Meeting international standards: A cultural approach in implementing the mini-CEX effectively in Indonesian clerkships

Abstract

Background: Medical schools all over the world try to adapt their programs to meet international standards. However, local culture might hamper innovation attempts.

Aims: To describe challenges in implementing the mini-CEX in Indonesia and investigate its effect on students’ clinical competence.

Methods: The study was conducted in the Internal Medicine and Neurology departments of the Universitas Gadjah Mada, Indonesia. Implementing the mini-CEX into the existing curriculum, while taking the Indonesian culture into account, implied a shift from group to individual feedback. We compared students’ final clinical competence before (Internal Medicine n = 122, Neurology n = 183) and after (n = 183 and 186, respectively) the implementation of the mini-CEX, using a modified Objective Structured Long Examination Record (OSLER). The Mann–Whitney test was used to analyze the data.

Results: We took power distance and individualism into account to facilitate the implementation process. After implementing the mini-CEX, the OSLER results were significant higher in Internal Medicine (p < 0.05). However, no differences were found in Neurology.

Conclusion: By managing the innovation process carefully and taking culture and local context into account, the mini-CEX can be implemented without changing the underlying concept. The shift from group to individual feedback seems to have a positive effect on student learning.

Acknowledgements

We are grateful to the Education Coordinators of the Internal Medicine and Neurology Departments, the Assessment Committee, and the Clinical Rotation Team (Clerkship Committee) who were actively involved in the implementation of the mini-CEX. We also would like to thank the students who participated in this study and Tineke Bouwkamp-Timmer for her constructive comments on several drafts of the manuscript.

Declaration of interest: The authors report no declarations of interest.

Ethical approval

Ethical approval for this study was obtained from the Medical Health Research and Ethic Committee (MHREC) at Universitas Gadjah Mada.