For Dr. dr. Niken Trisnowati, Assistant Vice Dean for Research at Universitas Gadjah Mada’s (UGM) Faculty of Medicine, Public Health, & Nursing, the idea of clinical effectiveness is that of achieving both quality and cost in healthcare, and clinical pathways are an important way to achieve high effectiveness.
“We remind our students that in delivering care to patients, clinical effectiveness is very important,” said Dr. Trisnowati. “We tell them that we should follow established clinical pathways, so we conduct the right examinations to get the right diagnoses. Not doing so will lead to wrong exams or tests done, causing cost wastage and also negatively affecting the patients.”
Importance of clinical pathways
Dr. Trisnowati shared that in Indonesia, specialties often follow clinical pathways set by their respective associations. For example, as a practising clinician in dermatology and venereology, she follows pathways set by the Indonesian Society of Dermatology & Venereology.
All clinical pathways should be founded on evidence-based processes, contribute to cost savings, and lead to good quality patient outcomes. These pathways need to be maintained by clinicians and associations regularly, to take into account the latest research and developments in the field.
However, she noted that each hospital usually has its own set of pathways. In addition, for certain diseases which are more complicated, or rarely seen, there may not be any established pathways developed.
In such cases, clinicians will refer to textbooks or journals for the recommended steps to take. She also pointed to digital clinical information tools, such as UpToDate, as a good source of reference with regards to clinical pathways. In fact, UpToDate contains a module named UpToDate Pathways, which provides interactive guidelines to help clinicians address more than 160 conditions.
“I have always told the registrars (students undergoing training in UGM’s teaching hospital) to refer to UpToDate as a resource when giving care… I have also been using UpToDate in my own practice,” she said. She pointed out that students could compare between the information in their textbooks and UpToDate, though “UpToDate is definitely less wordy”, and information can be quickly accessed via user-friendly tabs and categorisation. UpToDate is also easily accessed on mobile devices, making it suitable for busy clinicians or registrars.
The digital education journey
Such digital medical information resources are useful for students at UGM to access the necessary information from their homes; as with many educational institutes in the region, UGM students have been largely attending classes virtually since the start of COVID-19.
There are only a few exceptions – as Head of Residency Specialist Study Program of Dermatology and Venereology, Dr. Trisnowati explained that registrars are allowed to go to the university hospital for their training, under supervision. The outpatient clinics there were designated as ‘green zones’ by the authorities based on COVID-19 risk level.
However, education for the rest of the students are still mainly digital. Over the past year, the school has introduced many digital education tools to support virtual learning, said Dr. Trisnowati.
This included an e-learning portal for teachers to share slides and learning materials, which was developed by an in-house IT team. The faculty has also started to pre-record educational videos, or host live webinars on various medical topics. Other creative ideas include using animation videos or 3D printing to create models for demonstration.
This transition has not been without its challenges. For lecturers who are used to in-person interactions with their students, not being able to see their students’ reactions meant they couldn’t gauge how engaged they were, and how they should adjust their teaching. “It is difficult to hold to students’ attention for the full lecture period,” noted Dr. Trisnowati. There were also the usual technical issues that occur from time to time that disrupt classes.
Nonetheless, with the work that faculty members put in to keep classes engaging and interesting, feedback from students have been largely positive so far, from surveys held on the university and faculty level. “The students are very digitally-savvy, so they have adapted to digital learning fairly well,” she said.
Looking back, Dr. Trisnowati is proud of the journey that the faculty has taken over the past year. “Before COVID-19, we didn’t believe that we could deliver classes online, or via different methods other than face-to-face,” she said. She thus sees this as a silver lining – amidst the difficulties the pandemic has brought – that adoption of digital learning has been accelerated, with the wide range of benefits it can bring.
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