nedicine

1. III. Medical Education
a. What is Medical Education?
Medical education is education related to the practice of being a medical practitioner; either the
initial training to become a physician (i.e., medical school and internship), or additional training
thereafter (e.g., residency, fellowship and continuing medical education).
Medical education and training varies considerably across the world. Various teaching
methodologies have been utilised in medical education, which is an active area of educational
research.
Medical education is also the subject-didactic academic field of educating medical doctors at all
levels, including entry-level, post-graduate, and continuing medical education. Medical
education applies theories of pedagogy specifically in the context of medical education. Specific
requirements such as entrustable professional activities must be met before moving on in
stages of medical education.
In the Philippines, the education is principally offered and developed by accredited and
government recognized medical schools in the country. Before applying to any medical school,
a candidate must earn a bachelor's degree with credits in certain required subjects. The most
common pre-medical degrees include biology, psychology, pharmacy, medical
technology, biochemistry, microbiology, nursing, radiologic technology and physical therapy.
In addition, a candidate must take the National Medical Admission Test (NMAT), the national
entrance exam for all medical schools in the Philippines. The duration of a proper medical
school is typically 5 years. In the first and second year, students are taught basic medical
sciences, and on the third year, clinical and diagnostic approaches are emphasized. The last 2
years are spent on a clerkship and internship, which include practical years of intensive hospital
training. After the internship, the medical student becomes eligible to take the Physician
Licensure Examination (PLE). The PLE is administered twice a year, in the months of
September and March. A graduate of Medical Studies who passes the Philippine Physicians
Licensure Examination is called a Medical Doctor (MD) or a Physician. After passing the
Licensure Exam, graduates are eligible to enter the Residency Training Program in their field
of specialization. The Residency training program in the Philippines is regulated by their
respective Medical Societies: Philippine Board of Psychiatry, Philippine Board of Pediatrics,
Philippine Board of Cardiology, Philippine Academy of Family Physicians, etc. Each society has
created an Accreditation Committee/Board whose goal is to assure the delivery of the highest
quality medical care by implementing a structured residency program and a standard curriculum
in order to ensure the competence of those undergoing training in different fields of
specialization in the different training institutions nationwide
2. How medical education/training is being taught in various schools traditionally
The Doctor of Medicine (M.D.) degree is a five-year graduate program intended to teach
students the essentials of being a Medical Doctor. The program consists of three years
of academic instruction, one year of clinical clerkship and one year of post-graduate
internship.
In the first year, the subjects integrated in the curriculum are mainly composed of basic
sciences such as Human Anatomy and Physiology, Biochemistry, Preventive Medicine,
Community Health, Psychiatry and Medical Practice I. The second year is spent studying
fundamental concepts in Pathology, Microbiology and Parasitology, Pharmacology,
Medicine and Surgery, Psychiatry II and Medical Economics. During the third year of

2. studying Medicine, students are taught subjects that deal with common diseases
encountered in clinical practice, as well as interesting or rare conditions. The
pathophysiology, clinical features, diagnostic approaches and the management of these
diseases are also given emphasis. The final year of the Doctor of Medicine program is
spent on hospital duty.
The first two years of the Doctor of Medicine program are spent in class lectures
delivered through computers using LCD projectors complemented by slide/ film
showings, laboratory work, and group discussions. In the third and fourth years, students
begin to meet patients in an actual hospital setting. Students are rotated in various
hospital departments, spending up to two months in each department in the fields of
internal medicine, surgery, obstetrics and gynecology and pediatrics, and several weeks
in other specialties under the supervision of a faculty. After each clinical duty, students
undergo periodic evaluations to assess their performance.
To promote independent study, class hours were cut and more study periods were scheduled.
In the third year, lecture hours were likewise cut to give way to more practicum. Problem-based
learning was introduced in pathology, pharmacology and preventive and community medicine in
the early 1980’s.
The old curriculum (traditional) is organized based on generally accepted subjects which
are grouped into preclinical and clinical, plus preventive and community medicine. The
learning activities are based on the contents of the subjects, which has been rapidly
expanding. Most of them are held in classrooms, basic laboratories and the teaching hospital;
community exposure come late and short in the fourth year. Lecture is the principal method of
teaching.
Learning in this curriculum is fragmented and in the basic sciences, unrelated to the clinical
implication. Previously learned topics are easily
forgotten. The rapid expansion of biomedical science and technology overloads the curriculum
and overburdens the students.
The pure traditional curriculum is no longer considered appropriate nor adequate today. The
World Federation for Medical Education recommends a shift to the innovative curriculum which
had been pioneered, found effective and appropriate in several medical schools in western
developed countries. The Commission on Higher Education and the Association of Philippine
Medical Colleges have been promoting its adoption by Philippine schools.
The innovative curriculum had these characteristics:
 integrated horizontally and vertically with little departmental barrier using the organ
system based approach
 community-oriented with a variety of educational settings
 student-centered with self-directed learning activities
The teaching-learning activities fall under three (3) categories:
 tutorial and correlates which cover the main course content;
 selectives which cover important topics that are not included in the tutorials and
correlates; and
 patient-doctor which deals with development of communication and clinical skills and
humanistic attributes for medical practice.

3. The principal method of teaching in the innovative curriculum is Problem-Based Learning (PBL).
The Traditional Flexner Model (1996-2000)
The curriculum was originally organized according to the Flexner Model: two years of Clinical
Sciences. At the heart of this model is the assertion that science should be the basis of medical
practice; that training a student to be a good scientist will produce a good physician. Students
are required to do a research project, present it orally and write a scientific paper in
Microbiology and Parasitology, Pharmacology and Preventive Medicine and Community Health.
It remains critical that students understand the science basic to medical practice. Also, the four-
year medical course progresses from the study of the normal to the abnormal or diseased
human being. The basis of such is to establish what characteristically represents a normal
human being. Any deviation to its representation would be considered abnormal or pathological.
However, changes in the external environment required rethinking the Flexner model.
The Synchronized Model (2000 -2010)
Under the leadership of the Academy Chair, synchronization of course by system was
encouraged such that when the Respiratory System is being discussed in Anatomy, it should
also be the system being presented all the other subjects like Histology, Physiology, Internal
Medicine, Pediatrics, surgery, etc. Also, small group discussions were being started with
vignettes and case-based discussions including early exposure to patients in certain subjects.
This was based on the idea that learning the basic sciences should be correlated with clinical
medicine. Experiencing the clinical setting early and discussing subject matter in smaller groups
enabled the students to freely express themselves without fear of being embarrassed in a large
group, and to apply the basic science concepts in a real patient.
Competence Based Curriculum (2010-2015)
Aside from synchronizing the presentation of courses where it was applicable, modifications
were also being implemented as a result of yearly feedbacks. Competencies expected from the
student after completing the course were now being spelled out in terms of knowledge, skills
and attitude. The strategies include: 1) inclusion of case-based problem-solving in small groups;
2) journal reporting in relation to the subject matter being discussed; 3) more video clips were
being incorporated in lectures to emphasize clinical correlation; 4) visits to cancer facilities and
geriatric homes were included for a holistic approach in managing the patient; 5) evaluations
were now a combination of the objective MCQ and the objective Structured Clinical Examination
(OSCE) for the Clinical Sciences; 6) the research ethic was strengthened through annual
competitions and funding.
In short, the modified curriculum yielded a novel form with several innovations with the following
key elements: 1) a reduction in the didactic hours, now devoted mainly to basic sciences; 2)
introduction of problem-based cases and learning experiences in SGD’s; 3) exposure to clinical
experiences early in the curriculum; 4) improved integration of basic and clinical sciences
around biological principles and body systems; 5) interdepartmental curriculum organization and
synchronization; 6) a set of competencies were defined and must be demonstrated by the
student, by performance evaluation; and 7) re-orientation of the clinical experiences to better
reflect the health care delivery system.
THE CURRICULUM PRIOR TO CHANGE
A. External Factors

4. Medical education, perhaps more than at any other time, faces pressures for change in
response to the rapid development in medical and health care delivery, advances in information
technology, globalization influencing medicine and education, changing political and public
expectations, demands from within the profession and developments on how we look at
teaching and learning. The vision of a transformative education is: All health professional is all
countries should be education to mobilize knowledge and to engage in critical reasoning and
ethical conduct so that they are competent to participate in patient and population – centered
health systems as members of locally and globally connected teams (Lancet, 2010).
National Movement for Reform in Medical Education
Implementation of Outcomes-Based Education (OBE) is now the main thrust of the Philippine
Higher Education Institution’s (HEI’s) to compete with the regional and global academic field, on
the premise that they are able to offer quality degree programs that meet world-class standards
and produce graduates with life-long learning competencies. In addition, the Commission on
Higher Education (CHED) supported the development of HEI’s into mature institutions by
engaging them in the process of promoting a culture of quality. This was based on a shared
understanding of quality and that CHED encouraged institutional flexibility of HEI’s in translating
policies into programs and systems that lead to quality outcomes, assessed and enhanced
within their respective internal quality assurance (QA) system. The starting point of QA is the
articulation of the desired quality outcomes, set within the context of the HEI’s Vision, Mission
and Goals (VMG).
The VMG can be stated in operational terms as the HEI’s institutional outcomes (i.e. attributes
of ideal graduates and desired impact on society) that would serve as the foundation for the
development of a proper learning environment (i.e. teaching-learning and support systems). It is
important to note that the learning environment needs to be focused on developing the
attributes of the HEI’s ideal graduates.
CHED’s definition of OBE is: an approach that focuses and organizes the educational system
around what is essential for all learners to know, value, and be able to do, in order to achieve
the desired level of competence. Thus, this kind of teaching-learning system will have its
appropriate assessment of student performance.
CHED is also adopting an outcomes-based approach to assessment (monitoring and
evaluation) because of its potential to greatly increase both the efficiency and effectiveness of
higher education. This is to demonstrate that our achievement of outcomes matches
international norms.
The Philippine Qualification Framework (PQF) was designed to make our system more aligned
with these norms, including the Association of Southeast Asian Nations (ASEAN) Qualification
Reference Framework.
B. Internal Forces
The curriculum was reviewed internally four separate times during the decade prior to the
initiation of the OBE curriculum. First, after four years of the Flexner Model, The Academy
spearheaded the initiation of the Synchronized model in 2000 with the modifications in
strategies based on yearly feedbacks and evaluations from students and faculty. This was also
the time when Problem-Based Learning (PBL) strategies were on the rise; however, some
schols could only utilize hybrid representations of PBL.. During this time, results of yearly
feedbacks focusing on greater clinical correlations and more objective evaluations in both the

5. basic and clinical (OSCE) science were also being implemented. In 2013, using the self-study
instrument of the Association of Philippine Medical School. All in all, these curriculum reviews
made a number of recurring recommendations for change:
1. To promote students’ independent learning and analytical skills;
2. To develop and enhance faculty teaching skill;
3. To improve methods of student evaluation and course evaluation;
4. To include topics relevant to medical practice such as: professionalism, ethics, disaster-
preparedness, geriatrics, nutrition, empathy and care for the cancer patient, public health,
patient safety, etc;
5. To allow greater participation of faculty and students in curriculum design and
implementation.
FOUNDATIONS FOR CHANGE Changes are always occurring, and the question is: whether to
ignore changes while hoping for the best; observe changes and respond to them; or anticipate
changes and plan prospectively for them. It’s like being startled by an animal. Whether one goes
back, stands still or goes forward-depending on how fearsome or big the animal is. In medical
education, many external forces are big and most internal force is relatively harmless although
annoying. But we find ourselves in a challenging era. Faculty face a dilemma: the easiest
course of action is to let others make changes in response to new forces and then try and pick
the best of their changes. It is much more challenging to be a leader for change. Planning for
and implementing change provide an opportunity to be flexible, to adapt to ever-changing
external forces, and to remain relevant.
Some of the major issues prompting us to move forward were these:
1. Rapid advances in biomedical science;
2. Rapid changes in health care delivery system, with shifting priorities and relocation of
services from in-patient facilities;
3. Changes in health care financing that influence the environment in which the physician-
patient encounter takes place, including caring for increasing numbers of uninsured patients;
and
4. Information technology that is redefining everything we used to do from cataloguing,
managing and retrieving data and information.
In most of the discussions, the following arguments for curricular change began to be defined:
1. The continued growth of medical knowledge is becoming a progressive impediment to
student learning, in part because factual material is presented in piecemeal fashion without
sufficient opportunity for integration.
2. The expectations of society for the medical profession are not well addressed. This is
particularly relevant to communication, skills, ethics and cultural diversity, and to health
promotion and disease prevention.
3. Similarly, public health policy, and the organization and economics of medicine have not been
adequately addressed.
4. Modern medicine’s dependence on technology has diluted the pedagogical emphasis on
fundamental clinical skills.
5. The ways in which physician’s use information to make clinical decisions should be explicitly
taught in medical school such as the science of information management itself.
6. Medical students need to be imbued with a firm commitment to independent lifelong learning.
Following these efforts was a statement of JFSM’s guiding mantra essential for the OBE
curriculum, which was used as a focal point of reference for the elements to be incorporated in

6. the substance of the curriculum. JFSM’s guiding mantra involved: Self, Society and being
answerable to a Supreme Being specifically emphasized its mission statement as the 3s: JFSM
is dedicated to developing a professionally competent and holistic healer (SELF), socially
responsive to the needs of humanity (SOCIETY) and imbued with moral, ethical and spiritual
values (answerable to a SUPREME BEING).
In consonance with the goal of medical education which is to prepare broadly educated,
responsible physicians capable for pursuing postgraduate medical education in any clinical
discipline and/or pursuing a career in medically related research, it is essential that every
student should be proficient in:
1) Knowledge of the scientific basis and language of Medicine;
2) Information management;
3) communication;
4) clinical data gathering;
5) clinical decision making;
6) professionalism;
7) commitment to health promotion and disease prevention; and
8) commitment to lifelong learning.
DESIGNING THE OBE CURRICULUM
1. A first important change was the initiation of the effort to move from the traditional curriculum,
although synchronized and competency-based, with its sharp demarcation between the basic
and clinical science to a graduated, OBE curriculum in which basic and clinical science are
represented throughout the four years with emphasis on the disaster-preparedness graduate.
This process involved instituting disaster-preparedness sessions in different courses namely;
Preventive Medicine and Community Health, Medicine, Pediatrics, Surgery, etc. It also involved
strategies which would carry Basic and Clinical Science education all throughout the four years;
2. The second step was to increase students’ exposure to communities, facilities for geriatrics
and cancer patients as well as providing additional out-patient experiences in clinical core
course;
3. A third step was to institute an orientation or immersion process for the student to be
acquainted with the different areas in the hospital (ICU, ER, wards, specialty clinics, OPS,
triage, etc.) as early as the second year.
4. Fourth was to institute modular formats where applicable and utilize self-instructional
materials/modules;
5. Fifth, evaluation of faculty and courses were standardized in order to identify issues in a
manner to which The Academy could respond. Faculty development thus, is essential and the
OBE program of the Academy was made the cornerstone of faculty training and education
program;
6. Sixth, topics relevant to medical practice but were not found in the previous curriculum were
to be incorporated into the four-year program such as: Professionalism and Ethics; Patient
Safety and Disaster-Preparedness; Service and Empathy, Geriatrics and Nutrition.
Graduates of the M.D. program are expected to be able to:
 Competently manage clinical conditions of all patients in various settings

7.  Initiate planning, organizing, implementation, and evaluation of programs and health
facilities
 Effectively work in teams in managing patients, institutions, projects, and similar situations
 Adhere to national and international codes of conduct and legal standards that govern the
profession
 Abide by the principles of relevance, equity, quality, and cost-effectiveness in the delivery
of healthcare to patients, families, and communities
References:
https://www.nast.ph/images/pdf%20files/Publications/Monograph%20Series/NAST%20Monogra
ph%20Series%209.pdf
https://medium.com/@sajumonarch/medical-education-in-philippines-cf4bf9e80e5b
https://forums.studentdoctor.net/threads/pbl-philippines-med-schs.485300/
https://issuu.com/maanalto/docs/final_7_csbmep_2016