic principles of higher education for health professionals you can learn in the e-book provided by HPEQ Project. E-book can be downloaded for free from the website HPEQ. Want to know the website domain? Keep reading... ;)

BE A SOCIAL CREATURE! We should be with someone or the

mass who share the same vision with us. More importantly, we

should maintain a good relationship with “our parents”. Nothing

near advocacy success is created without great coordination and

cooperatiom.

Learn from the past. We should know how much advocacy

attempts towards an issue have made previously. Ask our

seniors/alumni who had similar experiences, what are the

hurdles, what are the tips and tricks. Do not make the same

mistake twice.

Set a target! We are heading to nowehere without sorting out aims

and indocators beforehand. Clear aims and indicators would help us

how far we have made it and what else to fight for.

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“When attempting to

advocate the need of a

teaching hospital for

nursing students, ILMIKI

(nursing student

organization) conducted a

survey at the institutional

level. This turns out to be

pocitively accepted and

responded by the AIPNI

(professional council).”

One thing to remember:

before formulating the

a d v o c a c y i d e a s , b e

insightful. Do the messages

really represent what we

actually need?

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One Good Example!

The effort of midwifery students from Universitas Sebelas

Maret (UNS) to have a decent library is a good practice of

advocacy. Before spreading out their opinions, they made

a cost-benefit anaylisisof the library was ever to be built?

Morever, they shared possible advantages not only for

students but also for the institution, such as improvement

of accreditation score. In the end, the campus agreed to

build a library and even distributed forms to ask students

what books they needed the most.

Create clear messages. The messages do not have to be sophisticated. It

should communicate our vision clearly to others. Start from the general

ideas to the specific ones. Underline every keypoint or give further

explanation so it could give a better impact.

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Determine and analyse targets and the stakeholders' profiles. Please

bear in mind that stakeholders and we are not always in the same page.

There are different visions and prespectives. Analyse their characters.

Learn about how is our position in front of them, what to do to be

accepted in their circle of power. Relationships among stakeholders ar

important to understand too. They can be either supportive or gettin

in your way.

Planning is everything! Problem identification, target determination,

resource analysis, strategies design, roles and responsibilities sharing

Each plan should be carried out with the SWOT analysis (strength,

weakness, opportunity, and threat). That way, we can establish some

alternative strategies as well as anticipation for everything that might

happen.

Don't create enemies! Send the

messages in a endearing way!

Good advocacy messages are not solely demanding but also solution-

providing. Showing possible advantages for stakeholders earns us extra

points!

Arrange the tactics before go to the battle. The strategies can be

designed based on what we have collated in the previous points.

Furthermore, consider also the influence of the bureaucracy. Are our

strategies to deal with the existing bureaucracy good and appropriate

enough?

Share the roles and responsibilities! Although Advocacy is strongly

related to communication, does not mean it will only work for those

who have good public speaking skill. Translate the plans into job

descriptions.

Not everyone has to go on stage and do the talk. Behind the screen work

such as strategy making, research, media/IT menagement, funding,

even adminisitrative tasks including cashflow record and photocopy are

parts of advocacy. Everyone can contribute according to his/her ability.

Timing. Pay attention to time and situation. No matter how good your

advocacy plan is, sometimes it would damage your victory if it is done in

the wrong time. For instances, when stakeholders are at their busiest

days, or there are more urgent issues to solve.

Camera, light.., ACTION! In advocacy, never be afraid of making the first

step! We are only entitled to fear if our strategies are not well-planned.

Follow up! This is very typical. Lack of evaluation and follow-up is

advocacy's story of life. Often people stop fighting especially after

everything has failed. Opinion channeling is no longer done. While in

fact, a failure should be evaluated together to create nextfurther

actions. Sometimes it is not a failure, but the process is not completed

yet. Good advocacy is done gradually. It's almost impossible to expect an

instant result.

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Establish a sustainable advocacy. Do not let every effort go to waste.

Do not make we cannot stay in campus forever, don't we want to

graduate? Make sure our advocacy is not limited to certain people and

period.

Alumni can still contribute. Moreover if they work somewhere close to

stakeholders. Even better if there are alumni associations that are able

to contribute in providing support especially for their juniors in

developing professional education in the institution.

Work hard pray hard! (And don't be sad when things don't work out).

Nobody says advocacy is easy. We should be proud for having tried.

Becoming education system-conscious is an amazing achievement.

Nah sebagai contoh, inilah yang seharusnya dilakukan Farrell semasa koass!Seandainya Farrell sudah menyadari hal ini selagi dia masih di bangku kuliah, barangkali keadaannya akan berbeda. Mungkin dulu dia bisa:

Be more proactive. Guide book for medical competencies are already

provided by Indonesian Medical Council. Surprisingly, not every student

knew it ever existed. Many of them realize that eight before of even after they

sit for national competency board. Farrell should have known this so he could

prioritize what he should learn better during his clinical years.

Talk to academic advisors. Good, communicative, and caring teachers are an

important channel toadvocacy. They can help conveying students' aspiration

to stakeholders.

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Get feedbacks from his colleagues about problems concerning teaching-

learning method. Make a mini survey on the efficacy of night shift duty. He

can coordinate with student councils or representatives. So when he has to

talk to stakehoders, he can present an objective data.

Formulating problems and offering solutions. Example of problem: many

students feel that 24-hr night shift duty is not effective. It makes them

exhausted and sleepy the following day and cannot study well. Moreover,

sometimes the skills are not worth the pain. Like vital signs and urine output

monitoring.

Example of solution: adjusting the schedule. Probably more frequent but

shorter period. So nobody has to sacrifice his/her biologic clock.

Maintain a good relationship with teachers. Students who talk a lot but show

poor academic records are not going to win faculty's heart. Farrell has the

potential as a good student, he just needs to make the best out of it.

Maintain a good relationship with his juniors. As an alumnus,

Farrell must have known better than them. So he can act as an

advisor if their juniors want to start advocating.

Write a letter or help students to talk to the faculty. One of the

causes of students' hesitations about talking to “parents” is a

concern of possible conflicts with institutions that might later

affect their college life, including grades or other academic

matters. For alumni like Farrell, that is not a burden because

they do not have such dependency. They have more freedom

to convey their aspiration.

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Because Farrell cannot turn back time, what he can do now is:

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A NOT-TO-DO LIST:

Public provocation with anger and emotional drive. This is not a win-win

solution and can backfire your plans.

Complaining in social media. Watch your words on Twitter, Facebook, blogs, and

perhaps newspaper. If possible, solve the problem internally before going public.

Blackmailing. It is immature and coward. Anonimity is not leading anywhere,

because it is difficult to make follow-ups and the responsibility is questioned.

Making up false data to support our ideas. Spreading rumors based on

assumptions and subjective opinions of certain group of people.

Using harsh word in arguments. Maybe in western countries, freedom of speech

allows young people to have discussion with older people without having to go

through awakward moments. In Indonesia, it is slightly different. Always adjust

ourselves when talking to seniors. Use polite and dignified words and keep our

emotion stable.

Putting professional ego over public's priorities. Sometimes it's difficult to

synchronize opinions between students. Different perspectives and professional

backgrounds lead to various judgments. And it's okay! If it's not possible to

achieve an agreement, it's important that we respect other people opinions.

Violence and abuse behaviours. It is pointless to create riots, burn down the

buildings, or use voodoos or black magic.

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“Witch, please put this snake inside my dean’s tummy. He never listens to students!”

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-Arsitawati P. Rahardjo

-Carol A. Aschenbrener, M.D.Executive Vice PresidentAssociation of American Medical Colleges

“Each finger has different shape and

size. But they work together and

complete each other.”

The health care we want to provide for the people we serve—safe, high-quality,

accessible, person-centered—must be a team effort. No single health profession can achieve this goal alone. These new competencies will build a path to a collaborative health

care workforce and the improved care that we all desire.”

have once received a wrong therapy because of a miscommunicat ion between d o c t o r s , n u r s e s , a n d i t s pharmacist.” - Mrs. Mercedes (not a real name), 30, patient. “Lots of people don't know what's the difference between dietitian and nutritionist, including some of my colleagues from another health professions.” - Mr. Boy (not a real name either), 23, a 3rd year student in nutrition sciences.

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“I

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INTERPROFESSIONALEDUCATION(IPE):YOU + ME = US!TOGETHER FOR THE BETTER!

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What is Interprofessional education (IPE)?

Interprofessional education is the application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, organisational, and inter-organisational relations and processes of professionalisation”.-Hugh Barr, United Kingdom Center for the Advancement of Interpersonal Education (CAIPE).

“Interprofessional education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care”.-CAIPE, 2002

Based on those two definitions, we can conclude that IPE occurs when the students from various health professions discuss the concept of health care and how they can improve the quality of care for the sake of the community. Specifically, IPE can be utilized to address the health issues as well as specific cases in the community to find applicable solutions through discussions.

Why does the world need IPE?

WHO Framework of Action on Interprofessional Education and Collaborative Practice stated that fragmented health systems have caused many countries

Does what Mrs. Mercedes said above sound familiar to you? Or

have you ever heard a story about a surgeon who amputated the wrong

leg? Such cases are the examples of iatrogenic error, which often happens

due to the lack of coordination between health workers rather than lack

of clinical ability. What Mr. Boy was tying to say is, many health workers

are unaware of their colleagues from another profession. To be honest

with ourselves, sometimes we as health professional students do not

realize who are working with us at the hospital, what their tasks are, and

how we should work with them. Each health profession has specific roles

and responsibilities. That is why, collaboration among health professions

is very important.

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to fail in their efforts to fulfill their health needs. Health problems are in fact related to many aspects of life, and these problems can not be solved by depending solely on a uniprofesional approach. Contributions from various study disciplines are needed to make a positive impact in eliminating health problems..

How could IPE make benefits to the development of medical practice?

“Building a regional network to support interprofessional collaboration not only ensured there was no competition for let between projects, it also made it possible for all interprofessional projects to share best practices, challenges and opportunities.” -Regional Health Leader (WHO, 2010).

In the world of health professional education, IPE will help prepare students to be able to get involved and contribute positively in the active collaborative practice when they work as health workers in the future.

3

IPE plays an important role as a bridge to the implementation of collaborative practice. Through IPE, students are trained on how to take part in a team, how they could make their contributions, respect others' arguments, give opinions, not only to colleagues from the same profession but also with students of other professions.

The WHO Framework of Action on Interprofessional Education and Collaborative Practice shows research results from 42 countries about the impact of collaborative practice to health. The results of the researches turn out to be very promising.

According to the researches, collaborative practice may improve: Access to of health care Use of specific clinical resourcesClinical outcome of chronic disease patients Service and safety of patients

In addition, the collaborative practice may decrease: Number of complications Length of stay/hospitalizationTension and conflict between service providers (caregivers) Staff turnover Hospital costs Number of clinical errors Mortality

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This is Cool!University of Western Ontario was one of the institutions that are aware of the role of IPE in developing health professional education. This can be seen from the website of the Office of

Interprofessiobal Education and Research (http://www.ipe.uwo.ca/). There, we can find health professional

students doing simulation to solve medical cases. Similar activities are also carried out by the University of Toronto, the

University of Minnesota, and some other institutions.

How should the concept of IPE be developed in Indonesia?

As in rest of the world, IPE has also been recognized in Indonesia. More and more people and institutions now realized that IPE is a promising new model of learning, especially for health professionals. However, many aspects in Indonesian health professional education system are still fragmented, while application of IPE demands an integrated system. Therefore, to put IPE into the standard of health professional education which applies nationally, there should be new policies related to the health system.

This will be a challenge for all stakeholders involved, namely policy makers and the students themselves. According to the WHO, the application of IPE in a country can be done via two mechanisms, namely the educator mechanism and curricula mechanism.

In educator mechanisms, we need: ·Supportive institutional policies ·Good communication between the participants ·Enthusiasm to run IPE ·Shared vision and understanding about the benefits of introducing a new curriculum ·Person in charge as the coordinator of educational activities who can identify barriers or obstacles in implementing IPE

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a. b. c. d.

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e.

a.

b. c.

5

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Meanwhile, in the curriculum mechanism, we need:Suitable learning principles such as problem-based learning or action learning setsLearning methods which can reflect real practice A good interaction between students

How can students get involved in IPE?

Student is an important element in the IPE as well as a moving factor to start collaborative practice in a country. Therefore, students must first understand the concept and benefits of IPE so that students are motivated to embody IPE in their learning proces. In general, IPE contains some of the following elements, which are important for its implementation.

olaboration

espectful communication

1. C2. R

Harmony among students of health professions can be seen from the HPEQ project activities! CIMSA President, General Secretary of PMSKGI, General Secretary of ISMKI, General Secretary of IKAMABI, General Secretary of ILMIKI, General Secretary of ISFARMASI, General Secretary of ISMKMI, the representative of AMSA, and 11 representatives of those student organizations, discuss issues of their education in a forum named HPEQ Student.

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A long journey starts with a small step:Example of IPE implementation in Indonesia

It's been 2 years since health study programs in the UMM (Universitas Muhammadiyah Malang) first implemented a system of integrated courses between medical, pharmaceutical, and nursing students with the aim to improve team coperation, both in clinical and non-clinical settings. The method applied was a case study in small group discussions, which would be reviewed based on the specialties of each profession.

eflection

mplementation of knowledge and skills

xperience in interprofessional team

This concept should be implanted on the students' mind since the beginning of education. to be able to introduce IPE as possible in health professional education system in Indonesia. And when students understand the required elements for the implementation of IPE they would be able to equip themselves with the elements. The abilities can be obtained through various means, such as taking part in student organization activities, learning good communication techniques, and maximizing their professional skills.

3. R4. I5. E

“Education is a slow-moving but powerful force.-William Fulbright

“Y

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ou've been mentioning HPEQ Project throughout this book. But actually, I'm not too familiar with that thing...” Someone, 20 years old, purely fictional

PARTICIPATION,COLLABORATION,HEALTH EDUCATION

WAIT, WHAT IS HPEQ?

SYSTEM, HPEQ

Health Professional Education Quality (HPEQ) Project is a program of Directorate General of Higher Education of the Ministry of Education and Culture of the Republic of Indonesia which aims to improve the quality of health care in Indonesia by improving the quality of health institutions and their students, which would later become the strategic health care providers. The HPEQ Project was established at the end of 2009 and it will end in December 2014.

In improving the quality of health professional education, the HPEQ Project involved a variety of stakeholders. They are the Government as policy makers, educational institutions as producers of health workers, as well as students as the user of education system.

To achieve the goal, the HPEQ Project works through its 3 components: Strengthening Policies and Procedures for School Accreditation, Certification of Graduates Using a National Competency-based

Examination, and Results-based Financial Assistance Package (FAP) for Medical

Schools.

Component 1: Component 2:

Component 3:

Masalah : tuntutan masyarakat akan tingginya kebutuhan pelayanan kesehatan

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Component 2:National Competency-based examination to

produce certified graduates from medical

schools

Component 3:Financial Assistance

Package for improving medical schools

Result:Increase number of

health workers

Expected outcome: Sufficient amount of qualified health

workers

Problem:The graduates quality

assurance

Problem: the high demand of health service from the society

Problem:health education institutions

quality assurance

Solution:New education institutions

establishments (especially from private sectors)Component 1:

Accreditation to create standardized

quality of educational institutions

Programs and activities run by the three components are aligned to the

national program mandated by the Ministry of Education and Culture; that is to

reduce disparity in quality of educational institutions and their graduates, through

improvement of the accreditation system, competency exam and certification

systems, as well as partnerships and coaching from well-established institutions to

new growing institutions. And because the HPEQ Project has also given space for

students' participation, this is the right time to prove how the students as the

agent of change can contribute to make sustainable improvement!

Hmmm... Then what is HPEQ Student?

To support the success of the three components above, the HPEQ Project

facilitates students to be involved actively in the policy making of education

system. Because there are so many activities in the project, to make it easier to

recognize, students' programs that are facilitated by HPEQ often referred to as

HPEQ Student programs.

Student activities in HPEQ Project begins with the Indonesian Health

Professional Student Summit: Students' Role in Health Professional Education

held on 19 November 2010 at the Faculty of Medicine University of Indonesia. At

that summit, health professional student organizations made a declaration which

expressed students' commitment to take part actively in health professional

education improvement, as well as commitment to support the sustainability of

interprofessional collaboration.

Right now, student representative from 7 health professions joined the

HPEQ project to work together on the follow-up of the declaration. Some of the

activities already carried out are, research on health professional students'

participation in the governance of health professional education in Indonesia, and

survey and focused group discussion (FGD) to assess the readiness of teachers and

students forIPE. This activity involved nearly 50 teachers and 200 students from

various universities. Previously, more than 6000 students have filled the

questionnaire related to the same study. This set of activities was a successful first

step to realize the concept of participation and collaboration in the improvement

of health professional education system in Indonesia.

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Now the question is, to be able to participate in the activities of the HPEQ

Project, is there any special procedure? Do I have to be the representative of

student organizations first? Do I have to pay the registration fee? Is there any

member-get-member system? Or do I have to send an SMS like REG <space> JOIN?

Of course not! HPEQ Project is not a multi level marketing business.

HPEQ Project is neither an exclusive group who works only with certain

students.

“Where should I look for information about HPEQ?”

To know more about HPEQ Project and HPEQ Student, you guys can

ask your student organization representatives or education coordinators in

your campus.

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Another way? Just Google it or go to the next page and read this book until

the end ;)

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To find out more about HPEQ, youcan go to www.hpeq.dikti.go.id &

www.worldbank.org/indonesia

““

Optimism is the faith that leads to achievement, nothing can be done without hope and confidence.

-Helen Keller

““

Small things make perfection, but perfection is no small thing.

-Sir Frederick Henry Royce, pioneering car manufacturer of the Rolls-Royce company.

ow that we have reached this chapter, perhaps we think, “Although seems simple, turns out d o i n g p a r t i c i p a t i o n a n d collaboration is not as easy as we thought...”

N

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That is correct! This is a very long, long road and the results will not come instantly. However, don't let these facts bring us down.

So this is what we can do within the next 30 minutes!

Start writing. It does not have to be a long, serious essay. But it is a good way to keep our ideas in a piece of paper, or a draft in your e-mail. Whenever we have time, we can develop those ideas. Remember, unheard ideas are plain wastefulness. Nowadays, there are easy access to social media and places to share. Writing is a good way of aspiration conveying.

Yo u h av e y o u r i d e a s w r i t t e n a l r e a d y ? S e n d t h e m a w ay t o contact@hpeqstudent.org !

Follow us @hpeqstudent on twitter and get yourself updated with the latest issue on Indonesian health education!

Not a twitter user? Visit HPEQ website at ! Provide us your input and feel free to join the discussions!

Take a visit to websites that are written in this book. Broaden our knowledge on education system!

Spread this information! The more students who are aware of the concept of collaboration, participation, and HPEQ Project, we are getting closer to reaching our goals!

“That's it? Will my actions ever give a positive impact? I don't feel like I have contributed enough to the health professional education system in our beloved country...”

If human beings never have faith in themselves, we should have gone extinct million years ago, just like the dinosaurs. Put aside all the negativity. As the young generation, we still have a lot to do. No matter how hard it is to fight for our idealism, we should believe that every genuine effort we give in, no matter how small, is going to make a positive change in the future. So don't give up, let's work it out together!

http://hpeq.dikti.go.id

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2

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“ “One generation plants the trees, and another gets the shade

-Chinese proverbs

ay! This is the kind of response that we are waiting for! The book you are holding now is made to build critical thinking and awareness of health professional students towards their education

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With all the limitation of time, energy, and resources, this book surely has flaws here and there. That is why the book is designed with a unique concept of “growing the seed”, meaning that it is prepared to keep improving as a guide for students to enchance the quality of their education system. We hope this book is getting a lot of improvement from the readers within the upcoming years, and continues to give something positive even when HPEQ Project has ended.

Therefore, we are very happy if any of you could be inspired and encouraged to make this book better. So don't hesitate to contact us, send your ideas, and make some changes!

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list ofabbreviations

ACKNOWLEDGEMENT

We, the team of writers:

1. Lhuri D. Rahmartani (medical doctor, Universitas Indonesia)2. Samuel Josafat Olam (medical doctor, Universitas Indonesia)3. Puspita Hapsari (medical student, Universitas Indonesia)4. Yosephine D. Hendrawati (pharmacy student Universitas Sanata Djarma)5. Gentur Adiprabawa (nutrition student, Universitas Gajah Mada)6. Vera Rakhmawati (nursing student, Universitas Indonesia)7. Rufita Ismu Astania (medical student, Universitas Gajah Mada)

Would like to thank:

1. Illah Sailah (Project Manager)2. Arsitawati P Raharjo (Executive Secretary)3. Aprilia Ekawati Utami (Research and Development Team)4. HPEQ Student team 5. Representatives of health professional: CIMSA, ISMKI, ILMIKI, PSMKGI, IKAMABI, ISMAFARSI, ISMKMI, dan ILMAGI6. Everyone who has contributed to the development of this book

REFERENCES