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CHAPTER I

INTRODUCTION

I.1. Background of the Problem

In Faculty of Medicine Universitas Gadjah Mada, to

assess students clinical skills, Skills Laboratory use

Objective Structured Clinical Examination (OSCE). OSCE

is firstly introduced by Harden et al.(1975) in Dundee

University. It is widely used and adopted in many

medical schools in Indonesia because it is believed as

one of good methods to assess students clinical

skills. Evenmore, OSCE is also used to assess students

clinical skills right before graduating from faculty of

medicine.

According to that, we know that clinical skills are

very important to be mastered by all fresh graduates

and medical doctors. In 1992, Faculty of Medicine

Universitas Gadjah Mada started to introduce clinical

skills learning through Skills Laboratory to all

students (Claramita & Widyandana, 2007). Skills

laboratory have a very important role to train

students clinical skills, so they will be able to

understand the competency standards for undergraduate

students (Nielsenet al.

, 2003). Skills laboratory also

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provides structured and well-planned clinical skills

training through several kinds of methods, which are

learning by using mannequins, peer-teaching, simulative

patients, and community services (Ledingham & Harden,

1998).

In Faculty of Medicine Gadjah Mada University,

clinical skills is given longitudinally in all stages

of curriculum during undergraduate study. Each topic is

delivered using different methods which are suitable

with the characteristic of the topic itself. Skills

laboratory in Faculty of Medicine Gadjah Mada

University is facilitated by one instructor. And after

practicing with the instructors, students are allowed

and are given chances to practice more independently,

so that they could understand more and master the

clinical skills well (Claramita & Widyandana, 2008).

But then, because of business of the instructors,

who mostly are staffs from faculty, they are sometimes

unable to faciliate the clinical skills learning

process properly. This leads to the ineffectiveness of

skills laboratory and causes inadequate students

comprehension about several clinical skills. To cope

with those problems, skills laboratory started to use a

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peer assisted learning program, which is called

Training from Senior Students (TFSS).

Since early 1990s, Peer Assisted Learning (PAL)

has been implemented and used in many undergraduate and

postgraduate programmes (Whitmann, 1988). Based on

General Medical Council (GMC, 2003), most medical

students in United Kingdom are expected to understand

the basic of teaching and to be able to demonstrate

their teaching ability to others. Hill et al. (1998)

also said that PAL helps students to develop their

knowledge and skills with their peers and boost their

confidences and self-esteem because colleagues are more

approachable compared to staffs from the faculty. TFSS

is given by the senior students, who are usually called

as skills laboratory assistants, for the junior

students or tutees and it gives more chances for junior

students to learn and try the clinical skills that they

have learned before during skills laboratory, at the

end of the day.

With all clinical skills learning facilities that

are provided by skills laboratory, students OSCE

scores should be good and most students should pass the

OSCE. But, in fact, based on OSCE scores evaluation,

students failure rate in OSCE isstill 30%, which is

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quite high. It may be related with the participation of

students in PAL.

Speaking of participation of students in PAL,

based on experiences of skills laboratory assistants,

not all tutees attended TFSS appropriately. Many of

them came late and went home early before the TFSS

sessions ended. And also during TFSS sessions, only a

few students were interested in practicing clinical

skills.

Based on several points written above, the

researcher is interested in and wants to explore more

whether participation of students in PAL has any

correlation with OSCE scores in Faculty of Medicine

Universitas Gadjah Mada.

I.2. Research Question

Based on background written above, research

question for this research is Is there any correlation

between participation of students in PAL and OSCE

scores in Faculty of Medicine Universitas Gadjah Mada?

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I.3. Objective of the Research

To determine whether there is any correlation

between participation of students in PAL and their OSCE

scores in Faculty of Medicine Universitas Gadjah Mada.

I.4 Benefit of the Research

This research provides us information about peer

assisted learning and its correlation with students

OSCE scores and will be beneficial for the researcher

itself, skills laboratory, institution, and medical

education area. The benefits of this research are:

a.Giving information about correlation between

participation of students in PAL and OSCE scores

to the skills laboratory.

b.Giving information about students suggestion on

PAL to skills laboratory.

c.Giving slight description about students point of

views on effectiveness and quality of PAL to

skills laboratory.

d.Result of this research could be used as one of

the basics to increase the effectiveness and

quality of PAL.

e.As a useful media for the researcher and others to

learn more about PAL.

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f.Giving contribution in scientific journals about

medical education.

I.5 Originality of the Research

There are many researches and publications

regarding PAL. Many studies explore the correlation

between PAL and clinical skill examination. Even, some

experimental studies compare the clinical skill

examination result of group with PAL method and another

group with non-PAL method.

Hudson & Todkin (2008) also did a study about PAL.

They grouped the second-year students into two groups.

Sixth-year students taught the first group, while paid

general practitioners or instructors taught the second

group. Hudson & Todkin also did qualitative survey to

all second-year students (n=125) using questionnaire

and focus group discussion (FGD) for the sixth-year

students (n=11) and the simulated patients (n=3). The

results of this research showed that PAL method could

enhance students self-confidence and create a more-

active learning process, compared to being taught by

the paid general practitioners or the real instructors.

The performance of the first group during the clinical

examination was also as good as the performance of

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students from the second group. The differences between

the research that was conducted by the researcher and

Hudson & Todkins research are in this research, there

was no experiments, there was no focus group discussion

for the senior students and simulated patients, and the

sample was only junior students.

Another research about PAL is research that was

done by Lockspeiser et al. (2008). This research

consists of 2 phases. In the first phase, Focus Group

Discussion (FGD) was held to the tutors (which are the

second-year students) and the tutees (which are the

first-year students). While in the second phase, the

researcher made questionnaires, based on the result of

FGD during the first phase. The questionnaires were

given to all first-year students and they were asked to

fill in the questionnaire based on their experiences

during PAL. The differences between this research and

the research that was conducted by the researcher are

there was no FGD for the tutors and the tutees.