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Clerkship Bedah

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    To study the phenomenon of disease without books is to sail an uncharted sea,

    while to study books without patients is not to go to sea at all(Osler, 1903)

    THE STRUCTURE OFBEDSIDE TEACHING

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    Weekly activity

    Mon Tue We Thu Fri Sat

    07.00 08.00 PretestPreround on

    patients

    Preround on

    patients

    Preround on

    patients

    Preround on

    patients

    Preround on

    patients

    08.00 09.00

    BST CRS BST CSS

    Grand rounds

    BST RPS09.00 10.00

    10.00 11.00 Out patients clinic

    Ward activity Ward activity Out patients clinic

    11.00 12.00

    12.00 13.00Meeting with chief

    of department

    13.00 14.00

    14.00 - Night shifts

    BST = bedside teaching; CRS = case report session

    CSS = clinical science session; RPS = resource person session

    Example 1

    Example 2

    http://g/Mini%20CEX/shands_activity_schedule.pdfhttp://g/Mini%20CEX/va_activity_schedule.pdfhttp://g/Mini%20CEX/va_activity_schedule.pdfhttp://g/Mini%20CEX/shands_activity_schedule.pdf
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    Bedside Teaching

    Ideal setting for

    Demonstration of Physical findings

    Interviewing

    Developing interpersonal skills Teacher, Trainee & Patient

    interaction

    Role-modeling

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    KEY STRATEGIES IN BEDSIDE TEACHING

    PRE-ROUNDS PREPARATIONPLANNING

    ORIENTATION

    ROUNDS (20) INTRODUCTIONINTERACTION

    OBSERVATION

    INSTRUCTION

    SUMMARIZATION

    POST-ROUINDS (100) DEBRIEFINGFEEDBACK

    REFLECTION

    PREPARATION

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    Case Analysis :

    Problem Hypothesis Mechanism Moreinfo

    Dont

    knowLearningissues

    Problem

    solving

    Decision

    Making:

    Diagnosistreatment

    FINALOBJECTIVES

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    Tingkat Kompetensi

    Akuisisi

    observasi tindakan

    Membantu sejawat melakukan tindakan Kompetensi

    Melakukan tindakan di bawahpengawasan langsung supervisor

    Melakukan tindakan dalam supervisiindirek

    Profisiensi

    Melakukan tindakan secara mandiri

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    Tutorial 1 (PBL)

    One or two

    students clerkthe patient ontheir own andpresent the

    findings to theirgroup inabsence of apreceptor

    Step One

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    Tutorial 1 (PBL)

    Group discuss theproblem and doself / group study tofind out information

    related to learningissues

    Step Two

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    Tutorial 2 (PBL + PBT)

    Students meet

    their preceptor andmake formalpresentation and

    go throughlearning issues.

    Step Three

    Preceptor, who is an expert clinician, will act as a facilitator and

    teacher, as and when appropriate

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    Case Report Session

    Discussions on patients who have been

    seen in previous contact (in BST)

    Discuss specific diseases /conditions

    according to the modules

    Preceptor guides the learning process

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    Clinical Science Session

    Discuss scientific issues related to topics chosenor assigned to a student or a group of students

    Enhances EBM practice in solving clinicalproblem

    Things to be discussed within 2 hours ofmeeting: Discuss previous learning issues (30 minutes)

    Presentation of new topic + discussion (1 hours) Generating next learning issues (15 - 30 minutes)

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    Resource Person Session

    Important topics related to the department

    Given by the experts

    First RPS can be used by the chief ofdepartment to emphasize the importance of

    knowing certain topics chosen in dealing with

    patients in the setting of primary health

    care/family medicine

    Encourages active participation of students

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    Activity Duration/week Duration in3 weeks

    Duration in9 weeks

    Bedside

    teaching

    3 x 2 hours 18 hours 54 hours

    Case report

    Session

    1 x 2 hours 6 hours 18 hours

    Clinical

    ScienceSession

    1 x 2 hours 6 hours 18 hours

    Expert

    session

    1 x 2 hours 6 hours 18 hours

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    Mini Clinical Examination

    Exercise (Mini-CEX)

    ABIM developed and validated the clinical exercise

    (CEX) as a method of assessing residents history

    taking and physical examination skills

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    Mini-CEX forms

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    The attending evaluates the students history andphysical examination, clinical judgment, humanism, andoverall clinical competence as a student, using thestandardized mini-CEX form

    The form uses a standardized nine-point scale :

    - 1-3(unsatisfactory)

    - 4 (marginal)

    - 4-6(satisfactory)

    - 7-9(superior)

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    Conclusion :

    The benefits of the mini-CEX :

    - skills are evaluated in a short time

    - the students will receive a feedback

    - could be used for observing the student at

    the bedside, hear the students assessment

    - low cost

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