Brahmaputra Marjadi

Introduction: Gender, sexuality and reproductive health (GSRH) education in Indonesian schools remains a challenge despite attempts to improve it. An innovative model for Indonesian GSRH school teachers and local health professionals was piloted in two provinces in 2019–2021, incorporating a WhatsApp Group/WAG-based community of practice/CoP after a GSRH training. Methods: Following a 2-day GSRH training, a WAG-CoP was offered in each province. Training participants voluntarily joined their province’s WAG to discuss post-training experiences with peers and the trainers for two years. After the first 12 months, a focus group discussion/FGD with Nominal Group Technique/NGT approach was conducted to evaluate the WAG-supported CoP model. After 24 months, WAG chat data were content-analysed to identify patterns of usage. Results: There were 74 (Province A) and 34 (Province B) training participants. The CoP model failed to gain traction in Province A. Province B participants completed the 24-month pilot. Province B WAG interactions (1,021 posts) were in short bursts (median 1 day; upper-quartile 2 days), predominated by thumb-ups (23.8%), thank-yous (18.3%) and social greetings (14.0%). Province B’s FGD and NGT revealed promising outcomes of the WAG-CoP model and the need for in-person get-together. The COVID-19 impact prompted the need for an online version of the training. Conclusion: The WAG-CoP for GSRH education in Indonesian schools had limited success. In-person interactions are needed to support the online forum. Policy Implications: GSRH improvement in Indonesian schools needs to incorporate a blended-mode ongoing support from peers, health professionals and experts to enable continuing professional development.

Background: Anecdotal evidence has indicated that Indonesian primary care clinics struggle to meet new licensing requirements under the new Omnibus Law in 2020. This study aimed to analyse the challenges associated with clinic licensing under this Law and identify potential practical solutions. Methods: This was a sequential exploratory mixed-method case study in Surabaya, the second-largest city in Indonesia. Participants were recruited using convenience sampling from a District Health Office WhatsApp group of 38% of primary clinics in Surabaya (85/223). We used a quantitative survey to assess primary clinics’ compliance with the new requirements. Subsequently, survey participants and key stakeholders were invited to two-phase focus group discussions (FGDs) where survey findings were reported and discussed. Quantitative data were analysed descriptively, and qualitative data were thematically analysed; both were synthesised at the final data analysis. Results: The survey response rate was 35% (30/85 clinics in the WhatsApp group). Compliance with the new regulation varied, with 17% of the clinics still awaiting license approval and 27% needing to obtain waste management permits. Eighteen survey participants and six key stakeholders participated in the FGDs. Five key challenges in primary clinic licensing were identified: regulation shifting, knowledge and perception, weakness in system design, time, and cost. Conclusion: The more complex licensing requirements have caused delays in license issuance for a convenience sample of primary clinics in this study. Ineffective communication and a lack of understanding between clinics, local government agencies, and external consultants have exacerbated these issues, leading to a heavy burden on clinic resources. To mitigate these challenges, policy-makers should prioritize simplifying sequential requirements, enhancing interagency coordination, and establishing clear communication channels—ensuring regulatory changes align with on-the-ground capacity and needs. By addressing these gaps, the licensing process can become more efficient and transparent, ultimately supporting clinic sustainability and healthcare access.

Background: Western Sydney University School of Medicine's Medicine in Context (MiC) programme integrates social determinants of health into the medical curriculum through workshops, tutorials and placements in community, General Practice and hospital settings, particularly in the hyper‐diverse Greater Western Sydney area. A gamified innovation to teach medical students about the significance of social capital was developed and evaluated in 2023. Teaching on patients' social capital is critical to ensure students adequately consider patients' networks in delivering tailored, patient‐centred care. Approach: A ‘ trio of learning activities ’ was designed that combined elements of gamification, simulation and experiential learning. First, a workshop that combined aspects of ‘ Choose Your Own Adventure ’ and hybrid ‘ Escape Room ’ was delivered, which introduced the concept of social capital and facilitated students' reflections on patients' and their own social capital. Second, students attended single‐day placements at community organisations. The third activity was a tutorial during which students explored social capital of the communities they observed and then debriefed their learning on social capital throughout the semester. Evaluation: The teaching innovation was evaluated at three time points using quantitative and qualitative questions. Evaluation results indicated students' overall understanding of the concept of social capital increased after the workshop, and the majority of students felt the learning activities were ‘Very Helpful’ to achieving their Learning Outcomes. Implications: Integrating simulation, gamification and experiential learning proved an effective and engaging method for teaching social capital within a short timeframe. Students' positive feedback indicates that this innovation can be applied to teach social determinants of health in a packed medical curriculum.

Despite recent calls to engage in scholarship with attention to anti-racism, equity, and social justice at a global level in Health Professions Education (HPE), the field has made few significant advances in incorporating the views of the so-called "Other" in understanding the nature, origin, and scope of knowledge as well as the epistemic justification of knowledge production. Editors, authors, and reviewers must take responsibility for questioning existing systems and structures, specifically about how they diffuse the knowledge of a few and silence the knowledge of many. This article presents 12 recommendations proposed by The Global South Counterspace Authors Collective (GSCAC), a group of HPE professionals, representing countries in the Global South, to help the Global North enact practical changes to become more inclusive and engage in authentic and representative work in HPE publishing. This list is not all-encompassing but a first step to begin rectifying non-inclusive structures in our field.

As more general practitioners (GPs) are consulted to navigate inclusive care for transgender and gender diverse (trans) children and young people, the experiences of families seeking care for trans children can inform GP practice. The aims of this study were to understand the experiences of parents of trans children in their interactions with GPs when seeking care for their children; to inform GPs about families’ experiences of good care; and to complement existing guidelines and resources for GPs on affirmative trans healthcare for children. This was a nation-wide, qualitative, constructivist study using semi-structured in-depth interviews, which was nested in a larger study on experiences of parents with a trans child across a range of Australian services and agencies. Eighteen parents of trans children in Australia were interviewed, recruited from online support and advocacy networks for parents of trans children. We found that although parents valued ongoing care from their family GP, some had to seek a new GP because they had or feared a negative reaction from their regular GP, or their regular GP did not have the knowledge to support their family. Parents sought GPs who would validate their child and affirm their child’s gender. Parents expected practical care from GPs such as referrals to gender-affirming specialists and other health practitioners, routine clinical procedures, and letters of support to services and agencies. Qualities that parents valued in a GP were a respectful manner, listening, putting the child first, asking appropriate questions, and being willing to learn. GPs that understand trans healthcare for children across a range of health areas and can respond positively in a respectful and matter of fact way to families are in short supply. Parent knowledge can inform GPs to support trans children in line with the Australian Standards of Care.

Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.

Background: Disadvantages such as social distress, safety, economic status and educational levels can significantly impact health risk factors, health care access and health outcomes. Teaching of disadvantage is critical for medical students to understand impact of disadvantages on patient health and facilitate patient‐centred care. Disadvantage was initially taught through one tutorial to third year medical students. Students often narrowly focused on financial disadvantage and failed to consider other disadvantages. In 2019, an innovation to teach disadvantage to first year students was developed and evaluated. Approach: A ‘trio of learning activities’ was designed that combined gamification and experiential learning. The first activity was the gamified Treasure Hunt where students overcame multiple disadvantages to collect ‘treasure’. The workshop introduced the topic and potential impacts of disadvantages on health. The second activity included placements at general practices where students observed patient disadvantages. The third activity was the end‐of‐semester tutorial during which students debriefed their learning on disadvantage throughout the semester. Evaluation: Students completed the sentence ‘Disadvantage is …’ after the Treasure Hunt workshop and after the tutorial. Seventy‐six percent of the 146 students participated in the evaluation. Responses were thematically analysed. Post‐workshop data indicated improvement in students' understanding of disadvantage including its different types, invisible nature of some disadvantages and people's lack of control over disadvantages. Post‐tutorial data indicated additional learning about intersectionality, clinical impacts and doctors' ability to address patient disadvantage. Implications: Combining gamification and experiential learning provided an effective and engaging way to teach about disadvantage in a limited time. Positive evaluation of the innovation indicates this approach can be utilised to teach social determinants of health.