IDENTIFYING ONE'S GOAL AND PROGRAM OF STUDIES

                Reynaldo O. Joson, MD, MHA, MHPEd
                          April 3, 1996

Part I. Assessment of Field of Service

1.1 Identifying existing conditions

     Field of service: MEDICAL EDUCATION

     Formal medical education was established in the  Philippines 
at  the start of the 20th century with University of Santo  Tomas 
being  the  first  and University of the  Philippines  being  the 
second  school (1908) to offer such a course.  As of 1996,  there 
are about 29 medical schools throughout the country.

     Each  year a total of more than 2,000 medical graduates  are 
being produced by all the medical schools in the country.

     Despite the seemingly adequate number of medical schools and 
medical graduates being produced, the Philippines has as a  whole 
poor health indices.  

     The following data on the Philippine health care system were 
gotten from the Community Medicine Development Foundation, Inc.:

     The Philippine health care system has failed to reach out to 
the majority of Filipinos.
  
     - Everyday, 28 infants die of tetanus; 1,277 children die of 
          pneumonia; 217 children die of diarrhea.

     - Everyday,  55  Filipinos  die of  tuberculosis  while  300 
          develop malaria. (1993)                                  

     - For  every  hospital  bed in the country,  there  are  701 
          patients. (1993)

     - Each  government Rural Health Unit serves 28,785  persons.  
          With  the implementation of the Local Government  Code, 
          municipal  governments have to support these RHUs  with 
          their meager local resources. (1993)
      
     - In  the rural areas where more than 60% of the  population 
          live,  only 10% of doctors, dentists,  and  pharmacists 
          practice.  (1993)

     - Fifty  percent of Filipino physicians and 65% of  Filipino 
          nurses are working abroad. (1993)

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     - The market is flooded with 12,000 pharmaceutical products, 
          many  of which are of questionable efficacy and safety.
          (1995)
     
     - The  government allots a mere 2.29% of its  annual  budget 
          for health services. (1995)

     Existing   health   care  services   are   inaccesible   and 
unaffordable to the majority of Filipinos.

     - Seventy-six percent of Filipino households live below  the 
          poverty line. (1995)
          
     - The average Filipino family of six requires a daily income 
          of PHP 245 to live decently -- but the legislated daily 
          minimum  wage  in only PHP 145.  Farm workers  earn  as 
          little as PHP 40 a day. (1995)

     - Farmers'  net  income on irrigated riceland  is  only  PHP 
          2,405/hectare/4-6  months  or  only  PHP  13.30  daily. 
          (1995)

1.2 Analyze reasons for existing conditions

     Present  medical curricula and medical educators  apparently 
are not effectively promoting health development in the country.

     At present, there is a global, national, and local call  for 
reformation of the medical education.

     At  the international level, the WHO, the  World  Federation 
for   Medical  Education,  the  Network   of   Community-Oriented 
Educational Institutions for Health Sciences, to name a few,  are 
calling  for  a reformation of the medical education to  make  it 
more  relevant and effective in promoting health  development  in 
all the countries in the world.

     At the national level, the Association of Philippine Medical 
Colleges Foundation (APMCF), the Department of Health (DOH),  and 
the  Commission  on Higher Education (CHED)  are  now  initiating  
reforms in the health sciences education in the country.

     In 1994, the APMCF conducted workshops on reformation of the 
medical education.

     The  DOH  and  the CHED are promoting  the  Partnership  for  
Alternative Health Science Education (PAHSE) since 1993.

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     At the local level, several medical schools, although  quite 
small  in  number, are now trying to make  their  curricula  more 
relevant  and  effective  and trying to call  the  other  medical 
schools  to follow suit.  Also, several medical educators,  again 
quite  small  in  number, are calling for and  assisting  in  the 
reformation of the medical education in the country.

     There  is  a need to improve the medical education  and  the 
educators in the Philippines in order to make the curricula  more 
relevant  and  effective in promoting health development  in  the 
country.

1.3 Identify ideal conditions or dreams

     All  medical  schools  should have  relevant  and  effective 
medical curricula and effective medical educators in order to  be 
able to promote health development in the country.

1.4 Identify needs to change conditions

     What are needed to bring about the desirable conditions are:

          CHANGE in the medical curriculum

               Community-oriented at least, if not community-based
               Problem-based
               Competency-based

          CHANGE in the medical educators

               Develop competency in implementing a reformed 
                    medical curriculum                    
               Develop competency in teaching          

1.5 Identify constraints

     Existing medical schools' resistance to change

          - "If it ain't broken, don't fix it" attitude

          - Not capable of changing to new curriculum
               no good understanding of a community-oriented,
                    problem-based, and competency-based
                    medical curriculum
               no competent trainors to assist change and 
                    training in new curriculum

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          - Need to re-structure system which may result in
               loss of power and position

     Not  enough agents (competent educators and  administrators) 
          for change at the moment

1.6 Choose priorities

     Despite the seemingly adequate number of medical schools and 
medical graduates being produced, the Philippines has as a  whole 
poor health indices.  

     Present  medical curricula and medical educators  apparently 
are not effectively promoting health development in the country.

     All  medical  schools  should have  relevant  and  effective 
medical curricula and effective medical educators in order to  be 
able to promote health development in the country or community.

     What are needed to bring about the desirable conditions are:

          CHANGE in the medical curriculum

               Community-oriented at least, if not community-based
               Problem-based
               Competency-based
               
          CHANGE in the medical educators

               Develop competency in implementing a reformed 
                    medical curriculum                    
               Develop competency in teaching          

     Main constraints in instituting change are:

          Resistance to change
          Inadequate agents of change

     I  don't think I can change all the medical schools  all  at 
once,  overnight  and  alone.  My chosen  priorities  as  far  as 
strategies are concerned are:

          Put up a pilot or change model
 
               in a new medical school
               in an existing medical school
               
                    to convince medical schools that "it"
     
                         can be done.
                         is effective.

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          Assist changes in the medical curriculum.

          Train medical educators in the desired curriculum.

          Recruit change agents.

II. Goals and Commitment

2.1 Actual Commitment

2.1.1 Identify present role and functions

          1. Medical educator 
               in the University of the Philippines
                    Functions:
                         1. Teaching medicine to students
                         2. Teaching medical faculty on how to
                              teach

               soon in Pamantasan ng Maynila
                    Function:
                         1. Teaching medicine to students

          2. Consultant
               Zambaonga Medical School Foundation
               Bicol Christian College of Medicine

               Functions:
                    1. Designing and implementing an innovative
                         medical curriculum
                    2. Training faculty on the implementation of 
                         the innovative medical curriculum

2.2 Future Commitment

2.2.1 Identify future role and functions

     CHANGE AGENT

          Functions:
               1. Put up a pilot or change model in
                    a new medical school
                    an existing medical school
               2. Convince other medical schools to reform
                    their medical curriculum
               3. Assist in the reformation of medical education
                    throughout the country

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2.2.2 Identify goals and commitment

     GOAL: To reform the medical education throughout the country
               to   make  it  more  relevant  and  effective   in 
               promoting health development in the community

     COMMITMENT: To convince and to assist medical schools in the 
                    reformation of medical education

III. Program of Studies

3.1 Identify needs to achieve goal and commitment

          Competencies in
     
               Organization planning and development
     
               Promoting change

               Instructional development and technology

3.2 Identify in SAIDI programs means to achieve goal

          Doctoral Program

               Organization planning and development

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3.3 Trace personal program of studies
               
                                                       Unit

                                                 Theory  Field 
                                                         Research

DOD 1.1 Philosophy of Organization Development    3         -

DOD 1.2 Philosophy and Theory of Planned Change   2         2
     
DOD 1.3 Philosophy of Structured System of 
          Organization                            3         2

DOD 1.4 Consultant Roles and Skills               2         2

DOD 1.5 Action Strategies and Programs            4         2

DOD 1.6 Organization Problem Diagnosis            3         2

DOD 1.7 Organization Planning                     4         2

DOD 1.8 Decision-making                           3         -

MOD/MIT 3.1 Developing Evaluation Plan            2         -

MOD/MIT 3.4 Cost Analysis                         2         -

MOD/MIT 5.4 Administration of Personnel           2         -

MOD/MIT 6.1 Persuasion                            2         -

MOD/MIT 6.2 Dissemination and Diffusion of
               Innovation                         2         -

DOD 9.9a Research Methods                         6

DOD 9.9b Statistics                               6

DOD 9.9c Dissertation Seminar or Proposal Module}  
                                                }14
DOD 9.9d Doctoral Research                      }

 
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3.4 Project time lines

                      1996      1997      1998      1999    2000

OD&P                  -----------------------   

Field Research        -----------------------          

Cognate Area          -----------------------

Research              -----------------------   

Dissertation                    ---------------------------------

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