The Journey

CHALLENGES IN IMPLEMENTING OUTCOME BASED EDUCATION THE JOURNEY OF A NEW MEDICAL SCHOOL

By Dean Melfer R. Montoya MD, MHPEd

February 2017

How can a new medical school to pull things through amidst the challenges of the current times and advances in technology and science? How updated can a physician be when prevailing best practices should be based on evidences? How innovative can a medical educator be, when a key development in medical education is a shift towards outcome based education?

This narrative starts about the man who started it all. It also tells us about the intricacies of setting up the Doctor of Medicine program. It allows us to have a peek inside the heart of the people involved in the infancy stage of the program. The story about their commitment is worth emulating. Their brilliant innovations in teaching – learning strategies can’t be discounted.

In less than two years of existence, we have realized how enormous the job is. To such a degree, we are thankful and honored to be given the chance to shape minds and touch the future.

Our altruistic President and Founder, Atty. Augusto W. Go, never stops in his pursuit for giving people access to good quality education. The University of Cebu College of Medicine Foundation, Inc. or UC School of Medicine (UCSM), as it is often called, came into being because he felt the need for the country to have more doctors. Thus began his quest of making medical education accessible to all people.

The man is known for the academic institution built in 1964, University of Cebu, which educates a spectrum of students in Cebu City and Mandaue City with its four campuses. In all of these, his interests and passion remains the same, that of democratizing quality education. The medical school is not an exception. It is made accessible by competitive school fees and varying scholarships. The school was established in synergy with the new hospital– UC Medical Center.

The process of looking for the right people to take charge of the day to day activities of the school was not a minute matter. Even before the college got its permit, a team of reputable physicians who were also academicians was formed to look into the specifications of the Doctor of Medicine program. Both the administration and my distinguished team of pioneer faculty members left no stone unturned in every effort to make the academic program appropriate to meet the local and global needs.

My team prepared the curriculum in terms of its design, content and delivery. The related required resources were taken into consideration. Among them were the organizational structure of the academe that will articulate the curricular design and efficiently implement the prescribed competencies of the school. That include searching for department chairpersons, faculty members in both basic and clinical medical sciences and clerkship directors as well.

We worked on the standards of the instruction. The groundwork and framework of the curriculum were laid. For all intents and purposes, the curriculum was crafted with the vision and the mission of the institution in mind.

As for its physical resource, the eighth and ninth floors of UC Banilad campus were converted into classrooms and facilities for the new College of Medicine. All the other physical requirements were taken into consideration in making the infrastructure. It was made sure that facilities such as the medical library, medical education unit, clinical skills laboratory and all the other laboratories for Gross Anatomy, Histology, Microbiology and Parasitology, Pathology, Biochemistry, Physiology and Pharmacology were all there working and available for use by the medical students. Two amphitheaters were purposely constructed for big group lectures. Several small rooms for small group learning were made available.

Last December 19, 2014, CHED gave UNIVERSITY OF CEBU COLLEGE OF MEDICINE FOUNDATION INC. the permit to operate. Guided with its vision “to become a leading medical academic institution that transforms lives and provides society with medical professionals who are driven to excel and serve”, it opened its doors to the pioneer batch of students on June 22, 2015, at UC Banilad Campus. Most of the students came from the Visayas and the Mindanao areas.

The curriculum is subject based with a hybrid type of teaching methodology. In this collaborative learning environment there is an integration of student-centered and educator-guided learning approach. Students and teachers work together in active and experiential learning. Active learning strategy becomes the core of the curricular delivery.

Each student has a personal mentor who serves many roles. The mentors provide a truly holistic student-centered support that focuses on personal and professional development. They accompany the students in their journey from a becoming a learner to a healer.

The curriculum is structured in four levels. After graduation, the graduates take a one-year internship in accredited teaching hospitals prior to taking the licensure exam.

Year level 1 and 2 comprise the foundation of the educational program which presents basic medical science information in a clinically and community relevant context. In addition to basic medical sciences, there are clinical science subjects added in Year level 2. Year level 3 continues with more clinical specialty courses in tandem with pre clerkship program where students participate in supervised patient care while rotating through various medical specialties. Year level 4 allows our clinical clerks in the clinical clerkship program to go on full time clinical activities during their rotation to different departments. Students graduate at the end of 4th year. In this set up, students and teachers work together and collaborate with each other.

When we started implementing our program, we did it with an “open mind” to say the least. While it was true, that the distinguished faculty members who were with me were all experienced in their respective fields, all of us had to be forewarned that a new directive is coming. It was due to the obvious reason that when the school started its first batch of students in SY 2015 – 2016, CHED was starting to invite school administrators for public consultation of the new program, standards and guidelines (PSG). The new PSG talked about how to implement the shift to competency based standards or outcome based education of the MD program. In consonance with the shift, the faculty believed that the national mandate for curricular reforms could address global responsiveness.

The official mandate through CHED MEMORANDUM ORDER NO. 46 SERIES OF 2012 entitled “Policy Standard to Enhance Quality Assurance (QA) in Philippines Higher Education Through an Outcomes Based and Typology Based QA” (Dec. 11, 2012) together with RA 10533, EO83 and CMO 20 tells us to harmonize and be attuned with the ASEAN and global community.

The mandate from CHED was also in synergy with the K-12 program of Department of Education.

There were other strong factors or forces geared towards the shift. The Lancet Commissions report entitled “Health Professionals for a new Century: transforming education to strengthen health systems in an interdependent world” came out in 2010 with a compelling call for Transformative Education, Interprofessional education, and Social Accountability of Medical Schools.

By coincidence, the Technical Committee for Medical Education (TCME) also made a proposal on “Rationalizing Medical Education in the Philippines” to transform medical schools to become “Excellent.” The goal of that proposal is to reach at least 90% institutional passing average of the medical schools in the Physician Licensure Examination by year 2020.

The curriculum change, therefore, was inevitable across all higher educational institutions. It was a directive. A big challenge indeed for a new medical school like ours.

The team of faculty members assigned to the medical education unit knew that another round of curricular work was to be done. Each of the members of MEU gathered reading materials from different academic journals to check on evidences of outcome based education. These same materials were disseminated to the other faculty members.

Some faculty members enrolled in a Masters of Medical Education program. All faculty members attended workshops and conferences on outcome based education sponsored by APMC or by their specialty and academic societies.

There was a school wide conference and workshop regarding OBE. Each department had also one on one meeting with the medical education unit. These activities lessened the confusion of faculty members who were implementing the curricular program to our pioneer batch of students.

Taking off from CMO no. 46 which states that “The OBE approach in the Philippines mixes OBE with other curriculum approaches and is open to incorporating disciplined based areas that currently structure HEI,” our direction was to align each discipline with OBE and to organize each course syllabus and all instructional designs based on the CHED program outcomes. In the process, we did a reverse planning model, since the course content, the learning and assessment methods are derived from the expected learning outcomes.

We have realized that Outcome based education has become an important development in medical education in many parts of the world. We had become fully aware that in curriculum planning, the end product of our training and the competencies expected of our graduates are valuable.

We likened things to a plant. Quoting Dr. Ronald M. Harden “The seeds we plant in our garden and how we cultivate them, including the growing conditions we create and the fertilizers we use, will depend on the plants we expect to grow” We started by reviewing both our own vision and mission. The statements below elucidated who we are, where we are going, and what will guide our journey.

“OUR VISION: University of Cebu School of Medicine aims to become a leading medical academic institution that transforms lives and provide society with medical professionals who are driven to excel and serve”.

“OUR MISSION: The UCSM is committed to develop exemplary physicians with a medical education of exceptional quality who practice patient-centered healthcare; responsive to the needs of the community through compassionate service; engaged in discovering new information through research; adheres to professional and ethical practice with social accountability; attain the habits of lifelong learning and be leaders in advancing medicine, health and well- being”.

We formulated the following attributes of our graduate taking off from our vision and mission. It was painstakingly done to make it simple enough but comprehensible and doable.

An Exemplary Clinician whose unparalleled knowledge and skills in the field of medicine coupled with compassion resonates to the least in the community through the practice of democratized patient-centered healthcare under the realm of utmost ethical standards.

A Visionary Industry Leader whose high degree of social accountability and unsurmountable drive to excel and serve gives hope to people across the universe in the present and next generations, and transforms lives of individuals that come along the way.

A Relevant Contributor of New Knowledge whose endless search for truth and means towards prosperity drives him to toil continuously for the advancement of medicine and health in different eras and sectors of human society.

A Global Filipino whose unwavering and inherent nationalism and patriotism embedded in the practice of his chosen field bounces back to his people at home and people across his shore.

A Versatile Scholar whose positive attitude towards evolution of learning and practices makes him embrace spontaneously change and technological advancement with the end goal of improving lives.

A Lifelong Learner whose earnest desire to upgrade and update his capacities, capabilities and competences that benefit his clients makes him a regular consumer of research outputs and participant of research activities.

We also coined a MOTTO that spells everything a graduate should be:

DRIVEN TO EXCEL. DRIVEN TO SERVE.

The medical education unit together with the faculty members of each department looked into the strengths, weakness, opportunities and threats of its own department. Each department made their own frequent meetings too. We worked on strengthening our weakness, eliminating our threats and exploring our opportunities.

We wanted to strengthen our research. The research coordinator laid out a very comprehensive plan. We wanted our graduates to make use of current research evidence in decision making when they become practitioners, academicians or researchers. Critical appraisal of journals was introduced at the level of first year.

It was decided that an ethics committee and a technical research committee should be organized. The organization part did not take long because we have committed people to do it. For the animal experimentation, IACUC (Institutional Animal Care and Use Committee) was organized with our veterinarian at the helm. This was followed with the organization of the IERB (Institutional Ethics Review Board) or ERC (Ethics Research Committee) in charge of studies involving human subjects.

Both committees scheduled their own training. The members of the IERB finished their Good Clinical Practice training and received certificates. The organization of these two important committees had the important support of the administration. To unite the research efforts of the faculty and students of UC – Banilad campus, these two committees were tasked to serve the needs of the entire university. This is a feather in the cap of the College of Medicine which pushed hard for this.

Realizing the current shortage of physicians especially in remote places, the staff of Preventive, Family and Community Medicine arranged a coordination meeting with the Cebu City Health Officer. The goal is for our students to do activities in different health centers starting first year. This will give them an opportunity to do hands on experience earlier in the basic health unit setting of the country. A move to let them be accustomed to the DOH programs in terms of implementation and evaluation. This will allow them to start on building partnerships with other health care providers, a good start for interprofessional education.

The different basic medical science departments in year level 1 and 2 made innovations in their learning methodologies. For any innovation that they did, the program outcomes were always in their mind. We made the curriculum map provided by CHED as a guide to indicate the level of emphasis of each outcome. The same was true with the clinical science departments of Year levels 2,3 and 4. Team based learning and case based learning were teaching strategies adapted.

But innovations initiated by the faculty never come to a halt. Everybody is willing to know more about the new dynamics of medical education.

Assessing attitudes of the student is another bigger challenge for we are faced with a new breed of millennials. We are continuously studying ways how our existing attitude scale can be improved. Each student is also required to submit a portfolio of reflections to hone their reflective skills and think further of their learning plans. Assessing reflective skills is being implemented.

Each mentor chats with one’s mentee and makes evaluation at the end of the school year through a Medical Student’s Attitude Evaluation tool.

Different types of assessment of student achievement are also implemented.

The efforts put in by the faculty members are praiseworthy. In addition to having an indomitable spirit, they have that all important trait called GRIT. To quote Angel Duckworth, GRIT is the “perseverance and passion for long term goals”.

The more seasoned faculty members are providing the impetus so that things happen. The younger faculty members on the other hand, become the eager and the best partners of the more senior ones. It helps that they share the same values in life.

The laudable impact of Outcome Based Education on our graduate is undeniable. This will allow our graduates to be learners for the whole of their lives so they remain current in clinical knowledge and skills. As early as first year they are made aware of their expectations. This will also bring out the best in knowledge, skills and attitudes so they can be ready for the needs locally and globally. These outcomes can enrich their credentials. Evaluation of their credentials become factual and detailed.

Plans for the future are many. As a two year old school, we are looking forward to quality assurance through PAASCU accreditation. We plan to have a continuous re-evaluation of our curriculum to ensure that the outcomes meet the needs of the profession and the wider community. Faculty development will not stop with majority of them looking forward to attain a Master’s degree in health profession’s education. We have to ensure that outcomes will be met through alumni tracking. Finally we hope to have an excellent passing rate in physician licensure exam, albeit all the challenges surrounding us.

Our two year journey is full of surprises. But we are so blessed to have the full support of the chairman and the chancellor who built a new medical school building, alongside UC Medical Center. This is another gift to the community, a testament to their generosity. The new school is located at Ouano Avenue, Subangdaku, Mandaue City, our home starting SY 2017 – 2018.

With all the efforts of the faculty members and the full support of the administration, we have high hopes, that our graduates will be able to to carry the vision and mission of the school and live the motto “Driven to excel. Driven to serve.” Along these lines, we look forward to seeing an AWG ( Augusto W. Go) in every UCSM graduate.