Study Reflection 1

Opening: The New Curriculum

All of us (including you as a reader, assuming you also are a medical student) are entering the change phase, the transformation phase. Of course the word ‘change’ is something scary and is hard to do. But the world’s keep changing and we gotta move on. Especially the way we learn or the curriculum. In the early 90s students studied medicine separately (anatomy, physiology, histology first and then get into diseases), in the 2000s it changed into problem based. It started from diseases and studied what needs to be learned from it. This is what we call the Academic Health System. This type of learning needs high critical reasoning. If not, it is hard to start it all.

For example, we are given Hepatitis B cases, one of highest incidence diseases in the world, and we know nothing about it, we haven’t learned a single thing. This is where problem based learning comes to shine. Hepatitis, what is the problem? Where is the problem? Why does this problem occur? The problem is it hurts. The problem lies in the tummy where the liver is. Then we start from the normal function of the Liver (of course following the understanding of the parts of the liver). Next to why the problem occurs. What makes the liver function abnormal and hurts the patient. This feels more integrated. We don’t need to learn all of the human body anatomy, physiology, histology, biochemistry like all of it first then get into disease.

To solve medical problems in this new type of system, doctors now don’t give us lectures in front of the class like the old days. Learning all of this is much easier now since we can just google it. We don’t need to open thick books page by page. Open youtube and there are people explaining things you need to know (well not all things actually). To simplify, today’s method encourages us to be active and face problems right away, since we can get all the information from anywhere. Now, it’s not about how much you know, it’s how you can solve this problem. Of course the ‘how much you know’ will have a role in the ‘how can you solve’.

The Academic Health System is the way right now. Many universities in Indonesia have moved to this kind of curriculum. The reason for this implementation is to increase the competitiveness of medical personnel candidates (doctors, pharmacist, nurses, and others) but alsos encourages them to collaborate with each other. This integrates the health system more since there will be no social gap between each medical personnel and communication will be more efficient.

To me, this is a double edged sword. Because we are tested not how much we know but whether we want to study or not. The challenge is different from the 1900's. It's not like we enter a medical school, we are dumped with much information from the books, and tested how much you memorize from the books you’ve read. The challenge now is, information is at arm’s length, do you want to take it or not. If you want it, good luck, if you don’t want it, don’t play in the medical field. If you can use information technology and communication technology wisely, you can solve problems. However, if you can’t and just use the internet for memes, you won’t be a medical personnel.

I thought this was a bad idea, I thought “Seriously? learning medical things on the internet and books alone?” So far, I’ve been thinking like that for almost a year since I’ve become a medical student. But now, I’m starting to see where this is going. At times I’m still pessimistic with my knowledge, feeling like there is something missing from what I know. Nevertheless, I need to face this change. I need to adapt to it. I need to not overthink. I need to just do it and focus, not complaining as much as I used to.

How we study

We started this block with the aforementioned transformative learning curriculum. This time, unlike the previous online learning, we used hybrid learning. It means we learned offline and online when needed. The point is when needed. For the efficiency of communication we did our tutorial offline and accessed learning materials online through the web and the most crucial thing is we studied cases. We learned 10 cases of gastrointestinal systems. We were given disease cases to solve. The so-called student centered and problem based learning are really implemented in my tutor group. Furthermore, both our tutors, Dr. Kiki Lukman and Ms Yunia Uyung, are active in class. They occasionally asked us critical questions to help us think critically. Of course, my teammates will always try to respond to the tutor’s questions and critics. I felt this group is much more alive than previous groups. We started with the first case which was kind of surprising since almost none of us studied cases before, but we quickly adapted to it. Doing more two way communication and critical questions really made our group more active. We are triggered by cases and questions. Dr. Kiki’s view of learning, which I see as a logical vision, really does show how eager he is to teach us. It’s not just leaving the members to do their own things. He really tutored us through and through. He guided us.

The fact that our group consists of the first years is also interesting. My friend, Alveron, from first year is really reliable. At times he responds to Dr. Kiki’s questions and I often ask him things I don’t know. Nadira with her ability to lead the group is astonishing. Icha is the quiet but smart and helpful member of the group. Farras with his amazing knowledge on what needs to be done. Hilya with her hardworking nature. Gigift with her kindness, knowledge, and explaining ability. Amanda with her fun behavior and comprehensive communication. Aqeel as the clown of the group. All in all, with their own respective advantages(?) they have something in common, patience. They have the patience to deal with someone like me. Someone who’s not really good at teamwork. Someone who often can’t keep up with their doings. I appreciate them so much.

Despite all that, there are some shortcomings. The fact that we need to go as far as going back and forth between Bandung and Nangor 3 times a week took us time and money. Nevertheless, the offline tutorial really made the difference. Doing tutorials online only makes it less of a discussion and more of a one sided communication. I was thinking about doing it semi offline where some of us study in tutorial room C32 and some of us do it through zoom since going offline all the time is kind of inefficient. However, I was proven wrong. Doing it full offline really gives the ‘study’ vibes. Next downside is the tutorial method. Doing a presentation all the time at first feels so wrong. Nothing would change from the previous online tutorial, but it started to change a bit like how I explained in the previous part, but still, I hope all of us can be more active at asking questions to each other rather than just responding to questions and critics.

If I were to hope, it would be nice if Unpad facilitates us with free transport between campuses. Or maybe, all of us move to Eyckman to study. Overall, this tutorial group is the most proper compared to my previous groups. I think, so far, this is the best tutor group I’ve had.

How I study

After discussing how our curriculum works and how we, as a group, study, now we talk about ourselves. What have I learned, what has improved, what are the shortcomings, what can I improve from myself? My name is Raditya Danendra. Learning with this problem based system stimulates me to think critically and increases my curiosity on solving problems. The first case we discussed was pretty mesmerizing. This was the first ever I’ve had to analyze a disease based on physical and lab examination. Hemoglobin levels, leukocytes level, aPTT, bilirubin levels, Glasgow Coma Scale, and other data. I was shocked at how powerless I was before that datas. Since, I take notes on how much is the normal value, what happens if the levels are too high or too low. From this kind of learning now I’m starting to be able to analyze cases of disorders or diseases (apa sih kyk runtut gitu loh yg awalnya gini akibatnya gini trs bs gini kemungkinannya gt2). This way, the aim of our curriculum is progressively achieved. The key is “I’m starting to be able to”, it’s not that now I have mastered disease analysis.

To name a few. There are 3 fundamental things to master in medical field studies, Inflammation, carcinoma, and normal function of our anatomy. It sure is that many diseases are derived from carcinoma like colon adenocarcinoma or liver cancer and inflammation of an organ or a tissue. Some will just swell as a consequence of the neutrophils and may lead to fever and some will eventually go to the necrotic phase which leads to cell death. Cell death leads to tissue damage and disorder of function. Peptic Ulcer, some diarrhea, cholecystitis, pancreatitis, hepatitis, cirrhosis. All of them are derived from inflammation and cell death within their respective location and yes most of them may induce fever. The difference in location may ease our diagnosis, especially when some of them like cholecystitis can spread the pain up to the shoulder due to nerve hits. Other than location, the blood test results really help with diagnosis. Usually with internal bleeding like ulcers in the stomach or intestine or maybe the abnormal function of the liver indicated by the low RBC count since the patient is experiencing blood loss due to perforation or internal varises. WBC also indicates that infection might be happening if the count is above normal. It shows that the body is reacting to unknown pathogens. Other blood composition closely related to digestive function is Bilirubin and some proteins like SGOT SGPT ALP GGT. High in all of those factors shows abnormal liver function since they should be less in blood.

The point is, then again, learning medicine this way is much more contextual, applicative, and fun. It stimulates me to think why, why, why. Every time I take notes on each patient's case I always write why in each condition. This patient is lethargic, why? The patient’s hemoglobin is low, why. The patient is given Metronidazole, why. Tell me why, like Backstreet Boys does. Then I searched it from the deepest part and then connected all the dots. Connecting dots is fun.

If we take a closer look, this is actually what SOCA is. I’m studying with SOCA style. However, with the overwhelmingly complex and many cases to discuss. I had a hard time managing all of it. Adding fuel to the fire, learning all different pathogens namely parasites like Ascaris lumbricoides, Ancylostoma duodenale, Enterobius vermicularis, Cryptosporidium, Cystoisospora and Trichiura. Then protozoa like Helicobacter pylori, Giardia lamblia, Entamoeba Histolytica, Entamoeba coli, Shigella, Salmonella, Balantidium coli, Vibrio cholera, Vibrio vulnificus, Vibrio parahaemolyticus, Campylobacter jejuni, and even Escherichia coli. Lastly viruses like rotavirus, adenovirus, coxsackievirus, reovirus, astrovirus, calicivirus and norwalk virus. I tried to learn each pathophysiology while dealing with cases at the same time. It was pretty tiring and I was personally hampered by it. As a matter of fact, I wasn’t and I’m not complaining. In fact, I see it more in a positive way. By facing this challenge I know where I’m lacking. I know what I don't know. And I was able to, bit by bit, correlate what I know about all those pathogens to the cases I was dealing with, especially diarrhea.

The essence is wisdom. Here’s what I mean: I’m able to collect data, extract information, form knowledge, create insight, and gain wisdom. Throughout this block, this is what my goal in every case is.

Oh yeah there is one more thing to mention. How I study outside tutorials. I often study alone either in the library or tutorial room. I’ve changed from “I like to study at home, in my room, I can’t study otherwise” to “I can’t study at home, I need a new atmosphere”. Hence the change in study habits. So, there are improvements in my study method. Applying the SOCA method to increase my critical thinking, searching for more study materials (literature) outside books, and finding a new atmosphere to study effectively.

Personal Improvement

So what have I improved from myself? And what can I improve from any of my shortcomings? Thinking critically is a huge part. Managing learning materials is also much improved, but the time management is still bad. I always tried not to stay up too late. I always sleep below 22:00. It has pros and cons. Were I to stay up late I might be able to learn more, but it’s not healthy. I usually studied in the morning, but distraction still exists. I need more focus. When I’m focused on something, because I have a goal, I rarely get distracted. I need to remember every time why I should study this material. That should do it justice. Now how about all of those cases where I said I’m overwhelmed? I’m planning to reanalyze all 10 GI cases and make notes of all of it by myself after the mid semester test. After all, what we have been discussing in every tutorial is the product of teamwork, not individuality. There is one weakness that is crucial for the group, that is I’m still not that close with my teammates. There’s still this gap which makes the inability to express my feelings and thoughts to the group. This may be just a problem which can be solved by time.

After talking about the negatives and how I can mitigate them, now we talk about the pros, the positive sides. I think more critically about these cases. Like I said before, I always ask why why why (and how how how), but that doesn’t mean I am a critical thinker just yet. This is just the beginning. Other than the improved critical mindset, focus is also crucial. Unlike in the previous block, this time I can focus on studying. I know the urgencies and the importance of what I should learn. Therefore I often study alone every single day including weekends. I even ended up thinking “I can’t use my weekend other than study, I don;t have anything to do other than that.” I think these 2 developments are thanks to the case given to me (us). The relevancies are so advantageous that I get curious on why many other tutor groups don’t use it.

Recap

To recap all of it I like our tutorial workflow combined with the skills lab and lab activity to support it. The learning is much more coherent, contextual, and applicative. The group is also amazing, there’s this saying which means you are wrong if you are the smartest in the room. I am not in the wrong room. I’m surrounded by amazing people in this group, be it my teammates or my tutors. Every flaw in our study workflow is mostly from me who have a hard time catching it all up. Of course, to balance(?) repent(?) all that I need to manage my studies more effectively so that I won’t be a burden to my teammates.