Challenges and opportunities in cultivating medical students’ competencies: Participatory action research from a hierarchical cultural setting

Figures & data

Table 1. Characteristics of the FGDs’ participants.

Participants		Gender		Department	Region
Teachers	Amount	Male	Female
Clinical	12	4	8	Pediatric (2 female) Surgery (1 male) Eye (1 female) Pharmacologist (1 female) Anesthesiologist (1 male) Sports medicine (1 female) Internal medicine (2 males) Neurologist (2 females) OB (1 female)	2 Sumatera 1 Yogyakarta 2 West Java 7 Capital city
Pre-clinical	12	2	10	Pharmacology (1 female) Biochemistry (3 females, 1 male) Physiology (2 females) Midwifery (3 females) Anatomy (1 female) Public health (1 male)	5 Yogyakarta 3 West Java 4 West Sumatera
Medical educators	13	1	12	Medical Educ. Unit (1 male, 12 females)	2 West Sumatera 2 Capital city 4 West Java 5 Mid Java
Total	37	7	30
Students
Residents	15	6	9	Pediatric (2 females) DV (1 female, 1 male) OB (2 females, 2 males) ENT (2 female, 1 male) Internal Medicine (2 females, 2 males)	3 West Sumatera 6 Capital City 3 Mid Java 3 East Java
Clinical clerkship	15	6	9	All students finished final rotation	4 Sumatera (west Indonesia) 5 Capital City 3 Kalimantan/Borneo 3 East Java
Pre-clinical	18	4	14	Students finished their final semester before clerkships	6 Sumatera (west Indonesia) 6 Capital City 2 Yogyakarta 4 East Java
Total	48	16	32

Figure 1. Cycles of the participatory action research in this study.

Figure 2. A ‘domino-card’ effect of the learning process in medical education taken form the focus group discussions of the cycles 1 and 2 of the PAR in this study, revealing challenges and opportunities towards student-centered learning approach.

Table 2. Themes and categories derived from participants’ answers for questions 1 and 2 of the FGDs.

		Overall frequency (ranked from the most frequent spoken concern)
Final themes	Categories	Total	Articulated by lecturer (6 groups N = 37)	Articulated by students (6 groups N = 48)
Theme 1: Teacher centered learning tendency	Lack of conception of facilitating learning	48	45	3
	Teacher-centered learning	40	29	11
	Lack of constructive feedback	36	10	26
Theme 2: Neglected nurturing on students’ personal and professional development	Neglected individual uniqueness	31	22	9
	Neglected training on Soft Skills	31	26	5
Theme 3: The top-down assessment and overall educational system	Summative assessment had driven curriculum into current situation	31	28	3
Theme 4: The hierarchical culture influence	FOG (Fear-Obligation-Guilty) culture	22	18	4
	Hierarchical culture (the context)	18	11	7
Theme 5: The impact on the teachers’ attitude based on above themes	Lack of proper role model	14	5	9

Table 3. Themes and categories derived from participants’ answers for question 3 of the FGDs.

			Overall frequency (ranked from the most frequent spoken concern)
Final themes		Categories	Total	Articulated by lecturer (6 groups N = 37)	Articulated by students (6 groups N = 48)
	Theme 1: Faculty development on continuous learning, mentorship, and assessment*	Faculty development series on constructive feedback*)	36	36
Theme 2: Supportive educational and healthcare system		Commitment from the Min. of Educ. on the policy regarding: Scheduled appointments for patients and students More formative accreditation system Proper Remuneration	31	6	1
	Theme 1: Faculty development on continuous learning, mentorship, and assessment*	More formative assessment*) Individualized feedback Portfolio	31	15	16
Theme 3: The need for reflection-learning training and guide**		Student development guidance and training series**)	24		24
	Theme 1: Faculty development on continuous learning, mentorship, and assessment*	The need for constructive feedback*)	25	9	16
		The need for good role models as medical teachers. This can be done if the educational policy supports *)	21	11	10
		Appraise individual uniqueness	15	12	3
		The need for professional training and guidance*)	12	10	2
		Challenges of hierarchical and collectivist culture within the generation gap *)	10	5	5
Theme 3: The need for reflection-learning training and guide**		The need for reflection-learning training and guidance**)	8	2	6
		Equal opportunity to learn soft and hard skills**)	7	4	3
		More experiential learning**)	6	3	3