“Ultimately the strongest driving force for change must be the students and the doctors themselves. They must be empowered to demand excellence in the courses they attend and realize that their education is not a favour to them, but a means of preparing them to be the sort of doctor we want in the future” (Lowry, 1993)
Medical students are often viewed as if they are in the rite-of-passage toward godhood – that they have to go through all of this so that they can finally breathe and bask in the status of a mythological creature when they finally get to suffix an M.D. to their name.
Medical school is everything they say: insane in its difficulty, merciless in its attrition rates, and a relentless thief of humanity. It is truly difficult and mostly for the wrong reasons.
First year in our institution is a haven of five subjects. One can learn the value of time management as the adjustment phase from college-style, sleep-first-before-study-but-you-will-still-ace-an-exam mindset, will take them to a beating within an inch of their life. But this is fairly simple, it’s medical school after all. It should be an easy concession.
Enter second year and five subjects morphed to a monstrous Fourteen. From the easing-in phase of studying normal bodily functions, we entered the diverse world of infections, cancer, or whatever ailment your body decide to come up with. The load begins to make itself felt and time can only be your enemy. It is commonplace to see medical students languishing with the immense study load.
In our school, massive improvements have been done since 2007. But changes in the curriculum have been limited, or even shackled, by outside forces. The problem is due to a system that has been maintained for the good part of the past 50 years.
Law and Board Exams
The Medical Act of 1959 enumerates all the blows that we will need to endure to attain that M.D. – in other words all the subjects we need to pass to become a physician.
But the kind of training it will confer to a student in 1959 (or 1969, its latest amendment) is meager compared with the walloping it does today with the explosion of free and unfiltered information thanks to technology. It practically dooms the millennial into assimilating the countless new discoveries, latest advancements, and confusing facts admixed with the classical ways of clinical reasoning.
Advancements of the past decades rendered the Medical Act of 1959 an obsolete law enacting inefficient means of molding and evaluating new physicians. This is evident in the microenvironment of medical school itself where sources for exam question is a toss up between the multiple sources available and clinician experience.
To put reality bluntly, the system has devolved to such a state that it is more likely that we get positive evaluation points through rote-learning than us applying and showcasing our acquired skills in delivering compassionate care and making sound clinical judgments.
In 2014, however, the Commission on Higher Education has released a new approach to teaching students. It has adapted the outcomes-based education that is gaining international traction as the primary mode of evaluation for students.
Here, the law should (ideally) do away with specifying required subject-based courses, and instead focus on defining what the outcome should be; focus on the traits that they are looking for in a finished product. This will empower institutions to become less lecturer-centered and more learner-centered.
They are already doing this in other countries, and it seems that the move is to further integrate our educational system with foreign standards which adapt the same method, particularly the ASEAN.
OBE, as cited by this paper, is “a move from a situation where WHEN and HOW students learn took precedence over WHAT is learned and WHETHER it is learned well (Spady, 1994).”
It is basically the system not giving a sixpence to the curricular rules of a particular school. All they need to do is to produce new physicians that possesses minimum competencies that will be defined and evaluated by law. It means that a school may even eliminate the requirement of an undergraduate pre-medical degree for as long as the outcome is a reasonably competent doctor! I’m pushing the boundaries here, but you get the idea.
But OBE is not the panacea. The role of a cooperative control of curriculum is still important in improving quality of medical education. Medical educational institutions are being called to develop a more dynamic curriculum that fosters contribution from and empowerment for its student-learners.
Furthermore, CHED has no legislative capacity to amend or repeal the Medical Act of 1959; and it seems that the latest clamor in congress got stuck and is nowhere to be found.
The paralysis in progress incited by our obsolete laws is a product of this self-perpetuating problem. Discussions abroad have already acknowledged the centrality of a learner-centered education in forming skilled and intellectually fertile doctors.
What we need is change for our future colleagues who will enter medical school with bright, shining eyes of idealism, a characteristic that our country needs more than ever.
We are learners and human beings above all else. We are Filipinos who wish to become doctors because we want to contribute something good to the inglorious state of the Philippine Healthcare system. It is only reasonable to demand what education should encourage us into doing that instead of jading and alienating the critical mass of physicians it is producing every year.
Let’s develop physicians who will have enough space to think and feel for themselves, physicians who are dynamic, innovative, creative, and unafraid to teeter on the cutting-edge of progress. [x]