Program Pendidikan dokter spesialis (PPDS) di Amerika Serikat

on Selasa, 31 Maret 2009

Residency in United States



Hi, sekedar berbagi informasi untuk menambah wawasan di antara mahasiswa kedokteran di Indonesia.

Sebagaimana kita ketahui, pendidikan program spesialis di Indonesia cukup banyak memakan biaya. Nah kalau kita ingin meringankan beban orang tua, ada baiknya untuk melihat kemungkinan mengikuti program spesialis (residency) di Amerika Serikat. Tentu untuk masuk program tsb, sangat kompetitif. Beberapa program, e.g., kulit, mata, radiology, anasthesi, hampir tidak mungkin ditembus oleh orang asing (i.e., yg bukan lulusan medical school di US). Tapi untuk beberapa jurusan lain, e.g., anak, penyakit dalam, psychiatry, peluang mendapatkan tempat cukup terbuka. Tapi, tentunya sangat kompetitif, karena akan bersaing bukan hanya dgn mereka yg lulusan amerika (yg tentunya lebih diminati oleh tiap2 program) tapi juga orang india, pakistan, amerika latin, china, eropa, afrika dll. Jadi persaingan sangat ketat, tapi kalau kita sudah diterima maka kita tidak akan dibebani oleh uang sekolah, iuran ini, iuran itu. Yang ada, kita malah dibayar alias digaji sekitar $40.000 - $50.000 (which is 500jt sampe 600 jt)per tahun. Lama pendidikan tergantung jurusan yg ditempuh. Untuk penyakit dalam & jurusan anak sekitar 3 tahun.

Bagaimana cara masuknya?

Ok..pertama...tentunya harus punya sertifikasi ECFMG (Educational Commission for Foreign Medical Graduates). Lihat di website mereka untuk tahu lebih jauh ttg ini: http://www.ecfmg.org/cert/index.html. Untuk dapat ECFMG sertifikat, maka kita harus lulus ujian USMLE (United States Medical Licensing Examination). Ujian tersebut ada 3 ujian theory dan 1 ujian klinik. Jadi ada USMLE step 1, step 2, step 2 cs (clinical skill) dan step 3. Untuk dapat sertifikasi kita harus sudah lulus USMLE step 1, step 2 dan step 2 cs. Masing2 ujian sekitar 8 jam. Untuk info lebih jauh, silahkan lihat di website:
http://www.usmle.org/examinations/index.html

Tapi INGAT...untuk bisa mendapatkan tempat di program residency, nilai ujian-ujian tsb sangat penting. Jika nilai kita hanya pas2-an. Jangan harap akan mendapatkan tempat di sini. Jadi cobalah untuk mendapatkan nilai 90 percentile ke atas. Untuk mempersiapkan diri, bisa beli buku2 dari KAPLAN, atau USMLE FIRST AID, atau cari video GOLJAN dll. Juga bisa berlangganan soal ujian dari USMLE World.

Ada baiknya ujian step 1 & step 2 diambil ketika kita masih tingkat 4 - 6. Ujian ini mungkin bisa dilakukan di Indonesia (sama spt ujian TOEFL). Biaya per ujian $800. Untuk ujian step 2 cs, hanya bisa dilakukan di beberapa kota di Amerika, e.g., Chicago, Philadephia, Houston. Biaya untuk yg ini adalah $1200.

Kalau kita mau benar2 ingin melanjutkan ke US, ada baiknya kalau mungkin kita melakukan salah satu rotasi kita di US. Dgn demikian kita akan terekspose dgn system di sini dan mungkin bisa mendapatkan kontak di sini. Selain itu beberapa program spesialisasi menyaratkan kita mempunyai US clinical experiences. Nah, dgn melakukan rotasi di US, maka kita bisa dapat clinical experience ini.

Langkah berikutnya adalah pendaftaran. Hal ini dilakukan secara serentak setiap thn, mulai tgl 1 september. Ini dilakukan online melalui ERAS. Untuk lebih lengkapnya lihat di website mereka: http://www.aamc.org/students/eras/guideline/start.htm

Document yg diperlukan biasanya adalah:
1. Surat rekomendasi dari dokter (3 buah): kalau bisa dapat dari dokter amerika akan sangat bagus sekali;
2. USMLE transcripts;
3. Personal statement;
4. Ijazah kedokteran;
5. Surat dekan;
6. Pas photo.

Sangat dianjukan untuk mengirimkan dokumen tsb ke ERAS (via pos/courier) sekitar bln Agustus, karena mereka akan perlu waktu untuk meng-upload dokumen tsb. Jadi pas tgl 1 september kita sudah siap untuk mengirim lamaran ke program yg kita tuju. Tiap program mempunyai persyaratan berbeda-beda (e.g. USMLE scores, US experience, visa sponsorship, graduation date). Jadi sebaiknya kontak program2 tsb sebelum kita melamar untuk mencari tahu persyaratannya. Untuk mencari program yg ada, silahkan lihat di FREIDA:
https://freida.ama-assn.org/Freida/user/viewProgramSearch.do

Nah, mulai tgl 1 september kita bisa mengirim lamaran via ERAS ke program yg kita tuju. Tentunya ada biaya lamaran disini. Untuk 10 program pertama per jurusan, biayanya $60. Selebihnya diitung satu per satu:

Number of Programs Per Specialty-----------ERAS Fees
Up to 10------------------------

-----------------$60
11-20--------------------------------------------$8 each
21-30--------------------------------------------$15 each
31 or more--------------------------------------$25 each

jadi makin banyak ngelamar, makin besar biayanya. Mungkin orang asing biasanya melamar sekitar 30-40 program per jurusan.

Setelah melamar, kita hanya akan menunggu. Kalau credential kita bagus, maka beberapa program akan mengundang kita untuk interview. Kalau tidak bagus, mungkin tidak ada yg mengundang kita interview. Tapi kalau kita bisa dapat 5-8 interview, itu sudah sangat bagus sekali.

Langkah selanjutnya adalah, kita merangking program yg kita minati. Berdasarkan interview kita (kalau kita dapat interview), kira2 program mana yg kita prioritaskan. Demikian juga si Program, dia akan merangking calon2 mana saja yg dia prioritaskan (Mungkin mereka mengundang 100 orang untuk interview, sementara mereka hanya akan menerima 10 orang). Hal ini dilakukan paling lambat tgl 27 Februari. Untuk info lebih lanjut silahkan lihat NRMP:
http://www.nrmp.org/res_match/yearly.html

Kalau kita bernasib baik maka kita akan tahu apa kita akan dapat tempat atau tidak tgl 17 Maret. Tapi kita masih belum tahu akan dapat tempat dimana.
Baru pada tanggal 20 Maret (Match day) kita akan tahu dimana kita akan diterima. Mungkin kita masuk pilihan nomor 1 kita atau mungkin pilihan nomor bontot.

Setelah itu....kalau matched....pasti hati kita akan happyyyyyy banget. Dan akan mengurus surat2 yg diperlukan, e.g., kontrak, visa dll.
Untuk program spesialisasinya sendiri, akan mulai serentak tgl 1 Juli.

Untuk lihat forum lain yg mendiskusikan ttg lamaran-interview-dan match proses, silahkan lihat sini: http://www.prep4usmle.com/forum/11/
Disitu ada juga diskusi ttg persiapan ujian USMLE step 1 & step 2.


Nah...jadi buat abang/kakak/teman2/adik2..yang minat PPDS di amerika serikat...mungkin bisa diancang2 dari sekarang mulai dari biaya dan persiapan...

USMLE step1,step2,step2CS sama step3 itu sangat,sangat susah...
saya malah pernah membaca di forum studentdoctor.net klo mereka bahkan kyk punya bimbel utk itu...
Untuk persiapan, silahkan baca buku-buku persiapan untuk ujian USMLE step 1. Ini ada beberapa yg saya upload filenya online.

Step 1 - Anatomy: http://www.mediafire.com/?3n92uneydmg
Step 1 - Biochemistry: http://www.mediafire.com/?22mtxexntdm
Step 1 - Physiology: http://www.mediafire.com/?5g1y0dnhfz7
Step 1 - Microbiology & Immunology: http://www.mediafire.com/?dzdjsxvi3y3
Step 1 - Pathology: http://www.mediafire.com/?3yamd51z4xt
Step 1 - Pharmacology: http://www.mediafire.com/?ewy1m1j1ljd
Step 1 - Question BOOK: http://www.mediafire.com/?8yygla2jirt
Step 2 - Question Book: http://www.mediafire.com/?bydomdezmg1

tapi tenang aja kok..USMLE step1,step2 bisa dilakukan di jakarta sehingga lebih mudah utk kita melakukan tes..
dan hampir semua FK di Indonesia di recognized sama pihak USMLE jadi gak masalah mengenai administrasi..........

Klo saya yang paling memberatkan itu biaya tesnya..hehehe..
bayangkan aja biaya USMLE step 1+step2+step3 aja 800+800+1200=US$2800!!!!(berarti sekitar 30 jutaan)...
iya klo lgsung tinggi nilainya...klo gak sama aja..
terus belum lagi USMLE step 2 CS yg harus di USA..
wah..biayanya...ngurus visanya...
mendaftarnya..wah..pasti banyak bgt kelaurnya...
tapi emang...klo udah lulus...bukan kita yg bayar ke mereka..tapi malah kita yang dibayar...(500 juta setahun!!berarti sebulan gaji kita 40 juta..)
belum lagi kesempatan kita untuk kerja di negara2 lain yg mengenal USMLE seperti singapore,HK,aussie...

jadi mungkin bwt abang2/kk2/temen2/adik2 yg bisa menghandle biaya yg sya sebutin tadi serta mau bekerja keras untuk USMLEnya, PPDS ke USA bisa menjadi alternatif selain mengikuti PPDS di Indonesia..

SAlam teman sejawat!!!

(oh,ya,klo mau tahu informasi PPDS di luar negeri atau melakukan clinical rotation di univ terkemuka kyk harvard medical school atau NUS..bisa buka disni http://forums.studentdoctor.net/)

Why do I hate PBL (Problem Based Learning) Curriculum??

on Rabu, 25 Maret 2009




If you’re a recent medical student, you will know this curriculum so well..
Since 2007, most of Indonesia medical schools had PBL as main curriculum and style of study…
My school had used PBL curriculum in 2004, so..there are 5 batches who used this
curriculum since 2004…

well,…..if you don’t know about PBL, this is the head…
PBL (Problem Based Learning) is a way of medical learning based Problems.
PBL emphasizes medical student to cope the problem in small group by learning some objectives
So you can solve the problem,eventually….
It makes you such an adult learner because you indepently search the objectives on your own instead of being taught , based on your need of learning…..
sometimes PBL calls KBK (Kurikulum berbasis Kompetensi)in Indonesia

So every week,you will get a case from scenario about your topic in this week..
For instance…in this week,your topic is about neoplasia(cancer)..you will get a scenario talking about a patient who get colorectal carcinoma. You will solve the problem in this scenario as if you were a real doctor. you approach the problems just like a real physician would in clinic…

Sounds impressive,right??.....No, you’re absolutely WRONG…

The Surprise is real physicians actually DON'T spend 2hours in tutorial discussing the cell signalling pathways involved in colorectal cancer…
And the fact is way too much different than the concept of PBL…

And..believe me…this curriculum is not as impressive as something you heard…

Well….It's not that I hate it that much.
What I hate is Its sanctity as the highest bastion of collegial learning, I think, is too much overwhelmed…and then…
Why the hell Indonesia medical schools so freakin’ proud being a PBL school ??!!!!!

So, these are the things I hate about PBL curriculum :

A. The amount of learning time

I think the time is too short…this is the main factor why I hate PBL…

How come they hope us shovelling massive amounts of data into our tender young brains in ONE WEEK ???

In conventional curriculum, you learned parasitology in 20 classes but in PBL you just learned about 3 classes???

last time I learned antibiotics and kortikosteroid just in 50 minutes…wow…you absolutely know how important antibiotics in medicine…and you just learned this in 50 minutes???

My tutor always complain my group why We just learned the topic only in superficial. “ You should learn this topic in its real core, not only in its superficial”..she said…Well it’s easy to say..but she never felt how’s the feeling being a PBL medical student who tried “half-died” to cope the whole aspect…
I mean…

how come you can learn deeply the anatomy,histology,physiology,biochemistry of neuro system in one Week??

Hello..We have real life…We don’t use the whole 24 hours a day only for study…

My school teaches us pharmacy less (or..can I say, Barely???)than before because this curriculum…..I feel like its going to be a huge hole to fill during my clinical phase… No wonder, there are some third year medical student in my school who didn’t know at all what the function of mesenamat acid….

And…ask me about gross anatomy of neuro system..Bite me coz
I completely forgot because I just learned that formally in lecture in 50 minutes and the whole neuro system topic in ONE WEEK..

B. Lecturer

The amount time of Lecturer is too limited…50 pages of medical textbook magically transform to 50 minutes..
How can I insist my brain to get the whole information in 50 minutes??

I hate When my lecture cut out the lecturer in the main core of topic and said..”this is your next job to gain more information about this topic”..
Well…it won’t be problem if one lecture said that, but how about the whole lecture give that task… oh,my…it’s really wasting my time…
It’s getting worse when the lecture didn’t mention any source to cope this topic…then..you will find me drowning in whole old medical textbook or googling until I find the right source…and it’s very wasting my time…

C. Tutorial


tutorial in US medical school...

is it just one /two people doing the talking while everyone else stares blankly and nods (without knowing what he/she nods for)??

C’mon…is there any of medical student who REALLY heard his friend during tutorial time??

It’s really boring listening a friend giving a clumsy explanation about the topic that a lecture could synthesize in two sentence. And It’s quite annoying when my tutor, who experts with the topic of the scenario, chuckled hearing my explanation. But when our group asked her/him about the topic, didn’t want to give information, because he/she should not give mini lecturer in tutorial, instead of that, asked me to searching this information...(why don’t you just give that information??)

When I finished my tutorial..sometimes I muttered "Man... that tutorial was 2 hours of my life I'll never get back".

D. Plennary Discussion

Well..the concept of HUGE class of groups making a discussion about medical case sounds impressive…but the fact is…..well…awful…

What I really hate is when An outstanding-brilliant medical student tried to make him/her impressive by asking a question ( who obviously he/she completely knows about that) to his/her an average medical student….

But actually that’s not the real problem..
The real problem is when there’s no any expert come to the plenary discussion..

I mean…you come to plenary discussion due to want getting the new information or clearing some misunderstanding in tutorial…
But…when you enter the discussion room, there’s no any expert..
Just your classmates giving presentation that material had given in lecturer…
And when you asked your question…..your classmates said..
“ I’m sorry..I can’t answer that question because our group don’t discuss that topic and we don’t have any information about that…”
SO WHAT’S THE POINT?????

And How come they hope us to learn each other while we had same question, same source, same amount of time to cope with this problem???

and there are so many reason why do I hate PBL…


Being PBL medical student...

the worst feeling being a PBL medical student is feeling that all the work I do is valueless because I forget most of what I learn within a week after any given exam. We're given a mountain of information to learn in a ridiculously short period of time ….so we study countless hours a day and all night trying to cram it all in. But then we take the exam, may or may not do well, but either way move on and end up forgetting the previous block and try to remember the mountain of information in next block….

We always argue that it's just Indonesia culture who can adapt the way of PBL...
but I changed my mind when I read some thread in studentdoctor.net/forum
Even US medical students relieved that they don't really like PBL because its inefficiency..
check out that sites...and you will find interesting statement...

However, on the other hand, I have to admit that PBL had made a new academical aura in our school (with the concept of self studying). PBL can be entertaining (usually in inverse proportion to how efficient/on-topic your discussion is). It may serve as some vague approximation of how medicine is practiced in the real world (the way of team to solve the clinical problem). It's a great way to get to know your classmates. And one is less likely to fall asleep than during a lecture (hahaha…think about my high school moment)….

But Sometimes I wonder How it will make difference if medical schools in Indonesia mix the PBL/KBK curriculum with the conventional curriculum…

Willy Suryawan
Fakultas Kedokteran Universitas Andalas 07
Bidang Pendidikan dan Profesi
Ikatan Senat Mahasiswa Kedokteran Indonesia (ISMKI) Wilayah I