Indonesian Physician’s Competency

8/6/2019 Indonesian Physicians Competency

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IndonesianIndonesian PhysiciansPhysicians

CompetencyCompetency

in Global Erain Global Era

Prof.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.ScProf.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.Sc

Dekan Fakultas Kedokteran UIIDekan Fakultas Kedokteran UII


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Prof.Dr.dr. H. Rusdi Lamsudin, M.Med.ScProf.Dr.dr. H. Rusdi Lamsudin, M.Med.Sc

Spesialis Saraf (Consultant)Spesialis Saraf (Consultant) Medical Doctor, Faculty of MedicineMedical Doctor, Faculty of Medicine, UGM, 1971, UGM, 1971

NeurologistNeurologist, Unair, Unair--UGM, 1978UGM, 1978

Master of Medical Sciences, New Castle Univ, Australia, 1986Master of Medical Sciences, New Castle Univ, Australia, 1986

Head of Executive BoardHead of Executive Board MuhammadiyahMuhammadiyah Hospital,Hospital, Yogyakarta, 1993Yogyakarta, 1993--19991999

Vice DeanVice Dean,, Faculty of Medicine Muhammadiyah Yogyaakarta UniversityFaculty of Medicine Muhammadiyah Yogyaakarta University,,19931993--19991999

PhD, UGM, 1996PhD, UGM, 1996

ShortShort--course, Unit Stroke & Neurocourse, Unit Stroke & Neuro--Intensive, Insburck, Austria,Intensive, Insburck, Austria,15 July15 July--1515October,October, 19971997

Head of Stroke Unit,Head of Stroke Unit, SardjitoSardjito Hospital, YogyakartaHospital, Yogyakarta, 2001, 2001--20052005 Head of Neurology Department Faculty of Medicine,Head of Neurology Department Faculty of Medicine, UGM, 2001UGM, 2001--20052005

Dean of Faculty MedicineDean of Faculty Medicine,, Indonesia Islamic University,Indonesia Islamic University, Yogyakarta, 2001Yogyakarta, 2001--2006, 20062006, 2006--20102010


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GLOBALIZATIONGLOBALIZATION

We are a part of a Global Village havingWe are a part of a Global Village havingDual CitizenshipDual Citizenship

Disease knows no boundariesDisease knows no boundaries

Communications revolutionCommunications revolution

Terrorism and local conflictsTerrorism and local conflicts

Distinction between domestic andDistinction between domestic and

international problems is losing itsinternational problems is losing itsusefulness.usefulness.


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GLOBALIZATIONGLOBALIZATION

We are a part of a Global Village havingWe are a part of a Global Village havingDual CitizenshipDual Citizenship

Disease knows no boundariesDisease knows no boundaries

Communications revolutionCommunications revolution

Terrorism and local conflictsTerrorism and local conflicts

Distinction between domestic andDistinction between domestic and

international problems is losing itsinternational problems is losing itsusefulness.usefulness.


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Globalization involves multiGlobalization involves multi--dimensionaldimensional

integration of world economics, politics,integration of world economics, politics,culture, health and human affairs, facilitated byculture, health and human affairs, facilitated by

a scientific revolution in information anda scientific revolution in information and

biotechnology.biotechnology.

Globalization is a process of broad socialGlobalization is a process of broad social

transformation that make national borders moretransformation that make national borders more

permeable.permeable.

Trade is the leader and most powerful force of ourTrade is the leader and most powerful force of our

time.time.


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NEW GLOBAL ECONOMICNEW GLOBAL ECONOMIC

ORDER (1945)ORDER (1945) International Monetary Fund (IMF)International Monetary Fund (IMF)

World BankWorld Bank

General Agreement on Traffic and Trades (GATT)General Agreement on Traffic and Trades (GATT)

World Trade Organization (1995)World Trade Organization (1995)

TradeTrade--related aspect of International Property Rightsrelated aspect of International Property Rights

(TRIPS)(TRIPS)

General Agreement on Trade in Services (GATS)General Agreement on Trade in Services (GATS)


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GLOBAL TRADEGLOBAL TRADE

1970 25% Global Output1970 25% Global Output



Speed of globalization is exceptionalSpeed of globalization is exceptional Good economic policiesGood economic policies

Structured reformsStructured reforms

Most Governments are ill equipped to manageMost Governments are ill equipped to manage

problems that transcend their bordersproblems that transcend their borders Global bodies are too weak to provideGlobal bodies are too weak to provide

monitoring of commerce, environment, socialmonitoring of commerce, environment, socialdevelopment, health, and educationdevelopment, health, and education


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GLOBALIZATION:GLOBALIZATION:

OPPORTUNITIESOPPORTUNITIES

A RISING TIDE WILLA RISING TIDE WILL

LIFT ALL BOATSLIFT ALL BOATS

Reduction in povertyReduction in poverty

Exchange of ideasExchange of ideas

Infusion of scientificInfusion of scientific

knowledgeknowledge

Improvement in healthImprovement in health

statusstatus

Social developmentSocial development


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GLOBALIZATION:GLOBALIZATION:

RISKSRISKS

A FAST RISING TIDEA FAST RISING TIDE

WILL LIFT BIGWILL LIFT BIGYACHTS BUT WILLYACHTS BUT WILL

CAPSIZE SMALLCAPSIZE SMALL

BOATSBOATS

Spread of diseaseSpread of disease

Hazardous materialHazardous material

DisparitiesDisparities

Negative behaviorNegative behavior

changechange

CorruptionCorruption


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CURRENT STATUSCURRENT STATUS

1 Billion People in the Developed World1 Billion People in the Developed World

United States, Europe, JapanUnited States, Europe, Japan

Increase in disposable incomeIncrease in disposable income Enhanced social injusticeEnhanced social injustice

Improved standard of livingImproved standard of living


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3 Billion People in Developing Countries are3 Billion People in Developing Countries are

integrated into the global economy, i.e.integrated into the global economy, i.e.

China, India, Thailand, TaiwanChina, India, Thailand, Taiwan

Stable governments (good economic policy)Stable governments (good economic policy)

Human capitalHuman capital

InfrastructureInfrastructure

Visionary leadershipVisionary leadership


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2 Billion People in poor countries have been left2 Billion People in poor countries have been leftbehindbehind Political instability (poor economic policies)Political instability (poor economic policies)

Poor or no infrastructurePoor or no infrastructure Lack of human capitalLack of human capital

No natural resourcesNo natural resources

Their participation in world trade is less than it wasTheir participation in world trade is less than it was20 years ago, with income falling and poverty20 years ago, with income falling and povertyincreasing.increasing.


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FIVE GAINS IN GLOBAL HEALTHFIVE GAINS IN GLOBAL HEALTH

Reduction in vaccine preventable diseasesReduction in vaccine preventable diseases

Reduction in childhood morbidity and mortalityReduction in childhood morbidity and mortality

leading to increased life expectancyleading to increased life expectancy

Tremendous advances in biomedical research; newTremendous advances in biomedical research; new

drugs, new vaccines, geneticsdrugs, new vaccines, genetics

Reduction in fertility ratesReduction in fertility rates

Public private partnerships adding additionalPublic private partnerships adding additionalresources to solve public health problemsresources to solve public health problems


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FIVE MISSED OPPORTUNITIESFIVE MISSED OPPORTUNITIES

Dealing effectively with HIV/AIDS epidemicDealing effectively with HIV/AIDS epidemic

Imbalance in resource allocations betweenImbalance in resource allocations between

prevention and medical careprevention and medical care

Environmental degradationEnvironmental degradation

DonorDonor--driven need of quick and time limiteddriven need of quick and time limited

results, did not allow for development of integratedresults, did not allow for development of integrated

health infrastructurehealth infrastructure Missed gender recognitionMissed gender recognition


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MISSED GENDER RECOGNITIONMISSED GENDER RECOGNITION

Failure to recognize gender dimensions ofFailure to recognize gender dimensions ofhealthhealth

Maternal morbidity still very highMaternal morbidity still very high

Failure to have family planning servicesFailure to have family planning servicesavailable to all womenavailable to all women

Gender based violence remains unGender based violence remains un--

addressedaddressed Exploitation of womenExploitation of women


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SYSTEM IS RUN BY COMPETITIONSYSTEM IS RUN BY COMPETITION

FOR PROFITSFOR PROFITS

Creates conditions in which powerful controlCreates conditions in which powerful control

Uneven enforcement of economic orderUneven enforcement of economic order

Short term focus on return (profits)Short term focus on return (profits)

No transparencyNo transparency

Create competition vs. collaborationCreate competition vs. collaboration

20% of worlds population receives more than 80% of the20% of worlds population receives more than 80% of the

worlds incomeworlds income DisparitiesDisparities


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WEAKENING THE NATIONALWEAKENING THE NATIONAL

GOVERNMENTSGOVERNMENTS

Power shift to multiPower shift to multi--national corporations,national corporations,influence of money in the political processinfluence of money in the political process

Weakening of occupational and environmentalWeakening of occupational and environmental

standardsstandards Less investment in health and social sectorsLess investment in health and social sectors

Privatization of health and social sectorsPrivatization of health and social sectors Russia, China, PakistanRussia, China, Pakistan

Weakening of safety net institutionsWeakening of safety net institutions Increase of corruptionIncrease of corruption


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SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY

Rapid change creates uncertainty, whichRapid change creates uncertainty, whichleads to polarization of a societyleads to polarization of a society

a)a) Unable to keep pace with change leads to:Unable to keep pace with change leads to: SmokingSmoking

Drug/alcohol abuseDrug/alcohol abuse

Child abuseChild abuse

Violent crimeViolent crime

STD/HIVSTD/HIV Unhealthy dietsUnhealthy diets


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SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY

b)b) Unable to keep pace with changes, individuals reactUnable to keep pace with changes, individuals reactand become fundamentalists, and struggle toand become fundamentalists, and struggle tooverthrow the government systemoverthrow the government system

IndiaIndia RussiaRussia

PakistanPakistan ChinaChina

EgyptEgypt United StatesUnited Statesc)c) Most people try to keep pace with changeMost people try to keep pace with change

Stress in individual and societyStress in individual and societyMore material things but no happinessMore material things but no happiness


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HUMAN VALUES OF SOCIAL JUSTICE,HUMAN VALUES OF SOCIAL JUSTICE,

EQUITY, COMPASSION ARE REPLACED BYEQUITY, COMPASSION ARE REPLACED BY

A SINGLE FOCUS ON PROFITSA SINGLE FOCUS ON PROFITS

Investment in community slows downInvestment in community slows down

Institutions such as schools look to outsideInstitutions such as schools look to outsidehelphelp

Further power shifts to wealthy people andFurther power shifts to wealthy people and

now the anti human rights activists havenow the anti human rights activists havelegitimacylegitimacy


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ENVIRONMENTAL DEGRADATIONENVIRONMENTAL DEGRADATION

Rapid exploitation of natural resources =Rapid exploitation of natural resources =

rapid profits = rapid environmental degradationrapid profits = rapid environmental degradation

Global warmingGlobal warming

CO2 accumulationCO2 accumulation

Ozone depletionOzone depletion

Many gains of the past may even be lostMany gains of the past may even be lost


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SUSTAINABLE DEVELOPMENTSUSTAINABLE DEVELOPMENT

BECAME AN EMPTY DREAMBECAME AN EMPTY DREAM

Development that meets the needs of the presentDevelopment that meets the needs of the presentwithout compromising the ability of the futurewithout compromising the ability of the future

generation to meet future needs.generation to meet future needs.

Human beings are the center of concern forHuman beings are the center of concern forsustainable development. They are entitled tosustainable development. They are entitled to

healthy and productive life in harmony withhealthy and productive life in harmony withnature.nature.


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Absolute Poverty is Still the Major RiskAbsolute Poverty is Still the Major Risk

Factor of Poor HealthFactor of Poor Health

The path leading from poverty to poor health goesThe path leading from poverty to poor health goesthrough inadequate nutrition, inadequate housing,through inadequate nutrition, inadequate housing,lack of education and lack of access to healthlack of education and lack of access to health

services.services. Need for actionNeed for action

We need sustainable development in globalizingWe need sustainable development in globalizingthe economythe economy

We need monitoring of unhealthy policiesWe need monitoring of unhealthy policies Change in global economic policiesChange in global economic policies


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Advocacy for healthy economic policies to narrowAdvocacy for healthy economic policies to narrow

the gap between the need and the services availablethe gap between the need and the services available

Effective dissemination of global health knowledgeEffective dissemination of global health knowledge

WFPHAWFPHA

Global Health CouncilGlobal Health Council

Necessary to move beyond health for all to considerNecessary to move beyond health for all to consider

all of the other dimensionsall of the other dimensions

Global good one world, one peopleGlobal good one world, one people

New research in social sciencesNew research in social sciences


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Global EraGlobal Era

6 millions physicians worldwide serving over 66 millions physicians worldwide serving over 6

billion inhabitantsbillion inhabitants

Over 1800 medical schools throughout theOver 1800 medical schools throughout theworldworld

Health services and medical practice areHealth services and medical practice are

undergoing profound changes forced byundergoing profound changes forced by

economic difficulties in financing healthcareeconomic difficulties in financing healthcare

systemssystems


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Increasing cost of health interventions are related costIncreasing cost of health interventions are related cost--

containment policies could threaten physicianscontainment policies could threaten physicians

humanism and valuehumanism and value

Rapid advances are occurring in biomedical sciences,Rapid advances are occurring in biomedical sciences,

information technology and biotechnologyinformation technology and biotechnology

New ethical, social and legal challenges for professionNew ethical, social and legal challenges for professionof medicine and call for preservation of a balanceof medicine and call for preservation of a balance

between science and the art of medicinebetween science and the art of medicine


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Medical StandardsMedical Standards


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Medical standards in use: the worldsMedical standards in use: the worlds

overviewoverview

USAUSA

The National Board of Medical Examiners (NBME) (1915)The National Board of Medical Examiners (NBME) (1915)

The Federation of State Medical Boards (1993)The Federation of State Medical Boards (1993)

EuropeEurope

Maastricht Agreement (1993)Maastricht Agreement (1993)

AustraliaAustralia The Accreditation Committee of the Australian MedicalThe Accreditation Committee of the Australian Medical

Council (1985, 1991)Council (1985, 1991)


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Medical standards in use: the worldsMedical standards in use: the worlds

overviewoverview

Latin AmericaLatin America

AsiaAsia

The World Federation for Medical EducationThe World Federation for Medical Education

(WFME) (1999)(WFME) (1999)


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Global Standard on Basic MedicalGlobal Standard on Basic Medical

Education (WFME, 2003)Education (WFME, 2003)

9 Area9 Area

36 Sub36 Sub--areas (Criterias)areas (Criterias)

STANDARDSTANDARD BasicBasic ---- mustmust

Quality developmentQuality development----shouldshould


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Institute for International MedicalInstitute for International Medical

Education (seven broad educationalEducation (seven broad educationaloutcomeoutcome--competence domains)competence domains)

Professional Values, Attitudes, Behaviour, andProfessional Values, Attitudes, Behaviour, and

EthicsEthics Scientific Foundation of MedicineScientific Foundation of Medicine

Clinical SkillsClinical Skills

Communication SkillsCommunication Skills Population Health and Health SystemsPopulation Health and Health Systems

Management of InformationManagement of Information

Critical thinking and researchCritical thinking and research


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The Five Stars Doctor (WHO)The Five Stars Doctor (WHO)

CommunicatorCommunicator

Care providerCare provider

Care managerCare manager Decision makerDecision maker

Community leaderCommunity leader


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National Competencies of PrimaryNational Competencies of Primary

Care Physicians (2005)Care Physicians (2005)

Effective communicationEffective communication

Performing basic clinical skillsPerforming basic clinical skills

Application of Principle from Biomedical, Clinical andApplication of Principle from Biomedical, Clinical and

Behavioral Sciences and Epidemiology in the PracticeBehavioral Sciences and Epidemiology in the Practiceof Family Medicineof Family Medicine

Management of health problems in the individual,Management of health problems in the individual,family and communityfamily and community

Accessing, critical appraising and managing informationAccessing, critical appraising and managing information Self awareness. SelfSelf awareness. Self--care and personal developmentcare and personal development

Professional, moral and ethics contexts of practiceProfessional, moral and ethics contexts of practice

Documents

Indonesian Physician’s Competency