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UNIVERSITAS MUHAMMADIYAH PURWOKERTO

UNIVERSITY OF MUHAMMADIYAH PURWOKERTO

Jl. Raya Dukuh Waluh PO BOX 202 Purwokerto 53181

Telp. (0281) 636751, Fax (0281) 637239

LEARNING GUIDE BOOK


BLOCK 8
CARDIOVASCULAR SYSTEM
Edisi Revisi 1
SKDI 2018

TEAM BLOCK 8
CARDIOVASCULAR SYSTEM
FACULTY OF MEDICINE
UNIVERSITY OF MUHAMMADIYAH PURWOKERTO
PURWOKERTO
2018

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LEARNING GUIDE BOOK

BLOCK 8
CARDIOVASCULAR SYSTEM

CONTRIBUTORS

Curiculum Coordinator
dr. Anis Kusumawati, M.Sc

Block Coordinator
dr. Susiyadi, Sp. An

TEAM BLOCK 8 CARDIOVASCULAR SYSTEM


FAKULTY OF MEDICINE
UNIVERSITY OF MUHAMMADIYAH PURWOKERTO
PURWOKERTO
2018

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LIST OF CONTENT

Title
Contributors
List of content
Preface

CHAPTER I INTRODUCTION
A. Block Description
B. Departement Involve

CHAPTER II LEARNING GUIDE


A. Area Of Competence
B. Learning Outcome
C. Standart Competence
D. Topic Tree
E. Learning Methode
F. Learning Facility
G. Learning Topic
H. Schedule
I. Syllabus
J. Evaluation Of Learning Process And Result

CHAPTER III QUALITY ASSURANCE OF BLOCK


CHAPTER IV REGULATION

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PREFACE

Cardiovascular is one of medical student curiculum using a new


methode called “Problem Based Learning” in the expanding curriculum, with
various topic and scenario consist of important point that need to be learnt.
The cause and risk factor of the cardiovascular disease can be congenital or
herediter, which involve age factor, nutrition, lifestyle or other factor as the
cause.
As we know that cardiovascular disease like Coronary Acute Syndrom
is the first disease can make someone suddenly died.
To understand and achieve the targeted competence in this block,
medical student is expected to be able to explain issue related to cardiology
system disorder, especially the pathogenesis mechanism and
pathophysiology of each disorder, clinical appearance, principle diagnosis,
comprehensive treatment consist of promotive, preventive, educative,
curative. Medical student is also expected to understand the complication of
each cardiology disorder with a family medicine approach.
Competence based Curiculum have been agreed and establish by the
Konsil Kedokteran Indonesia (KKI) to be used as a guide to plan the medical
curriculum in learning centre across Indonesia with Standar Kompetensi
Dokter Indonesia (SKDI) 2018. Implemented using SPICES (Student
centered, Problem-Based, Integrated, Community,based, Elective, Early
exposure to clinical situation, Systematic). Therefore, there have been
changes of education methode from teaching methode with teacher-centered
to learning methode with student-centered.
PBL methode using the SPICES, is an efective learning methode to
develop dan enhance the ability to think critically and self_directed learning,

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which is very impotant to create a personality that has principle of life-long


learning. Because of that, PBL is thought to be an effective learning methode
for medical student in the level of basic education and basic medical education
integrated in every semester starting from the first semester until eight
semester.

Purwokerto, September 2018

Team Block Carsiovascular System

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CHAPTER I
INTRODUCTION

A. BLOCK DESCRIPTION
Name : Block of Cardiovascular
Code : 131401308
SKS : 5 SKS
Schedule : Semester 3th
Block Description :
Block of cardiovascular is the 8th block in two year of medical student.
This block will go on for six weeks where’s in the 3th and last week the
medical student will be evaluate.
This block will begin by understanding the anatomy, physiology,
histology and the pathophysiology of the cardiovascular system.
Thereafter the medical student will learn the abnormality involving the
organ, criteria diagnosis, and the therapy. Subsequently medical student
should be able to practice their knowledge and skill of cardiology at the
community health facility or the hospital.

B. DEPARTEMENT INVOLVE

1. Anatomy
2. Histology
3. Physiology
4. Pathology Clinic
5. Pathology Anatomy
6. Pharmacology
7. Internist
8. Pediatric
9. Radiology
10. Herbal Medicine
11. Heath Nutrient
12. Rehabilitation Medic
13. Islamic

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CHAPTER II
LEARNING GUIDE

A. AREA OF COMPETENCE

1. Behave Professionaly

Behave professionaly in a practise of medicine and support health


regulation, have sense of moral and ethics. Understanding ethical
issue and also the aspect of medicolegal in the practise of
medicine, implementing safety patient’s programme.
2. Self Correction and Self Development
Do practise of medicine with full awareness based on the
individual ability and limitation, overcome emotional problems,
personal problems, health problems and wellfare that can
influence the profession ability, long life learning, planning,
implementing and monitor the profession development
continously.
3. Effective of Communication
Able to collect information verbaly and non-verbal with patient at
all age, member of the family, society, colleague, and other
profession related to the case of cardiology diasease.
4. Management Information
Access, manage and evaluate critically the implementation of
information to explain and solve the health problems, or make
final decision in a primary health care.
5. Scientific of Medicine

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Identify, explain and plan the solution to solve the health


problems scientifically according to the latest principle of
medicine in order to obtain maximal result.
6. Clinical Skill
Perform the clinical procedure to correspond the problems and
needs of the patient, accroding to the rights of authority.
Melakukan prosedur klinis sesuai masalah, kebutuhan pasien dan
sesuai kewenangannya
7. Management of Health Problems
Manage the health problems that arise from individual, family, or
society in a comprehensively, holisticaly, coordinately and
colaborately in a context of primary health care.
Mengelola masalah kesehatan pada individu, keluarga, ataupun
masyarakat secara komprehensif, holistik, berkesinambungan,
koordinatif, dan kolaboratif dalam konteks pelayanan kesehatan
tingkat primer
8. Bioethical
9. Islamic Competence
Orientation to health individual problem colaborately with
Islamic competence.

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B. LEARNING OUTCOME
After completing six weeks of learning process in this block, medical
student should be able to :

1. Explain the anatomy, physiology, histology and patophysiology of


the cardiovascular system.
2. Explain anamnesis, physic diagnostic, supporting diagnostic to
know diagnosis cardiovascular disease.
3. Explain management cardiovascular disease.
4. Explain the principle promotive, preventive, curative and
rehabilitative cardiovascular disease.
5. Able to perform the skill needed related to the cardiovascular
system based on the level competence
6. Implementing the principle of muslim in the practice of medicine
related to the cardiovascular system.

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C. STANDART COMPETENCE

1. List of Problem Cardiovascular System


a. sakit/nyeri dada
b. berdebar-debar atau dada bergetar, debar jantung tak beraturan
c. sesak napas/napas pendek
d. kebiruan
2. List of Disease Cardiovascular System
No Daftar Penyakit Tingkat
Kemampuan
Gangguan dan Kelainan pada Jantung
1 Kelainan jantung congenital (Ventricular 2
Septal Defect, Atrial Septal Defect,
Patent Ductus Arteriosus, Tetralogy of
Fallot)
2 Radang pada dinding jantung (Endokarditis, 3A
Miokarditis, Perikarditis)
3 Syok (septik, hipovolemik, kardiogenik, 3B
neurogenik)
4 Angina pektoris 3B
5 Angina pektoris pada anak 2
6 Infark miokard 3B
7 Infark miokard pada anak 2
8 Gagal jantung akut 3B
9 Gagal jantung akut pada Anak 2
10 Gagal jantung kronik 3A
11 Gagal jantung kronik pada Anak 2
12 Cardiorespiratory arrest (henti jantung 3B
paru)
13 Cardiorespiratory arrest pada Anak 2
14 Kelainan katup jantung: Mitral stenosis, 2
Mitral regurgitation, Aortic stenosis,
Aortic regurgitation, Penyakit katup
jantung lainnya
15 Bradikardi simptomatik 3B
16 Takikardi: supraventrikular, ventrikular 3B
17 Takikardi: supraventrikular, ventrikular pada 2
Anak
18 Fibrilasi atrial 3B
19 Fibrilasi atrial pada Anak 2
20 Fibrilasi ventrikular 3B
21 Fibrilasi ventrikular pada Anak 2

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22 Atrial flutter 3B
23 Atrial flutter pada Anak 2
24 Ekstra-sistol supraventrikular, ventrikular 3B
25 Ekstra-sistol supraventrikular, ventrikular 2
pada anak
26 Bundle Branch Block 2
27 Aritmia lainnya 2
28 Kardiomiopati 2
29 Kor pulmonale akut 3B
30 Kor pulmonale akut pada Anak 2
31 Kor pulmonale kronik 3A
32 Kor pulmonale kronik pada Anak 2
33 Penyakit Kawazaki 2
34 Spell hypoxic 3B
35 Sindrom koroner akut (angina pektoris tidak 3B
stabil, infark miokard akut)
Gangguan Aorta-Arteri
36 Hipertensi esensial 4A
37 Hipertensi esensial pada anak 3A
38 Hipertensi esensial dengan penyulit 3A
39 Hipertensi sekunder 3A
40 Rujuk balik hipertensi sekunder 4A
41 Hipertensi pulmoner 1
42 Hipertensi krisis (emergensi) 3B
43 Penyakit Raynaud 2
44 Trombosis / trombo emboli arteri 3B
45 Koarktasio aorta 2
46 Penyakit Buerger's/ Thromboangiitis 2
Obliterans
47 Subclavian steal syndrome 1
48 Aneurisma Aorta 1
49 Aneurisma diseksi 1
50 Aneurisma pembuluh darah perifer 2
51 Demam jantung reumatik 3A
52 Abses diabetik 3A
53 Gangren diabetik 3A
54 Iskemik tungkai akut 3B
55 Iskemik tungkai kronik 2
56 Peripheral artery disease 3A
57 Anomali vaskular 2
58. Malformasi vaskular 2
59. Trauma vaskular 3B
Vena dan pembuluh linfe
60. tromboflebitis 3A
61. Tromboflebitis pada anak 2
62. Limfangitis 3A
63. Limfangitis pada anak 2

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64. Varises (primer, sekunder) 3A


65. Obstructed venus return 2
66. Trombosis vena dalam 3A
67. Emboli vena 2
68. Limfedema (primer, sekunder) 3A
69. Limfedema (primer, sekunder) pada anak 2
70. Insufisiensi vena kronik 3A
71 Insufisiensi vena kronik pada anak 2

3. List of Skill Cardiovascular System

No Keterampilan Tingkat
Keterampilan
ANAMNESIS
1 Melakukan anamnesis dengan bahasa yang 4A
mudah dipahami oleh pasien dan
keluarga/pengasuhnya terkait keluhan
utama sesuai daftar masalah
kardiovaskular.
2 Mendapatkan data tentang faktor risiko 4A
penyakit kardiovaskular yang ada pada
diri pasien
PEMERIKSAAN FISIK
3 Inspeksi dada 4A
4 Palpasi denyut apeks jantung 4A
5 Palpasi arteri karotis 4A
6 Perkusi ukuran jantung 4A
7 Auskultasi jantung 4A
8 Pengukuran tekanan darah 4A
9 Pengukuran tekanan vena jugularis (JVP) 4A
10 Palpasi denyut arteri ekstremitas 4A
11 Penilaian denyut kapiler 4A
12 Penilaian pengisian ulang kapiler (capillary 4A
refill)
13 Deteksi bruits 4A
Pemeriksaan Fisik Diagnostik
14 Tes (Brodie) Trendelenburg 4A
15 Tes Carvallo (Carvallo’s sign) 4A
16 Tes Perthes 3
17 Test Homan (Homan’s sign) 3
18 Uji postur untuk insufisiensi arteri 3
19 Tes hiperemia reaktif untuk insufisiensi arteri 3
20 Test ankle-brachial index (ABI) 3

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21 Penilaian edema 4A
22 Penilaian perubahan warna kulit tungkai 4A
Pemeriksaan Diagnostik
23 Elektrokardiografi (EKG): pemasangan dan 4A
interprestasi hasil EKG sederhana
24 Exercise ECG Testing 2
25 Echocardiografi (M-mode, 2DE, Doppler, 2
transesofageal)
26 Phonocardiografi 2
27 USG Doppler 2
28 Exercise ECG Testing 2
29 CT Cardiac 1
30 Angiografi (arteriografi dan venografi) 1
31 Pemeriksaan Sidik Perfusi Jantung 1
32 Pulse Oximetry 4A
33 Ambulatoir Blood Pressure Monitoring 4A
34 Holter Monitor 2
35 Cardiac Magnetic Resonance Imaging 2
36 Kateterisasi Jantung, Elektrofisiologi 2
Resusitasi
37 Pemasangan bebat tekan 4A
38 Heparinisasi 4A
39 Sidik Perfusi Jantung 1
40 Defibrilasi (manual dan otomatik) 4A
41 Kardioversi 3
42 Kateterisasi Jantung 2
43 Operasi jantung 1
44 Kardioversi 3
45 Defibrilasi 4A
46 Valsava Test 4A
47 Massage Karotis 4A
48 Penggunaan Automated External 4A
Defibrillator (AED)

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D. TOPIC TREE CARDIOVASCULAR SYSTEM

NYERI DADA BERDEBAR KEBIRUAN DYSPNEU

Anatomi Fisiologi Histologi Sistem kardiovaskuler

Patofisiologi Sistem Kardiovaskuler

Biomarker Jantung

Pemeriksaan penunjang Kardiovaskuler Rontgen

EKG

Penyakit Kardiovaskuler

Farmakologi beta bloker

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E. LEARNING METHODE

1. Debriefing
Debriefing is done everyday according to schedule, to give
medical student a basic understanding or prior knowledge of the
concept related to the topic of their study.

2. Lecture
Learning in classroom where medical student hear expert teach
them in front of the class.

3. Expert Consultation
An activity whereas medical student will be doing consultation
with an expert about the problems they’re facing or the solution
that occur in their disscusion. The consultation will be carried out
by an agreement between the medical student and the expert of
place, date and time.

4. Self Directing Study


Self directing study is schedule to give the medical student a
chance to summarise the topic that are given to them. Based on
the learning outcome, the medical student are expected to
understand the topic according to the aim of the subject. If there
is any medical student who do have a problem during their
independent learning, they can discuss it with other medical
student or find a source of reference and consult with an expert.

5. Problem Based Learning (PBL)

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The main focus of Problem Based Learning methode is the


tutorial. The class id divided into small groups consist of ten
medical student, each group is supervised by a tutor. During the
tutorial session, each medical student should know the learning
outcome from each health issues that are discussed and also
agreed on how to achieve those learning outcome. The medical
student need to understand the knowledge and skill that
correspond to the learning outcome. The medical student should
also learn on how to work as a team, to share and help each other,
to do their assignment that are given with their best effort. By
getting used to do an independent learning and socialise with
others, give the medical student the basic need for their next task.

The implementation of the tutorial is as follow :


a. The medical student is faced with a scenario filled with
health issue that are designed to force them to find a
scientific information.
b. The medical student will search for important keywords in
each scenario and also tried to build questions as many as
they could after reading and understanding the scenario.
c. Every medical student tried to solve the problems that arise
by finding scientific source of information, collecting the
related data that are needed to enhance the understanding
and implementation of the basic concept.
d. The medical student discuss any information they find to
organise the accurate and complete data based on the
learning outcome in a form of directed discussion with or
without a tutor within the scheduled time.

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e. In order to get an accurate information, the medical student


is allowed to be involve in an expert consultation or an
expert lecture.

In a Problrm Based Learning, a tutor acr as a facilitator in


the learning process of the medical student. A tutor does not have
to be an expert about the health issues that are being discussed.
Tutor have a very important role in directing the medical student
to achieve their goal in education. For that, an intensif interaction
is needed between the tutor and the medical student.
To perform a Problem Base Learning there is a seven jumps
methode that can be used to achieve the learning outcome. The
seven jumps methode consist of :
L-1 : Describe the terminology and the concept
L-2 :Define the problem
L-3 : Analise the problem
L-4 : Draw a conclusion from L-3
L-5 : Formulate the learning objective
L-6 : Collecting additional information
L-7 : Synthesising and verify the new information

6. Skill Lab
Skill lab Skills laboratorium is aiming at practising the medical
student’s skills using a learning model for example, the
manequin, phantom and patient simulation. This activity is
perform from an early start and continously integrated throught
out the block. Clinical skills that are being learnt and practise in
the skills laboratory is one of the main competence in medical

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education, which mean that the medical student need to practise


their skill frequently according to the skill competence in every
block. Every skills is schedule in the learning process within
every block during which the medical student will be able to
practise with or without an instructor.

7. Practical
Practical in laboratory related topic in cardiovascular system.

8. CD interactive
Performing a CD interactive is aiming to give the medical
student a better visualisasion of the health issue according to the
topic of the block. After watching the visualisasion then the
medical student will continue to discuss the issue between the
lecturers, so the medical student will get a comprehensive
understanding about the issue that are being dicussed.

9. Review Artikel

Review artikel is method see a article or jurnal. Learn content,


analisys and presented the result with another group.

10. E- learning

Methode with internet media and medical student can learn


without see their lecture.

F. LEARNING FACILITY
- Staff os lecturer
- Tutor with a ratio 1:10

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- Laboratory
- Internet Access
- Library and e-Library
- Discussion room (PBL)
- Lecture room
- Laboratory skill and equipment
- LCD and Laptop
- White Board
- Wireless Microphone
- Secretariat Block room
- CD movie

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EXPERT LECTURE

Week Topic Departement

1 Pengantar Blok Team block

Anatomi jantung Anatomy

Struktur histologi jantung Histology

Proses mekanisme siklus jantung Physiology

Patologi Anatomi PA

Biomarker jantung Patology Clinic

2 Kelainan congenital pada jantung Pediatric

Gangguan dan kelainan pada jantung Cardiology

3 Gangguan aorta dan arteri Cardiology

Vena dan pembuluh darah Cardiology

Defibrilation Anesthesiology

4 EKG Cardiology

Farmakologi penyakit jantung Pharmakology

Herbal jantung Herbal Medicine

5 Rehabilitasi Medik pasien jantung RM

Radiologi Jantung Radiology

Diet pasien jantung Nutrition Health

Keislaman Islamic

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TUTORIAL/PROBLEM BASE LEARNING (PBL)

Week Topic

1 selalu saja emosi

2 sakitnya dadaku

3 tolong, mbahku sesak

4 saatnya beraksi

5 dadaku

PRACTICAL

Topic Departement
Anatomi klinis jantung Anatomy
Histologi jantung dan pembuluh darah Histology
Pembacaan EKG normal Physiology
Patologi Anatomi Jantung PA
β- Bloker Farmakology
Digitalis Farmakology

REVIEW ARTIKEL
SKILLS LAB

Topic Departement
Pemeriksaan Fisik Jantung (IPPA)
Pemasangan EKG & Interpretasi hasil EKG Skills
sederhana Laboratory
Rontgen jantung
Resusitasi Jantung Paru
Resusitasi Neonatus

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G. SCHEDULE
SCHEDULE OF BLOCK CARDIOVASCULAR SYSTEM
Terlampir

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H. EVALUATION OF LEARNING PROCESS AND RESULT

1. Component Assesment of the Block


Grades will be obtain after the medical student completed all the
activity from the learning process. The component of the grades are
:
a. Writing Examination (MCQ)
The precentage of the writing exam is 50% from the total
grade. The criteria to be able to do a writing exam are :
1) Attendance for expert lecture is > 80%
2) Attendance for discussion tutorial is > 80%
Writing exam is scheduled twice in every block. First exam
will be held in the 3rd week and the second exam will be held
in 6th week.
The score will be between 0-100
Question will be in a form of computer based test (CBT)
Topic of the exam is from expert lecture and discuccion tutorial
The team block of cardiovascular is responsible for the exam.
b. Tutorial
1) Attendance for tutorial is > 80%
2) The precentage of the tutorial is 20 % from the total grade
3) Assessment will be done during the discussion directed by
a tutor.
4) Score for tutorial consist of :
The criteria for attendance is as follow :
a. 1= present or late less than 30 minutes
b. 0 = not present or late more than 30 minutes
c. Score for clinical skills
a) Score for clinical skills is excluded from the total score of
the block. Score for clinical skills consist of score of
responsi (30%) and OSCE (70%)
b) Criteria for medical student to be able to do clinical skill
examination is attendance must be 100%.
c) Score for clinical skill examination have a minimum score
for each station in order to passed the exam. The medical

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student who did not passed the minimum score for certain
station, then they will get a zero score for that particular
station.
d) The total score for clinical skill is the total score of all
station divided by the number of station.
e) The team responsible for the clinical skill’s score is the
evaluation’s team and the clinical skill’s team.
d. Practical score
The percentage of the practical score is 25%.
e. Article Review score
The percentage of article review score is 5%
2. Passing Criteria
a. Attendance of all learning methode is not less than 80 %
b. Performance in tutorial PBL minimum70
c. Practical score minimum 70
d. Submit all the assignment before due date
3. Remedial
a. Remedial is given to the medical student who fulfill the criteria
to do a remedial examination. (attendance is no less than 80 %).
b. Remedial written exam is to be held with agreement
c. Grades obtained by remedial is the best grade with a maximum
of 68.
4. Score Component
The overall grade of the block is determined according to the
following reference :
Grade Scale Interpretation

A 4.00 Level of proficiency> 80.0 %


A/B 3.50 Level of proficiency> 70.0 – < 80.0%
B 3.00 Level of proficiency> 65.0 – < 70.0%
B/C 2.50 Level of proficiency> 60.0 – < 65.0%
C 2.00 Level of proficiency> 55.0 – < 60.0%
C/D 1.50 Level of proficiency> 50.0 – < 55.0%
D 1.00 Level of proficiency> 45.0 – < 50.0%
E 0.00 Level of proficiency< 45.0%

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The overall grade of the block of each student is determined through


a judicial block meeting.

Note: The value of each component of the block score is determined


by the block team, agreed through semiloka block, depending on the
activities conducted within the block, and on the percentage of
distribution of block objectives through the activities conducted.

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CHAPTER III
QUALITY ASSURANCE OF BLOCK

A. BLOCK REGULATION
1. Quality Component
a. Medical student
b. Lecture / Tutor / Expert
c. Facility
d. Education regulation
e. Management
f. Lecture
g. Self directed learning
h. PBL
i. Laboratory skill
j. Practical
k. Evaluation
2. Quality Standart
a. Lecture
1) Actualisation of lecture is 100% from the total plan
2) Medical student who follow the lecture is  90%
3) The fulfilled of adequate learning facilities for the
activity, for example everyroom has its own LCD,
computer, soundsystem, OHP, AC, whiteboard and room
capacity is relevent to the number of medical student.
4) Consistent scheduling (unchanged 2 times)
5) The availability of module, CD, reference to use.

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6) The availability of monitoring and learning evaluation in


the end of each block.
b. Self Directed Learning
1) The availability of chances to do a self directed learning
in the running schedule.
2) The availability of portofolio containing the medical
student activities
3) The fulfilled of adequate facilities to do a sel directed
learning inside the campus area for example, resting place
and study ground.
4) The availability of module, references that are useable in
the library.
c. PBL
1) Actualisation is 100% from total plan
2) Medical student who follow this activity is  90%
3) The fulfilled of adequate learning facilities for the
activity, for example everyroom has its own LCD,
computer, OHP, AC, whiteboard and room capacity is
relevent to the number of medical student.
4) Consistent scheduling (unchanged 2 times)
5) Number of expert involve in this activity is 90%
d. Practical and Laboratory Skill
1) Actualisation is 100% from total plan
2) Medical student who follow this activity is 100%
3) The fulfilled of adequate learning facilities for the
activity, for example everyroom has its own LCD,

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computer, OHP, AC, whiteboard and room capacity is


relevent to the number of medical student.
4) The availability of manequin or standart learning tool for
every practical and skill that are trained.
5) Consistent scheduling (unchanged 2 times)
6) The rotation of trainer is less than 20% from initial plan.
7) Lecturer will trained cilinical experts and general
practitioners as a trainer on a particular skill
8) The availability of module, references that is useable in
the library.
e. Evaluation
1) The evaluation plan for medical student is all able to be
implemented 100 %
2) The correspond between planned learning outcome ,
taught and evaluated is 80%.
3) The implementation of evaluatuion and
monitoring of the learning process is 80% from total
leraning process.
B. MANUAL PROSEDUR BLOK
1. Expert Lecture and CD interactive
a. Lecture is held according to the schedule that has alreaddy been
planned before.
b. The medical student arrive 10 minutes before the lecture begin
and fill in the absence form available.
c. The expert arrive 5 minutes before the lecture begin and do
some preparation and also fill in the absence form available.

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d. The expert will give an intreactive explanation by directing the


medical students to be able to learn actively and independently.
e. The medical students pay attention and make important notes.
f. The lecturer will lead the discussion with the topic that have
been given during the luecture to point out and trained the
medical students in expressing their opinions, act ctirically and
ask direct questions to get a response or an explanation.
g. At the end of each lecture, the lecturer will evaluate the learning
process and fill in the questionnaire.
2. PBL
PBL in block of Dermatology is held bu the form of tutorial. The class
id divided into small groups consist of ten medical student, each
group is supervised by a tutor. During the tutorial session, each
medical student should know the learning outcome from each
health issues that are discussed and also agreed on how to achieve
those learning outcome. The medical student need to understand
the knowledge and skill that correspond to the learning outcome.
The medical student should also learn on how to work as a team,
to share and help each other, to do their assignment that are given
with their best effort. By getting used to do an independent
learning and socialise with others, give the medical student the
basic need for their next task. .
3. Practical or laboratory skills
Practical or laboratory skills is done is a specific room called the
laboratorium or clinical skills room. The topic of the practical is
adjusted to the learning topic of the block, for example practical
of anatomy, histology, physiology and medical biochemistry.

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Before each practical session begin, the medical student should


have know the topic of the practical from the practical’s guide
book. After the practical session, the medical student will made a
written report. It is expected that after each practical session, the
medical students is able to do the practical tha has been taught to
perform aclinical examination.
4. Evaluation
a. Oral Examination
Medical student is faced with one or more examiner who
will be asking questions. The question will be answered by
oral, can be long cases or short cases.
b. Long Essay Question
In a long essay question, the medical students will answered
the written question, for questions which need long answers.
c. Short Essay Question
In a Short Essay Question, the answer will be based on the
form of semi-structure. Short Essay Question is also called
Modified Essay Question. The question is expected to be in
the form of vinette consist of case illustration and the
medical student will answer briefly according to the question
asked.
d. Multiple Choice Question
Multiple Choice Question is an objektive instrument consist
of case description and the medical student choose one of
the structure answers available.
e. Extended Matching Items (EMI)

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EMI is a relative new form which is obyektive and similar


to MCQ, the difference is connecting the answer and the
question which is already available. There is only one
correct answer for each question.

C. BLOCK MONITORING
1. The monitoring of the learning process is held periodicaly every
week by team of quality assurance.
2. The monitoring of learning process is held in the end of the block
by all staff involve including medical students, lecturer and staff
administration by filling in the form available.
3. Evaluation form and block monitoring form is included.

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REGULATION
A. Regulation for Lecture and Expert Consultation
1. Medical student is compulsory to be present during the lecture.
The attendance allowed to be able to sit in a written exam is >
80%.
2. Medical student is compulsory to be present inside the lecture
room before the lecture begin.
3. Medical student is compulsory to fill in the absence form for
lecture.
4. Medical student is compulsory to follow the lecture with a good
behaviour, do not talk to others outside of the topic of the lecture
given, so not to interrupt the learning process.
5. Medical student by any reason is unable to be present during the
lecture is compulsory to inform (written) the accademic
coordinator or block coordinator.
6. Absence in the lecture activity must be accompanied with an
acceptable reason. For example :
i. Sick / gave birth ( with an evidence of the doctors letter)
ii. Get Married
iii. The dearh of main family member (father, mother, siblings)
iv. Undergo activity by the faculty/university proved by a dean
recomendation.

B. Regulation for Group Discussion (PBL)


1. Medical student is compulsory to follow the tutorial. The
attendance allowed to perform a written exam is > 100%
2. Medical student is compulsory to be present inside the discussion
room before the tutorial begin.
3. Medical student is compulsory to fill in the absence form for
tutorial.
4. Medical student is compulsory to be active during the tutorial
discussion.

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5. Medical student by any reason is unable to be present during the


lecture is compulsory to inform (written) the accademic
coordinator or block coordinator.
6. Absence in the tutorial activity must be accompanied with an
acceptable reason. For example :
i. Sick / gave birth ( with an evidence of the doctors letter)
ii. Get Married
iii. The dearh of main family member (father, mother, siblings)
iv. Undergo activity by the faculty/university proved by a dean
recomendation.

C. THE SUBMISSION OF STRUCTURE ASSIGNMENT


Structure assignment is by a form of logbook and portofolio.
Logbook is submitted when the tutorial is about to begin. Every logbook
is completed with a minimal five source of reference. Source of trusted
reference is textbooks, scientific journal, and other trusted internet source
(taken from trustes website and the information can be verify). References
from the newspaper is consider unvalid source of reference.
Portofolio assignment is a group assignment. Every portofolio must
be completed with a minimal ten source of trusted reference and three of
then have to be a scientific journal. Portofolio is submitted in the last
session of tutorial for each cases.

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TUTORIAL CASE :

Scenario 1

My Chest Pain

A man on 43 years and as na actress and athlete suddenly felt a pain


on his left chest when he do baseball exercise with his friends. He felt so pain
like suppressed heavy thing and radiating to the left arm. This man also smoke
1 packet cigarettes a day and like oily food. And the history of his father dead
by heart attact 2 years ago.

When Physical examination the patient look pain. Week pulse, once a
while ektrasistole, weight 92 kgs, height 168 cms, awareness compos mentis,
blood pressure 100/70 mmHG. Pulse 100x/minute, content less pressure,
regular rhyme, respiratory rate 22x/minute, JVP not increase.

On inspection show there is no heaving, show


lineamidclaviculasinistra SIC IV. On palpasi showed apeks on SIC IV
lineamidclaviculasinistra, there no thrill. On perkusi showed that waissr of
heart look normal. And the sound of auskultasi heart I on normal intensity,
sound of heart II also on normal intensity, normal splitting. There no murmur.
no gallop. And no ronchi.

On EKG wave it is showed large Q waves and ST elevation segment.


The diagnose of doctors is infark miokard due to thrombosis cononary artery.
Plasma analysis showed there is incline on cardiac enzymes. The patient had
been given oxygen and morphine. Infusion of streptokinase also prepare to
released thrombus coroner and start to give regular aspirin in low dose

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Scenario 2

Always Emotion

A man, successful young entrepreneurs, 38 years old. Lately complain


that his has headache, stiffness on his neck and hard to get better slept. In
already run for 1 week, his name is Boy, he is type of emotional person,
emotional and angry is be one of his habbit. Boy rarely do exercise and almost
every night always go out dinner with his clints at fancy restaurant. He is
smoker but not drink alcohol. He has a family history disease, his father
suffered a stroke.

On phycal examination weight 86 kgs, height 162 cm, Blood pressure


160/100 mm Hg, pulse 90x/minutes, temperature 36,2 oC and respiration
22x/minutes. Normal vision and no limb muscle weakness.

In the laboratory tests showed that the triglycerides 525 mg/dl with
numbers of HDL 30 mg/dl and LDL 314 mg/dl

Scenario 3

Please Help my Grandfather got Tightness

Mbah Roso is a vegetable trader at the tradisional market, 67 years


old, and he often fell ill. This evening Mbah Roso brought to ER at UMP
Hospiital because he fell something wrong due to shortness of breath
accomoanied by cough with phlegm. The sputum colour is pink and spumous,
his chest sometimes felt pulsate, hard to sleep and need 3 pillows to make him
better sleep, decrease urination, both of his legs swalen. Before this mbah roso
has been treated at hospital with the same complaint

On physical examination showed blood pressure 110/60 mm Hg, pulse


125x/minutes, regular, respiratory rate 35x/minutes, temperature 36.70C and
jugular venous pressure (JVP) 5±3 cm Inspection result showed that chest
wall symmetrical. and ictus cordis laterally shifted to the bottom. On Palpation
found that ictus cordis shifted to lateral bottom in spatium intercostale (SIC)
VI, 2 cm Lateral linea midclavicular. On percussion showed that border of the

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left side of heart shifted to laterally bottom and the right side of heart on SIC
V Linea right of parasternal. The result of auscultation showed that sound of
heart I on increase intensity, sound of heart II normal, the noisy of pansistolic
is spread laterally, rytme of gallop is positively, On lung examination showed
that on normal vesicular, wet ronkhi smooth basalt and on abdominal
examination found hepatomegaly and ascites.

On laboratory tested it’s found that level of hemoglobin (Hb) 9 g/dl,


65 serum urea, 1,4 serum creatine. EKG resulted on Right ventricle
hiperthropi and left ventricle hiperthropi. On photo examination of thorax
showed that cardiomegaly with CTR 0,60, apex cordis shifted to bottom, waist
heart show bulging, and pulmonary vascularization become increased,
examination of blood gas analisis showed that asidosis metabolic be
compensated

Scenario 4

It’s Show Time

A nurse in hurry report that the patient on the bangsal, 56 years old, female,
has been hospitalized 2 days, suddenly loss her consciousness, cold sweat,
rapid of pulse increased, weak and oliguric. The patient look confusion and
agitation. Blood pressure 80/50 mm Hg, pulse 120 x/minutes, respiratory rate
28 x/minutes, temperature 360C. The patients had story of uncontrolled
hypertension for 5 years.

ECG results as showed below.

The doctor then took action on the patient.

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Scenario 5
MY CHEST

A 14-year-old man came to the UMP Hospital with his family, with
complaints of shortness of breath arising. Complaints of tightness in the chest
are affected by activities, for example when the patient is walking ± 20 meters,
and suddenly the patient feels tight. The patient said that this feeling of
tightness was not influenced by weather or emotions. Tightness is reduced
when the patient rests. Patients also complain of heart palpitations, no
complaints of chest pain.
The patient's mother said that patients often experience recurrent cold
cough. On physical examination, it was found that the general condition
seemed moderate, composmentis consciousness, pulse 98 x / minute,
breathing 28 x / minute, temperature 36.8 ºC.
On physical examination :
- BB 35 kg, TB: 145 cm.
- Neck found increase in JVP 5 + 4 cmH20,
- Pulmo is not found abnormalities.
- Heart: inspection looks corded, palpation of palpable palate at ICS V
midline cystic cords, percussion dullness, auscultation sounds irregular
BJ and I-II gallop (+).
- The inferior extremity has edema.

Laboratory examination :  Hb 9.0 g / dl,


 Ht 28.6%,
 erythrocytes 3.6 jt / µl,
 LED 80 mm / hour,
 leukocyte 8700 / ul,
 Neutrophil segment 64
 32% lymphocytes,
 4% monocyte
 Platelets 536000 / ul.
In immunology and serology, ASTO was positive, quantitative CRP> 24 mg / l.
On chest X-ray examination, cardiomegaly with CTR> 50% was obtained.
On ECG examination, there is a prolonged PR interval.

The general practitioner who is guarding the IGD recommends


hospitalization.

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