Exploration of Medical Professionalism Across Postgraduate Medical Education in Indonesia

The implementation of competency-based medical education (CBME) and accreditation worldwide have influenced the emergent national policies in Indonesia’s postgraduate medical education (PME). The policies demanded a more open, accountable, authentic, and stable definition and elaboration of the graduated learning outcomes commonly declared as a competency framework. Medical professionalism (MP) has emerged as one essential domain in this national competency framework. However, the globalised competency approach raises some difficulties in its deployment as a competency framework, especially for MP, when it is applied into the teaching-learning practice in a specialist context, especially where there is minimal information on how MP is conceptualised. At the same time, PME has been the primary workplace for clinical skills learning for both undergraduate medical students and junior medical specialists.
Additionally, as a clinical learning site, PME continues to be the top place for clinical referral in the hospital-based healthcare system. This means the proportion of patients with complex clinical needs is higher than would be encountered in undergraduate training. Medical professionalism is an important element in the provision to realise good medical care and ensure patient safety. In that case, understanding MP conception and how to deploy it in such complex medical specialist practice and learning is an urgent agenda. However, the lack of information and publication about MP in Indonesian PME/MSE indicates that the agenda has not been scrutinised and warrants exploring. Therefore, this study serves as the first attempt to explore the conception of medical professionalism in Indonesia’s medical specialist context.
This study asked how MP is conceptualised by specialists and residents in neurology and orthopaedic surgery training. Specifically, whether and to what extent do conceptions of MP in Indonesia’s postgraduate medical education differ from current MP concepts and discourses within the, largely western, ME literature. The study adopted a socio-material perspective, believing that constructing the MP concept is an integral part of professional learning and social practice where learning is distributed and mediated in many activities and multiple social actors. In social practice, ideas, concepts, and ideologies are represented as discourses captured in various talking genres, such as an interview. Consequently, the study combined two modes of interview: semi-structured interview (SSI) and interview-to-the double (ITTD). While the SSI attempted to explore the discourse informing ideas of professionalism and professional learning held by participants, the ITTD problematised these ideas by capturing the everyday discourses of professional practice.
Fairclough’s critical discourse analysis (3D-CDA) has been used as a data analysis method. The analysis shed light on MP conception in practice, which is related to cognitive, operationalised and dilemmatic discourses. These three discourses frame an insight that learning professionalism is not a linear individual learning process but a co-production that evolves in professional activities involving many social actors. Reflecting on these findings, learning MP should be sought both as individual development and social actors’ engagement; something rarely tackled in medical professional education practice. The analysis also explored four ideological discourses: 1) postcolonial mind, 2) spiritual-religious worldview, 3) communalism/collectivism, and 4) competing-symbolised externally regulated practice. As ideologies, these four discourses possibly function as powers that influence Indonesian medical specialist communities in different contexts to conceive and apply MP, and as such, warrant further investigation