Imunisasi secara medis merupakan tindakan yang aman, namun sesekali terancam olehefek samping atau efek buruk yang disebut KIPI. Dalam bentuk program, imunisasi massalakan memunculkan kekerapan KIPI ...yang dapat merugikan jasmani dan bahkan nyawapasien yang semula sebagai klien petugas kesehatan. Hukum, khususnya hukum administrasinegara yang dilandasi oleh etika sosial dan manajemen yang lege artis mengharuskan pejabatkesehatan hingga ke tenaga pelaksana kesehatan melaksanakan program tersebut sehinggatujuan imunisasi tercapai, tanpa menimbulkan gugatan hukum yang tidak perlu dari pasienyang dirugikan akibat KIPI. Efektivitas dan efisiensi program akan seimbang denganyuridisitas dan legalitasnya. Bila gugatan hukum muncul, kerangka hukum penyelesaiandan perlindungannya terdapat dalam lingkup hukum administrasi negara, yang berbedadengan hukum kesehatan perorangan. Petugas kesehatan dilindungi oleh standar proseduroperasional, pemberian informed-consent kolektif, pembuatan surat-tugas dan bahkantindakan diskresioner sesuai dengan kondisi dan situasi lapangan demi kepentingan kliendan pasien. Persyaratan diskresi tersebut secara hukum diuraikan, termasuk rantaitanggungjawabnya hingga ke pejabat tertinggi dalam bidang kesehatan. Pokja KIPI yangberfungsi sebagai lembaga independen dan penasehat pemerintah, dapat berfungsi sebagailembaga yang memverifikasi fakta hukum, penyelesaian kasus sengketa medik pada KIPI,serta usulan pemberian santuan kepada korban bila diperlukan, sebelum kasus tersebutmasuk ke lembaga peradilan resmi yang seringkali justru sulit menciptakan keadilan.
Background: Agreement on the importance of teaching and assessing ethical competence as part of professionalism in medical education continues to grow. The assessments of ethical competence at the ...“does” level in preclinical students or a large group of resident candidates are considered less efficient and expensive. It is necessary to find an alternative form of ethical competence assessment instrument as a complementary test at the level “knows how” before being tested at the level “does.” This research proposed investigating the Situational Judgement Test (SJT) potential and obtaining evidence of the SJT as an instrument of ethical competence assessment.Methods: This study was a literature review of 39 journal articles relating to SJT, obtained through PubMed data-based and google scholar search engine.Results: There was evidence of the use of SJT to assess ethical competence. Ethical competence can be evaluated by ethical decisions making ability. SJT containing procedural skills in ethical decisions making. SJT having good values as deliberation in ethical dilemmas and idealistic ethical ideology (conative test) also exists. These findings support the evidence of potential SJT to assess ethical competence.Conclusion: SJT can be used to assess ethical competence at the level “knows how” before being tested at the level “does” based on the following reasons: SJT can contain content questions that are conative, SJT can assess the ability of ethical decision making based on an assessment of procedural knowledge related to ethical deliberation of ethical decision making in ethical dilemmas.
Clinical reasoning as an essential skill for psychiatrists, especially in forensic psychiatry, relies on their thinking and decision-making skills. However, not all psychiatrists are aware of their ...decision-making styles. This study examines the validity and reliability of the Indonesian translation of the Decision Style Scale (DSS) instrument among general psychiatrists in the Indonesian forensic psychiatry setting.
This is a cross-sectional study involving 32 general psychiatrists from all nine psychiatric residency training centers in Indonesia. The study was conducted between August 2020 and February 2021. The translation process involved certified independent translators. The validity was tested using Item-Level Content Validity Index (I-CVI), Scale-Level Level Content Validity Index (S-CVI), and item-total correlation. Internal consistency reliability was measured using Cronbach's alpha.
After translation, the instrument was sent back and received feedback from the original authors of DSS. The final version of DSS was valid with an I-CVI score of 0.84–1 and an S-CVI score of 0.99. All but one item had a corrected item-total correlation of more than 0.30. The reliability test of DSS also showed acceptable results with Cronbach's alpha values of 0.43–0.83, and an overall internal consistency score of 0.83 and 0.62 for intuitive and rational scales, respectively.
DSS serves as a valid, reliable, and readily-available tool to measure psychiatrists' decision-making styles in forensic psychiatry settings. Enhancing psychiatrists’ awareness of their decision-making styles may help in mitigating the risk of bias in forensic psychiatry evaluations.
Decision-making; Forensic psychiatry cases; General psychiatrists; Validity; Reliability.
Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The ...quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.
Inconsistency in the quality of forensic psychiatry report has been criticized for several years. Yet, there are limited guidelines to provide minimally satisfactory forensic psychiatry evaluation ...conducted by psychiatrists. In addition to the impact towards the forensic psychiatry service, this lack of standardized guidelines may impact the relevant competency development and its various teaching methods of forensic psychiatry among general psychiatrists. Therefore, this study aims to identify components of psychomedicolegal analysis competency as a form of clinical reasoning in forensic psychiatry.
A comprehensive literature review and expert panel discussions were conducted simultaneously to formulate an initial list of psychomedicolegal analysis competency. A total of fourteen experts were chosen based on their expertise in different disciplines that have intersections with forensic psychiatry and the general psychiatry curriculum (e.g. general psychiatrist, forensic psychiatrists and psychologist, law practitioner, and medical education director). The expert panel were instructed to score and provide feedbacks on the items of the initial list. Four-point Likert scale were used in order for the experts to express the relevancy of the core competence to forensic psychiatry practice until it reached the consensus.
The final 60 items of psychomedicolegal analysis competency were developed after three rounds of Delphi technique and reached a consensus (>70% and medians score of at least 3,25). These competency then categorized into four steps 1) preparing the case (Item 1–11), 2) conducting the evaluation (Item 12–41), 3) writing the report (42–51), and 4) giving expert opinion in court (Item 52–60).
We developed 60 items of psychomedicolegal analysis competency that can be used as a standardized guide for psychiatrists to conduct forensic psychiatry evaluation, write the report and provide expert opinion in court. Implementation of this guideline can be used to shape further forensic psychiatry education for general psychiatrist and psychiatry residency.
Emotion is essential in psychiatrists’ clinical decision-making in conducting forensic psychiatric evaluations. However, psychiatrists may not be aware of their own emotions and thus prone to the ...risk of bias in their evaluations. An English version questionnaire was previously developed to assess emotional response and regulation. This study aims to assess the validity and reliability of the translated and adapted Indonesian version of The Multidimensional Emotion Questionnaire (MEQ) among Indonesian general psychiatrists in forensic psychiatry settings.
This is a cross-sectional study that translated and adapted The Multidimensional Emotion Questionnaire (MEQ) designed by Klonsky et al. This study was conducted between August 2020 and February 2021, involving 32 general psychiatrists across the country who represented general psychiatrists from different educational backgrounds, clinical experiences, and workplace settings. The translation process was done by a certified independent translator and tested for validity by Item-Level Content Validity Index (I-CVI), Scale-Level Level Content Validity Index (S-CVI), and corrected item-total correlation. Cronbach's alpha values measured reliability aspects.
The MEQ was valid and reliable, with an I-CVI score of 0.97–1, an S-CVI score of 0.99, and Cronbach's alpha values of 0.85–0.98 for each emotion. The majority of items had a corrected item-total correlation of higher than 0.30.
A proper and available tool to measure general psychiatrists' emotions in evaluating forensic psychiatric cases is essential in enhancing evaluators’ awareness of their own emotions to eventually mitigate bias. The Multidimensional Emotion Questionnaire (MEQ) was valid and reliable for Indonesian forensic psychiatry contexts.
Several general psychiatrists experience lack of confidence when they perform forensic psychiatric evaluations that may be due to limited or insufficient training. This study aimed to determine ...whether structured forensic psychiatry educational modules are associated with general psychiatrists’ self-confidence in conducting forensic psychiatric evaluations in Indonesia.
A cross-sectional study was conducted with 246 general psychiatrists. A questionnaire was developed exclusively for this study by a group of experts based on relevant references and it was distributed online. Sample questions included: “How often do you perform forensic psychiatric evaluations?”, “As a general psychiatrist, are you confident in conducting forensic psychiatric evaluations?”, and “Do you experience any difficulties when conducting forensic psychiatric evaluations?” Data were analyzed through SPSS 20 for Windows; a p-value <0.05 indicated statistical significance.
Compared to general psychiatrists who did not study structured forensic psychiatry educational modules during their residency training, those exposed to such modules reported confidence in conducting forensic psychiatric evaluations in the following cases: insanity defense in cases of violence, insanity defense, fitness to stand trial, malingering, capacity to consent to treatment, risk of recidivism, guardianship, and parenting capacity. Furthermore, those with higher self-confidence were less likely to experience difficulties in conducting forensic psychiatric evaluations.
Structured forensic psychiatry educational modules during general psychiatry residency training played an important role in the development of psychiatrists’ self-confidence.
Forensic psychiatry module, Psychiatric evaluation, Indonesia, Self-confidence.
BACKGROUND Photography is an integrated part of standard forensic examination procedures, acting as a guide and the evidence itself. Despite its potential, no research has yet explored the use of ...35mm format cameras (digital single-lens reflex DSLR) in sexual violence cases. This study aimed to assess the impact of DSLR camera image characteristics on the interpretation of child sexual abuse cases. METHODS This cross-sectional study used 55 digital photos selected through a convenience sampling. The samples were interpreted by two independent forensic experts who were not affiliated with this research and were compared with the results of the doctor’s examination from the medical records. RESULTS The metadata extraction results (EXIF data) indicated that all characteristic values had an abnormal distribution. The digital photos’ characteristics were associated with the use of a 50mm focal length (p = 0.011). A range of lens opening values (aperture = f7.1–f8.0), shutter speed (1/100–1/125 sec), and sensor sensitivity (ISO = 800–1600) were not associated with the experts’ interpretation conformity. Additionally, the conformity index for the overall interpretation by the two forensic experts differed in each area. CONCLUSIONS Focal length of 50mm was significantly related to interpretation conformity. The exposure triangle settings, including aperture (f7.1–f8.0), shutter speed (1/100–1/125 sec), and ISO (800–1600), can serve as fundamental guidelines for digital camera settings in examining child sexual violence cases.
Meru Betiri National Park (MBNP) is home to a variety of medicinal plants that local communities collect for individual use and sale. In MBNP, a variety of actors are interested in medicinal plants ...for different reasons. This paper analyzes the interest and influence of ten important actors related to medicinal plant collection and use in MBNP: national park management, the Plantation and Forestry Office of Jember District, farmer groups (jaket resi), medicinal plant collectors (pendarung), medicinal plants purchasers (pengepul), small-scale medicinal plant industries of the Toga Sumber Waras, Bandealit plantation company, a conservation NGO (LSM KAIL), loggers (blandong), and log buyers (borek kayu). To examine and map the position of different interests and influences of actors involved in medicinal plant usage, this paper uses a power grid matrix. The analysis confirms that five of the ten aforementioned actors play a direct role in the medicinal plant policy process, while five actors do not and can be categorized as context setters, subjects, or crowd. This paper ends by recommending a strategy for considering policy options that promote shared interests and minimize anticipated objection from actors concerning the harvest of medicinal plants in MBNP. It concludes that the utilization of medicinal plants in MBNP, together with protection of natural resources, should become an integral part of the park's conservation strategy.
•We identify multi actors in Meru Betiri National Park.•We map interest and influence of those actors.•We make a power-grid matrix analysis.•We consolidate different interests of actors.•We promote participative park management strategy.
BACKGROUND The COVID-19 pandemic has caused many medical, ethical, and medicolegal changes, including constant adjustments in service guidelines. Continuing to revise healthcare regulations and ...guidelines can potentially cause clinical disputes or medical negligence that require ethical and legal solutions. This study aimed to determine the ethical and medicolegal aspects of the potential factors that cause clinical disputes during the pandemic and provide anticipative solutions to national ethicomedicolegal policies.
METHODS A systematic literature search in PubMed, ScienceDirect, ClinicalKey, and Google Scholar was performed using keywords “clinical dispute,” “ethics,” “medicolegal,” “ethicolegal,” and “COVID-19”. The inclusion criteria were articles that contained information on shortage, justice, ethical distribution in intensive care, the possibility of lawsuits and disputes among stakeholders during the pandemic, and stakeholders’ roles in managing the pandemic. Key evidence was analyzed and synthesized following national ethicomedicolegal policies.
RESULTS We identified 19 articles from the 4 databases. Based on the literature, the main ethicomedicolegal impact of the COVID-19 pandemic appears in 3 aspects: (1) a shortage of fair and ethical intensive care services with fair and ethical distribution efforts, (2) legal protection for medical personnel from legal charges while providing health services during the pandemic, and (3) the government’s role in managing the pandemic together with the stakeholders involved.
CONCLUSIONS Ethicomedicolegal clinical dispute management and its norms require an update, especially when deciding the complexity of COVID-19 service standards. Ethicomedicolegal professionals are needed as intermediaries to manage cases of clinical disputes and to implement fair malpractice criteria in Indonesia.
PDF
