MEDICAL STUDENTS' PERCEPTIONS ON PUBLIC

HEALTH COURSE IN UNDERGRADUATE

PROGRAM FACULTY OF MEDICINE
UNIVERSITAS PADJADJARAN

STEVEN SAPUTRO

UNIVERSITAS PADJADJARAN
FACULTY OF MEDICINE
BANDUNG
2018

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MEDICAL STUDENTS' PERCEPTIONS ON PUBLIC HEALTH COURSE
IN UNDERGRADUATE PROGRAM FACULTY OF MEDICINE
UNIVERSITAS PADJADJARAN

ABSTRACT

Background

Based on standard competence for Indonesian medical doctors, SKDI 2012,

beside biomedical science, humanity, and clinical medicine, doctors should have
public health competence to manage health problems comprehensively. Faculty of
Medicine Universitas Padjadjaran has public health in the undergraduate
curriculum as Public Health Orientation Program (PHOP), which is given in 7
semesters. This study was conducted to evaluate the PHOP based on students'
perception.

Summary of Work

An online survey was conducted to undergraduate medical students at Universitas

Padjadjaran. Using a descriptive, cross sectional study design, we administered an
online survey consist of questions with Likert scale ratings from 1 to 10 as well as
qualitative questions to the respondents. The rating greater than or equal to 7 were
considered have positive perceptions. All informants completed informed consent
forms and were reassured of the confidentiality.

Summary of Results

The survey was participated by 128 undergraduate medical students, batch

2013-2017. Based on the survey, 95.3% of the respondents agreed that PHOP was
important. As much as 93.0% thought that PHOP would be useful when they
become doctors. However, only 58.6% respondents are interested in Public Health
and most of the students (78.1%) emphasized biomedical subjects than PHOP.
Most of the students (68.0%) had a negative perception about the learning

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method. Most of the students stated that the method should be more interesting
and applicable. Students also prefer to have more practice in the society.

Discussion and Conclusions

While most of the students thought that public health was important and would be
useful when they become doctors. Most of them thought that the delivery method
should be improved to be more contextual, interesting and applicable. Further
investigation is needed to design appropriate methods for the students' preferences
as well as effective to achieve the learning objectives.

Take Home Messages

Public health is very important approach that medical doctors should have,
especially in Indonesia where many public health problems still occur.
Unfortunately, most of the students emphasize more of biomedical subjects
compared to public health. This might be because of the delivery methods are lack
of creativity and outdated. Public Health lecturers should be able to generate new
methods which are more interesting, update, and applicable.

Keywords

Public health, Public Health Orientation Program (PHOP), undergraduate medical

students, learning method

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 INTRODUCTION

Public health is one of the competences that Indonesian doctor required to

possess. Based on standard competences for Indonesian medical doctors, ​Standar
Kompetensi Dokter Indonesia ​(SKDI) 2012, beside biomedical science, humanity,
and clinical medicine, doctors should have public health competence to manage
health problems comprehensively.​1,2 In managing health problem, doctor should
be able to do health promotion and disease prevention.

Faculty of Medicine Universitas Padjadjaran has public health in the

undergraduate curriculum as Public Health Orientation Program (PHOP), which is
given throughout seven semesters containing principles of public health,
environmental health, health care management, occupational health and family
medicine.​3

From time to time, PHOP curriculum is evaluated to be more contextual and

applicable. Based on Oemar Hamalik, the components of curriculum consist of
learning objectives, teaching materials, learning methods, learning process, study
assessment, learning facilities, learning motivation and quality of lecturers.​4
Evaluation is done to every curriculum component by using study assessment
result as main indicator. So, the evaluation will consist of evaluation of learning
objective achievement, evaluation of teaching matter, evaluation of learning
model and evaluation of study assessment result.​4,5

In curriculum evaluation, instruments are needed for data and information

gathering. There are two types of instruments in curriculum evaluation. They can
either be test or non-test. Test instruments constitute those procedures used to
assess the study result. Meanwhile, non-test instruments consist of behavior scale,
assessment scale, observation guideline, interview guideline, questionnaire and
document checking.​4

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Based on explanation above, assessing study result is not the only way to evaluate
the curriculum. Non-test instrument can be used to observe the curriculum deeper.
This study was conducted to evaluate the PHOP based on students' perception.

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 METHODS

Program Description
Public Health Orientation Program (PHOP), as the name implied, is a public
health course in Faculty of Medicine Universitas Padjadjaran. PHOP is given
throughout seven semesters, which consist of PHOP I – PHOP VII.​3 The number
shows the semester. PHOP is given since the students were in first year program.

The materials in PHOP consist of basic principles of public health, environmental

health, health care management, occupational health and family medicine.​3 The
learning methods are lecture, group discussion and seminar. The assessment is
written examination which is given in the middle and the end of each semester.
The exception for PHOP VI which the delivery method is integrated within
Kuliah Kerja Nyata Mahasiswa​ (KKNM), a community project based method.

Survey Development
An online survey was conducted to undergraduate medical students at Faculty of
Medicine Universitas Padjadjaran aimed to evaluate the Public Health Orientation
Program (PHOP). Using a descriptive, cross sectional study design, an online
survey was administered consist of questions with Likert scale ratings from 1 to
10 as well as qualitative questions to the respondents.​9,10

Four questions were posed to assess students’ perception about PHOP material.
For example, “In my opinion, the materials of PHOP are easy to understand.”
Two questions were posed to assess students’ perception about learning method of
PHOP. For example, “In my opinion, the learning method of PHOP is
interesting.” Two questions were posed to assess students’ perception about their
motivation of learning PHOP. For example, “In my opinion, I’m interested to
learn PHOP.” Six questions were posed to assess students’ perception about the
quality of lecturer. For example, “In my opinion, the lecture masters the material
well.” Two questions were posed to assess students’ perception about assessment
of PHOP. For example, “In my opinion, the examination materials are correlated

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with the lecture materials.” Free-text questions are also conducted to know
student’s perception about PHOP materials and its learning method.

Data Collection
All medical students who enrolled in the Faculty of Medicine, Universitas
Padjadjaran, 2013-2017 batches were eligible to participate in the study. An
online invitation to participate was distributed to all respondents. The invitation
explained the purpose of the survey and contained an embedded link to survey
instrument. Participation was voluntary and responses were collected
anonymously. Students who wished to participate were given a week to complete
the survey.

Data Analysis
Data were analyzed using Mircrosoft Excel 2013 and IBM SPSS version 20. The
data were calculated and presented quantitatively. The qualitative data then
grouped and categorized into themes. The ratings that are greater than or equal to
7 are considered as having positive or good perceptions and grouped as 'Agree'.
The ratings that are less than 7 are considered as having negative or bad
perceptions and grouped as 'Disagree'’. Qualitative analysis was also conducted
on free-text response to three survey items: “Write your impression and
suggestion about material of PHOP in Faculty of Medicine Universitas
Padjadjaran.”, “Write your impression and suggestion about learning method of
PHOP in Faculty of Medicine Universitas Padjadjaran.” and ”Additional
Comments.”

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 RESULT
Study Participants
The survey was participated by 128 undergraduate medical students. Around
11.7% (n=15) of respondents were students batch 2013, 5.5% (n=7) of
respondents were students batch 2014, 37.5% (n=48) of respondents were students
batch 2015, 17.2% (n=22) of respondents were students batch 2016, 28.1% (n=36)
of respondents were students batch 2017.

Study Results

The PHOP material was important and useful when the students become doctors.
Table 1 shows students’ perception about PHOP material

Table 1. Students’ Perception about PHOP Material

Material of PHOP Disagree (%) Agree (%) Mean ±​ ​SD

Easy to
48 (37.5) 80 (62.5) 6.73 ± 1.6
understand
Important 6 (4.7) 122 (95.3) 8.49 ± 1.2
Interesting 47 (36.7) 81 (63.3) 7.00 ± 1.7
Useful when
9 (7.0) 119 (93.0) 8.59 ± 1.2
become doctor

Table 2. Students’ Perception about Learning Method of PHOP

Learning Method
Disagree (%) Agree (%) Mean ±​ ​SD
of PHOP
Interesting 87 (68.0) 41 (32.0) 5.72 ± 1.6
Easy to
81 (63.3) 47 (36.7) 5.77 ± 1.6
understand

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Based on table 2, it concluded that learning method of PHOP was less interesting
and didnt’t made the students understand the material well.

Table 3. Students’ Perception about Motivation of Learning PHOP

Motivation of
Disagree (%) Agree (%) Mean ±​ ​SD
Learning PHOP
Interested to
53 (41.4) 75 (58.6) 6.73 ± 1.9
PHOP
More emphasize
biomedical
28 (21.9) 100 (78.1) 7.64 ± 1.8
subjects than
PHOP

Based on table 3, most of the students more emphasized biomedical subject than
PHOP.

Table 4. Students’ Perception about Quality of Lecturer of PHOP

Quality of
Disagree (%) Agree (%) Mean ±​ ​SD
Lecturer
Mastering the
13 (10.2) 115 (89.8) 8.05 ± 1.4
material
Interesting in
delivering 81 (63.3) 47 (36.7) 5.91 ± 1.6
material
Creative in
delivering 87 (68.0) 41 (32.0) 5.70 ± 1.6
material
Discipline in class 30 (23.4) 98 (76.6) 7.38 ± 1.5

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 Never absent
84 (65.6) 44 (34.4) 5.63 ± 1.9
giving lecture
Student knows
53 (41.4) 75 (58.6) 6.48 ± 1.9
the lecturer

Based on table 4, it conluded that the lecturers mastered the learning material
well.

Table 5. Students’ Perception about Assessment of PHOP

Assessment of
Disagree (%) Agree (%) Mean ±​ ​SD
PHOP
Correlation
between learning
material and 47 (36.7) 81 (62.5) 6.57 ± 2.0
examination
material
Long preparation
60 (46.9) 68 (53.1) 6.50 ± 2.4
time

Based on table 5, the students agreed that learning material correlated with the
examination material.

Student Comments

Students comment regarding the materials were useful and exciting. Most of the
students concerned about the learning method. They provided comments
regarding the method should be improved to be more contextual, interesting and
more applicable. Then, students preferred lecturer’s explanation to student group
presentation because it was not effective moreover when the study-material is

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quite difficult. However, students emphasized more discussions than just ordinary
lectures.

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 DISCUSSION
In our study, most of the students thought that public health is important and
would be useful when they become doctors although some students thought that
material of PHOP is not easy to understand and interesting. This phenomenon
happens because of two probabilities. Firstly, the students more emphasized
biomedical subjects more than PHOP proven with 100 (78.1%) students chose to
learn biomedical subjects than PHOP. They focused more on biomedical subjects
and tended to underestimate PHOP. They didn’t spend much time to learn PHOP,
therefore they thought PHOP is quite difficult to understand. Secondly, the claim
“delivery method was not interesting” is proven by 87 (68.0%) students, who had
bad perception about learning method of PHOP and 81 (63.3%) students thought
that the method didn’t make them understand the subject easily. They were bored
by the method and tended not to focus when the lecture was held. Most of them
thought that the delivery method should be improved to be more contextual,
interesting and applicable.

The students had good perception about correlation between the material and the
examination although they didn’t spend much time to prepare the examination
because they emphasized more on biomedical subjects as explained above and
only 75 (58.6%) students were interested to PHOP.

The lecturers had good capability to teach proven with 115 (89.8%) students
agreed that the lecturers mastered the material taught. Then, 98 (76.6%) students
agreed that the lecturers were discipline. However, the students thought that the
lecturers were less interesting and creative in delivering the course.

Previous study under title “Public Health Orientation Program (PHOP):

Perception of Medical Doctor Internship Program Participants at the Faculty of
Medicine, Universitas Padjadjaran” by Sharon Gonodiputro et al. (2015)
concluded that PHOP is very useful and important in internship program. Our

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study was in line with it. Either in undergraduate program or internship program,
PHOP is useful and important.

Our study has several limitations. First, this study conducted using an online
anonymous survey, and hence results were vulnerable to recall bias - that is,
overestimation and underestimation of results. Second, the overall participants
was less than anticipated when viewed from the number of students per batch.
However, the number of participants had fulfilled the minimum number of sample
based on Lemeshow formula.​10

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 CONCLUSION

While most of the students thought that public health was important and would be
useful when they become doctors, they emphasized more on biomedical subjects
than PHOP. Most of them thought that the delivery method should be improved to
be more contextual, interesting and applicable. Likewise, the quality of lecturers
in delivering material should be improved. Further investigation is needed to
design appropriate methods for the students' preferences and improve the quality
of the lecturers in delivering the course as well as effective to achieve the learning
objectives.

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 TAKE HOME MESSAGE

Public health is very important approach that medical doctors should have,
especially in Indonesia where many public health problems still occur.
Unfortunately, most of the students emphasize more of biomedical subjects
compared to public health. This might be because of the delivery methods are lack
of creativity and outdated. Public Health lecturers should be able to generate new
methods which are more interesting, update, and applicable.

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