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      Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum

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          Abstract

          Background

          According to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care) were adequately transferred from the expected curriculum to implemented curriculum and teaching process.

          Methods

          Discourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care.

          Results

          Text analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives.

          Conclusions

          There is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used.

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          Most cited references8

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          The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching.

          To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum. Semistructured interviews with individual students. One medical school in the United Kingdom. 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame. Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training. Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years. Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.
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            The ecology of medical care revisited.

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              Growth of medical knowledge.

              Knowledge is an essential component of medical competence and a major objective of medical education. Thus, the degree of acquisition of knowledge by students is one of the measures of the effectiveness of a medical curriculum. We studied the growth in student knowledge over the course of Maastricht Medical School's 6-year problem-based curriculum. We analysed 60 491 progress test (PT) scores of 3226 undergraduate students at Maastricht Medical School. During the 6-year curriculum a student sits 24 PTs (i.e. four PTs in each year), intended to assess knowledge at graduation level. On each test occasion all students are given the same PT, which means that in year 1 a student is expected to score considerably lower than in year 6. The PT is therefore a longitudinal, objective assessment instrument. Mean scores for overall knowledge and for clinical, basic, and behavioural/social sciences knowledge were calculated and used to estimate growth curves. Overall medical knowledge and clinical sciences knowledge demonstrated a steady upward growth curve. However, the curves for behavioural/social sciences and basic sciences started to level off in years 4 and 5, respectively. The increase in knowledge was greatest for clinical sciences (43%), whereas it was 32% and 25% for basic and behavioural/social sciences, respectively. Maastricht Medical School claims to offer a problem-based, student-centred, horizontally and vertically integrated curriculum in the first 4 years, followed by clerkships in years 5 and 6. Students learn by analysing patient problems and exploring pathophysiological explanations. Originally, it was intended that students' knowledge of behavioural/social sciences would continue to increase during their clerkships. However, the results for years 5 and 6 show diminishing growth in basic and behavioural/social sciences knowledge compared to overall and clinical sciences knowledge, which appears to suggest there are discrepancies between the actual and the planned curricula. Further research is needed to explain this.
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                Author and article information

                Journal
                Asia Pac Fam Med
                Asia Pacific Family Medicine
                BioMed Central
                1444-1683
                1447-056X
                2011
                25 April 2011
                : 10
                : 1
                : 4
                Affiliations
                [1 ]Department of Medical Education, Faculty of Medicine, Gadjah Mada University, Jalan Farmako, Sekip Utara No 1, Grha Wiyata Building 3rd floor, Yogyakarta - Indonesia
                [2 ]Faculty of Medicine, Gadjah Mada University, Jalan Farmako, Sekip Utara No 1, Radiopoetro Building 1st floor, Yogyakarta - Indonesia
                [3 ]Department of Family and Emergency Medicine, University of Iowa, Carver College of Medicine, USA
                [4 ]Institute for Education, Faculty of Health and Life Sciences, Maastricht University, The Netherlands
                Article
                1447-056X-10-4
                10.1186/1447-056X-10-4
                3111348
                21513582
                134e61c4-cc7b-49ce-8f18-6b7ae19a93cb
                Copyright ©2011 Claramita et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 January 2011
                : 25 April 2011
                Categories
                Research

                Medicine
                patient-centered care,continuous care,comprehensive care,discourse analysis
                Medicine
                patient-centered care, continuous care, comprehensive care, discourse analysis

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