Charting the Course of Progress: APMC’s Role in Revolutionizing Philippine Medical Education
August 23, 2024
Charting the Course of Progress: APMC’s Role in Revolutionizing Philippine Medical Education
by Louiejabe Yap Nuniala, UPCM Class of 2028
It is innate within human nature to fret and worry whenever those whom we hold dear become ill. The next logical step then is for us to consult physicians, or those with knowledge regarding health and medicine, and ask for their invaluable medical advice. After all, doctors undergo decades of education and training to save lives; hence, their pedestal in society. However, in an era dominated by innovations and technological advancement, there is a challenge in integrating the concepts of health equity and health for all that underscores the humanistic nature that defines medical practice. As such, how we define medical education continues to evolve and transform following the needs of changing societal landscapes.
Association of Philippine Medical Colleges, Inc. Logo
A Look into the History of APMC
In the Philippines, one of the organizations that oversees medical education is the Association of Philippine Medical Colleges (APMC). Its origin can be traced back to post-second-world-war Philippines when seven medical schools coexisted with sporadic partnerships and collaborations. To formalize the organization of these medical schools and standardize the education that they offer, then Health Secretary Dr. Elpidio Valencia requested the deans to organize The Medical Council of School Deans which primarily coordinated the course requirements with government hospitals for the internship of medical students in government facilities. This served as the predecessor of the APMC which was officially founded in 1967 with the following seven member institutions: University of Santo Tomas, University of the Philippines College of Medicine (UPCM), Manila Central University, Southwestern University, Far Eastern University, University of the East Ramon Magsaysay Memorial Medical Center, and the Cebu Institute of Medicine.
Initially, the APMC’s role was confined to developing standards, assuring quality, offering curricular and technical assistance, and generating best practices for advancing medical education in the country. However, through the years, its role transformed to analyzing key issues relevant to medical education and developing policy recommendations. These included the introduction of the concepts of primary health care and family planning in the medical curricula implemented nationwide.
Further exemplifying its commitment to providing solutions to the country’s health problems, the APMC also played an important role in shortening the duration of the medicine program from five years to four. Due to this, medical students can opt to finish their internship in any accredited hospital anywhere in the country rather than cluster together within metropolitan hubs where most medical schools are situated. This change allowed the redistribution of medical graduates to remote areas in need of more human resources for health. Decades after its conception, more institutions were added to the roster with 71 medical schools scattered across the country today.
The Evolution of Medical Education in the Philippines
Due to the evolving needs of the country’s healthcare landscape, the state of how we train physicians has also drastically changed. In addition, due to the introduction of the pivotal role of technology in healthcare and the country’s push for Universal Health Care (UHC), the state of medical education in the country will also shape the kind of health professionals that will champion equitable health for all.
Former UP College of Medicine (UPCM) and UP Manila Chancellor, Dr. Ramon Arcadio
In an exclusive interview, past APMC president, former UPCM dean, and former UP Manila chancellor Dr. Ramon Arcadio narrated the transformation of Philippine medical education from having a more traditional, didactic, and theory-based approach to one that reflects a more integrated, evidence-based, and community-oriented viewpoint. The first revolution of medical education in the Philippines is based on the report of American educator Abraham Flexner in 1910. Flexnerian medical education was characterized by a traditional, discipline-based curriculum that underscores the precedence of basic sciences subjects over clinical courses. Although some aspects of Flexnerian education have been retained in how medicine is taught today, one of the major criticisms of this approach is that it focuses substantially on basic sciences and research at the expense of the humanistic and patient-centered aspects of medicine.
During the 70s, problem-based learning was adopted in the Philippines, inspired by its implementation in Australia, Canada, and the Netherlands. Within this approach, students are encouraged to think critically and collaborate while analyzing a clinical case in a small group setting. At the time, this was considered the best approach, since students get to take the initiative in discussing the cases, identifying key learning objectives, and providing diagnoses or management plans. However, it is also recognized that this method is resource-intensive, has complex assessments and evaluations, and has varying learning outcomes.
Initially, some medical institutions in the country resisted adopting problem-based learning. Dr. Arcadio recalled receiving complaints when he was working for the Commission on Higher Education (CHED) regarding the changes in the approach to medical education and its incompatibility with the temperament of faculty and students alike. As a result, some medical schools shifted back to a more discipline-based approach. However, Dr. Arcadio also noted that in its essence, the approaches that these medical schools implemented did not revert to Flexenarian, but rather towards a more integrated outlook that fuses elements of problem-based learning and discipline-based learning.
CHED underscored the significance of academic freedom in Philippine medical education, fostering a flexible approach, and encouraging diverse perspectives; thus, advancing medical knowledge and cultivating competent physicians. With this, more medical schools implemented other approaches to medical education and training. One of which is evidence-based learning, which prioritizes rigorous scientific evidence to ensure high-quality patient care and continuous learning. Another emerging approach is the promotion of community-oriented medical education which ensures that future health professionals are socially responsible and committed to providing health services that are responsive to community health needs. Dr. Arcadio also emphasized the eclectic nature of Philippine medical education due to the emphasis on academic freedom which allowed medical schools to adapt strategies and curricula design that they deem appropriate for their students and stakeholders.
Dr. Ramon Arcadio, former president and current Executive Director of the Association of Philippine Medical Colleges, Inc.
APMC as a Catalyst for Progressive Medical Education
Decades of changes in medical education in the country attest to the lasting impact of the APMC on revolutionizing health professional training via accreditation and quality assurance. Through rigorous evaluations of a medical school’s curriculum, policies, and facilities, the Philippine Accrediting Association of Schools, Colleges, and Universities (PAASCU) assures quality and standardization in medical education. By working collaboratively with PAASCU, the APMC ensures that medical schools not only meet national standards for medical education, but also commit themselves to continuous improvement.
Notably, the APMC also cemented its role in representing its member institutions in policy discussions and advocating for teacher training — one of the strongest instruments that holds the potential to revolutionize medical education. As a concrete example, Dr. Arcadio pushed for the necessity of obtaining a Master in Health Professions Education (MHPEd) for all faculty members of medical schools. Other than improving the pedagogical skills of health educators, the MHPEd program fosters faculty members’ capacities to improve curriculum design, strengthen assessment tools, promote educational research, and nurture interprofessional collaboration. However, up to this day, MHPEd remains a recommendation rather than a requirement for medical schools in the country.
Challenges Faced and the Way Forward
Despite significant progress, improvements can still be made regarding medical education and training in the country. For example, continuous training in improving instructional design, among other competencies, should be offered to faculty members in order to ensure quality medical education. Another challenge faced by the Philippine medical education system, especially with the advent of evidence-based learning, is the ever-growing body of knowledge secondary to continuous advancements in biomedical and clinical research. There should be a mechanism that would allow the separation of the must-knows and the nice-to-knows – where the latter should not be the focus in all assessments and evaluation. Additionally, it is also an ongoing quest to encourage more, if not all, academic medical institutions in the country to subject themselves to accreditation under PAASCU and membership under the APMC. Last, there is a mismatch between health education and national service. As such, national priority programs should be incorporated and emphasized in the medical curriculum and instructional design.
Moving forward, the implementation of UHC in a fragmented and decentralized healthcare system challenges the state of medical education in the country to maintain its dynamic nature to address local and global health needs. Aside from ensuring quality through patient safety, error prevention, and enhancing health outcomes, emphasis should also be given to the provision of affordable quality medical education. This promotes accessibility and inclusivity in medicine, offering equal opportunities regardless of race, gender, socioeconomic status, location, or other factors. Furthermore, the spotlight moving toward primary care calls for social accountability — a system that cultivates competent physicians who also advocate for social justice. Under this paradigm, equity is more than a moral imperative, and medical education should then be redefined as an instrument in reducing health disparities and creating a more inclusive healthcare system for all.
Social accountability should be a foundation of primary care implementation. Service, research, and social accountability should be incorporated in the way we train the future health workforce of our country.
Due to the implementation of UHC, a reorientation of health professional education is expected in the coming years; the APMC plays an indispensable role in this shift to meet our country’s demand for human resources for health that are competent in providing quality primary care services that all Filipinos deserve. The next few decades will also bear witness to the wide-scale implementation of initiatives such as the Return Service Agreement which intends to reduce the maldistribution of the health workforce in the country; albeit, its effectivity remains to be seen.
Dr. Ramon Arcadio, driving force behind APMC, champions rigorous accreditation to elevate standards in Philippine medical education
All in all, these changes stem from a core principle of medicine: a deep dedication to the sanctity of life. Each patient encounter reflects the delicate balance between life and loss; hope and despair; victory and defeat. In the busy corridors of hospitals and clinics across the country, healthcare workers stand at the forefront of every patient’s medical journey — making decisions that reverberate to every aspect of a patient’s life. As such, our medical education is persistently challenged to deliver the best care for all in terms of quality, safety, and effectiveness. However, our responsibility as healthcare providers extends beyond patients' recovery; we are called to this vocation not only to heal, but also to challenge the inequities and struggles that our patients face every day. Thus, APMC leads in revolutionizing medical education mindful of our struggles beyond the scope of medicine. After all, it is by investing in the future generation of healthcare professionals through the cultivation of social consciousness and accountability that we can achieve genuine health for all.