MODUL CFHC-IPE TAHUN III Mahasiswa Semester 5 Angkatan 2014

COMMUNITY AND FAMILY HEALTH CARE
WITH INTERPROFESSIONAL EDUCATION
cover
CFHC-IPE MATERIAL BOOK
YEAR 3
SEMESTER 5 - 6
Year 3 topic: WELL-PREPARED VILLAGE
(KELUARGA SIAGA)
Focus of study :Reducing maternal and infant mortality risks and increasing life expectancy
Specific ability :Community Diagnosis and Program Planning The Shares Information and
Shared Decision Making Community Empowerment
Community and Family Health Care Program- Interprofessional Education (CFHC-IPE)
Faculty of Medicine
UniversitasGadjahMada
Yogyakarta
2016
1
KONTRIBUTOR
Dra. RA YayiSuryoPrabandari, M.Si, Ph.D dr. Mora Claramita, MHPE, Ph.D

Department of Public Health Department of Medical Education
Faculty of Medicine UGM Department of Family, Community
Medicine and BioethicsFaculty of
dr. Hikmawati Nurrakhmanti, M.Sc. Medicine UGM
Department of Family, Community
Medicine and Bioethics dr. Aghnaa Gayatri, M.Sc.
Faculty of Medicine UGM Department of Family, Community
Medicine and Bioethics
Faculty of Medicine UGM
Ko-Kontributor
dr. Fitriana Murriya, MPHC - Department of Family, Community Medicine and Bioethics
dr. Fitriana - Department of Family, Community Medicine and Bioethics
Tim Tahun 3
Dr. rer. nat. dr. BJ Istiti Kandarina

dr. Mahar Agusno, Sp.KJ (K)
Dr. Susetyowati, DCN, M.Kes
Akhmadi, S.Kep., M.Kes., M.Kep., Sp.Kom
Editor
Anggarjito Sugiarto Estu Prabowo, SKM

Arum Rahayu, S.Si
2
PREFACE
CFHC-IPE program is designed to stimulate undergraduate students within faculty of

medicine to understand the practice of health professionals (doctors, nurses and dieticians).
They are attached in a family as a group and advocate their health issues during their study
periods in the faculty. With this program, the students are expected to understand the
importance of continuing and comprehensive advocation in a family. When the family faces a
health issue, the students may detect the underlying cause and propose a systematic approach
to overcome the problem.
This CFHC-IPE is an interprofessional and multiple approachprogram. It needs some

essential skills as visualized in Figure 1. The three groups students from undergraduate medical
degree, nursing and health nutrition program study should perform their unique skills with
Family and community health approach. To apply those skills, the students should master some
supporting curricula: Interprofessional Education (IPE), Evidence Based Medicine (EBM),
Professional Behavior (PB), as well as Skills Lab (SL) training.
Figure 1. Matrix of CFHC-IPE program
Year Coordinator
3
CONTENTS
Contents
Cover ..............................................................................................................................................................1
CURRICULUM CONTRIBUTORS ....................................................................... Error! Bookmark not defined.
PREFACE .........................................................................................................................................................3
CONTENTS ......................................................................................................................................................4
BACKGROUND ................................................................................................................................................6
ANNUAL MATRIX CFHC-IPE ...........................................................................................................................7
ACTIVITIES ......................................................................................................................................................8
Learning Objectives: (semester 5 to 6) .....................................................................................................8
General activities .......................................................................................................................................8
LESSON PLAN .................................................................................................................................................9
Table 1. Detailed Lesson Plan Semester 5 .................................................................................................9
Table2. Detailed Lesson Plan Semester 6 ............................................................................................... 11
Table 3. Role of students and supervisors during each activities ......................................................... 12
RESOURCES ................................................................................................................................................. 13
EDUCATION AND COUNSELING ................................................................................................... 13
PedomanKomunikasi UGM ................................................................................................................. 15
PATIENT EDUCATION ...................................................................................................................... 18
COUNSELING ...................................................................................................................................... 20
SHARES INFORMATION AND SHARES DECISION SKILLS .................................................... 26
ASSESSMENT ............................................................................................................................................... 28
Table 4. Metode penilaian hasil belajar ................................................................................................ 28
Table5. Format Kajian Masalah Kesehatan Antar Profesi .................................................................... 29
Table6.Checklist Kompetensi CFHC IPE Tahun Ketiga......................................................................... 30
REFERENCE .................................................................................................................................................. 32
APPENDICES ................................................................................................................................................ 34
Appendix 1. General PPT format ............................................................................................................ 34
Appendix 2. Portfolio Assessment ......................................................................................................... 35
Appendix 3. Portfolio Format ................................................................................................................. 37
Appendix 4. Checklists of Inter-professional Education ........................................................................ 38
Appendix 5. Feedback card/form ........................................................................................................... 40
4
Appendix 6. Skenario tutorial C1 C6 berbasis kegiatan di komunitas (kegiatan CFHC-IPE) .............. 47
Appendix 7. Tutor-guide for Scenario which was based on community settings (CFHC-IPE settings) 55
Appendix 8. Form Penilaian Hasil Observasi ......................................................................................... 59
Appendix 9. Tools Kajian Integrasi IPE ................................................................................................... 60
Appendix 10. Ringkasan Alur Kegiatan dan Laporan Mahasiswa ......................................................... 66
5
BACKGROUND
There is an outgrowing health issues around community problems such as the high
prevalence of infectious as well as non communicable diseases such as diabetes and
hypertension. Those diseases need a collaborative management from not only the doctors but
also the nurses and dieticians.
Faculty of Medicine UGM has three undergraduate health study programs: undergraduate
medical degree, nursing program and health nutrition program. With the CFHC-IPE program, we
expect that those students could perform and train their interprofessional collaboration in the
community.
The aims of CFHC-IPE Semester 5 to 6:

1. The students can establish a hypothesis of the family as well as community health
problem
2. The students can propose a health problem solving for example: education, advocation,
health promotion and prevention
3. The students can understand and analyse the health system within community
6
ANNUAL MATRIX CFHC-IPE
YEAR 1
- Example of care study: water and sanitation
Healthy Family - Students introduce themselves to their attached community
Year 2
- Example of case study: the danger of smoking habits
Community health awareness - Students identify the health risk in the family and community
- Students can perform a simple health promotion
Year 3
- Example of case study: maternal and child problem
Alert and well-prepared village - Students assess a more individual problem, plan a simple
individual health conseling and evaluation
Year 4
- Students identify any possible problem during disaster event
Disaster awareness - Students propose a disaster simulation and community training
7
ACTIVITIES
Learning Objectives: (semester 5 to 6)

1. Students can learn and perform communication skills in community setting
2. Students are able to perform a screening and discussion about non communicable
diseases comprehensively and interprofessionally
3. Students are able to perform an informed dan shared decision making process
4. Students are able to perform an advanced intervention with 5A Phase: Assist dan
Arrange Follow up
5. Students can draw a tutorial case
General activities
1. Lecture
a. Overview of CFHC in semester 5
b. Guideline to think select the major problem within family/personal health
Time allocation: 100 minutes
2. Practical work
Covers these topic of discussions:
a. ASK: Health problem exploration done together with community (dasawisma,
RT/RW,PKK) using various types of methods, such as:
PRA Method (Participatory Rural Appraisal)
Rapid Assessment Procedure
b. ASSESS:priorities the problems together with individu/family/community,
c. PLAN / ADVICE: Plan shared activity by involving the community (emphasizing
the shares information and shares decision with individual or community)
d. ASSIST: Assist the activity by involving the community
e. ARRANGE FOLLOW UP / MONITORING PROGRAM
3. Fieldwork
a. Applying Screening on Non-communicable disease within community
b. Discussion of changing health behaviour using 5A guidelines
4. Feedback session
a. Faculty lecture feedback
b. Fieldwork feedback
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LESSON PLAN
For detail information in each activity (ASK-ASSESS-ADVICE-ASSIST-ARRANGE FOLLOW UP) please refer to these following tables:
Table 1. Detailed Lesson Plan Semester 5

Block Activities Detailed Activites Time Allocation Location
Lecture Overview of CFHC in Semester 5 100 minutes On campus
Practical work Case identification guided with faculty 100 minutes On campus
supervisors/facilitators (Guideline ASK-
ASSESS-ADVICE)
Dalam rangka mengklarifikasi ulang
pengamatan faktor risiko, mahasiswa
membuat persiapan kunjungan lapangan :
kegiatan, kapan dilaksanakan, periapan apa
yang harus disiapkan, bahasan apa yang
harus digali lebih tajam.
Fieldwork Attachment in Family/Community using 5 A 200 minutes Community
C1 guide: ASK & ASSESS
In Family :
Masing-masing mahasiswa mengklarifikasi
kembali hasil pengamatan faktor risiko di
tahun 2.
Feedback Presentation with fieldwork supervisor (DPL) 50 minutes Puskesmas / Family
doctors clinics
Presentation with Faculty supervisor (DPF) 50 minutes On Campus
Laporan hasil temuan dikeluarga terkait
faktor risiko, menentukan 1 kasus (PTM) di
kelompok, membuat persiapan eksplorasi
secara IPE
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guide: ASSESS
Bersama-sama dengan kelompok melakukan
eksplorasi secara IPE dikeluarga terpilih
C2 doctors clinics
Presentation with faculty supervisor (DPF) 50 minutes On Campus
Mendiskusikan hasil eksplorasi IPE (tools
kajian integrasi IPE) dan merencanakan
bentuk intervensi yang tepat

guide: ADVICE
Melakukan intervensi sebagai tindak lanjut
dari hasil penelusuran kasus di keluarga
terpilih
C3 doctors clinics
Kajian antar profesi kesehatan terjadwal 50 minutes On Campus
mandiri berbasis panduan IPE (tools kajian
integrasi IPE) melibatkan kelompok lain
yang satu wilayah (RT/RW atau Tingkatan
yang lebih tinggi)
Final report and Presentation and evaluation with faculty 100 minutes On campus
evaluation supervisor (DPF)
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Table2. Detailed Lesson Plan Semester 6
Block Activities Time Allocation Location
Lecture Overview of CFHC in Semester 6 100 minutes On campus
Practical work Case identification guided with faculty 100 minutes On campus
supervisors/facilitators
Fieldwork Attachment in Family/Community using 5 A guide 200 minutes Community
: ADVICE
Kelompok mahasiswa melakukan FGD bersama
C4
masyarakat menentukan intervensi di komunitas
(mengacu pada masalah prioritas dikomunitas)
doctors clinics
Fieldwork Attachment in Family/Community using 5 A guide 200 minutes Community
: ASSIST
Kelompok mahasiswa melalukan intervensi
C5 komunitas (pengabdian masyarakat)
doctors clinics
guide: ARRANGE FOLLOW UP
Kelompok mahasiswa memberikan follow up
terkait intervensi yang sudah dilakukan. (Evaluasi
dari kegiatan intervensi)
C6 Feedback Presentation with fieldwork supervisor (DPL) 50 minutes Puskesmas / Family
doctors clinics
Kajian antar profesi kesehatan terjadwal mandiri 50 minutes On Campus
berbasis panduan IPE (Poster)
Final report and Presentation and evaluation with faculty 100 minutes On campus
evaluation supervisor (DPF)
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Table 3. Role of students and supervisors during each activities
Campus Activities Activities during fieldwork
No
Role of faculty supervisors Students Task Role of fieldwork supervisor Students Tasks
Facilitate students Write diary on reflection forms Facilitate observation process Follow approval of
reflection process provided after field visit for five of GMU students concerning attendance schedule, by
1 concerning medical learning phase: ASK-ASSESS-ADVICE- real community health fulfilling target
in primary care setting ASSIST-ARRANGE FOLLOW UP problems based on approval of
attendance
Facilitate reflection using Discuss reflection in discussion Allow students to join for 1. Join and participate
constructive feedback session with faculty supervisor example, PHC programs or NGO activities suggested by
emphasized the informed on campus programs related with health field instructor
and shared decision making promotion individually or in
skills (ASK-ASSESS-ADVICE- together with
2 ASSIST-ARRANGE FOLLOW community members
UP) 2. Propose a program of
educating the
patients/ community
in which have a high
sustainability
Discussion, feedback and Receive feedback reflectively Facilitate students reflection Receive feedback
reflection as scheduled with (understand their positive sides verbally concerning real responsively (understand
3
faculty supervisor on and those that need to be community health problems local community needs)
campus improved)
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RESOURCES
EDUCATION AND COUNSELING
The Shares Information and Shares Decision Making Skills

with a Community Based Approach
Mora Claramita
YayiSuryoPrabandari
Third year students should have an ability to educate and counsel the patients by applying
shares information and shares decision-making skills. One of way is to DISCUSS the care-plan
with patients. However, many facts prove that students communication skills capacity, are
limited on cognitive aspects rather than application. Students inflexible communication affects
their professionalism. Students usually focus on diseases perspective rather than
communicating with the patients. Moreover, so far, skills lab has limitation in providing
opportunities for students to engage in real setting directly. Direct exposure to community has
been proven in many studies to improve knowledge transfer mechanism into an applicable,
flexible and professional competence (Dornan et.al, 2010). Therefore, a community based
approach is used to introduce students in learning education and counseling skills by discussing
with the patients, involving the patients perspectives, sharing information and sharing clinical
decision making with patients (individual, family or community).
13
Targets:
Students explores individual/ family/ communitys health problems through

series of self introduction, ask and assess methods in the real learning settings.
For detail skills please refer to UGM doctor-patient communication skills guideline in
Tabel 1:
THE GREET AND INVITES rows.
Targets:
Students shared decision with individual/ family/ community about a particular

health problem that needs intervention of series of advices, assist and arrange
follow up methods.
For detail skills please refer to UGM Doctor-Patient Communication Skills Guideline in
Tabel 1:
THE DISCUSS row.
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Pedoman Komunikasi UGM
(SAPA AJAK BICARA DISKUSI)
Taken from: Claramita M, Susilo AP, Kharismayekti M, Van Dalen J, Van der Vleuten
C.Introducing a partnership doctor-patient communication guideline to teachers in a culturally
hierarchical context of Indonesia.Educ for Health 2013; 26 (3): 147-55
Deskripsi Isi
LatarBelakangBudaya KeterampilanKomunikasi yang
Struktur KetrampilanKomunik KeterampilanKomunikasi
Indonesia sebaiknyadiperkuat
asi
SAPA Kemampuanmembinas 1. Menyapadanmenyambutpasien Pasien di Indonesia baik Kemampuan untuk menyapa dan
ambung rasa denganhangat yang dari kalangan pendidikan menyambut pasien seperti anggota
danhubungan menunjukkanperhatianterhadap tinggi maupun rendah, keluarga sendiri (dengan memperhatikan
masalahkesehatannya
interpersonal yang secara umum hubungan antar keluarga sesuai masing-
2. Menggunakan kata-kata yang
dilandasiperhatiandank memperlihatkan perhatian mengharapkan masing budaya daerah) dengan harapan
einginanuntukmenolon secara verbal kedudukan yang setara agar lebih akrab dengan pasien.
Kepercayaandan gmasalahkesehatanpa 3. Menunjukkan sikap dan bahasa dengan dokter.
rasa sien - selama proses tubuh alamiah yang Dokter perlu bersikap Semanak
nyamandaripasie konsultasikesehatanbe memperlihatkan perhatian Prinsipberikutdianut: (Friendly - disesuaikan budaya
n yang rlangsung secara non-verbal setempat):Ibu, Bapak, Mas, Dik,
didapatkandari 4. Melakukan obervasi dan Kesetaraan
- (Iragiliati, 2006)
merespon pernyataan pasien - Kepercayaan
proses sambung
(verbal dan non-verbal) - Komunikasiduaara
rasa mengenai perasaannya dan Nama panggilan sesuai yang diinginkan
dengandokter, h
harapannya. Hal ini dilakukan pasien perlu disebutkan sebagai
akanmendorongp sebagai kontrak awal agenda klarifikasi.
asienuntukmence pertemuan hari ini.
ritakankeluhanny 5. Melakukan refleksi atas harapan
asecaraterbuka. pasien
AJAK BICARA Kemampuan memulai 1. Mempersilakah dan Biasakan menggali Eksplorasi yang baik dapat menggali
dan menstruktur memfasilitasi pasien keluhan pasien dari seluruh riwayat penyakit hanya dengan
pembicaraan tentang mengutarakan keluhannya sudut pandangnya dulu satu-dua pertanyaan terbuka.
sampai selesai (ekplorasi
masalah kesehatan (termasuk
penyakit dari sudut pandang
Ekplorasi dan pasien mengekplorasi latar Salah satu contoh ekplorasi keluhan
pasien)
observasi yang 2. Menggunakan pertanyaan belakang pasien, pasien menggunakan pertanyaan
adekuat oleh terbuka di awal keluarga, lingkungan, terbuka:
dokter terhadap 3. Menggunakanpertanyaantertutu dan budaya), kemudian
masalah puntukmengklarifikasisesuatu baru dilakukan Gimana, Pak (ceritanya)...?
kesehatan pasien 4. Menyimpulkan apa yang penggalian keluhan dari
dan latar menjadi permasalahan pasien Ada keluhan apa, Bu?
sudut pandang medis
dan mengecek kembali
belakangnya untuk klarifikasi (e.g.
pengertian/ persepsi sakit
akan membantu dengan pasien Identitas, keluhan Apa yang bisa saya bantu?
proses 5. Menggunakan pertanyaan utama, RPS, RPD,
penegakkan tambahan secara efektif RPK, RPSosial, Ax Rasanya bagaimana hari ini, Pak?
diagnosis dan 6. Menanyakan adakah masalah sistem)
rencana lain yang ingin disampaikan Datang sendiri atau ada yang
penatalaksanaan 7. Meminta persetujuan lisan/ mengantar, Bu?
Waspadai perbedaan
tertulis akan agenda konsultasi
(terapi/ edukasi) hari ini (sudah tersebut di hierarki antara pasien
dengan dokter, bahwa ( masuk ke eksplorasi keluarga)
SAPA, bisa diulangi untuk hal
yang spesifik). dokter biasanya
dipandang lebih tahu Di rumah sehari-hari..? (masuk ke
tentang suatu penyakit ekplorasi daily activity)
daripada pasien.
Oh, mengapa kira-kira bisa seperti itu,
Bu? Apa ada perubahan aktivitas?
15
(tunggu respon), Perubahan pola makan?
(tunggu respon),.. (masuk ke ekplorasi
RPS,RPD,RPK dari sudut pandang
pasien)
Memahami sudut 1. Menanyakan peristiwa Pasien di Indonesia

pandang pasien hidup, lingkungan, dan mempunyai sikap yang
terhadap penyakitnya komunitas di mana pasien sangat khas yang
tinggal yang mungkin
membutuhkan fasilitasi
mempengaruhi
kesehatannya dan bukan diabaikan
2. Menanggapi harapan pasien oleh dokter:
terhadap penyakit dan akibat
dari penyakitnya terhadap a. Keterlibatan keluarga/
kehidupannya sehari-hari masyarakat sekitar
pasien amat berperan
(Dengan catatan: bila
pasien setuju akan
keterlibatan mereka
dan bila pasien
dianggap cukup
dewasa memberikan
informasi Bukan
anak dibawah 5 tahun
dan penderita dengan
gangguan bicara/
pendengaran)
b. Pasien di Indonesia
secara umum ingin
bersikap sesopan dan
sehormat mungkin
pada dokter. Ini bukan
berarti pernyataan
Ya berarti setuju.
c. Penggunaan
obat/jamu tradisional
atau pengobatan
alternatif menjadi
suatu kebiasaan yang
sulit dihindarkan baik
di kalangan
pendidikan tinggi
maupun rendah
DISKUSI Kemampuan membagi 1. Menyamakan persepsi Selalu waspada akan Kemampuan menyamakan persepsi
informasi antara pasien dan dokter sistem hirarki di sebagai salah satu usaha bahwa dokter
Pengambilan tentang pengertian penyakit Indonesia, yang kental. ingin berada dalam satu level yang sama
keputusan klinik (Shares information) maupun rencana terapi
Dokter secara umum dengan pasien, (level informasi):
2. Penghargaan terhadap
secara bersama- dipandang lebih tinggi
harapan/ persepsi pasien
sama oleh pasien lebih lanjut (Harapan statusnya daripada Apa yang sudah Ibu ketahui tentang
dan dokter mengenai penyakit dan pasien. Hal ini membuat penyakit ini?
dengan cara akibat penyakit itu thd pasien tidak nyaman
menyamakan kehidupan pasien sehari-hari untuk berdiskusi (Nada suara tidak menyalahkan, tidak
persepsi terlebih dan masa depannya serta kembali lagi ke menguji)
harapan akan proses diskusi
dahulu diikuti kemampuan SAPA dan
dalam agenda pertemuan
dengan hari ini) AJAK BICARA
memberikan 3. Menginformasikan
penjelasan dan penjelasan sesuai standar
mendiskusikan pengetahuan dokter yang
rencana tertinggi dalam bahasa
selanjutnya awam
4. Selalu berusaha komunikasi
dua arah
Kemampuan mencapai 1. Eksplorasi segala Penjelasan yang efektif Selalu pertimbangkan partisipasi
persetujuan (bersama kemungkinan yang cocok/ untuk pasien di keluarga dalam proses edukasi pasien
antara pasien dan sesuai untuk keputusan Indonesia adalah yang: (bila pasien setuju):
klinik yang diambil
2. Eksplorasi kemungkinan
1. Mengikutsertakan
16
dokter) pasien mematuhi rencana keluarga/ Contoh diskusi antara dokter dan pasien:
terapi masyarakat sekitar
(Shares decision (Dengan catatan: Seandainya Ibu menggunakan obat
making) bila pasien setuju tradisional, mohon saya diberitahu, saya
Perkembangan lebih lanjut tentang akan keterlibatan ingin belajar lebih banyak tentang obat
shares decision termasuk mereka dan bila tradisional.. Setelah itu mungkin kita bisa
didalamnya adalah kemampuan pasien dianggap mengamati bersama sejauh mana obat
untuk cukup dewasa tradisional bermanfaat pada penyakit
untuk mengambil Ibu. (Beri kesempatan diskusi).
- Nanting keputusan Bukan
- Menyampaikan Bad-news anak-anak dan Catatan:
(misal pengobatan terus usia lanjut)
menerus untuk penyakit
kronis) Pasien yang mengatakan nderek atau
- Persuasi Kental dg 2. Waspada akan manut bisa berarti persetujuan tercapai.
stigma contoh comunal- sinyal non-verbal Tapi selalu cek non verbal dan verbal
test utk HIV lebih berhasil dari pasien yang
pasien, atas pengertian yang diterima
daripada individual test mungkin saja
kurang setuju pasien kembali ke kemampuan SAPA
- Konseling kental dengan
hub keluarga dan dukungan 3. Mendiskusikan
penggunaan obat Ingat bahwa Ya di konteks Indonesia
sebaya
tradisional bukan selalu berarti persetujuan maupun
(Kelebihan dan kepatuhan
Kekurangan harus
diketahui dan
disepakati
bersama antara
dokter dan pasien)
Kemampuanmenyeles 1. Menanyakan masalah yang Tanggapapabilapasienin Mem-verbalkan undangan untuk bertanya
aikanpembicaraan belum dimengerti pasien ginmengutarakansesuatu akan sangat membantu pasien:
dan berikan kesempatan bila (biasanyaterlihatsecara
pasien ingin menyampaikan Ada yang mau ditanyakan lagi, Bu?
non-verbal).
sesuatu
2. Menyimpulkan hasil
pertemuan hari ini dan Masih ada yang mau disampaikan, Mas?
rencana ke depan
3. Mengucapkanterimakasih Segalainformasitertulisse Kalau ada apa-apa segera kontrol/ hub
derhana saya?
(Misalpanduanuntukpend
erita DM) Menghantarkanpasienuntukkeluarruanga
akansangatmenjembatan nakanmemperjelaspenghargaandokterter
ikomunikasi verbal yang hadappasien.
terbatasantarapasiendan
dokter di Indonesia
17
PATIENT EDUCATION
Nowadays medical education has been focused on factual medical knowledge and medical
problem approach based on medical sciences. Almost all processes of study are held in
classroom, laboratory, and university network hospitals. Therefore, graduates of medical
faculty know little about common community problems and are unprepared to work in regional
areas (Magzoub, 2000). Community-based study is a way of showing complexity of health,
environment and social problems in the community. Enhancing collaboration between
community and university is necessary to find appropriate education models for students
education and society empowerment (Flicker, 2007).
Recently many medical faculties have been trying to enhance their curriculum to be community
oriented by implementing community-based education program (Kristina, 2005). This is being
tested by medical faculty of GMU. Using community-based education, at the beginning of
education process, students are exposed to community health problems (Magzoub, 2000). This
education program will assist them in enhancing their experiences, community services, and
community research. According to Davenport (2000), students knowledge will be more
meaningful when they have to deal with reality. Facing facts will enable them to help certain
community based on communitys need.
Feletty (2000) stated that community observation is a way of understanding community

problems. Students can utilize their communication skills to recognize such problems. By
community involvement, students have many opportunities to work together as a team and
apply their knowledge in real community setting, not only in a demonstration or with simulated
patient (Hamad, 2000). Recognizing communities problems, students can implement
appropriate health approach to the community (Webber, 1990) holistically and
multidisciplinary (magzoub, 2000). Moreover, students will also be able to learn local cultures
and their impacts to community health perspective when they live and work within certain
community (Hamad, 2000). Students who engage themselves in certain community can help
them learn more about health. They have lots of models to educate the community. Verbal
communication with community involvement, community discussion on certain interesting
issues, booklet, videos, all can help them understand more about health (Webber, 1990).
Community-based education has positive impacts not only for students but also for the
academic institution and primary health services. Involvement of academic institution in a
community setting help strengthening relationship among institutions, particularly medical
faculty GMU, in various areas such as government, community institutions, and international
18
organizations (Magzoub, 2000). With multidisciplinary relation, it is expected that community-
based education can contribute in the improvement of health system in Indonesia.
A study by Claramita et al, 2009 shows that some points require observation when students
conduct skills training in community setting:
Benefits
Benefits of conducting medical skills training in community setting are as follow:
1. Experiential learning enhanced awareness and reflection on patients background
2. Responsiveness of community health problems to gain their trust
3. Initiation of two ways exchange information based on patients perspective
4. Awareness and initiation of community empowerment
5. Awareness on the dilemma of using evidence-based medicine and using traditional
medicine applying negotiation skills
6. Awareness of the non-verbal atmosphere of politeness
Obstacles
Students obstacles during medical skills training in community setting are as follow:
1. Students tend to over communicate about their experiences in the community, and
carried out by their own stories lack of time to reflect on communication theories.
2. Students lack of depth in exploration. They tend to focus on statements or problems
that arise initially.
3. Students are incapable to respond others emotion
4. Students have problems in share thinking skills
5. Some believe that doctor-patient communication skills are genetic and related to
personality.
Dilemma
Dilemma between laboratory and community settings felt by students during medical skills
training in community setting.
Is health promotion part of students expectation? Community expectation? Or community

needs?
From the study, it is extremely important to provide opportunities for students to engage
directly in the community adjacent to where they study or Medical Faculty GMU.
19
COUNSELING
Introduction
Beginning in the year 1970 most people agreed that counseling is beneficial and should made
more widely available (Tyler, 1969, cit. Hershenson, Power & Waldo, 1996). Not only people in
the mental health area use counseling, but also other areas, including general health areas.
Doctors, nurses, midwives and other health providers start learning and implementing
counseling in the last three decades. As the development of customer oriented climate and
patient right, it is important for doctors to enhance their counseling skills, not only their
medical skills.
What is counseling?
The central purpose of counseling is to facilitate wise choice and decisions. However, some
professionals also give other definition, counseling can be used to promote adjustment or
mental health. To give more understanding on the definition, counseling is meant by assisting
an individual, family or group through the client counselor relationship:
To develop understanding of intrapersonal and interpersonal problems
To define goals
To make decisions
To plan a course of action reflecting the needs, interests and abilities of the individual,
family or group
To use informational and community resources, as these procedures are related to
personal, social, emotional, educational and vocational development and adjustment
What is the difference between counseling and psychotherapy?
Psychotherapy implies adherence to a medical model, which views the person seeking help (the
patient) as ill and the goal of intervention as curing that illness. Counseling, while it can have
therapeutic effects, focuses instead on promoting healthy development by assisting the person
seeking help (the client) to learn to cope effectively with problems of living. Thus, the goal of
psychotherapy is the elimination of psychopathology (phobia, severe depression or anxiety),
whereas the goal of counseling is to empower the client to achieve healthy growth
(Hershenson, Power & Waldo, 1996, page 4)
20
Counseling process
As written in the skills laboratory manual, a counseling process may summarized as GATHER:
G Greet, give warm greeting to client
A Ask. Ask clients what happened to them
T Tell. Tell client alternatives
H Help. Help client in choosing
E Explain. Explain to the client about the chosen

alternatives
R Return. Ask the client to return for follow up
21
Besides GATHER, two things that facilitate the counseling process should be considered:
C L E A R
Clarifying. Listening. Encouraging. Asking for Repeating.
Clarify the Always perform Encourage feedback. After Encourage
patient's as a good patients to you gave your patients to
problem listener express their interpretation apply the
concentrate emotions and and alternatives
Keep eye explain their alternatives, ask they choose and
contact problems patients for ask them to
their opinion return
Show interest
about your
body language
interpretation
Encourage or alternatives
client to talk
Ask client to
explain
Re check use
paraphrase
Leave your
opinion
Stay calm
R Relaxing. Maintain a relax situation when

conducting a counseling
Opening up to client, disclosure your self as

O counselor and show your honest acceptance of
the diversity
Leaning toward client. Always see to the client

L problem and show your interest and motivated
body language
E Eye contact. Establish eye contact during the

counseling process
S Smiling and sitting squarely
22
Counseling principles
The process of counseling should follow principles below:

Acceptance
Counselor should accept clients as they are, and understand the diversity
Individual
Except for the group counseling, individual counseling should implemented individually
and the client should be seen as an unique person.
Confidentiality
The confidentiality of client problem should be kept
The client is the decision maker
Counselor should let the clients to make their own decision
Emotion control
Whatever the reaction or behavior of clients, counselor should stay calm
Avoid judgment
Although client has un manner behavior, counselor should stay in the neutral way and
avoid judging the client
Communication skills that should be mastered in counseling process

Relating
Maintain a good and relax relationship between counselor and counselee
Observing
During the counseling process, counselor should observe the clients body language or
non-verbal language
Listening
As noted previously, counselor should maintain its listening behavior
Questioning
The way for asking client should perform adequately. It is suggested that counselor
should use open question
Attending behavior
Acceptance of client is important. Counselors should show their non verbal language
that show an acceptance and readiness to help
Talking
Use appropriate language and stay calm, avoid of giving judgment or blaming the client
Summarizing & paraphrasing
Sometimes counselor need to make summary or paraphrase (repeat the client talk with
your own language)
Interpreting
23
Counselors also needs to make their own interpretation of the problem or emotion of
the clients
Giving interpretation
The interpretation of the main problem and its emotion should be given to the clients.
Researches regarding counseling a smoking cessation case
Several researches have been conducted for helping the smokers to quit. Some of
them use the behavioral treatment, whereas the others use NRT (Nicotine Replacement
Therapy) (Tang, Law & Wald, 1994; Fowler, 1994) and combining of behavioral
treatment (counseling) and NRT (Gourlay, Forbes, Marriner, Pethica&Mc Neil, 1995).
Considering that stop smoking needs hardly effort, even though innovation
strategies have been conducted, some studies involving medications or combining
medications and behavioral treatments are still implemented. Fowler (1994) conducted
randomized trial using nicotine patch to help the people stop smoking. His study showed
that 19.4% out of 842 subjects, who used patches were quit at 12 weeks, compare to 11.8
% out of 844 in the placebo patch group. The number of people who were quit decreased
after 12-52 weeks, 10.8 % out of 842 in the patch group and 7.7% out of 844 in the
placebo group.
Gourlay and his colleagues (1994) added brief counseling at monthly visits besides
giving twelve transdermal nicotine for relapsed smokers. This study indicated that 6.7%
(21 out of 315 subjects) had stopped smoking compared with 1.9% (6 out of 314) allocated
in placebo. After 26 weeks the percentage of people who had stopped smoking were 6.4%
(20 out of 315), whereas in the placebo only 2.6% (8 out of 314).
Brief counseling for helping patients stops smoking an example
24
A brief counseling for assisting patients stop smoking has been developed in the USA. The
process of brief counseling as below:
ARRANGE
ASK ASSES ADVICE ASSIST
FOLLOW-UP
ASK
Take the tobacco use as vital sign (always ask smoking behavior)
Place smoking status in chart
Enter smoking status in problem list (if yes)
ASSESS
Assess the willingness of clients to stop smoking
Assess the motivation of quitting smoking
ADVISE
Praise patient for trying or planning to stop smoking
Link smoking to present symptoms/visit
Discuss health, short-term benefits
Give clear cessation message
Ask all tobacco users if we give you some help, are you willing to try to stop?
ASSIST
For those who say YES Ready to stop now:
Provide motivational and self-help
Map out plan with patient
Set date for stopping
For those who say NO Not ready to stop
Provide motivational literature
Ask about barriers to stop
Encourage reconsideration in future; offer ongoing support
ARRANGE FOLLOW UP
Mention that you will follow up at next visit
Arrange follow-up date for those ready now as appropriate
Telephone/personal contact on quit date
Final remark
Counseling is one of communication skills. For mastering this counseling skill, students should
practice and practice. Use your day life social interaction as a field for practicing. Helping
friends problem is one example to practice your counseling skill. Enjoy your practice, good luck!
25
SHARES INFORMATION AND SHARES DECISION SKILLS
The goal of Patient Education and Counseling skills is the SHARES INFORMATION AND SHARES
DECISION skills with patients (individual, family or community). We should remind ourselves
that doctor-patient communication does not stop after the information is delivered by the
doctors. This should be two-way communication as we have learned during the Active Listening
skills in Block 1.1. The two-way communication in which involve discussion with the patients
should be maintained during the whole consultations until a care-plan was decided and agreed
by the doctors and the patients. Most of medical compliance increases when the patients
understood the background of a clinical decision making. The shares information and shares
decision skills is vital when it comes to chronic diseases such as diabetes mellitus, hypertension,
asthma, or tuberculosis that needs extra cooperation from the patients to maintain their health
condition. It is the central duty of general practitioners to help the patients preventing their
chronic diseases from falling into further levels of prevention in the natural history of
diseases. This is the fundamental reason why education and counseling skills as well as health
promotion skills is necessary for general practitioners to be.
The shares information and shares decision making skills is not only useful for chronic diseases
but also for other diseases that require extra prevention and promotion e.g. malaria, dengue
fever, typhoid fever, etc. Without adequate exploration on individual or communitys NEED
and WANT, health professionals may falls into a health promotion program which not fully
understandable by the patients. Therefore, an optimal health promotion program may not be
reached. Education and counseling skills related to health promotion skills is the central
challenge of health promotion system in Indonesia.
More about shares information and shares decision skills was provided in the UGM Doctor-
Patient Communication Skills Guideline in Table 2, particularly on the Discuss row. To proceed
into a partnership discussion with patients, students should master the Greet and Invites
skills in which already learned during the first and second year of medical education in Faculty
of Medicine UGM.
The UGM Guideline on communication skills Greet-Invites and Discuss was validated during
July 2010 and will be registered as a patent - trademark soon. The invention of the UGM
guideline was emerged from series of studies conducted in the Skills Lab FM UGM 2006-2010
(Claramita, et al, 2010).
26
Evaluation:
1. Feedback will be given orally by every field instructor, communication instructor and
physical examination instructor in every occasion (field or skills lab)
2. Professionalism assessment will be given by field instructor using approval of
attendance
27
ASSESSMENT
The studentsassessment would have several types i.e. checklist from both teachers/supervisors
during fieldwork and faculty supervisor (DPL/DPF), feedback, and portfolio. The checklist from
teachers would contribute 20 percent for the end of your mark. The checklist distributed in
your activities such as presentation with your field teachers (DPL) or while discussion session -
tutorial with your faculty teacher (DPF). While your friends feedback would contribute on your
portfolio i.e. as a formative.Furthermore, your portfolio will have 80 percent contribution for
your mark.
Penilaianberdasarkanpada:
Table 4. Metode penilaian hasil belajar

Yang dinilai Bobot Penilai Format
Penilaian
DPF DPL
1. Kajian Kelompok Masalah 33,3 % 50% 50% 1. Format Kajian Berbagai

Kesehatan Individu dan Profesi Kesehatan
Keluarga dilihat dari Berbagai terlampir (Tabel 5
Profesi Kesehatan (format Halaman 29)
Kajian terlampir (Penilaian 2. Ceklist IPE terlampir
IPE terlampir) (Appendix 4 Hal. 38)
3. Tools Kajian Integrasi IPE
(Appendix 9 Hal. 60-65)
2. Kajian Kelompok Pemenuhan 33,3% 50% 50% Checklist Hasil Observasi

Tujuan Belajar CFHC Tahun 3 (Appendix 8 Hal 59)
3. Refleksi Individu 33,3% 100% - Format refleksi terlampir

(Appendix 3 Hal 37)
Total 100%
28
KegiatanKajian Masalah Kesehatan Antar Profesi merupakan kegiatan mahasiswa dalam
kelompok kecil terjadwal untuk mendiskusikan secara mandiri setiapmasalah kesehatan
individu yang ada di keluarga binaan.
Peraturan untuk kegiatanKajian Masalah Kesehatan Antar Profesi:

Terjadwal diskusi mandiri tanpa tutor namun absensi penuh berlaku.
Diskusi berlangsung selama minimal 2 jam.
Hasil diskusi ditulis dalam format: diketik dengan TNR font 11 spasi 1.5 dalam sebuah
tabel yang rapi.
Tabel dibawah ini hanya sebuah contoh, isinya dapat lebih dari 1 halaman per masalah
pasien.
Table5. Format Kajian Masalah Kesehatan Antar Profesi

Small Group Case of small Medicine View Nursing View Health Nutrition
(5 students) Group View
Student 1 provide thick Medical students Nursing Health Nutrition
narration of provide their students students provide
the patients in view on the provide their their view on the
the family (one patients problem
view on the patients problem
patient to five based on
patients ) keywords and patients based on keywords
literature problem based and literature
searching on keywords searching
concerning the and literature concerning the
health problem of searching problem of
the patient concerning the nutrition status of
ASUHAN the patient
KEPERAWATAN
based on
Nanda
Guideline of the
patient
Student 2
Student 3
Student 4
Student 5
29
Table6.Checklist Kompetensi CFHC IPE Tahun Ketiga
Tahun 3
Tema : Keluarga Dipersiapkan (Kesehatan Pria, Wanita, Anak)
Mengelola dilema etika khusus untuk pasien interprofessional / penduduk berpusat situasi
perawatan.
Mempertahankan kompetensi dalam profesinya sendiri yang tepat untuk dipraktekan.
Menggunakan lingkup pengetahuan sepenuhnya,keterampilan,dan kemampuan profesional
kesehatan yang tersedia dan petugas kesehatan untuk memberikan perawatan yang aman,
tepat waktu, efisien, efektif, dan adil.
Terlibat dalam pengembangan profesional dan interprofessional yang keberlanjutan untuk
meningkatkan kinerja tim.
Menggunakan kemampuan yang unik dan saling melengkapi semua anggota tim untuk
mengoptimalkan perawatan pasien.
Menggunakan bahasa yang sopan untuk situasi sulit, percakapan penting, atau konflik antar
profesi.
Melibatkan profesional kesehatan lainnya untuk situasi perawatan spesifik.
Mengintegrasikan pengetahuan dan pengalaman profesi lainnya untuk perawatan situasi
khusus untuk menginformasikan keputusan perawatan, sementara menghormati pasien dan
nilai-nilai dalam masyarakat dan prioritas / preferensi untuk perawatan
Menerapkan praktik kepemimpinan yang mendukung praktik kolaboratif dan efektivitas tim.
Merefleksikan kinerja individu dan tim, sebaiknya tim, peningkatan kinerja
Menggunakan strategi perbaikan proses untuk meningkatkan efektivitas kerja sama tim
interprofessional dan dasar perawatan yang digunakan tim.
Demonstrate high standards of ethical conduct and quality of care in ones contributions to
team-based care.
Menerapkan ketrampilan komunikasi biopsikososial spiritual.
Mampu mengidentifikasi dan menganalisis masalah kesehatan di masyarakat.
Menilai dan mengambil catatan pada masalah kesehatan individu,keluarga dan masyarakat
selama kerja lapangan.
Membangun setiap hipotesis masalah kesehatan individu, keluarga dan masyarakat.
Menyarankan solusi apapun untuk masalah kesehatan (seperti pendidikan , konsultasi,
advokasi, atau prosedur pencegahan).
Memahami setiap analisis sistem kesehatan yang terkait.
Memahami secara profesional dari konstruksi sosial.
Kepemimpinan
Menyepakati solusi
Those competencies would be assessed either by teachers or your mate in several academic activiety in
the field. The feedback should be noted in the feedback form which will be part of reflection in the
portfolio. Nevertheless, all competencies are part of reflection in the students portfolio.
30
PENUGASAN :
Uraikan apa yang telahAnda OBSERVASI dan LAKUKAN terkait hal berikut :
Tulis Laporan Kelompok satu halaman persatu topik terkait Kompetensi tahun 3.
Pisahkan paragraph antara hasil observasi Anda dan apa yang telah Anda lakukan.
31
REFERENCE
Claramita, M, Susilo AP, van Dalen J, 2010, Workshop on UGM Doctor-Patient Communication
Skills Guideline, Faculty of Medicine GadjahMada University, February 2010.
Claramita, M, Utarini A, Soebono H, van Dalen J, van der Vleuten C, 2010, Doctor-patient
communication in Indonesia: The conflict between ideal and reality, Advances in Health
Sciences Education, online-published, September, 2010
Claramita M, Prabadari Y, van Dalen J, van der Vleuten C, Developing and validating doctor-
patient communication skills guideline for a hierarchical context, less verbally expressed
style of communication and communal society, a poster presented at 7 th APMEC
conference Singapore, 2010.
Claramita, M. and Widyandana, 2007, Skills Laboratory, Faculty of Medicine Gadjah Mada
University, Yogyakarta.
Claramita, M, Kharisma Yekti M, and Prabandari YS, Proposal for Junior Teacher Research Grant
2009: Learning Clinical Skills in the Community Setting, Faculty of Medicine, GMU,
Yogykarta
Prihatiningsih TS and Widyandana Proposal for Senior Teacher Research Grant 2009:
Transferability of Procedural Skills in the Community Setting, Faculty of Medicine, GMU,
Yogykarta
Davenport, BA., 2000, Witnessing and the Medical Gaze: How Medical Students Learn to See at
a Free Clinic for the Homeless, Medical Anthropology Quarterly 14(3):310-327.
Feletti, G., Jaafar, R., Joseph, A., dkk, 2000, Implementation of Community-Based Curricula,
Handbook of Community-Based Education: Theory and Practices, hal.11-26, Network
Publication, Maastricht.
Flicker, S., Savan, B., McGrath, M., dkk, 2007, If you could change one thing... What
community-based researchers wish they could have done differently, Community
Development Journal Vol 43 No 2; April 2008 pp. 239253.
Hamad, B., 2000, What is Community-Based Education? Evolution, definition and rationale,
Handbook of Community-Based Education: Theory and Practices, hal.11-26, Network
Publication, Maastricht.
32
Kristina, TN., 2005, Generic objective for Community-Based Education in Undergraduate
Medical Programmes: the prespective from developing countries, Disertasi S3, Diponegoro
University press, Semarang.
Magzoub, M., 2000, Some Principles Involved in Community-Based Education, Handbook of

Community-Based Education: Theory and Practices, hal. 27-38, Network Publication,
Maastricht.
Patton, MQ., 1990, Qualitative Evaluation and Research Method, 2nd edition, Sage Pub, London.
Webber, GC., 1990, Patient Education, A review of the issues, Medical Care 1990;28:1089-1103.
American Medical Association. 1992 How to Help Stop Smoking. USA: National Cancer Institute,
Centers for Disease Control and Prevention, American Society of Addiction Medicine
Fowler, G. (1994) Randomised trial of nicotine patches in general practice: results at one year.
BMJ COM, 308:1476-1477, dowload 12/26/01
Gourlay, S.G., Forbes, A., Marriner, T., Pethica, D., & McNeil, J.J. (1995) Double blind trial of
repeated treatment with transdermal nicotine for relapsed smokers.BMJ COM, 311:363-
366, download 12/26/01
Herhshenson, DB., Power, PW., & Waldo, M. 1996 Community Counseling Contemporary
Theory and Practice. Boston: Allyn and Bacon
Tang, J.L, Law, M., & Wald, N. (1994) How effective is nicotine replacement therapy in helping
people to stop smoking. BMJ COM, 308: 21-26, download.
33
APPENDICES
Appendix 1. General PPT format
Instruction:Each small group of field group should make a Ppt and submitted via game
Time of Ppt submission:
After the end of Semester 5 and 6 (scheduled presentation with the fieldwork supervisor)
Ppt format-Guide set:
a. At minimum font 20
b. Title page contains group members, name of DPF and DPL, Village name, head
of the village name
c. Content : preface/introduction, body, conclusion, problems during fieldwork
d. Equipped with supporting pictures, quotation and video whenever possible
e. Purposes of presentation: all process from the learning objectives for each
semesters, to show what you have done and what you have learned from the
field-work activities and gaining feedback from the fieldwork supervisors
Abilties should be mastered:
All the list of the third-year competencies of CFHC-IPE (Table 4)
Assessors:
This presentation will be assessed by DosenPembimbingLapangan (Family Doctor/ Puskesmas

Doctor) based on the list of competencies on Table 4.
34
Appendix 2. Portfolio Assessment
Portfolio is a continuous assessment method when the students analyze their own study
through guidance and feedback of self-assessment and action plan. In this module, students
have to fulfill their portfolio and collecting them in a binder. Scoring will be done by at least 2
examiners (DPL and DPF) concerning students performance from the quantity and quality
(each range 1-6).
Quantity of the portfolio consists of the length of time of study, number of pages and
resources. Quality of the portfolio concentrates on students written reflection and individual
action plan.
Topics of Reflection to be What will be assessed

assessed
Quantity 50% Quality 50%
Rigorous resources and Self assessment and Action Plan

compiled documents by reflection 25%
students 25%
Objectives 1 Scale 1 to 6 Scale 1 to 6 Scale 1 to 6

Objectives 2 Scale 1 to 6 Scale 1 to 6 Scale 1 to 6
Dan seterusnya Scale 1 to 6 Scale 1 to 6 Scale 1 to 6
Mean of scale 1 to 6 of 2 observers will be the final score.
Scale 1: Poor performance E (Fail)

Scale 2: Under expectation D
Scale 3: About expectation C
Scale 4: Meet expectation B
Scale 5: Above expectation A/B
Scale 6: Excellent A
Quantity (Rigorous resources and compiled documents by students)

1. Only providing 1 variation of documentation* of learning process
2. Providing 1 variation of documentation* of learning process and 1 variation of resource** (article/journal/text book)
3. Providing 1 variation of documentation* of learning process and 2 variations of resources** (article/journal/text book)
4. Providing 1 variation of documentation* of learning process and 3 variations of resources** (article/journal/text book)
5. Providing 2 variations of documentations* (photos/interviews/observations/artifacts*) of learning process and 3
variations of resources (article/journal/text book)
6. Providing 3 variations of documentations* of learning process and 3 variations of resources**
35
*Documentation variation
Photos
Result of Observation
Result of Interviews
Artifacts (forms, guidelines)
**Resources variation
Article
Textbook
Journal
Quality (Self Assessment and Reflection)
1. Self Assessment and Reflection not clear and specific

2. Self Assessment is clear but not specific, reflection without using reliable references (articles/journals/textbooks)
3. Self Assessment is clear and specific, reflection without using reliable references
4. Self Assessment is clear and specific with reflection using reliable references
5. Self Assessment is clear and specific, dynamic (capturing growth and change throughout the program) with reflection
using reliable references.
6. Self assessment is clear, specific, dynamic, able to establish correspondence between program activities and life
experiences, reflection using reliable references.
Quality (Action Plan)
1. Not able to formulate a clear and specific action plan regarding their development during the program
2. Able to formulate a clear but not specific action plan regarding their development during the program
3. Able to formulate a clear and specific action plan regarding their development during the program
4. Able to formulate a clear and specific action plan based on a poorly defined purpose and goals, regarding their
development during the program.
5. Able to formulate a clear and specific action plan based on a clearly defined purpose and goals
6. Able to formulate a clear and specific action plan based on a clearly defined purpose and goals, not only regarding
their development during the program, but to be later used in real-life situation.
Portfolio assessment =
36
Appendix 3. Portfolio Format
Reflection Form
The Shares Information and Shared Decision Making
Self-Assessment:
1. Details of what Ive done:

1.
2.
2. The lessons learnt from the activity:
1.
2.
3. The problems I encounter during the activity :
1.
2.
Plan of Action:
4. Plan of action for improvement (according to the problems mentioned before):
1.
2.
Attached Evidence: (Should be attached)
5. The evidence of what I did for improvement (can be a note taken during expert
discussion/paper read/ article read/ video recording of re-practice):
1.
2.
37
Appendix 4. Checklists of Inter-professional Education
Checklist ini akan digunakan oleh DPL dan DPF dan dengan penilaian formatif. Penilaian
dilakukan dengan cara memberikan tanda Pada kolom Skor.
Skor Penilaian
No Kompetensi Penilaian Kemampuan Mahasiswa (Kolom 7)
0 1 2 3
1. Menempatkan kepentingan pasien dan populasi di
pusat pelayanan kesehatan interprofessional.
Nilai atau
2. Manage ethical dilemmas specific to
etika untuk
1 interprofessional patient/ population centered care
praktek IPE
situations.
3. Maintain competence in ones own profession
appropriate to scope of practice.
1. Menggunakan lingkup pengetahuan sepenuhnya,
keterampilan, dan kemampuan professional
Peran dan kesehatan yang tersedia dan petugas kesehatan
tanggung untuk memberikan perawatan yang aman, tepat
2
jawab waktu, efisien, efektif, danadil.
2. Terlibat dalam pengembangan professional dan
interprofessional yang keberlanjutan untuk
meningkatkan kinerja tim.
1. Menerapkan ketrampilan komunikasi biopsikososial
Komunikasi spiritual.
3
IPE 2. Menggunakan bahasa yang sopan untuk situasi sulit,
percakapan penting, atau konflik antar profesi.
1. Mengintegrasikan pengetahuan dan pengalaman
profesi lainnya untuk perawatan situasi khusus untuk
menginformasikan keputusan perawatan, sementara
Tim dan menghormati pasien dan nilai-nilai dalam masyarakat
4
kerja tim dan prioritas / preferensi untuk perawatan.
2. Demonstrate high standards of ethical conduct and
quality of care in ones contributions to team-based
care.
1. Mengidentifikasi dan menganalisis permasalahan
kesehatan dalam komunitas
2. Menilai masalah kesehatan individu, keluarga dan
masyarakat di daerah binaan.
Kompetensi
5 3. Menegakkan diagnosis hipothesis pada tingkat
komunitas
individu, keluarga dan masyarakat
4. Memberikan usulan pemecahan masalah(misalnya
edukasi, pendampingan management kasus, advokasi
dan promosi dan pencegahan)
38
Keterangan :
0 = tidak memiliki kemampuan
1 = kemampuan rendah
2 = kemampuan menengah
3 = kemampuan baik (mencakup semua kolom 7)
Total = .......... x 100

15
Mengetahui DPL/DPF,
Yogyakarta, / / 201
()
i
g
n
39
Appendix 5. Feedback card/form
1. Any activities done by each students willl be assessed by supervisors (Dosen

Pembimbing Lapangan (DPL) and Dosen Pembimbing Fakultas (DPF) or their peer
students.
2. Whenever the supervisors are unable to give any feedbacks, students are expected to
ask feedbacks from their peer students.
3. Students are required to get 3 feedbacks, whatever from the combination of DPL , DPF
or from their peer students. Please note your feedbacks in these pages and get their
verification from your DPL/DPF.
40
Semester 5
C1
No. Assessment
Activities (Semester, year): Verification
Feedback Suggestion
1.
DPL/DPF*
Name :
Kegiatan (Semester, Tahun): Verification

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
41
Semester 5
C2
No. Assessment
Feedback Suggestion
1.
DPL/DPF*
Name :

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
42
Semester 5
C3
No. Assessment
Feedback Suggestion
1.
DPL/DPF*
Name :

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
43
Semester 6
C4
No. Assessment
Feedback Suggestion
1.
DPL/DPF*
Name :

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
44
Semester 6
C5
No. Assessment
Feedback Suggestion
1.
DPL/DPF*
Name :

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
45
Semester 6
C6
No. Assessment
Feedback Suggestion
1.
DPL/DPF*
Name :

Feedback Saran
2.
DPL/DPF*
Name:

Feedback Suggestion
3.
DPL/DPF*
Name:

Feedback Suggestion
4.
DPL/DPF*
Name:

Feedback Suggestion
5.
DPL/DPF*
Name:
46
Appendix 6. Skenario tutorial C1 C6 berbasis kegiatan di
komunitas (kegiatan CFHC-IPE)
TUGAS BELAJAR MAHASISWA:
SKENARIO 5 KASUS PASIEN yang dijumpai mahasiswa dari Seting Belajar di Komunitas
Kriteria untuk scenario dari seting belajar di Komunitas:
1. Kasus merupakan pengalaman nyata mahasiswa ketika menjumpai pasien di seting

belajar komunitas (ketika CFHC, ketika di Puskesmas, ketika penugasan blok, pasien
yang ditemui di dekat tempat tinggal)
2. Kasus telah dipilih dan disepakati oleh TKT-TKB dengan kata kunci yang telah
diumumkan dalam blok
3. Kasus dapat berbeda untuk masing-masing kelompok mahasiswa, asal kata kuncinya
sesuai dengan arahan dari TKB
4. Setiap kelompok mahasiswa harus sudah mendiskusikan kasusini, belajar mandiri
selama 2 jam sesuai waktu yang disepakati kelompok (Pertemuan I Mandiri: sebelum
minggu ke-2) untuk mengisi format kasus di bawah ini, sesuai arahan, secara bersama-
sama.
5. Mahasiswa menunjuk pemimpin diskusi dan satu sekretaris dalam Pertemuan I Mandiri
6. Setiap kelompok kemudian menyepakati kasusnya dan setelah belajar mandiri,
mendiskusikan kasus ini bersama dengan tutor (Pertemuan II terjadwal dengan Tutor).
Jadwal akan dikeluarkan secretariat TKB.
7. Tutor adalah pemimpin diskusi di Pertemuan II terjadwal
8. Teknik Pengumpulan kasus: Kasus harus sudah dikumpulkan mahasiswa dengan format
(terlampir), maksimal minggu ke-2 blok berjalan kesekretariat TKB tahuan 3 atau 4. Hal
ini untuk memastikan kesiapan mahasiswa.
9. Keluaran pada saatPertemuan II dengan Tutor adalah: Rumusan masalah (maksimal 2
hal) terkait dengan kasus yang dibicarakan.
10. Rumusan masalah ini diketik dan diserahkan pada skeretariat TKB sebagai bahan Diskusi
Panel dengan beberapa pakar di akhir Blok.
11. Selalu ingat tentang level of evidence, bahwa informasi dari pakar adalah level ke-4.
Dengan demikian jangan abaikan proses SELF-STUDY
47
MEDICAL RECORD GUIDE
- for any cases brought by students from community settings
Tutorial Group: Year..Group.Block.
Keywords from the Block coordinators/ TKB: (1) (2) (3)
We met the patient during this learning experience: (Coret yang tidakperlu):
Puskesmas/ CFHC/ or else please filled in
1. WHO IS THE PATIENT?
Write a rich summary of patients personal identity, occupation, daily habits, lifestyle,
patients family, home environment, etc. Write any reason of why this patient is so
important to your group?
Example:
We met the patient name: Siti Halimah, 68 year-old lady, during a home visit at CFHC
activity year 2. She was the grandmother of the family that we visit regularly. Bu Siti, or we
should call her Mbah Siti is 68 year-old who lives with her daughters family in a small
village called: Desa Sukamaju. Mbah Siti helps her daughter takes care of her grandsons, 7
and 1 year-old and during the day she still goes to the rice field. Her husband died of stroke
attack 5 years ago. Her daughter and son in law are school teachers nearby the village.
Mbah Siti still prepares meals like rice, tempe bacem, sayur lodeh, and other typical
traditional Javanese food. They live all together in a small house made from bamboo, Joglo
style, ground floor made from partly land and partly cement, almost no window in their
house so sunlight is impossible to reach the main hall. When it is rainy season, the house
felt like sauna steem room, which was very hot and humid.
This patient is very important to our group because we met her for the first time when we
visit this family. She is a humble and generous ladybla-bla.and we remember her
because we concern about her elderly life as well as her grandchildren early life, considering
the impact of this illness.
48
2. WHAT IS THE HEALTH PROBLEM?
Write a rich summary of patients history of illnesses accompanied by physical

examination and supportive examination needed
Example:
The health problem of MbahSiti was coughing for more than..days with blood and
difficulty in breathing(write the summary of the history taking, current history, past
history and family history)
This result is supported by physical examination: (write a rigorous physical examination

format below only served as a general guideline. Students may adjust if necessary)
Vital signs:
Head and Neck:
Heart:
Lungs:
Abdomen:
Extremity:
Supportive examination: labs, X-Ray, etc:
Routine Blood exam:
X-Ray:
BTA:
Did you feel the need to check the blood sugar in elderly patients?
49
3. WHAT IS THE POSSIBLE DIAGNOSIS AND TREATMENT OF THIS PATIENT?
Write any possible differential diagnosis and diagnosis:
1.
2.
3.
4.
5.
Write any possible treatment for this patient:
a) Treatment of non-pharmacology:
b) Treatment of pharmacology:
50
4. WHAT ARE POSSIBLE PATIENTS PROBLEMS based on patients perspectives?
Write a rich summary of what patient might perceive as her problem, regarding the
diagnosis and treatment that we proposed and how do you approach that as a health
professional?
Patients problem may be rather different with doctors problem, however, if we start
from what the problem is perceived by the patients, we may help the patients better,
because we start with thinking as they think. Patients usually think about: FEAR
HOPE EXPECTATIONS WORRY IMPACT OF ILLNESS ON DAILY LIFE (keywords for
patients perception)
Example:
The exact diagnosis of lung tuberculosis in an elderly patient seems obvious because it
is supported by physical findings and laboratory findings. Also the treatment was based
on guideline of treating TB patient from.and .(references)
However, the patient may be reluctant intaking medication on daily basis because of
these possibilities:
1. She may feel comfortable after 1 month medication so she felt that the
medication should be stopped
2. She may feel embarrassed and therefore she takes herbal medicine instead of
pills
3. She does not understand the importance of taking TB-drug package
Any effort from the students to approach patients perspective:
Example:
We did regular home visit to mbahSitis family and we tried to talk to her, the
importance of the medication and it will prevent other family members to get the
disease. We try to explain the duration of the TB treatment that will last more than 6
months. We understand that it will be boring, however..etc..etc..
During taking medication, she also has to continue to take care little grandsonsit had
made her guilty because she did not want her family to expose the same illness. It is
kind like a dilemma for the patient becausebla.bla..bla
51
5. WHAT DO YOU PLAN TO LEARN FOR CARING THIS PATIENT?
During taking care of this patient, what kind of problem that you found, what are
learning objectives that you think it is important and how do you seek information to
overcome your problems?
Our problems with this particular patient-care are: (LEARNING OBJECTIVES)
1. Obtaining blood sample for BTA test which was very difficult because of
bla..bla.bla
2. Health provider as well as other patients family safety, due to infectious disease
like TB
3. Educating patient on the importance of not stopping medication for more than 6
months
4. What about MDR TB?
5. How many is TB in Indonesia? (Epidemiology?)
6. How much is it related to Diabetic Mellitus problem?
SELF STUDY:
Results of this SELF STUDY should be ready when there is a schedule to discuss with a
tutor/ attached
1. We checked the references on obtaining gold standard diagnosis for TB

2. We checked the references on patient and provider safety due to TB
3. We had checked the method for educating chronic illnesses and patient-
empowerment for a specific disease like TB
4. We had checked the references on MDR TB
5. We had checked the references on TB Patients with Diabetic
Results of SELF STUDY are attached
52
6. IF YOU MEET ANOTHER PATIENT JUST LIKE HIM/HER, WHAT WOULD YOU DO
DIFFERENTLY NEXT TIME?
Please discuss this questions with your friends and write a list of what would you do
better next time. Please consider general issues like:
Epidemiology of this case world-wide, in Indonesian context, and in Yogyakarta

Patient and provider safety
Inter-professional or team work
Clinical practice guidelines or consensus
Medical ethics and law (Undang-Undang. Peraturan Daerah, Regulasidll)
Patient education and counseling
Other issues
Example:
We think that people like MbahSiti who suffers from both TB and DM type II are a lot in
Indonesia. During home visit with MbahSiti, we did not get adequate chance to talk with her
because during the day she mostly work in the rice field and we do not have much time in
the evening to visit. However, next time we will try to talk to her in a convenient time for
her so she could undertand comprehensively about treatment of TB.
It is also important to check and educate other family members at the same house, due
to..bla-bla-bla.
As one of MDGs target in Indonesia, TB is uneasy to eradicate because of bla-bla

bla.as a health professional we may do better next time
in..bla.bla.bla.
Other references that we would like to know are:
TB guidelines, TB consensus, etc
53
7. IF THERE ARE EXPERTS OF THIS PROBLEM, WHAT WOULD YOU LIKE TO LEARN FROM
THEM?
Discuss with your friends on what do you want to learn from the experts in order to
comprehend this particular patient-care better (maximum 2 problem formulation).
Remember that experts opinion are listed as number 4th as level of evidences, so please not
to neglect any self study.
Example:
What we would like to learn from the experts regarding this case are:
1. The MDR TB are still very high in Indonesia, how we deal with that and where is
exactly the problem lied? Is it on the treatment formula? Is it with the patients
adherence? Or else?
2. How to put into practice the DOTS program in reality?
Note: You must submit these two problems to TKB Secretariat once this discussion is
finished.
54
Appendix 7. Tutor-guide for Scenario which was based on
community settings (CFHC-IPE settings)
Panduanuntuk Tutor Skenariodarisetingbelajar di Komunitas:
1. Tutor memfasilitasi mahasiswa dalam 1 sesi tutorial saja

2. Mahasiswa sudah membawa kasusnya dalam format yang kami sediakan dan sudah
melakukan Sesi SELF STUDY sebelum tutorial.
3. PANDUAN PERTANYAAN TUTOR dalam diskusi tutorial dengan masalah dari seting
belajar komunitas (terlampir)
4. Hal yang kritikal adalah perlunya upaya belajar sepanjang hayat oleh mahasiswa dengan
cara:
a) TAHAP BELAJAR: Memahami bahwa proses belajar mengenai penetapan diagnosis
banding, diagnosis, maupun terapi pada tahap pendidikan ini adalah tahap belajar.
Dengan demikian semua hasil diskusi mahasiswa tidak harus selalu benar. Tugas tutor
adalah membantu mengarahkan pola pikir/penalaran klinik mahasiswa agar
mahasiswa selalu berusaha belajar dari keterbatasannya
b) KETERBATASAN DIRI: Penekanan pada uncertainty dan keterbatasan diri sangat
penting, meskipun seorang dokter telah merasa bahwa diagnosis yang akan
ditegakkannya sudah dapat dipastikan. Kewaspadaan pada keterbatasan diri dan
berbagai kemungkinan-kemungkinan lain, menjadi bekal dari seorang dokter untuk
selalu meningkat kandiri, belajar sepanjang hayat, berinisiatif melakukan up-date
ilmu, bertanya pada kelompoknya, seniornya, dan selalu mengikuti perkembangan
ilmu kedokteran.
c) RELASI DOKTER-PASIEN: Penekanan pada relasi/ hubungan dokter pasien sangat
penting agar mahasiswa memahami bahwa dalam pengelolaan masalah kesehatan,
hanya dengan menegakkan diagnosis dan memberikan terapi begitu saja tidak cukup
bagi keluaran kesehatan.
d) ETIKA PROFESI: Pembahasan mengenai hal dilematis antara kenyataan yang dihadapi
mahasiswa ketika belajar di seting komunitas yang sangat mungkin tidak se-ideal
55
teori-teorimedis yang dipelajari di kampus, perlu ditekankan dengan prinsip-prinsip:
Menghormati sejawat sesame dokter, semangat memperbaiki diri, semangat sebagai
pemimpin perubahan kearah yang lebih baik (seandainya mahasiswa nanti bekerja di
seting layanan kesehatan yang tidak ideal, ia akan selalu berupaya memperbaiki diri
dan bukan menyalahkan orang lain, menyalahkan system kesehatan, standar
prosedur, atau apapun), dan tetap mendasarkan perilaku profesinya pada bukti
ilmiah terkini, keselamatan pasien dan petugas kesehatan, etika, hokum dan perilaku
professional serta komunikasi yang efektif.
56
PANDUAN PERTANYAAN UNTUK TUTOR pada sesi belajar dengan kasus dari komunitas
(CFHC-IPE):
(1) WHO IS THE PATIENT?

Write a rich summary of patients personal identity, occupation, daily habits, lifestyle,
patients family, home environment, etc. Write any reason of why this patient is so
important to your group?
(2) WHAT IS THE HEALTH PROBLEM?

Write a rich summary of patients history of illnesses accompanied by physical
examination and supportive examination needed.
(3) WHAT IS THE POSSIBLE DIAGNOSIS AND TREATMENT OF THIS PATIENT?

Write differential diagnosis, diagnosis, treatment of pharmacological and non
pharmacological.
(4) WHAT ARE POSSIBLE PATIENTS PROBLEMS (based on patients perception)?

Write a rich summary of what patient might perceive as her problem, regarding the
diagnosis and treatment that we proposed and how do you approach that as a health
professional?
Patients problem may be rather different with doctors problem, however, if we start
from what the problem is perceived by the patients, we may help the patients better,
because we start with thinking as they think. Patients usually think about: FEAR HOPE
EXPECTATIONS WORRY IMPACT OF ILLNESS ON DAILY LIFE (keywords for patients
perception)
(5) WHAT DO YOU PLAN TO LEARN FOR CARING THIS PATIENT?

During taking care of this patient, what kind of problem that you found, what are learning
objectives that you think it is important and how do you seek information to overcome your
problems?
Learning objectives are:
SELF STUDIES are: (results of self study should be reported her, during this tutorial
session)
(6) IF YOU MEET ANOTHER PATIENT JUST LIKE HIM/HER, WHAT WOULD YOU DO DIFFERENTLY
NEXT TIME?
Please discuss this questions with your friends and write a list of what would you do better
next time. Please consider general issues like:
Epidemiology of this case world-wide, in Indonesian context, and in Yogyakarta
57
Patient and provider safety
Inter-professional or team work
Clinical practice guidelines or consensus
Medical ethics and law (Undang-Undang. Peraturan Daerah, Regulasidll)
Patient education and counseling or other issues
(7) IF THERE ARE EXPERTS OF THIS PROBLEM, WHAT WOULD YOU LIKE TO LEARN
FROMTHEM?
Discuss with your friends on what do you want to learn from the experts in order to
comprehend this particular patient-care better. Remember that experts opinion are
listed as number 4th as level of evidences, so please not to neglect any self study.
Write maximum 2 problem formulation

Students must submit these two problems to TKB Secretariat once this discussion is
finished
58
Appendix 8. Form Penilaian Hasil Observasi
Tahun Kategori penilaian
Nilai Nilai
Upaya Pemberian Informasi & Pemberdayaan Skala Likert
3 Min Max
Masyarakat
1. Tidak terjadi pemberian informasi dan pemberdayaan
masyarakat
2. Terjadi pemberian infornasi satu arah dari mahasiswa
atau tenaga kesehatan
3. Terjadi pemberian informasi dari tenaga kesehatan
namun keterlibatan keluarga binaan/komunitas dalam
pengambilan keputusan dan aksi selanjutnya belum
1 5 1 2 3 4 5 (*)
optimal
4. Terjadi pemberian informasi dan keterlibatan keluarga
binaan/komunitas dalam pengambilan keputusan dan
aksi selanjutnya secara optimal
5. Berdasarkan informasi dari tenaga kesehatan maka
keluarga binaan/komunitas mampu mengambil
keputusan dan aksi selanjutnya secara berkelanjutan
*Lingkari nilai yang sesuai
59
Appendix 9. Tools Kajian Integrasi IPE
A. Laporan Kasus Klinis Kedokteran
Bagian 1. Anamnesis
1. Hasil Anamnesis
Resume anamnesis yang terkait dengan keluhan utama, anamnesis riwayat penyakit sekarang,
dahulu dan keluarga; penggali factor-faktor resiko yang terkait dengan keluhan utama.
Kesimpulan anamnesis yang memuat pola pikir yang mampu mengarahkan kepada diagnosis
banding serta identifikasi masalah aktif dan pasif pada pasien perlu dituliskan.
2. Pembahasan Anamnesis
Bagian ini merupakan telaah kritis yang menjelaskan pola pikir mengapa alur anamnesis
berlangsung demikian. Mengapa pola dan sudah berapa hari panas yang diderita pasien anak
perlu dieksplorasi sangat detail. Mengapa pula perlu ditanyakan apakah anak tersebut diare,
muntah, dan sebagainya. Di akhir pembahasan anamnesis ini perlu dituliskan mengapa
beberapa diagnosis banding diajukan dan mengapa suatu masalah dipilih sebagai masalah
aktifnya.
Bagian 2. Physical Examination

1. Hasil Pemeriksaan Fisik
Bagian ini memuat resume hasil pemeriksaan fisik berdasarkan inspeksi, palpasi, perkusi dan
auskultasi terhadap pasien. Pemeriksaan fisik dilakukan secara general maupun lokal
2. Pembahasan Pemeriksaan Fisik
Pembahasan Pemeriksaan Fisik menjelaskan hasil pemeriksaan fisik yang ditemukan Apakah hasil
pemeriksaan fisik sinkron dengan kesimpulan anamnesis dan masalah aktif yang diderita pasien.
Selanjutnya, apakah berdasarkan pemeriksaan fisik tersebut sudah diyakinkan bahwa diagnosis
dapat ditegakkan untuk selanjutnya dilakukan penanganan lebih lanjut, atau disimpulkan bahwa
masih diperlukan pemeriksaan penunjang dalam proses penegakan diagnosis yang lebih tepat. Jika
kemudian disimpulkan perlu dilakukan pemeriksaan penunjang, maka perlu ditentukan bagaiamana
scenario pelaksanaan pemeriksaan penunjang tersebut.
60
Bagian 3. Laboratory Examination
1. Hasil Pemeriksaan Laboratorium
Berisi hasil pemeriksaan laboratorium secara rinci yang telah dilaksanakan berdasarkan scenario
yang telah ditentukan
2. Pembahasan Pemeriksaan Laboratorium
Dalam pembahasan pemeriksaan laboratorium perlu dijelaskan significant finding apa dari hasil
tersebut apakah kemudian diagnosis pasti bisa ditegakkan atau malah sebaliknya, justru
menggugurkan pola pikir yang selama ini diikuti sejak anamnesis dan pemeriksaan fisik, sehingga
perlu dilakukan reinventing anamnesis dan pemeriksaan fisik yang lebih teliti sesuai dengan
kompetensinya.
Bagian 4. Diagnosis
1. Diagnosis
Tuliskan diagnosis akhir yang telah ditegakkan. Tuliskan juga jika masih ada kemungkinan
diagnosis banding, namun usahakan sesedikit mungkin (maksimal 2)
2. Pembahasan Diagnosis
Pembahasan diagnosis merupakan penjelasan secara konseptual patofisiology suatu penyakit
yang menjadi diagnosis kerja secara keseluruhan dikaitkan dengan clinical findings yang ada.
Mahasiswa pendidikan dokter, keperawatan dan gizi kesehatan harus menjelaskan dari aspek
teori dan konsep yang dijadikan dasar penegakan diagnosis kerja.
Jika kemudian diagnosis kerja masih disertai dengan diagnosis banding, maka perlu dijelaskan
argument teoritis mengapa masih diperlukan diagnosis banding tersebut.
Bagian 5. Treatment and Management

1. Treatment dan Tindakan
Tuliskan treatment dan tindakan yang diperlukan dalam penanganan pasien tersebut secara
rinci.
2. Pembehasan Treatment dan Tindakan
Pembahasan treatment dan tindakan mencakup penjelasan mengapa treatment atau tindakan
tersebut dipilih ketimbang jenis treatment atau tindakan yang lainnya.
61
Selanjutnya untuk jenis sediaan, dosis dan jangka waktu pemakaian perlu dijelaskan alur pikir
yang dikembangkan. Termasuk di dalamnya isu tentang farmakokinetik dan farmako dinamik,
efisiensi dan efektivitas, keamanan dan efek samping perlu dibahas secara detail.
B. Laporan Kasus Klinis Keperawatan

Pengkajian keperawatan
1. Pengkajian secara holistik(biopsikososial,kultural dan spiritual) difokuskan pada masalah
keperawatan yang dijumpai.
2. Data penunjang seperti hasil Laboratorium.
Analisis data:
Data Diagnosa Keperawatan Sifat Masalah
Data Subyektif
Data Obyektif
Data Subyektif
Data Obyektif
Data Subyektif
Data Obyektif
Diagnosis keperawatan (Acuannya NANDA)

Perencanaan keperawatan (Nursing Intervention Classification NIC)
Implementasi Keperawatan
Evaluasi dan tindak lanjut (Nursing Outcome Classification NOC)
C. Pelaporan Kasus Klinis Gizi

IDENTITAS PASIEN
DATA SUBYEKTIF
1. Riwayat Penyakit
62
2. Berkaitan Dengan Riwayat Gizi
Data Sosio ekonomi Penghasilan:
Suku:
Jumlah anggota keluarga:
Aktifitas fisik Jenis pekerjaan:
Jumlah jam kerja:
Jenis olahraga:
Frekuensi:
Jumlah jam tidur sehari:
Mempersiapkan makanan Fasilitas memasak :
Fasilitas menyimpan makanan:
Alergi makanan Makanan:
Penyebab:
Jenis diet khusus:
Alasan:
Yang Menganjurkan:
Masalah gastrointestinal Nyeri uluhati (ya/tidak)
Mual (ya/tidak)
Muntah (ya/tidak)
Diare (ya/tidak)
Konstipasi (ya/tidak)
Anoreksia (ya/tidak)
Perubahan
pengecapan/penciuman (ya/tidak)
63
Penyakit kronik Jenis Penyakit
Modifikasi Diet
Jenis dan lama pengobatan
Kesehatan mulut/menelan Sulit menelan (ya/tidak)
Stomatitis (ya/tidak)
Gigi lengkap (ya/tidak)
Pengobatan Vitamin/mineral/suplemen gizi lain
Frekuensi dan Jumlah
Perubahan BB Bertambah/berkurang, lamanya
Disengaja/tidak
Riwayat/Pola makan
DATA OBYEKTIF
3. Antropometri :
BBkg TB cm LLA TSF mm TL

PB cm LK cm LD LPinggul cm LPinggang
4. Pemeriksaan fisik dan klinik :

5. Pemeriksaan penunjang :
6. Anamnesis Gizi : Recall 24 jam (tgl: Diet)
Implementasi Energi (kal) Protein Lemak (gr) KH (gr) Vitamin
(gr)
Asupan oral/enteral
Infus
Kebutuhan
% Asupan (AKG)
64
7. Terapi Obat: jenis dan interaksi obat dengan zat gizi
ASSESMENT GIZI
8. Antropometri
9. Biokimia
10. Fisik dan Klinis
11. Dietary
DIAGNOSIS GIZI (PES)
INTERVENSI GIZI (PLANNING)
1. Terapi Diet, Bentuk makanan dan cara pemberian
2. Tujuan Diet
3. Syarat/prinsip Diet
4. Perhitungan Kebutuhan
5. Rencana Parameter yang Dimonitor
Fisik dan Klinik
Antropometri
Laboratorium
Dietary
6. Rencana Konsultasi Gizi
Masalah
Motivasi Gizi
IMPLEMENTASI
1. Kajian Terapi Diet puskesmas (Rawat Inap)
2. Jenis Diet/Bentuk Makanan?Cara Pemberian, Nilai Gizi
3. Rekomendasi Diet :
a. Standar diet dan Pemesanan Diet:
b. Konseling Gizi
c. (rawat jalan dan rawat inap)
65
Appendix 10. Ringkasan Alur Kegiatan dan Laporan Mahasiswa
1. Mahasiswa didalam melaksanakan kegiatan selalu mengacu pada LESSON PLAN
(Halaman 9 -11) disesuaikan dengan blok dan jadwal pelaksanaan.
2. Kajian Interprofesi on Champus dapat dilihat dalam LESSON PLAN: tools kajian integrasi
IPE (Appendix 9 Halaman 60-65)
3. Bentuk Laporan & Penilaiannya (Tabel 4 Halaman 28)
a) Laporan IPE (Tabel 4 Halaman 28 Poin 1)
Format kajian masalah kesehatan antar profesi (tabel 5 Halaman 29)
tools kajian integrasi IPE (Appendix 9 Halaman 60-65)
Penilaian DPL & DPF (Appendix 4 halaman 38-39) penilaian kelompok
b) Laporan mahasiswa bentuk NARASI (Tabel 4 Halaman 28 Poin 2)
Merupakan narasi hasil observasi/kegiatan setiap kunjungan lapangan
Laporan (individu) narasi digunakan untuk feedback dengan DPL & DPF
Laporan dinilai (DPL & DPF) format penilaian (Appendix 8 Hal 59) penilaian
individu
Dilengkapi dengan Feedback card (Halaman 41-46)
c) Laporan Refleksi (Tabel 4 Halaman 28 Poin 3)
Format laporan mahasiswa refleksi (Appendix 3 Halaman 37)
Penilaian dilakukan oleh DPF (Appendix 2 Halaman 35-36) penilaian individu
66
Appendix 11. Jadwal Kegiatan
AGUSTUS-DESEMBER 2016
WAKTU
NO KEGIATAN KETERANGAN
MINGGU BLOK HARI & TANGGAL JAM
1 Lecture : Overvew CFHC Sem 6 II C.1 Senin, 29 Agst 2016 15.00-16.40 R. Audit, R.K 2 & R.K 3
2 Practical Work II C.1 Rabu, 31 Agst 2016 15.00-16.40 R. Diskusi RP, GW
3 Fieldwork I + Presentation with fieldwork supervisor (DPL) II C.1 Sabtu, 3 Sep 2016 07.00-13.00 Keluarga mitra & DPL
4 Feedback 1 with DPF (15.00-16.00/R. Diskusi RP, GW) IV C.1 Rabu, 14 Sep 2016 15.00-16.00 R. Diskusi RP, GW
5 Fieldwork II (200 minutes) + Feedback 2 with DPL (50 minutes) I C.2 Sabtu, 8 Okt 2016 07.00-13.00 Keluarga mitra & DPL
6 Feedback 2 with DPF III C.2 Senin, 17 Okt 2016 15.00-15.50 R. Diskusi RP, GW
7 Fieldwork III + Presentation with fieldwork supervisor (DPL) I C.3 Sabtu, 19 Nov 2016 07.00-13.00 Keluarga mitra & DPL
8 Kajian IPE on campus III C.3 Senin, 28 Nov 2016 15.00-16.40 R. Kuliah RP
9 Upload laporan di GAMEL III C.3 Rabu, 30 Nov 2016 Max 23.55 GAMEL
10 PRESENTASI: Final report & evaluation III C.3 Kamis, 1 Des 2016 15.00-16.40 R. Diskusi RP & GW
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MODUL CFHC-IPE TAHUN III Mahasiswa Semester 5 Angkatan 2014

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MODUL CFHC-IPE TAHUN III Mahasiswa Semester 5 Angkatan 2014

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COMMUNITY AND FAMILY HEALTH CARE

WITH INTERPROFESSIONAL EDUCATION

CFHC-IPE MATERIAL BOOK

Year 3 topic: WELL-PREPARED VILLAGE

Community and Family Health Care Program- Interprofessional Education (CFHC-IPE)

Dra. RA YayiSuryoPrabandari, M.Si, Ph.D dr. Mora Claramita, MHPE, Ph.D

Dr. rer. nat. dr. BJ Istiti Kandarina

Anggarjito Sugiarto Estu Prabowo, SKM

CFHC-IPE program is designed to stimulate undergraduate students within faculty of

This CFHC-IPE is an interprofessional and multiple approachprogram. It needs some

Figure 1. Matrix of CFHC-IPE program

The aims of CFHC-IPE Semester 5 to 6:

Learning Objectives: (semester 5 to 6)

Table 1. Detailed Lesson Plan Semester 5

Fieldwork Attachment in Family/Community using 5 A 200 minutes Community

EDUCATION AND COUNSELING

The Shares Information and Shares Decision Making Skills

Students explores individual/ family/ communitys health problems through

THE GREET AND INVITES rows.

Students shared decision with individual/ family/ community about a particular

THE DISCUSS row.

Memahami sudut 1. Menanyakan peristiwa Pasien di Indonesia

Feletty (2000) stated that community observation is a way of understanding community

Is health promotion part of students expectation? Community expectation? Or community

What is the difference between counseling and psychotherapy?

G Greet, give warm greeting to client

A Ask. Ask clients what happened to them

T Tell. Tell client alternatives

H Help. Help client in choosing

E Explain. Explain to the client about the chosen

R Return. Ask the client to return for follow up

R Relaxing. Maintain a relax situation when

Opening up to client, disclosure your self as

Leaning toward client. Always see to the client

E Eye contact. Establish eye contact during the

S Smiling and sitting squarely

The process of counseling should follow principles below:

Communication skills that should be mastered in counseling process

Researches regarding counseling a smoking cessation case

Brief counseling for helping patients stops smoking an example

Table 4. Metode penilaian hasil belajar

1. Kajian Kelompok Masalah 33,3 % 50% 50% 1. Format Kajian Berbagai

2. Kajian Kelompok Pemenuhan 33,3% 50% 50% Checklist Hasil Observasi

3. Refleksi Individu 33,3% 100% - Format refleksi terlampir

Peraturan untuk kegiatanKajian Masalah Kesehatan Antar Profesi:

Table5. Format Kajian Masalah Kesehatan Antar Profesi

Magzoub, M., 2000, Some Principles Involved in Community-Based Education, Handbook of

Time of Ppt submission:

Ppt format-Guide set:

Abilties should be mastered:

All the list of the third-year competencies of CFHC-IPE (Table 4)

This presentation will be assessed by DosenPembimbingLapangan (Family Doctor/ Puskesmas

Topics of Reflection to be What will be assessed

Rigorous resources and Self assessment and Action Plan

Objectives 1 Scale 1 to 6 Scale 1 to 6 Scale 1 to 6

Mean of scale 1 to 6 of 2 observers will be the final score.

Scale 1: Poor performance E (Fail)

Quantity (Rigorous resources and compiled documents by students)

Quality (Self Assessment and Reflection)

1. Self Assessment and Reflection not clear and specific

Quality (Action Plan)

The Shares Information and Shared Decision Making

1. Details of what Ive done: