38 https://doi.org/10.21009/JISAE JISAE (Journal of Indonesian Student Assessment and Evaluation) ISSN : P-ISSN: 2442-4919│E-ISSN: 2597-8934 Vol 7 No 1 (2021) Website : http://journal.unj.ac.id/unj/index.php/jisae THE CLINICAL COMPREHENSIVE RACTICE EVALUATION SYSTEM OF PHYSIOTHERAPY STUDENTS DIPLOMA-IV BINAWAN UNIVERSITY Noraeni Arsyad1, Binawan University Dinny Devi Triana2 Postgraduate Lecturers of UNJ ABSTRACT This study aims to describe the problems of the clinical practice assessment system that are not in accordance with standards which has an impact on the results of Binawan University Diploma IV physiotherapy graduate. Some items in measuring devices to assess the clinical performance of physiotherapy students have low responsive level. To solve this problem, this study uses descriptive qualitative methods with case study approach that uses various sources of information in gathering data to provide conclusions or detailed descriptions. Data is collected through in-depth interviews with student, clinical instructors and document observations. Data analysis through reduction techniques, presenting data and giving conclusions through triangulation of sources, data and methods by connecting the suitability of relevant theories with the data obtained. The results of the study are generally illustrated the assessment system has been running more focused on case reports, general competency and group comprehensive test assessments. It was found that lack of an independent clinical performance assessment to see individual competencies related to learning outcome from implementation of comprehensive practice physiotherapy clinic. Thus the findings are expected to improve and evaluate the implementation of clinical comprehensive practice evaluation system of physiotherapy students Diploma IV Binawan University. Keywords: Assessment System, Comprehensive Clinical Practice, Physiotherapy Education, Performance Appraisal Address for Correspondence: 1noraeni.arsyad88@gmail.com INTRODUCTION The concept of thinking about the development of human resources involves education and training systems, it becomes interesting to discuss when the education system is more geared towards preparing whole people while training is more towards preparing workforce that is ready to work. There rise education trends in the future which begin to shift the education system towards a system that refers to the needs of the community, then vocational higher education is one of the appropriate programs in preparing graduates who are ready to work and are able to work. http://journal.unj.ac.id/unj/index.php/jisae 39 |JISAE (Journal of Indonesian Student Assessment and Evaluation)|Volume 7 Number 1 Vocational education according to UU No. 12 of 2012 concerning Higher Education causa number 16 namely Vocational Education is a higher education diploma program that prepares students for jobs with certain applied skills until the applied undergraduate program. Vocational health education examined in this study is physiotherapy education, physiotherapy itself is one of the health professionals who have independence in applying their knowledge. World Confederation for Physical Therapy (WCPT) suggests that the Physiotherapy profession is responsible for outlining the scope of the profession of practice and defining the role of physiotherapy (Policy Statement: Description of Physical Therapy. United Kingdom, 2011). Physiotherapy has a definition in accordance with Minister of Health Decree No. 1363 at 2001, namely the form of health services aimed at individuals and or groups to develop, maintain and restore bodily movements and functions throughout the life cycle using manual handling, movement enhancements, equipment (physical, electrotherapeutic and mechanical), functional and communication training As an independent health professional has a function to provide services to individuals and the community to develop, maintain, and restore maximum movement and functional ability during life. This includes improving physical, psychological, emotional, and social conditions (Policy Statement: Description of Physical Therapy United Kingdom, 2011); (Kigin, 2009). Physiotherapy services with integrity in order to improve the performance of physiotherapy requires professional standards as the basis for every physiotherapy profession in carrying out its self. Physiotherapy profession standards is prepared by referring to international standards issued by WCPT and adapted to conditions in Indonesia as stipulated in Minister of Health Decree Republic Indonesia Number 376/MENKES/SK/III/2007 concerning Physiotherapy Professional Standards. The efforts to create competent and professional physiotherapist candidates who have insight in applying their expertise on the field of health, a physiotherapy Education Institution must provide students to carry out comprehensive clinical practice/ physiotherapy clinical practice which is one of the lecture programs that must be carried out by physiotherapy students. This activity is expected to be able to make students practice the theories that have been obtained in theoretical courses in the previous semester so that students can develop their expertise and skills in the world of work. The defense advocates in the practical field are practically and functionally in supporting theory mastery on campus, and the best way to learn professional and interpersonal skills that are more based on clinical mastery Clinical based learning and assessment become an important component in health professional education programs, one of which is physiotherapy. Professional competence includes a variety of scientific understanding, therefore it is difficult to assess the standardization of student clinical practice (Rethans et al., 2002). It is known that there are a number of individual assessment methods for learning, so before a general assessment is needed an assessment that can stimulate student self-development, for example evaluating peers in terms of assessments among students in the implementation of practical learning. Applying the assessment conducted by peers / colleagues can more effectively improve student learning outcomes, peer assessment techniques make students have to study again during the assessment process is complete (Ijudin, 2020), but further development is needed if it is made into an assessment system for a clinical comprehensive practice physiotherapy program. Guidelines from the WCPT regarding physiotherapy patient management competencies must be possessed namely; examination, evaluation, diagnosis and prognosis, and interventions (World Confederation for Physical Therapy, 2011). Student competency assessment of standardized structured and objective clinical assessment can be done with physiotherapy management procedures to see practical performance. In general, to determine the development of learning can be through conceptual class discussion or application. Things that encourage individual assignments have not been able to describe students' skills in practice, but the instructor uses normative examination standards in student skills training that require complete information instruments with formative and informative psychometrics (Oli, 2018). 40 There are some measuring devices related physiotherapy student competency assessment in clinical practice but it reported rate low response for several measuring devices that need reliability of the instrument. Here are some measuring tools for evaluating clinical performance from several countries; Table 1. Measuring Clinical Performance of Physiotherapy Students Instrumen Citation Origin Country Number of Item Examination of Clinical Competence (ECC) (Loomis, 1985) Kanada 40 Blue MACS (Hrachovy et al., 2000) USA 50 Clinical Internship Evaluation Tool (CIET) (Fitzgerald et al., 2007) USA 42 PT CPI (versi 1997) (Roach et al., 2012) (Adams et al., 2008) (Proctor et al., 2010) USA 24 Royal Collage of Surgeon Ireland tool (RCSI tool) (Meldrum et al., 2008) Irlandia 36 Common Clinical Assessment Form (CAF) (Jette et al., 2007) Irlandia 40 PT MACS (Lois Stickley, 2005) (Kathleen Luedtke Hoffmann et al., 2012) USA 53 Clinical Competence Scale (CCS) (Yoshino & Usuda, 2013) Japan 53 items in 7 domains Clinical Performance Assessment Form (APP) (Dalton et al., 2011) (Dalton et al., 2012) (Murphy et al., 2014) Australia 20 Canadian Physical Therapy Assessment of Clinical Performance (ACP) (Mori et al., 2015) Canada 16 Clinical Competence Evaluation Instrument (CCEVI) (Muhamad et al., 2015) Malaysia 35 The implementation of a comprehensive clinical practice of Physiotherapy Program Diploma-IV Binawan University which is included curriculum implementation section is considered not yet effective in terms of the limited amount of practice land, lack of resources Clinical instructors who are tasked with assisting students in practical fields and evaluation system of comprehensive clinical practice has not been standardized, although there are several measuring devices still found certain items that have a low level responsive to assess the clinical performance but still needed evaluation system for physiotherapy student in psychometric and informative. The impact of the graduates is not guaranteed to have competencies that accordance with objectives of program. This research is expected to be able answering the research problem regarding comprehensive clinical practice evaluation system for physiotherapy students of Diploma IV Binawan University METHOD This Research is a study of qualitative descriptive case study were carried out focused on a particular case to be observed and analyzed closely and intensively on various factors associated with the case in order to obtain an accurate conclusion. Data in case studies are collected from various sources and research results only apply to the cases investigated. In this research, the phenomenon which is the case is the incompatibility of the clinical performance evaluation system in the implementation of clinical comprehensive practice program for physiotherapy students of Diploma IV Binawan University The case study approach has several characteristics; (1) identifying cases study, (2) the cases are bound by time and place, (3) case studies use various sources of information in gathering data to provide a detailed picture and general conclusions through in-depth interviews with students, clinical practice instructors and observations of documents regarding the comprehensive clinical practice assessment system for physiotherapy students of Binawan University, (4) researchers will have a focus in describing the context for a case. Analysis of the data through reduction techniques, presentation of data through 41 |JISAE (Journal of Indonesian Student Assessment and Evaluation)|Volume 7 Number 1 triangulation, data and methods to strengthen the relevant agreement between theory and data obtained resulting the conclusion generally. RESULTS AND DISCUSSION Clinical Comprehensive practical learning of physiotherapy student Binawan University has 6 credits and it is the introduction of working atmosphere that will be faced by students, so it can ready-made and ready to plunge in the world of work after completing the studies. To achieve this, students are prepared getting to know the work environment of a physiotherapist. In the Field Practice program, individual students are given the opportunity to participate in work government institution or private institutions (Hospitals, Clinics, Nursing Homes, Children's Foundation) which have activities related to efforts for implement in the workplace. The comprehensive practice of physiotherapy will provide students with understanding and application in practice according to the characteristics and competencies of physiotherapy profession practice. It will focus on issues relating to legal guidelines and clinical behavior in the physiotherapy profession. Students expected to implement learning experience in the classroom and laboratory for assignments and study in general practice and clinical fields, especially with regard to the development of modern physiotherapy clinical practice role. Students build their understanding of practical competencies to develop a vision of the future and a role in practice including components of health services and public health development. Students will also be directed to a clinical- based learning experience where they will be allowed to practice mastery of basic skills in practice. Finally, students are expected to conduct clinical comprehensive practice and group discussions and apply clinical practice group presentations Regarding the assessment system applied by the clinical instructor towards clinical comprehensive practice activities, it is known that students were only told what aspects would be assessed during the practice. Skills, knowledge and behavior become the main aspects with some assessment elements such as; discipline, attitude, individual activity, communication and case analysis capabilities. Basically, this aspect is an assessment format determined by the organizing institution so that clinica instructors only follow the directions or assessment sheets provided for practical activities. As one of the clinical practice instructors said, DV; "Evaluation system follows the form that has been given by Binawan University... absent, discipline and so on ... just follow it anyway... doing consul every day... and at the end of the case presentation for one group as a final assessment" Based on the results of tracing interviews regarding the application responses and also the expectations of the implementation clinical comprehensive practice of physiotherapy with students and clinical practice instructors, the responses from the student were differences in assessment exams when compared to other institutions where student participants from other institutions received exam schedules individuals who will be carried out by lecturers or clinical educators (CE) who come to the practice area and conduct an assessment of individual students when handling patients. This was said by DWO student participants; "it is the first time we practice so at the beginning we do not have a describing about clinical practice, but when we got tandem with another institution like Poltekes III Jakarta its looks different in evaluation system for individual examination, so we hope in the future Binawan University could apply some evaluation for individual assessment “ The same thing was conveyed by one of clinical instructors, through his response regarding the implementation of clinical comprehensive practice, DH said; "Well, the format of assessment was given by institution, in my opinion it was given in groups instead of individuals, the assessment was not only groups but also individuals, so clinical performance could be seen from each individual" Based on interviews it is known that the individual practice assessment has not been done to assess the competency of Physiotherapy student Binawan University. Its also known from practicum guidelines provided by institutions where competency assessment is only 42 based on a comprehensive examination at the end of the program in each area practice by making case papers, presentation of case report papers and discussion. The exam can be done specifically or can be done in conjunction with tutorial activities, practice supervising physiotherapy activities, independent practice, group discussions and group case conferences. Assessment is also given related to the implementation of knowledge, skills and overall behavior. Comprehensive test assessment aimed at groups starting from the ability to carry out examination / measurement of physiotherapy, enforcement of physiotherapy diagnoses, treatment plan, establishing physiotherapy methodologies, implementing physiotherapy and evaluating. The importance of assessing clinical performance individually to see student learning outcomes in comprehensive practice requires measuring tools that are able to describe the overall assessment of competencies obtained during the practical program. Although currently there is still no literature review that synthesizes evidence related to the validation and reliability of clinical performance assessments, standardized assessment procedures that are in accordance with the application of the world of work are very important in evaluating clinical performance of students in clinical practice activities. A measuring tool is needed to assess the standard of clinical performance of students through a certain period of time in the vulnerable implementation of clinical practice. This study aims to determine the implementation of a comprehensive practice clinical evaluation system for physiotherapy students at Binawan University. Based on the results found the rating system applied refers to three components; individual case report assessments, general competency assessments and group comprehensive test assessments. The assessment leads to an assessment of the process of learning the practice of reflection which is applied by activating student participants to use critical thinking. The importance of learning practice in physiotherapy by describing themselves as physiotherapy professional behavior (KF & GM, 2002). There is also a reflection thinking process is generally to develop a person's complex understanding such as knowledge of practice (IXER, 1999), clinical review based on practical experience (Clouder, 2000), self- evaluation and skills (Jette et al., 2007), reasoning and decision making (Donaghy & Morss, 2007). Unfortunately it is not reflected in the assessment system applied by the physiotherapy study program in clinical comprehensive practice where the development of thought processes includes the skills acquired during clinical practice. In practical learning students are expected to develop Higher Order Thinking Skills (HOTS) where students are able to communicate actively and massively related to the subject being discussed, it will provide student awareness of learning and encourage them to learn and try to understand each material indicator (Umar, 2019). The World Confederation of Physiotherapy (WCPT) stipulates that clinical practice must cover one third of the overall physiotherapy education program, emphasizing the importance of physiotherapy students obtaining competencies determined by education providers in the professional stage and must provide formative and summative assessments for each practice module. This can only be achieved through an assessment process where clinical performance is assessed based on observations by clinical instructors (O’Connor et al., 2018). However, based on the findings of the comprehensive physiotherapy clinical practice program at Binawan University there was no individual clinical performance assessment conducted for each student participant so the practice assessment only focused on the three assessment components mentioned above. 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