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All Journal Eureka Herba Indonesia Enigma in Education
Lestini Wulansari
Department of Obstetrics and Gynecology, Phlox Institute, Palembang, Indonesia
Humanities Education Languange, Linguistic, Communication & Media Mathematics Medicine & Pharmacology Other

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The Power Imbalance Personified: A Mixed-Methods Analysis of Senior-to-Junior Bullying in Indonesia's Medical Residency Programs Alex Putra Pratama; Henry Clifford; Ahmad Erza; Ericca Dominique Perez; Fakhrul Setiobudi; Dedi Affandi; Lestini Wulansari; Fachrudin Sani; Vita Amanda; Zahra Amir
Enigma in Education Vol. 3 No. 1 (2025): Enigma in Education
Publisher : Enigma Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61996/edu.v3i1.92

Abstract

Bullying within medical residency is a pervasive global issue with severe consequences for residents' mental health and patient safety. In Indonesia, where hierarchical structures in medicine are deeply entrenched, senior-to-junior bullying is a significant yet under-investigated problem. This study aimed to analyse the prevalence, forms, and lived experiences of bullying perpetrated by senior residents against their junior counterparts in Indonesian medical residency programs. A sequential explanatory mixed-methods design was employed. In the quantitative phase, an anonymous online survey was distributed to 584 junior medical residents across five major teaching hospitals in Indonesia. The survey included the validated Negative Acts Questionnaire-Revised (NAQ-R) and questions on demographics and specialty. In the qualitative phase, 25 junior residents who reported high levels of bullying were purposively selected for in-depth, semi-structured interviews to explore their experiences. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were subjected to reflexive thematic analysis. Quantitatively, 81.3% (n=475) of junior residents reported experiencing at least one bullying behaviour weekly. The most common forms were work-related, such as excessive workloads and meaningless tasks, and personal humiliation. Year of residency was significantly associated with bullying exposure. Qualitatively, four major themes emerged: (1) ‘The Hierarchy as an Unassailable Mandate for Abuse’; (2) ‘The Pedagogy of Fear: Bullying as a Misguided Educational Tool’; (3) ‘Silent Suffering and the Armour of Complicity’; and (4) ‘The Perpetuating Cycle: Victims on a Trajectory to Becoming Perpetrators’. The qualitative findings revealed that bullying was often rationalised by seniors as a necessary part of medical training. In conclusion, senior-to-junior bullying is alarmingly prevalent and deeply embedded in the culture of Indonesian medical residency programs. It is personified through a profound power imbalance, rationalised as an educational necessity, and sustained by a culture of silence. Urgent, multi-level interventions focusing on systemic change, faculty training, and robust confidential reporting systems are imperative to dismantle this destructive cycle.
Apoptotic Induction and Cell-Cycle Arrest in Triple-Negative Breast Cancer Cells by Annona muricata Acetogenin Fractions: An In Silico and In Vitro Study Lestini Wulansari; Leonardo Simanjuntak; Vania Delma
Eureka Herba Indonesia Vol. 6 No. 2 (2025): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i2.142

Abstract

Triple-negative breast cancer (TNBC) is an aggressive molecular subtype that lacks oestrogen, progesterone and HER2 receptors and retains cytotoxic chemotherapy as its principal systemic option, creating a rationale for adjunctive phytotherapy. Annona muricata L. (Annonaceae), known in Indonesia as sirsak, contains Annonaceous acetogenins with well-documented mitochondrial and apoptotic activity. This study integrated molecular docking with in vitro pharmacology to characterise the anticancer effects of an HPLC-standardised acetogenin-enriched fraction (AEF) from Indonesian A. muricata leaves on TNBC cells. Annonacin, bullatacin, squamocin and muricatacin were docked against EGFR, Bcl-2, CDK2, caspase-3 and topoisomerase II-α (AutoDock Vina); AEF was tested on MDA-MB-231 and MDA-MB-468 TNBC cells with MCF-10A non-tumorigenic controls (n = 6 independent biological replicates per arm). Outcomes included viability (MTT), apoptosis (Annexin-V/PI), cell-cycle distribution (propidium iodide), caspase-3/7 luminescence, Western blotting (Bcl-2, Bax, cleaved caspase-3, cyclin D1, p21) and mitochondrial ΔΨm/ROS. Bullatacin showed the strongest binding to Bcl-2 (ΔG = −9.6 kcal/mol) and caspase-3 (ΔG = −8.9 kcal/mol). AEF inhibited MDA-MB-231 viability with IC50 12.4 µg/mL (95% CI 10.8–14.1) and yielded a selectivity index of 4.20 over MCF-10A. Apoptotic cells increased 4.62-fold, the G1 fraction rose from 41.2% to 64.8% (p < 0.001), caspase-3/7 activity rose 3.81-fold and the Bcl-2/Bax ratio decreased by 61%. In conclusion, bullatacin-rich Annona muricata acetogenins selectively induce intrinsic apoptosis and G1 arrest in TNBC cells, supporting their further translational development as Indonesian phytotherapeutic leads for hormone-refractory breast cancer.
Co-Authors Ahmad Erza Alex Putra Pratama Dedi Affandi Ericca Dominique Perez Fachrudin Sani Fakhrul Setiobudi Henry Clifford Leonardo Simanjuntak Vania Delma Vita Amanda Zahra Amir