Current Status of Basic Medical Education in the Philippines 2016

Current Status of Basic Medical Education in the Philippines 2016 In celebration of the Golden Anniversary of the Association of Philippine Medical Colleges, Inc.

Edited by: Ramon L. Arcadio, MD, MHPEd Zorayda E. Leopando, MD, MPH NAST Monograph Series 21 • 2017

Current Status of Basic Medical Education in the Philippines 2016 In celebration of the Golden Anniversary of the Association of Philippine Medical Colleges, Inc.

Edited by: Ramon L. Arcadio, MD, MHPEd Zorayda E. Leopando, MD, MPH

Copyright 2017 National Academy of Science and Technology, Phils.

Department of Science and Technology Bicutan, Taguig, 1631, Metro Manila Philppines nast@dost.gov.ph | secretariat@nast.ph ISSN 1655-4299 Publisher: National Academy of Science and Technology (NAST)

Editors: Ramon L. Arcadio, MD Zorayda Leopando, MD

Editorial Assistants: Cynthia M. Villamor

Anne Marie D. Alto

Editorial Advisers: Joselito F. Villaruz, MD

Alberto B. Roxas, MD

Fernandino J.A. Fontanilla, MD

Alfaretta L.T. Reyes, MD

Diosdado G. Madrid, LlB February 2017 NAST Monograph Series No. 21

TABLE OF CONTENTS Preface

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Message 3 ACD. Fabian M. Dayrit, Ph.D. Vice President, National Academy of Science and Technology, Phils.

Message 4 Dean Joselito F. Villaruz, MD, PhD President, Association of Philippine Medical Colleges Invocation 6 Fernandino J. A. Fontanilla, MD, MBAH Dean, College of Medicine San Beda College List of Abbreviations

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Health Education and Heatlh Care System Reform ACD. Antonio Miguel L. Dans, MD, MSc

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Minimum Standards for the Doctor of Medicine Program Dean Alfaretta L.T. Reyes, MD

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Quality Standards for Basic Medical Education Program Ramon L. Arcadio, MD, MHPEd

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The Licensure Examination System of Professionals in the Philippines Hon. Miguel L. Noche, Jr., MD

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The Eclectic Nature of Philippine Medical Curricula Melflor A. Atienza, MD, MHPEd

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Implementing Learning Outcomes in the Medical Curriculum Erlyn Sana, Ph.D.

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Synthesis

Zorayda E. Leopando, MD, MPH Professor, Former Vice Chancellor, University of the Philippines, Manila

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Closing Remarks ACD. Carmencita D. Padilla, MD, MAHPS Professor and Chancellor, University of the Philippines Manila

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The Editors

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Annex 98 CHED Memorandum Order No. 18 Series of 2016

PREFACE With the increasing globalization in the practice of medicine, there is an urgent need to institute constructive reforms in medical education to facilitate the development of the physician’s capability to practice medicine worldwide particularly the ASEAN Region. Transformative education calls for making medical education relevant to health care needs and country-specific. There should be balance between global competitiveness and national relevance and social accountability.

The World Federation for Medical Education (WFME) states that such reforms are essential to achieve the following objectives: prepare the physicians for the needs and expectation of society; cope with the explosion in medical scientific knowledge and technology; inculcate physician’s ability for lifelong learning; ensure training in new information technologies; adjust medical education to changing conditions in the health care delivery system. Thus, the Association of Philippine Medical Colleges and the National Academy of Science and Technology jointly sponsored this Symposium entitled — “Current Status of Basic Medical Education in the Philippines 2016.” Representatives from the following agencies participated in the discussion: Commission on Higher Education (CHED), Professional Regulation Commission (PRC), Department of Health (DOH), Philippine Medical Association (PMA), National Academy of Science and Technology (NAST), Association of Philippine Medical Colleges (APMC), the deans and the faculty of various colleges of medicine.

This monograph synthesizes some pressing issues and offers recommendations to address them. Some of these issues are: • Updated standards, policies and guidelines in medical education • Quality assurance and accreditation standards • Congruence between the medical curriculum and the licensure process • A curricular design (learning outcomes) for the eclectic nature of Philippine medical curriculum • Synchronization between medical education and the healthcare delivery system 1

The editors would like to thank: The National Academy of Science and Technology (NAST) for co-sponsoring the project; all the speakers and the participants for the lively discussion; Chancellor and Acd. Carmencita D. Padilla and Acd. Edward Wang for their valuable support in funding the project; Ms. Cynthia Villamor and Ms. Anne Marie Alto of UP Manila for their editorial assistance.

Ramon L. Arcadio, MD, MHPEd

Zorayda E. Leopando, MD, MPH The Editors

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MESSAGE ACD. Fabian M. Dayrit, Ph.D. Vice President, National Academy of Science and Technology, Phils.

On behalf of the Officers and Members of the National Academy of Science and Technology, Philippines, I would like to express my felicitations to the Association of Philippine Medical Colleges, Inc., for the celebration of their golden anniversary.

The Symposium on the Current Status of Basic Medical Education in the Philippines was organized by NAST PHL in partnership with the APMC, through its acting executive director, Dr. Ramon L. Arcadio.

It is enshrined in the constitution of the Philippines (Article 2, Section 155) that health is a fundamental human right. As the highest advisory body to the President of the Philippines in matters related to S&T, NAST PHL fully supports the advocacy on Universal Health Care (UHC) or Kalusugan Pangkalahatan, with one NAST member and UHC advocate, National Scientist Ernesto O. Domingo.

In providing quality healthcare for everyone, we should acknowledge the significance of having quality medical education that can produce skilled and competent health practitioners.

It is very timely to assess the current status of our country’s basic medical education addressing the need for constructive reform in Philippine medical education. This assessment will enable us to analyze our medical education system in detail, which will be important in aligning it with international standards.

I would also like to take this opportunity to commend all the health practitioners in our country, many of whom perform their work beyond the call of duty, as well as the students who chose to dedicate themselves to the field of medicine.

Mabuhay!

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MESSAGE Dean Joselito F. Villaruz, MD, PhD President, Association of Philippine Medical Colleges These are, indeed, exciting times for Philippine medical education. Recent developments have made it imperative to revisit and re-evaluate its status in order to get at a truer picture of its strengths, needs and direction.

The last monograph on the status of Philippine medical education was produced ten years ago, in 2006. At that time, the prevailing curriculum was traditional and competency based. Needless to say, much has changed in the world since then and Philippine medical education is trying to keep up. Most urgently, we are now gearing towards full-fledged ASEAN integration which demands that we should be at par with our ASEAN neighbors in the quality of doctors that we are producing.

Amidst this challenge, many questions beg for answers: Are we churning out the right kinds of doctors who could respond competently to the health needs of the Philippines and its neighbors? Are the curricula of our medical schools prepared to accept the challenge? Are the changes that our school are undertaking, for example, the shift towards outcome-based education (OBE) enough or even appropriate? Is there a need for radical reforms in certain components of medical education in our country, like the Physician Licensure Examinations? What steps are we supposed to take so that the needed changes could be actualized and how do we evaluate the progress that we are making?

In a bid to find answers to these nagging questions, the Association of Philippine Medical Colleges, Inc. (APMC) and the National Academy of Science and Technology, Philippines convened a symposium on the Current Status of Basic Medical Education in Philippines this year. As part of the celebration of the Golden Anniversary of the APMC, the symposium brought together the best minds, who also represent the most important agencies and stakeholders involved in Philippine medical education 4

to grapple with the challenges, provide insights and set directions for medical education in the Philippines today.

This publication is the output of the symposium. It is our hope that this compendium will be a usable and useful piece in the tapestry of multisectoral efforts to secure the future of healthcare in the Philippines and the world.

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INVOCATION Fernandino J. A. Fontanilla, MD, MBAH Dean, College of Medicine San Beda College Heavenly Father, in this day and age when the word “change� is a common byline, we come to realize that the future is never certain. Only one thing is certain, that change is inevitable.

As we gather here today, not by chance or coincidence but out of a sincere concern for the future of medical education in our country, we come to You asking for Your guidance and wisdom. Help us to keep an open mind and to engage in meaningful discussion. Provide us with an environment that is conducive to a productive exchange of ideas.

Allow us to grow closer as a group, nurturing the bonds of community and friendship. Fill us with Your grace, Lord, as we make decisions that will affect our students, staff, faculty, alumni and other stakeholders of our various institutions.

Continue to remind us that in all that we do here today, in all that we accomplish, we do them for Your greater glory. Amen.

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ACRONYMS ACD Academician ACGME Accreditation Council of Graduate Medical Education APMC Association of Philippine Medical Colleges BOM Board of Medicine CHED Commission on Higher Education CMO Commission on Higher Education Memorandum Order DOH Department of Health DOTS Directly Observed Treatment Short Course ECFMG Educational Commission for Foreign Medical Graduates FAAP Federation of Accrediting Associations of the Philippines GIDA Geographically Isolated and Disadvantaged Area HEIs Higher Education Institutions INQAAHE International Network for Quality Assurance Agencies in Higher Education KSA Knowledge, skills and attitudes LERIS Licensure Examination Registration Information System LO Learning Outcomes MD Doctor of Medicine MPL Minimum Pass Level MSSU Mariano Marcos State University NAST National Academy of Science and Technology NBI National Bureau of Investigation NMAT National Medical Admission Test NTTCHP National Teacher Training Center for the Health Professions OAS Online Application System OBE Outcome-based Education OMR Optical Mark Reader OPSD Office of Programs Standards Development PAASCU Philippe Accrediting Association of Schools, Colleges and Universities 7

PACU-COA Philippine Association of Colleges and Universities Commission on Accreditation PCP Philippine College of Physicians PERRCs Permanent Examination Registration Record Cards PGH Philippine General Hospital PHILCAT Philippine Coalition Against Tuberculosis PHL Philippines PLE Physician Licensure Examination PMA Philippine Medical Association PNP Philippine National Police PQF Philippine Qualifications Framework PRBM Professional Regulatory Board of Medicine PRC Professional Regulation Commission PRL Professional Regulatory Law PSG Policies Standards and Guidelines PTSI Philippine Tuberculosis Society, Inc. TB Tuberculosis TCME Technical Committee on Medical Education TPHPE Technical Panel for Health Profession Education TQDB Test Questions Data Bank UN United Nations UP University of the Philippines UPM University of the Philippines Manila UPCM University of the Philippines College of Medicine USAID United States Agency for International Development WFME World Federation of Medical Education WHO World Health Organization

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HEALTH EDUCATION AND HEALTH CARE SYSTEM REFORM ACD. Antonio Miguel Dans, MD, MSc Professor, Section of Adult Medicine, College of Medicine University of the Philippines Manila Member, Health Sciences Division, NAST PHL Case Scenarios, Studies In Contrast Showcasing Inequity I’d like to begin with two patients I recently saw. First is Mr. Jose who is 42 years old. I met him when we were giving relief services to an island in Busuanga municipality affected by the typhoon Yolanda, and where Mr. Jose had lost 3 boats. We were the first team to arrive in the area a month after storm which, at that time, they still had no relief. When I saw him, he wasn’t there for anything related to flood or to the surge. He had high and uncontrolled blood pressure, his blood sugar was high, he had tuberculosis which was untreated, and he had not consulted a physician in the past 3 years. He literally had no medications at that time. He said, mabuti pa kung may bagyo, may doktor dito (being hit by typhoon is actually a blessing in disguise, as doctors get to visit our communities), because if there is no typhoon, nobody goes there to check on them.

The other case is Mrs. Rosete who was admitted to a private hospital in Metro Manila a few years ago. She is 56 years old from Quezon City. She presented with acute diarrhea, fever, and seemed dehydrated so she was admitted to that hospital. Maybe because of slightly low blood pressure she had some dizziness, but to clear her of this problem, she was referred to a neurologist. She also had high blood sugar and was a known diabetic so she was referred to an endocrinologist who said that after this illness tides over, her blood sugar might normalize. The creatinine was slightly high, maybe from dehydration. The patient also had an episode of gout during admission so she was referred to a rheumatologist who said it was from dehydration from diarrhea. Perhaps the 9

most unfortunate thing is that she had changes in her electrocardiogram. So she was then referred to a cardiologist, underwent coronary angiography.

This is based on the abstract given by the patient which seemed to be a success story but if you talked to the patient, she was very sad. Mrs. Rosete had just spent 180,000 pesos for diarrhea.

These two cases are interesting because the first has too little health care and the other has too much. I am not sure who is luckier and less lucky between the two: the one who did not see a physician for a long time or the one who was seen by too many. It is not just these two cases who are reflective of the national situation. A lot of Filipinos do not receive health care; 2 of every 3 Filipinos die unattended by a doctor, nurse, or midwife for the illness that caused their death. Too little health care is very common.

Too much health care is also very common. 1,500,000 families pay for catastrophic expenses after a medical illness (Ulep et al, 2013). A catastrophic health expense is defined as ‘spending more than 40% of your liquid assets on a health care problem in a year.’ These two situations show us a lot of inequities and imbalance in the health care that we deliver. These are driven by experiences within the health care system similar to the cases above.

There are three parts in this discussion: (1) analyze the health care system, (2) propose a health care system reform, and (3) discuss the role of the academe.

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PART I - HEALTH CARE SYSTEM ANALYSIS There are a lot of good news and bad news in our health care situation: Good news, PhilHealth coverage has increased from 51% in 2010, to 88% in 2015, and sometime this year, more than 90% (PhilHealth Annual Report, 2010, 2015, 2016). The bad news is, utilization is very low. The number of people who actually use their PhilHealth privileges when they need it, especially amongst the poor, is the lowest – only 33%. But amongst higher income Filipinos, utilization is more than 90% (Faraon et al, 2013).

Another good news, the health budget increased from 28.7 billion in 2010, to 205 billion in 2015 (DOH Budget). The bad news is, the number of Filipinos who die without seeing a health care worker increased. It was 45% in 2010, now it climbed up to 66% (PhilHealth Statistics, 2011).

There seems to be some discrepancy in our ability to render health care and in our actual success in providing that kind of health care.

One of the main problems causing these bad news is a double burden in disease.

There was the epidemiologic transition where there was a drop in infections, deaths from diarrhea, pneumonia and tuberculosis. Population ages, thus, there is a rise in non-communicable diseases such as heart attack, stroke, arthritis, ulcers, etc. We are at stage 2 of that transition and that is according to the words of public health specialists, where infectious diseases have not yet gone down but non-communicable diseases are on the rise while our health care system is mainly designed to address infections. This is the double burden that taxes the health care system and the first to suffer from these is the poor. This leads to inequities in access and in health outcomes.

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We believe these inequities in exist from womb to tomb. Below is a table to demonstrate some examples.

Table 1. Inequities in healthcare from womb to tomb Inequity in Healthcare Access

Inequity in Healthcare Outcomes

Pregnancy

Unattended births • poorest quintile (58%) • richest quintile (4%)

Neonatal mortality • poorest quintile (19%) • richest quintile (9%)

Childhood

Complete vaccination • NCR (80%) • ARMM (30%)

Under-5 mortality • poorest quintile (5.2/1000) • richest quintile (1.7/1000)

Adult life

Current tobacco use • poorest quintile (33%) • richest quintile (18%) Source: Philippine Health Statistics, 2010

Heart attack rates • lowest quintile 40% higher than richest

In pregnancy, there is inequity in access. 58% of births in the lowest quintile are unattended compared to only 4% in the richest quintile – that is a thirteen fold difference. Does this lead to inequities in outcome? Figures on neonatal mortality according to the Philippine Health Statistics reveal that maternal deaths in the poorest quintile is 19/1000, compared to the richest quintile that is 9/1000. Death rates are double amongst the poor. In childhood, vaccination rates in the National Capital Region is 80% but in poor regions, such as ARMM, it is only 30%.

Does this lead in discrepancies in mortality? In the poorest quintile, the under 5 mortalities is 5.2/1000, compared to 1.7/1000 in the richest quintile.

In adult life, our attempts to stop smoking are more successful in the richest quintile where smoking is 18%. Whereas in the poorest quintile, it is 33%. The people who can 12

afford cigar least are the ones smoking and this leads to heart attack rates which are 40% higher in the lowest quintile.

66% of deaths among Filipinos are unattended. There are inequities. And why are we unable to cope with the double burden? We think there are three causes in the health care system: 1. Work force shortage a. Good news – the Philippines is the number 2 exporter of doctors in the world next to India–whose population is more than a billion (Matsuno, 2009). Therefore, per capita, we are the highest exporter of doctors. We are also the number 1 exporter of nurses (Philippines: Major Source of Nurses). b. Bad news – in the public sector, where the ideal ratio of health care workers to population should be 25:10,000, the actual is only 5 health care workers per 10,000. Looking at the situation among doctors, the ideal is 10:10,000. The actual is 0.5/10,000. The overall deficit of doctors both in the private and public sector is 30,000 (Dans et al, 2015). We know of municipalities where Municipal Health Officers (MHOs) are in charge of 40,000 patients which is almost an impossible task.

2. Policy fragmentation - we have 46 health care programs listed in the Department of Health website. They are donor-driven, the coverage is overlapping, and therefore, we are unable to prioritize and to coordinate, plus, we use common resources for all these different programs.

Figure 1 shows overlaps in the 46 health care programs. Examples of overlapping programs are the safe motherhood program, women’s health, reproductive health, and breastfeeding, which all have common interest and gives us the same resources.

There is child protection, childhood disease, and child health. We also have infant feeding, unang yakap (the first embrace after a child is born), new born care, and neonatal screening. We see that there are overlaps and yet there is so much that is being missed.

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Figure 1: Health Programs, Department of Health, Philippines Cancer Ctrl Salintubig

Infectious Ds Environ H Diabetes Mental H

Reprod H Child H Occup H

Filariasis

Waterborn Ds

Cardiovasc Ds

Tuberculosis

Micronutrient

Infant Feeding

Belly Good

Dental H

Women’s H

Adolesc/Youth

Neonatal Sc Unang Yakap

Food Fortif Breastfeeding

Newborn Sc

Helminthiasis

Safe Motherhood

Child Protection

Violence/Injury

Child Ds

Blindness

Malaria

Immuniz

Leprosy

Smoking

Schisto

Climate PWD

COPD

Oral H Dengue

HIV

Rabies

Tigdas

Source: List derived from Department of Health Website 3. Administrative fragmentation – we work in a decentralized system; we have 42,000 barangays, independent LGUs, with the DOH functions as an advisory body.

There is politicization of workforce and other problems in health care caused by this fragmentation.

The Department of Health needs to implement these fragmented programs in 81 provinces, 144 cities, 1,491 municipalities, 42,000 barangays, and countless private facilities. If you count these programs and divide this to many different health care providers, our health care system is fractured into millions of little bits and this becomes one of the causes of why we are unable to cope with the double burden.

The Primary Care Coalition believes that we cannot address the health care 14

problems–HIV, diarrhea, dengue, pneumonia, and such–by addressing each of thesesmall problems one by one. We will remain unable to manage these problems unless we undertake health care system reform.

PART II - PRIMARY CARE: HEALTH CARE SYSTEM REFORM There is a common confusion between what is primary health care and primary care.

They sound the same but are very different. Primary health care is a philosophy, primary care is a system for health care delivery, and primary prevention is a service.

These are conceptual definitions of Primary Care and how each are related: • Primary prevention is a preventive service focused such as vaccination, checkups, lifestyle advice. Treatment of risk factors are focused on healthy people.

• Primary care includes all that, but in addition, it provides holistic first-contact given by stewards of health care who are able to guide a person through health care system. It includes vaccination, etc., plus curative aspects of health care. If a patient has a cold, or headache, or hypertension, this is where they go.

• Primary health care includes preventive services rendered in a primary care system. It is a philosophy which includes concepts such as: lowering health inequities, promoting universal health care, and promoting self-reliance in health among community members. It includes prevention, primary care, plus, public health intervention, universal payments for health care, universal health care, multi-sectoral roles, and environment protection.

Why focus on Primary Care?

Without primary care, primary health care becomes an abstract idea. If we cannot even take care of a headache, then the idea of self-reliance becomes very abstract.

Second, without primary care, who delivers primary prevention? Being in the middle of this relationship among conceptual ideas, primary care serves a key role in achieving the two other ideas.

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Primary Care, in its operational definition, is a health care system that enables patient access to health care providers with 4 important functions: 1. Primary care providers are the first contact. Whatever the patient comes with, they go to primary care first. If it is a headache or diarrhea, hypertension or chest pain, that is where they first go.

2. Primary care providers provide comprehensive care. Most of the illnesses should be addressed by these providers who render holistic care.

3. Primary care providers are the coordinators for specialized services. They decide what tests or drugs are needed or if patients need to see specialists or need admission and referral to other facilities.

4. Primary care providers are the principal point of continuing care. After a kidney transplant, for instance, patients need to go home to the community. And this is who they go home to–the person in charge of all their problems–primary care.

Putting the primary care provider, the facilities, specialists, pharmacists, and laboratories together, this is commonly referred to as the Primary Care System.

Figure 2: Primary Care System

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Structural Definition of Primary Care If health care were an ocean it could be divided in many ways. It could be divided vertically into different specializations such as cardiology, dermatology, endocrinology, etc. We could also divide health care horizontally into primary, secondary, and tertiary care. Primary Care, on the other hand, is analogous to snorkelers. They can swim far and broad, but they cannot go deep.

Healthcare workforce can then be likened to scuba divers. Specialists, who can render Secondary Care, can go deep, but their heavy equipment do not allow them to go very far. Tertiary Care, which can be likened to a submarine, is when specialists need to work in specialized facilities to render health care, for example, heart center, kidney center, and lung center in our country.

Primary care is the first contact. It is comprehensive, they can swim far, but not deep.

They are coordinators for services who decide where patients go, as well as the principal point of continuing care. For them to get back out, they need to go through primary care again.

Figure 3: Comparison Between the Three (3) Levels of Care and Various Specializations

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Primary Care, in its simplified definition, is “outpatient” care funded by the Social Health Insurance System (e.g. PhilHealth). It is an oversimplification but it is the definition many people will understand.

Why we need outpatient care: 1. Many persons who do not have easy access to a hospital have access to an outpatient facility. Many people have access to outpatient care, at least more than those who have access to an outpatient facility.

2. Most diseases need outpatient care, not hospitalization.

3. Most hospitalizations require prior outpatient care. We blame patients for coming late to hospitals, waiting until their disease is severe, but it is only because they do not have primary care. They are the ones who decide when they need to go to a hospital.

4. Disease prevention takes place during outpatient care, not during hospitalization.

If we want to put more effort in preventive care, we need to invest in outpatient care.

In order to shed light in the common misconceptions about Primary Care, TRUE PRIMARY CARE is compared with PhilHealth TSEKAP package called ‘Primary Care Benefit’ (PCB): Table 2. Misconception about Primary Care TSEKAP (PCB) Package

True Primary Care

Definition

Tests done on all. Even healthy people.

Payor

Public service, therefore, Health services, therefore, government funded (DOH) insurable (PhilHealth)

Capitation

Smaller; small budget per Larger; budget shared family across all families

Coverage

Limited to lowest quintiles 18

Services for people who need healthcare.

All Filipinos, rich or poor

a. The said TSEKAP (PCB) package has recently been launched in limited areas and is available to indigents. But a ‘checkup’ means doing tests on everyone including healthy people; blood sugar is done once a year for ages 40; and the breasts are examined after the age of 50. In contrast, primary care provides services for people who need health care. People with symptoms who think that they have something wrong with them. Those services are first contact, comprehensive care, coordinator and principal point of continuing care. b. The funding is different. When health care service is given to everyone, it is the government, particularly the Department of Health, who pays for it. Pap smear is given to all women after their first sexual contact. Pap smear has to be paid for by the DOH. In contrast, health service is something some people experience. Some might need it and others might not in a certain year. Therefore, it is insurable. For example, in car insurance, if everyone gets an accident, we will not have what we call ‘car insurance’. Car insurance only works because some people get into an accident and others do not. So the funding is different since true primary care is needed only by some for a certain year, and it can be paid for by PhilHealth rather than the DOH. Vaccination of all children for the national immunization program is another example that the DOH is paying for. However, bypass or surgery is paid for

by PhilHealth because these are insurable. c. We have a very small budget to pay for TSEKAP (PCB). If we are to conduct a urinalysis on 100 million Filipinos, and it costs 10 pesos each, that will already cost 1 billion from the budget. In contrast, we have a larger budget in true primary care.

One proposal we’re testing for PhilHealth is, if you had 800 pesos per citizen, how much could it cover? We are estimating and doing the pilot studies and we think, PhilHealth can cover for outpatient care’s yearly cost of up to 3,000 or 4,000 pesos based on a budget of 800 pesos per head. This is the same as paying 1,000 pesos for insurance but we are insured up to 30,000 pesos. We pay 800 pesos for primary care, we might use up to a few thousand. d. Since the coverage for the TSEKAP (PCB) packages has been limited to the lowest quintile and indigent patients, we think true primary care should be for all Filipinos 19

rich or poor. This is consistent with the principle of social health insurance where the rich subsidize the care for the poor under a principle of solidarity. Primary care should be universal, if not, PhilHealth will be bankrupt in a few years.

What does this health care system reform achieve?  Primary care addresses the workforce shortage because we will have physicians seeing a lot of patients with a lot of problems. We won’t have a lot of Mrs. Rosetes all over the place who are seen by a lot of physicians.  It also provides a lot of incentives for primary care payments through the Primary Care Benefit packages.  It solves policy fragmentation. Instead of 46 programs we will have 1 program.

If we want to focus on HIV, we train our primary care without putting a separate office with separate people and separate budget for HIV. This is the same for malaria, dengue, and other of those illnesses.  It solves administrative fragmentation because if the government starts paying for health care, then they get a handle on health care. They can say, ‘We will pay you if…’ and that is something we cannot say now because they do not pay for primary care.  It will restore health care in central administration.

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PART III - THE ROLE OF THE ACADEME Figure 4: Roadmap to Primary Care

Recruit The threshold density of health care worker to population is 25/10,000. The leaders in primary care are the family physicians, but we have very few of them. We will need help from pediatricians, internists, general physicians, nurses, midwives, and community health workers. We also need to tap private physicians to see public patients. So the role of the academe here is to be responsible for the production of these health workers. As previously mentioned, 30,000 is the deficit of doctors based on WHO thresholds for physician density.

Retrain Many people believe primary care is easy when in fact, primary care is one of the most difficult specialties in medicine. One needs to know so many things: infectious diseases, maternal health, child health, management of non-communicable diseases, and, navigate the health system to tell patients when they need a referral, an admission, tell who are covered with PhilHealth and who are not.

We need to use community health workers because there is not enough nurses, doctors, and midwives. In the United States, there are physician assistants who are engineers and architects who render Primary Care within a 5-mile radius of an accredited primary care providers. So we can train community health workers, certify them, and we are proposing, they can be primary care providers, level 0; a graduate midwife can also undergo training and certification as level 1; a nursing graduate as level 2; and graduate physicians as level 3. In the UP Manila School of Health Sciences, there is a step-ladder program where you can move across different health professions depending on how long you train.

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We need specialists at the highest level, and we reckon it will be family and community medicine in the level 4. We are also proposing different reimbursement rates for PhilHealth for different primary care providers.

Figure 5: Academic Programs In Primary Care

Augmentation of the supply of primary care providers is also being proposed. It has been discussed in PCP the possibility of developing a Primary Care Internal Medicine Program, which has already been developed in other countries as well as a Primary Care Pediatric Program. The disadvantage of internal medicine is that they see only adults, the disadvantage of pediatrics is they only see children, and that is the advantage of family medicine – they can see both. A career path may also be provided by offering a master’s degree which is available in some countries for nurses and doctors who train in other field so they can go into primary care.

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What the diagram achieve: 1. A career path in primary care. There can be no success in a career if the career is a dead end.

2. It separates the track for primary care. Many have suggested that on graduation, after medical training, all students must be capable of rendering primary care. It’s an attractive idea, however, the main complication as it does in other countries is that primary care became a stepping stone, making it the lowest rung of the ladder. One can graduate as a physician, take internal medicine, then cardiology, then cicatrization, and still be in primary care. But no one is going into primary care if it is the lowest. Thus, the need for a separate track for it. We will need specialty training like family medicine, perhaps a master’s degree, and possibly, primary care programs in other fields.

Regulate From the point of view of the academe, the regulation in training and accreditation of primary care providers is their obligation. Other sectors of society have obligations in regulation such as: • Facilities – the Department of Health should make sure there is infrastructure, supplies, electronic records, etc. If we cannot push electronic records, we should not go into primary care because it is very prone to abuse. There is a need for networking framework.

• Non-visit encounters – patients do not have to see the doctor personally. They can text, email, or call their physician. Sometimes doctors just ask for the blood sugar and patients have to come back to them every 3 months. Many primary care systems insist that doctors allow their patients to consult them without going to them. This is good for the patient, for PhilHealth, and even for the doctor who can see patients who actually need to be seen.

• Beneficiaries – the patients themselves will be assigned yearly to a facility of choice. If they are not happy with the health care, they can move next year to someone else. But to avail of benefits from PhilHealth, they need to pass through primary care. In the problem with cataracts, a lot of people had their cataracts removed unnecessarily before they are actually needed. This is because patient can go straight to the ophthalmologist without going through primary care.

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From PhilHealth’s point of view, primary care is their gatekeeper. Although we dislike the term because gatekeeper protects what’s inside the gate, which is not exactly its role, because the role of primary care is to take care of people entering it.

Reassessment Health systems research is the role of the academe. We need continuous assessment of a success of a primary care program, the knowledge of our caregivers, and the quality of health care. Are the admissions going down? Are patients actually utilizing it? Has it gone up from 33% among the poor? Is the proportion of health care paid out-of-pocket for decreasing? Are patients satisfied? Are the caregivers satisfied with the system?

The five milestones are ideas developed after three years of meetings with broadranged organizations: the Primary Care Coalition, the Philippine College of Physicians, the Society of General Internal Medicine, PhilHealth, and the University of the Philippines. The Primary Care Coalition is made up of 70 organizations including 27 professional organizations. This is a big opportunity that the Association of Philippine Medical Colleges will be interested in pushing this program.

Summary In the health care system, the main problems are: workforce crisis (maldistribution or shortage) and fragmentation (administrative and programmatic). The health care reform evolution is proposed into primary care, and the roles of the academe are outlined in recruiting, retraining, retaining, regulating, and reassessing the health care situation.

Evolving into primary care would entail not just academic institutions but professional orientation– doctors, nurses, and midwives must accept it. The public perception is very low, but the public also needs to accept it. There is a very low regard for something important such as this. It is distressing that primary care providers are considered non-specialists when in fact they are the most important specialists in the country. It also entails political will from the barangay level, to the municipality, 24

to the province, to the region, and even to our national leaders.

Ninoy Aquino once said, ‘the Filipino is worth dying for’ but he never had a chance to tell us why. What makes us special as a people? What makes us want to work for the Filipino people?

Working through this proposal makes us understand what makes Filipinos special – our ability to take care of others. Look at the manpower we export: the nurses, midwives, doctors, caregivers, teachers, nannies, cooks, entertainers (who are also taking care of other people), stewards and stewardesses – that is what we are good at, and that is what we should be proud of as a race. The irony of it all is, because of our exportation of this care-giving professions, we are unable to care for our own people and ourselves.

It is time we do something about it; for our people, for our patients, and for our very own children. By the time we get sick, we don’t want them in a health care system where they will be seen by no doctor or by ten doctors. The academe will play a big role and we hope that the coalition will partner with APMC in the struggle for health system reform.

References: Dans, A. (2015). Primary Care Roadmap. Presented in a Primary Care Meeting on November 24, 2015 at the Conference Room Philippine Rural Reconstruction Movement, Mother Ignacia, Quezon City DOH Budget. (n.d.). Retrieved from Department of Health: http://www.doh.gov.ph/doh-budget Faraon, E.J.A., Estrada, J.A.G., Farillas, E.L.F., Mabera, F.R.D., Paras, A.M.P., Pastrana, M.K.R., Yap, A.M.L. (2013). Significant predictors of underutilization of inpatient benefits among PhilHealth members in selected barangays in Manila. Acta Medica Philippina 47 (3), 69–73.

Matsuno, A. (2009). Nurse migration: the Asian perspective. ILO/EU Asian Programme on the Governance of Labour Migration. Retrieved on 18 December 2016 from: http://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/documents/ publication/wcms_160629.pdf.

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PhilHealth Annual Reports. (2010 and 2015) . (n.d.). Retrieved from PhilHealth: https://www.philhealth.gov.ph/about_us/annual_report Philippines: Major Source of Nurses. (n.d.). Retrieved from Mercan Recruit: http://www.mercanrecruit.com/philippines-major-source-of-nurses Sinson, F. A., Rebanal, L. R., & Timbang, T. D. (2010). Philippine Health Statistics 2010.

Retrieved from Republic of the Philippines Department of Health: http://portal.doh.gov.ph/content/philippine-health-statistics-2010.html Sinson, F. A., Rebanal, L. R., & Timbang, T. D. (2011). Philippine Health Statistics 2011.

Retrieved from Republic of the Philippines Department of Health: http://www.doh.gov.ph/node/2705 Ulep, V.T., & dela Cruz, N.O. (2013). Analysis of Out-of-Pocket Expenditures in the Philippines. Philippine Journal of Development, 40, 1-2.

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OPEN FORUM Agnes D. Mejia, MD Professor and Dean, College of Medicine University of the Philippines Manila Moderator Dr. Zorayda Leopando (Professor of Family and Community Medicine, College of Medicine, University of the Philippines Manila): Thank you, Tony, for validating what we have been doing for the past 40 years: that there is really a need to have a training program in Primary Care, and that program should start in the medical school. The first R – recruitment, is the most difficult. We are having difficulty recruiting physicians to go into family medicine. The DOH has mandated all the DOH hospitals to have training program in family medicine and to expand to practice-based pathway for training which we are already doing, but we are having difficulty recruiting potential residents. Some of our programs do not even have residents now because we are still considered as second-rate specialists. If we would not be able to break that thinking, then we will have difficulty convincing doctors to go into Primary Care.

Within the colleges, there are still faculty members who will say ‘Bakit ka nagpunta sa family medicine? Sayang ka.’ If there are faculty members who will think that way, how are we going to have graduates going into Family Medicine? We have to have respectability. We have accreditation process of training programs, specialty board examination, reassessment and recertification, but those are not enough. They have to be compensated better. The experiences of other countries show that doctors who go into Primary Care are earning as much as those who are in other specialty fields and it seems that PhilHealth is not ready to do that. PhilHealth is ready to spend for Z packages and all others pero tinitipid nila ang Primary Care. First, 500 pesos for Primary Care Benefit 1, ngayon ginawa nilang 1,800 pesos for Tsekap but this is on hold.

So who’s going to pay for Primary Care? The LGU is currently doing that since health service is devolved to them. However, when you go to the community, you realize that the LGU is supposed to deliver and finance health workforce, but there is a problem of inadequate workforce because the Department of Budget has limitations on the number of employees per municipalities. Thus, some LGU officials cannot employ 27

the adequate number to reach the required provider patient ratio because they have filled up every item. So there has to be a policy change regarding this to enable the LGU to employ a suitable number of health professionals in Primary Care. We are also doing retraining, recruitment, regulation, but it is the reassessment which is not yet complete.

What happens if we have different kinds of Primary Care physician providers? We have to have a single focus, otherwise, we shall have difficulty attracting medical graduates if we have different kinds of primary care physicians. The WHO has already acknowledged that the primary care physicians that we are going to work with are going to be the family physicians– that is in the 2009 World Health Assembly Resolution 12 on Primary Care. But how are we going to do that if we have different kinds of primary care physicians after a basic medical education?

Dr. Antonio Dans: From the point of view of the definition of Primary Care, internists can provide first contact, render comprehensive care, coordinate services and can serve as the principal point of continuing cares. That is possible. From the point of view of government, a better investment will be in Family Medicine because then, they do not need a pediatrician separate from an internist, and obstetricians for delivery. Internists can serve continuities not just within a single illness. Continuity is from womb to tomb so it is a worthwhile investment. The problem is, there is only 4,000 family physicians in the country, and we lack 30,000 doctors in any field. In many countries, nurses and midwives are allowed to render primary care as well as health care workers who are non-health care professionals. Perhaps in the next 100 years we need many entries into Primary Care. But maybe a hundred years from now, family medicine can be the core or the center for rendering primary care as it is in countries like Canada, where the only recognized primary care providers and the only primary care providers paid by government are from the field of family medicine.

Dr. Ofelia Samar-Sy (Dean, Bicol Christian College of Medicine): Aside from the lack of doctors doing primary health care, the problem really is we don’t have enough doctors. We don’t have any more doctors to man our hospitals. If you said that 30,000 is the backlog, how do you address that backlog?

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Dr. Agnes Mejia: I think we need to differentiate. Is it maldistribution or shortage? Or is it both? If you would look at Lorenzo et al. 2010, the big issue is maldistribution, second is doctor-centric.

Dr. Dans: We do not have data on regional requirements but we do have data for our public and private healthcare force ratios. So in the private sector, we have an excess of 30,000 doctors, which is why Ms. Rosete had that experience. In the public sector we have a deficiency of 60,000 doctors. Now you can see, there are two problems here: first, an overall deficit, second, maldistribution. That is why one of the solutions is to convince PhilHealth to give payments for primary care in the public and private sectors. So if I am a private physician, I get paid zero balance for seeing public patients. So we tap the private sector and that will move some of the excess into public service. We do that in hospitals–zero balance for indigents, it subsidizes their health care.

Dean Madeleine Sosa (Dean, College of Medicine, De La Salle Health Sciences Institute): When we talk about primary care, are we just talking about doctors who are going to be deployed to secondary or primary hospitals, or in the community as well? Or, are we also talking about doctors who are going to tertiary institutions?

Because there is one wall we need to break: the tertiary institutions or hospitals that only accept, for example, specialists. There will be institutions training residents in different subspecialty, for instance, who will say that they only admit doctors who will come back with a subspecialty rather than the specialization. That is something we need to consider since we want primary care to be delivered by different sectors and that also include the bigger hospitals, thus, tertiary institutions.

Dr. Dans: Primary care needs to be rendered at the smallest unit which is the barangay health centers or the private clinics. The issue about training is a doubleedged sword. In Canada and Australia, after graduating from general medicine, you cannot stop there. You have to go into a specialty and if you want to go into primary care, you go into family medicine. In the United States, you can be a general internist or general pediatrician. We have had general internists going to the provinces and being told that we do not accept general internists. So by providing a separate 29

track for them where they are not just general internists but they become primary care internists, they just do not become a general physician but a family physician, they just do not become nurses but primary care nurses. Elevating their status in a separate ladder is the best way of promoting primary care. This will be difficult but we need to think in the long run. One of the main hindrances to primary care is it is the lowest rung in the stepladder of specialization and that has to stop.

Dr. Jose Juliano (Academician, Calamba Medical Center): In England, you register to a family doctor and you can never see a specialist without the approval of the family doctor. So why can’t we do it with PhilHealth? If there are not enough family doctors, we can assign even any doctor as the family doctor who knows your history, your previous diseases and therefore can give patients better advice. If he does not know what to do then he can refer you to a specialist.

Dr. Dans: Many people thank the Primary Care Coalition for a novel idea but it’s not a novel idea. We’re the only ASEAN country with no clear plan for achieving primary care. Except perhaps for the poorest countries, we are the ones without primary care system where you can make PhilHealth claims straight to a specialist. Something that is common and accepted in other countries is non-existent in the Philippines, and unless we reform that system then it’s going to be hard to solve problems like Mr. Jose and Mrs. Rosete. About specialists serving as primary care, that is a doubleedged sword but we do not have a choice now. I would not trust your cardiologist to do a breast exam on a woman, or even an internal exam. A lot of medicine has this rule: if you don’t use it, you lose it. We can always say, ‘I was a medical student, too, I know how to see children.’ I can’t see children if I haven’t seen a child patient in 30 years. So I would leave that to a pediatrician or a family physician. On the other hand, they are or only workforce right now. We have more specialists than primary care providers and therefore in our diagram on training we’re saying, ‘Sure why not let the ophthalmologist practicing in a GIDA (geographically isolated and disadvantaged area) take primary care training for a week or two, then certify him to receive PhilHealth payments level 3. That is possible. We think specialists can render primary care if they retrain in primary care.

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MINIMUM STANDARDS FOR THE DOCTOR OF MEDICINE PROGRAM Alfaretta Luisa T. Reyes, M.D. Chair, Technical Committee for Medical Education Commission on Higher Education The Philippine medical education is ensured of its high quality through quality assurance process being implemented by different bodies concerned.

The CHED-Office of Programs and Standards Development (OPSD), through the respective technical committees, is responsible for developing policies, standards and guidelines (PSG) for the various health professions education programs. The Technical Panel for Health Professions Education (TPHPE) assists the CHED-OPSD in setting standards and in the monitoring and evaluation of these programs offered by the higher education institutions (HEIs).

The Federation of Accrediting Agencies of the Philippines (FAAP) through the Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU) conducts the external accreditation of the basic medical education program.

The practice of medicine is regulated by the Professional Regulatory Board of Medicine of the Professional Regulation Commission as mandated by Republic Act 2382 known as Medical Act of 1959.

Standards are maintained by Philippine medical schools at various levels. The government, through the Commission on Higher Education, sets the minimum standards through series of CHED Memorandum Orders (CMOs) updated periodically upon recommendation of the Technical Committee for Medical Education (TCME).

The CHED PSGs is the primary basis of the objectives of basic medical education for which the medical school builds its capacity to fulfill PSGs.

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For the past five to six years, the CHED-TCME has been conducting joint PRC-CHED monitoring and evaluation visits to several medical schools to look into their compliance with the minimum standards for the doctor of medicine program. Based on the performance of the respective graduates of medical schools in the Physician Licensure Examination (PLE) administered by the Professional Regulatory Board of Medicine, Professional Regulation Commission, approximately fifty percent of these institutions are academically-challenged. Their performance rate in the PLE has been lower than the national passing average rate. From these visits and revisits, many of them have several deficiencies based on the required minimum standards for compliance.

There was a world-wide observation of mismatch between the education and training of medical graduates and their roles as health professionals in the health system.

In line with the international call for transformative education and innovation as recommended in the Lancet Commission Report, TCME proposed action plans on rationalizing medical education in our country to address this concern. The plans approved by the CHED Commission-en-banc were aligned in the 2016 PSGs. The ASEAN integration will be fully operational by the end of 2016. This will pave the way to the exchange of professional services. The HEIs are strongly urged to prepare their graduates to acquire the professional competencies required by both the local and global labor markets. This is the essence of the Executive Order (EO) No. 83 known as the Philippine Qualifications Framework (PQF) signed by Pres. Benigno C. Aquino in October 2012.

In conformity with the amended Medical Act of 1959 and the Higher Education Act of 1994, in pursuance of an outcome-based quality assurance system as stipulated under CMO No. 46 series of 2012, the Commission adopted and promulgated the Policies, Standards and Guidelines (PSGs) for the Doctor of Medicine Program as specified in the CMO No. 18 s. 2016. With the purpose of rationalizing Philippine Medical Education, these PSGs will keep our program abreast with the call for global responsiveness and local relevance.

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All HEIs planning to offer the Doctor of Medicine Program must first obtain proper authority from CHED in accordance with existing rules and regulations and the provisions of CMO No. 18 s. 2016.

Autonomous and deregulated institutions, state universities and colleges (SUCs) and local universities and colleges (LUCs), upon approval by their respective governing boards to apply for government authority, should strictly adhere to the provisions in CMO No. 18 s. 2016, CMO No. 40 s. 2008 “Manual of Regulations for Private Higher Education” and CMO No. 2 s. 2004 “New Procedures in the Processing of Applications of Government Authority to Operate the Doctor of Medicine and Bachelor of Science in Nursing Programs.”

Issuance of government authority (permit and recognition) for HEI to operate the MD program is embodied in CMO No. 18 s. 2016.

1. Permit – to cover the first two to three year levels with CHED revisit.

1. Permit – requires full compliance of minimum requirements 2. Recognition of the entire MD program (with CHED revisit).

All higher education institutions (HEIs) with an existing Doctor of Medicine program are directed to shift to learning outcomes/competency-based/outcome-based approach as stipulated in CMO No. 18 s. 2016 regardless of the type of HEI. Schools are permitted to design their curricula which can either be disciplinebased, integrated, problem-based, community-based, competency-based, outcomebased or any other innovative model. This must be suited to their own contexts and missions. They are given flexibility to innovate provided they can show that the required minimum set of outcomes and competency standards are achieved and that the program educational objectives are satisfied by this alternative means.

As mentioned in CMO No. 46 s. 2012, CHED subscribes “to a more eclectic approach that resonates with a “weak” or “lower case” “obe” The “obe” approach in Philippine higher education mixes outcomes-based education with other curriculum approaches and is open to incorporating discipline-based learning areas that 33

currently structure HEI curricula.�

The main goal of the basic medical education program is to develop professional physicians for the Philippine healthcare system. Medical schools should produce graduates as primary care physicians who can pursue general medical practice after passing the physician licensure examination.

The following are the minimum set of desired program outcomes (POs) that explicitly states the minimum standards for the doctor of medicine program. (Cuyegkeng, Detoya, Lapitan, et al., 2013). These must be aligned with the vision-mission and goals of the institution.

Minimum Program Outcomes Common to all disciplines and HEIs Graduates of all higher education programs shall have the ability to: 1. Articulate and discuss the latest developments in the specific fields of practice as defined in the Philippine Qualification Framework (PQF).

2. Communicate effectively and orally and in writing using both English and Filipino 3. Work effectively and independently in multi-disciplinary and multi-cultural teams

Based on HEI Type Demonstrate a service orientation in one’s profession among graduates of professional institution.

Participate in various type of employment, development activities, and public discourses, particularly in response to the needs of the communities one serves among graduate of colleges.

Participate in the generation of new knowledge or in research and development projects among graduates of universities.

All Health Related Professions

MD Program

Demonstrate a competence in handling health problems of individuals, families, communities.

Demonstrate clinical competence.

Demonstrate higher order thinking skills, problem solving, decision-making, logical and critical thinking skills.

Lead and manage health care teams

Subscribe to professional, legal and ethical practice.

Work collaboratively within interprofessional and multiprofessional teams.

Communicate proficiently.

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Communicate effectively

Engage in research activities Collaborate within interprofessional teams Utilize systemsbased approach to healthcare Engage in continuing personal and professional development

4. Recognize professional, social and ethical responsibility 5. Preserve and promote “Filipino historical and cultural heritage” (based on R.A. 7722)

In addition to the above, graduate of State Universities and Colleges must have competencies to support “national, regional and local development plans” (RA 7722)

Engage in self-directed lifelong learning, and Promote the use of health system approach in the delivery of service

Adhere to ethical, professional, and legal standards Demonstrate nationalism, internationalism, and dedication to service Practice the principles of social accountability

6. Engage in lifelong learning and understand the need to keep current of the developments in the specific field of practice 7. Work “independently and/or in teams or related fields with minimum supervision”

The Art and Science of Medicine shall be emphasized in the MD program. Clinical science courses may be introduced in the basic science year levels. It is recommended that medical students should be exposed early to patient care and healthcare delivery system.

The teaching of interprofessional and multi-professional education shall be promoted to develop students to work effectively with the team. Leadership and management must be entrenched in the curriculum. Medical schools are strongly encouraged to give equal emphasis to ambulatory and hospital in-patient care and to health promotion maintenance and curative care. Equal emphasis should be given in addressing population health needs and individual patients.

The medical school is required to develop its own curricular goals aligned to its vision and mission and shall prepare the syllabi for all courses based on its curriculum and its methods of delivery including instructional designs.

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Courses or modules should be organized and sequenced according to the principles of learning. In addition to the conventional courses/subjects or modules regardless of the curriculum design, the minimum curricular content shall include courses or topics such as alternative medicine, geriatrics and nutrition, public health and health economics, evidence-based medicine, genetics, diagnostic imaging. Topics such as professionalism, patient safety, andragogy, interprofessional education, leadership and management, disaster risk reduction and management should be integrated in relevant courses.

The medical school shall formulate a curriculum map. This contains the program outcomes and the different courses or modules per year level according to the degree of breadth and depth that these courses contribute to attaining the program outcomes. Courses are categorized according to how program outcomes are covered in the course: I - Introduced P - Practiced D - Demonstrated Based on the adopted curriculum that is consistent with its vision-mission and the means of its delivery, medical schools should satisfy the minimum requirements on physical resources for the library, laboratories, base hospital and other facilities and the human resource requirements in terms of administration and faculty as provided in the 2016 CHED guidelines.

The institution must have a clear description of its administrative structure. It must enforce a sound organizational structure that reflects the curriculum design to efficiently implement the prescribed program outcomes.

The Dean who acts as Chief Academic Officer of its own unit must possess the required qualifications and qualities, including teaching and administrative experience, to interpret the prevailing standards in medical education with sufficient authority.

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The institution shall have a strong teaching staff. The faculty must possess the required qualities and academic and professional qualifications to teach the courses.

They are required to teach only in their respective area of expertise. The school must implement a robust faculty development program for capacity building of the faculty especially on innovative approaches in medical education. The aim is to make their courses more experiential and interactive.

The medical school must implement the major components of its clinical training program in its base hospital with Level III DOH classification with accredited residency training programs in medicine, pediatrics, surgery and OB-Gyn. If it does not own its base hospital for training, the institution is required to enter into a Memorandum of Agreement with an appropriately accredited hospital in the same city/province or within the region. Accessibility, safety of faculty and students and a reasonable travel time should be considered. A base hospital can be utilized by only one medical school.

The institution shall enter into a Memorandum of Agreement with an identified community or a government health facility to implement its community-based health program where students can rotate and experience working with the community.

As stated in the provisions in the 2016 PSGs, the medical school shall comply with the minimum of the core book collections in the library. It shall have adequate physical plant and other resources to include classrooms, basic laboratories, Information Technology (IT), audio-visual and clinical facilities to support its various educational activities. A clinical skills laboratory is required to equip the students with the needed clinical skills before they are exposed to actual patients. The facilities shall represent a variety of appropriate educational settings similar as possible to the intended future place of practice.

The medical school must have admission policies and a clear description of the selection process. The admission criteria should include the applicant’s general weighted average grade and National Medical Admission Test (NMAT) percentile score together with the corresponding assigned weights. It is also recommended 37

that non-academic qualities be assessed through personal interview.

As stipulated in the 2016 PSGs, the NMAT score cut-off of at least 40th percentile will be implemented by all HEIs offering the doctor of medicine program.

A freshman quota shall be set by the medical school, subject to its carrying capacity based on its faculty resources and adequacy of teaching facilities available.

It is imperative that the institution comply with the other minimum instructional standards set by CHED. These include faculty to student ratio during teachinglearning activities, patient load, the variety of clinical cases seen by students, the minimum number of faculty relative to the student population. Students are required to keep a personal log following the CHED prescribed format on patient seen and procedures performed.

Research must be strongly encouraged in the institution. Research agenda must be developed and capacity building of the faculty and students must be strengthened for them to participate in research activities. Appropriate budget and required facilities must be provided including privileges for the faculty.

Compliance of medical schools shall be based on the three-year consolidated Physician Licensure Examination (PLE), institutional performance of the graduates of medical schools and the performance of graduates of each school in the PLE, and the outcome of the joint CHED-PRC monitoring and evaluation activities as to adherence to the CHED guidelines on the following areas: 1. Dean/Administration 2. Faculty 3. Curriculum and Instruction including community program 4. Students (admission, promotion, retention and other services) 5. Base hospital and clinical materials 6. Laboratory and clinical facilities 7. Library and learning facilities including physical plant 8. Research 38

After due process, the Commission shall impose sanctions on medical schools who are non-compliant with the provisions of the CMO No. 18 s. 2016.

To ensure continuous quality improvement of its medical education program, medical schools are strongly advised to undergo quality assurance by PAASCU whose standards conform with those set by the World Federation for Medical Education.

Schools who do not yet qualify for external accreditation are encouraged to undergo consultancy visits by PAASCU or seek assistance from APMC to help improve their programs.

In summary, full compliance of medical schools to the CHED policies, standards and guidelines for the doctor of medicine program will ensure high quality of medical education in our country that is locally relevant and globally responsive.

References: Executive Order 83 Series of 2012: Institutionalization of the Philippine Qualifications Framework.

Commission on Higher Education (CHED). CHED Memorandum Order No. 46, series of 2012. (Policy-Standard to Enhance Quality Assurance (QA) in the Philippine Higher Education through an Outcome-Based and Typology-Based QA).

Cuyegkeng, M.A., Detoya, G., Lapitan, L. et al., (2013). CHED Implementation Handbook for OBE and ISA. Quezon City: CHED (also known as Commission on Higher Education OBE Framework Implementing Guidelines 2013).

Sana, E., Roxas, A., Reyes, A. (2015). Introduction of Outcome-Based Education in Philippine Health Professions Education Setting. Philippine Journal of Health Research and Development, 19 (1), 60-74. University of the Philippine, Manila Commission on Higher Education (CHED). CHED Memorandum Order No. 18 series of 2016. (Policies, Standards and guidelines for the Doctor of Medicine (M.D.) Program).

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Arcadio, R.L., Santos-Ocampo, P.D. (2005). Current Status of Medical Education in the Philippines. NAST Monograph Series No. 9, (p10, 11, 29, 32).

Unified CHED TCME – PRC Evaluation Tools. Evaluation Forms for Application for Government Permit / Recognition of Doctor of Medicine Program; for Monitoring and Evaluation of Existing Programs.

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QUALITY DEVELOPMENT STANDARDS FOR THE BASIC MEDICAL EDUCATION PROGRAM Ramon L. Arcadio, MD, MHPED Vice-President, PAASCU Chair, PAASCU Commission on Medical Education Professor Emeritus, UP Manila QUALITY ASSURANCE AND ACCREDITATION Quality Assurance is a general term which includes a range of activities in medical education like accreditation. The other activities are audit, assessment, certification, and benchmarking. The International Network of Quality Assurance Agencies in Higher Education (INQAAHE) states that “quality assurance may relate to a program, an institution or a whole higher education system. In each case, quality assurance is all those attitudes, objects, actions and procedures which, through their existence and use, and together with quality control activities, ensure that appropriate academic standards are being maintained and enhanced by each program.”

WHAT IS ACCREDITATION Accreditation attests to the quality determined upon an external review of a program which meets certain standards for a designated period of time. It is a concept, a means of self-regulation which focuses on evaluation. It is a process which involves self-evaluation and an external review of peers. It is a status, a certification of having met standards of quality or excellence.

WHAT ARE THE AIMS OF ACCREDITATION • To stimulate medical schools to formulate their plans for change and quality improvement • To safeguard medical practice and manpower utilization through well-defined standards

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WHAT ARE THE SOURCES OF ACCREDITATION STANDARDS At the NATIONAL level, the sources are CHED, PAASCU, APMC and the best practices of medical schools. At the REGIONAL level, it is the Association for Medical Education in the Western Pacific Region (AMEWPR). The GLOBAL level, it is the World Federation for Medical Education (WFME) and other International Networks.

ACCREDITATION HISTORY (MD PROGRAM) In 1999 APMC and PAASCU jointly developed the survey instrument. In 2001, PAASCU created the Commission on Medical Education. In 2003, the University of the Philippines Manila was the first MD Program to receive formal accreditation followed by the University of the East in 2004 then Cebu Institute of Medicine in 2007.

PAASCU ACCREDITATION PROCESS There are six steps in the accreditation process; 1. Institutional self-survey 2. Pre-survey or preliminary visit 3. Formal survey visit 4. Initial accreditation (3 years) 5. Full accreditation (5 years) 6. Periodic re-survey ACCREDITATION LEVEL APPLICANT Status CANDIDATE Status: After Preliminary Survey Level I: ACCREDITED Status, 3 years Level II: RE-ACCREDITED Status, 3 or 5 years Level III: RE-ACCREDITED Status Meets first 2 criteria plus 2 of the rest: • HIGH STANDARD OF INSTRUCTION • HIGHLY VISIBLE RESEARCH TRADITION • Highly visible community program • Strong faculty development • Highly creditable licensure exam performance 42

• Working Consortia or Linkages • Extensive Library & Learning Resources Level IV: RE-ACCREDITED • Very high Quality Academic Programs • Prestige and Authority • Comparable to Excellent Foreign Universities • Meets Additional Criteria as follows: Excellent Outcomes in: ▪ Research ▪ Teaching and Learning ▪ Community Service and Social Upliftment ▪ International Linkages and Consortia ▪ Planning Process ACCREDITATION BENEFITS Private Medical Schools • For Level 1 and 2, full administrative and financial deregulation, grants and funding assistance • For Level 3, all the benefits for Level 1 and 2, plus curricular deregulation, privilege to offer distance education and extension classes • For Level 4, all the mentioned benefits, and give full autonomy for the program Government Medical Schools • It is useful for budgetary allocation when your president goes to Congress to defend the budget, they can ask you about your accreditation level. You have an edge among other schools if you have an accreditation level.

• Funding assistance ▪ Scholarships ▪ Faculty development ▪ Facilities development • Use of word “Accredited” in publications and newspaper

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AREAS TO BE EVALUATED A. Vision-Mission Objectives 1. Statement of the Vision-Mission 2. Specific Objectives 3. Acceptance by the Faculty 4. Orientation of Students B. Faculty 1. Academic Qualifications 2. Performance 3. Selection of Faculty Members 4. Teaching Assignments 5. Rank and Tenure 6. Faculty Development 7. Salaries and Fringe Benefits 8. Faculty Involvement C. Curriculum and Instruction 1. Program of Studies and Curriculum 2. Instructional Design and Materials 3. Community Involvement 4. Evaluation, Grading, and Graduation Requirements 5. Management of Instruction D. Clinical Training/Service Facilities 1. Community-based Health Facility 2. Ambulatory Care Facilities 3. In-Patient Care Facility

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E. Research 1. Human Resources 2. Orientation 3. Activities 4. Quality 5. Support from Administration 6. Dissemination and Utilization 7. Ethical Standards F. Students 1. Admission 2. Promotion, Retention, Dismissal 3. Student Services 4. Student Discipline G. Library 1. Administration and Staffing 2. Financial Support 3. Holdings 4. Organization and Maintenance of Collection 5. Library Services 6. Management Information System 7. Physical Facilities H. Administration 1. Administrative Organization 2. Planning 3. Financial Management 4. Administration of Records 5. Academic and Scholarly Connections

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I. Physical Plant and Other Resources 1. Human Resources 2. Physical Resources and Laboratories 3. Audio-Visual Facilities Summary Accreditation is: • A true reflection of quality • An impetus for institutional development • An effective instrument to upgrade the standards of medical education in the Philippines • Concerned with quality over and above those required by the government • Voluntary accreditation serves as an alternative to government supervision and regulation.

References: Application For a Survey Visit. (n.d.). Retrieved from Philippine Accrediting Association of Schools, Colleges and Universities: http://paascu.freeiz.com/wp-content/ Checklist of Materials. (n.d.). Retrieved from Philippine Accrediting Association of Schools, Colleges and Universities: http://paascu.org.ph/?page_id=132 uploads/2015/09/Application-for-a-Survey-Visit-Basic-Medical-Education.pdf Retrieved from International Network of Quality Assurance Agencies in Higher Education: http://www.inqaahe.org/ Retrieved from Philippine Accrediting Association of Schools, Colleges and Universities: http://paascu.org.ph/

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OPEN FORUM Dr. Eleanor Galvez (Examiner, Philippine Regulatory Board of Medicine, PRC): When we surveyed schools who would like to open a medical education program, we know there is difficulty for them to have administrators and faculty who have the sufficient experience. How do we address that? Secondly, the tool PAASCU is using reflects the indicators of what CHED expects from medical schools. I wonder how aligned is this with CHED? Also, is there continuing coordination with CHED so they can somehow update their indicators? Because if we will allow schools to open, it will take some time to apply for accreditation. Would these indicators change for that reason?

Lastly, at Professional Regulation Commission (PRC), there are institutions abroad as well as medical doctors who are seeking the help of PRC to get a government seal.

Would there be a challenge in the near future that when these schools who will not be accredited by PAASCU will be asked for government seal or recognition instead?

Dr. Mejia: The question for Dr. Retta is: what do we do, as TCME, if a school did not comply with all the requirements for administrators and faculty during the visit?

Dean Alfaretta Reyes: In order to be issued the permit, there must be 100% compliance of the various areas and the standards discussed are only the minimum.

We are having problems especially in the NCR since we have probably about 13 or 15 medical schools who are existing and are in the pipeline. For so many years, we have been clamoring to have a moratorium on the opening of medical schools. But when we submitted the proposal on rationalizing medical education in the Philippines about 4 years ago, it was denied. This time, when we resubmitted rationalization, that was the only aspect denied of us by the commission en banc. Consequently, we are forced to look at it. We are also aware that there is a dearth of faculty members in medical schools, wherein only a few want to teach and are really committed especially in the basic sciences. This is the reason why we keep telling the schools who would like to open that they have to have a feasibility study of why they want to open a medical school. It would be good if it is a clamor coming from the community similar to Ateneo de Zamboanga wherein the community clamored for a medical school. Or probably in regions where there are no medical schools yet, we also 47

encourage them to open.

And, of course, when it comes to faculty members, which is the hardest aspect, we are not the ones who will solve that problem. Schools must take a look at how they can do it. What other schools are doing is if there are established medical schools in the area, they can come up with a Memorandum of Understanding (MOU), initially, for the first two years to assist them. That is the only way. But, when the competition is there, then the efficiency of your faculty will suffer. Here will be a kangaroo faculty– teachers jumping from one school to the other, and that can affect the quality of expertise that they will be giving to the medical schools. That is not commitment since those professors will just give a lecture, and then fly.

Dr. Mejia: The other question is if PAASCU and CHED are aligned with one another.

Dr. Arcadio: The standards that Dean Retta discussed are already the updated standards. The standards of CHED now has made it easier for PAASCU because CHED did not only make minimum requirements, but quality requirements. PAASCU has a more liberal interpretation of the standards because we want the schools to exercise their academic freedom. The CHED recognizes 2 umbrella organizations: (1) for private schools, and (2) for city schools and chartered universities. There are 4 accrediting agencies in the Philippines and CHED recognizes the work of these agencies. These accrediting agencies actually function by the authority of CHED. Dr. Leopando: There has already been an agreement that the PRC will be a cosignatory in the accreditation of all residency training programs, as well as in the board certification of all the specialists who passed the specialty board examination. This is a work in progress. When it comes to basic medical education there is government recognition because CHED is the signatory for the recognition.

The specialty is a different story, but now, the PRC is more active when it comes to recognition of specialists and programs.

Dr. Sana: Is there an agency or a possibility for the rules of accreditation to be changed? If schools will comply with the minimum standards, then there are 48

standards that are being met already. And if they are being met already, in conclusion, you can expect that there is quality in that medical school. It would be a little inconsistent if new schools wouldn’t be allowed to apply for accreditation.

There are 13 new schools that will have to wait for graduation of 2 batches even if they have already secured permission from CHED. If, for example, Ateneo School of Medicine and Public Health has secured a permit and they have graduated students, they will need to wait for a significant period of time before they get accredited. Isn’t that a little inconsistent?

Dr. Arcadio: Ateneo has 5 batches already, but because of the change of the deanship, this school has other priorities before accreditation. They are catching up in compliance with the other requirements and then they will apply for accreditation.

Dr. Mejia: Dr. Arcadio, do you see the accreditation to be mandatory? Because right now it is voluntary.

Dr. Arcadio: We have to follow the rules of CHED. CHED declares that accreditation is voluntary and accreditation is also voluntary worldwide. No one can be forced to be accredited or not. Although now, we are telling the schools that if graduates came from unaccredited schools, they will no longer be accepted in the United States for post graduate studies, for internship, or do residency or fellowship. It is important for all the schools to be accredited. There isn’t much of a problem because, in time, all the schools will be accredited. Some of these schools are just preparing very well their documents.

Dean Jose Cueto, Jr. (Dean, College of Medicine, Mariano Marcos State University): Majority of the 10 ASEAN countries impose a mandatory accreditation. It is only in the Philippines where the accrediting body is a private organization. In the 9 other ASEAN countries, majority are government institutions or government-authorized accrediting bodies. One good practice of Indonesia is,their accrediting body is exclusive to health professions so they can focus only on health professions courses.

Some of the features we can adapt is the United States’ LCME or Liaison Committee on Medical Education, which nominally states that they also have voluntary system 49

of accreditation. However, it functions as a mandatory system because only graduates of LCME accredited schools are allowed to take the U.S. LME. So what is the point of setting up a medical school if it is not accredited by the LCME? Or if the graduates will not be allowed to take U.S. LME? Indonesia has also a very good feature in the sense that, because accreditation is mandatory, before the first batch graduates from a medical school, the medical school has to obtain accreditation from the accrediting body. So it is not a requirement that a school should have 3 to 5 batches before being allowed to have external accreditation. Those are features found not only in the ASEAN region but also in other continents. Maybe we can rethink, discuss, and try to identify best features that we can find from the other countries and come up with a new system. For example, MSSU will have its first graduates in 2019. They will have their internship in 2020, and they will take the licensure examinations in 2021. By 2023, the ECFMG rule that ‘no graduate from a non-accredited school will be allowed to take the U.S. LME’ will already be enforced. Therefore, we, my school and other recently-opened schools, are in a distinct disadvantage. So we cannot just allow new medical schools to operate without the participation of the accrediting body.

U.S. medical schools, on the other hand, are under close-monitoring of the accrediting body until they produced first 2 or 3 batches. This helps them for a very simple reason: the LCME has been established by the American Medical Association and the Association of American Medical Colleges–the counterpart of the APMC. And since the accrediting body was set up by the AAMC, they are heavily involved in monitoring, helping, and developing the medical schools. There are features that we can adopt. The CMO was issued in 1995 and was revised in 2005 but they practically have the same provisions; not much was revised.

Also, the provision on having a creditable performance in the licensure exam only affects level 3 accredited schools. Why is it that the board policy of PAASCU states that schools should first have 3 to 5 years of good performance before they can apply?

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Dr. Arcadio: These ideas can be broght up to the board of trustees of PAASCU and we will do so, although at the moment, this is the rule for all courses with board examination. At the moment, schools cannot apply for a visit if their national passing average is below the national passing average. We have requested PAASCU for some leniency in this, even if the medical school is below the national passing average, and PAASCU will visit them on a consultancy basis.

Dean Cueto: On the matter of the national passing average as the standard: when I entered the Board of Medicine in 2009, the national passing was 52. When I left in 2015, the national passing average was already near 70. In six years, the standard has not been changed. So in 2009, any medical school who had a passing average of 53, could already apply for external accreditation. Moving to 2015, if a school do not have a passing average of 70, they cannot apply for external accreditation.

What kind of standard is that when it moves depending on the performance of the graduates? And if we compare professions, nursing has 43 and accountancy has 27.

So if you are in an accountancy school with a 28% passing rate, then you can apply for external accreditation because that is above the national passing average. If external accreditation is really a mark of excellence, then it should be criterionreferenced; not moving up or down depending on the performance of the different batches of takers in the licensure exam.

Dean Reyes: That can be discussed in the board and probably be one of the recommendations of the PAASCU. But as mentioned, it will take time because it is not solely for the medicine program but all programs with licensure examinations.

Regarding the developmental plans, CHED is the one who will do the monitoring and evaluation. Once the permit has been given, it will not end there. They will be revisited 2 years later before they are given the recognition. When we were coming up with the PSG of 2016, we were discussing about these developmental plans and how to help the academically-challenged schools because we keep on saying that they have to have quality medical education. We want to target by 2020 that all 13 schools are already accredited. It is quite idealistic but that is what we wanted.

There is a reason why we thought of developmental but when we were discussing this with PAASCU, they had limitations regarding this, and that is why we are forced 51

to talk with APMC. After discussing this further with PAASCU, they were amenable that they would do it.

The medical schools can also apply and ask help from PAASCU and that is the reason why there are about 12 schools who underwent that particular consultancy period.

But it is expensive to undergo such consultancy when you know that you cannot qualify yet. However, it depends on the medical school if they really want to be helped for developmental plans for the improvement of the education they are offering.

From the floor: A text message from one of the parents from one of the schools that have not yet complied with the requirements of CHED is asking, ‘will the PRC allow the students of the said school to take the licensure exam after graduation?’ Second questions is, why should we allow schools to operate without permits or without compliance?

Dr. Miguel Noche, Jr.: If the school has not yet been recognized by CHED, therefore, we will not allow their students to take the exam.

Dean Reyes: They may not even be allowed by the APMC to undergo internship because they have not been given any certificate of compliance. That means to say, they cannot graduate their students nor have them apply for internship, and they need to have an internship before they are allowed to take the board exam. We’ve been calling the attention of this higher education institution.

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THE LICENSURE EXAMINATION SYSTEM OF PROFESSIONALS IN THE PHILIPPINES Hon. Miguel l. Noche, Jr., MD Chairman, Professional Regulatory Board of Medicine Introduction The objectives of the Republic Act No. 2382, otherwise known as “The Medical Act of 1959 “ as cited in Section 1, Article 1 are: “This Act provides for and shall govern (a) the standardization and regulation of medical education; (b) the examination for registration of physicians; and the supervision, control and regulation of the practice of medicine in the Philippines .” Section 2 of the same Act states further: “Endorsement: For the purpose of implementing the provisions of this Act, there are created the following agencies: Board of Medical Education under the Department of Education (now the Commission of Higher Education), and the Board of Medical Examiners under the Commission of Civil Service (now under the Professional Regulation Commission)”.

Hence, the Professional Regulation Commission (PRC) through its Licensure Office administers and conducts the licensure examinations for the Professional Regulatory Boards (PRBs) of the 46 regulated professions in the Philippines. Figure 1 shows the Organizational Chart of the PRC where the Licensure Office is under the direct control of the Commission Proper. The Licensure Office with its several divisions, with the support of the Information and Communication Technology Division and the Education Statistics Division are responsible for the implementation of the various administrative processes in the conduct of the various licensure examinations. The different division of the Licensure Office includes the following: • Application, Evaluation and Qualification • Examination Division • Rating Division • Education Statistics Division • Test Development, Research and Statistics Division 53

Figure 1: PRC Organizational Chart

Mandate To administer the licensure examinations to aspiring professionals.

Vision The Professional Regulation Commission (PRC) is the instrument of the Filipino people in securing for the nation a reliable, trustworthy and progressive system of determining the competence of professionals by credible and valid licensure examinations and standards of professional practice that are globally recognized.

Objective To ensure that the integrity, validity, efficiency and credibility of the various licensure examinations are maintained and safeguarded through a strict, systematic and orderly implementation of the standard procedures in the administration and conduct of licensure examinations.

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The Regulated Professions The Regulated Professions are classified into 4 clusters: Technology Professions, Health and Allied Professions, Business, Education and Economic Professions, and Engineering Professions.

Table 1: The Regulated Professions By Cluster Technology Professions

Health and Allied Professions

Business, Education and Economic Professions

Engineering Professions

Agriculture

Dentistry

Accountancy

Aeronautical Engineering

Architecture

Medical Technology

Criminology

Agricultural Engineering

Chemistry

Medicine

Custom Brokers

Chemical Engineering

Environmental Planning

Midwifery

Guidance Counseling

Civil Engineering

Fisheries

Nursing

Librarian

Electrical Engineering

Forestry

Nutrition and Dietetics

Professional Teachers

Electronics Engineering

Geology

Optometry

Psychology

Geodetic Engineering

Interior Design

Pharmacy

Real Estate Services

Mechanical Engineering

Landscape Architecture

Physical and Occupational Therapy

Social Workers

Metallurgical Engineering

Master Plumbers

Radiologic Technology

Mining Engineering

Sugar Technology*

Respiratory Therapy

Naval Architecture and Marine Engineering

Veterinary Medicine

Sanitary Engineering

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Scope or Coverage The Licensure Examination System covers the following phases: 1. Processing and evaluation of applications for licensure examinations 2. Building and Maintenance of a Test Questions Data Bank (TQDB) a. Encoding of the test questions in the TQDB b. Merging of the Databank questions c. Extraction of test questions and printing of initial copies 3. Examination administrative processes 4. Correction and rating of answer sheets and release of examination result Responsibility and Authority The Professional Regulatory Boards, the Licensure Office and the divisions under it, are responsible for the proper implementation of the various policies, rules and regulations relative to the administration and conduct of the various licensure examinations.

The Licensure Office plan, direct and coordinate the activities and functioning, prepare administrative issuances relative to the administration of application, qualification evaluation, examination, and rating of the examinees for the licensure examinations.

The Professional Regulatory Boards, on the other hand, prepare the examination questions in accordance with the syllabus or Table of Specifications for each subject.

They attend seminars on the preparation and construction of test questions. They prepare the manuscript of the test questions, in handwritten, typewritten or computer-printed format. They are solely responsible for the confidentiality and security for these manuscripts.

Figures 2 and 3 depict the perspectives of the Applicant and the Commission on the Licensure Examination System, while the administrative processes involved in the conduct of licensure examinations are summarized in Figure 4.

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Figure2: The Licensure Examination: From The Applicant’s Perspective

Figure 3: The Licensure Examination: From The PRC’s Perspective

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Figure 4: Administration of Licensure Examinations

Admission of Examinees to the Licensure Examination Applicants are only admitted to the licensure examinations after substantially proving compliance and possession of qualification requirements provided for under the Professional Regulatory Law (PRL) of a given Professional Regulatory Board (PRB).

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Figure 5: Qualification Requirements: Physician Licensure Examination Article III The Board of Medical Examiners; Registration of Physicians Section 8. Prerequisite to the practice of medicine. No person shall engage in the practice of medicine in the Philippines unless he is at least twenty-one years of age, has satisfactorily passed the corresponding Board Examination, and is a holder of a valid Certificate of Registration duly issued to him by the Board of Medical Examiners.

Section 9. Candidates for board examination. Candidates for Board examinations shall have the following qualifications: (1) He shall be a citizen of the Philippines or a citizen of any foreign country who has submitted competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his country’s existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof; (2) He shall be of good moral character, showing for this purpose certificate of civil status; (3) He shall be of sound mind; (4) He shall not have been convicted by a court of competent jurisdiction of any offense involving moral turpitude; (5) He shall be a holder of the degree of Doctor of Medicine or its equivalent, conferred by a college of medicine duly recognized by government; and (6) He must have completed a calendar year of technical training known as internship the nature of which shall be prescribed by the Board of Medical Education undertaken in hospitals and health centers approved by the Board.

The Republic Act No. 2382 or the “The Medical Act of 1959” provides the qualifications to be admitted to the Physician Licensure Examination. These can be seen in Figure 5. Section 8 of the Act states that the Board Examination is a “prerequisite to the 59

practice of medicine. No person shall engage in the practice of medicine in the Philippines unless he/she is at least twenty-one years of age, and has satisfactorily passed the corresponding Board Examination and is a holder of a Certificate of Registration duly issued to him by the Board of Medical Examiners�. Section 9 of the same Act defines the qualifications of the candidates for Board Examinations (Figure 5).

The role of the application division in the admission of applicants to the Board Licensure Examinations: 1. Evaluates all applications to various board licensure examinations 2. Forwards to the Professional Regulatory Boards all applications requiring technical evaluation of training and other qualification 3. Issues Notice of Admission 4. Prepares the Master List of Examinees with their corresponding list of room and building assignments.

The steps in applying for the Board Licensure Examinations are as follows: 1. Submission of personal data through the Online Application System (OAS) at www.prc.gov.ph 2. Presentation of picture for scanning, cropping, editing, uploading in the database 3. Presentation of documentary requirements 4. Printing of Application Form 5. Payment 6. Issuance of the Notice of Admission For the past years, the Commission has adopted another option in applying to the Board Licensure Examination known as the Licensure Examination Registration Information System (LERIS 2.0). This system promises to control the influx of applicants through the appointment system; it reduces the redundancy of tasks as applicants are able to upload their own picture eliminating the process of scanning, cropping, editing and uploading on the part of PRC; reduced transaction time; and cost efficient with more focused evaluation on the part PRC staff.

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The following steps are followed in applying for the Board Licensure Examinations using the Enhanced LERIS 2.0 system: 1. Submit personal data through www. prc.gov.ph 2. Upload picture 3. Pay at any designated payment center (Bayad Center, GCash, Bank) 4. Print Application Form 5. Schedule Appointment with PRC 6. Present documents at PRC on scheduled appointment date 7. Present for biometrics 8. Claim Notice of Admission Figures 6 to 11 show the PRC Online Application System, the Application Form, the Processor Evaluation Form, sample of the Evaluating Form Process, and sample of the Permanent Examination Registration Record Card.

Figure 6: The Online Application System

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Figure 7: Application Form

Figure 8: Application Form

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Figure 9: Processor’s Evaluation

Figure 10: Sample of the Evaluating Process

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Figure 11: Sample of the Permanent Examination Registration Record Card (PERRC)

Admission to the Licensure Examination The Application Division of the Licensure Office evaluates all applications to various board licensure examinations and if the applicant’s documents are compliant, a Notice of Admission is issued after paying the appropriate examination fee. The Division then prepares the Master List of Examinees with the corresponding List of Room and Building Assignments of Examinees. The application processor pairs/ checks the Permanent Examination Registration Record Cards (PERRCs) against the room assignments, then forwards both records to the Examination Division. The Application Processor makes a final review of all applications for deficiencies (Figure 11).

Test Questions Data Bank (TQDB) Every Professional Regulatory Board formulates test questions that are outcomebased, in accordance with the syllabi and Table of Specifications. Subsequent processes include encoding, then merging of the new questions with the unused questions stored in the databank, and finally extraction of 100 questions from the 64

Test Questions Data Bank System. The latter questions will be used for the current board examinations.

A few hours before the start of the actual examination for a given subject, the Board assigned to the subject and the Confidential Room staff enter the Confidential Printing Room for the extraction and printing of test questions. The confidential Printing Room is a restricted area and only authorized persons are allowed to enter.

An NBI or PNP Security Officer is assigned inside the room. Just outside the door of the Confidential Printing Room is a PRC Security Officer.

Conduct of Examinations The Professional Regulation Commission (PRC) conducts Board Licensure Examinations for the 46 Professional Regulatory Boards. A total of 73 Board Licensure Examinations are being conducted every year. Some Professional Regulatory Boards conduct one examination every year and majority, twice a year. Examinations are written except for the Board of Metallurgical Engineering which is computer based.

Practical examinations in addition to the written examinations are being conducted by some Professional Regulatory Boards such as Board of Dentistry and Board of Optometry.

The Commission maintains an Annual Calendar of Board Licensure Examinations which are conducted in schools, colleges and universities in Metro Manila, Regional Offices and Satellite Testing Centers. The National Bureau of Investigation and the Philippine National Police provide the details of security enforcers to ensure the peaceful and orderly conduct of examinations free from any taint of irregularities.

The Professional Regulatory Boards prepare the Program of Examinations. They also prepare outcome based examination questions following their respective Table of Specifications. The questions are prepared in three categories: (1) easy, (2) moderate, and (3) difficult. They subject their test items to Peer Review and item analysis.

On the other hand, the Examination Division coordinates with schools/universities/ college authorities for the use of venues of the examinations, recruits and trains 65

personnel, coordinates with the NBI and PNP, prepares the Special Orders/Travel Orders, prepares the examination materials and prepares the Confidential Printing Room.

Examination Administration Process Inside the Confidential Printing Room, several administrative processes are involved to ensure that the integrity, reliability, efficiency, credibility, and validity of the various licensure examinations are maintained and safeguarded through strict, systematic, and orderly implementation of the standard procedures. The Professional Regulatory Boards and the Rating Division staff are quarantined from the printing of the initial copies until the duration of the examination. The Boards are only released from the Confidential Printing Room one hour after the last subject of the examination are distributed to the examinees.

With strict security measures, the appropriately sealed boxes/envelopes containing the test questions are distributed to the Testing Centers and again following strict administrative procedures, the test questions are distributed to the individual Examinees and collected after the examination where post examination processes are again undertaken per subject.

Correction of Answer Sheets and Release of Examination Results The sealed packages/envelopes containing the answer sheets of the examination are opened in the presence of the Board Member for the particular subject. No human intervention is involved in the process. The Answer Sheets of the Examinees are read through the Optical Mark Reader (OMR). The Answer Key generated by the Board is compared to the answer sheets of the examinee. The Output generated is known as the Score File. The ratings generated in the correction for every subject is deliberated by the Board. The statistics generated arranged from the highest score to the lowest score is reported which is used by the Board in determining the Minimum Passing Level (MPL) of the subject. Transmutation follows and done for every subject and grade of the Examinees. Once MPL is established, the names of the examinees are decoded through the Optical Mark Reader. During the entire process the Board Members and the Rating Staff are quarantined until the release of the 66

results of the examination.Rating and Release of Examination Results: Ratings are mandated by the provisions of the Professional Regulatory Laws. Some Regulatory Laws provide a general average of 75% to pass a given examination, while others require 70%. A Report of Rating containing the subjects covered and ratings of an examinee is generated.

Rating to Pass the Examination To pass the Physician Licensure examination, an examinee must obtain a general average rating of seventy five percent (75%) without a grade lower than fifty percent (50%) in any subject.

Target Date Release of the Physician Licensure Examination Results for 2016 Examination Date Mar. 6, 7, 13 & 14, 2016 Oct. 10, 11, 17 & 18, 2016

Target Date of Release

Actual Date of Release

March 18, 2016

March 16, 2016

September 22, 2016

September 21, 2016

Statistics First Half of the Year

# of Examinees

# of Passers

% of Passing

1,044

483

46.26%

February 2015

832

594

71.39%

February 2014

815

425

52.15%

February 2013

863

420

48.67%

# of Examinees

# of Passers

% of Passing

September 2016

3,695

2,899

78.46%

August 2015

2,921

2,429

85.28%

August 2014

2,730

2,218

81.25%

August 2013

2,211

1,834

82.95%

March 2016

Second Half of the Year

*Performance in the Physician Licensure Examination from February 2013 to March 2016. Note that the performance at second half of the year is much better as compared with that of the first half of the year.

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Summary 1. The Republic Act No. 2382, otherwise known as �The Medical Act of 1959� mandates the PRC - Professional Regulatory Board of Medicine to conduct the licensure examination for Physicians.

2. The Licensure Examination is the instrument of the Filipino people in securing for the nation a reliable, trustworthy and progressive system of determining the competence of professionals by credible and valid licensure examinations and standards of professional practice that are globally recognized.

3. The administrative processes involved in the conduct of the examinations starting from application and approval for admission in the examination to the building and maintenance of Test Questions Data Bank and finally to the conduct of a credible examinations and release of examination results were described.

References: Retrieved from Republic Act 2382 or Medical Act of 1959 amended by Republic Act No. 4224 on June 29, 1965 and by Republic Act No. 5946 on June 21, 1969: http://www.prc.gov.ph/uploaded/documents/MEDICAL%20LAW.pdf Retrieved from Professional Regulation Commission: http://www.prc.gov.ph/about/ default.aspx?id=6 Retrieved from Online Application for Licensure Examination: http://www.prc.gov.ph/online/applic_prc/prc_apply.aspx

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OPEN FORUM Dr. Samar-Sy: There are many graduates who took the board exam several times.

When they fail on the third time, they are supposed to have a refresher course. After that, they can try to take again the exam for unlimited times. Do we have any plans of requiring them again to have a one year refresher course after the sixth take? Or maybe do not allow them anymore to take the board exam and just go back to the medical school?

Dr. Noche: The board of medicine conducted a study which showed that for the repeaters, the percentage of passing is about 30%. The decision of the board that time was to probably scarp up that particular phrase that requires a refresher course after the third examination because they way we look at it, refresher course is not useful. Maybe, as mentioned in my recommendation, if it is the school that will give the review course for that particular group of students, then it may probably be better. So in the amendments of the Medical Act that we have provided in the Senate, we did not mention having another refresher course for repeaters because we did not believe in it.

Dr. Samar-Sy: Tracing the students who did not pass is the problem. They are ashamed, and even if you get in touch with them or ask their classmates to get in touch with them, they wouldn’t come even for a review and even if it is free. If there is a ruling that they should go back for review classes again then maybe that would be better.

Dr. Noche: It is maybe because of the fact that our test questions in the licensure examination is competency-based (which will pretty soon be outcome-based) and if you watch the proceedings of the review, it is mostly lecture. So maybe that is one reason why the performance of those repeaters are not good enough in the refresher course. In fact, we thought of the idea of giving a maximum of 10 takes and that is all. Anyway, the medical act is still floating in the Senate, we can still amend it.

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Dr. Sese: Will the board exam be aligned with the new OBE curriculum? Because the problem with PBL failing to really get high board exam results is because of the misalignment with the PRC. Will we be doing computer-based or a practical exam for that? My second concern is, I am a new dean, and I have inherited a lot of nonpassers. Now the burden is on my shoulders to look for them and to make them pass. What is worse is that some of these graduates have been practicing without license, and hospitals would hire them because there are no other residents to man the hospitals. There were also cases filed since they are practicing without license.

The consultants are affected by this because they use the consultant’s name. This criminalization is very fearful. How can we help these doctors who have not passed the board exam?

Dr. Noche: We always say in the past APMC meetings that the doctors who have failed in the licensure examination are still the responsibility of the medical school.

The common complain of the medical school is that they can no longer trace these doctors. What we are giving them is maximum number of times they can take the licensure exams, after that they can retake the program again and others.

Dr. Sese: In the evaluation of schools, do you really have to include the repeaters and those who are malpracticing? They are no longer part of the school’s responsibility because did not really graduate under our terms.

Dr. Noche: I think you are still responsible and the number of repeaters are still evaluated.

Dean Reyes: We have a sanction. But it is the overall performance of the first takers because while we were discussing that we thought ‘why not consider the overall?’ and the directors of OPD said that ours is not about looking for the recognition or who’s at the top, but it is more of sanction for sanction purposes.

Dr. Noche: Actually what the CHED requested the school was to submit their total first timers and repeaters. But then the office took the first-time takers only, and that made the school very happy.

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Dr. Sosa: Assuming that the examinations that we are giving the Philippine Licensure Exam is valid, and the goal of the exam is for the graduate to practice medicine, is it also a tool wherein you can give an assessment to the medical school as regards to their performance? Not just on the percentage of the students passed but likewise, the areas of improvement to the respective medical school where most of the student failed to accomplish. Is it part of your mandate to give us a feedback as regards to which of these areas we need to improve so that the schools can do better in the next examination?

Dr. Noche: We will look at the record of the school as far as repeaters are concerned.

Although it is not included in the evaluation, we look at it.

Dr. Mejia: I requested PRC to give us the percentile ranking of our school. That is very important because you may have 100% passing mark, but if your percentile ranking is askewed to the left, then it is different as when your percentile is askewed to the right. As of now, we have not received that yet from the PRC, but this is going to be very helpful for the school.

Dr. Noche: Once we receive that, we will endorse it to the statistics office.

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THE ECLECTIC NATURE OF PHILIPPINE MEDICAL CURRICULA Melflor A. Atienza, MD, MHPEd, FPCP, FPSG Professor, National Teacher Training Center for the Health Professions University of the Philippines Manila Introduction Schools are expected to produce graduates that will serve society. The school curriculum is the guide of administrators in implementing the program, of teachers to teach effectively, and of students to achieve the outcomes expected of them. But curriculum is an abstract concept that is difficult to define. Genn (2001), adapting the words of Voltaire speaking of philosophy, described curriculum as “when they who hear do not know what they who speak mean, and when they who speak do not know what they themselves mean.”

This was written in jest to drive the point on the difficulty in giving one definition of curriculum. Experts in education have given varying definitions, from “knowledge coming from the disciplines,” (Phenix as cited in Henson, 1995) to “experiences learners have under the guidance of a teacher,” (Caswell and Doak as cited in Henson, 1995). Curriculum can be seen as written plan or actual experiences. McDonald viewed this as a means while Popham and Baker describe this as the ends the school needs to achieve (Cited in Henson, 1995). Putting these together, curriculum then is a plan for instruction describing the experiences learners go through under the teacher’s guidance aimed at achieving intended outcomes.

Foundations of Curriculum Planning Outcome-based education (OBE) curriculum design begins with clear, explicit articulations of learning outcomes that graduates should be able to demonstrate at acceptable professional standards. These learning outcomes arise from the needs of society that schools hope their graduates will competently address. Understanding the nature of the curricula of the 46 medical schools in the Philippines should 72

therefore begin with understanding the health problems and healthcare situation in the country. There are new and emerging diseases that physicians and health professionals continue to address. Dr. Antonio Dans, during his lecture for the “Current Status of Basic Medical Education in the Philippines� on May 25, 2016, summarized the problems we continue to face as issues of healthcare, inequity in access to healthcare, workforce shortage, problems with administration and policies, and persistent inequity in health outcomes.

The rapidly expanding knowledge and advancing technology are real challenges to physicians dealing with a different kind of clientele, who are more informed, more demanding and presenting with varied needs. Frist (2005) explained beautifully how the 21st century patients can personally engage their preferred health professionals from physicians to nurses to emergency responders and keep them updated on their conditions. Such required online documentation of everything happening with the patients who themselves control their own medical records.

When the Association of Philippine Medical Colleges (APMC) was established 50 years ago, there were only six medical schools. Since that time, forty other medical schools have risen. In 2015, more than 3000 new physicians were sworn into the profession. Despite this number, the country’s 100 million population still lack physicians. According to the Department of Health, there are only seven doctors per 10,000 Filipinos. To reach the desired ratio of 1 physician for every 1,000 population, 30,000 doctors are still needed. Furthermore, these numbers alone do not reflect the maldistribution of physicians, who are concentrated in the urban areas.

Add to this the poor health-seeking behavior of some patients and what results is not only the trend in mortality and morbidity but the fact that more than half of the patients who died of the top 10 killers in the country have not seen a health professional (Department of Health, Philippines, 2013).

These are the issues, problems and challenges, the realities that medical schools should have prepared their students to address by the time they graduate. Aside from these realities, Zais (1976) explained that curriculum designers should formulate 73

a learning theory where the basic knowledge, skills, and attitudes (KSA) can be organized to respond to the needs and capabilities of the learners who need to be prepared for the professions. The teachers and school as an organization should likewise prepare themselves for the delivery of these KSAs to ensure effective implementation.

Figure 1: The Eclectic Curriculum

The eclectic nature of curriculum in Philippine medical schools Philippine medical schools have only the population health problems and the advancing knowledge and technology as the homogenizing elements in choosing their philosophical reality and epistemology. All these institutions vary in focus, delivery strategies, and values on which realities should be addressed the most. Through the help of APMC, we surveyed the deans informally by cell phones and asked them their respective curriculum designs. The curricula of 36 of 46 medical schools are summarized on the chart. Twelve medical schools are implementing discipline-based curriculum; nine are following the hybrid curriculum, or eclectic curriculum. This means combining whatever is best or useful in many systems and applying them. Although the rest have stated following one type of curriculum, schools have adopted various 74

innovative strategies in order to ensure producing competent graduates.

Figure 2: Types of Curricula of Philippine Medical Schools (N=36) 14’’ 12’’ 10’’ 8’’ 6’’ 4’’ 2’’ 0’’

Discipline-based

Hybrid

Outcome/ Integrated Competency-based

Problem-based

Communitybased

Curricula can be viewed as focusing on products or outcomes and on the process or procedures. They are more distinctly explained in the table below.

Table 1: Comparison of Product and Process Oriented Curriculum Designs (O’Neill, 2010) Curriculum Models

Types of Curriculum

Focus

Product

• Performance-based • Discipline-based • Integrated

• Plans and intentions • Precise assessment • Choice through electives

Process

• Experiential-based • Problem-based

• Learning activity • “Getting ingredients right” (processes, messages, conditions) and outcomes will follow

Schools at times set the outcomes, thereby being product curriculum model. But they also focus on specific approaches, strategies or activities that is believed to 75

ensure competence. Hence, many of the current medical schools use a combination of product and process model.

Expectations of Professionals in the Workplace But regardless of curriculum designs and their actual implementation and delivery strategies, medical schools are expected to produce graduates who should be able to demonstrate the standard learning outcomes set for physicians. The essence of outcome-based education (OBE) is that schools may choose their own ways of teaching, in what form, pacing, environment, etc. But the final reckoning will be if graduates are able to prove they can demonstrate autonomy, complexity, and responsibility and accountability, can be in control of their work environment, able to make discrete judgment calls and decision (International Labor Organization, 2006).

Medical schools are actually at liberty to organize and deliver their own combination of the best features of curriculum designs but in the end, they are expected to have prepared their graduates to show that they can perform professional competencies independently or with minimum supervision. They should also expose their students to maximum learning opportunities so that they can analyze problems and situations systematically and scientifically, can make critical decisions, and remain in control when complexities occur in the workplace.

Finally, medical schools, being the primary socialization agent that prepares the physicians as “captains of the ship� of the medical team, they are expected to inculcate in their students that the sense of responsibility and accountability should be in their core character. The ability to acknowledge one’s own limitations, standing firmly for decisions and choices made, and performing all their actions with the intention to deliver the best care to their clients should be firmly established in all medical students, teaching them these values from their first up to their last years in medicine.

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Conclusion Medicine is a noble profession. Among the professions in modern society, it also enjoys the highest esteem. But with the prestige comes responsibilities. Medical schools are challenged to respond to the global call for transformative learning and address real population health problems. The iconic Yoda in the classic hit “Starwars” movie said “Always remember: your focus determines your reality” and most aptly captures this call. Let us implement the teaching of the learning outcomes in medicine with the genuine passion and commitment. Then we can hope that our graduates can be what our good Archbishop Antonio Cardinal Tagle described, in his commencement speech during the University of the Philippines Manila Graduation Ceremonies (2014) as the real agents of social reform: “Sana sa inyong paglalayag, makita pa lang kayo, sasabihin na nila ‘Salamat, nakakita ng kami ng mapagkakatiwalaan.’ Hindi sukatan ng dangal at katapatan ang maraming alam lamang.”

References: Frist, William H. Health care in the 21st century. New England Journal of Medicine.

2005. 352: 267-272.

Department of Health. (2013). Mortality: All cause by attendance. http://www.doh.gov.ph/mortality.

Henson RT. (1995). Curriculum Development for Educational Reform. New York: Harper Collins College Publishers.

O’Neill, G. (2010). Overview of Curriculum Models. UCD Teaching and Learning Resources. www.ucd.ie/teaching.

Zais, R. (1976). Curriculum Principles and Foundations. New York: Harper and Row Publishers.

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IMPLEMENTING LEARNING OUTCOMES IN THE MEDICAL CURRICULUM Erlyn A. Sana, PhD Professor, National Teacher Training Center for the Health Professions University of the Philippines Manila Introduction Outcome-based education (OBE) as a curriculum and instructional design focuses on the clear identification of learning outcomes that learners should be able to demonstrate as evidence of achievement. Spady (1994) describes these learning outcomes as: • Clear learning results that we want students to demonstrate at the end of significant learning experiences • Tangible application of what has been learned • Actions and performances that embody and reflect learner competence in using content, information, ideas, and tools successfully • Defined according to the actions or demonstrations As an educational design, learning outcomes serve as the main focus in determining what to teach or what competencies learners should be taught, how to teach them or the delivery strategies, and in assessing learner achievement as well as the quality of any educational program. OBE puts premium on learning outcomes which, once achieved by the learners also establishes their educational qualifications acceptable according to the Philippine Qualifications Framework (PQF). In general, licensed graduates of medicine are qualified to get Level 7 educational qualification in the PQF. (Commission on Higher Education (CHED) Memorandum Order No. 18, Series of 2016; En banc CHED Resolution 038-2001).

Learning Outcomes in Philippine Basic Medical Education According to the Commission on Higher Education Memorandum Order (CMO) Number 18, Series of 2016, graduates of medicine should be able to demonstrate the 78

following learning outcomes: 1. Demonstrate clinical competence 2. Communicate effectively 3. Lead and manage health care teams 4. Engage in research activities 5. Collaborate within inter professional teams 6. Utilize systems-based approach to healthcare 7. Engage in continuing personal and professional development 8. Adhere to ethical, professional and legal standards.

9. Demonstrate nationalism, internationalism and dedication to service 10. Practice the principles of social accountability These learning outcomes (LOs) reveal that Filipino physicians are competent general medical practitioners, self-directed and regulated learners, team players, socially accountable, leaders and managers, and advocates of social change. While being socialized professionally to respond to national health and development problems, they should likewise be competent to deal with the same concerns of other populations of different countries and cultures.

To determine the congruence of these learning outcomes with the rest of the world’s, I compared them with the learning outcomes in post-graduate medical curriculum of the Accreditation Council of Graduate Medical Education (ACGME) and the World Federation for Medical Education (WFME). Table 1 presents the strong and constructive alignment of these learning outcomes.

Table 1: Comparison of Learning Outcomes Basic medical education (Philippines; CMO 18, s. 2016)

ACGMCE, US (2005)

WFME, Europe (2003)

1. Demonstrate clinical competence

Patient care, medical knowledge

Patient care, medical knowledge

2. Communicate effectively

Interpersonal & communication

Interpersonal communication skills

3. Lead and manage health care teams

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4. Engage in research activities

Appraisal & utilization of new knowledge, scholarly capacity to contribute to research & development

5. Collaborate within inter professional teams

Practice-based learning

Function as supervisor, teacher, and trainer

6. Utilize systems-based approach to healthcare

Systems-based practice

Ability to understand health care, & identify & carry out system-based improvement of care

Professionalism

Professionalism

7. Engage in continuing personal and professional development 8. Adhere to ethical, professional and legal standards.

9. Demonstrate nationalism, internationalism and dedication to service 10. Practice the principles of social accountability

Interest and ability to act as advocate for patients, Knowledge of public health and policy issues

Knowing that the healthcare systems of the US and Europe are basically primary health care in nature, we can understand the blank cells in the ACGME and WFME. My task is discuss the implementation of these LOs in basic medical education. I could not pretend to be knowledgeable about how they can and should be carried out in the actual curriculum because I am not a physician and I hardly teach and interact with medical students. Allow me then to share my actual experiences in some projects that I have been privileged to do with medical and other professionals.

These commissioned projects directly impact on teaching medical students.

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Best Practices and Lessons Learned from Two Case Studies Table 2 presents two case studies of these projects that I have completed in the past 10 years. I was the project leader in these commissioned works that were completed from 2003 to 2016.

Table 2: Comparison of Two Case Studies Project Descriptions and Accomplishments

Case Study 1

Case Study 2

General title

Competency-based programs for medical, allied medical, and law practitioners

Integration of tuberculosis (TB) control in Philippine medical curriculum

Specific projects

Post-graduate training of general practitioners, pediatricians, internists, obstetriciansgynecologists, family and community physicians, social workers, nurses, midwives, family court judges and personnel in handling victims of abused women and children (2006 to the present)

Development of core curriculum integrating TB and Directly Observed Treatment Short Course (DOTS) therapy in Philippine medical schools (2003 to the present)

Deliverables

• Department of Health’s Administrative Order 20130011: Revised policy on the establishment of women and their children protection units in all government hospitals • Training manuals on the 4Rs: recognizing, recording, reporting, and referring women and children abuse • Competency enhancement training for family court judges and personnel published in Child Abuse Review (International Journal by Wiley and Sons).

Volume 23, Issue 5, Pages 324 - 333, September/October 2014. First published online in the Wiley Online Library (wileyonlinelibrary. com) DOI: 10.1002/car2255, 13 March 2013

Curricula ready for integration in various designs or medical prog grams from Flexnerian, to competency-based, communitybased, problem-based, eclectic designs (published in Annals Academy of Medicine, Singapore.

November 2007. Vol. 36, No. 11, pages 930-936)

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1. Collaborative Practice, Interprofessional, Multi-Disciplinary, & Team-Based Approach Both case studies needed an assembly of various professionals. My colleagues and I from the National Teacher Training Center for the Health Professions (NTTCHP) composed the health professions teachers. In the first case, we worked with medical and law faculty members who were also champions of women and children protection work. In the second case, I had the privilege of working with champions and advocates against TB. Our collective inputs in the medical curriculum and post-graduate programs in medicine developed into a completely new design that integrated women and children protection work, as well as TB as a biomedical and socio-psychological construct. This best practice clearly addressed Learning Outcome 2: Communicate effectively and LO5: Collaborate within inter professional teams.

2. Network with Relevant Partners Both projects were commissioned by many agencies and partners. The first case involved NTTCHP through me, and we needed the administrative clearance and support of the University of the Philippines Manila (UPM). The Department of Health and its specific bureaus namely the Family Health Office, Health Human Resource Development Bureau, and the Health Emergency Management Staff served as our main partners that commissioned to us first case study. The Philippine Judicial Academy of the Supreme Court of the Philippines commissioned the training of law practitioners. In the course of developing and implementing the first set of trainings, various agencies were likewise involved such as the Philippine National Police, Department of Interior and Local Government, and the Philippine General Hospital.

The second set of projects on TB DOTS enabled us to work with not just UPM but also the Association of Philippine Medical Colleges (APMC), selected medical schools like UP, the University of the East-Ramon Magsaysay Memorial Medical Center, the De La Salle Health Sciences Institute, and non-government organizations notably the Philippine Tuberculosis Society, Inc. (PTSI) and the Philippine Coalition Against TB (PHILCAT). Funding agencies for the first set of projects were provided by The British Embassy in Manila, the Department of Health, and the Supreme Court of the 82

Philippines. The second set of studies were supported by PTSI, PHILCAT, and the United States Agency for International Development (USAID) through the Innovations and Multisectoral Partnerships to Achieve Control of Tuberculosis (IMPACT). The series of long and continuous engagements with these partners were built-in features that made us adopt the systems-based approach to transformative learning in the health sciences. It was obvious that we could not proceed to specific phases of the project without the others. Their inputs did not just enrich the curriculum designs but also facilitated their implementation. In this particular best practice, LO3: Lead and manage health care teams and LO6: utilize systems-based approach were inevitable components that contributed to the effective implementation of the projects.

3. Begin with Needs Assessment In all the projects for both cases, a series of consultations with all stakeholders was conducted. This activity was performed to systematically gather data to determine what is out there all along, and how are things done by whom, when, at what costs.

In this series of needs assessment, our teams were already able to identify and collect rich data, artifacts, and other documents that guided our succeeding work.

These data and documents were compared and reconciled with existing research evidence. We experienced and implemented in this practice both LO4: engage in research activities and LO6: utilize systems-based approach in healthcare.

4. Based on Honest Results in the Needs Assessment, Design Back True to the design of outcome-based education, after the formal and systematic needs assessment and multi-stakeholders consultations, both projects developed the main training and curriculum designs. Program outcomes, subject matter, delivery strategies, assessment, monitoring and evaluation plans were derived and systematically formulated, even before higher education institutions were mandated to shift to OBE. The case of the programs with the Supreme Court of the Philippines paved the way for the completion of six module videos that are now part of the institutionalized training programs of the Philippine Judicial Academy. These instructional videos are available in compact discs and because they can easily be transported, are also being used by the academy in training legal personnel who are not actually involved in court proceedings. The Child Abuse Sensitivity Inventory 83

has also evolved to other instruments leading to measuring sensitivity to child trafficking and cybercrime. Those who pursued child and women protection work after the series of our trainings were awarded additional professional certificates of competence as child and women protection specialists. In the case of the TB DOTS projects, selected medical faculty and their institutions were given recognition as Master TB Educator awardees. These best practices reflect the implementation of LO1: demonstrate clinical competence and LO7: engage in continuing and personal development.

5. Sustainability Mechanisms In Place, With Social Accountability and Due Diligence Checks Spread throughout the projects were the holding of regular meetings and consultations with partners and stakeholders. During these meetings, our teams agreed to set some standard operating procedures which evolved into professional norms which we proudly claimed as our additional qualifications of quality. The succeeding offers to pursue more projects are testimonies to our professionalism.

These standard operating procedures SOPs include systematic and updated documentation of everything, informing all concerned partners of progress reports, regular financial and liquidation reports, and safe custody of all records and funds.

These SOPs were kept even after the projects were completed and challenged all of us to document the experience in form of publications. Coming up with journal articles were really not part of the deliverables but with due diligence, we were able to publish the competency training for family court personnel in the British Child Abuse journal while the TB DOTS project was published in the Annals of Academy Singapore. They also gave us plenty of opportunities to present the various outputs in national and international conferences. The latest we had was in the conference of the International Society for the Prevention of Child Abuse and Neglect in Dublin, Ireland in 2013. The TB DOTS project was a constant feature at the national conventions of APMC and NTTCHP. These accumulated experiences are clear implementations of LO8: Adhere to ethical, professional, & legal standards, LO9: Demonstrate nationalism, internationalism, & dedication to service, and LO10: Practice the principles of social accountability.

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Conclusion The conscious and deliberate shift to OBE might look overwhelming in the beginning.

But medical schools and the rest of institutions involved in higher education, in many indirect and unconscious ways have actually been teaching and implementing medicine the outcome-based way. With the formal articulation of learning outcomes in basic medical curriculum and the experiences I discussed in this document, I have strong confidence that our medical schools, through the continuous leadership and vision towards transformative learning of the APMC, will be able to carry out the desired learning outcomes in the next coming years. Happy 50th anniversary APMC! Bibliography Commission on Higher Education. (2001). CHED en banc resolution. Retrieved from http://www.chanrobles.com/bacheloroflawsmastersdegree.htm#.VB5j6PldXWE Commission on Higher Education. (2012). Policy standard to enhance QA in Philippine higher education through outcome-based and typology-based QA. Quezon City: Commission on Higher Education.

Commission on Higher Education. (2016). CMO 18, Series of 2016: Standards, Policies, and Guidelines for Medical Education. Quezon City: Commission on Higher Education.

Global Consensus on Social Accountability. (2010, December). Global Consensus on Social Accountability for Medical Schools. London, United Kingdom, UK. Mezirow, J., & cited in Glisczinski, J. (2007). Transformative higher education: a meaningful degree of understanding. Transformative Learning Journal 5 (4), 317328.

Republic of the Philippines Official Gazette. (2012). Executive Order 83 Series of 2012: Institutionalization of the Philippine Qualifications Framework. Manila: Office of the President.

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Sana, E. A., Herrera, A. H., Avellano, A. A., Legarda, K., Vilches, N. C., & Madrid, B. J. (2013). Competency enhancement training of family court judges and personnel handling child abuse cases. Child Abuse Review (International Journal by Wiley and Sons)., 324-333.

Sana, E. A., Roxas, A. B., & Reyes, A. L. (2015). Introduction to Outcome-Based Education: The Philippine Health Professions Education Experience. Philippine Journal for Health Research and Development, 60-74.

Sana, E., Atienza, M., Madrid, B., Legarda, K., Avellano, A., Fajutagana, N., . . . Pareja, M. (2012). Development of Problem-Based Learning Training Manual on the 4Rs (Recognizing, Recording, Reporting, and Referring) of Women and Child Abuse for Pediatric and Obstetrical-Gynecologic Residency Program. Manila: Family Health Office, Philippine Department of Health.

Spady, W. (1994). Outcome-Based Education: Critical Issues and Answer. American Association of School Administrators.

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OPEN FORUM Dr. Cueto: Assessing learning outcomes will be the most problematic task. After its assessment, how is it going to be documented? In OBE, it has to be an individual assessment. If you are handling a class of 150, giving each of them an opportunity to demonstrate their skills, knowledge, and values, and then add to it the degree of independence, will be a very difficult task. There is a reason why I only admitted 18 students in my school, and 25 students this coming year, so that in one session, I will be able to at least give half of them a chance to demonstrate.

Clinical competence is the first in the 10 learning outcomes. Since the passing percentage of each institution is a very big part of how CHED, the Technical Committee on Medical Education, and PAASCU will be evaluating the medical schools, you will still not be able to remove the emphasis of the medical schools on teaching clinical competence and then relegating the other 9 for the simple reason: when they take their licensure exams, the exam is only focused on testing the clinical competence under the R.A. 2382. So for the medical schools, how are we going to assess and document in an individual basis? For the board of medicine, how will they come up with changes in the questions when they are making examinations under Republic Act 2382 or the Medical Act of 2009 which states that written examination on the 12 subjects will be given?

There will be no chance for testing integration in the different subjects because all of those are discipline-based. A school’s curriculum may be innovative but the test in discipline-based. There are some non-alignment as far as that is concerned. Our exam questions will be outcome-based assessment framework, and then we will try to see how they will come out since that will entail adjustments from the medical schools. But overall, it is at the level of the medical schools where these 10 program outcomes should be assessed; not at the level of the board of medicine, because the licensure exams just provide a threshold. When a medical graduate already exceeds the medical threshold, he is admitted to the profession of medicine. The 9 other program outcomes may not be tested in the licensure exam.

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Dr. Sana: There are best practices that are already succeeding in many schools around the world that are outcome-based so there is recognition of outcome-based assessment. Even before outcome-based assessment, we are already doing this with the performance-based assessment. If you know about the Miller’s Pyramid, there are layers of Knows, Knows How, Shows, and Does. Each layer of that pyramid are corresponding best practice outcome-based assessment. The assessments vary from the usual tests: the written examinations, to the usual practical examinations, etc., all the way to the preparation of an electronic portfolio.

According to the Miller’s pyramid, portfolio is one of the best ways you could determine the quality of clinical competence because it is a multi-sectoral feedback accomplished by several raters including the individual learner. There is also a corresponding corroborating documents and evidence of the achievements reached by the students. OBE will certainly be what you will need in the next few semesters.

Dr. Mejia: Even if it’s OBE there is a chance of integrating the exams and what we teach in the classroom. It is just a matter of learning how and how to put it in practice.

From the floor: In education, there is no perfect curriculum as every curriculum is a dynamic process. How long are we going to embrace this kind of curriculum when we have so many types or models of curriculum previously adopted which have been branded to be better? Now that outcome-based is here, what do we expect in the near future considering that the medical education is now embracing such kind of curriculum?

Medical schools are now being tasked to comply with the OBE. I have been reading about outcome-based curriculum and there are no empirical evidence that really prove its effectiveness. There are some researches that show that there are some drawbacks when it comes to outcome-based curriculum. Therefore, we should not think that the outcome-based curriculum is the perfect model for any educational system.

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Dr. Atienza: Actually, even in our book, we did not discuss a lot about outcome-based education because at that time, it was the competency-based curriculum that was really being followed. We are also aware of the studies that OBE may not be working but usually these studies are for primary and secondary levels. For higher education, the emphasis are on the outcomes. How long will this be? Well, we’re really not sure if there will be another one that is coming, but when you look at all the curricula, if we make the outcomes clear and we make sure that whatever strategies we use will be towards the outcome, the assessment will follow.

Assessment, as mentioned, is not entirely about looking at the performance in the clinical setting. Even a written exam, if focused in higher order of thinking skills, will contribute to the assessment of the student. That will be one way of implementing outcome-based education and ensuring that every graduate is competent to handle the patients that they are given, as well as the roles that they are expected to do after graduation.

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SYNTHESIS Zorayda E. Leopando, MD Professor Former Vice Chancellor, College of Medicine University of the Philippines Manila We started with a good prayer from Dean Dino and he talked about change and a lot of things about change.

I like the presentation of Dr. Tony Dans and I think all of you liked his presentation, but it is really a challenge on how we can address what he has raised because basically, he raised the need to focus on primary care in the academe. He said this is what the country needs.

He prepared a roadmap for us and it includes some sort of a ladderized curriculum.

It involves 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 who come to see them.

He emphasized on recruitment, retraining, retention, regulation, and reassessment of primary care physicians. He gave some suggestions on how recruitment and retraining can be done, including some specialists who might be interested to go into primary care. The very important thing is retention because as of now, the project that the government has will not really retain doctors. Like for example, the Doctors to the Barrios program is only for two years, when what we want to happen in primary care is that the doctors who are trained to provide continuing care to the population who are registered to them so that there will be more comprehensive, continuing, and relevant care.

Going into primary care is not a temporary thing that when you are done, you can leave. The countries who have shown good outcomes has primary care physicians 90

with the primary care serving on a long-term basis. Dean Retta Reyes discussed the policies, standards, and guidelines on medical education which already has a number CMO18 series of 2016. This has been disseminated and there are standards that are to be complied with, and the areas for evaluation are the mission and vision of the school organization and administration, curriculum and instruction, issues about the faculty, the students, including admission, facilities, laboratory and clinics, library resources, the base hospital, the community outreach program and physical plan.

She also related to us 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 interprofessional 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.

I think one of the most difficult program outcomes is how to demonstrate nationalism and internationalism and I once asked my interns in the community – how do you think nationalism can be best taught to the medical students? They said – “Ma’am, every day we sing the national anthem and recite “Panatang Makabayan,” exposure to the community, living with them is another thing because they’ll get to know what are needed”.

We listened to Dr. Arcadio’s presentation and he gave us the sources of accreditation, the aim of accreditation, the process of accreditation, and both Dr. Reyes and Dr. Arcadio utilized the World Federation for Medical Education 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 then the global standard coming from WFME. Dr. Arcadio also discussed 91

the benefits of getting accreditation. He gave the process of accreditationand he emphasized that the most important aspect in accreditation is the self-assessment.

He can relate it to the most important thing that every one of us should do regularly–self-assessment. Dr. Erlyn Sana mentioned something about her doing self-assessment after her return. This is something we had to do regularly also so that we will know if we are still relevant, or if there are things we need to learn.

He said that the institutional-self survey is the most important because when the accreditation team comes, they will just do validation. There are survey visits, initial accreditation, and he gave the stages of accreditation.

It’s the presentation of Dr. Arcadio that had many questions, the first being – “why do we have to wait for new medical schools to have three batches of graduates and who have taken the examination before they are accredited. If it is developmental, the accreditation process should be earlier so that it can be addressed. The response is, even the new medical schools can already apply for accreditation. But it’s not for accreditation alone, but for consultancy visit so that whatever problems, these can be brought up and the solutions can be discussed. Assistance can be given by CHED itself and APMC who are jointly monitoring the medical schools, and the APMC helps with the academically-challenged medical schools.

We had the presentation of Dr. Noche on medical licensure exam wherein he gave the requirements, qualification, process of application, and the process itself, emphasizing that there is a table of specification that they are following. However, this is still discipline-based.

The main question here that was raised was the issue on repeaters. What are the things that can be done because after three failures, they have to go back to the medical school for a one year refresher course? But then, the medical schools are saying that these repeaters do not appear and they do not go to the medical schools anymore probably out of shame or for whatever reasons. The medical schools are not able to help the repeaters because they no longer come back for help.

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It was asked if we can possibly have a limit to the number of times the repeaters can take the examination. Dr. Noche even cited the bar examinations which can be taken 10 times. These are things that will be studied and possibly, see how can be integrated with the Medical Act. Dr. Noche also added that the examinations that they are doing are still based in the Medical Act of 1959. This is so because we really do not have a medical act to replace the 1959. There were series of amendments but we need to have a new one. Doctors should probably work together to make sure that we will really have a new one.

Dr. Noche gave recommendations on what can be done with regard to the examination like conducting career orientation of students entering the Doctor of Medicine program. Usually, the career orientation is done when they are about to graduate already. This should be moved forward to the time that they entered the school. Review the admission criteria of medical schools for students to determine whether these students are really fit to take medicine or if they really want to be in 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. Some medical schools are already doing comprehensive examination but they are recommending that it should be given in the middle so you can make an assessment and see how you can further improve the training program.

Involve actively the medical schools in the review and development of new table of specifications. Continuous development of the faculty and becoming effective education, from entry of students until graduation. We know that we are experts in the field of medicine that we have specialized, but how to teach is not part of our training. So if we are going to have faculty development, teaching effectively should be part of that.

Provide adequate facilities in support of the outcome-based education; intensify monitoring and evaluation of the implementation of the new medical curriculum.

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There was a question on whether the examination is aligned with outcome-based, the answer is, shift to outcome-based test questions; intensify the monitoring of low-performing schools and provide strategies on how to improve; address the firsttime repeaters, their needs; encourage a review for repeaters under the schools where they graduated.

We went to the lecture of Dr. Melflor Atienza on the eclectic nature of the Philippine medical curriculum. They made a survey on the kind of curriculum that the 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 2 or 3 answers.

She also talked about the different principles in medical education, the strategies and the implications. Those were the things that we have to do and these are the implications of all these principles.

With Dean Erlyn Sana, she discussed the Philippine quality framework which is important especially now that we have gone into ASEAN Integration. She repeated the 10 learning outcomes, and because her topic is implementation, she shared with us the projects that they have done. For the activities and the results, she related this to the 10 learning outcomes. She also made comparison on basic medical education learning outcomes, the American competency in general medical education. The competencies that the US have are being used not only by the specialty, but also 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 - one who is clinically competent, self-directed and regulated learner, team player, socially accountable, leader and manager, and advocate.

We were supposed to come up with general guidelines on the implementation of strategies for change and constructive reforms in medical education when we have 94

transcribed all the questions and answers in the open forum. We will disseminate these to all the participants so that you can give your input because everything that happened here, everything that were presented, every question and answer exchanged during the open forum will be included in the monograph that the NAST will be publishing. This is a follow up to what was done 10 years ago on basic medical education.

We’d like to thank all the speakers for all the comprehensive sharing. We can say that there is consistency is what the speakers have said such as: • the need for transformative medical education relevant to what the country needs; • elevate quality of medical education through monitoring and accreditation; and • the need to align OBE with the way Physician Licensure Examination is undertaken.

Good afternoon to all.

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CLOSING REMARKS ACD. Carmencita Padilla, MD, MAHPS Professor and Chancellor University of the Philippines Manila I just want to take this opportunity to actually thank the community of deans and academics from the different schools for this activity.

I do want to make a few commitments even if I’m not the president of NAST, but Chancellor Arcadio, you don’t have to wait ten years; I will support another activity in five years’ time. I just want to share with you that Dr. Arcadio approached me a few months ago, but who can say ‘no’ to Dr. Arcadio? We have to produce it! We had to produce this event, including the monograph that we have committed. NAST is indeed lucky to have a community of deans interested in improving the future of our future doctors.

Once again, I do want to thank APMC for this activity. In behalf of NAST, we look forward to working with you in the future, and my commitment is there because I’ll still be around in the next 5 years. Thank you!

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THE EDITORS Ramon L. Arcadio, MD, MHPEd Dr. Arcadio is a pediatrician and medical educator. He is an advocate and pioneer in quality assurance and accreditation of medical schools and pediatric residency training programs. He initiated and organized the shift of the INTERMED PROGRAM of the UP College of Medicine from the traditional to the Organ System Integrated Curriculum. He organized the expansion of the UP Manila School of Health Sciences in Baler, Aurora and Koronadal City. He is the first and founding chair of the Department of Family and Community Medicine of the UP College of Medicine and Manila Doctors Hospital. He initiated the two-track residency training and fellowship programs at the UP-PGH. At present, Dr. Arcadio is a Professor Emeritus of Pediatrics at the UP Manila. He is a former chancellor of UP Manila and a former dean of the UP College of Medicine.

He obtained his master’s degree in health professions education at the UP Manila National Teacher Training Center (UP-NTTC).

Zorayda E. Leopando, MD, MPH Dr. Zorayda E. Leopando, Professor of Family and Community Medicine at the College of Medicine, U.P Manila, finished Family Medicine, Public Health and Academic Family Practice. Her interest in Primary Care led to the workshop on “Review of Core Curriculum in Community Medicine” and possibility of integrating Family Medicine” with the final version “Integrated Core Curriculum in Family and Community Medicine” published in 2008. As vice chair of the Task Force for the DOH Family Medicine Residency Training Program, she helped organized 18 programs starting 2013.

Dr. Leopando is Founding President of the Foundation for Family Medicine Educators. She established two academic links in Primary Care with the United Kingdom. She initiated the Master of Science in Clinical Medicine – Family and Community Medicine, with graduates from the Philippines, Indonesia and Vietnam.

Dr. Leopando is founding co–editor in chief of the Asia Pacific Family Medicine Journal and editor in chief of two volumes of Textbook of Family Medicine.

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CHED Memorandum Order No. 18 Series of 2016 Republic of the Philippines Office of the President Commission on Higher Education CHED MEMORANDUM ORDER No. 18 Series of 2016 Subject: POLICIES, STANDARDS AND GUIDELINES FOR THE DOCTOR OF

MEDICINE (M.D.) PROGRAM In accordance with the pertinent provisions of the Republic Act 2382, otherwise known as the “Medical Act of 1959 as amended”, and Republic Act No. 7722, otherwise known as the “Higher Education Act of 1994”, in pursuance of an outcome-based quality assurance system as stipulated under CMO No. 46 s. 2012 and for the purpose of rationalizing medical education in the country with the end in view of keeping apace with the demands of national relevance and global responsiveness, the following Policies, Standards and Guidelines (PSGs) for the Doctor of Medicine Program are hereby adopted and promulgated by the Commission.

ARTICLE 1 INTRODUCTION

Section 1. Rationale Based on the guidelines for the implementation of CMO No. 46 s. 2012, this PSG implements the “shift to competency-based standards/outcome-based education.” It specifies the “program outcome/core competencies” expected of Doctor of Medicine graduates “regardless of the type of higher education institution (HEI) they graduated form.” However, in recognition of the spirit of learning outcomes/competency-based/outcome-based education and the typology of HEIs, this PSG also provides “flexibility and ample space for HEIs to innovate in the curriculum in line with the assessment on how best to achieve program outcomes in their particular contexts and respective missions.

ARTICLE II AUTHORITY TO OPERATE

Section 2. Government Authority All higher education institutions (HEIs) intending to offer the Doctor of Medicine program must first secure proper authority from the Commission in accordance with the existing rules and regulations and the provisions in this PSG. All HEIs with an existing Doctor of Medicine program are required to shift to a learning outcomes/competency-based/outcome-

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based approach as mandated by this PSG. Autonomous and deregulated institutions, State universities, and colleges (SUCs), and local colleges and universities (LCUs), upon approval by their respective governing boards, should likewise strictly adhere to the provisions in this PSG, CMO No. 40 s. 2008 “Manual of Regulations for Private Higher Education” and CMO No. 2 s. 2004 “New Procedures in the Processing of Applications of Government Authority to Operate Doctor of Medicine and Bachelor of Science in Nursing programs.”

Article III GENERAL PROVISIONS The Articles that follow provides for the minimum standards and other requirements, which are expressed as a set of desired program outcomes as stated in Article IV Section 4. The minimum number of units of this curriculum is hereby prescribed under Section 13 of RA 7722 otherwise known as “Higher Education Act of 1994” and a brief description of the curriculum map is shown in Article V Section 7.1. In addition, using a learner-centred and learning outcomes/competency-based approach, outcome-based education, the suggested curriculum delivery methods are shown in Article V Section 9. The description of course syllabi provided in Article V Section 10 contains some of these methods.

Based on the curriculum and the means of its delivery, these guidelines provide the physical resource requirements for the library, laboratories and other facilities and the human resource requirements in terms of administration and faculty as shown in Article VI. The HEIs are allowed to design their curricula suited to their own contexts and missions, provided they can demonstrate that the same lead to the attainment of the required minimum set of outcomes, albeit by a different route. In the same vein, they have latitude in terms of curriculum delivery and in terms of specification and deployment of human and physical resources. The HEIs should ensure they can show that the attainment of the program outcomes and satisfaction of program educational objectives can be assured by the alternative means they proposed.

The HEIs can use the CHED implementation Handbook for Outcomes-Based Education (OBE) and the Institutional Sustainability Assessment (ISA) available in CHED website, as a guide in making their submissions for Sections 4-10 of Articles IV and V of this PSG.

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ARTICLE IV PROGRAM SPECIFICATIONS Section 3. Program Description 3.1 Degree Name Graduates of this program shall be conferred with the degree of Doctor of Medicine.

Graduates may use the title “M.D.” after their names, only after they have been issued the license to practice medicine by the Professional Regulations Commission. The degree of Doctor of Medicine is the primary educational qualification for the Physicians’ Licensure Examination (PLE) in the Philippines which is equivalent to Level 7 of the Philippine Qualifications Framework (PQF) and International Standard Classification of Education (ISCEd).

3.2 Nature of the Field Study The Doctor of Medicine Program is at least a four (4)-year post baccalaureate program consisting of basic science and clinical courses. The medical schools may adopt different types of curricula like discipline-based, integrated, problem-based, community-based, competencybased and outcome-based or any other innovative designs, provided the program outcomes are achieved.

3.3 Program Educational Objectives (PEOs) The main goal of the Doctor of Medicine program is to develop professional physicians for the Philippine healthcare system. The graduate of the Doctor of Medicine program is a primary care physician who can pursue general private medical practice after passing the Physician Licensure Examination (PLE).

With additional training, graduates of the MD program may pursue any of the following careers to include: • General medical practitioner • Local Government Unit Physician • School physician • Company/Corporate physician • Community physician • Clinical specialist • Researcher/Medical/Scientist/Innovator • Health Professions teacher • Health Administrator • Health Information Manager • Health Economist • Health Policy Maker

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3.4 Allied Fields All health science programs are considered to be allied fields of the Doctor of Medicine program.

Section 4. Program Outcomes The minimum standards for the Doctor of Medicine program are expressed in the following minimum set of program outcomes and must be aligned with the mission, vision and goals of the institution: 4.1 Program outcomes Common to all disciplines and types of HEIs (CHED Implementation Handbook for OBE and ISA, 2013) a. Articulate and discuss the latest developments in the specific fields of practice (as defined in the Philippine Qualifications Framework (PQF) b. Communicate effectively and orally and in writing using both English and Filipino c. Work effectively and independently in multi-disciplinary and multi-cultural teams d. Act in recognition of professional, social, and ethical responsibility, and e. Preserve and promote “Filipino historical and cultural heritage” (based on R.A. 7722) Graduates of all higher education programs shall have the ability to: a. Work effectively in multi-disciplinary and multi-cultural teams b. Recognize professional, social and ethical responsibility c. Communicate orally and in writing using both English and Filipino effectively d. Engage in life-long learning and an understanding of the need to keep current of the developments in the specific field of practice according to the Philippine Qualifications Framework (PQF) e. Appreciate “Filipino historical and cultural heritage” as per RA 7722 f. Work “independently and/or in teams of related fields with minimum supervision” 4.2 Program Outcomes based on HEI type (CHED Implementation Handbook for OBE and ISA, 2013) a. Demonstrate a service orientation in one’s profession among graduates of professional institutions b. Participate in various type of employment, development activities and public discourses, particularly in response to the needs of the communities one serves among graduates of colleges c. Participate in the generation of new knowledge or in research and development projects among graduates of universities

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d. In addition to the above, graduates of State Universities and Colleges must have competencies to support “national, regional and local development plans� (RA 7722)

4.3 Program Outcomes common to all health-related professions Graduates if medicine program shall have the following attributes common to all healthrelated professions: a. Demonstrate competence in handling health problems of individuals, families, communities b. Demonstrate higher order thinking skills, problem solving, decision-making, logical and critical thinking skills c. Subscribe to professional, legal, and ethical practice d. Work collaboratively within interprofessional and multiprofessional teams e. Communicate proficiently f. Engage in self-directed lifelong learning, and g. Promote the use of health system approach in the delivery of service 4.4 Program Outcomes specific to the Doctor of Medicine Program Program Outcomes

Operational Definition of Program Outcomes

1. Demonstrate clinical competence

Competently manage clinical conditions of all patients in various settings

2. Communicate effectively

Convey information, written and oral format, across all types of audiences, venues and media in a manner that can be easily understood

3. Lead and manage health care teams

Initiate planning, organizing, implementation and evaluation of programs and health facilities.

Provide clear direcion, inspiration and motivation to the healthcare team/ community

4. Engage in research activities

Utilize current research evidence in decision-making as practitioner, educator or researcher Participate in research activities

5. Collaborate within Effectively work in teams in managing patients, institutions, projects and interprofessional teams similar situations 6. Utilize systemsbased approach to healthcare

Utilize systems-based approach in actual delivery of care Network with relevant partners in solving general health problems

7. Engage in continuing personal and professional development

Update oneself through a variety of avenues for personal and professional growth to ensure qualirt healthcare and patient safety

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8. Adhere to ethical, professional, and legal standards

Adhere to national and international codes of conduct and legal standards that govern the profession

9. Demonstrate nationalism, internationalism and dedication to service

Demonstrate love for one’s national heritage, respect for other cultures and committed to service

10. Practice the principles of social accountability

Adhere to the principles of relevance, equity, quality and cost effectiveness in the delivery of healthcare to patients, families and communities

Section 5. Performance Indicators The curriculum should contain performance indicators that measure whether terminal competencies have achieved the identified competency standards of each of the program outcomes. These performance indicators will serve as a basis for evalutaion of student achievement through different points in the curriculum.

ARTICLE V CURRICULUM Section 6. Curriculum Description 6.1 Mission and Vision The medical school shall adopt a curriculum that is consistent with its Vision-Mission that should be made known to all its stakeholders. There should be mission statements that describe the educational process that shall produce a medical doctor who has achieved the required program outcomes and conform with the World Health Organization standards on multi professional patient safety curriculum.

6.2 Duration It shall be a full-time study of at least four (4) years, the fourth year of which shall be a complete 12-month rotating clinical clerkship undertaken mainly in the base hospital with Level III DOH classification with accredited residency training programs in medicine, surgery, pediatrics and OB-Gyn. The program should be at least 1,440 hours per year level for the first 3 years and 2,080 hours for the fourth year or clinical Clerkship for a total of 6,400 hours for the enttire MD Program. Enhancements of clinical training may be undertaken in affiliate health facilities, both local and foreign hospitals with accredited training programs.

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6.3 Minimum Curricular Content The minimum curricular content regardless of the curriculum design shall include the following: • Human Anatomy including Gross, Microscopic and Developmental Anatomy • Human Physiology • Biochemistry, Molecular Biology, Genetics and Basic Nutrition • Pharmacology and Therapeutics including Alternative Medicine • Microbiology, Parasitology and Immunology • Internal Medicine including Geriatrics and Dermatology • General and Clinical Pathology and Oncology • Obstetrics and Gynecology including Women’s Health • Pediatrics and Nutrition including child protection • General Surgery and its divisions including Anesthesiology and Pain Management • Orthopedics • Otorhinolaryngology • Opthalmology • Psychiatry and Behavioral Sciences • Basic and Clinical Neurosciences • Family and Community Medicine including Public Health, Preventive Medicine and Health Economics • Physical and Rehabilitation Medicine • History and Perspectives in Medicine • Research, Evidence-based Medicine and Medical Informatics • Legal Medicine, Medical Jurisprudence and Forensic Medicine • Radiology and other diagnostic imaging 6.4 Integrated topics The minimum curricular content regardless of the curriculum design shall include the following topics that should be integrated in all medical courses: • Bioethics, Professionalism and Good Clinical Practice • Patient Safety and Quality Assurance • Consultation Skills, Physical Diagnosis • Andragogy • Disaster Risk Reduction and Management • Leadership and Management • Interprofessional Education 6.5 Medical Education Unit The medical school shall have a committee/body/unit that shall develop, implement, monitor and evaluate the medical curriculum regularly. Stakeholders including the alumni and student representatives shall be cconsulted in the evaluation and development of the

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medical curriculum.

Section 7. Curriculum Design For the guidance of all higher education institutions offerring a medical program, a sample curriculum generic to all types of higher education institutions was developed as classified under CMO No. 46 s. 2012. Program outcomes and specific competency standards have likewise been developed and formulated.

Each HEI shall develop its own curricular goals aligned to its vision and mission, and shall prepare the syllabi for all courses based on their curriculum and means of its delivery including the instructional designs. The courses under the medical curriculum shall be dependent on the curriculum model adopted by the HEI, namely: • Subject/discipline-based • Integrated, e.g. Organ-system, problem-based • Community-oriented/community-based • Other innovative curriccula 7.1 The Curriculum Map The curriculum map contains the program outcomes and the different courses per year level according to the degree of breadth and depth that these courses contribute to achieving the program outcomes. In the curriculum map, courses are categorized according to how program outcomes are covered in the course: • I - introduced (program outcomes are merely introduced in the course) • P - practiced (program outcomes are not just introduced but practiced in the course), and • D - demonstrated (program outcomes are practived, demonstrated and assessed in the course) Medical schools are encouraged to design their respective curriculum mapping and based on the results, decide in terms on how each of the courses will be further revised, improved, or modified to be made consistent with the program outcomes.

7.2 Components Depending on the curriculum model, the components of the medical degree program as represented in the curricular framework shall consist of the following: • Basic Sciences • Clinical Sciences • Other Courses and Elective

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Section 8. Program of Study The program of study implemented by the medical schools shall be dependent on the adopted curriculum model and the typology of the institution.

The Art and Science of Medicine as a noble profession shall be emphasized. Clinical science courses may be introduced in the basic science years. Early exposure of medical students to patient care and healthcare delivery system is recommended.

Methods of teaching interprofessional and multi-professional education shall be promoted.

Leadership and management must be embedded in the curriculum. Equal emphasis should be given to ambulatory and hospital in-patient care, and to health promotion and maintenance and curative care. Furthermore, aside from focusing on individual patients, there should be equal emphasis in addressing population health needs.

Section 9. Curriculum Delivery The medical school shall prepare a clear mechanism for curriculum delivery to achieve program outcomes and their competency standards.

Section 10. Syllabi for all courses The medical school shall prepare instructional designs and syllabi for all couses. Each syllabus shall contain the following: • Course name/title/number • Course description • Credit units with equivalent number of hours • Pre-requisite/s • Description of Students and their year level • Instructional Settings/Venue • Entry competencies required of students • Program/Learning outcomes, competency standards, course objectives and learning objectives • Teaching learning activities and instructional resources • Suggeted textbooks and references • Other Resources required • Assessment and evaluation Section 11. Internship 11.1 Internship is the last phase of the basic training of the physician.

11.2 Satisfactory completion of the 12-month internship is a requirement for taking the

Physician Licensure Examination (PLE).

11.3 The implementation of the Postgraduate Internship Program shall be supervised and

monitored by the Association of Philippine Medical Schools recognized by the

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Commission.

ARTICLE VI REQUIRED RESOURCES Section 12. Academic Organization/Administration The medical school shall have a clear description of its structure and governance.

The program in medical education leading to the Doctor of Medicine (M.D.) degree shall be conducted in an environment that fosters intellectual challenge and spirit of inquiry as characterized by the community of scholars that constitutes a college/university.

The medical school shall have a base hospital with Level III DOH classification with accredited residency training programs in medicine, surgery, pediatrics and OB-Gyn. An HEI which does not own its base training hospital shall be required to enter into a Memorandum of Agreement with an accessible, appropriately-accredited hospital in the same city/province.

The school shall be responsible for planning, controlling and monitoring/evaluation of the activities of its students and faculty therein.

The institution must implement an organizational structure of the academe that reflects the design of the curriculum in order to efficiently implement the prescribed program outcomes for medical education. It is recommended that higher educational institutions be organized in such manner as to assure integration of the curricular components.

It desirable that all medical schools shall have a Medical Education Unit composed of qualified academicians who shall be responsible for faculty development and training and other functions as designated by the dean.

The medical school shall establish linkages with medical practice and the healthcare system while engaging in a dynamic relationship with hospitals and government health facilities where the medical students undergo training. Moreover, there shall be a community-based health program where the students shall rotate and experience working with the community. The medical school shall enter into a Memorandum of Agreement with the identified community.

12.1 The Dean The medical school shall be under the immediate administration and supervision of a Dean, who acts as its Chief Academic Officer of its own academic unit and who, by training and experience, is capable of interpreting the prevailing standards in medical education and possesses sufficient authority to implement them.

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a. Qualifications. The qualities and qualifications of the Dean: • must be a holder of Doctor of Medicine degree; • must be a licensed physician with updated PRC ID; • preferably a holder of at least a master’s degree in Health related discipline, Educational Management or Management/Administration; • with a minimum teaching experience of five (5) years in a College of Medicine and holds at least a rank of Associate Professor; • with a minimum administrative experience, at the least as Department Chair for three (3) years in College of Medicine; • must be a member of good standing in an accredited professional or academic organization; • should be of good moral character.

The Dean shall be appointed by the Board of Trustees/Regens or by the President/CEO of college or university. Upom appointment, the Dean should have a duly notarized employment contract or term of office on a full-time basis. The Dean shall not have any other appointment/s in any other medical school. b. Responsibilities of the Dean: The duties and responsibilities of the Dean shall be, but not limited to, the following: • uphold the organizational structure of the college of medicine; • formulate, implement and evaluate short, medium and long-term plans of the college in consulatation with stakeholders; • recommend the appointment of the Associate Dean, College Secretary, Department Chairs and others, that may be deemed necessary, for the approval of the Board of Trustees/Regents; • recomment the appointment and termination of the teaching and support staff; • approve assignments of the faculty members as recommended by the corresponding Department Chair; • make necessary recommendations for periodic curricular improvement; • implement professional and personal development of the faculty; • supervise and approve the admission of students as recommended by the Committee on Admission, which screens applicants based on criteria proposed by the committee and approved by the Board of Trustees/Regents or the concerned authority; • promote student development plans; • promote research activities among faculty, students, and support staff • evaluate and recomment improvement in infrastructure, such as library and • assist in securing/obtaining endownments/grants and the like, for research and/or educational purposes; • prepare and recomment the annual budget of the college for approval by the Board of Trustess/Regents;

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• maintain harmonious relations with alumni; • pursue opportunities for collaboration with other academic institutions, local and international; • recommend disciplinary actions on erring students, faculty members and other school personnel after observing the due process required by law; • promote social accountability of medical schools 12.2 Department Chair a. Qualifications The qualities and qualifications of the Department Chair are as follows: • must be a holder of Doctor f Medicine degree; • must be a licensed professional with updated PRC ID; • preferably a holder of at least a master’s degree in Health related discipline, Educational Management or Management/Administration; • non-physician faculty member may qualify provided he/she is a holder of at least a master’s degree in the health related discipline; • with a teaching experience of at least three (3) full-time years, or six (6) part-time years in College of Medicine; • with experience in academic committee work as Chair of at least (3) years in the college; • with a rank of at least Assistant Professor in a medical school; • must be a member of the specialty or academic society of good standing; • preferably a board certified specialist, if applicable; • should be of good moral character b. Duties and Responsibilities of Department Chair: The Department Chair shall have, but not be limited to, the following duties and responsibilities: • recruit and evaluate prospective staff of the department and recommend their appointment/promotion to the Dean based on set criteria; • organize the department towards the attainment of the objectives of the medical education program in accordance with the policies set by the Board of Trustees/ Regents; • review periodically or upgrade the curriculum and modules as well as teaching methods and evaluation techniques; • coordinate and supervise all activities in the department including regular feedback on its progress and content; • encourage the faculty and staff to participate in research activities; • prepare the budget of the department for recommendation to the Dean;

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Heads of clinical departments shall preferably habe the following additional responsibilities: • head the corresponding clinical department/services in its own training hospital; • supervise the staff and student activities in the corresponding Heads of departments shall not be allowed to hold administrative positions in any other academic institution, although they may be allowed to teach in the latter with the permission of the former.

Section 13. Faculty 13.1 The medical school shall have a strong teaching staff who are qualified to teach basic and clinical medical sciences. Appointment of the faculty members shall be based on academic and professional qualifications, teaching ability and/or research potentials.

13.2 The school shall have a staff recruitment policy which defines the type, responsibilities and balance of academic staff required to deliver the curriculum, as well as a faculty development program.

13.3 The qualities and qualifications of the faculty are as follows: • must be a holder of Doctor of Medicine degree; • must be a licensed professional with updated PRC ID; • preferably a holder of at least a master’s degree in Health related discipline or Educational Management; • non-physician faculty member may qualify privided he/she is a holder of at least a master’s degree in the health related discipline; • must be a member of good standing in the accredited professional, specialty or academic society, as appropriate; • may teach in only one (1) medical school with full-time appointment or in two (2) medical schools with part-time appointments. A faculty member with full-time appointment may teach in another medical school as a lecturer provided there is permission from the mother medical school.

13.4 New faculty members shall undergo training in teaching-enhancement programs of

the college or its equivalent.

13.5 All faculty members are required to teach only in their respective areas of expertise.

13.6 Additional Requirements

a. The medical school shall have a system for recruitment, promotion,

retention and separation of faculty.

b. The medical school shall have a faculty development program in place.

c. The faculty may form an association to look after their welfare

d. In the absence of duly constituted departments, the dean will nominate

and directly recommend faculty members for appointment

e. Each faculty member shall enjoy academic freedom within the pureview of

institutional policies and other rights and privileges granted by law.

f. For new programs, there should be at least a faculty member with previous

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teaching experience in the same discipline for at least two (2) years

13.7 The academic ranks in their corresponding minimum qualifications, in addition to existing rules and regulations of the institution, specifically, on pedagogic skills, are as follows:

a. A degree of Doctor of Medicine is equivalent to a general Master’s degree for

ranking purposes only (CHED Resolution en banc 038-2001)

b. The entry level rank of the faculty member is an Assistant Professor, except

for teaching residents who will carry the rank of instructor.

c. At least one recently (not more than 5 years) published research as

principal author in a peer-reviewed, scientific journal is required for

promotion across ranks.

d. Minimum teaching experience:

• Assistant Professor - none

• Associate Professor - at least 3 years as Assistant Professor

• Full Professor - at least 3 years as Associate Professor a. Training - All medical faculty members should be certified as fellow/

diplomate of their respective specialty or academic society. b. A faculty member from another HEI may be appointed at any level of the academic ranks without passing through antecedent ranks if warranted/ justified by the applicant’s training, productivity including research publications, demonstrated ability, maturity or eminence in the particular field of study without violating existing college/university regulations. c. Each department shall have a chair and a complement of faculty members necessary to effectively implement the curriculum. d. In schools implementing the innovative curriculum in each section/unit/ module there shall be a coordinator and a complement of faculty members with the necessary medical background possessing facilitative skills. e. The definition of full-time faculty shall be left to the institution, provided however, that a minimum of twenty (20) hours per week is regularly rendered excluding administrative functions. f. There should be at least one (1) full-time faculty member in each department.

Section 14. Library 14.1 The Medical Library Facility

a. There shall be a medical library, established separately or as a section in the

general library, within the medical school premises.

b. The library shall have a seating capacity of at least 10% of a student population at

any given time.

14.2 Librarian The medical school library shall be administered and operated by a qualified, competent

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librarian assisted by trained support personnel, adequate in number as the curricular programs, and the student population may require. The work assignments of the professional and support staff are commensurate with their qualifications and experience. The chief librarian should have a Master’s degree in Library Science.

14.3 Book Collection: The medical school library shall have a minimum of the following core book collection: a. Official textbooks - 1 title per subject/discipline at 1 volume per 50 students of latest edition, aligned with the official prescribed textbooks of the Professional Regulatory Board of Medicine; 50% of the copies may be electronic b. Reference books - at least ten (10) titles per subject/discipline not older than 10 years c. Journals (in print and/or online) • At least one (1) current subscription to peer-reviewed international medical journal per major subject or discipline.

• At least ten (10) current peer-reviewed local medical journals listed in Western Pacific Region Index Medicus (WPRIM) d. Computer-based reference systems shall be provided and Internet access shall be made available to students for a minimum of twenty (20) hours per semester

Section 15. Facilities and Equipment The medical school shall have adequate physical plant and otjer resources to support its various educational activities. It shall have not only classrooms but also laboratories needed for the program.

15.1 Classroom requirements The school shall provide appropriate physical space for the class size based on the following provisions: a. All students in the class should be comfortably seated b. The ventilation and temperature for the entire room should be conducive for learning and instruction. c. The audiovisual facilities should be clearly perceptible in all areas of the classroom 15.2 a.

b.

c.

Laboratory requirements The laboratories shall have the necessary equipment to achieve the desired program outcomes based on the presented course syllabi and projected activities.

It is not necessary that the facilities be highly sophisticated but they shall be adequate enough for the students to achieve the skills and competencies for specific learning objectives.

It is a must for medical schools to have a skills laboratory before the students are exposed to actual patients.

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d. The facilities shall represent a variety of settings that are similar to the actual place of medical practice including community, ambulatory care facilites and in-patient care facilites.

15.3 Audio-visual equipment The medical school shall have adequate audio-visual equipment and software necessary to achieve the desired program outcomes. These include film, slides and overhead projectors, film, tapes and CDs, charts, pictures and models.

Section 16. Base Hospital 16.1 The school must implement the major components of its clinical training program in the base hospital which should be at least a DOH-licensed Level III hospital with accredited residency training programs in medicine, surgery, pediatrics and OB-Gyn. 16.2 A base hospital can be utilized by only one (1) medical school.

16.3 The base hospital preferably, should be in the same city/province but MUST be within the region. Accessibility, safety of the students and faculty and a reasonable travel time should be considered.

Section 17. Students 17.1 Admission Policy and Selection: The medical school must have admission policies including a clear description of the process of selection. The minimum criteria for admission should include: • General Weighted Average Grade • NMAT score However, it is highly recommended that applicants undergo interview to access nonacademic qualities like: • Motivation to be a good physician • Social consciousness • Stress-tolerance • Integrity 17.2 Standards for Admission The Admission Committee shall implement the admission policies and standards set by College. Qualified applicants are recommended by the Committee for approval by the Dean.

17.3 Minimum Qualification for Admission Applicants seeking admission to the medical education program must have the following qualifications: a. Holder of at least a baccalaureate degree b. Must have taken the National Medical Admission Test (NMAT) not more than two (2)

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years from the time of admission, with a percentile score equivalent to or higher than that currently prescribed by the school or the Commission, whichever is higher; learning and instruction. c. The applicant shall submit the following documents to the medical schools:

• Birth certificate and certificates of good moral character from two (2)

professors in college

• Official transcript of records

• Certified true copy of NMAT score

17.4 a.

b.

c.

Certificate of Eligibility for Admission to the Medical School On the basis of foregoing documents, the medical school is responsible for and accountable for the insurance of the Certificate of Eligibility for Admission to the medical school.

Foreign students must secure a Certificate of Eligibility from CHED Central Office prior to admission in any medical school in the country.

Likewise, it is also the responsibility of the medical school to verify the authenticity of the NMAT score against the master list provided by the recognized testing center.

17.5 NMAT Score cut-off a. An NMAT score cut-off of at least 40th percentile will be implemented by all higher education institution offering medial program. b. Medical shools are hereby required to declare their NMAT cut-off score as part of their Annual Report (electronic and hard copy) to be submitted to CHED. 17.6 Transferees The medical schools shall admit only transfer students with certificate of transfer credentials, provided that they are placed under probationary status for one (1) year.

17.7 Freshman quota: a. The medical school shall set a freshman quota subject to its carrying capacity based on its faculty resources and adequacy of teaching facilities available. The declared quota of the HEI shall be submission to the Commission subject to validation b. No educational institution shall be established excusively for foreign students (Constitution Art. XIV, Section 4).

17.8 Assessment of Students a. The school may define the methods used for assessment of student performance including standards for passing the assessment. b. The formative and summative assessment shall be consistent with the program outcomes. c. Comprehensive examinations shall be administered by the medical school at the

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end of second and fourth year. d. A copy of the examination result shall be included in the annual report to be submitted to CHED. 17.9 Student Support and Counselling The student must provide student support including mentoring, counseling, immunization, healthcare, scholarships, and accident insurance, whenever rotating outside the medical schools.

17.10 Student Representation The school should state its policy on student representation and participation in the design, management and evaluation of the medical curriculum and other matters relevant to the students.

Section 18. Instructional Standards 18.1 Curricular framework The institution shall have a curricular framework which is consistent with its vision and mission.

18.2 Standard of Instruction The medical college shall maintain a high standard of instruction to ensure the total effectiveness of medical students training for future professional practice.

18.3 Academic Setting The teaching-learning activities shall be held in a variety of appropriate setting. These shall include adequately lighted, ventilated and equipped classrooms and laboratories, ambulatory care clinics, emergency unit and inpatient facilities, and industrial, community and family setting, etc. Overcrowding in the classroom, laboratory and other venues for instruction, needless to say, is not conductive to learning, and must not be allowed. For practicum in the clinical departments and Community and Family Medicine, the setting shall be as similar as possible to intended future places of practice.

18.4 Teaching Methods Teaching method shall utilize up to date techniques. Cases should reflect the disease on the top causes of morbidity and mortality of the country or region where the school is located.

18.5 Stakeholders The curriculum should be periodically evaluated by all stakeholders to ensure its relevance to the population health needs, changing patterns of medical practice, the social determinants of health, advances in the medical science and innovations in medical education.

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18.6 Assessment of Students The system of evaluation shall utilize appropriate methods of assessment of student competencies, Knowledge, skill and attitude consistent with the desired program outcomes.

18.7 Evaluation of Students The institution shall adopt a systematic plan of evaluation of student progress through the course. It should be consistent and congruent with the program outcomes, educational objectives and instructional methods set by the institution. Methods of formative and summative assessments including clinical examinations shall be developed and validated for this purpose.

18.8 Course Evaluation The students shall participate in evaluation of course and teaching effectiveness of faculty.

18.9 Institutional Policies Institutional policies shall be made known to the medical students to serve as their guide in preparing for their courses.

18.10 Base Hospital The school must implement the major components of its clinical training program in the base hospital with Level 111 DOH classification with accredited residency training programs in medicine, surgery, pediatrics and OB-Gyn. A base hospital should be able to provide one (1) clinical material per clinical clerk at any given time. The base hospital must be located within the same geographical area specifically within the same city or province.

18.11 Faculty to Student Ratio per clinical department For every 100 students, there must be at least three (3) specialty-board certified faculty member in each of the (4) major clinical departments.

18.12 Faculty to Student Ration per session For the various teaching-learning activities, the maximum faculty-student ratio is as follows.

Lectures -1:100* Laboratory Sessions -1:25 Small-Group Tutorials (SGD) Preceptorships -1:10 *a higher ratio maybe allowed if with adequate audio-visual facilities 18.13 Clinical Cases Clinical materials should have variety of patients that reflects the top common causes of morbidity and mortality in the country. A student should keep a personal log following a CHEDprescribed format on patients seen and procedures performed.

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18.14 Patient Load Clinical materials shall be provided by the out-patient services with a load of at least fifty (50) patients per day an in-patient service of one (1) occupied hospital bed per clinical clerk (4 year student) at any given time. Clinical materials are defined as patients who can be examined by medical students hands-on.

18.15 Affiliated Hospitals To provide for adequate clinical exposure, other duly accredited hospitals/health facilities formally affiliated with the medical school may be utilized. However, the clinical program in such affiliated medical hospitals must conform with the course objectives set forth by the medical school. Consultants in the base or affiliated hospital who are participating in the teaching of medical students must receive appointment from the college and shall be assigned to directly supervise the students in the out-patient services.

18.16 Obstetrics Cases In Obstetrics, at least ten (10) maternity cases shall be followed through to delivery by each clinical clerk who must have actual charge of those cases under the supervision of a clinical preceptor.

18.7 Extension Services The medical school shall provide extension services for instruction of medical students in Family and Community Medicine either independently or in cooperation with the Department of Health or other agencies.

18.8 Minimum number of Faculty There should be at least twenty (20) full-time faculty members in a medical school at any time, including faculty administrators. There should be at least one (1) full time faculty member for every 50 students.

Section 19. Residence and Unit Requirements 19.1 Minimum Residence No degree shall be conferred upon a student unless the last two (2) curriculum years of the medicine course were taken in the college which is to confer the degree.

19.2 Prerequisites Guidelines on pre-requisites shall be made part and parcel of the academic policies of the school. The rules on prerequisite courses shall be strictly observed by medical institutions. No student shall be permitted to take up any subject until the prerequisite courses are passed.

19.3 Promotions No student shall be promoted to the next year level in case of an outstanding deficiency in the current year level. On a case-to-case basis and at the discretion of the Dean, a student who failed in a major subject may be given additional advanced minor loads, provided that the

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rules on pre-requisites are strictly observed.

19.4 Academic Dismissal A student who fails in forty percent (40%) or more of the total annual academic load, in hours, at any year level shall be dropped from the rolls. A medical student who fails in the same subject/course twice at any year level shall be automatically dropped from the rolls.

Medical schools may, however, prescribe a more stringent policy on dismissal due to academic deficiency.

19.6 New and transfer students shall be accepted only in the first semester of the academic year.

Section 20. Miscellaneous Provisions 20.1 Annual Report The medical school shall submit an annual report to CHED at the end of the school year using the prescribed format.

20.2 Performance Evaluation Performance of medical schools in the PLE and compliance with the existing standards for medical program shall be jointly monitored by CHED and PRC. Medical schools whose performance in the Physician’s Licensure Examination is below the national passing average shall undergo consultancy visit by the accredited association of medical schools for technical assistance.

20.3 External Accreditation Medical schools are encouraged to undergo external accreditation.

Section 21. CHED Evaluation for New Programs 21.1 Self Assessment tool All higher education institutions intending to offer the Doctor of Medicine program must perform a Self Assessment/study utilizing the CHED Monitoring and Evaluation tool for new program prior to submission of application.

21.2 Processing of Applications All applications for new MD program shall be processed per provisions of CMO No. 2 s.

2004.

Section 22. Sanctions 22.1 Non-compliance with the provisions of this CMO, after due process, shall cause the Commission to impose sanctions. The sanctions for medical schools shall be based on the 3

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year consolidated Physician Licensure Examinations (PLE) institutional performance and the outcome of the monitoring visits and shall adhere to the following guidelines: 22.2 Compliance of medical schools shall be based on the following major areas: a. Performance of their graduates in the Physician Licensure Examination b. The institutional passing average or performance of the graduates of medical schools in the PLE for the past three years based on data provided by the Professional Regulatory Medicine. c. Outcome/result of the Joint CHED-PRC monitoring and evaluation activities

1. Dean/Administration

2. Faculty

3. Curriculum and Instruction including Community program

4. Students (Admission, Promotion and Retention)

5. Base hospital and clinical materials

6. Laboratory and physical facilities

7. Library and Learning facilities

8. Research 22.3 Overall Performance in the PLE a. The overall three-year PLE performance shall be computed as the Total number of First Time takers who passed the PLE divided by the total number of First Time takers over the last three calendar years. b. Higher education institutions offering MD program whose overall three year performance in the PLE is fifty percent (50%) and below for the past three consecutive calendar years (INITIALLY for 2016, 2017 and 2018) shall be imposed sanctions based on the following: Overall PLE Performance

Action/s

30-50%

Warning Admit only students with NMAT score of 50th percentile CHED monitoring visit in one (1) year

20-29%

Probation Admit only students with NMAT score of 50th percentile CHED monitoring visit in 6 months

Below 20%

Phase out program Stop admissions with gradual phase out

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ARTICLE VII QUALITY ASSURANCE The policies, standards, and guidelines are hereby issued to ensure high quality of medical education in the country. Medical schools are advised to undergo external accreditation.

Section 23. Continuous Quality Improvement To ensure continuous quality improvement, HEIs are strongly encouraged to undergo quality assurance by an external accreditation body which conform with the minimum standards set by the World Federation for Medical Education (WFME).

For basic medical education programs which cannot qualify yet for external accreditation, the Commission, in coordination with the recognized association of Philippine medical schools and recognized accrediting body will provide assistance to these schools to undertake selfstudy or self-assessment together with their developmental plans for improvement and will jointly work together until external accreditation becomes possible.

ARTICLE VIII TRANSITORY PROVISIONS Section 25. Repealing Clause This order supersedes all previous issuances concerning medical education which may be inconsistent or contradictory with any of the provisions thereof.

Section 26. Effectivity Clause This set of Policies, Standards and Guidelines shall take effect beginning Academic Year 2016-2017 fifteen (15) days after its publication in the Official Gazette or in a newspaper of national circulation.

Quezon City, Philippines. April 7, 2016 FOR THE COMMISSION:

PATRICIA B. LICUANAN, Ph.D. Chairperson

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ANNEX 1. International Standard Classification of Educational Qualifications (ISCEd) Level

ISCEd 2011

Description

Corresponding ISCED 1997 level

0

Early childhood Education (01 Early childhood educational development)

Education designed to support early development in preparation for participation in school and society.

Programmes designed for children below the age of 3.

None

0

Early childhood Education (02 Preprimary education)

Education designed to support early development in preparation for participation in school and society.

Programmes designed for children from age 3 to the start of primary education.

Level 0: Pre-primary education

1

Primary education

Programmes typically designed to provide students with fundamental skills in reading, writing and mathematics and to establish a solid foundation for learning.

Level 1: Primary education or first stage of basic education

2

Lower secondary education

First stage of secondary education building on primary education, typically with a more subject-oriented curriculum.

Level 2: Lower secondary education or second stage of basic education

3

Upper secondary education

Second/final stage of secondary education preparing for tertiary education and/or providing skills relevant to employment.

Usually with an increased range of subject options and streams.

Level 3: Upper secondary education

4

Post-secondary non-tertiary education

Programmes providing learning experiences that build on secondary education and prepare for labour market entry and/or tertiary education. The content is broader than secondary but not as complex as tertiary education.

Level 4: Postsecondary non-tertiary education

5

Short-cycle tertiary education

Short first tertiary programmes that are typically practically-based, occupationallyspecific and prepare for labour market entry. These programmes may also provide a pathway to other tertiary programs.

Level 5B: First stage of tertiary education: typically shorter, more practical/technical/ occupationally specific programmes leading to professional qualifications

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6

Bachelor or equivalent

Programmes designed to provide intermediate academic and/or professional knowledge, skills and competencies leading to a first tertiary degree or equivalent qualification.

Level 5A: First stage of tertiary education: largely theoretically based programmes intended to provide qualiffications for gaining entry into more advanced research programmes and professions with higher skills requirements.

7

Master or equivalent

Programmes designed to provide advanced academic and/or professional knowledge, skills and competencies leading to a second tertiary degree or equivalent qualification

Level 5A: First stage of tertiary education: largely theoretically based programmes intended to provide qualificaions for gaining entry into more advanced research programmes and professions with higher skills requirements.

8

Doctoral or equivalent

Programmes designed primarily to lead to an advanced research qualification, usually concluding with the submission and defence of a substantive dissertation of publishable quality based on original research

Level 6: Second stage of tertiary education (leading to an advanced research qualification).

ANNEX 2A. Program Outcomes, Competency Standards, and Performance Indicators in Medical Degree Program Program/Learning Outcomes 1. Competently manage clinical conditions of clients in various settings

Competency Standards

Performance Indicators

Given a clinical situation in any setting/ workplace, the medical graduate should be able to: 1. Establish effective rapport 2. Obtain accurate history 3. Perform thorough physical examination 4. Formulate appropriate diagnostic plan including a list of differential diagnosis and established clinical diagnosis

1. Comprehensive portfolio of graduates enumerating successful clinical cases and problems solved, clinical procedures performed, including those with complications and how they were resolved 2. Satisfactory performance in the licensure examination for

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5. Develop a client-centered management plan 6. Maintain an accurate and complete medical record 7. Refer cases appropriately

physicians.

3. Certificate of satisfactory completion of clinical clerkship not only in the hospital but also in the community and appropriate specialized public health care facility.

2. Convey information, in written and oral formats, across all types of audiences, venues and media in a manner that can be easily understood

Given various settings and purposes, the medical graduate should be able to: 1. Listen actively to process information 2. Explain clearly relevant information to client and family 3. Secure client’s cooperation and consent 4. Communicate effectively with other health professionals and stakeholders 5. Utilize information technology efficiently 6. Convey messages effectively using various forms of communication

1. Submit actual communication plan, lesson plan, presentation for public or lay forum, etc., educating a given audience on selected health issues 2. Competently use information and communication technology in the presentations for better, and more convenient exchange

3.A. Initiate planning, organizing, implementation, and evaluation of programs and health facilities.

Given a program to manage or a health team to lead, the medical graduate should be able to: 1. Initiate planning, organizing, implementation and evaluation of programs and health facilities.

2. Provide clear direction, inspiration and motivation to the healthcare team

1. Submission of actual organization and management plan implemented to adress certain health issues or problems during formal medical education 2. Actual statements of support, policy statements, and position papers calling on seleccted constituents to support given health issues

Given different data and information, the medical graduate should be able to: 1. Critically appraise relevant literature 2. Apply research findings into practice appropriately Given a clinical dilemma, the medical graduate should be able to: 1. Formulate sound, relevant, and viable research questions 2. Consider an appropriate research design

1. Present a comprehensive portfolio 2. Submit actual critical appraisals of relevant literature 3. Submit copies of research projects, publications of completed, proposed, on going, etc.

3.B. Provide clear direction, inspiration, and motivation to the healthcare team/ community 4.A. Utilize current research evidence in decision making as practitioner, educator or researcher 4.B. Participate in research activities.

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3. Gather data systematically 4. Apply appropriate statistical analysis 5. Write a cohesive research paper, and 6. Disseminate research outputs 5. Effectively work in teams with co-physicians and other professionals in managing clients, institutions, projects and similar situations

Given different scenarios, the medical graduate should be able to collaborate appropriately with other healthcare providers and other health professional groups

1. Show certificates of membership to selected and relevant professional societies 2. Present a portfolio of cases referred and co-managed with other physicians and professionals

6.A. Utilize systemsbased approach in actual delivery of care.

Given a clinical situation in any setting/ workplace, the medical graduate should be able to: 1. Relate social determinants to health and illness 2. Utilize each component of the health system for optimum care, and 3. Advocate for partnership with related government and non-government agencies

1. Identify relevant health care facilities in strategic geographic places for efficient delivery of care, 2. Enumerate lists of actual partners that have been involved in health care delivery from national, to regional, and local levels.

7. Update oneself through a variety of avenues for personal and professional growth to ensure quality healthcare and patient safety.

Given different scenarios in any workplace, the medical graduate should be able to: 1. Pursue lifelong learning and personal growth 2. Acquire transferrable skills, and 3. Demonstrate integrity, compassion, gender sensitivity, resourcefulness

1. Proof of active participation in a series of continuing professional development in relevant areas 2. Completion of formal or informal, short- or long-term training or studies to enhance clinical management

8. Adhere to national and international codes of conduct and legal standards that govern the profession.

1. Demonstrate professionalism 2. Comply with ethical and legal standards, and 3. Adhere to the Oath of Professionals and the Hippocratic Oath

1. Proof of no pending administrative, legal, or medicolegal case 2. Service record to a relevant facility where professional practice is recognized 3. Membership in the official organizations of medical practitioners, civil or government service, etc.

6.B. Network with relevant partners in solving general health problems

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9. Demonstrate love for one’s national heritage, respect for other cultures and commitment to service

Given different scenarios in any setting/ workplace, the medical graduate should be able to: 1. Demonstrate responsible citizenship 2. Exhbit cultural competence, and 3. Serve with dedication

1. Certificates of participation in community and civic organizations, medical missions, etc.

2. Submission of Statement of Assets and Liabilities 3. Use of Official Receipts in clinics 4. Evidence of orher services rendered to the public, professional groups, etc.

5. Proof of Filipino citizenship

10. Adhere to the principles of relevance, equity, quality and cost effectiveness in the delivery of healthcare to patients, families, and communities

Given different scenarios in any setting/ workplace, the medical graduate should be able to: 1. Address the health neds of the patients, family, and community providing health promotion, disease prevention, cure and rehabilitation 2. Utilize clinical practice guidelines, quality assurance methods to provide high quality health care 3. Deliver quality care to all patients regardless of socio-economic status, political affiliations, religious belief, ethnicity and gender, and 4. Utilize appropriate resources in the application of evidence-based data

1. Comprehensive portfolio of graduates enumeratinf successful clinical cases and problems solved, clinical procedures performed, including those with complications and how they were solved 2. Proofs of involvement and active participation in various health or socially-relevant community endeavors.

3. Comprehensive portfolio of awards, commendations, public recognitions of excellent services rendered

ANNEX 2B. Sample Program Outcomes and Curricular Goals Program Outcomes/Core Competencies 1. Competently manage clinical conditions of clients in various settings

Sample Curricular Goals 1. Correlate the clinical presentation with mechanism of illness 2. Select the most appropriate diagnostic plan 3. Formulate the most appropriate plan of management (pharmacologic) 4. Anticipate possible complications (disease-related and treatment-related) 5. Educate patient and family regarding disease prognosis, management 6. Formulate health and wellness plan for patient and families

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2. Convey information, in written and oral formats, across all types

1. Utilize available forms of communication 2. Make use of information technology efficiently

of audiences, venues and media in a manner that can be easily understood

3. Practice effective and clear communication amongst learners, teachers, and clients

3A. Initiate planning, organizing, implementation, and evaluation of programs and health facilities.

3B. Provide clear direction, inspiration, and motivation to the healthcare team/ community

1. Assume leadership role in any health care team he is situated 2. Implement healthcare programs as planned 3. Monitor process and outcomes of health programs

4A. Utilize research evidence in decision making as practitioner, educator or researcher.

4B. Participate in research activities

1. Critically appraise relevant literature 2. Create a research proposal using information from critically appraised literature 3. Correlate research findings with mechanisms of disease and management of illness

5. Effectively work in teams with cophysicians and other professionals in managing clients, institutions, projects, and similar situations

1. Demonstrate attributes of collaboration with colearners 2. Identify the relevant agencies in the health profession

6A. Utilize systems-based approach in actual delivery of care 6B. Network with relevant partners in solving general health problem

1. Formulate an inventory of health care issues in the community diagnosis 2. Identify the relevant health care agencies that exist in the community

7. Update oneself through a variety of avenues for personal and professional growth to ensure quality healthcare and patient safety

1. Exhibit the attribute of a motivated, self-directed learner 2. Demonstrate the attributes of integrity, compassion, gender sensitivity, resourcefulness in the dealings with co-learners, academic and non-academic staff 3. Perform transferrable skills under supervision

8. Adhere to the principles of relevance, equity, quality and cost-effectiveness in the delivery of healthcare to patients, families, and communities

1. Use evidence-based data and appropriate technology in the delivery of comprehensive health care within socio-cultural context 2. Formulate plan to make sure optimum health care available to all 3. Recommend solutions to the most important health issues and disease problems

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ANNEX 2C. Sample Competencies Goal Explain relevant information clearly

Learning Objectives

Knowledge

Skills

Attitudes

At the end of year level 4, medical students in various settings should be able to: Explain to the patients and their family the condition, diagnostic, and management options, and prognosis

Epidemiology, pathophysiology, S/ Sx, Dx, Mx (pharma and nonpharma, complications, prognosis, follow up)

Hx, PE, verbal and non-verbal communication skills, listening skills, synthesis of information, documentation

Explain health issues relevant to a group in a community

Epidemiology, community dx and resources, current health issues, impact of diseases in the community, social determinants of health, health promotion, disease prevention, basic principles of teaching

Interpersonal skills, networking skills, teaching skills, how to make informationa and communication materials

Honesty, compassion, empathy, cultural competence, sensitivity, resourcefulness, professionalism

ANNEX 2D. Sample Instructional Design in Pediatrics Program Outcome

Learning Objectives

Clinical Competence

At the end of clinical rotation in Pediatrics, YL4 students should be able to explain to the patients & theor family, the condition, diagnostic, & management options, and prognosis

TeachingLearning Activities

Content Diagnosis and management of common pediatric diseases Principles of communication with different pediatric age groups, Basic principles of teaching, Professional ethics, Social determinants of health, Levels of prevention

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Ward work Case discussion Conferences Bedside rounds Journal report

Resources All clinical settings

Assessment

A. Formative 1. Bedside assessment Access 2. Video-recorded to library ward work and online 3. Self-assessment collections (reflection paper) B. Summative Preceptors 1. OSCE 2. Written Video examination camera 3. Journal reports 4. Case presentation

ANNEX 2E. Sample Course Syllabus in Human Physiology Please follow the outline below in presenting the syllabus below.

• Course name/title/number • Course description • Credit units with equivalent number of hours • Students • Venue • Entry competencies • Learning objectives and learning outcomes • Teaching learning activities • Suggested textbooks and references • Other resources required • Assessment and evaluation I. Course name/title/number II. Course Description The study of the physiology of the cell, the nervous system, the muscular system, the cardiovascular system, blood and immunity, the respiratory system, the renal system, fluid electrolyte and acidbase balance, the gastrointestinal system and the endocrine system. Special topics like sports physiology, fetal and neonatal physiology, aviation, space and underwater physiology of aging are also included.

It is handled by faculty members from various fields of medicine such as anesthesiology, cardiology, gastroenterology, hematology, infectious medicine, nephrology, obstetrics and gynecology, ophtalmology, pediatrics, pulmonology, surgery, and toxicology.

III. Credits: explain this further in terms of units: it is given eight (8) hours a week on a twice a week basis that covers lecture and laboratory sessions for a total of 276 hours a year or 8 credit units.

IV. Explain venue and entry competencies: add here the year level: first year medical students V. Learning Outcomes Following outcome-based curriculum, Human Physiology will be geared towards enabling the first year medical student to achieve the following learning outcomes with their corresponding level of emphasis: *please revise this based on the fnal list (refer to previous sections)

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Learning Outcomes

Level of Emphasis

1 - Demonstrate clinical competence

Practiced

2 - Communicate effectively

Practiced

3 - Lead and manage health care teams

Introduced

4 - Engage in research activities

Practiced

5 - Demonstrate interprofessionalism

Introduced

7 - Engage in continuing personal and professional development

Practiced

8 - Adhere to ethical, professional and legal standards

Practiced

*Taken from Physiology curricular map (1P, 2P, 3I, 4P, 5I, 7P, 8P) VI. Course Objectives First year medical students who have completed this course should be able to: 1. Integrate the normal functions of the different organ systems of the body, the pathophysiologic mechanisms of diseases usually seen in the community and the physiologic principles involved in the treatment of these diseases.

2. Convey information, in written and oral formats to their classmates and faculty members utilizing different types of audiovisual resources.

3. Plan, organize and implement selected acquired physiologic principles through the different teaching-learning strategies like case discussions, small group discussions, and laboratory conferences.

4. Solve problems, and critically analyze given data from case studies and laboratory experiments.

5. Effectively work as a team with co-students, faculty, staff, and other professionals in managing with assigned projects in Physiology.

6. Pursue lifelong learning and personal growth through self directed learning 7. Develop attitudes and values essential for a primary health care physician

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VII. Course Content In order to facilitate learning in Human Physiology, the topics are clustered into blocks. There are eight blocks and their focused topics are as follows: Blocks

Focused Topics

Generalities

Cell physiology Nerve Physiology (nerve, synaps, signal transduction, reflexes and automatic nervous system) Muscle physiology (skeletal, cardiac, and smooth)

Gastrointestinal physiology

G.I. I (Motility) G.I. II (Secretions)

Hematology and Immunology

Hematopoeises Hemostasis Immunology I (Innate) Immunology II (Adaptive)

Cardiovascular physiology

Electrical properties (EKG) Heart as a pump I and II Hemodynamics Cardiovascular regulation Circulation to special regions of the body

Respiratory physiology

Respiratory physiology I (Oxygen Delivery) Respiratory physiology II (Ventilation and Perfusion) Respiratory physiology III (Work of breathing)

Renal physiology

Renal I (Urine formation) Renal II (Urine concentration) Fluid and electrolytes Acid-base balance

Endocrine physiology

Hypothalamus-pituitary Thyroid physiology Bone and parathyroid physiology Pancreas Adrenals Reproductive system

Special topics

Fetal physiology Geriatric physiology Aviation, space and underwater physiology Sports physiology Smoking

The Academic Year is divided into four shifting periods. Two blocks are taken during each shifting period.

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VIII. Credit Units and Equivalent Hours Topics/Subtopics

T-L Strategies (hours)

Time Allotment (hours)

Lec

Lab

SGD/Figure Review/ Self-Directed Learning/ Workshops/Conferences

Written Examination

Generalities

2.5

2

2.5

1.5

8.5

Nerve Physiology

7.5

3

7.5

2.5

20.5

Muscle Physiology

5

3

5

2.5

15.5

Hematology

5

3

8

2.5

18.5

Respiratory Physiology

7.5

3

14.5

3.5

28.5

Cardiovascular Physiology

15.5

3

25

5.5

49

Renal Physiology

10

3

17

3

33

Immunology

7.5

3

6.5

2

19

GI Physiology

7.5

3

4.5

3

18

Endocrine Physiology

15

3

15

4.5

37.5

Applied Physiology

9

0

16

3

28

92

29

121.5

33.5

278 (8 units)

Total

IX. Resources Learning materials like reference books, journals, and manuals are available in the medical library.

Computers are available n the Medical Informatics Center (IMC) where students gain access to internet, view Multimedia Teaching Aid Projects (MTAP) prepared by students of previous years.

Physiology@UST400 which contains 400 must know concepts in physiology; uploaded using the Blackboard System of the ELEAP ccan also be accessed at the MIC or at home.

The laboratory is equipped with the latest version of Powerlab/Lab Tutor 4 where students can use it to perform experiments in a well-controlled environment. The results are automatically recorded and can be shared with students of different sections. Students used built-in computer programs to compute and analyze data. Other laboratory equipment and apparatuses are constantly upgraded.

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Official Textbook • Physiology (Updated Version) by Berne R, Levy M, Koeppen B, Stanton B, 6th edition, 2010 Reference Textbooks: 1. Essential Medical Physiology by Johnson L, 3rd edition, 2003 2. Basic Immunology by Abbas A & Lichtman A, 3rd edition updated, 2011 3. Vander’s Human Physiology by Widmaier E, Raff H, Strang K, 12th edition, 2011 4. Medical Physiology by Boron W, Boulpaep E, 2nd (Updated edition), 2011 5. Textbook of Medical Physiology by Guyton A, Hall J, 12th edition, 2011 6. Review of Medical Physiology by Ganong W, 23rd edition, 2010 X. Evaluation Written examination - for each lecture topic - pre-laboratory experiments - pre- and post-laboratory conference - pre- and post-laboratory synthesis part of case-based discussion Performance rating scale - Small group discussion - Figure review - Case discussion - MTAP presentation Class attendance frequency Laboratory Performance checklist Online Rating Scale - Self-directed learning - critical appraisal of 2 online resources

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ANNEX B. Sample Instructional Design in Gastrointestinal Physiology Topic: GI Physiology Student: 1st Year Medical Students Venue: Plenary lecture: Rm 404; Individual SGD rooms, Physiology Laboratory Rm 216 Number of hours: 18 hours Schedule: Sections A&C: M&W 7-11 am; Sections B&D: T&TH 12-4 om Module/Unit Description: GI Physiology is taken up during the second semester. It consists of GI 1 on Cephalic, Oral and Esophageal Functions; GI 2 on Gastric, Intestinal and Colonic Phases of the Integrated response to a Meal and GI 3 on Liver and Gallbladder Physiology.

Instructional activities include plenary lectures. Small group discussions, Figure Review activities, Case discussions, and Laboratory experiments.

Entry competencies: prior knowledge in cellular processes, automatic nervous system Learning Outcomes: please refer to the new and final list of program outcomes Learning Objectives: Students who have completed thus init should be able to: 1. Demonstrate competence and effective communication skills involving (1P, 2P)

a. physiologic mechanisms governing the GIT systems

b. correlation of clinical conditions that results from impaired GI physiologic

processes 2. Analyze a given GI physiologic data using information technology and other resources (4P) 3. Conduct self-directed learning on selected topics in GI Physiology (8P) 4. Interact with fellow students. faculty staff and non-academic personnel tactfully, using appropriate language, speech patterns and non-verbal communication (2P, 3I, 5I) 5. Demonstrate a caring and respectful approach during classroom encounters (8P) After the topic on GI Physiology, given the first year medical student should be able to: Learning Objectives and Learning Outcomes addressed Explain all the physiologic mechanisms involved in the GI systems given a case (1P, 2P, 4P, 7P)

Content

T-L Activities

Physiologic mechanisms, secretion of enzymes, gastrointestinal motility, digestion, absorption, excretion

1. Plenary lecture by faculty 2. Small group discussion 3. Review of figures 4. Simulation exercises using

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Resources

1. Textbooks: Berne & Levy 2. Classroom in large group setting 3. Case: Peptic Ulcer 4. Laboratory

Evaluation

Written examination Performance rating scale -SGD -Figure review -Case discussion Class attendance

GI physiologic events: chewing, salivation, GI motility: from the esopohagus to the rectum

Correlate clinical events with impaired physiologic processes (1P, 2P)

Collaborated as a group demonstrating the following attributes of teamwork, collaboration, and diligence in dealing with classmates, faculty and nonacademic staff (1P, 5P, 8P) Synthesize the GI laboratory results & other information during the GI post-laboratory conference into a

Common GI disorders: acidrelated disorders, motility disorders, hepatobillary disorders

multimedia resource: Four GI processes 5. Case discussion 6. Self-directed learning - critical appraisal of online resources

equipment & facilities 5. Technical/ laboratory assistant

frequency Online rating scale

7. Small group discussion: GI 1 Physiology: Cephalic, Oral and Esophageal Functions GI 2 Physiology: Gastric, Intestinal and Colonic Phases of the Integrated response to a meal GI 3 Physiology: Liver and Gallbladder Physiology

Performance rating scale -SGD -Class attendance frequency

8. Laboratory experiment: GI Motility 9. SGD 10. Case discussion

Laboratory Performance checklist Performance rating scale -SGD -Case discussion

11. Laboratory Conference

Performance rating scale -Laboratory Conference

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comprehensive oral report. (1P, 2P, 4P) Present a collaborated multimedia teaching aid group presentation showing selected GI physiologic mechanisms (1P, 2P, 4P)

12. Multimedia Teaching Aid Project (MTAP) sessions

Performance rating scale -MTAP presentation

*Learning outcome: 1 - clinical competence; 2 - communication skill; 3 - leadership and management; 4 - management of research; 5 - interprofessionalism; 7 - personal and professional development; 8 - ethical, professional and legal standards Degree of emphasis: I - introduced, P - practiced, D - demonstrated Small Group Discussion (Sample Evaluation Tool) Group Participation 60% Content knowledge 15% ------Group Participation 15% ------Communication skills 15% ------Group motivation 15% ------Individual participation (Frequency of significant participation) 35% Attendance 5%

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ANNEX 3. Sample Curriculum Map for the Basic and Clinical Sciences Legend of Ratings: Identified Program Outcomes shall be indicated by the corresponding numbers as shown below: 1. Demonstrate clinical competence 2. Communicate effectively 3. Lead and manage health care teams 4. Engage in research activities 5. Collaborate within interprofessional teams 6. Utilize systems-based approach to healthcare 7. Engage in continuing personal and professional development 8. Adhere to ethical, professional and legal standards 9. Demonstrate nationalism, internationalism, and dedication to service 10. Practice the principles of social accountability Program Outcomes shall be categorized as shown below: • I - introduced (program outcomes are merely introduced in the course) • P - practiced (programs outcomes are not just introduced but practiced in the course) • D - demonstrated (program outcomes are practiced, demonstrated, and assessed in

the course Sample Curricular Map for the Basic Sciences Group of courses

Year I

1. Anatomy & Histology

1P, 2P, 3I, 4I, 5I, 7P, 8P

2. Physiology

1P, 2P, 3I, 4P, 5I, 7P, 8P

3. Biochemistry

1P, 2P, 3I, 4P, 5I, 7P, 8P, 9P

Year II

4. Microbiology & Parasitology

1P, 2P, 3P, 4P, 5I, 7P, 8P, 10I

5. Pathology

1P, 2P, 3P, 4P, 5I, 7P, 8P

6. Pharmacology

1D, 2P, 3P, 4P, 5I, 6I, 7P, 8P, 9P, 10I

7. Legal Medicine & Jurisprudence

Year III

1D, 2P, 3P, 4P, 5P, 7P, 8P

1D, 2D, 3P, 4P, 5I, 6P, 7D, 8D, 9P, 10P

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Sample Curricular Map for the Clinical Sciences Groups of courses

Year I

Year II

Year III

Year IV

1. Medicine

1P, 3P, 2P, 4P, 5P, 6I, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

2. Pediatrics

1P, 3P, 2P, 4, 5P, 6I, 7P, 8P, 9P, 10P

1D, 3P, 2D, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

3. ObstetricsGynecology

1P, 2P, 3P, 4P, 5, 6I, 7P, 78, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

4. Surgery: Ophtalmology, ENT, Anesthesiology, Orthopedics

1P, 2P, 3P, 4P, 5P, 6I, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

1P, 2P, 3P, 4D, 5D, 6P, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3D, 4D, 5D, 6D, 7D, 8D, 9D, 10D

Year III

Year IV

1P, 2P, 3P, 4P, 5P, 6I, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

1P, 2P, 3P, 4P, 5P, 6I, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

2P, 3P, 4I, 5I, 6I, 7P, 2P, 3P, 4I, 5I, 6I, 7P, 8P, 9I, 10P 8P, 9P, 10P

2D, 3D, 4D, 5D, 6D, 7D, 8D, 9D, 10D

1P, 2P, 3P, 4P, 5P, 6I, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7D, 8D, 9D, 10D

5. Preventive Medicine & Public Health

1P, 2P, 3I, 4P, 5I, 6I, 7P, 8P, 9I, 10I

Sample Curricular Map for the Other Courses Groups of courses 1. Neuroscience*

Year I 1P, 2P, 3I, 4I, 5I, 7P, 8P,

2. Psychiatry* 3. Leadership & Management, Health Policy & Health Laws*

2P, 3I, 4I, 5I, 6I, 7P, 8P, 9I, 10I

4. Geriatrics

Year II

5. Patient Safety*

1P, 2P, 3I, 4P, 5I, 6I, 7P, 8P, 9I, 10I

1P, 2P, 3P, 4D, 5D, 6P, 7P, 8P, 9P, 10P

1D, 2D, 34, 5D, 6P, 7P, 8D, 9D, 10P

1D, 2D, 3D, 4D, 5D, 6D, 7D, 8D, 9D, 10D

6. Disaster Risk Reduction & Management*

1P, 2P, 3I, 4P, 5I, 6I, 7P, 8P, 9I, 10I

1P, 2P, 3P, 4D, 5D, 6P, 7P, 8P, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6P, 7P, 8D, 9P, 10P

1D, 2D, 3P, 4D, 5D, 6D, 7D, 8D, 9D, 10D

7. Interprofessional education*

3I, 5I, 10I

5P, 10P

5P, 10P

5D, 10D

*To be integrated into other subjects as appropriate

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ANNEX 4. CHED Prescribed Student Logbook on Patients Seen and Procedures Performed Sample Student Logbook on Patients Seen and Procedures Performed (page 1) ____________ Semester, AY _______ Date

Name of Patient

Department

Diagnosis

138

Procedures Performed

Monitor’s Signature

Supervisor’s Signature

(page 2) Sample Procedures Performed Psychomotor Skills Outcomes

Procedural Skills for 4th year medical student: Procedures Performed (example)

Date

Venue

Subject Mannequin

Excision of skin cysts NGT Insertion IV insertion Suturing Folley catheter insertion Lumbar tap Circumcision Basic Life Support ACLS Normal Vaginal Delivery Immunization Breastfeeding counseling Tuberculin skin test PAP Smear

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Patient

Supervised Yes

No

Signature of Supervisor

ANNEX 5. Annual Report Form to CHED ANNUAL REPORT FOR MEDICAL (M.D.) PROGRAM (To be submitted at the end of the school year) Name of the Institution: Address: Program: Duration/No. of Years: Government Recognition: Number Date issued: External Accreditation: Accrediting Agency: Telefax: Email: Website: Name of Dean: Date of submission:

Effectivity:

I. Faculty Profile A. List of Faculty Members who are holders of MA/MS/PhD Name of Faculty

MA/MS/PhD degree (year obtained)

B. List of faculty members who attended conference(s) on Medical Edication during the year Name of Faculty

Specify local/internation conference

C. List of faculty members with publication(s) in Refereed Journals during the year Name of Faculty

Specify title & journal

D. Total number of faculty members: Full time: Part time:

140

E. Does your institution have a Medical Education Unit? Yes If yes, since when?

Who is the head?

No

II. Admissions A. Statement policy on NMAT score (Please declare admission policy on NMAT Cut-off score set by the medical school) B. Basis for Admission Weight (%)

Admission Requirement/s

Minimum Rating Requirement to be admitted, if any

General Weighted Average Grade (GWAG) NMAT Score Interview Score Others

C. Number of Students Admitted 1. What is your DECS, Ministry of Education/CHED-Approved quota for freshmen admission?

2. What is your suggested quota?

Name

Gender Male

NMAT Score

Female

Pre-Medical Program Name of School

Course/ Program

GWAG

D. Summary of Admitted Students D1. Total number of admitted students: D2. Proportion of admitted students with NMAT score of more than 40th percentile: D3. Proportion of admitted students with Latin Honors: % D4. Proportion of students who are transferees from other medical schools: %

141

%

III. Enrollment Data Year Level

Female

Male

No. of Students Regular

Irregular

On Leave

1 2 3 4

A. Statement policy on promotion board: (Please declare existing policy on promotion of students set by the medical school) B. List of Students per Year Level Year Level

Name of Students

C. List of Irregular Students Year Level

Name of Students

D. List of students who are on Leave-of-Absence Year Level

Name of Students

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Total

E. List of students who dropped out in the College Year Level

Name of Students

F. Results of Comprehensive Examinations at Year 2 and Year 4 Year Level

Name of Students

Score

V. Graduation A. List of Graduates General Weighted Average Grade

Name

Submitted by:

143

Class Rank