Preparing for the Health
Future for Filipino
Obstetrician-Gynecologists
Jose Y. Cueto Jr., MD, MHPEd
Member, Board of Medicine
Confluence of Events
 PRC
Planning Workshop (Feb. 10-11)
1. Medical manpower survey
2. Predicting medical manpower needs for
the next 10-15 years
Confluence of Events
 MRA
Meeting in Thailand (Feb. 21-23)
1. Draft of core competencies
2. Template for data-gathering (ASEAN)
The Future?
 Looking
at the present
 Identifying
 Predicting
the trends
the possible developments
 Developing
a plan
Questions to Answer
 What
are the key areas to consider in
predicting the future?
 What is the present situation now?
 Can we identify a “trend”?
 What are the most possible future change
or scenario?
 What do we need to improve on?
I. Population Trends
(Bureau of Census, US Dept. of
Commerce, 1996)
Population Trends
YEAR
POPULATION
GROWTH RATE
PER YEAR
1996
73 MILLION
2.3%
2010
99 MILLION
1.8%
2020
113 MILLION
1.8%
Demographics: Age Structure
Age Bracket
Distribution (%)
0 – 14 years
34.9% (M 17.8m / F 17.1m)
15 – 64 years
60.9% (M 30.3m / F 30.4m)
65 - above
4.2% (M 1.8m / F 2.3m)
Demographics
Birth Rate
25.68 per 1000 women
Fertility Rate
3.23 children per woman
Death Rate
5.06 deaths per 1000 citizens
Trend and Projection
 High
growth rate
 High fertility rate
 High number of childbearing age
 High birth rate
very busy OB practice
II. Health Statistics
Infant Mortality Rate
Maternal Mortality Rate
% of birth attended by health
professional
% of maternal deaths attended
by health professional
29/100,000 live births
138/100,000 live births
65.3%
62%
Trend / What to do
 High
IMR
 High MMR
 Wide discrepancy among regions
 Many factors involved
Analysis of root causes
Failure of present measures
The Future
 Increase
in population, increase in number
of poor citizens
 Budget for health may remain the same
 Deterioration in medical services
 Increase in mortality rates
III: Education and Training
Number of Accredited
Training Programs
91
A. Government
42
B. Private
34
C. University
17
Education and Training
 Core
Curriculum
 Duration: 4 years
 Modular: 6 years
 Consortium
 Accreditation Requirements
 Residents In-service Examinations
 Subspecialty Training
Certifying Exams (2001-2006)
Number of
Examinees
Passed
Failed
Written Exams 1,437
934 (65%)
503 (35%)
Oral Exams –
1,310
879 (67%)
427 (33%
Written Exams
155
Oral Exams
146
Average
number passed
per year
Trend
 Total
 Ave.
No. of Residents: 878 per year
No. of examinees (WE): 239.5/year
 No. passed (WE): 155/year
 Backlog: 84.5 examinees
Trend
 Ave.
No. of examinees (OE): 218/year
 No. passed (OE): 146/year
 Backlog: 72.3 examinees
Deeper Study
 What
happened to those who failed?
 Did they eventually pass the exams?
 Did they go into practice?
 Did they join another organization?
 Are they now classified as “GP with
training” by Philhealth?
IV: The Practice of OB-GYN
 POGS
Fellows: 2,029
 Diplomates: 224
 Distribution
available
and place of practice: data not
Philhealth Data
• Data on CS claims from July 2008 to June
2009
• Performed by Fellows/diplomates: 59.86%
• GP’s with training, PAMS, DOH-certified:
29.5%
• MD’s with no training: 7.4%
Profile Data Needed
1.






Type of Practice
Solo
Group, single specialty
Group, multi-specialty
Salaried
Salaried / Private practice
Others
Profile
2. Scope of Practice
 General OB-GYN
 OB only
 Gynecology only
 Perinatology
 Infectious Disease
 Gynecologic Oncology
 Endocrine/Infertility
 Uro-gynecology
 Ultrasonography
Profile
3. Setting or place
 Metro areas
 Non-metro areas
 Area without diplomates and Fellows
Profile
4. Experience
 Less than 5 years
 5-10 years
 11-20 years
 More than 20 years
Questions
 At
any given time, what is the
predominant profile?
 How do we make projections for the
future?
 How many training programs do we need?
 How many graduates do we need to
produce?
Questions
 How
do we address maldistribution?
 What is our stand on those performing
operations without credentials?
 What do we recommend about the GP’s
with training? (products of accredited,
non-accredited TP’s)
 What will the picture be in 2020-2030?
V. Hospitals / Levels of Care
Data from PHA:
Level
Level
Level
Level
4
3
2
1
TOTAL
Gov’t
50
41
281
338
710
Private
77
185
425
442
1129
Hospitals / Levels of Care
 Different
needs (competence and
expertise)
 Different capabilities (equipment, facilities)
 Varying profiles of patients
Senate Hearing
 President
of PAMS
 Publicly complained against specialty
organizations which he described as
“elitist”
 Claimed that specialty exam questions are
geared to practice in big medical centers
 Pointed out that diplomates and Fellows
could not be found practicing in provincial,
district and local hospitals
Training Curriculum
 Primary
care: 1st year
 Secondary care: 2nd year
 Tertiary care: 3rd/4th years
Trend and Questions
•
•
•
•
Levels 3 and 4 constitute 29.4%
Majority belong to Levels 1 and 2
How should training programs respond?
Are there enough diplomates and Fellows?
Problem
 Standards
for accreditation of programs
and certification of graduates
 Rule being implemented:
only one standard
only one examining board for specialty
 Need to respond to national needs
VI. The Regulatory Body
The Professional Regulation CommissionBoard of Medicine
 RA 2382 as legal basis
 Art. I. Sec. 1 “the supervision, control
and regulation of the practice of
medicine”
 Quasi-legislative and quasi-judicial
functions
Board of Medicine
Drafted resolutions:
1. Practice of medicine
2. Classification of physicians (GP/specialist)
3. Declaring residency training as practice of
medicine
4. Deputizing PMA to oversee residency
training
5. Mediation of cases
Philhealth Workshop






Topic: Credentialing and Privileging
BOM: GP and Specialist
No “GP with training” classification
If cases are filed in regular courts or PRC, the
practitioner will only be classified as GP
Solution: give 5 years to pass certifying when
practicing in Metro areas
In areas w/o diplomates and Fellows, give
incentives for them to practice
Pending Bills amending RA 2382
 List
of Sanctions
 Art. V. Sec. 28 (k)
 Performing….an area of medical
specialization without fulfilling
specialization requirements prescribed by
the IPMA and the Board
Control of Residency Training
Three Institutions
1. PRC - PMA
2. DOH - PMAC
3. CHED - TPME
The Future
 What
would be the best arrangement or
relationship between medical specialty
organizations and the regulatory body?
 What amendments should we
recommend?
VII: Continuing Professional
Education
 In
many countries, initial certification after
residency training
 After a period of time (7-10 years), require
re-certification exams
 Traditional: attendance in conventions
 Expensive, difficult to evaluate
 Distance from place of practice
 Sponsorship from drug companies
CPE

Non-traditional Activities / Sources of Data
1. Practice evaluation
2. Outcomes assessment
3. Self-assessment programs
4. Distance learning modules
5. Submission of list of cases, procedures
6. CME Committee bulletins, advisories, updates,
CPG’s
7. Feedback from PRC, PMA, Philhealth, others
PRC
 Longitudinal
tracking of physicians
 Done every 3 years on renewal of PRC
ID’s
 After licensure
 After residency training
 Additional training
Future
With improvement of IT technology, there
will be less need to gather all members in
large-scale conventions
 What will be the most effective method of
disseminating new knowledge /
information?
 Or learning skills?

VIII: The ASEAN Mutual
Recognition Agreement (MRA)
 Exchange
of professionals
 Licensed in home country
 Main problem: regulatory law limits
practice of medicine to Filipino citizens
 Exception: reciprocity arrangement
Determining Equivalence
 Data-gathering
1.
2.
3.
4.
on:
MD degree program
Residency training: curriculum
competencies
certification
Subspecialty training
Competencies (GP, etc.)
MRA
 Main
concern: competence, ability to
compete with graduates from other
countries
 Communication skills
 Regulatory laws and policies
 Culture
 Direction of transfer
Future
Completion of data from member
countries
 Implementing guidelines
 Solving problems like legislation
 Orientation and dissemination to
practicing physicians
 Continuing communication

IX: Scientific and Technological
Developments
1. Genomics
2. Stem Cell
3. Vaccines
4. Drugs
Scientific and Technological
Developments
5. Advances in operative procedures (lap, robotics,
etc.)
6. Imaging techniques
7. Information technology
8. Changes in management (operative to nonoperative)
Scientific and Technological
Advances
9. Tumor markers / screening methods
10. Transplantation
Trend
 Numerous
advances
 Different stages of development
 Offer cures or treatment for various
disorders
 Definite impact on the training of
physicians and on the practice of medicine
Conclusion
1. There will be a lot of factors that will
impact on the future of ObstetricianGynecologists
2. The future is bright with the increase in
number of potential patients and the
sustained interest of medical graduates
in the specialty
Conclusion
3. Trends in education, training and
eventual practice in the specialty can be
identified
4. The impact of regulatory laws and
international agreements should be
studied
Conclusion
5. There are scientific and technological
advances that will become part of the
practice of medicine.
6. Our main problem as members of
academic, certifying and regulatory bodies
is to determine what to retain and what to
change
Conclusion
7. There is a need to conduct researches on
various educational and practice-related
topics and issues
8. There is a need for a national
comprehensive plan for developing the
medical manpower of our country
THANK YOU!
GUIDELINES FOR
CURRICULUM PLANNING
Jose Y. Cueto Jr., MD, MHPEd
Member
Board of Medicine
Overall Plan
CURRICULUM
INSTRUCTION
Curriculum: Basic Elements
Hilda Taba: “Curriculum Development:
Theory and Practice”
1. Objectives
2. Content
3. Teaching-learning activities
4. Evaluation
Planning a Curriculum
GOAL
GENERAL/SPECIFIC OBJECTIVES
COMPETENCIES OR ABILITIES
CONTENT OR SUBJECT MATTER
Planning a Curriculum
TEACHING-LEARNING ACTIVITIES
ORGANIZATION OF ROTATIONS
EVALUATION OF RESIDENTS
RESOURCES
Planning a Curriculum
1.
2.
3.
4.
5.
Instructional Design for Rotations
(Oncology, Infectious diseases, etc)
Objectives
Content
Teaching-learning activities
Resources
Evaluation
Planning a Curriculum
 Evaluation
of Program (by accrediting
 Evaluation
of Graduates (by certifying
body)
body)
The Goal
 Sets
the overall target for the whole
training program
 May be worded “To train residents to
assume the following roles….”
The General Objective
 What
should be accomplished at the end
of the whole program
 Emphasis on the role as clinician, in the
diagnosis and management of diseases
The Specific Objectives
 The
objectives at the end of each year of
training
 Different domains: Cognitive
Psychomotor
Affective
The Competencies
 The
abilities that should be acquired by
the trainee
 The competencies include:
Cognitive
Psychomotor
Affective
Interpersonal Skills
Communication Skills
The Content
 This
specifies all the subject matter that
the trainee needs to learn in the different
domains
 Cognitive, Psychomotor, Affective
The Teaching-Learning Activities
 The
wide range of learning experiences of
the trainees coupled with the activities
utilized by the trainors to “teach, train,
demonstrate”
 Include actual patient management in
different settings, rounds, presentations,
discussions, conferences
Acquisition of Psychomotor Skills

1.
2.
3.
Fitts and Posner (1976)
Cognitive Phase
Associative Phase
Autonomous or Fixation Phase
Psychomotor Skills
Documentation of progression
 Assists
 Supervised operations
 Operations independently performed
Operation
1.Hysterectomy
2. Cesarian
section
3. Adnexal
surgery
1st
Assist
Supervised Independently
performed
Advantage
Credentialing and privileging
 Complete documentation
 Use for determining hospital privileges to
be granted
 Physician will only be allowed to perform
procedures based on what he was able to
do during training

The Organization of Rotations
 Sequence
and structure, duration
 Covered by the Instructional Design for
the particular rotation
 Short periods (1-4 months)
The Evaluation of Residents
 The
knowledge, skills and attitudes
acquired by the residents during rotations,
at end of rotations, at the end of the year,
and at the end of the training program
need to be assessed
 Utilize different methods
 Feedback should be given after the
evaluation
 Internal and external
The Resources
 Sufficient
number of trainors
 Adequate facilities, equipment, and clinical
material
 Support services
Evaluation of Program
 To
assess the overall quality
 Different components
 Conducted by appropriate body
 Structured system
Evaluation of Graduates
 For
certification
 Written, oral and practical exams
 Feedback to institutions
Instructional Design for Rotation
 Detailed
 Covers
each rotation
 Communicates what should be learned
during the rotation
Summary
The basic elements of a curriculum were
identified
 For planning a residency training
curriculum, additional elements were
incorporated
 The guidelines can be modified as the
need arises
 Ownership of the curriculum should be
developed to ensure its implementation

THANK YOU!