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"Latar Belakang : Melanoma malignum (MM) merupakan tumor ganas yang berasaldari proliferasi sel melanosit dan dapat ditemukan pada kulit, mukosa dan okular. Angka mortalitas MM cukup tinggi, terutama pada stadium lanjut yang ditandai dengan metastasis. Metastasis MM dipengaruhi berbagai faktor risiko yang dapat berbeda pada MM kulit, mukosa dan okular, salah satunya yaitu proses imunologi tumor yang dapat dinilai dari Tumor Infiltrating Lymphocyte (TIL). Komponen TIL yang berperan dalam proses penghindaran sistem imun pada MM adalah sel T regulator dengan penanda yang paling spesifik sampai saat ini adalah Foxp3. Hubungan Foxp3 dengan stadium MM masih kontroversial dan sampai saat ini belum ada penelitian mengenai hubungan Foxp3 pada TIL dengan stadium MM di Indonesia. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan karakteristik klinikopatologik dan ekspresi Foxp3 pada TIL dengan stadium MM. Metode: Penelitian analitik pada sediaan MM di Departemen Patologi Anatomik FKUI/RSCM selama periode Januari 2010 hingga Desember 2021. Pengambilan sampel penelitian dilakukan secara total sampling dari kasus yang memenuhi kriteria inklusi sesuai perhitungan besar sampel untuk masing-masing kelompok. Pemeriksaan imunohistokimia menggunakan antibodi primer monoklonal Foxp3. Data imunoekspresi dianalisis untuk mengetahui hubungannya dengan stadium MM. Hasil: Didapatkan 54 kasus MM, 19 kasus diantaranya merupakan MM kulit, 29 kasus MM okular, dan 6 kasus MM mukosa. Mayoritas kasus (63%) merupakan stadium lanjut.Tebal tumor dan mitosis berhubungan dengan stadium klinis MM kulit dan keseluruhan.Jenis kelamin perempuan, tebal tumor >2 mm, mitosis >16/10 LPB, adanya invasi limfovaskular dan invasi perineural umumnya mempunyai ekspresi Foxp3 yang rendah.Pada MM kulit dan MM keseluruhan, ekspresi Foxp3 yang rendah ditemukan padastadium klinis lanjut meskipun tidak didapatkan hubungan yang signifikan.Kesimpulan: Tebal tumor dan mitosis berhubungan dengan stadium klinis MM kulit dan keseluruhan. Karakteristik klinikopatologik tidak berhubungan signifikan dengan ekspresi Foxp3

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Background: Malignant melanoma (MM) is a malignant tumor originating from

proliferation of melanocyte cells and can be found in skin, mucosa and ocular. The

mortality rate for malignant melanoma is quite high, especially at advanced stage

characterized by metastases. Various risk factors can predispose MM into metastases,

which can be different in cutaneous, mucosal and ocular MM, one of which is the

immunological process of the tumor which can be assessed from Tumor Infiltrating

Lymphocyte (TIL). TIL components that play a role in the process of avoiding the immune

system in malignant melanoma are regulatory T cells, whose the most specific marker so

far is Foxp3. The association of Foxp3 with clinical stage of malignant melanoma is still

controversial and until now there has been no research on the association of Foxp3 in

TIL with clinical stage of MM in Indonesia.

Aims: This study aims to determine the association between clinicopathological

characteristics and Foxp3 expression in TIL with MM clinical stage.

Methods: Analytic study on malignant melanoma diagnosed at Anatomical Pathology

Department FKUI/RSCM during January 2010 until December 2021. Sampling was

carried out by total sampling from cases that met the inclusion criteria according to the

calculation of the sample size for each group. Immunohistochemical examination using

Foxp3 monoclonal primary antibody. Immunoexpression data were analyzed to

determine its relationship with clinical stage of malignant melanoma.

Result: There were 54 cases of MM: 19 cases were skin MM, 29 cases of ocular MM, and

6 cases of mucosal MM. Majority of cases (63%) were in advanced stages. Tumor

thickness and mitosis associated with clinical stage of cutaneous and overall MM. Female

gender, tumor thickness >2 mm, mitoses >16/10 HPF, presence of lymphovascular

invasion and perineural invasion generally had low Foxp3 expression. In cutaneous MM

and overall MM, low Foxp3 expression was found at advanced clinical stage although

no significant association was found.

Conclusion: Tumor thickness and mitosis associated with clinical stage of cutaneous and

overall MM. Clinicopathological characteristic was not statistically significant with

Foxp3 expression. Low Foxp3 expression was associated with advanced clinical stage

although no statistically significant association was found."

"Latar Belakang: Kompetensi "mengambil keputusan terhadap dilema etika yang terjadi pada pelayanan kesehatan individu, keluarga dan masyarakat" tercantum dalam SKDI 2005 sehingga harus ada dalam kurikulum dan dilaksanakan di dalam modul. Penerapan proses pengambilan keputusan etis (PKE) berkaitan dengan manajemen pasien, karena itu pembelajaran pada tahap klinis pendidikan kedokteran menjadi keharusan. Penelitian ini dilakukan untuk mengetahui proses pembelajaran pengambilan keputusan etis di tahap klinispendidikan kedokteran di FKUI. Metode: Penelitian merupakan penelitian deskriptif kualitatif dengan mengidentifikasi komponen Buku Kurikulum, Buku Rancangan Pengajaran modul praktik klinik, dan dokumen lain; wawancara mendalam pengelola program studi, pengelola modul, staf pengajar; serta Focus Group Discussion (FGD) pada mahasiswa. Hasil: Tidak ada modul praktik klinik yang lengkap mencantumkan PKE dalam dokumen. Pengelola modul kurang memahami kompetensi PKE SKDI 2006. Sebagai klinisi, staf pengajar mampu mengidentifikasi dan mengambil keputusan penyelesaian dilema etika. Mahasiswa memahami PKE dan menemukan kasus berdilema etika dalam proses pembelajaran tahap klinik. Mahasiswa mendiskusikan dilema etika yang ditemui dengan residen dan/atau dokter penanggungjawab kasus. Mahasiswa memiliki prior knowledge yang didapat pada tahap preklinik. Kesimpulan: Proses pembelajaran pengambilan keputusan etis di tahap klinis merupakan hidden curriculum.Perlu dilakukan peningkatan kapasitas staf pengajar di bidang teori etika kedokteran dan penyusunan modul agar PKE menjadi komponen tertulis dalam kurikulum.

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Background: Ethical Reasoning is one of competency component stated in the ?2006 Indonesian Medical Doctor Competencies Standard? therefor it has to be taught in medical faculties. The competency should be stated in all documents related to the curriculum. The learning of ethical reasoning should be done in clinical years since it is related to patient's managements. This research was done to evaluate the ethical reasoning learning process in the clinical stage medical education in Faculty of Medicine University of Indonesia.

Method: This is a descriptive qualitative research which identifies the component of curriculum inside the curriculum documents; indepth interview to the module developer, module organizer, and teachers; and focus group discussion with clinical year medical students.

Result: Ethical Reasoning Competency was not written as the aim of any module, as seen in the Instructional Design of all documents. The module developer did not recognize this competency despite their daily practice of ethical reasoning. The students learnt ethical reasoning in clinical stage by observing the medical staff during their interaction with patient with ethical dilemma. The student were able to identify the cases based on their prior knowledge from previous stage.

Conclusion: Ethical reasoning learning process in clinical stage is part of hidden curriculum.Capacity building for faculty members in medical ethics theory and module development for the faculty member are needed to make the ethical reasoning process as a part of the curriculum."