Medical Education Participants, Prepare Thoroughly Before Stress Strikes

Pursuing specialist medical education requires thorough preparation, facing physical and mental pressure that is prone to stress.

SUPRIYANTO

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The decision to take the specialist medical education program or PPDS is not as easy as turning the palm of your hand. There are various considerations that make a doctor want to deepen medical knowledge further. It also takes years.

It took eight years for C (34), a doctor in West Sumatra, to prepare himself to apply for PPDS. In mid-2024, he attempted to apply for a scholarship to continue his medical education after graduating from the Faculty of Medicine at Padjadjaran University.

There are many factors to consider before continuing my education - from economics to family readiness and others. Currently, I am waiting for a scholarship announcement. Hopefully, I succeed so I can study without a large expense," said the person when contacted from Bandung on Tuesday (16/4/2024).

This mature thinking must be done after seeing colleagues who have previously taken PPDS. Most of them have difficulties in following the series of lectures as well as the busy activities that consume time and energy.

This pressure becomes even greater when experienced by PPDS students who have minimal experience. According to C, some of his colleagues who complained about this pressure came from doctors who had just graduated from undergraduate programs and immediately continued their specialist program.

The specialized department that will be studied also has an influence. C even thought carefully about which part he would realistically take and considered the available time.

Finally, C took a skin specialist education. He thought the pressure there was lighter. "That doesn't mean there's no pressure. But these skin specialists are not as crowded in large departments as (specialists in) pediatrics, surgery and internal medicine. "Even the ob-gyn (obstetrics and gynecology) may only be able to go home until their second year to take a shower," he said.

C considered the condition of her husband who works outside of the medical field. Therefore, the decision was made to balance career and family life.

Also read: Support from people closest to you helps maintain enthusiasm for completing medical education

Furthermore, C is also thinking about the growth of her two children. As a mother, her instinct is to ensure that both of her toddlers can get maximum love and affection from their mother and father.

“Because you're in college, of course there are assignments. Moreover, there are additional jobs outside campus, such as seminar committees, workshops, or event sections. It will increase busyness, things like this can become stressors(causes of stress) during education. So, I have to be realistic," he said.

Economic issues also become the reason why colleagues of C feel stressed during education. The doctor's practice permit (SIP) who pursue specialist education will be revoked during PPDS. This condition has an impact on the family's source of income.

"If I'm still doing quite okay, because I work as a civil apparatus. So, I still receive a basic salary. I feel sorry for those who work in the private sector. Not to mention that PPDS education takes years," said C.

Various pressures have made doctors who pursue PPDS face challenges. The screening results conducted by the Ministry of Health regarding the participants' mental health in the PPDS program found symptoms of depression.

Of the total number of PPDS participants who experienced symptoms of depression, the highest percentage was found among those from the Cipto Mangunkusumo Hospital in Jakarta, Hasan Sadikin Hospital in Bandung, and Sardjito Hospital in Yogyakarta. Follow-up actions were taken for participants with severe depression symptoms.

The mental health screening on March 21, 22, and 24, 2024 showed that 22.4 percent of PPDS participants in 28 vertical hospitals experienced symptoms of depression. The screening was conducted on 12,121 PPDS participants using the Patient Health Questionnaire-9 questionnaire.

Of the total number of PPDS participants who experienced depression, 0.6 percent or 75 participants had severe depression symptoms; 1.5 percent or 178 participants had moderate to severe depression; 4 percent or 486 participants had moderate depression; and 16.3 percent or 1,977 participants showed mild depression symptoms.

A specialist medical education student will feel guilty and stressed if the patient they are treating cannot be cured or passes away.

Warning

KOMPAS/KORNELIS KEWA AMA

An eye specialist doctor in Malaka recently performed cataract surgery in the area. There are sufficient numbers of specialist doctors available in Malaka.

The campus also paid attention to this problem. Padjadjaran University responded positively to the data. Meanwhile, Hasan Sadikin Hospital, which is mentioned in the Ministry of Health's screening data, is one of the main teaching hospitals for PPDS participants at the Faculty of Medicine, Padjadjaran University.

The Vice Rector for Academic and Student Affairs at Universitas Padjadjaran, Arief Kartasasmita, stated that the results of this screening serve as a warning for them to revisit the standards for specialist doctor education at Unpad.

Arief admits that it cannot be denied that PPDS participants are vulnerable to stress. This can be seen from several international journals indicating that specialist doctor education is one of the most stress-inducing educational processes.

He revealed that the vulnerability to stress experienced by PPDS students not only concerns the education process, but also the type and educational environment.

"A medical education student will feel guilt and stress if the patient they are treating cannot be cured or dies," said Arief.

He stated that Unpad had issued regulations so that students, including PPDS participants, could take part in the educational process comfortably and happily.

DEONISIA ARLINTA

Screenshot of a presentation by a specialist in digestive surgery at Hasan Sadikin Hospital in Bandung, Reno Budiman, regarding robotic surgical tools.

Hasan Sadikin Hospital and Cicendo Hospital are also partners of Unpad that provide psychologists and psychiatrists to handle students with mental pressure.

It is known that there are around 1,400 students undergoing PPDS at Unpad. Unpad also partners with around 30 hospitals as educational hospitals for PPDS.

"Unpad will strive to provide a comfortable educational service for PPDS students. This effort is to prevent the stress that PPDS students are prone to from being compounded by a poor system," said Arief.

KOMPAS/FABIO MARIA LOPES COSTA

Head of Disease Prevention and Control Unit (P2P) of West Java Health Agency, Rochady Hendra Setia Wibawa, in Bandung City, West Java, on Wednesday (March 20, 2024).

Head of the Disease Prevention and Control Department of West Java Health Office, Rochady Hendra Setia Wibawa, who is also an alumnus of PPDS at Unpad, stated that a good adaptation process is needed when a general practitioner decides to follow PPDS. This is because there is a significant difference between the education process for general practitioners and PPDS.

"When deciding to enroll in a residency program, the student will no longer attend classes on campus or read materials. The majority of the education process involves direct interaction with patients in the teaching hospital," he stated.

They also urge families to provide full support for PPDS students to overcome every challenge in the education process.

"The support of families is very much needed by PPDS students. They not only face mental pressure, but also an education process that takes 8 to 10 hours in the hospital," said Rochady.

Don't be biased

The Chairman of the Indonesian Doctors Association in West Java, Eka Mulyana, hopes that the screening results of the Ministry of Health regarding depression symptoms experienced by PPDS students must ensure that the samples are not biased.

Bias in sampling may occur when performed by students under different conditions such as being fit or exhausted after going through hours-long patient operation processes.

According to him, the triggers of depression symptoms experienced by PPDS students can also be environmental factors, personal problems in their families, or financial issues.

"The profession of a doctor is different from other professions. We handle humans who are facing medical issues and are required to work for maximum results," said Eka.

He also suggested the need for the Minnesota Multiphasic Personality Inventory (MMPI) test, a psychological test to assess personality and psychopathology. He deemed this test to be more accurate in detecting mental health problems experienced by an individual.

"Feeling stressed is normal in every profession. One usually experiences depression when unable to face the pressure in their profession," said Eka.

The pressure that doctors face in pursuing their specialist education cannot be taken lightly. Careful preparation when undergoing specialist education needs to be considered to avoid ending up with physical and mental pressure that is disruptive.

Also read: Recognize the Symptoms, Depression in Potential Doctors Can Be Avoided