The state of and needed reforms in medical education was the theme of the recent symposium conducted by the Association of Philippine Medical Colleges (APMC) and National Academy of Science and Technology in celebration of the former’s golden anniversary.
Six lectures were delivered during the symposium. In the first, “Health Education and Health Care System Reform,” Dr. Antonio Dans, professor at the UPCM-PGH Section of Adult Medicine, stressed the need to focus on teaching primary care in the academe. He proposed the training of community health workers, midwives, nurses, primary care physicians, and eventually, the family physicians, hoping that the doctors would be the one at the primary care facilities attending to the patients. He emphasized the need for the recruitment, retraining, retention, regulation, and reassessment of primary care physicians, including the retraining of some specialists who might be interested to go into primary care. He stated that going into primary care is not a temporary task. He said that countries who have shown good health outcomes have primary care physicians serving on a long-term basis.
In the second lecture, Technical Committee on Medical Education Chair Dean Alfaretta Luisa T. Reyes discussed the Standards, Policies and Guidelines (SPG) on medical education stipulated in the Commission on Higher Education Memorandum Order (CMO) 18, series of 2016. These provisions have been disseminated to all medical schools. Standards that are evaluated for recognition and accreditation include the vision of the school organization and administration, curriculum and instruction, issues about the faculty, students, including admission, facilities, laboratory and clinics, library resources, base hospital, community outreach program, and physical plan.
She also related the program outcomes that focus on demonstration of clinical competence; communicating effectively; leading and managing the health care team; engaging in research activities; collaborating with an inter-professional team; utilizing system-based approach to health care; engaging in continuing personal and professional development; adhering to ethical, professional, and legal standards; demonstrating nationalism, internationalism, and dedication to service; and practicing the principle of social accountability.
In the third lecture, Dr. Ramon Arcadio, Vice President, Philippine Accrediting Association of Schools, Colleges, and Universities (PAASCU) presented the sources, aims, process, and benefits of accreditation. Both Dr. Reyes and Dr. Arcadio utilized the World Federation of Medical Education (WFME) criteria for evaluation of training programs in medicine. Dr. Arcadio identified the source of accreditation standards and these are related to the CHED – that is the SPG of the CHED, the PAASCU way of accreditation, the APMC, and the best practices of the medical schools. They also looked at the regional process of accreditation, specifically in medical education, and the global standard coming from the WFME.
Dr. Arcadio’s lecture elicited the most number of questions, such as “why do we have to wait for new medical schools to have three batches of graduates and who must have taken the examination before they are accredited?” Dr. Arcadio clarified that if the school is in the developmental stage, the accreditation process should be earlier so that it can be addressed. He stated that even medical schools can already apply for accreditation. But it is not for accreditation alone but for consultancy visit so that whatever problems they may have can be brought up and the solutions can be discussed. Assistance can be given by the CHED itself and APMC who are jointly monitoring the medical schools, with the APMC helping the academically-challenged medical schools.
Dr. Miguel Noche, Chair of Professional Regulatory Board of Medicine, Professional Regulation Commission (PRBOM, PRC), lectured on the medical licensure exam discussed the requirements, qualification, process of application, and the examination process itself, emphasizing the table of specification being followed. The main question raised here was the issue on repeaters and what can be done to track and help them. It was asked if a limit can be set on the number of times the repeaters can take the examination. These are things that will be studied and possibly, see how they can be integrated into the new Medical Act. Dr. Noche added that the medical licensure examinations being done until now are still based in the Medical Act of 1999. There were amendments but a new one is needed. He urged doctors to work together to make sure a new one is enacted. He recommended the holding of career orientation for students entering the Doctor of Medicine program, review of the admission criteria of medical schools for students to determine whether the students are really fit to take medicine, monitor the performance of the students during the undergraduate years, for example, conduct a comprehensive written examination at the middle part of the medical course, and utilize the results of the evaluation in guiding the students to the need for few years until graduation, involve actively the medical schools in the review and development of new table of specifications, continuous development of the faculty and becoming effective educators, from entry of students until graduation.
Other recommendations were to provide adequate facilities in support of the outcome-based education; intensify monitoring and evaluation of the implementation of the new medical curriculum, and shift to outcome-based questions.
Dr. Melflor Atienza, professor at the National Teacher Training Center for the Health Professions (NTTCHP), discussed the eclectic nature of the Philippine medical education system. She shared the results of a survey on the kind of curriculum that medical schools have here in the Philippines. Ten years ago, mostly it was discipline-based and hybrid when there were only 36 medical schools. Now, in 46 medical schools, they got 36 respondents and 46 responses because there were some who gave two or three answers. She also talked about the different principles in medical education, the strategies and the implications.
Former NTTCHP Dean and Professor Erlyn Sana discussed the Philippine quality framework which is important especially now that the Philippines is into the ASEAN Integration. She repeated the 10 learning outcomes and shared the projects that they have done. She related the activities and results to the 10 learning outcomes and compared the basic medical education learning outcomes and the Accreditation Council for Graduate Medical Education (ACGME). The competencies being used by the US states are being used not only at the specialty but also at the basic medical education level. She also compared it with the continuing professional development of WFME, saying that all these things are comparable.
She said that there is a need for a new breed of physicians who are clinically competent, self-directed and regulated learners, team players, socially accountable, leaders, managers, and advocates.
The proceedings of the symposium will be used as basis for the formulation of general guidelines on the implementation of strategies for change and constructive reforms in medical education. Based on a synthesis presented by Dr. Zorayda Leopando
