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CHAPTER I
INTRODUCTION

I.1. Background of the Problem
In Faculty of Medicine Universitas Gadjah Mada, to
assess students clinical skills, Skills Laboratory use
Objective Structured Clinical Examination (OSCE). OSCE
is firstly introduced by Harden et al. (1975) in Dundee
University. It is widely used and adopted in many
medical schools in Indonesia because it is believed as
one of good methods to assess students clinical
skills. Evenmore, OSCE is also used to assess students
clinical skills right before graduating from faculty of
medicine.
According to that, we know that clinical skills are
very important to be mastered by all fresh graduates
and medical doctors. In 1992, Faculty of Medicine
Universitas Gadjah Mada started to introduce clinical
skills learning through Skills Laboratory to all
students (Claramita & Widyandana, 2007). Skills
laboratory have a very important role to train
students clinical skills, so they will be able to
understand the competency standards for undergraduate
students (Nielsen et al., 2003). Skills laboratory also


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provides structured and well-planned clinical skills
training through several kinds of methods, which are
learning by using mannequins, peer-teaching, simulative
patients, and community services (Ledingham & Harden,
1998).
In Faculty of Medicine Gadjah Mada University,
clinical skills is given longitudinally in all stages
of curriculum during undergraduate study. Each topic is
delivered using different methods which are suitable
with the characteristic of the topic itself. Skills
laboratory in Faculty of Medicine Gadjah Mada
University is facilitated by one instructor. And after
practicing with the instructors, students are allowed
and are given chances to practice more independently,
so that they could understand more and master the
clinical skills well (Claramita & Widyandana, 2008).
But then, because of business of the instructors,
who mostly are staffs from faculty, they are sometimes
unable to faciliate the clinical skills learning
process properly. This leads to the ineffectiveness of
skills laboratory and causes inadequate students
comprehension about several clinical skills. To cope
with those problems, skills laboratory started to use a


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peer assisted learning program, which is called
Training from Senior Students (TFSS).
Since early 1990s, Peer Assisted Learning (PAL)
has been implemented and used in many undergraduate and
postgraduate programmes (Whitmann, 1988). Based on
General Medical Council (GMC, 2003), most medical
students in United Kingdom are expected to understand
the basic of teaching and to be able to demonstrate
their teaching ability to others. Hill et al. (1998)
also said that PAL helps students to develop their
knowledge and skills with their peers and boost their
confidences and self-esteem because colleagues are more
approachable compared to staffs from the faculty. TFSS
is given by the senior students, who are usually called
as skills laboratory assistants, for the junior
students or tutees and it gives more chances for junior
students to learn and try the clinical skills that they
have learned before during skills laboratory, at the
end of the day.
With all clinical skills learning facilities that
are provided by skills laboratory, students OSCE
scores should be good and most students should pass the
OSCE. But, in fact, based on OSCE scores evaluation,
students failure rate in OSCE is still 30%, which is


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quite high. It may be related with the participation of
students in PAL.
Speaking of participation of students in PAL,
based on experiences of skills laboratory assistants,
not all tutees attended TFSS appropriately. Many of
them came late and went home early before the TFSS
sessions ended. And also during TFSS sessions, only a
few students were interested in practicing clinical
skills.
Based on several points written above, the
researcher is interested in and wants to explore more
whether participation of students in PAL has any
correlation with OSCE scores in Faculty of Medicine
Universitas Gadjah Mada.

I.2. Research Question
Based on background written above, research
question for this research is Is there any correlation
between participation of students in PAL and OSCE
scores in Faculty of Medicine Universitas Gadjah Mada?






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I.3. Objective of the Research
To determine whether there is any correlation
between participation of students in PAL and their OSCE
scores in Faculty of Medicine Universitas Gadjah Mada.

I.4 Benefit of the Research
This research provides us information about peer
assisted learning and its correlation with students
OSCE scores and will be beneficial for the researcher
itself, skills laboratory, institution, and medical
education area. The benefits of this research are:
a. Giving information about correlation between
participation of students in PAL and OSCE scores
to the skills laboratory.
b. Giving information about students suggestion on
PAL to skills laboratory.
c. Giving slight description about students point of
views on effectiveness and quality of PAL to
skills laboratory.
d. Result of this research could be used as one of
the basics to increase the effectiveness and
quality of PAL.
e. As a useful media for the researcher and others to
learn more about PAL.


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f. Giving contribution in scientific journals about
medical education.

I.5 Originality of the Research
There are many researches and publications
regarding PAL. Many studies explore the correlation
between PAL and clinical skill examination. Even, some
experimental studies compare the clinical skill
examination result of group with PAL method and another
group with non-PAL method.
Hudson & Todkin (2008) also did a study about PAL.
They grouped the second-year students into two groups.
Sixth-year students taught the first group, while paid
general practitioners or instructors taught the second
group. Hudson & Todkin also did qualitative survey to
all second-year students (n=125) using questionnaire
and focus group discussion (FGD) for the sixth-year
students (n=11) and the simulated patients (n=3). The
results of this research showed that PAL method could
enhance students self-confidence and create a more-
active learning process, compared to being taught by
the paid general practitioners or the real instructors.
The performance of the first group during the clinical
examination was also as good as the performance of


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students from the second group. The differences between
the research that was conducted by the researcher and
Hudson & Todkins research are in this research, there
was no experiments, there was no focus group discussion
for the senior students and simulated patients, and the
sample was only junior students.
Another research about PAL is research that was
done by Lockspeiser et al. (2008). This research
consists of 2 phases. In the first phase, Focus Group
Discussion (FGD) was held to the tutors (which are the
second-year students) and the tutees (which are the
first-year students). While in the second phase, the
researcher made questionnaires, based on the result of
FGD during the first phase. The questionnaires were
given to all first-year students and they were asked to
fill in the questionnaire based on their experiences
during PAL. The differences between this research and
the research that was conducted by the researcher are
there was no FGD for the tutors and the tutees.