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Raharjanti NW, Soemantri D, Wiguna T, Findyartini A, Purwadianto A, Indriatmi W, Poerwandari EK, Mahajudin MS, Nugrahadi NR, Roekman AE, Leonardo R, Ramadianto AS, Levania MK. Defining the tasks of clinical reasoning in forensic psychiatric evaluation: Psychomedicolegal analysis competency. Heliyon 2023; 9:e14077. [PMID: 36915550 PMCID: PMC10006738 DOI: 10.1016/j.heliyon.2023.e14077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
Objective 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. Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
| | | | - Tjhin Wiguna
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Agus Purwadianto
- Forensic Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wresti Indriatmi
- Dermatology and Venerology Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Marlina S Mahajudin
- Department of Psychiatry, Airlangga University, Surabaya, East Java, Indonesia
| | | | | | - Ronald Leonardo
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Monika Kristi Levania
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Menaldi SL, Raharjanti NW, Wahid M, Ramadianto AS, Nugrahadi NR, Adhiguna GMYP, Kusumoningrum DA. Burnout and coping strategies among resident physicians at an Indonesian tertiary referral hospital during COVID-19 pandemic. PLoS One 2023; 18:e0280313. [PMID: 36662883 PMCID: PMC9858322 DOI: 10.1371/journal.pone.0280313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/27/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has increased the burden on resident physicians. They may use different coping strategies to manage those burdens, which partly determine their mental health outcomes, including burnout syndrome. This study explores the relationship between coping strategies and burnout among resident physicians during the COVID-19 pandemic in an Indonesian tertiary referral hospital. METHODS This online cross-sectional study was conducted from June to August 2020, involving nine residency programs in the Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital. Burnout syndrome was assessed using Maslach Burnout Inventory, while Brief COPE measured coping strategies. RESULTS A total of 388 residents participated in this study. High emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA) were found in 15.5%, 5.2%, and 39.2%, respectively. Residents more often use adaptive than maladaptive coping strategies. Higher PA was correlated to residents using problem-focused (r = 0.299; p < 0.001) and emotion-focused (r = 0.397; p < 0.001). Meanwhile, dysfunctional coping strategies are moderately correlated with EE (r = 0,518; p <0,001) and DP (r = 0,507; p<0,001). CONCLUSION The use of dysfunctional coping strategies is linked to higher emotional exhaustion and depersonalization aspect of burnout. However, a higher sense of personal accomplishment is linked to problem-focused and emotion-focused strategies. Appropriate identification and intervention of residents with dysfunctional coping strategies may be beneficial in reducing burnout risk.
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Affiliation(s)
- Sri Linuwih Menaldi
- Department of Dermatovenereology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Medical Education, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Natalia Widiasih Raharjanti
- Department of Medical Education, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mardiastuti Wahid
- Department of Medical Education, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Clinical Microbiology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Adhitya Sigit Ramadianto
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nadia Rahmadiani Nugrahadi
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - G. M. Yudi Prasetia Adhiguna
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dewi Anggraeni Kusumoningrum
- Department of Medical Education, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Raharjanti NW, Wiguna T, Purwadianto A, Soemantri D, Indriatmi W, Poerwandari EK, Mahajudin MS, Nugrahadi NR, Roekman AE, Saroso OJDA, Ramadianto AS, Levania MK. Translation, validity and reliability of decision style scale in forensic psychiatric setting in Indonesia. Heliyon 2022; 8:e09810. [PMID: 35815133 PMCID: PMC9257327 DOI: 10.1016/j.heliyon.2022.e09810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Natalia Widiasih Raharjanti
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Corresponding author.
| | - Tjhin Wiguna
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Agus Purwadianto
- Forensic Department, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Wresti Indriatmi
- Dermatology and Venerology Department, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Nadia Rahmadiani Nugrahadi
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Aisha Emilirosy Roekman
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Adhitya Sigit Ramadianto
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Monika Kristi Levania
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital—Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Ramadianto AS, Kusumadewi I, Agiananda F, Raharjanti NW. Symptoms of depression and anxiety in Indonesian medical students: association with coping strategy and resilience. BMC Psychiatry 2022; 22:92. [PMID: 35130862 PMCID: PMC8820032 DOI: 10.1186/s12888-022-03745-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/31/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Depression and anxiety are prevalent mental health issues among medical students due to the various challenges during medical education. These issues affect not only their quality of life, but also their academic and professional development. Coping strategy and resilience are two factors that may influence students' mental health outcomes. Data of medical student mental health in Indonesia is scarce, hampering efforts to systematically address the problem. Hence, this study aims to estimate the prevalence of depressive and anxiety symptoms in Indonesian medical students, and their association with coping strategy and resilience. METHODS Undergraduate medical students from each year of study (Preclinical Year 1 to 4, Clinical Year 1 and 2) in the Faculty of Medicine Universitas Indonesia were randomly selected to participate in this cross-sectional study. The study questionnaire included sociodemographic characteristics, Depression Anxiety Stress Scale (DASS) to measure symptoms of depression and anxiety, Brief COPE to measure coping strategy, and Connor-Davidson Resilience Scale (CD-RISC) to measure resilience. Scores of depression and anxiety symptoms were analyzed by comparing them between different sociodemographic groups and by measuring their correlation with coping strategies and resilience. Multiple regression analyses were conducted to identify predictors of depression and anxiety symptoms. RESULTS Among 532 respondents, 22.2% reported symptoms of depression and 48,1% reported anxiety, including 3.0% and 8.1% with extremely severe depression and anxiety, respectively. Students not living with immediate family had higher depression score; female students and those in Preclinical Year 1 and Clinical Year 1 showed higher anxiety scores. Dysfunctional coping strategies and lower resilience are predictors of higher depression and anxiety symptoms. CONCLUSIONS Students show different levels of depressive and anxiety symptoms, signifying different levels of mental health support needs from universal mental health promotion to psychiatric treatment. Prevention programs can be targeted towards students with risk factors, such as not living with immediate family, undergoing first year of preclinical studies or clinical rotations, coping with dysfunctional strategies, and having low resilience. Additionally, medical educators must be aware of other, non-student factors that may impact student mental health, such as curriculum design and learning experience.
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Affiliation(s)
- Adhitya Sigit Ramadianto
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Irmia Kusumadewi
- grid.9581.50000000120191471Department of Psychiatry, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Feranindhya Agiananda
- grid.9581.50000000120191471Department of Psychiatry, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Natalia Widiasih Raharjanti
- grid.9581.50000000120191471Department of Psychiatry, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Raharjanti NW, Purwadianto A, Soemantri D, Bardosono S, Mahajudin MS, Poerwandari EK, Levania MK, Tua Sorimangaraja Silalahi HM, Satvika Rumthi PT, Manulang TKP, Ramadianto AS, Wiguna T. Self-confidence in conducting forensic psychiatric evaluations among general psychiatrists in Indonesia. Heliyon 2021; 7:e08045. [PMID: 34622054 PMCID: PMC8482431 DOI: 10.1016/j.heliyon.2021.e08045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSION Structured forensic psychiatry educational modules during general psychiatry residency training played an important role in the development of psychiatrists' self-confidence.
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Affiliation(s)
- Natalia Widiasih Raharjanti
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Agus Purwadianto
- Forensic Department, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Saptawati Bardosono
- Nutrition Department, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Marlina S Mahajudin
- Department of Psychiatry, Airlangga University, Surabaya, East Java, Indonesia
| | | | - Monika Kristi Levania
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Putu Trahinari Satvika Rumthi
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Timotius Kevin P Manulang
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Adhitya Sigit Ramadianto
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Raharjanti NW, Wiguna T, Purwadianto A, Soemantri D, Bardosono S, Poerwandari EK, Mahajudin MS, Ramadianto AS, Alfonso CA, Findyartini A, Nugrahadi NR, Lazuardi MQ, Subroto PAM, Saroso OJDA, Levania MK. Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls. Front Psychiatry 2021; 12:691377. [PMID: 34421677 PMCID: PMC8374734 DOI: 10.3389/fpsyt.2021.691377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/09/2021] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Natalia Widiasih Raharjanti
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Agus Purwadianto
- Department of Forensic and Medicolegal, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Adhitya Sigit Ramadianto
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - César A Alfonso
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Department of Psychiatry, Columbia University, New York, NY, United States
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nadia Rahmadiani Nugrahadi
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Qolby Lazuardi
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Priscilla Aya Maheswari Subroto
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Monika Kristi Levania
- Department of Psychiatry, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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