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TEACHING BIOETHICS & MEDICAL HUMANITIESfor MEDICAL STUDENTS in Indonesia

Case of Gadjah Mada

Soenarto Sastrowijoto

CENTER FOR BIOETHICS & MEDICAL HUMANITIES

Faculty of Medicine Gadjah Mada UniversityYogyakarta

December 2005

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INTRODUCTION International Standard in Basic Medical Education

(WFME, 2003) 1)

Competence – based curriculum (Knowledge, skills, attitude/behaviors/ ethics

Development of Science & Technology : New technology and New techniques – economics issues – ethical problems (Fig.1)

Medical practice – Clinical decision making : scientific, ethics, legal and humanities based.

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The limit number of Human resources for Bioethics teaching policy issues !

Share experiences among countries in teaching bioethics for medical students

What kind of policy should be developed related to HR capacity building (in Bioethics and Humanities)

Education / Teaching / Training on Bioethics and Humanities to improving HR competencies (cognitive, psychomotor, affective) in Bioethics and Humanities

INTRODUCTION

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Medical Education

• Medical Practice

MD

Clinical Decision Making

• Education Standards • Medical Education Standards

• Medical Care Standards

1. Scientific (EBM)2. Ethics (Moral principles)3. Legal (Act, Regulation)4. Humane

“Stake holders”

• Quality Assurance (Jaminan mutu)

• Social Accountibility

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New Biomedical Sciences

New Technology (Recombinant – DNA Technology)

Methods of Medical SCIENCES

Methods of Medical Sciences - TECHNIQUES

Scholar Physicians

Medical Technology INDUSTRY

Economics of Medical Care

ETHICALISSUES

Drugs Devises Physical Setting

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INDONESIAN EXPERIENCE• National Core Curriculum, Teaching Ethics

I - Various (before 1993) – Medical Care/ ServiceII - Humanities (1993) – Sensitive to Socio Economic, Culture, Anthropology, Religion, etcIII - Bioethics & Medical Humanities (1997) – Combined

• Teaching Strategy - Conventional – senior lecturers – role Model - Structured lectures

- Innovative/hybride/PBL

• Hidden Curriculum in Bioethics

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UGM EXPERIENCE• Before 1993 - Nat. Core. Curric. I - Senior lecturer

1993 - Nat. Core. Curric. II - Humanities (12 Credit) Team teaching1993 - Bioethics & Medical Humanities Structured – Team teaching – lectures Semester 1 - Ethics & Law I (one credit)2 - Social Medicine I (two credits)3 - Behavioral medicine I (one credit)4 - Medicine Philosophy (two credits)5 - Behavioral Medicine II (one credit)7 - Behavioral Medicine III (one credit)Teaching Strategy : Conventional lecturing

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• 2002 - UGM started PBL and Student Centered Curriculum Bioethics and Medical Humanities is in Block VIat the end of year I (Fig. 2) - The Topic Tree (Fig. 3) Block VI consisted of 3 Modules : Bioethics, Medical

Behavior, and Medical Law.Each of modul – some learning units for SGD

• WHO Searo - Material for Bioethics teaching (WHO – SEARO)- Field studies (India, Thai, Indonesia, etc)- Results - accepted, sincronized with the

local issues. - case studies (learning unit) of Block VIshould be renewal continuously

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Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

E1: Exam for BSc in M edicine (BSc.M ed or S.Ked)E2: Exam for M D or Doctor (Com prehens ive Exam )E3: Exam for GP Licence (by each country's com m ittees )

(16 Aug-2 Oct '04)

Block III

Biomedical Science II

7 weeks

Block II

Biomedical Science I

(6 Dec '04-22 Jan '05)

5 weeks

Blo

ck II

(1 May-17 Jun '06)

Biomedical Science III

7 weeks

(7 Feb-26 Mar '05)

Block V

Public Health and

Entrepreneurship

Mak

e U

p Te

st

Sem

este

r Hol

iday

s

Mak

e U

p Te

st Sem e ster Holidays

(30 J ul-18 Aug '07)(25 Jun-28 Jul '07)

Mak

e U

p Te

st

Sense Organ

3 weeks

Year 1

2 w

eeks

: (8-

20 N

ov '0

4)

2 w

eeks

: (22

Nov

-4 D

ec '0

4)

2004/2005

Block I

Study Skills and

Information Tech.

7 weeks

(4 Oct-6 Nov '04) Idul

Fitr

i Hol

iday

s

(13 Mar-29 Apr '06)(21 Nov '05-7 Jan '06)

Absorption

7 weeks6 weeks

(19 Sept-29 Oct '05)

Block IX

Neoplasm, Degenerativ e

7 weeks

2006/2007

(21 Aug-16 Sept '06)

Year 2

(12 Mar-28 Apr '07)Sem

este

r Hol

iday

sBlock XV

Nephrology , Urology

Infection

Mak

e U

p Te

st

Sem

este

r Hol

iday

s

4 weeks

(18 Sept-14 Okt '06)

and Regenerativ e Process

(30 Apr-16 Jun '07)

(28 Jan-16 Feb '08)

Block XVII

Psychiatry

7 weeks

Reproductive Health

7 weeks

Block XVI Block XVIII

Neurology, Behavior andEndocrine and

10 weeks 8 weeks 4 weeks Hol

iday

s Obsgyn

(18 Feb-26 Apr '08) (5 Mei-28 Jun '08)

(15 Jun-25 Jul '09)

Year 4

Blo

ck X

X

2 w

eeks

: (22

Oct

-3 N

ov '0

7)

Internal Medicineand Trumatology

6 weeks

(5 Nov-15 Dec '07)

International Health and Man. of

New Emerging Diseases

6 weeks2008/2009

(15 Sept-22 Nov '08) (1-27 Dec '08) (29 Dec '08-24 Jan '09) (26 Jan-21 Feb '09) (2-28 Mar '09) (30 Mar-11 A pr '09) (13-25 Apr '09) (27 Apr-9 May '09)

K3ME2

10 weeks 4 weeks 4 weeks 4 weeks 4 weeks 2 weeks 2 weeks

MF An

Hol

iday

s PH

2 weeks 2 weeks 2 weeks

(11-23 May '09) (1-13 Jun '09)

CURRICULUM IN BASIC MEDICAL EDUCATION 2002 (5 YEARS)GADJ AH MADA UNIVERSITY FOR BATCH III (2004-2009)

Year 5

Paediatric H

olid

ays Surgery

Hol

iday

s Opt Psychiatry

Mak

e U

p Te

st

Block X

Musculo Skeletal Sy stem

and Locomotion

7 weeks

(23 Jan-11 Mar '06)

Block XI

Digestion and

5 weeks

(26 Jun-29 Jul '06)

2005/2006

Block VIII

Immunology and

Metabolism

7 weeks

(22 Jan-10 Mar '07)

2 w

eeks

: (31

Oct

- 12

Nov

'05)

Blo

ck V

III (1

4-19

Nov

'05)

3 weeks

(30 Ok t-18 Nov '06)

Medical Science Hemopoit ic & Lymph.Dis. Hem opoitic & Lym ph.Dis.

Hem ostasis & S hock

Idul

Fitr

i Hol

iday

s2

wee

ks: (

16-2

8 O

ct '0

6)

Block XIV

Hemostasis & Shock

4 weeks

and Technology

Sem e ster Holidays

5 weeks

Hol

iday

s Pae diatr ic

(7 Jul-2 Aug '08)

Block XIX

2007/2008

(4 Aug-6 Sept '08)

Sense Organ

3 weeks

(20 Aug-8 Sept '07)

Elective

4 weeks

(10 Sept-6 Okt '07)

5 weeks

Neurology

Hol

iday

s

Block XIX Block XX

Idul

Fitr

i Hol

iday

s2

wee

ks: (

8-20

Oct

'07)

Block XXI

Emergency Medicine

Block XXII

and Body Fluid

Mak

e U

p Te

st

7 weeks

(20 Nov '06-6 Jan '07)

Mak

e U

p Te

st

ENT RadDV

6 weeks

(17 Dec '07-26 Jan '08)

E1Sem ester

Holidays

3 weeks

Year 3

Block IV

Block VII

Lif e-Cy cle and

Gerontology

4 weeks

(22 Aug-17 Sept '05) Idul

Fitr

i Hol

iday

s

Block XIVBlock XIII

6 weeks

(28 Mar-14 May '05) (16 May-2 Jul '05)

Block VI

Medical Humanities

and Bioethics

7 weeks

(11-30 Jul '05)

Block VII

Life-Cycle and

Gerontology

3 weeks

(1-20 Aug '05)

Semester Holidays

3 weeks

Block XII

Circulation and

Respiration

7 weeks

Block XIII

Medical Sc ience

and T echnology

3 weeks

(31 J ul-19 Aug '06)

Fig. 2

10Fig. 3

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• By time, teaching Ethics for undergraduate medical students developed appropriately.

• Development of Contents (ethics, bioethics & medical humanieties, (attitude behavior, ethics, law, civics & religion) ; teaching strategies, conventional to innovative (student – centered and PBL) ; faculty member capability (degree programme, Master & Doctoral, training, workshop, scientific meeting)

• Workshop and trainings WHO and UNESCO, or others strengthening Medical Health Institution – Educations.

• In Indonesia the “National Networking for Bioethics and medical Humanities” was established in 2000, with their National Scientific Conference each two years, also strengthening, Teaching Bioethics.

DISCUSSION

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CONCLUSION

• The effort of the Educational institution in ballancing of knowledge, skills and attitude/ behavior / ethics teaching should be continuously renewed.

• Sharing experience in teaching bioethics and medical humanities could be regularly carried out through networking / partnership/collaboration activities, among institutions/ countries

• National policy should be developed ! Related to Bioethics and Humanities experts, for services, research and education

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