The ZMSF curriculum was initiated and developed around the philosophy of Problem Based Learning and Community Oriented Medical education. The students are exposed to real or simulated problems arranged around themes of learning. Immediately after each tutorial session the students are exposed to real patients, clinics and the community. These exposures are intended to highlight the concept of the practice of medicine as applied not only to individuals, but also to a group of people and/or population.
Close to fifty percent of the four year program is based in the community. The fourth year is entirely spent in the community implementing health programs for health development through intersectoral approaches. Likewise , each students implements an interventional research. This latter component in their training is meant to help provide a data base for the community and likewise intervene an existing health problem in the community through research. The vision of the medical schools is as follows:
The ZMSF envisions a medical school whose curriculum combines competency and problem based instruction with experiential learning in the community, responsive to the changing patterns of health care development and the needs of communities, sensitive to the social and cultural realities of Western Mindanao and imbued with the belief that we exist not only for ourselves but also for others.
The entire four year program is designed around the concept of learning through problems and management of those problems. Small group learning composed of eight (8) students is utilized as they have been documented to be the core of PBL ( Albanese & Mitchell, 1993; Barrows and Tamblyn, 1980; Norman & Schmidt, 1992). Table 1 outlines the division structure of the curriculum into learning modules. These form the base for the case problems.
THE INTEGRATED EDUCATIONAL HELIX
The paradigm shift indicated by the use of the discipline integrated learning modules is structured in a triple helix philosophy that was designed by the school developers. All subjects are integrated into a spiral design. Figure 7 describes the triple helix model used to guide the integration and development of the program content. A series of working problem is presented in an iterative fashion so that learning of progressively more complex material is achieved.
Ongoing exposure to similar working problems serves to reinforce prior knowledge and link new knowledge. The central cylinder represents the collated clinical problems into which the student integrates the various disciplines in the context of the problem on hand.
Although the curriculum approach is mainly based on learning through problem solving , it consists of three ( 3 ) learning strands, each running parallel with maximum integration along a spiral or iterative progression. These three strands of the helix are in themselves unique even as they attempt to integrate all the facets of learning within each of the proposed learning modules and arrange them in an increasingly complex format. The three strands are 1) Working problem Strand; 2) Professional skill Strand and 3) Population Strand. The whole concept behind the helix is to discard the discipline barriers and to create a meta-discipline or meta-paradigm in which all the information is learnt in relation to a problem case.
The working problem strands involves not only solutions to clinical problems but also very importantly it looks at the method of problem analysis. This strand is the student centered problem based tutorial sessions. Using a hypothetical-didactive approach, the underlying mechanisms of the disease is discussed by drawing information from Basic and Clinical science disciplines. Pertinent unanswered questions during the tutorial become learning issues that propel the students to gather additional information from various sources between tutorial sessions. These information are subsequently shared to the group in the next session. The process culminates in the understanding of the problem in three perspectives namely 1) Biological perspective , which looks at the basic and clinical sciences as they relate to the disease or problems proposed; 2) the Behavioral perspective, which looks at the impact of the problem/s on the individual family and the community. Incorporated within this approach are the psychological implications, ethical dilemmas with regards to decision making and the actual personal relationship of the doctors to the patients involved. The third perspective is the population medicine, is the multifaceted arena in which the sociological , anthropological, political and economic impacts of the disease are encompassed.
This strand involves sessions where experimental and practical applications of the working problem strands. Communication skills, physical examination and therapeutic regiments are and other diagnostic skills and treatment techniques are taught.
The communication skills extend from interviewing to counseling patients including the parents and relatives of the patients. This strand proposes to built on the knowledge learnt from the working problem strand and apply practical experience both in role-play and experiential setting to the repertoire of the students. For instance , if the cardio- vascular problems are being tackled in the tutorial sessions, the skills to be taken in the professional skills strand include cardiac auscultation, cardiac radiology, reading of electro-cardiograph tracings.
This strand has important implication for the students and their future professional practice in the Philippines. It focuses on the practice of medicine as applied to a group or population and not only to geographic community. Its importance lies in its focus on population and groups not only on the ill individuals but more importantly, that health issues affect the whole communities. Working problems which starts from a discussion of an isolated individual problem is brought to a discussion that tackles the wider and broader issues of health. Inclusive within this strand is the idea of future planning and therefore preventative and protective medicine and development of health.
The curriculum is implemented in (8 ) PHASES , each composed of learning units. Under each units, are series of modules .
|PHASE 1 – INTERFACING
It is presumed that students accepted into our medical program are baccalaureate graduates of conventional approaches in education and learning. This phase therefore prepares the students to cope with the transition from the traditional or conventional methods of teaching to the current medical curriculum as implemented in this institution.
|PHASE 2 – OVERVIEW OF MEDICINE
This phase presents a total overview of the scope of medicine
|PHASE 3 – PHYSICIAN’S ROLES
This phase introduces the students to the science of medicine providing him/her a broad perspective to their subsequent roles and the scope of their responsibilities.
|PHASE 4 – DOH PRIORITY PROBLEMS
The ten leading causes of mortality and morbidity as reported by the Department of Health ( DOH), like Trauma, Infection, Infestations, Maternal Child Health are taken up to ensure that the students are prepared to face the realities of community health problems, thus enabling them to a certain extend, function as students doctors already.
|PHASE 5 – OTHER ORGAN SYSTEM PROBLEMS
This phase is devoted to other problems of the adult and children arranged by organ systems, starting from simple system progressing to a multi-systemic problem of acute and chronic diseases.
|PHASE 6 – CLINICAL CLERKSHIP
This phase involves the clinical rotation of students in the 4 major departments of the hospitals ( Pediatrics, Surgery, Obstetrics-Gynecology, Internal Medicine) and a few minor departments (Ophthalmology, ENT, Orthopedics, Radiology, Laboratory Medicine , Pathology)
|PHASE 7 – COMMUNITY BASED CLERKSHIP
This involves students being assigned to their respective communities for their community based medical health services and research for 12 months. This exposure is not new to them as they have been previously exposed to this same community on a month long exposure per semesters in the previous years. The only difference is that by now they are in the community for an extended period. This meant for the final and full implementation of their health programs which has been previously started. This phase provides the students the actual opportunity to integrate and apply all professional skills in the context of medical practice in the community setting.
|PHASE 8 – POST GRADUATE INTERNSHIP
This phase is part of the government ‘s requirement to do the post graduate clinical internship prior to taking the certified Board Examination for Medicine. Here the students spend 6 months in a medical center accredited by the APMC, and the remaining 6 months rotating in provincial, municipal hospitals, and Health centers. This is meant to provide the students a full appreciation of the total spectrum of the delivery health care system of the Philippines.
STUDENT EVALUATIONS AND RETENTIONS
The curriculum of the ZMSF puts the learner and not the teacher in the center of its educational process. To facilitate the development of this curricular goal, the educational program is well defined by using very explicit educational objectives along with quality criterion-reference evaluation probes.
At the beginning of each modular course, the tutors spells out the modular goals ( Terminal Objectives , Enabling objectives, and Case Domain) including the competencies a student must demonstrate as a result of the course experience.
As specified, are the assessments techniques that will be used and the criteria upon which the student work will be judged. e.g. MCQ, Short answer Essay, OSCE, Projects outputs, Research. Grades are reduced to a three point system of Excellence, Satisfactory and Unsatisfactory. Elements of surprise or secrecy are modes discouraged in this system. The students in this curriculum do not compete with other students for marks or grades. Rather, students compete with the present MPL ( Minimum Passing Level) and are encouraged to score above the MPL as high as possible on each examination to ensure higher level of competency. Consequently, students tend to support each other, study in groups, and learning tends to be enjoyable, while anxieties and stresses are minimized.