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IndonesianIndonesian PhysiciansPhysicians
CompetencyCompetency
in Global Erain Global Era
Prof.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.ScProf.Dr.dr.H. Rusdi Lamsudin SpS(K), M.Med.Sc
Dekan Fakultas Kedokteran UIIDekan Fakultas Kedokteran UII
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Prof.Dr.dr. H. Rusdi Lamsudin, M.Med.ScProf.Dr.dr. H. Rusdi Lamsudin, M.Med.Sc
Spesialis Saraf (Consultant)Spesialis Saraf (Consultant) Medical Doctor, Faculty of MedicineMedical Doctor, Faculty of Medicine, UGM, 1971, UGM, 1971
NeurologistNeurologist, Unair, Unair--UGM, 1978UGM, 1978
Master of Medical Sciences, New Castle Univ, Australia, 1986Master of Medical Sciences, New Castle Univ, Australia, 1986
Head of Executive BoardHead of Executive Board MuhammadiyahMuhammadiyah Hospital,Hospital, Yogyakarta, 1993Yogyakarta, 1993--19991999
Vice DeanVice Dean,, Faculty of Medicine Muhammadiyah Yogyaakarta UniversityFaculty of Medicine Muhammadiyah Yogyaakarta University,,19931993--19991999
PhD, UGM, 1996PhD, UGM, 1996
ShortShort--course, Unit Stroke & Neurocourse, Unit Stroke & Neuro--Intensive, Insburck, Austria,Intensive, Insburck, Austria,15 July15 July--1515October,October, 19971997
Head of Stroke Unit,Head of Stroke Unit, SardjitoSardjito Hospital, YogyakartaHospital, Yogyakarta, 2001, 2001--20052005 Head of Neurology Department Faculty of Medicine,Head of Neurology Department Faculty of Medicine, UGM, 2001UGM, 2001--20052005
Dean of Faculty MedicineDean of Faculty Medicine,, Indonesia Islamic University,Indonesia Islamic University, Yogyakarta, 2001Yogyakarta, 2001--2006, 20062006, 2006--20102010
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GLOBALIZATIONGLOBALIZATION
We are a part of a Global Village havingWe are a part of a Global Village havingDual CitizenshipDual Citizenship
Disease knows no boundariesDisease knows no boundaries
Communications revolutionCommunications revolution
Terrorism and local conflictsTerrorism and local conflicts
Distinction between domestic andDistinction between domestic and
international problems is losing itsinternational problems is losing itsusefulness.usefulness.
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GLOBALIZATIONGLOBALIZATION
We are a part of a Global Village havingWe are a part of a Global Village havingDual CitizenshipDual Citizenship
Disease knows no boundariesDisease knows no boundaries
Communications revolutionCommunications revolution
Terrorism and local conflictsTerrorism and local conflicts
Distinction between domestic andDistinction between domestic and
international problems is losing itsinternational problems is losing itsusefulness.usefulness.
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Globalization involves multiGlobalization involves multi--dimensionaldimensional
integration of world economics, politics,integration of world economics, politics,culture, health and human affairs, facilitated byculture, health and human affairs, facilitated by
a scientific revolution in information anda scientific revolution in information and
biotechnology.biotechnology.
Globalization is a process of broad socialGlobalization is a process of broad social
transformation that make national borders moretransformation that make national borders more
permeable.permeable.
Trade is the leader and most powerful force of ourTrade is the leader and most powerful force of our
time.time.
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NEW GLOBAL ECONOMICNEW GLOBAL ECONOMIC
ORDER (1945)ORDER (1945) International Monetary Fund (IMF)International Monetary Fund (IMF)
World BankWorld Bank
General Agreement on Traffic and Trades (GATT)General Agreement on Traffic and Trades (GATT)
World Trade Organization (1995)World Trade Organization (1995)
TradeTrade--related aspect of International Property Rightsrelated aspect of International Property Rights
(TRIPS)(TRIPS)
General Agreement on Trade in Services (GATS)General Agreement on Trade in Services (GATS)
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GLOBAL TRADEGLOBAL TRADE
1970 25% Global Output1970 25% Global Output
2002 50% Global Output2002 50% Global Output
2020 67% Global Output2020 67% Global Output
Speed of globalization is exceptionalSpeed of globalization is exceptional Good economic policiesGood economic policies
Structured reformsStructured reforms
Most Governments are ill equipped to manageMost Governments are ill equipped to manage
problems that transcend their bordersproblems that transcend their borders Global bodies are too weak to provideGlobal bodies are too weak to provide
monitoring of commerce, environment, socialmonitoring of commerce, environment, socialdevelopment, health, and educationdevelopment, health, and education
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GLOBALIZATION:GLOBALIZATION:
OPPORTUNITIESOPPORTUNITIES
A RISING TIDE WILLA RISING TIDE WILL
LIFT ALL BOATSLIFT ALL BOATS
Reduction in povertyReduction in poverty
Exchange of ideasExchange of ideas
Infusion of scientificInfusion of scientific
knowledgeknowledge
Improvement in healthImprovement in health
statusstatus
Social developmentSocial development
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GLOBALIZATION:GLOBALIZATION:
RISKSRISKS
A FAST RISING TIDEA FAST RISING TIDE
WILL LIFT BIGWILL LIFT BIGYACHTS BUT WILLYACHTS BUT WILL
CAPSIZE SMALLCAPSIZE SMALL
BOATSBOATS
Spread of diseaseSpread of disease
Hazardous materialHazardous material
DisparitiesDisparities
Negative behaviorNegative behavior
changechange
CorruptionCorruption
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CURRENT STATUSCURRENT STATUS
1 Billion People in the Developed World1 Billion People in the Developed World
United States, Europe, JapanUnited States, Europe, Japan
Increase in disposable incomeIncrease in disposable income Enhanced social injusticeEnhanced social injustice
Improved standard of livingImproved standard of living
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CURRENT STATUSCURRENT STATUS
3 Billion People in Developing Countries are3 Billion People in Developing Countries are
integrated into the global economy, i.e.integrated into the global economy, i.e.
China, India, Thailand, TaiwanChina, India, Thailand, Taiwan
Stable governments (good economic policy)Stable governments (good economic policy)
Human capitalHuman capital
InfrastructureInfrastructure
Visionary leadershipVisionary leadership
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CURRENT STATUSCURRENT STATUS
2 Billion People in poor countries have been left2 Billion People in poor countries have been leftbehindbehind Political instability (poor economic policies)Political instability (poor economic policies)
Poor or no infrastructurePoor or no infrastructure Lack of human capitalLack of human capital
No natural resourcesNo natural resources
Their participation in world trade is less than it wasTheir participation in world trade is less than it was20 years ago, with income falling and poverty20 years ago, with income falling and povertyincreasing.increasing.
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FIVE GAINS IN GLOBAL HEALTHFIVE GAINS IN GLOBAL HEALTH
Reduction in vaccine preventable diseasesReduction in vaccine preventable diseases
Reduction in childhood morbidity and mortalityReduction in childhood morbidity and mortality
leading to increased life expectancyleading to increased life expectancy
Tremendous advances in biomedical research; newTremendous advances in biomedical research; new
drugs, new vaccines, geneticsdrugs, new vaccines, genetics
Reduction in fertility ratesReduction in fertility rates
Public private partnerships adding additionalPublic private partnerships adding additionalresources to solve public health problemsresources to solve public health problems
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FIVE MISSED OPPORTUNITIESFIVE MISSED OPPORTUNITIES
Dealing effectively with HIV/AIDS epidemicDealing effectively with HIV/AIDS epidemic
Imbalance in resource allocations betweenImbalance in resource allocations between
prevention and medical careprevention and medical care
Environmental degradationEnvironmental degradation
DonorDonor--driven need of quick and time limiteddriven need of quick and time limited
results, did not allow for development of integratedresults, did not allow for development of integrated
health infrastructurehealth infrastructure Missed gender recognitionMissed gender recognition
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MISSED GENDER RECOGNITIONMISSED GENDER RECOGNITION
Failure to recognize gender dimensions ofFailure to recognize gender dimensions ofhealthhealth
Maternal morbidity still very highMaternal morbidity still very high
Failure to have family planning servicesFailure to have family planning servicesavailable to all womenavailable to all women
Gender based violence remains unGender based violence remains un--
addressedaddressed Exploitation of womenExploitation of women
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SYSTEM IS RUN BY COMPETITIONSYSTEM IS RUN BY COMPETITION
FOR PROFITSFOR PROFITS
Creates conditions in which powerful controlCreates conditions in which powerful control
Uneven enforcement of economic orderUneven enforcement of economic order
Short term focus on return (profits)Short term focus on return (profits)
No transparencyNo transparency
Create competition vs. collaborationCreate competition vs. collaboration
20% of worlds population receives more than 80% of the20% of worlds population receives more than 80% of the
worlds incomeworlds income DisparitiesDisparities
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WEAKENING THE NATIONALWEAKENING THE NATIONAL
GOVERNMENTSGOVERNMENTS
Power shift to multiPower shift to multi--national corporations,national corporations,influence of money in the political processinfluence of money in the political process
Weakening of occupational and environmentalWeakening of occupational and environmental
standardsstandards Less investment in health and social sectorsLess investment in health and social sectors
Privatization of health and social sectorsPrivatization of health and social sectors Russia, China, PakistanRussia, China, Pakistan
Weakening of safety net institutionsWeakening of safety net institutions Increase of corruptionIncrease of corruption
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SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY
Rapid change creates uncertainty, whichRapid change creates uncertainty, whichleads to polarization of a societyleads to polarization of a society
a)a) Unable to keep pace with change leads to:Unable to keep pace with change leads to: SmokingSmoking
Drug/alcohol abuseDrug/alcohol abuse
Child abuseChild abuse
Violent crimeViolent crime
STD/HIVSTD/HIV Unhealthy dietsUnhealthy diets
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SOCIAL CHANGE IN SOCIETYSOCIAL CHANGE IN SOCIETY
b)b) Unable to keep pace with changes, individuals reactUnable to keep pace with changes, individuals reactand become fundamentalists, and struggle toand become fundamentalists, and struggle tooverthrow the government systemoverthrow the government system
IndiaIndia RussiaRussia
PakistanPakistan ChinaChina
EgyptEgypt United StatesUnited Statesc)c) Most people try to keep pace with changeMost people try to keep pace with change
Stress in individual and societyStress in individual and societyMore material things but no happinessMore material things but no happiness
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HUMAN VALUES OF SOCIAL JUSTICE,HUMAN VALUES OF SOCIAL JUSTICE,
EQUITY, COMPASSION ARE REPLACED BYEQUITY, COMPASSION ARE REPLACED BY
A SINGLE FOCUS ON PROFITSA SINGLE FOCUS ON PROFITS
Investment in community slows downInvestment in community slows down
Institutions such as schools look to outsideInstitutions such as schools look to outsidehelphelp
Further power shifts to wealthy people andFurther power shifts to wealthy people and
now the anti human rights activists havenow the anti human rights activists havelegitimacylegitimacy
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ENVIRONMENTAL DEGRADATIONENVIRONMENTAL DEGRADATION
Rapid exploitation of natural resources =Rapid exploitation of natural resources =
rapid profits = rapid environmental degradationrapid profits = rapid environmental degradation
Global warmingGlobal warming
CO2 accumulationCO2 accumulation
Ozone depletionOzone depletion
Many gains of the past may even be lostMany gains of the past may even be lost
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SUSTAINABLE DEVELOPMENTSUSTAINABLE DEVELOPMENT
BECAME AN EMPTY DREAMBECAME AN EMPTY DREAM
Development that meets the needs of the presentDevelopment that meets the needs of the presentwithout compromising the ability of the futurewithout compromising the ability of the future
generation to meet future needs.generation to meet future needs.
Human beings are the center of concern forHuman beings are the center of concern forsustainable development. They are entitled tosustainable development. They are entitled to
healthy and productive life in harmony withhealthy and productive life in harmony withnature.nature.
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Absolute Poverty is Still the Major RiskAbsolute Poverty is Still the Major Risk
Factor of Poor HealthFactor of Poor Health
The path leading from poverty to poor health goesThe path leading from poverty to poor health goesthrough inadequate nutrition, inadequate housing,through inadequate nutrition, inadequate housing,lack of education and lack of access to healthlack of education and lack of access to health
services.services. Need for actionNeed for action
We need sustainable development in globalizingWe need sustainable development in globalizingthe economythe economy
We need monitoring of unhealthy policiesWe need monitoring of unhealthy policies Change in global economic policiesChange in global economic policies
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Advocacy for healthy economic policies to narrowAdvocacy for healthy economic policies to narrow
the gap between the need and the services availablethe gap between the need and the services available
Effective dissemination of global health knowledgeEffective dissemination of global health knowledge
WFPHAWFPHA
Global Health CouncilGlobal Health Council
Necessary to move beyond health for all to considerNecessary to move beyond health for all to consider
all of the other dimensionsall of the other dimensions
Global good one world, one peopleGlobal good one world, one people
New research in social sciencesNew research in social sciences
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Global EraGlobal Era
6 millions physicians worldwide serving over 66 millions physicians worldwide serving over 6
billion inhabitantsbillion inhabitants
Over 1800 medical schools throughout theOver 1800 medical schools throughout theworldworld
Health services and medical practice areHealth services and medical practice are
undergoing profound changes forced byundergoing profound changes forced by
economic difficulties in financing healthcareeconomic difficulties in financing healthcare
systemssystems
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Global EraGlobal Era
Increasing cost of health interventions are related costIncreasing cost of health interventions are related cost--
containment policies could threaten physicianscontainment policies could threaten physicians
humanism and valuehumanism and value
Rapid advances are occurring in biomedical sciences,Rapid advances are occurring in biomedical sciences,
information technology and biotechnologyinformation technology and biotechnology
New ethical, social and legal challenges for professionNew ethical, social and legal challenges for professionof medicine and call for preservation of a balanceof medicine and call for preservation of a balance
between science and the art of medicinebetween science and the art of medicine
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Global EraGlobal Era
Medical StandardsMedical Standards
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Medical standards in use: the worldsMedical standards in use: the worlds
overviewoverview
USAUSA
The National Board of Medical Examiners (NBME) (1915)The National Board of Medical Examiners (NBME) (1915)
The Federation of State Medical Boards (1993)The Federation of State Medical Boards (1993)
EuropeEurope
Maastricht Agreement (1993)Maastricht Agreement (1993)
AustraliaAustralia The Accreditation Committee of the Australian MedicalThe Accreditation Committee of the Australian Medical
Council (1985, 1991)Council (1985, 1991)
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Medical standards in use: the worldsMedical standards in use: the worlds
overviewoverview
Latin AmericaLatin America
AsiaAsia
The World Federation for Medical EducationThe World Federation for Medical Education
(WFME) (1999)(WFME) (1999)
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Global Standard on Basic MedicalGlobal Standard on Basic Medical
Education (WFME, 2003)Education (WFME, 2003)
9 Area9 Area
36 Sub36 Sub--areas (Criterias)areas (Criterias)
STANDARDSTANDARD BasicBasic ---- mustmust
Quality developmentQuality development----shouldshould
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Institute for International MedicalInstitute for International Medical
Education (seven broad educationalEducation (seven broad educationaloutcomeoutcome--competence domains)competence domains)
Professional Values, Attitudes, Behaviour, andProfessional Values, Attitudes, Behaviour, and
EthicsEthics Scientific Foundation of MedicineScientific Foundation of Medicine
Clinical SkillsClinical Skills
Communication SkillsCommunication Skills Population Health and Health SystemsPopulation Health and Health Systems
Management of InformationManagement of Information
Critical thinking and researchCritical thinking and research
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The Five Stars Doctor (WHO)The Five Stars Doctor (WHO)
CommunicatorCommunicator
Care providerCare provider
Care managerCare manager Decision makerDecision maker
Community leaderCommunity leader
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National Competencies of PrimaryNational Competencies of Primary
Care Physicians (2005)Care Physicians (2005)
Effective communicationEffective communication
Performing basic clinical skillsPerforming basic clinical skills
Application of Principle from Biomedical, Clinical andApplication of Principle from Biomedical, Clinical and
Behavioral Sciences and Epidemiology in the PracticeBehavioral Sciences and Epidemiology in the Practiceof Family Medicineof Family Medicine
Management of health problems in the individual,Management of health problems in the individual,family and communityfamily and community
Accessing, critical appraising and managing informationAccessing, critical appraising and managing information Self awareness. SelfSelf awareness. Self--care and personal developmentcare and personal development
Professional, moral and ethics contexts of practiceProfessional, moral and ethics contexts of practice
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