title: Meeting international standards: a cultural approach in implementing the mini-CEX effectively in Indonesian clerkships.
abstract: Abstract Background: Medical schools all over the world try to adapt their programs to meet international standards. However, local culture might hamper innovation attempts.
  
  
  OBJECTIVE
  To describe challenges in implementing the mini-CEX in Indonesia and investigate its effect on students' clinical competence.
  
  
  METHODS
  The study was conducted in the Internal Medicine and Neurology departments of the Universitas Gadjah Mada, Indonesia. Implementing the mini-CEX into the existing curriculum, while taking the Indonesian culture into account, implied a shift from group to individual feedback. We compared students' final clinical competence before (Internal Medicine n = 122, Neurology n = 183) and after (n = 183 and 186, respectively) the implementation of the mini-CEX, using a modified Objective Structured Long Examination Record (OSLER). The Mann-Whitney test was used to analyze the data.
  
  
  RESULTS
  We took power distance and individualism into account to facilitate the implementation process. After implementing the mini-CEX, the OSLER results were significant higher in Internal Medicine (p < 0.05). However, no differences were found in Neurology.
  
  
  CONCLUSIONS
  By managing the innovation process carefully and taking culture and local context into account, the mini-CEX can be implemented without changing the underlying concept. The shift from group to individual feedback seems to have a positive effect on student learning.
authors.affiliation: Universitas Gadjah Mada , Indonesia .
authors.forename: Yoyo
authors.initials: Y
authors.lastname: Suhoyo
authors.forename: Johanna
authors.initials: J
authors.lastname: Schönrock-Adema
authors.forename: Gandes Retno
authors.initials: GR
authors.lastname: Rahayu
authors.forename: Jan B M
authors.initials: JB
authors.lastname: Kuks
authors.forename: Janke
authors.initials: J
authors.lastname: Cohen-Schotanus
mesh_terms: D002982:Clinical Clerkship / Q000458:organization & administration* / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003469:Culture; D003479:Curriculum; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007214:Indonesia; D007388:Internal Medicine / Q000193:education / Q000592:standards; D038622:Internationality; D009462:Neurology / Q000193:education / Q000592:standards