emerging trends in the training of filipino physicians reynaldo o. joson, md, mha, mhped, ms surg...
TRANSCRIPT
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Emerging Trends in the Training of Filipino Physicians
Reynaldo O. Joson, MD, MHA, MHPEd, MS SurgPostgraduate Course and 1st Alumni Homecoming
Zamboanga Medical School Foundation, Inc.
Carlos Dominguez Conference Hall
Zamboanga City
April 26, 2002
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Greetings and Thanks!
Invitation to be one of speakers
Invitation to revisit ZMSF
Opportunity to interact with graduates
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Greetings and Thanks!
Honor and privilege
Opportunity for deja vu
7 years – challenging, exciting, happy moments
Driving force to think and learn from my topic
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de javu1994 Preparation
Faculty Training
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de javu
First batch of faculty
First batch of students
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de javu
PBL
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deja vu
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Initial Programme
1. Emerging Trends in the Concepts of Health
2. Emerging Threats to the Filipino Health
3. Emerging Trends in the Training of Filipino Physicians
4. Emerging New Roles of Filipino Physicians
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Central Message
The emerging trends in the training of Filipino physicians in Philippine medical schools
in consideration at the very least of the
•emerging trends in the concepts of health,
•emerging threats to Filipino health, and
•emerging new roles of Filipino physicians.
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Preparation of TalkDid NOT communicate with other speakers!
Strictly speaking, whatever the speakers will say on the three topics, should have an influence on the training of Filipino physicians.
The only question left to answer –
is there an emerging trend in the training of Filipino physicians that considers the emerging trends in the concepts of health, emerging threats to Filipino health, and emerging new roles of Filipino physicians?
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Emerging Trends in the Training of Filipino Physicians
Reynaldo O. Joson, MD, MHA, MHPEd, MS SurgPostgraduate Course and 1st Alumni Homecoming
Zamboanga Medical School Foundation, Inc.
Carlos Dominguez Conference Hall
Zamboanga City
April 26, 2002
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Emerging Trends
Emerging Trends - something starting to be practiced in a certain community, whether global or local.
Emerging Trends in the Training of the Filipino Physicians - what is that something starting to be practiced in the training of Filipino Physicians.
Training in Medical Schools
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Emerging Trends in Medical Education in the Philippines
Reynaldo O. Joson, MD, MHA, MHPEd, MS SurgPostgraduate Course and 1st Alumni Homecoming
Zamboanga Medical School Foundation, Inc.
Carlos Dominguez Conference Hall
Zamboanga City
April 26, 2002
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Emerging Trends
Previous state
Emerging trends
Changes
Reasons
Status
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Emerging Trends in Medical Education in the Philippines
Traditional medical
curriculum
Emerging trends in medical
curriculum
Changes
Reasons
Status
How/Problems
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What governs type of medical curriculum?
1. The weighted objectives of the school administration in establishing and maintaining a medical school
Business objective
Community health development objective
Other objectives like excellence and social responsibility
2. The trend in the medical education, both global and national
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What governs type of medical curriculum?
30 medical schools in the Philippines
30 types of medical curriculum
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Medical Curricula in the Philippines
Evolving and still evolving!
Difficulty in identifying traditional curriculum and emerging trends!
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Medical Curricula in the Philippines
Traditional - predominant types of medical curriculum adopted and being adopted by most medical schools in the country in the past and even up to the present times.
Types of curriculum –
• Philosophy-orientation-objectives
• Content
• Teaching-learning methods
• Assessment methods
• Other elements of curriculum
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Medical Curricula in the Philippines
Emerging trends - what is/are different from the traditional curriculum that is/are starting to be practiced
-by at least two medical schools in the country and perceived to be as something better than the traditional ones
-during the past 10 years
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Medical Curricula in the Philippines
Emerging trends - what is/are different from the traditional curriculum
Types of curriculum –
• Philosophy-orientation-objectives
• Content
• Teaching-learning methods
• Assessment methods
• Other elements of curriculum
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Medical Curricula in the Philippines
Emerging trends - what is/are different from the traditional curriculum that is/are starting to be practiced
-by at least two medical schools in the country and perceived to be as something better than the traditional ones
-during the past 10 years
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Philosophy-orientation
Competency-based curriculum with lip service to community-orientation and holistic concept of health
Competency-based curriculum with more community-orientation; application of holistic concept of health with attention on psychosocial concerns
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Objectives Competency-based curriculum with lip service to attitude and skills
Competency-based curriculum with more attention towards attitude and skills
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Content Everything that are published including nice to know and all biases of faculty
Must know
Concept teaching
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Content Discipline or subject based
Organ-system integration
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Teaching-learning methods
Lecture-based learning
Problem-based learning
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Teaching-learning methods
Classroom teaching Clinical teaching
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Teaching-learning methods
Lip service to self-indirected learning
More of self-directed learning methods
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Teaching-learning methods
Print learning materials
Electronic learning materials
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Emerging Trends in Medical Education in the Philippines
Predominant Traditional Practice
Emerging Trends
Assessment methods
Less of practical exam
More of practical exam
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Emerging Trends in Medical Education in the Philippines
How many schools?
Which schools?
About 10/30
Let’s NOT talk about this!
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Emerging Trends in Medical Education in the Philippines
Driving forces for the changes or the emerging trends, aside from survival reason and keeping up with the trends?
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Emerging Trends in Medical Education in the Philippines
Driving forces for the changes or the emerging trends, aside from survival reason and keeping up with the trends?
1. Continuous drive to be more effective and efficient.
Applicable to changes and trends seen in content, teaching-learning methods, and assessment methods such as must-know and concept teaching; problem-based learning methods, and electronic learning materials.
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Emerging Trends in Medical Education in the Philippines
Driving forces for the changes or the emerging trends, aside from survival reason and keeping up with the trends?
2. Realization, even if late, of the true values that must be honestly brought out by the school and inculcated into the graduates.
Applicable to the changes and trends seen in philosophy-orientation-objectives.
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Emerging Trends in Medical Education in the Philippines
Driving forces for the changes or the emerging trends, aside from survival reason and keeping up with the trends?
2. Realization, even if late, of the true values that must be honestly brought out by the school and inculcated into the graduates.
Curriculum must be truly community-oriented and truly contributing towards health development of a target community. Curriculum must put holistic concept of health into practice and equal if NOT more emphasis on development of attitude and skills of physicians-to-be.
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Emerging Trends in Medical Education in the Philippines
How are the changes being implemented or what is the status of the trend in the Philippines and their associated problems, if any?
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Emerging Trends in Medical Education in the Philippines
How are the changes being implemented?
The answer right away is WITH DIFFICULTY but the changes definitely will occur in due time.
10/30 schools!
More will be forthcoming!
PBL!
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Emerging Trends in Medical Education in the Philippines
What are the problems in adopting the emerging trends in medical education in the Philippines?
2 problem areas:
1. School administration - put more weight on business objectives (viability of the school) over emerging trends.
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Emerging Trends in Medical Education in the Philippines
What are the problems in adopting the emerging trends in medical education in the Philippines?
2 problem areas:
2. Faculty, most of whom, do NOT have competency to teach and do NOT understand philosophy and principles of andragogy or teaching-learning and on top of this, most of whom put more weight on income generation (personal viability) over commitment and love of teaching.
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Emerging Trends in Medical Education in the Philippines
Traditional medical
curriculum
Emerging trends in medical
curriculum
Changes
Reasons
Status
How/Problems
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Vision for More Effective Medical Curriculum in the Philippines
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What brought about my Personal Vision/Aspirations for a More Effective Medical Curriculum in the Philippines?
Areas of Dissatisfaction
1. Present medical schools and their curricula have NO documented direct and significant impact on the health development in the country.
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What brought about my Personal Vision/Aspirations for a More Effective Medical Curriculum in the Philippines?
Areas of Dissatisfaction
2. A lot of things in the present medical curricula are not relevant.
3. Present medical curricula are NOT student-friendly.
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1. Present medical schools and their curricula have NO documented direct and significant impact on the health development in the country.
1a. Present medical schools are contented merely with graduates passing the board.
1b. Present medical schools consider that with production of board-certified physicians
and with the latter practicing in the country, they have already contributed to the health
development in the country.
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1. Present medical schools and their curricula have NO documented direct and significant impact on the health development in the country.
1c. Present medical schools consider incorporating a community immersion subject a way of
contributing to the health development in the country.
1d. Present medical schools do not work closely with the Department of Health which is the main agency in charge of health development in the country.
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My vision and aspiration:
Medical schools and their curricula should have documented direct
and significant impact on the health development in the
country.
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My vision and aspiration:
They should go beyond producing board-passers, community
immersion, and should work closely with DOH by incorporating the latter programs in their curricula.
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My vision and aspiration:
As part of requirements for graduation, students with the help of faculty
should solve (at least attempt) one health problem in their assigned community formally documented through an action research.
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Community Health ManagementAction Research Outputs
• Reducing the Incidence of Diarrheal Diseases in Barangay Bantonan, Camalig, Albay, Through a 4-year Community Participated Intervention Program Using a Primary Health Care Approach (With Pictorial)
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Community Health ManagementAction Research Outputs
• Reducing the Incidence Rate of Intestinal Parasitism Among Children 1 to 14 Years Old From 90% To 50 % by the year 2000 in Barangay Taladong, Camalig, Albay Using a Primary Health Care Approach
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Community Health ManagementAction Research Outputs
• Reducing the Prevalence Rate of Underweight (2nd and 3rd Degree) Children (0 -5 Years Old) in Barangay Bariw, Camalig, Albay Using a Primary Health Care Strategy
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My vision and aspiration:
As part of requirements for graduation, students with the help of faculty
should solve (at least attempt) one health problem in their assigned community formally documented through an action research.
With such strategy, at the end of the day, medical school can say that with its medical curriculum, it has contributed to the health development in the country.
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2. A lot of things in the present medical curricula are not relevant.
2a. Students are taught things that are uncommon and rare in the
country with the same emphasis as common medical conditions.
Example: Crohns’s disease, ulcerative colitis, rare hereditary and newborn diseases, etc.
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2. A lot of things in the present medical curricula are not relevant.
2b. Students are taught things which are NOT used in clinical practice.
Example: Students are taught traditional medical recording which is NOT done by certified physicians.
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2. A lot of things in the present medical curricula are not relevant.
2b. Students are taught things which are NOT used in clinical practice.
Another example:
We often heard medical teachers saying:
“You have to do this while you are still students. Once you are a consultant or an expert like me, you don’t have to do it anymore.”
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2. A lot of things in the present medical curricula are not relevant.
2c. Students are NOT taught effective “study methods” of certified
physicians, which is in the form of problem-based learning.
Practically, all certified physicians after graduating from medical schools learn medicine using the problem-based learning method. Yet, this is not being taught to the medical students until recently when slowly a number of schools have adopted PBL as a learning method.
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My vision and aspirations:
Medical curricula should be relevant.
In the curriculum, students should be taught
1. common things found in the country2. processes and procedures used in
clinical practice 3. problem-based learning method
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3. Present medical curricula are NOT student-friendly.
3a. There is NO standardization of “processes”.
3b. There is NO coordination among various disciplines.
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3a. There is NO standardization of “processes.”
There are as many philosophies of medical management as there are medical
teachers.
As many approaches in medical management as there are medical
teachers.
As many diagnostic approaches as there are medical teachers.
As many treatment approaches as there are medical teachers.
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3a. There is NO standardization of “processes.”
There are as many prescribed study methods for students as there are medical teachers.
There are as many biases that the students will have to contend with as there are medical teachers.
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3a. There is NO standardization of “processes.”
The end result of this lack of standardization is that the students are confused andto survive, they just try to please their master-medical teachers from whom they will get their passing grades.
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3a. There is NO standardization of “processes.”
Another end result of this lack of standardization is that thestudents expend too much energy and become exhausted
which is UNNECESSARY because there is A way to reduce and prevent it.
In other words, the present medical curricula in the country are NOT student-friendly.
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3b. There is NO coordination among various disciplines or specialties.
Each specialist faculty wants the students to learn his/her
discipline.
There are overlaps among disciplines.
Furthermore, there are conflicts among disciplines, the conflicts consisting of different philosophy and approaches.
As I said earlier, there are as many philosophy and approaches as there are medical teachers.
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3b. There is NO coordination among various disciplines or specialties.
The end result of this lack of coordination and
integration among various disciplines is again,
CONFUSION and EXHAUSTION on the part of the students.
In other words, NOT STUDENT-FRIENDLY.
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My vision and aspirations:
Medical curricula should be student-friendly to be more effective, efficient, and humane.
In the curriculum, there should be
1. Standardization of management of a patient process
2. Standardization of managerial process 3. Frameworks (being used all
throughout)4. Standardization of learning method –
PBL5. Integration/coordination among
various disciplines
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RJoson’s
Medical Curriculum Model
A comprehensivevertically integrated curriculum
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community-oriented-based learningcompetency-based learningproblem-based learningdistance learning
vertically individual health management learning
community health management learningintegrated
biophysical issues learningcurriculum psychosocial issues learning
bioethical issues learningmedicolegal issues learningresearch issues learning
basic medical sciencesclinical medical sciences
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RJoson’sMedical Curriculum Model
Use of Frameworks and Templates
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RJoson’sMedical Curriculum Model
Use of Frameworks and Templates
To make the curriculum
not only faculty- and student-friendly but also
to promote efficiency and mastery of the processes used in the practice and
teaching of medicine
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RJoson’sMedical Curriculum Model
Samples of Frameworks and Templates
• Management Process • Management of a Patient Process • Problem-based Learning Format • Templates for discussion of biological foundation
and basis on clinical management• Templates for Course Pack Writing and
Development • Action-research format for the community health
problem solving project• Templates for end-of-course symposia
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Management Process
• Situational analysis - problem-identification
• Planning
• Implementation
• Evaluation
• Improvement
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Management of a Patient Process
Patient
Interview (Symptoms)
MD
GOALHealth Problem Resolution
Physical Exam (Signs)
Clinical Diagnostic Process
Pattern Recognition
Prevalence
Clinical Diagnosis Advice
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Management of a Patient Process
Patient
MD
GOALHealth Problem Resolution
Paraclinical Diagnostic Process
Indication (Certainty Deg/Mgt Plan)
Selection (Benefit/Risk/Cost/Avail)
Clinical Diagnosis Advice
Interpretation (Clinical Correlation)
Pretreatment DiagnosisAdvice
Clinical Diagnostic Process
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Management of a Patient Process
Patient
MD
GOALHealth Problem Resolution
Paraclinical Diagnostic Process
Specific Objective of Treatment
Selection (Benefit/Risk/Cost/Avail)
Clinical Diagnosis Advice
Mgt Outcome Evaluation
Pretreatment Diagnosis Advice
Treatment
Health Maintenance Advice
Clinical Diagnostic Process
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Problem-based Learning in Medicine
Learningthe science and art
of medicine in the
functional or clinical context
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P.S.Whatever prescriptions given by
Dr. Fortunato Cristobal on the changing concept of health and
Dr. Jimmy Tan on the emerging roles of the physicians in the Philippines
should be incorporated into the emerging training of physicians in the Philippines.
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Thank You and
Good Day