Assessing medical student preparedness for the clinical phase: perspectives of clinical faculty across specialties and medical school types in Indonesia

Abstract

Background

Evidence indicates that medical students often enter their clinical phase of undergraduate medical education without adequate preparation, which can affect their learning and patient safety. This study aimed to compare the preparedness of medical students to begin their clinical phase at public and private medical schools in Indonesia during and before the COVID-19 pandemic, based on the perspectives of clinical faculty.

Methods

This study employed a mixed-methods approach with an explanatory sequential design. Quantitative data were collected from 48 clinical faculty members across eight Indonesian medical schools using a validated Indonesian version of the 39-item Student Readiness for Clerkship Survey, with each item measuring a specific competency. Qualitative data were obtained through focus group discussions. Descriptive and inferential statistics were employed to analyze survey data, and thematic analysis was conducted to extract key themes from the qualitative responses.

Results

The clinical faculty from public institutions rated students significantly higher in 35 out of 39 competency areas compared to their counterparts in private institutions. These survey findings were reinforced by the FGD findings, which revealed four key factors influencing medical students' preparedness: a strong clinical education system, competent clinical faculty, qualified medical students, and robust institutional support.

Conclusion

This study reports perceived differences in clinical preparedness between public and private medical students in Indonesia and highlights institutional and educational factors that may contribute to these differences, informing efforts to strengthen the clinical education system.

Resumen

Antecedentes

La evidencia muestra que muchos estudiantes de medicina ingresan a la fase clínica de su formación sin la preparación adecuada, lo que puede afectar negativamente su aprendizaje y la seguridad del paciente. Este estudio tuvo como objetivo comparar la preparación de los estudiantes para iniciar la fase clínica en facultades de medicina públicas y privadas en Indonesia, antes y durante la pandemia de COVID-19, desde la perspectiva del profesorado clínico.

Métodos

Se utilizó un enfoque mixto con un diseño secuencial explicativo. Los datos cuantitativos se recopilaron mediante la versión validada en indonesio del Student Readiness for Clerkship Survey, un cuestionario de 39 ítems que evalúan competencias específicas, aplicado a 48 docentes clínicos de ocho facultades de medicina. Los datos cualitativos se obtuvieron mediante discusiones en grupos focales. Se emplearon estadísticas descriptivas e inferenciales para el análisis cuantitativo, y análisis temático para los datos cualitativos.

Resultados

Los docentes de instituciones públicas evaluaron significativamente mejor a los estudiantes en 35 de las 39 competencias en comparación con los de instituciones privadas. Los resultados cualitativos respaldaron estos hallazgos, identificando cuatro factores que influyen en la preparación clínica: un sistema educativo sólido, profesorado clínico competente, estudiantes bien calificados y apoyo institucional adecuado.

Conclusión

Este studio describe diferencias percibidas en la preparación clínica entre estudiantes de medicina de instituciones públicas y privadas en Indonesia y destaca factores institucionales y educativos que pueden contribuir a estas diferencias, apartando elementos para fortalecer para fortalecer el sistema de educación clínica.

Introduction

Medical schools in Indonesia have been rapidly increasing, from five public medical schools and one private medical school in 1960 to nine public and ten private medical schools in 1970. As of 2019, there were 38 public and 51 private medical schools in Indonesia,¹ that produce around 8000 medical doctors per year.² The Indonesian population in mid-2024 reached 281,6 million, served by 202,967 medical doctors, consisting of general practitioners and specialists. The growing population in Indonesia has created a demand for more medical doctors to achieve the desired doctor-to-population ratio of 1:1000. To address the shortage of medical professionals, the Indonesian government has supported the establishment of new medical schools to meet this need. As of January 2025, there were 117 medical schools in Indonesia, of which the majority were in Java, the most populous island in Indonesia. On average, there are around 12,000 graduates each year from 117 medical schools in Indonesia, and around 2700 graduates from the 24 medical schools that currently provide specialist medical education.¹ The rapid growth of new medical schools in the future presents a challenge for ensuring the quality of medical graduates.

Beyond admission or selection processes to enter medical schools and the curriculum design, medical faculties play a crucial role in shaping and educating students throughout the undergraduate medical education.³ Undergraduate medical education in Indonesia consists of two phases: a preclinical phase lasting 7–8 semesters, and a clinical phase lasting 3–4 semesters. The clinical phase referred to in this study corresponds to the clinical phase of undergraduate medical education. Students who complete the preclinical phase are awarded the Bachelor of Medicine degree. They receive preparatory training for the clinical phase and then take the Hippocratic Oath. Students are then divided into small groups, each consisting of five students, who undertake clerkships according to a predetermined schedule. The number of clinical departments involved in the clerkships in medical schools varies, around 14–17, which may be completed at the teaching hospital, affiliated network hospitals, other educational facilities, or a combination of these settings, over a specified period, situated in either rural or urban areas. After completing the clinical phase, students take a national examination as an exit exam, and upon passing the examination, they take the physician's Hippocratic Oath and are awarded the medical doctor degree.

The clinical phase, also referred to as the professional phase, clinical clerkship, medical clerkship, or simply clerkship, provides students with hands-on experience in real healthcare settings. This phase allows them to apply the theoretical knowledge and skills gained during the academic phase directly in patient care.⁴ It unfolds through interactions among students, patients, and healthcare professionals, and is influenced by both formal, standardized aspects of teaching and assessment, as well as informal, personal, and context-specific elements of the learning environment.⁵

Medical students' initial encounters with patient care are pivotal in their development into future physicians. If students are not adequately prepared for the clinical phase, their learning in real-world settings may be compromised, potentially impacting patient safety.⁶ Readiness for the clinical phase can be understood through the lens of sociocognitive learning theory, which defines preparedness as a mindset geared toward navigating uncertainty, being ready not only to manage challenges and setbacks but also to seize emerging opportunities.⁷

During the COVID-19 pandemic, many developing countries like Indonesia struggled to manage the widespread effects across various sectors, including education. The pandemic introduced new challenges and intensified existing issues in the clinical phase of undergraduate medical education. Disruptions included the closure of teaching hospitals and campuses, shortages of personal protective equipment, inadequate e-learning infrastructure, poor internet access, high mortality rates, and a significant decline in non-COVID-19 patient visits.⁸ As a result, medical students were largely restricted to remote learning with minimal or no direct patient interaction. Now, as the situation transitions from pandemic to endemic, clinical education is evolving with innovations to address future challenges.⁹

There is limited understanding of how clinical faculty perceive medical students' readiness, based on their competencies, to begin the clinical phase of their undergraduate medical education, comparing during and before the COVID-19 pandemic, particularly across public and private medical schools in Indonesia. This study, therefore, takes into account the differences between these two types of institutions, recognizing that high school graduates often favor public medical schools due to their established reputation, national entrance exams, extensive educational resources, and a wider range of specialized programs.³

Materials and methods

Study design

This study utilized a mixed-methods approach with an explanatory sequential design, which allowed researchers to expand on the quantitative findings with a more detailed qualitative analysis.¹⁰ The researcher sent official letters to 72 Deans of medical schools across Indonesia. These institutions were selected because each had graduated at least three cohorts of students before the COVID-19 pandemic. The letters included details about the study, ethical approval, participant recruitment, and a link to the online survey. The email and letter also contained the link to the informed consent form and the survey itself. As a result, the study employed a non-probabilistic convenience sampling with a self-selection approach.¹¹ The study was conducted between July and December 2021.

The quantitative stage

• 1.

  Study subjects

The population of this study was clinical faculty members from public and private medical schools in Indonesia with a minimum of three years of experience in supervising clinical students, starting from 2018. With extensive prior experience in supervising and assessing students across multiple cohorts, they can make informed judgments regarding changes in student competencies over time, and they might give a more objective assessment of clinical students' competencies than students' self-assessment. This assumption followed a report from the previous study that the preparedness for clerkship survey achieved a high validity, reliability, and inter-rater reliability among clinical faculty members.¹² The sample size for the survey was determined using a cross-sectional sample size formula for a continuous outcome (readiness for the clinical phase of the study),¹³ with α = 0.05, σ² = 0.21.¹⁴ This calculation yielded a minimum requirement of 40 clinical faculty members, referred to as participants throughout the study.

• 2.

  Instrument

This study utilized the 39-item Student Readiness for Clerkship Survey (SRCS), developed by Peterson et al. (12). The original SRCS demonstrated near-perfect correlations between item score averages within faculties (r = 0.99) and students (r = 0.98), yielding a high reliability (0.88–0.97).¹⁴ The original SRCS was translated from English into Indonesian, then back-translated to verify consistency of meaning and ensure content validity.¹⁵ A professional translator carried out the translations, and the first author reviewed and refined them in 2021, which yielded a significant moderate to very strong Pearson correlation, ranging from 0.652 to 0.949. Additionally, the reliability test yielded a Cronbach's alpha of 0.987. The survey instrument measured students' competency in nine areas: history taking, physical examination, proposing differential diagnoses, communication, empathy, patient management, awareness of the limit of competence, inter-professional work ability, and self-care. Each item had five levels of scales: 1 = an unacceptable level of competence, 2 = a marginal level of competence, 3 = a satisfactory level of competence, 4 = a high level of competence, and 5 = an extremely high level of competence.¹²

• 3.

  Data collection and analysis

Participants evaluated the competencies of students undertaking their first clerkship in the participants' respective departments during the COVID-19 pandemic, and compared them with pre-pandemic cohorts, based on their professional perception, through their long-term experience supervising and examining multiple student cohorts. In the quantitative study, the Shapiro–Wilk test showed a non-normal data distribution; therefore, the data were analyzed using the Mann–Whitney U and the Kruskal-Wallis test.¹⁶ All statistical analyses were performed using the IBM SPSS version 24.0 for Windows.

The qualitative stage

Following the data analysis of the survey, participants had the option to join the focus group discussions (FGDs) by selecting a suitable date and time from the list. The FGDs were chosen for gathering participants who were primarily homogeneous in terms of relevant expertise and experience, allowing them to share in-depth insights on a specific topic.¹⁷ Five FGD sessions were conducted, with each session involving at least five participants and lasting around 60–75 min. FGDs were conducted online using video conference platforms due to COVID-19, moderated by the investigator, and recorded on the platform for further analysis. Data collection was concluded when theoretical saturation was reached, indicated by the absence of new themes or insights in successive FGDs, redundancy of information, and stability of the coding framework.^18,19

At the end of the discussion, the moderator applied member checking or respondent validation, the process of returning to study participants to confirm whether the findings accurately reflect their perspectives and experiences.²⁰ The FGDs were guided by the concepts of the first clerkship experience,^7,21 which then developed to explore further the views on the traits of clinical students during the pandemic, characteristics of medical students considered ready for the clinical phase, key competencies for clinical students, and factors influencing preparedness for the clinical phase.

The collected qualitative data were transcribed word-for-word and examined through thematic analysis, employing both inductive and deductive approaches using the coding and thematic analysis guidelines. Initially, authors – who also served as FGD moderators – independently analyzed two transcripts to identify preliminary core themes and subthemes. This initial analysis and discussion informed the subsequent examination of all remaining transcripts.²²

Results

Quantitative study

Forty-eight participants from eight medical schools, three public medical schools, and five private medical schools participated in the study. Of these, 19 were from public medical schools and 29 from private medical schools. As the study aimed to compare students' preparedness to begin the clinical phase at public and private medical schools in Indonesia, the analyses were also categorized based on the type of medical school (public or private).

Table 1 indicates the average age of participants from public medical schools was 47.05 years (SD 7.39), ranging from 36 to 64 years. The average age of participants from private medical schools was 50.17 years (SD 10.62), with ages ranging from 30 to 69 years (Table 1). A significant gender difference was observed between the participants (p = 0.019). In the public medical school group, female participants gave a higher rating on C14 (Demonstrate a clear understanding of anatomy in the context of physical exams and interventions) compared to males (p = 0.044). Whereas in the private medical school group, male participants gave a higher rating on C19 (Explain the short-, intermediate-, and long-term management plans that were developed for the patients under your care) than females (p = 0.044).

Table 1.

Characteristics of the main study clinical faculty members by type of medical school.

Characteristics	Public		Private
	Freq	%	Freq	%
Gender^a
Male	5	26.3	18	62.1
Female	14	73.7	11	37.9
Total	19	100.0	29	100.0
Area of specialization
Internal medicine, pulmonology, cardiology	2	10.5	5	17.2
Pediatrics	2	10.5	1	3.4
Otolaryngology	1	5.3	3	10.3
Ophthalmology	2	10.5	1	3.4
Surgery	1	5.3	5	17.2
Anesthesiology	1	5.3	1	3.4
Primary care	5	26.3	4	13.8
Neurology	0	0	2	6.9
Dermatology venereology	0	0	2	6.9
Obstetrics gynecology	1	5.3	2	6.9
Psychiatry	1	5.3	1	3.4
Radiology	1	5.3	1	3.4
Forensic	1	5.3	0	0
Medical rehabilitation	0	0	1	3.4
Clinical pathology	1	5.3	0	0
Total	19	100.0	29	100.0

a

Mann–Whitney U test p-value = 0.019.

Among participants, the largest proportion at public medical schools was primary care, whereas the highest percentage at private medical schools was surgery. As depicted in Fig. 1, participants from public medical schools gave higher ratings (blue bars) on most clinical students' competency than those from private medical schools (orange bars). The Mann–Whitney U test revealed statistically significant differences in ratings in 35 competencies. However, there were no significant differences of ratings in four competencies: C5 (Document the history and physical exam findings), C7 (Communicate respectfully and effectively with your patients and their families), C23 (Describe the psychosocial aspects of your patient's problems), and C37 (Demonstrate self-care (e.g., adequate rest, emotionally stable, takes time to eat)).

Figure 1.

Mean score of each item in the survey by type of medical school.

In this study, there were 15 areas of specialization, which were categorized into three groups: surgery, non-surgery, and primary care. The surgery group included surgery, obstetrics and gynecology, ophthalmology, and otolaryngology specializations. The primary care group included only the primary care specialization. The non-surgery group included the rest of the specializations. The number of clinical faculty members in each specialization area group is shown in Fig. 2.

Figure 2.

Number of clinical faculty members in each group of the specialization area.

Table 2 shows the results of ratings by groups of specialization. The Kruskal-Wallis test showed significant differences in ratings in seven competencies in public medical schools, but there was no difference in ratings in private medical schools. The seven competencies were C1 (Take a full medical history), C2 (Take an appropriate history of the current problem), C3 (Formulate a problem list), C7 (Communicate respectfully and effectively with your patients and their families), C13 (Explain the underlying pathology and pathophysiology of your patients' key problems), C24 (Demonstrate compassion for and interest in your patients), and C29 (Pursue opportunities to learn the required technical procedures).

Table 2.

Mean score rating of competency by group of specialization area in the public medical schools.

Item	Mean score rating			p-value
	Primary care	Non-surgery	Surgery
C1	4.00	3.56	2.60	0.040
C2	4.00	3.56	2.60	0.040
C3	3.60	3.33	2.40	0.033
C7	4.00	3.56	3.00	0.033
C13	3.80	3.22	2.60	0.047
C24	3.80	3.89	2.80	0.003
C29	4.20	3.44	2.80	0.025

Qualitative study

Characteristics of FGD participants

Thirty-one participants took part in the FGD discussions on the four topics; eight of them were from public medical schools, while the remaining 23 were from private medical schools. Eleven participants were males, and twenty were females. The themes and their corresponding supporting statements are outlined in Table 3 below.

Table 3.

Statements of all participants.

Perspective themes	Supporting statements
Characteristics of clinical students during the COVID-19 pandemic
1. Lack of clinical experience	“During the pandemic, the students have limited clinical skills. Medical students need hands-on experience, especially in physical diagnosis. However, they are good at making social media. It is more innovative and diverse” (B.1.2.1).
2. Lack of professionalism	“I see that the most prominent difference between before and during the pandemic is students' attitude, especially in terms of respect toward lecturers who are talking during Zoom. It is also seen in terms of students' seriousness.” (B.2.1.21).
Characteristics of medical students who are ready for the clinical phase of study
1. Self-capacity	“There are three parameters: knowledge, self-capacity, and readiness to face the technical or system in the clinical phase. Sometimes, we as lecturers focus more on knowledge preparation and technical readiness. However, the student's inner readiness is still lacking.” (A.1.1.1 l)
2. Adaptive	“Students must have high readiness or adaptability to all conditions that will occur. Meanwhile, for non-academic criteria, students must not have interpersonal and interprofessional obstacles.” (B.3.1.2)
The most important competencies for clinical students
1. Competencies for daily practice	“The most important competencies are to determine the examination needed to establish a diagnosis, be able to interact between doctors and patients and their families, and how to manage the disease.” (B.1.1.1)
2. Empathy and professionalism	“Students should be skilled, independent, and empathetic.” (A.2.1.1)
Factors contributing to preparedness to begin the clinical phase of the study
1. Student admission	“If the input is good, of course, the output will also be good. The results can be seen in each clinical phase.” (A.2.1.1).
2. Character development	“We have prepared their knowledge in the preclinical stage. However, to build personal capacity, it is better if the pre-clinical stage uses a learning method that enables students to develop good characteristics.” (A.4.1.2). Note:
3. Personal characteristics	“Personal characteristics are somewhat concerning, as indicated by the MMPI test. Stress management should also be seen and followed up on once or twice a month. The next is interpersonal skills. Several times, we provide consultation for students whose MMPI tests showed that they did not care about other people.” (A.4.1.2). Note: MMPI = Minnesota Multiphasic Personality Inventory.
4. Evaluations	“What needs to be done is the self-evaluation of clinical faculty on how to guide and supervise the students to be qualified doctors. The clinical system should be clear, and the clinical phase in each department should be evaluated.” (B.1.2.3)
5. Family support	“The most contributing factors to the clinical phase are parents and family support. Parents and family should not add any burden to the students.” (B.1.1.1)
6. Adequate facilities and cases	“First, the clinical phase needs adequate facilities, and the medical school should have a good support system, including e-learning. Second, students should be placed in the right hospital, where they can learn many cases by their competency level.” (B.1.1.2)

Discussion

Clinical learning in most medical schools in Indonesia typically consists of a phase in each department, conducted either in a hospital, public health center, or other health-related institutions, over a specified period, situated in either rural or urban areas. The clinical phase of the study lasts for three to four semesters. In Indonesia, clinical faculty members often hold the perception that students are not adequately prepared for clinical learning. The transition from the academic to the clinical phase is unavoidable, and students need to be well-prepared. Preparedness to begin the clinical phase may have positive impacts on clinical learning and patient safety.²³

Despite the excitement of becoming clinical students, evidence indicates that the transition may become a source of high stress and anxiety when students experience difficulty in shifting their knowledge structure from theory to practice and difficulty in performing professional activities.²⁴ A review of 52 studies indicated that burnout affects 40–80% of medical students, especially during clinical years, and resilience consistently emerged as a stable buffer against stress.²⁵ Research conducted at a private medical school in Indonesia reported that most medical students, especially females, felt anxiety during their transition from the academic to the clinical phase due to increased workload, which affected their poor learning responses.²⁶

Prior research on the readiness to begin the clinical phase had been conducted in four medical schools in Canada. The research utilized self-assessment surveys completed by students after they had finished a mandatory rural family medicine phase. In addition, the clinical faculty members also completed the same surveys. The results showed that students could identify their relative strengths and weaknesses, and their judgment aligned very well with those of clinical faculty raters, with coefficient correlations of 0.88–0.91.²⁷

The pandemic disrupted the clinical phase, revealing student anxiety over virtual clerkship readiness and gaps in skill acquisition via online formats. Faculty perspectives during emergency transitions stressed the limits of virtual interactions and the importance of restoring in-person training. Efforts such as student-led professionalism development in clerkships have emerged, embedding reflection on the hidden curriculum to build readiness and faculty alignment.²⁸

In our study, all clinical faculty members had more than five years of experience, and some were nearing retirement; thus, they have extensive experience in examining and assessing students' clinical competencies. Overall, clinical faculty from public medical schools rated each medical student's competency higher than their counterparts from private medical schools. During the FGD, it was revealed that the public medical schools involved in the study already applied e-learning systems both for the preclinical and clinical stages of studying, which was recognized as a potential contributing factor. In contrast, most private medical schools in the study were in the stage of developing an e-learning system. During the COVID-19 pandemic, most teaching hospitals restricted only the green area, a safe zone, for hands-on clinical teaching, whereas some allowed their students to have clinical experience in the yellow areas of the hospital. Moreover, during the COVID-19 pandemic, the majority of hospital beds, especially at the COVID-19 referral hospital, were occupied by COVID-19 patients, thus decreasing the number of non-COVID-19 patients. Therefore, some medical schools that participated in our study added some weeks at the end of the two-year clinical stage to provide hands-on clinical experience and more varied cases for future primary care physicians. Some clinical faculty members provided students with reference books for self-directed learning, followed by assigning educational videos for them to watch. Eventually, students were instructed to record themselves performing history taking and physical examinations with friends, parents, or siblings at home. This approach was implemented during the pandemic, recognizing the importance of clinical reasoning and strong history-taking and physical examination skills for accurate diagnosis.²⁹

Across specialties and institutions, clinical faculty involved in the FGD consistently highlight professionalism and willingness to learn as primary indicators of preparedness. Our results align with an earlier study that examined clinical supervisor views on essential student attributes for effective clinical learning in medicine, nursing, and pharmacy. This study indicated that good communication and interpersonal skills, adaptability, and personal attributes like resilience are particularly valued.²⁷

Although many faculty members expressed concerns about students' shortcomings during the clinical phase, positive role modeling was identified as the most effective method for teaching professionalism to medical students. Our FGD found the importance of self-evaluation for clinical faculty. In the absence of a gold standard for measuring clinical teaching quality, educators should seek feedback from multiple sources to assess their performance and identify areas for improvement. Negative influences, including negative role modeling, confusion, and stress, also influenced medical students' preparedness to begin the clinical rotation.²⁴

Our study found that clinical faculty from the surgery specialization area in public medical schools had higher expectations, which were reflected in lower scores for some medical students' performances during clinical rotations, compared to clinical faculty from non-surgical and primary care specializations. To be able to participate in the surgery, including in surgical emergencies, students had to be prepared by mastering the basic surgery skills, including scrubbing, gowning, principles of sterility, stapling, suturing, and tissue handling. Therefore, the surgeon was expected to be a positive role model by asking questions, describing the anatomy, and allowing medical students to participate in the surgery.⁷ However, the pandemic intensified challenges in surgical education by limiting clinical exposure and reducing educator availability.

Undergraduate medical education is a long and demanding journey. In addition to intellectual abilities, self-efficacy plays a significant role in influencing academic performance, psychological resilience, and motivation throughout medical training.²⁵ Numerous medical schools globally, including in Indonesia, incorporate the MMPI into their admissions procedures.³ Prior studies also reported the importance of mental readiness to begin the clinical phase of studying, which is in line with our FGD findings. Those who have psychological readiness are expected to be able to perform better under stress. Moreover, undergraduate medical students need to adapt to student-doctor life and balance work and life; therefore, supporting their transition and fostering a patient-centered approach is key to their professional development.⁵

This study showed several strengths. This study was the first to utilize the validated Indonesian version of the 39-item Student Readiness for Clerkship Survey to assess medical students' competencies in preparing for the clinical phase of their education during COVID-19 and before, based on the clinical faculty perspective from various specializations, in public and private medical schools in Indonesia. The findings of this study offer considerations for enhancing 1) structured faculty development programs focused on clinical supervision and assessment; 2) early diagnostic assessments at the start of the first clerkship to identify gaps in student preparedness; 3) strengthened institutional support through standardized mentoring and supervision frameworks; and 4) the integration of blended learning approaches to support clinical education during periods of disruption.

Study limitation

This study had several limitations, including a small sample size, its single-center design, unequal group sizes between faculty from public and private universities, and the overall sample composition. This study acknowledged the potential for institutional self-selection bias, whereby faculties that perceived their undergraduate medical education and student preparation more positively may have been more inclined to participate, while those facing institutional challenges or perceived deficiencies may have chosen not to participate. These limitations may have influenced the representativeness of the participating faculties and the generalizability of our findings to other undergraduate medical education settings.

Moreover, the qualitative and quantitative results are derived from participants' professional perceptions. We acknowledge that perception-based data may involve potential biases, including those related to participants' affiliation with and evaluation of their own institutions. We also acknowledge that the potential for recall bias inherent in these retrospective assessments may limit the ability to draw definitive conclusions about true temporal changes in student preparation. We believe that acknowledging this limitation improves the transparency and interpretability of the study. Future research could use mixed methods studies incorporating objective performance measures and longitudinal designs to examine changes in student preparedness across cohorts.

Conclusions

This study reports perceived differences in medical students' preparedness for the clinical phase between public and private medical schools in Indonesia, based on clinical faculty perceptions. Several factors, including the education system, faculty experience, student characteristics, and institutional support, are suggested as potential contributors to readiness for the clinical phase. These insights may inform future efforts to strengthen clinical education systems and enhance their adaptability to challenges such as the COVID-19 pandemic.

Credit authorship contribution statement

Wienta Diarsvitri

• 1.

  Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

• 2.

  Drafting the work or revising it critically for important intellectual content; AND

• 3.

  Final approval of the version to be published; AND

• 4.

  Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Jo Hart

• 1.

  Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

• 2.

  Drafting the work or revising it critically for important intellectual content; AND

• 3.

  Final approval of the version to be published; AND

• 4.

  Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethical statement

All procedures followed the ethical standards of the ethics committee of human experimentation (institutional and national), and with the Helsinki Declaration of 1964 and its later amendments. This study did not involve any identifying data that could breach privacy. Approval for this study was sought from the Human Research Ethics Committee at the Faculty of Medicine, Hang Tuah University, with a certificate number I/020/UHT.KEPK.03/III/2021 in March 2021 and from the School Student Project Ethics Committee (S-SPEC) of Keele University under Application Ref 21–24 in July 2021.

Funding

This study did not receive any external funding. The publication of this study was supported by the University of Hang Tuah, Surabaya, Indonesia.

Acknowledgments

The authors acknowledge the University of Hang Tuah for supporting the publication of this study.