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October 27, 2011

Teaching Community Medicine in the 21st Century

I have just attended the general assembly and annual convention of the Philippine Academic Society of Community Medicine in Manila yesterday, a move which actually hoped to revive the long-hibernated academic society of professors teaching community medicine.With its theme: Community Medicine - Past, Present and Future Directions, the half-day convention highlighted updates on the status of Community medicine education in the country and highlighted best practices of other med schools with regards to faculty development. I am thankful that my University, the University of Saint La Salle, tapped me to represent the school, being the lone delegate from Negros. In the many talks, I was actually interested on the talk given by Dr. Elizabeth Paterno. Her talk was on Global Trends in Community Medicine. Among the many highlights in her talk were: presently, the way community medicine is being taught in our schools is still anchored on the Flexnerian type of teaching (scientific-based), far from what is ideally community-based where the community is perceived not as a laboratory or classroom but actually a partner in bringing to fruition concrete and sustainable social change; Medical education as a whole is still largely hospital-based, including Preventive Medicine/Family Medicine/Family and Community medicine, as contrary to the proposed ideal that is community-oriented and integrative in its approach; That while there is more demand for physicians in the front-lines, medical schools in the Philippines still continue to produce clinicians rather than community medicine physicians who can best serve the unmet needs in the front lines. She also made mention in her talk about how education must be approached. Education must be informative, centered around skills and knowledge formation, thus leading to the production of experts. Education must also be formative, centered around values formation, thus leading to the production of professionals. But education must also be transformative, centered around leadership skills, thus leading to the production of leaders. She also made mention that there has been a notable disregard for social determinants of health and the teaching of community medicine is still medical. While I was listening to Dr. Paterno, I could not help but scribble what my recommendations would be to be included in my post-conference report to be submitted to the office. The following are my recommendations:

1. There has to be, from the start, particularly during the screening process, an investigatory pursuit for students' interest to be working in the community as community physicians or public health. In this way, students whose motivation of becoming doctor is to serve the community as community physicians can already be identified and tagged by the institution to be nurtured thus sustaining the motivation all the way to clerkship and even internship. The University of St. La Salle College of Medicine has this Mentor Program wherein a group of medical students are matched with a Professor (who are all MD's) and will be "mentored" throughout the year. They won't be "tutored" which is definitely different from being "mentored'. Part of the mentoring I think will also be nurturing their motivation to become doctors.

2. Increase community exposure and community-based learning. For example, the entire second semester of the third year medical students will be exclusively community-based. In their adopted community, they must have performed the following: community profiling, community diagnosis (situational analysis, local health needs analysis, stakeholder's analysis), project proposal and implementation and recommendation. Clerks for example must have at least an extra 2 weeks spent for leadership and management skills training.

3. Researches must be geared towards addressing social determinants of health. Researches of first year, second year and third year students must be community-oriented. The objective is to produce conclusive recommendations that would benefit the community and or address the needs of a local health system or even influence local and national health policies.

4. Establish an integrated community medicine education unit in the University (College of Nursing and College of Medicine) to establish integrated health teams that can serve the community. By allowing partnerships with medical allies, teamwork is being developed and the hierarchical and "doctor-centered" perspective approach to health care service can be overcome. An integrated health team can be composed of a medical clerk, community health student nurse/s, a rural midwife, barangay health worker, a clinical instructor or preceptor (either coming from the COM or CON and whose job is to solely supervise the conduct of the team). The role of the integrated health team is to address health needs of individuals in a community through a more integrated approach, coming from different perspectives, to include even the patient's perspective.

5. To study the possibility of doing a dual-degree for medical students. Medical students can opt to go for a curriculum that would give them an MD-MPH rather than just an MD after they graduate. This can either be seen as an optional choice for enrolling medical students or part and integrated in the entire curriculum of the medical school. I think it is really feasible because all you need are additional units since some of the courses taught in medical school can already be accredited to the MPH course (e.g. Biostatistics, Microbiology, Bioethics, etc). Additional courses (2 in each semester) can be feasible in an In-Classroom-Off-Classroom format, almost like a "distance learning" type but with a notable classroom instruction. Courses that can be included are: Disaster Management, Health Legislation and Policy, Health economics, Basic Epidemiology, etc.

These are just random thoughts that solidified while listening to the talks. To be accepted or not is not really the desire although it is what is being hoped. Again, the problem is definitely systemic and it may take years before we see results if we address solely the systemic problem.

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