“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”
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