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PROBLEM-BASED LEARNING
(PBL)CARA BELAJAR
di Fakultas Kedokteran Universitas Andalas
Rahmatina B. HermanBagian Pendidikan Kedokteran (BPK)
Fakultas Kedokteran – Universitas Andalas
Bimbingan Aktivitas Kemahasiswaan dan Tradisi Ilmiah (BAKTI)Fakultas Kedokteran Universitas Andalas
Tahun Akademik 2013/2014
BPK FK UNAND BAKTI 2013/20134
Education
Purpose of Education
“….provide assistance to learners that enables
them to achieve levels of development (and
efficiency) that they would not be able to
achieve by themselves
Tiffin and Rajasingham
BPK FK UNAND BAKTI 2013/20134
Kemp
Learning is key
to success of
an education
How to succeed an education?
BPK FK UNAND BAKTI 2013/20134
What is Learning?
Learning is a change in human capability, which
can be retained, and not due to the process of
growth (Gagne)
Learning is a change in behavior as a result of
experience (Haggard)
Learning is a process by which behavior is
changed, shaped, or controlled (Tiffin and
Rajasingham)
BPK FK UNAND BAKTI 2013/20134
Teaching-Learning Strategy
Teacher-centered (Teaching)
Student-centered (Learning)
BPK FK UNAND BAKTI 2013/20134
One-way didactic methode (Sefton, 2001)
student student student student student student student
Teacher
Teacher-Centered (Teaching)
student
BPK FK UNAND BAKTI 2013/20134
……Teacher-Centered (Teaching)
Teacher is solely responsible for what the
student is expected to learn
Teacher decides what
information and skills
the student should to
learn in what sequence
and at what pace
BPK FK UNAND BAKTI 2013/20134
The Learning Pyramid
Teach each others
Lecture
Discussion group
Demonstration
Audiovisual
Reading
Practice by doing
5%
10%
20%
30%
50%
75%
80%
AverageRetention Rate
National Training Laboratories, Bethel, Maine, USA
BPK FK UNAND BAKTI 2013/20134
Constructivism Theory
Knowledge is constructed from experience
Learning is a personal interpretation of the world
Learning is an active process in which meaning is developed on the basis of experience
Conceptual growths comes from the negotiation of meaning, the sharing of multiple perspectives and the changing of our internal representations through collaborative learning
Learning should be situated in realistic settings; testing should be integrated with the task and not a separate activity
BPK FK UNAND BAKTI 2013/20134
Adult Learning Theory(Malcolm Knowles)
Adults are autonomous and self-directed
Adults have accumulated a foundation of life
experiences and knowledge
Adults are practical
Adults are relevancy-oriented
Adults are goal-oriented
Adults need to be shown respect
BPK FK UNAND BAKTI 2013/20134
Teaching Learning
Teacher centered
Knowledge transfer
Reinforces passiveness
Teachers provide answers
Teachers direct students
Student centered
Knowledge acquisition
Reinforces activeness
Teachers ask questions
Teachers guide students
Teaching vs Learning
BPK FK UNAND BAKTI 2013/20134
Interpersonal communication, complex interaction - facilitated by a tutor (Sefton, 2001)
facilitator
student
student
student
student
student
studentstudent
student
Student-Centered (Learning)
BPK FK UNAND BAKTI 2013/20134
Student-Centered (Learning)
The student learn to determine what he needs
to know
Teacher responsibility in the beginning by
providing the student experience and guidance
It is expected that student will eventually take
full responsibility for his own learning.
Active acquisition of information and skills by
student
BPK FK UNAND BAKTI 2013/20134
Student-Centered Learning Strategy
Active learning
Collaborative learning
Inquiry-based learning
Cooperative learning
Problem-based learningPeer led team learning
Team-based learning
Peer instruction
Inquiry guided learning
Just-in-time teaching
Small group learning
Project-based learning
Question directed instruction
Independent learning
Adult learning
Self-directed learning
Autonomous learning
Discovery learning
Think-pair share
Experiential learning
Performance-based learning
Task-based learning
Work-based learning
Competence-based learning
Case-based learning
Etc
BPK FK UNAND BAKTI 2013/20134
PBL is a learning method on principle of using
problems as a starting point for the acquisition
and integration of new knowledge (Barrows,
1982)
In PBL students work on the problem which is
explicitly used to get students themselves to
identify and search for the knowledge that they
need to obtain in order to approach the
problem (Ross, 1991).
What is PBL?
BPK FK UNAND BAKTI 2013/20134
The acquisition of an integrated body
of knowledge related to the problem
and the develop or application of
problem-solving skills
The Objective of PBL
BPK FK UNAND BAKTI 2013/20134
Student-Centered
Problem-Based
Integrated
Community-Oriented
Early Clinical Exposure
Self-Directed/ Selective with Core
Philosophy of Learning in PBL
BPK FK UNAND BAKTI 2013/20134
tutor
studentsproblem
Tutorial
group
process
Three elements of the tutorial process in PBL
BPK FK UNAND BAKTI 2013/20134
New information is better processed and retained
Problem solving skills are enhanced
Integration of basic science and behavioral science
knowledge is stimulated
Students learn how to learn
Student are stimulated to undertake self-directed
activities
Student motivation is enhanced
Integration of knowledge from different discipline is
fostered
……The Role of Problems
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Seperangkat tindakan cerdas dan penuh
tanggung jawab yang dimiliki seseorang
sebagai syarat untuk dianggap mampu oleh
masyarakat dalam melaksanakan tugas-tugas di
bidang pekerjaan tertentu
SK Mendiknas No. 045/U/2002
Pengertian Kompetensi
BPK FK UNAND BAKTI 2013/20134
Tahap Pendidikan Dokter
Pendidikan Dokter di Indonesia mengacu kepada
Standar Pendidikan Profesi Dokter dan Standar
Kompetensi Dokter yang disahkan oleh Konsil
Kedokteran Indonesia (KKI)
Pendidikan Dokter Layanan Primer terdiri atas dua
tahap:
> Tahap Akademik : S.Ked
> Tahap Profesi (Tahap Klinik): Dokter
Internship dan Uji Kompetensi untuk memperoleh
Sertifikat Kompetensi dari KKI
BPK FK UNAND BAKTI 2013/20134
Kurikulum fakultas disusun kedalam blok
Menyusun matriks blok dan kompetensi
Menetapkan kordinator blok dan kordinator
tahap
Menyusun kurikulum blok
Menyusun modul dan skenario setiap blok
Menyusun strategi implementasi PBL untuk
setiap blok
Strategi Implementasi Tahap Akademik
BPK FK UNAND BAKTI 2013/20134
KURIKULUM FAKULTAS
BLOK BLOK BLOK BLOK
MODUL MODUL MODUL
SKENARIOmingguan
SKENARIO
mingguan
BPK FK UNAND BAKTI 2013/20134
Dilaksanakan setiap hari Sabtu
Student-Centered Learning
Tahun I : Mata Kuliah Wajib Universitas
Agama, Bahasa Inggris, Kewarganegaraan
Tahun II : Family Oriented Medicine (FOME)
Tahun III : Metodologi Riset, Skripsi
Tahun IV : Preclerkship
Pembelajaran Ekstra-Blok
BPK FK UNAND BAKTI 2013/20134
1. Tutorial dengan konsep “7 jump”
2. Belajar mandiri
3. Praktikum skills lab
4. Kuliah pengantar
5. Praktikum ilmu dasar
6. Diskusi pleno
7. Clerkship (co-schaap)
8. Internship
Strategi Pembelajaran
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Mahasiswa dibagi kedalam kelompok kecil (10 – 11 mahasiswa / kelompok)
Kordinator blok bertanggung jawab terhadap implementasi kurikulum blok termasuk:- Menyusun “Study Guide”- Menyusun Skenario (dari bank skenario)- Menjalankan semua aktivitas akademik di blok
Kordinator Tahun bertanggung jawab terhadap implementasi kurikulum pada tahun yang dikordinirnya
Kordinator Tahap bertanggung jawab terhadap implementasi kurikulum pada tahap yang dikordinirnya
Strategi Implementasi PBL
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What is Small Group?
Small group work is characterized by student
participation and interaction (Crosby 1996)
The Goals of Small Group Learning:
- The development of communication skills
- The development of intellectual and professional
competencies
- The development of presentation skills
- The personal growth of students (and perhaps the
tutor)
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Process in Small Group Learning
INCREASING
DEGREE
TIMEFORMING
STORMING
NORMING
PERFORMING
MOURNINGnnnn C.I nnnn C.I
nnnn C.I
nnnn C.Innnn C.I
wwww ACTIVE ROLE
OF THE TEACHER
uuuuINDIVIDUAL
GROWTH AND
EXPECTATIONS
GROUP 8888
GROWTH
GOAL
C.I = CRITICAL INCIDENT
OPTIMUM GROUP
GROWTH AND
INDIVIDUAL
GROWTH
BPK FK UNAND BAKTI 2013/20134
Tutorial dalam konteks PBL adalah:
suatu active learning process di dalam diskusi kelompok
kecil
distimulasi oleh suatu problem (skenario)
mengaktifkan prior knowledge mahasiswa
difasilitasi oleh seorang tutor
dipimpin oleh seorang mahasiswa yang terpilih
dibantu oleh seorang sekretaris yang terpilih
Untuk mencapai tujuan belajar melalui aktivitas
terstruktur yang disebut seven-jump
1. Tutorial
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………..menggunakan problem untuk
mendorong aktivitas pembelajaran
berdasarkan a need-to-know basis
(Woods, 1994)
Kunci Tutorial dalam PBL
BPK FK UNAND BAKTI 2013/20134
Tutorial adalah “jantung” PBL
Bentuk dan ukuran “jantung” merupakan
gambaran tujuan belajar yang spesifik
Setiap denyut “jantung” memberi /
menyediakan informasi baru / lebih maju
“Jantung” yang sehat akan menjamin
pencapaian tujuan belajar
Peran tutorial dalam PBL
BPK FK UNAND BAKTI 2013/20134
Effective Tutorial
Characteristics of an effective tutorial group:
♦♦♦♦ cohesive
♦ high motivation
♦♦♦♦ mutual helps among individuals
♦♦♦♦ have a high motivation to learning together
All members understand the tasks that must be
completed and at the same time trying to complete the
task with high spirit
(Sefton, 2001)
BPK FK UNAND BAKTI 2013/20134
……Effective Tutorial
Each member of the group respect the opinion of
others, but remain critical
Discussion conducted cooperatively, not competitively
The quiet member to be encouraged to actively
participate, the dominant member to be asked to
reduce its dominance
Each member has to be helped to not having personal
stress
(Sefton, 2001)
BPK FK UNAND BAKTI 2013/20134
Seven Jump
1. Clarifying unfamiliar terms
2. Defining problems
3. Brainstorming possible hypotheses or
explanations
4. Arranging explanations into a tentative solution
5. Defining learning objectives
6. Gathering information
7. Sharing the results of information gathering and
private study
BPK FK UNAND BAKTI 2013/20134
Process
- Students identify any words whose
meaning is unclear - other group
members may be able to provide
definitions.
- Students should be made to feel
safe, enabling them to be honest
about anything they do not
understand.
Clarifying unfamiliar terms
BPK FK UNAND BAKTI 2013/20134
..….Clarifying unfamiliar terms
Reason
Unfamiliar terms act as an obstacle to
understanding. Clarification of even
half - understood terms may start the
process of learning.
Written output
Words or names on which the group
cannot agree a meaning should be
listed as learning objectives.
BPK FK UNAND BAKTI 2013/20134
Process
- This is an open session when
students are encouraged to
contribute their view of the
problem under discussion.
- The tutor may need to encourage
them all to contribute to a fast-
moving and wide-ranging analysis.
Defining problems
BPK FK UNAND BAKTI 2013/20134
…..Defining problems
Reason
It is quite possible for every member
of tutorial group to have a different -
perspective, on a problem. Comparing
and pooling these views broadens the
intellectual horizons of those involved
and defines the task ahead.
Written output
List of issues to be explained
BPK FK UNAND BAKTI 2013/20134
Process
- A continuation of the open session
- but students now try to formulate,
test and compare the relative merits
of their hypotheses or explanations
of the problem or case.
Brainstorming possible hypotheses or explanations
BPK FK UNAND BAKTI 2013/20134
……Brainstorming possible hypotheses or explanations
ReasonThis is a crucial step, that prompts the use
of previous learning and memory and allows
students to test or draw on another’s
understanding; Links can be formed
between the items if incomplete knowledge
that exist within the group. If well handled by
the tutor and group, it pitches learning at the
deeper level of 'understanding' rather than
the superficial level of 'facts'.
Written outputList of hypotheses or explanations
BPK FK UNAND BAKTI 2013/20134
Process- Students will have thought of as many
different explanations as possible of what
is occurring.
- The problem is scrutinized in fine detail
and compared against the proposed
hypotheses, or explanations, to see how
they will match and if further exploration is
needed.
- This starts the process of defining learning
objectives, although it is inadvisable for
them to be recorded in writing too soon
Arranging explanations into a tentative solution
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……Arranging explanations into a tentative solution
Reason
- This stage actively processes and
restructures existing knowledge and
identifies gaps in understanding.
- Making written records of learning
objectives too soon hinders thinking
and short-circuits the intellectual
process, resulting in objectives that
are too broad and superficial.
BPK FK UNAND BAKTI 2013/20134
Written output
- This involves organizing explanations
for problems, representing them
schematically, trying to link new ideas
with each other, with existing
knowledge and with different contexts.
- This process provides a visual output
of the relationships between different
pieces of information and facilities
storage of information in long-term
memory.
……Arranging explanations into a tentative solution
BPK FK UNAND BAKTI 2013/20134
Process
- The group agrees a core set of learning objectives that all students will study.
- The tutor encourages them to be focused, not too broad or superficial and achievable within the time available. Some students may have objectives that are not shared by the whole group because of their own personal learning needs or interests
Defining learning objectives
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……Defining learning objectives
Reason
- The process of consensus uses the
expertise of the entire tutorial group
(and tutor) to synthesize the foregoing
discussion into appropriate and
attainable learning objectives.
- This not only defines the learning
objectives but also pulls the group
together and concludes the discussion.
Written outputLearning objectives
BPK FK UNAND BAKTI 2013/20134
BLOK HEMATOLIMFOPOEITIK
MENGAPA HARUS DINA?
Dina, 12 tahun, dibawa ibunya ke IGD RSUD setelah tertabrak motor
sepulang dari sekolah. Dari pemeriksaan ditemukan fraktur tulang
radius. Dokter merencanakan tindakan reposisi dibawah anestesi
dan meminta paramedis untuk melakukan pemeriksaan darah rutin
pasien. Ketika hasil pemeriksaan siap, dokter sangat terkejut karena
Hb Dina 5,6 gr%, padahal tidak ada perdarahan luar maupun dalam
akibat kecelakaan tersebut. Ketika dokter bertanya pada ibunya, ibu
Dina mengatakan bahwa anaknya menderita epilepsi dan sejak usia
6 tahun rutin minum obat. Dina juga termasuk anak yang susah
makan, tidak suka minum susu dan makan daging. Akhirnya dokter
meminta untuk dilakukan pemeriksaan darah lengkap serta pungsi
lumbal. Ibu Dina jadi bertanya-tanya, mengapa perlu dilakukan
pemeriksaan tersebut pada anaknya? Bagaimana anda
menerangkan permasalahan ini pada ibu Dina?
BPK FK UNAND BAKTI 2013/20134
Step 2. Defining problems
1. Mengapa Dina dibawa ke IGD RSUD?2. Mengapa dokter merencanakan reposisi?3. Mengapa dokter meminta melakukan pemeriksaan
darah rutin?
4. Apa artinya Hb 5,6 gr%?5. Mengapa dokter menanyakan riwayat kesehatan
Dina masa lalu?6. Apa artinya minum obat rutin selama 6 tahun
terakhir?7. Apa artinya susah makan, tidak suka susu dan
daging?8. Mengapa dokter memutuskan pemeriksaan darah
lengkap dan pungsi lumbal?
BPK FK UNAND BAKTI 2013/20134
Step 3. Brainstorming possible hypotheses or explanations (prior knowledge)
1. Dina dibawa ke IGD RSUD karena kecelakaan
2. Dokter merencanakan reposisi karena fraktur
3. Pemeriksaan darah rutin karena Dina akan dianestesi
4. Hb 5,6 gr% artinya anemia berat
5. Untuk menelusuri penyebab anemia pada Dina
6. Minum obat secara rutin bisa menekan (depresi) hematopoetik
7. Susah makan, tidak suka susu dan daging menyebabkan defisiensi nutrisi termasuk bahan untuk produksi darah
8. Pemeriksaan darah lengkap dan pungsi lumbal untuk diagnosis pasti kondisi hematopoetik dan penatalaksanaannya
BPK FK UNAND BAKTI 2013/20134
Step 4. Arranging explanations into a tentative solution
Kecelakaan
Fraktur Reposisi Anestesi
Darah Rutin Anemia
Obat
Depresi hematopoetik
Anemia aplastik
Susah makan
Defisiensi
Anemia defisiensi
Tatalaksana
Anamnesis, Pemeriksaan fisik, penunjang
BPK FK UNAND BAKTI 2013/20134
Step 5. Defining Learning Objectives (LO)
1. Menjelaskan pengertian dan jenis-jenis anemia
2. Menjelaskan aspek epidemiologi dan faktor-faktor yang mempengaruhi terjadinya anemia defisiensi dan anemia aplastik
3. Menjelaskan patofisiologi terjadinya anemia defisiensi dan aplastik
4. Menjelaskan gejala dan tanda anemia defisiensi dan aplastik
5. Menjelaskan diagnosis dan diagnosis banding anemia defisiensi dan aplastik (anamnesis, pemeriksaan fisik dan pemeriksaan penunjang)
6. Menjelaskan pemeriksaan laboratorium yang diperlukan untuk menunjang diagnosis anemia defisiensi dan aplastik
7. Menjelaskan penatalaksanaan anemia defisiensi dan aplastik secara komprehensif
8. Menjelaskan prognosis anemia defisiensi dan aplastik
9. Menjelaskan kasus anemia defisiensi dan aplastik yang memerlukan rujukan
BPK FK UNAND BAKTI 2013/20134
Process
This could include
- finding material in textbooks,
- carrying out a computerized literature search using the Internet looking at pathological specimens,
- talking to an expert, and
- anything else that will help provide the information the student is seeking.
Gathering information
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……Gathering information
Reason
Clearly an essential part of the
learning process is gathering and
acquisition of new information, which
students do on their own
Written output
Students' individual notes
BPK FK UNAND BAKTI 2013/20134
Process
- Students begin by returning to their list of learning objectives.
- They first identify their individual sources of information, pool their information from private study and help each other understand and identify areas of continuing difficulty for further study (or expert help).
- After this, they attempt to undertake and produce a complete analysis of the problem.
Sharing the results of information gathering and private study
BPK FK UNAND BAKTI 2013/20134
……Sharing the results of information gathering and private study
Reason
This synthesizes the work of the group,
consolidates learning and identifies
areas of uncertainty, possibly for
further study.
Written output
Students' individual notes
BPK FK UNAND BAKTI 2013/20134
2. Kuliah Pengantar
Tujuan: “mengantarkan” mahasiswa untuk
pembahasan modul/ skenario setiap minggu
Bukan bertujuan untuk transfer of knowledge
Karena itu Kuliah Pengantar harus dilaksanakan pada
minggu pelaksanaan modul/ skenario yang
bersangkutan
Dilaksanakan selama 50 menit/ topik kuliah
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3. Belajar Mandiri
Belajar mandiri dilaksanakan di kampus/
perpustakaan
Sumber pembelajaran:
- Printed material: Buku ajar (textbook), jurnal ilmiah
- Internet: situs (website) yang dapat
dipertanggungjawabkan keilmiahannya
- Pakar: staf pengajar/ dosen, pakar lainnya
Hasil Belajar Mandiri harus diserahkan ke Dosen
Pembimbing dan bila perlu bisa didiskusikan
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4. Praktikum Ilmu Dasar
Tujuan praktikum: membantu pemahaman teori
Dilaksanakan di laboratorium ilmu dasar yang
bersangkutan
Pelaksanaan selama 2 jam per topik praktikum per
kelompok praktikum
Dilaksanakan di bawah bimbingan instruktur dari staf
pengajar/ dosen ilmu dasar yang bersangkutan
BPK FK UNAND BAKTI 2013/20134
5. Praktikum Skills Lab
Tujuan praktikum: mahasiswa memperoleh
keterampilan yang berkaitan dengan profesi dokter
Dilaksanakan di laboratorium sklills lab
Pelaksanaan selama 2 jam per topik praktikum per
kelompok praktikum
Dilaksanakan di bawah bimbingan instruktur yang
ditetapkan oleh Kordinator Blok
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6. Diskusi Pleno
Tujuan Diskusi Pleno: sharing antar kelompok tutorial
Dilaksanakan setelah selesai tutorial untuk setiap
modul/ skenario, yaitu selesai tutorial hari kedua
Wajib diikuti oleh semua kelompok mahasiswa pada
Blok yang bersangkutan
Dua kelompok tutorial menyajikan hasil tutorial
mereka, kelompok lain wajib menyimak dan memberi
masukan/ sharing hasil tutorial masing-masing
kelompok
BPK FK UNAND BAKTI 2013/20134
6. Diskusi Pleno…..
Diskusi dipimpin oleh staf Blok yang bersangkutan
dan dihadiri oleh dosen pemberi Kuliah Pengantar
pada modul yang bersangkutan
Tidak dibenarkan mengajukan pertanyaan yang
bersifat menguji atau untuk mencari solusi masalah
yang tidak terpecahkan sewaktu tutorial, karena
semua masalah harus dapat dicarikan solusinya pada
tutorial kedua dari setiap modul/ skenario
Dilaksanakan selama dua jam
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7. Clerkship (Co-schaap)
Merupakan proses pembelajaran pada Tahap Profesi
(Tahap Klinik)
Tahap pertama dilaksanakan di Rumah Sakit
Pendidikan dan jejaringnya berupa rotasi pada
setiap Bagian Klinik dengan durasi waktu yang telah
ditentukan untuk setiap bagian dan diakhiri dengan
ujian
Tahap kedua: dilaksanakan di Puskesmas/ Layanan
Primer
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8. Internship
Internship bertujuan untuk memandirikan Dokter
yang baru lulus
Dilaksanakan di wahana internship yang telah
ditetapkan
Pelaksanaan internship tidak lagi di bawah tanggung
jawab Fakultas Kedokteran
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1. Evaluasi mahasiswa (ujian)
● Ujian/ penilaian blok
- Observasi oleh Tutor (Penilaian tutorial)
- Ujian tulis
- Skills lab: CEP (Checklist Evaluation of live Performance)
- Ujian praktikum
● Ujian tahunan dan ujian akhir (komprehensif):
- Ujian tulis (progress test)
- Skills lab: OSCE (Objective Structure Clinical Evaluation)
2. Evaluasi tutor
3. Evaluasi program
Evaluasi di Tahap Akademik
BPK FK UNAND BAKTI 2013/20134
Penilaian Tutorial
Menggunakan borang terstruktur:
- Partisipasi
- Komunikasi
- Persiapan
- Keaktifan
- Critical thinking
- Group skills
- General comments
BPK FK UNAND BAKTI 2013/20134
Tanggung Jawab Mahasiswa
Mengikuti semua proses pembelajaran
Peraturan Akademik:
- Menghadiri semua kegiatan akademik
- Tidak hadir harus dengan alasan yang dapat
diterima pimpinan
- Sanksi: tidak diizinkan mengikuti ujian blok
Mematuhi semua peraturan yang berlaku di Institusi
(Universitas dan Fakultas)
Attitude/ Prilaku
BPK FK UNAND BAKTI 2013/20134
Ruang tutorial
Ruang kuliah
Library
ICT
Laboratorium: - ilmu kedokteran dasar
- skills lab
Ruang diskusi pleno
Rumah-sakit pendidikan
Sarana Pendukung
BPK FK UNAND BAKTI 2013/20134
Menetapkan kredit (sks) per blok
Aktivitas akademik di dalam setiap blok
didasarkan pada sks per blok
Indeks Prestasi (IP) / Student‘s Academic
Performance
Penasihat Akademik / counselor
Efisiensi dan Produktivitas
BPK FK UNAND BAKTI 2013/20134
Tell me and I will forget
Show me and I will remember
Involve me and I will understand
Step back and I will act
Chinese proverb