“Internship” Dokter &

Peran Organisasi Profesi

Kedokteran

Sukman T Putra, SpA(K),FACC,FESC

MPPKIkatan Dokter Indonesia

PIT2 PDUI 2011

Pendidikan:

Dokter Umum – FK.UI 1977

Spesialis Anak – FK.UI 1987

Ped.Cardiology Fellow, Children’s Hosp.Melbourne,Australia, 1990-1991

Fellow of American College of Cardiology (FACC) - 2003

Fellow of European Society of Cardiology (FESC) – 2004

Organisasi:

Ketua Umum Pengurus Pusat Ikatan Dokter Anak Indonesai ( IDAI )

Wakil Ketua Umum II Pengurus Besar Ikatan Dokter Indonesia ( IDI )

General Secretary ASEAN Pediatrics Federation

International member of American Academy of Pediatrics (AAP)

Council member Asia Pacific Pediatric Cardiology & Pediatric Cardiac Surgery Society

Curriculum Vitae

Dr. Sukman Tulus Putra,SpA(K),FACC,FESCKepala Divisi Kardiologi,Dep Ilmu Kes Anak FK.UI/RSCM Jakarta

Patients need Good Doctors•Care of their patients their

first concern•Keep their knowledge andskills up to date

•Maintain goodrelationships with patients & colleagues

•Honest & trustworthy•Act with integrity

PIT2 PDUI, 2011

Professionalism&

Medical Association

MEDICINE is, in essence, a moral enterprise, and its professional

associations should be built on ethicallysound foundations.

At very least, when physicians form associations,such occasions should promote the interest of those they servePellegrino ED. JAMA 1999;282(10):984-986

Professionalism &

Medical Association

This, sadly has not always been the

case.

When economic, commercial and political agendas so often take

precedence over ethic obligation.

Pellegrino ED. JAMA 1999;282(10):984-986

Medical Association......When physicians form associations, they should make this promise collectively..............................Whithout such commitment, they are

easily degenerate into self-serving

trade association, lobbies or unions

OUTLINE

What is doctor & what does doctor do? Professionalism in Medicine Internship in Medicine The Role of Medical Association Medical Internship in Indonesia Summary

• MEDICINE is more than the sum of our knowledge about disease.

• Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moment of fears, anxiety and doubt….

Stern DT. Measuring Medical Professionalism (2006)

PIT PDUI, 2011

A century ago :

“ the role of doctors was clear & simple”

…to acquire facility in the art of diagnosis

… to grow in clinical judgment

… to appreciate the relative value of symptoms

and the physical signs

… to give the patients and his friends the

forecast or prognosis

… to conduct the treatment that the patients

may be restored t health

What is a Doctor &

What does a Doctor do ?

Prof. William Osler (Oxford)

MJA 2005;183:560-561

What is a Doctor & What does a Doctor do ?

MJA 2005;183:560-561

One hundreds years on…....... ..........Things has changed

7 Physician Role

Medical Experts Applying medical knowledge, clinical skills & professional attitude

Communicators Fascilitating effective doctors-patients relationship

Collaborators Achieve optimal patients care by effective tem work

Managers Contriobuting in health care organization and the effcetive health care system

Health Advocators Influencing advancement of health and well being individuals, communities,population

Scholars Demonstrating lifelong commitment of learning, application & translation medical knowledge

Professionals Applying ethical practice, profession led-regulation,high personal standards of behavior

CanMEDS physician competency framwork (2005)

Doctors are often

portrayed as:

• Poor communicators

• Arrogant

• Defensive

• Too quick to use jargon

• Resistant to change

• Self-interested

• Operating in an exclusive

• Highly paid club culture Doctors in Society :

Medical Professionalism in changing world

Royal College of Physicians (2005))

What is a Doctor &

What does a Doctor do ?

The medical profession is built

around a networks of relationships

created between the doctor and “other

people” not only “sick people”

Not all who visit DOCTORS are sick or PatientsDOCTORS always remain for EVERYONE

The Good Doctor ( 2002 )

What is Profession?

An occupation whose core elements is work, based of mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning , or practice of an art founded on it is used in the service of others.

Its members profess a commitment to competence, integrity, morality ,altruism and the promotion of public goods within their domain

What is

Professionalism?

People think of professionalism in three main

ways :

the mastery of technical knowledge and skills

strong ethical principles and values such as

honesty, respectfullness and reliability

notions of calling of service, in which altruism

comes before anythings else

Measuring Medical Professionalism (2006)

Professionalis

m in Medicine

Physician

Patient

• Proffessional competence

• Legal and ethical conduct

• Adequacy of access

Lawyers

And

Courts

• Proffessional competence

• Legal and ethical conduct

• Adequacy of access

Professional

Associations

• Proffessional competence

• Legal and ethical conduct

• Adequacy of access

• Public health promotion

Hospitals

• Proffessional competence

• Legal and ethical conduct

• Financial performance

Managed

Care Plants

• Proffessional competence

• Legal and ethical conduct

• Financial performance

Investors

• Financial performance

Employers• Proffessional competence

• Financial performance

Private

Payerrs

• Proffessional competence

• Financial performance

Government

• All six domains

Accountability of the physician

Modified from Emanuel, E. J. et. Al. Ann Intern Med 1996;124:229-239

Professionalism &Medical Association

Medical Association

.....Association should be aware of the

dangers of focusing attention on

the economic concerns of their

members at the expense of their of moreimportant public and professionalresponsibilities.................

Pellegrino ED,RelmanAS. JAMA 1999;282(10):984-986

The Role Medical

Professional

Organization

Education

Licensing

Regulation

Representation

Academic VS Professional

BASIC Medical Education(S Ked)

DOCTOR of Phylosophy(PhD) /S3

Master ofMEDICINE (S2)

Medical Doctor(MD)

Inernship in MEDICINE

Residency( Specialty)

Fellowship(SUB-Specialties)

What is “Internship” in Medicine ?

A transitional training period for newlygraduated doctors starting their carreers.(1940)

One-year in different clinical placement “Interns” as active learners, practice based

learning.

Physician in training who has completed medical school but

DOES NOThave full license to practice

Medicine unsupervised

Education

Educational standards andcurriculum : undergraduates(medical students, internship andresidency training)

Continuing medical education(CME) and continuing professionaldevelopment (CPD)

Licensing

For practice of medicine in theareas of expertise

The requirement for licensuremay vary significantly by countryor region.

In some countries separate licenseis required in each region

The Challenges ofMedical Associations at Present

Explosion technology

Changing marketForces

Problems in healthcare delivery

Globalisation

Bioterrorism

Medical professinalism in millenium : a physician charter, MJA (2002)

Health Care in theLate 19th and 20th Century

Patients MedicalAssociations

Physician

Emmanuel EJ. What is accountability in health care.Ann Intern Med.1996;124:229-239

A set of Professional Responsibilities

1. Professional competence2. Honesty with patients3. Patients confidentiality4. Mainataining appropriate

relationship with patients5. Improving quality of care

Commitment to:

Maintaining Trustby managing Conflict of Interest

Threatening personal- organisation ineraction with for-profit industries (pharmaceutical, devices company)

Physician have an obligation to recognize, disclose to general public, and deal with

conflict of interest that arise in the

course of their professional

INTERNSHIP DOKTER di INDONESIA(2009)

Stakeholder : Departemen Kesehatan Institusi Pendidikan Kedokteran KD/KDDKI (IDI) RS Pendidikan

Penyelenggara:• Komite Internship Dokter Indonesia(Pusat dan Propinsi)

School of Medicine

Professional

Medical

Education

CME/CPD

The Role of Perofessional Medical Association

Tujuan INTERNSHIP

Memberikan kesempatan kepada dokterbaru, lulusan Program Studi PendidikanProfesi Dokter berdasarkan kurikulumberbasis komtensi (KBK)

Menerapkan serta mempraktikkankompetensi yang diperoleh selamapendidikan dalam rangka penyelarasanantara hasil pendidikan dan praktekdi lapangan

Wahana Pelayanan Kedokteran

Dilaksanakan di wahana pelayanankesehatan primer (pemerintah/swasta)yang telah memenuhi syarat internship

Rumah Sakit Puskesmas :dengan atau tanpa perawatan Klinik layanan primer lainnya

Pendampingan

Setiap peserta ‘internship” mendapatpendampingan/ disupervisi olehseorang dokter yang memenuhi kriteria:• Bersedia menjadi pendamping internship• Masih praktik aktif minimum 2 tahun

dengan rekam jejak yang baik• Memiliki SIP yang masih berlaku• Telah mengikuti pelatihan menjadi

pendamping.

Permasalahan/Kendala Kewenangan dokter ‘intern” dalam hal

penanganan pasien perlu diperjelas. Interaksi antara dokter “intern” dan dokter

spesialis yang ada belum berjalan baik, sehingga transfer of knowledge &skills tidakoptimal.

Peran dokter pendamping perlu diperjelastermasuk rewards

Proses administratif (penerbitan STR dan SIPsementara lambat. Tempat tinggal tidakdisediakan oleh RS wahana

Permasalahan/Kendala

Peran KIDI (Komite Internship Dokter Indonesia)di tingkat propinsi kurang berperan

IDI Wilayah di beberapa tempat belummengambil peran yang optimal, bahkan terkesanmempersulit dalam rekomendasi SIP/STR ?

RS wahana belum mersakan pentingnyakehadiran dokter “intern” dalam peningkatankualitas pelayanan kesehatan.

MASALAH/

TANTANGAN

DOKTER

INDONESIA

GLOBALISASI

UUPKUUSISDIKNAS

TRUST

MENURUN

AKB/AKAB

TINGGI

PENDIDIKANDU/Spes.

SISTEM YANDOK

KESEJAHTERAAN

DESENTRAL-

ISASI

MASALAH/ TANTANGAN YANG KITA HADAPI SEKARANG

UU RSUU KES.

Kesimpulan & Saran

“Intership” merupakan proses pendidikanprofessional yang penting bagi sorang dokterdalam meniti jenjang karir di masa depan.

Oleh karena ‘internship” adalah suatu sistemjenjang pendidikan profesi yang berlaku globalmaka perlu segera diadakan evaluasi untukperbaikan oleh pemegang otoritas masalah ini.

Peran Perhimpunan Profesi (ditingkat cabang/wilayah) perlu ditingkatkan dalam pembekalanpengetahuan dan keterampilan dokter ‘intern”