Begin with the Ends in Mind

The Philippines promulgated Republic Act (RA) 10533: the “Enhanced Basic Education Act of 2013;” this law changed the 6-year elementary and 4-year high school curricula to the compulsory K-12 basic education model. Such reform aligned the Philippine basic educational system with the rest of the world.¹ Consequently in 2018, RA 10968: The Philippine Qualifications Framework was released. This law further ensured that professionals educated from K-12 and seek further education either from the technical and vocational or to formal academic degrees from baccalaureate to post-graduate will be accorded educational qualifications acceptable to national and international accrediting bodies.

The K-12 reform has to be sustained at the level of higher education institutions (HEIs). In 2012, the Commission on Higher Education (CHED) released its CHED Memorandum Order (CMO) 46 instituting the Policy Standards to Enhance Quality Assurance (QA) in Philippine Higher Education through an Outcomes-Based and Typology-Based QA. Outcome-Based Education (OBE) refers to a curriculum and quality systems model “clearly focusing and organizing everything in the educational system around what is essential for all students to be able to do successfully at the end of their learning experiences. This means starting with the clear picture of what is important for students to be able to do, then organizing the curriculum, instruction, and assessment to make sure that learning ultimately happens.”² Article 3 Section 14 of CMO 46, 2012 stipulates the rationale of adopting outcomes-based education (OBE) because “it has the potential to greatly increase both the effectiveness of the QA system, and the quality, efficiency, and effectiveness of higher education. Mature evaluation systems are based upon outcomes, looking particularly into the intended, implemented, and achieved learning outcomes.”³

Among the first to respond to CMO 46 was the Technical Panel for Medical Education. In 2016, CHED released CMO 18: Polices, Standards, and Guidelines for the Doctor of Medicine (MD) Program.⁴ In consistency with OBE curriculum design, CMO 18, enumerated the final program outcomes (POs) as well as their corresponding specific competencies and performance indicators expected from those who will finish the MD program. These expressions of educational intents refer to the “ends in mind” for the perusal of students, their teachers, the medical schools, training institutions, and their publics.

Although released in 2016, three years before the promulgation of RA 11223: The Universal Health Care Act in 2019, CMO 18 reflects the strong call towards transformative education of medical students, and make them truly respond to the changing population health needs of the Philippines. CMO 18 further mirrors the call of the World Health Organization (WHO) for transformative scale-up of health professionals’ education and training defined “as the sustainable expansion and reform of health professionals’ education and training to increase the quantity, quality, and relevance of health professionals, and in so doing strengthen the country health systems and improve population health outcomes.”⁵ The POs for graduates of the MD Degree are summarized to include the (1) health care provider role in PO1: demonstrate clinical competence and PO2: communicate effectively; (2) manager role reflected in PO3: lead and manage health care team, PO5: collaborate with interprofessional teams, PO6: utilize systems-based approach to healthcare; and (3) community leader seen in PO8: adhere to professional, ethical, and legal standards, PO9: demonstrate nationalism, internationalism and dedication to service, and PO10: practice the principles of social accountability. These ends in mind refer to what the medical faculty should inculcate among their students in terms of essential knowledge, skills, and values (KSVs) as general medical practitioners. In formulating POs, Spady also identified “enabling learning outcomes” that will make students work towards and achieve the essential KSVs.² In CMO 18, these enablers are PO4: engage in research activities and PO7: engage in continuing personal and professional development. Without these two POs, medical students and professionals may not be able to respond according to the changes of the time. Essential to these last two program outcomes are critical thinking, collaborative learning, integration of information and communications technology (ICT), and evidence-based practice.

Even before the COVID-19 pandemic and despite having many issues to address in terms of transformative learning, Philippine medical education has been a testament of outstanding quality. Among the licensure examinations administered by the Professional Regulation Commission, results of the medical board examination registered the highest performance rating compared to other health sciences and allied fields.⁶ Graduates of medicine have always enjoyed the highest esteem because of their critical thinking, capability to solve problems with the best evidence, and being effective members of the health care teams.⁷ With these professional attributes of medical students and graduates, the quality of medical education they experience with their institutions should be recognized. The use of the right blend of traditional yet classic teaching methods with the modern delivery strategies and platforms, evidence-based practice, collaborative learning, and use of ICT are all distinct marks of evolving medical education.^8-10

The article on Interactive Journal Club (IJC) by Falcon et al.¹¹ explored yet another innovation in medical education. The authors shared their experiences in going through IJC in their Health Informatics 201 class. Although admittedly done in quite a limited setting and forced by the COVID-19 restrictions to be conducted online,¹² the student’s experience as reported in the article captures the achievement of the basic enabling outcomes (PO4 and PO7), as well as PO2 and PO5. Had the article enumerated the publications that were reviewed in the journal club, the achievement of other POs would have also been possible. The article identified the basic need for the expectations and essential learning outcomes to be clarified at the beginning of the exercise to ensure maximum learning. The article articulates the value of beginning with the end in mind, clarifying with the learners what they are expected to be able to do and perform within acceptable standards before any actual teaching-learning experience is carried out.

Erlyn A. Sana, PhD
National Teacher Training Center for the Health Professions
University of the Philippines Manila