Second Regional Seminar on Education and Training : Travelling Seminar on Medical Education, Philippines/ Australia/ Singapore, 30 April - 15 May 1969 : final report

wmo-o161 . SBCotm BmIOllAL SEMlliAR 01' BwCA'lIOl' AID mAllf.DIG: 'lBAVRT·I.m 8J!I01IAB 011. !li:DlCAL BWCA'lION

Phllipp1Dea/AustreJ.1a/S1ngapore

30 Apr1l. to 15 May 1969

FIlIAL 1IBE'OR'I ,:... '

.

by the

BBGIOlIAL. QJnCB

J'(lR 'l.BE WIS'l.GUt PACme of the W9rld Health Organ1 zation ManU a , Phllipp1Des

September

1969

-

NO'l'E

The views eJCpressed in tllis report are those ot the consultants and participants at the seminar and do not necessarily reflect the pol1a,y of' the World Health Organization.

This report has been prepared. by the Western Pacific Regional Of'fice ot the World Health Organization f'or Governments of' Member states in the Region and f'or those who participated in the Second Regional. Sem;jnar on Education and Training: TravelllIlg Semjnar on Medical Education which was held in the Phil1ppines, Australia and Singapore from 30 April

to 15

M!I.y

1969.

1. 2.

• ••••••••••••••••••••••••••••••••••••••••••••••

........, ....•....••.•........ 2.1 Seminar ~ in each location •••••••••••••••• 2.2 Visits to Institutions Jade by the Seminar Grou.p ••

1 1

2.3 lla.rt1c1l'1L1lt s •••••••••••••••••••••••••••••••••••••• 2.4 Working ~ •••••••••••••••••••••••••••••••••••• 3. COOlttRI ~S ~

2 2

.•.......•••. ........•.....•.•••.•.•..• ••••••••••••••••••

3 3 4

4.

SUlfi\RY OF DISCUSSIOliS OF Ml\IN TOPICS

4.1 Assessment of medical manpower requirements ••••••• 4.2 General objectives of the undergraduate medical

4 5 5

4.3 The need

cu.rriculllJD ••••••••••••••••••••••••••• " •••••• " .... for relevance of medical education

4.4 4.5

4.6

4.7 4.9

4.8

prograDlll8s to meet CO!JDlll!D~ty hee.J.th needs ••••••• Development of a medical curricul.um - Role of facUlty, students ••••••••••••••••••••••••••••••• Requirements for admission of students to medical school ••••••••••••••••••••••••••••••••• Evaluation of student 'performance ••••••••••••••••• Teaching methods in medical schools ••••••••••••••• Utilization of comDun:fty hee.J.tb resources in medicalUDdergraduate education ••••••••••••••••• The desirability of a 'prellminar,y degree course in iDed.1c1ne • ~ • " •••••••••••••• " " ••••••••• " •••• " ••

6 7 8 9

9 11 11

4.10 Research and electives in medical education ••••••• 4.11 Training for general practice in its undergraduate aDd post~uate aspects ••••••••••••••••••••••• 4.12 Co-operatioD and collaboration between medical schools " COIfCWSIOBS AlID RBCOloINBfmATIONS

....................... ................ . ...•..•..............•.. •••

13 15

Assessment of medical manpower and requirements General objecti vee of the und~te medical

curriculum

••••••••••••••••••••••••••••••••••••• _

5.4

The need for relevance ot medical education 'prograIIDes to meet collllmUl1.ty health needs ••••••• DevelO,PJDellt of a medical. curricul.um - Role of faculty I students ••...•••••••••.••.•.•••.•••.••• Requirements for admission of students to med.1ca.l schools •••••••••••••••••••••••••••••••••

17 17 18

- - :f.1 ~ble

of Contents

!!§! Bvaluat10n of stwlent perfOl'laDce ••••••••••••••••••• ~each1Qg methods in medical schools ••••••••••••••••• Utilization,of cOJlllllWl1ty halth resources inaed1cal Wldergra4uate educat10n ••••••••••••••••••••••••••• Des1rab1l1ty of a prel1m1Mry degree course in , medicine •••••••••••••••••••••••••••••••••••••••••• Research and electives inmed1cal education ••••••••• TreJn;fng for general. practice (UDdergra4uate and graduate aspects) ••••••••••••••••••••••••••••••••• Co-operation and collaboration between medical schools ••••••••••••••••••••••••••••••••••••••••••• ASSOCIA~ION

...

18

19 20 20 20

5.9 5.10 5.11

21 22 22

5.12

6.

K>VE TO BS'l'AmrISB A BmIONAL 6(.'HOOIS

OF MlmlCAL

••••••••••••••••••••••••••••••••••••••••••••••••••

AbNI'M I

•••••••• •••••••••••••••••••••••••••••••••••••••

25/26 27 31

•

Ammx III

AliI) ~T

LIS'f OF PARTICIPAlfl'St. OllSEltVlmS t COBSUIlrAl'llS . ••••••••••••••••••••••••••••••••• •••••••••••••••••••••••••••

41/42 43

v

..... , ........................... .

1.

OBJECTIVES

'!'he objectives of the seminar wre I

1.1

1.2

i., 1.4

To provide.an opportunity for an eXohange of informat1on on the organiZation and progl'81111118S of the var10us medical schools in the Region. To .cODsider new trends in the f'ieJd of medical eduCat10n and their app110ability to medical education prOgl'IUIIIII8S in the ReSion. To disc\1SS the llIa,ior problems related to medical education in the Region aDd to cOnsider how these DIllY be solVed. To explore possible avenues of co-operation and. oollaboration between the vario\1S schoola.such as student exchangel faculty exchange or establishment of' an association of medioa1 ..schoola in the Western Pacifio Region. 2.

ORlANIZATION ANDI'l'INERAm'

was,

'!he .em1l1Jl" oovered the per10d JO April to 15 May 1969.. with sessions being held in Man1la,· Sydney, Perth and S!nppore. '!'he itinerary followed

Manila

,

perth

Sydney

SiJlgapore

- 30 April to 3 May ,.. 4 to 8 May - 8 to 12 May - 13 to 15 May

Dr D.R. '!'hamson, Director of Health Services, acting tor Dr. F.J. D.Y, Regicaal Director, opened the Seminar in Man1la. Sir William Refsbauge, Director General of Health, Commonwealth of Australia, delivered the opening address at the Sydney Session, Sir Stanley Prescott, Vice. Chancallor,thiversity of Western Australia opened the Perth Session, and Dr Toh Chin COye, Vice Chancellor of the University ot Singapore, the Singapore Session. 2.1 Seminar

programme

in each location

During pre-semi per visits by the Regional Adviser in Education and. Training, a list of topics proposed by WHO were discussed with Deans and faculty members 10 each locat1on.

'!'he topios finally seleoted weres

1. 2. ,.

4.

Assessment of medical manpower requirements. General objectives ot the medical undergt'aduate curriculum. '1'he need for relevance of medical edUCation prOgl'iUlllles .to meet community health needs. Development Of. a medical curriculum - role of faculty and students.

- 2 -

5. Requirements for adlD1ssion of students to medical schools. 6. Evaluation of student performance. 7. Teaching methods in medical schools. 8. Utilization of community health resources in medical undergt'aduate education. 9. Desirability of a preliminary degt'ee course in medicine. 10. Research and electives in medical education. 11. ~1D1Qg for general practice (undergraduate and graduate aspects). 12. Co-operation and collaboration between medical schools 12.1 Exchange of teachers 12.2 Exchange of students 12.} National Associations of Medical Schools 12.4 Regional Association of Medical Schools Four or five topics were discussed in each place as shown in Annex I. To gain the widest possible view on the important subject "Co-operation and collaboration between medical schools". this topic was discussed everywhere. WHO was gt'eatlY assisted in the admin1strative arrangements in each city by the local Deans and their staff. as well as by the health departments. Annex II outlines the programme followed at each session and shows the Chairman# Vice-chairman and Rapporteur elected in each place. 2.2 Visits to Institutions made by the Seminar Group

ihe seminar participants were afforded tbe opportunity of making the following visits. Phil1ppines University of the Philippines - Medical College. University of Santo Tomas. Medical College. Comprehensive Community Health Care Programme. Bay. Laguna. Australia University of Sydney. Faculty of Medicine. Sydney. University of New South Wales. Faculty of Medicine. Sydney. University of West Australia. Faculty of Medicine. Perth. Sir Charles Gairdner Hospital. Perth. Singapore UniverSity of Singapore. Faculty of Medicine. 2.} PartiCipants

2.}.1 Travelling participants All countries in the Region with medical schools were invited to nominate a dean of medical school or a senior academic interested in medical education to participate as a travelling member of the seminar.

-3.i'en countries. ~~. Australia. Camboc11a. Cb1na(Wwan). PiJi. Laos. New Zeal..arld. Papua' ahd'Hi8w GuiDea,' Ph1l1ppines. Republic; of· Korea. Republic of VIet-Ham. dul¥' nClll1Datedpartlclpants. ' .A$ JapaQ. Hcog Koag. Malq81a and Singapore were Wlable to send participants. China (Taiwan), ~ pM UpptaU .ad tba Republic ot Korea were each inY!ted tonOlllinatea' second

one. Invitat10ns Were also attended throutn the WHO South",East AsIa Regional Office to Indonesia and biland. Onl¥ 1ha1land was8.ble to send a participant. 'lbe fourteen travell1ns.paz1;i~tsare

UatlKi

~,,~

III.

2.,.2 Local partIcIpants; In each of the tour places where sessions were held. invitations were extended to Deans and members of /ll8dioal faculties.. as well as other persons interested and involved in IIJed1cal ~ati9A prqgr.....s. '!beset 1ncl\Kied . representatives of /ll8dical aa8ooia1~lOnS'and societles.post-gr8.duate organizations .. medJ,.c-.l st~ts~ie1;"e8 ,~, h,ealth de~t~.

'~~pert~o~pants .~~ obs~.r. ,.;~ III., 2.4 Worldng Papers A

eaOb

location are listed in ~

J.ist ot the working paper.sprepared tor .tlle Seminar 18 s1?own in

Armex IV.

Ast.he'l'ravelllng Sem1narwas the tirstWHO meeting on mediCal edDCatlon' held in the Region since the 196, ~oDference of Deans. partioipants were recauested toprep8Z'8 ~COUfttrY 'rep01"tsprOVid1ns . (a) '. relevant up-to-date information on developments in Ille4!cale4ucation in their countries since . 196'. .

(b) 'caDments education. the tIrs", ~8s1on in

on any

8peC~al ~Obleals. iIllD,~d1cal.

COJU$1deratlon. wU.s1vexi ~.

to emerge .:and .: it , co~tJ"ies

was

Men1la •. Jra. 'tbfj 'd1S(lU8Sion. '; ""-".

Amlex .11')' at _general p&ttern was" seen evid8nt tbatanUmber were ., . . .' '.', ." otProblems ., .. . QOIIMQ to ~ . .

t~)the;reportss~tted("e

<a>

maldistribution ot physicana with concentration in . .oities. - .- ... " "brain' drairi" ~both'permanent ·1088 ot gaduates overseaaindt8lllP0raJ.'7lO8s in tile post-reg1stratiori. f)1" ,resldencYperlod; .~

.

-

~.

~.

- 4 (c) relevance of curriculum - the formulation of a curriculum to meet national health. ne8ds was noted as bemg a difficult' but essential task • ~< ,

. Other problems shared by more than one country were ns>ted being: (a) (b) (c) shortage of teachers for basic and pre-clln1oal sciences;

. _.

wae tb8

shortage of French-speaking teachers where French language of instruction;

problems relating to adequate pay for faculty.

4. 4.1

StMt1ARY OF DISCUSSIOllS OF MAIN TOPICS

Assessment of lliedical manpower requirements

There is a pressing demand for expanded health services based on qualified health and medical manpower in both the developing and the more developed countries. In several countries, including China (Taiwan) and the Republic of Korea, there have been recent studies of medical manpower. The type of practice, organization of health services and distribution versus maldistribution of manpower, are 1Jnportant questions. '!he recognition of the inter-dependence of all members of the health team, including physicians, nurses and paramedical personnel, should-be a oentral factor in any manpower study. The seminar noted the important role of the physician as the leader of the health team. Any study of medical and health manpower must be undertaken in the oontext of national health planning. This relationship wlll be most satisfactorily accomplished i f manpowerst\ld1es are \lnder the auspioes ot a governmental authority with a strong univerSity component.

..

!<r

The methodology of manpower studies is still evolving and the collection of reliable data may be difficult. However, the seminar recognized that incomplete data may reveal useful facts. Any consideration of manpower leads to one of the most pressing problems facing the Region - the loss of manpower, primarily doctors and nurses, to other oountries, especially the un1~ States of America and the United Kingdom. Higher stipencia, advantageous clinical and research facilities, educational programmes end lack of career opportunities a.t home are four important factors in this loss.

There is an urgent need for greater understanding by the countries receiving these physicians ot the problem posed by .such migratiOns. It is often not realized that in many instances educational opportunities abroad will be less desirable and less relevant_than those at home.

- 5 -

• Manpower studies should explore the problems and factors relating to the "brain drain". such as why do graduates leave the oountry - why do graduates return to the oountry - what developments would induce graduates to remain at home - what oan the recipient oountries do to le ssen the flow of foreign graduates and what is the dimension of the problem.

•

To lessen the flight of phySicians to ather countries the doctor must find in his own country. (a) (b) (c) 4.2 professional satisfactionJ adequate financial remuneration; a satisfaotory social environment for his family.

General objeotives of the undergraduate medioal currioulum

For III8llY years the undergraduate phase of medioal education has been oonsidered as the period in whioh the student must memorize a great mass of information trom the basio medioal soiences and on the diagnosis and treatment of disease. Since World War II there has been a rapid growth in training progr8llllleS after medical sohool to prepare the young doctor for speo1alized praotioe. Thus the medical school period has become the phase in which the emphasiS should be on principles and fundamentals with the acquisition of technical skills left to the graduate and post-graduate periods. '!he speoifio objectives will vary in regard to the community and the country but it is possible to establish general objectives which are broadly applicable. In the developing oountries health problems are of a different order ot magnitude and more urgent. It is essential that both students and faculty understand and support the obJeotives of the educational programme. . Inherent in any statement of obJeotives is the responsib1lity to foster motivation in. the student. Human1tar1an1smis an essential attribute of the physioian and its development oatl be ano~r inherent factor in the educational process. The medical student enters school with a desire for exposure to clinioal medioine at the earliest possible period. It is important. however. that he should first acquire a solid background in the basio soiences. 1he need for relevance of medical education programmes to meet

community health needs. ReoognItion must be given to the ecologioal Situation, the stage of socio-eoonomio development and the ethos of the community in planning a medical currioulum and the programmes whioh follow. A dynamic situation demands a mechanism for continuing review of the goals of the Faculty.

1'.

--6 It 18 desirable to establish a core curriculum which mq V&r7 . little trCllll countr7 to count17 _ but which would evolve with adVfUlCing Md10al knowledp. 'ibis ccnsists essentially of physical_ bebav1oural.- biological and cl1n1cal sc1ences. Beyond this, there is a need far relevance of the curriculum in terms ot the caamun.1ty and clinical aspects, as ..11 as SC1118 special aspects, e.g., epidemiology, parasitology, microbiology and pathology which should. be considered in the milieu of each cO\mtry. ~

Strong departments of social and preventive medicine can influence the pb1losopby and content of the curriculum as _11 as the attitudes of Paoulty. A properly balanced curriculum is not easy to achieve, since caapeting cl.a1ms of departments can lead to conflicts. A full-time dean without departmental loyalties and responsibilities may have an 1IIIpartant role in helping to resolve these ditticulties and guiding the faculty constantly towards a relevant ed.\lcation far the students. outside organizations such as WHO ar the General Medical CO\mOll in the United KingdCllll may be helpful in performing an objective evaluation of the effectiveness of the curriculum in relation to caamun.1ty health neede.

4.4

Development of a medical curriculum - Role of Faculty, students.

Recognizing the need for an organization within the faculty which keeps the curriculum \mder scrut~ and advises changes, the following factors require consideration:

4.4.1 Size ot curriculum cOlllll1ttee The cOlllll1ttee may be very small or large depending on looal circumstances. 4.4.2 structure and power of the cOlllll1ttee

These V&r7 widely in accordance with local conditions. Some schools place the resp0D81bllity in the· hallds of the faculty and seek only a4vice trCllll special c<Xlllll1ttees which. may include sub-professional staff and students. others support the view that all curricul ar matters should be entrusted to a small ourriculum ccma:lttee and that the faculty should change only details and not the princ1ples of the cOlllll1ttee's recommendations. and discussions between faculty members and students can be useful in planning the curriculum.

4.4., Seminars

'!here 1s fairly general agreement that the aim of a curr1culum is towards the graduation of the "undifferentiated" doctor and tbat IMdical ed.\lcat1on is incomplete without a period of graduate tra1n1ng.

•

- 7 , Concerning the role of departmental oha1rmen. although their autClOOll:7 in research is recognized. they should accede to the faculty on plann1nl the ourrioulum • students can play an linportant role in planning the curriculum. Five significant changes merit consideration in connection with ourriculum development. (1) shifting curriculum time between various disciplineS a different balanoe being sought. e.g •• between biological and behavioural sciences; more emphasis on the teaah1ng laboratory and the patient as against the lecture; the development of a clearly defined oore curriculum supplemented b,y electives; integrated teaching; in medical schools with a six-year course. the institution of a preliminary degree course. thus shifting the medical course to a post-graduate study.

..

(2) (:~)

(4) (5)

In the development of a new sohool and its curriculum. an outside oonsultant with wide knowledge can be helpful in reviewing international trends. However. recanmendations of an outside consultant may lack relevance to the local conditions.

4.5

Requirements for admission of stUdents to medical school

A wide variation of reqUirements exists 1n different countries. ranging from the requirements of most schools in the United States of America and Canada for a core of physical and biological sciences to the new medical sohool in Auckland. New Zealand. which has no prerequisites for entry. '!here is a problem between the desirable goal of a broad cultural background and the requirements in the physical and biological sciences. Without a strong background of the biological sciences. an understanding of modern medicine is not to be expected. There is a limited amount of money available for health and high failure rates in students are wasteful of money and time for staff student and state. Faculty effort 1s squandered and frustration and disappointment results for those who have failed. An attrition rate of over 1.fff, ie undesirable. '!he wisdom of admitting a high percentage of women is debatable. Many women having qualified. marry and assume family responsibilities which lead

- 8 to their w:Lthdrawal wholly or partly from professional practice. Cbanges in society and the structure of medical practice m8¥ allow tbe continuing practice' of women, or their re-entry, after family responsibilities have lightened. 'Besides academic achievement ~ other requirements for entry into medical school include IIXItivation, personality, health, psychological stability, and financial resources. Selection will usually be based on academic grounds reserviD8 the interview - for the applicants w:Lth marginal qualifications or questionable IIXItivation.

1

4.6

Evaluation of student performance

There are important questions relating to the present techniques used for the evaluation of student performance: (1) What.~an be learned about the clinical performance of students by the traditional bedside techniques using the long case and several short cases! (Is this merely "psychological assault" on the student or does it yield valuable information on the clinical competence of candidates?) (2) llies the essay test gives reliable information about the' candidate's knowledge of medical facts? (3) llies the objective, multiple-choice test indicate the range and depth of knowledge of the student!

Begarding the first question, the examination of the patient at the bedside in a stressful situation is one aspect of the historic role of the doctor. The essay test indicates the candidate's ability to assemble and organize factual information. The multiple-choice objective test has gained popularity but it may discriminate against students who have not had previous experience w:Lth the philosophy and techniqll8s of the test. In any system of evaluation, the student must be familiar with the methods employed.

Communication gaps based primarily in language m8¥ &tfect the performance of overseas students on tests and examinations. In any method of evaluation, the stUdent must be familiar with the methods employed. All tests and examinations should be used as educational instruments for feedback of information to the teacher and student. This will allow the student to detect his academic detici ts at an early stage and undertake remedial learning.

•

- 9It is important to develop reliable methods for appraising the perf'omance of graduates when they become practising physicians. Such appraisals could g1ve information on the effectiveness of the educational progl'8DllleS. Of prime importance is a balance in the application 01' various methods for evaluating the student. lhe es~ test, performance .at the bedside and in the teaching laboratory, .and the multiple-choice test all have a role to play.

•

It is essential to develop. all testing procedures as educational instruments based on the lmowledge that has been developed by the student.

4.7

~ach1ng metbods in medical schools

'!he teacher and the student will always be the two focal points in education. B:lwever, t~ ir communication ~ be expanded and strengthened by improved teaching methods. . ~d&y' there are several broad approaches to this problem. One or these is the development or a close relationship between the medical faculty and professional educators. In some medical schools tbe latter have been granted full acadendc status in departments or divisions 01' research in medical education. A second approach is the utilization of the wide variety of audiovisual aids. lhese include video tape, tape recordings with slides or filmstrips, closed-circuit television and computers. ~ach1ng machines are currently being developed 1'or audio-visual applications. In the medical scbool period there is a real danger that audio-visual aids will become too widely used in the classroom at the expense 01' personal staff'student contact. 'lhe use 01' audio-viSUal aids may have special value in programmes of continuing education for practising physicians; open channel television and two-way radio are currently popular. 'lhe major purveyor or informs... . tion to the practising physician is the detail man representing p~ ceutical manufacturers. Despite the variety of organizations involved in continuing education, it is generally agreed that the effort is inadequate, primarily because 01' a lack 01' interest on the part 01' physicians.

i

4.8

Utilization education

or

community health resources in medical undergraduate

r

1here are several disadvantages 01' basing clinical teaching principally on tbe teaching bospital. A distorted picture results in the stUdent's mind of the incidence 01' disease, the types 01' disease commonly encountered in practice, and the general medical problems 01' the community. lhe staff' 01' the bospital,lIIOreover, is highly specialized in ever narrowing fields. In this environment it 1s very difficult to give students a clear , . view of their responsibilities to the individual, the 1'amily and the community.

- 10-

is an increasing recognition by academic st8.f1' ot the need to widen the scope ot a student's education, both within the hospital imd outside its walls. In the tormer case, the appointment ot su1tablyqualitied and motivated general practitioners with teaching Efkills CaD 1IIIike a 'WOrthwhile contribution. '!he departments ot paediatrics, medicine or social and preventive medicine appear to be appropriate to organize the broader aspects ot cOlllllunity medicine and its presentation to stlldents, both within and outside the hospital. General practitioners might be attached to these departments and retain their vi tal links with tamily practice. A special university department ot general practice received no support during the seminar discussions. There is an initial ditficulty in appointing general practitioners trained adequately tor their teaching task. Some general practitioner organizations bave successful schemes in operation tor preceptor training. In the hospital ~ be it is desirable to bave a co-ordinating body such as a Board ot Studies, bringing together academic tull- time statt and general practitioners, which ~ be ettective in organizing teaching ot coUlllllDi ty aspects. .

~ere

IDcal medical associations can provide a common meeting ground tor all groups involved in teaching and paramedical personnel ~ 'WOrk with medical students in field training. '!he attachment ot students to gpod general practitioners tor some period ot their course, which is common practice in British and Australian medical schools, was strongly supported by student observers but the period ot attachment should be a reasonable one and not Just t'WO or three weeks.

•

Students bave a sharpened social conscience and are persuading or even torcing the taculty to give more attention to the socio-economic factors and the behavioural sciences. ~ere is some doubt about the teasibility ot identifYing students socially committed at the point ot entry into the medical course. Even it this were possible, and an increasing proportion admitted, they 'WOuld be exposed to a high tailure rate in a course now including a high scientific content. Concerning the use ot private and colIDIIUDity hospitals and health department facilities, there is some danger of engaging staff' without special skills or training in teaching. Supervision is also dif't1cult and a lowering of standards ~ result. !It) overcome this, only teachers wi th experience should be selected and all teachers should be under a teaching adviSOry board responsible to faculty. '!he use of existing community health facilities bya medical school is exemplified in the Comprehensive CoDllllWlity Health care Programme operated by the University of the Philippines in ~, IBguna, 'Where a session ot the travelling seminar was held. 1h1s programme started in 1965 and there is now a 'programme ot teaching in health centres. '!he emphasis is on intern training which is an essential part ot the medical course. Students in earlier years also receive some instruction in the· centre. The University has assumed full responsibility for the total health care of' the municipality of' ~, IBguna, 'Where there are very tew

-

11 •

• ,pr1w.te doctors as 1s the case in so lIIBD1' rural. areas in developiDs counU-1es. This factor makes the scheme possibl.e in a ~ which 'WOuld be difficult or 1mpossibl.e in countries with laree DUlIIbers ot doctors 1D private practice. The College ot Medicine, the Institute ot Jbrg1ene and paramedical colleges are involved 1D the project. A field programme vith a vide disc1pl.1nary approach can be successful 111 a mU1eu ot this sort, 111 1ntluenciDg YOWlS doctors towards COJIIIIIWl1ty medicine and prov1d1ng them vith the appropriate sk1lls. In the centre at lla¥.. JAsuna, there are !acUities for diagnostic medic1De, out.patients, maternal and child health progr8.DIIDEIs" m:1.dvitery, as well as J.s.boratory d1asnostic !acUities and an X-~ unit. In addition, heal't;h sub_centres 111 remoter areas are staffed by the a1n centre, which sends out w~ a doctor aDd nurse team.

•

Centres of this nature have -.zIy attractions tor undergraduate education and s1m1lar ones, although different4' adpdnistered and organized, are being incorporated into the programmes in Bons Kans, Chlna ('l'a1 wan), Papua IItld )Jew GuiDeS., and tbll :republic of Kozoea. III all oases .. students receive instruction in the centres and are given an insight into CODIDOn diseases, epidemiological patterns and cOlllllWl1ty medicine· in all its aspects which could be achieved in no other ~.

4.9 The desirability of a prelipdnary degree course in medicine ~

In addition to a standard Bachelor of Science course, a pre] 1m1nary degree course in medicine (B.Sc.) may be awarded in hWIILIl b10J.osy at the end of the third year. Such a programme bas as one of its a1ms the broadening ot the backsround of the medical student by an ear4' introduction to the behavioural sciences 1nclud1Ds anthropoJ.osy, psychology and socioJ.osy. This vill also encourase an understandiDg of the psycbopb;ysiolog1cal components of at. sease in contrast to the normal range of human behavioural patterns. FOg1"8lIIIl8

A second a1JD is to aftord the student an opportunity it) enter a leading to h1gher decrees in the biological sciences as an alterDative to the study ot medic1De. It 1s hOped that some ot the students who pursue this programme may enter academic careers.

The doctor is beiDg called upon by society today to lead healthproJlDtixlg social agencies.. the backsround for wh;I.ch medical education Sivee little preparation. By plAciDg greater emphasis on the bebaviOtUl'al. aCiences, it should be possible to C01Tect the baJ.s.nce between tbe scientific aDd the social obligations of the doctor. 4.10 Research and electives 111 medical education In consider1Ds this topiC, three questions can be posed:

1. 2.

Should medical students have a research experience! If so, to what extent! Should it be interwven with the established educational. progreuae or set as an el.ect1ve period? Is an el.ective period desirabl.e? If so, how should it be used?

3.

-

~

!

TheN 1& DO wdve:real4r accepted &iIII for the undersl'8duate courae reJ.e'1Ut to a ~culu 80c1ety. ~ 'bolleva tlIat the alii 8bould be that of the ToCklBeporil - to produce Ita bl'Cl84l.¥ educated. ~ . , can bec=e a 4octor by :fUrther tra1D1ns~. . yet the eJl!Pbas1& 111 the select10n of med:1cal students toc1q" 121 1I1cr-.a1Jl84r on a backgrouDd 111 mat~t1C8 aDd the sc1ences rather thaD broader qual1Ues 1Dcln ding mcit"i'V8.t:1on. ~ JllUSt be a plAce 111 mecl1cal educat10n tor research 111 the w:1deat SeDSe. Research encourases a .tudent to tb1J:llt cr1t:1~ and to real1Ze tbat there are ~ gaps 111 0111" kDovleclge of mecl1cal sc1ence.

It 1s worthwbile tor the student to become cl:1l"ec~ 1I1volved 111 a research project and 1t may be des1mble tor b1m to spend a year a~ frail the UDIleqraduate CUl"r1culum. Such aD a;per1ODce may encoUl'llge students to enter aceda:1c careers. A research a;per1encesbould DOt be compulsor,y but students sboul4 be ccourased to CODIl1clar such a prosraaae. Probab~ DO mre· thaD the top ~ of the students would have a deep cOJlll1tmeDt

to a research opportwdty. h1.8 ~eDce

E1ect:1ve periods may atford the student an opportwdty to bl'Cleden or to prote JIIOre dee~ :1Dto a field of spec1al 1Dterest.

The lqtJl of the elect:1 ve period may be l.1m:1ted becauae of the need to ~ s~s on the vocat:1onal aspects of Ullderp0a41B te 'b'a1D:1ng. ExchaDse of stu4euts to countr1es w:1th d:1fter:1ns d:1seaae ll&tterns may be benefic1al 111 help1Dg the .students UllderstaD4 the broad probl_

of med:l.c1De. 4.11 ~!Z f o r s eral pracUce 111 its UDd!l!Jl'!4uate and post.

II!4U*

aspeeu

J'ar need

I*)re

to fami'S-rize students. 14th .g·eD~. ~~t1ce 111 the underszad...te

attent:1on 1&

DOW

be1ns g1 V8¥l by med1cal schools to the

years, larg~ throU6h attachment to gener8l pract1tioners. There 1& support 1D 8OID8 countr1es, e.g., Austral1a, :tor the dew tbat general pract:1ce should be recosn1zed u a spec1al1ty vh1ch, 11ke med1c:1De or sura8Z7 deaenes a .sp8c1Al progz'8IIIIe :1D the post-szaduate .yea.rs. CriUc1sm las been directed to the somewlBt exot1c atmosphere of +-.chins bosp1tal8 where pn.ct:1ca.l.q all undergraduate 1Dstruct:1OD 111 cl1D1cal teach1ns 1s g1ven. The d1sease lI8tte1"Ds of pat1ents 111 8uch hospitals are DOt represeDtaUve ot co.am1tyhealth probI..a. General pzactS:t1oner attachment schemes are DOW lOre v1d~ recosn1sed aDd supported 111 ~ schools. In the countries represented at the .... Mr, there . . DO support tor the establlshment of wdven1ty clepart.ments ot general pract1ce.

- 13 -

Academ:l.es as well. . . spec:Sal1st hospital staff involved j,n teaching bave a respons1b1l1ty to be better informed of the role O"f . general practitioners by vis1ts apd direct obsenation. The. f'I&II¢l¥ doctor 1s of paramount :S.mportance in c0lllllUD1ty health care and the decline in numberS in tb1s field 1s to be deplored. An increasing role in medical. education, recogn1tion in some titular ...ay of preceptors by faculty, and a v:S.gorous prosl'&IIIIIe of post-Sraduate and· contlmt1ns tra:Sn:Sns tor gene:al practice .C8D all help to elevate the status of the general practitioner and augment the number enter1ns th1s branch. The study of the patient in the boaIe sltuation affords an excellent oPllOrtun1ty for students to become fBm1l:S4r with cOlllllWl:S.ty health and general practice problems. 4.l2 Co-operation and collAboration between medical schools

Since World War II there bas been an increas1Dsq l1veq exc~e of ideas apd progr&DDD8s in medical education between countries. This has been made possible in part by greater flex1bil1ty of the h1storic systems of medical education - Br1t:S.sh, French and GerDan. For JIIIUl¥ years patterns of med1cal education for the world were set in IDndon, Paris apd Berlin. These three major systems were represented in the countries part1c:l.pating in the travell1ns sem:SMr. From the last balf of the e:S.ghteenth century until the middle of the nineteenth century, French medical education based in the great teaching hosp1tals of Paris led the world. There was a heav.y eJIIPbas1s on cl.1n1cal medicine and the student began the study of the patient on the morn:S.ng of h1s first day in med1cal school. The basic sclences were appropriateq called "accessory" sciences as an indlcation of what was thoUSht to be thfJ. r minor role. The French system was adopted throughout latin America, in the M1ddle East and in French lDdo.Ch1Da includ1ns laos, Cambodia and the area that today is Viet.lBm.

The Brltish system as developed 1n !DDdon empbaslzed the cl.1n1cal clerkship. In Scotland, the empbasis was on the lecture in a university settins. British med1cal education in the Western Pacific Region 1& represented by Austral1a, Fiji, Bons ~.t JllWtp1a, New z,.lend , Papua aIId. lew Gu1Dea and Stnsepore. In the middle of the nineteenth century, German med1cel science ,asceuted to the role of world leadership. In contrast to the Paris and !Dlldon hoap1tal systems I the German system eJIIPhas1zed fUndamental research in the basic mecU.cel sciences. Pasteur eorking in an attic laboratory in Paris even after his JIIOnumental contributioBS ex;pressed his env.y of the splend1d research institutes spr:Sns:Sns up across the Rhine.

- 14 Japan adopted Gel'JIIUl medica1 education in 1.870; there is no instance in bistor,y when a country with no colonial. ties adopted a system o~ medical education as complete~ as the Japan~e ~orb.3d the German system. With territorial. conquests the Ja~ese il8)lAIlted the Ger-.n system in the Republic of Korea and China ('la1~). . The first medical school in the Philippines, Santo Teas, founded in 1.87l offered a French system of medical education through Spanish JII1l1tary medical officers who taught at the Scbool. The University of the Philippines, College o~ Medicine, with a faculty predoJldT!8ntq f:rom the United states of Amer1ca offered an American system of medical education. The American system is a combination of the German empbasis on the basic medical sd8llces and the IDndon baspital empbasis on the clinical clerkShip. Today the French are developing stronger empbasis on the basic l!Ie1enceswh1le.t~ GermBns are extending programmes in clinical tra1n1ng. The British are developing continuity in postgraduate tra1n1ng and the United States is eatabliahiDg core curricula with electives. Bach system 18 borrowing frOm the other and countries with fo:rmer colonial relationships are moving towrd prograumes oriented toward Ilational needs. Some of the distinctive features of the historic systems remain but exchange is DOW feasible and desirable. medical

The Fan Amerl 'til Federation of Association of Medical Schools founded in 1962 bas a IlJembership representing the medical schools of north, central and south America. The Association of African Medical Scbools includea the institutions in Trans-8abaran Af'r1ca. In 1968, an Association of Medical Schools in the Middle East was founded. The Western Pacific, South-East Asia and Europe are the o~ regions without such an association. National organirations for medical education and medical schools bave been established in Brazil., Colombia, CeDBda, India, Mex:l.co, Peru, United K:f.nsdom, the United states and most recent~, the Ph1l1ppines. The progt'8DIID8s and objectives of regional or national association include:

(a), (b)

ma1n.tenance and el.evation of standards of undergraduate medical edl1catlon; facilitation of cOlllllW11cation between medical scbools for exchange of infonation through conferences, sMDBrs, wontshops, journals and newsletters; organiration of teacher and student exchange; representation o~ JDed1cal education to governments; development of specific prosraDIII8s such as teachiDg ~ planning, JDBDpOWer studies and regional tra'n 1 ng centres.

(c)

(4) (5)

-

15

-

• (1)

lIat~

there are problems and obstacles:

reJat10:p.ship with governments.. espec1a1Joy if there 111 a, . JD1n1stry of eclucat10n which controls the medical schools; ~e and culture wouJ.cl be a eM 1 1 ense 1D the Westerll Pac1fic, with the )'rench-speaking, Japanese and Korean representat:Lves;

(11) .

(111)

Dat:LoDBl pride and r:LvaJ.r:Les; relat:Lons with med:Lcal associations and 1DterDationaJ. orgau;1zations: a Dat10nal medical associat1on DiB;y feel that 1t shouJ.cl be the vo1ce of medical education which would be resented by the med:Lcal. schools. 'rhere DiB;y be conflicts with 1DterDatioDBl organ1zat:Lons concerned with health and medic1De; the r:Lch Datio:p.s versus the poor Dat:Lons - every nation part1c:Lpating 1D an association shouJ.cl have a feeling of equality and of naking a significant contribution; establishment of a programme • it is essent1al that a regiODal or a Dat:LoD/il.l association liave a d;yrIam:Lc prograJIIIIe from the beginning.

(iv)

(v)

(vi)

ExcMnge of students 11&3' be d1fficult 1f they are moving between institutions with d1fferiIIg systems of medical educat:Lon or where there are d1fferences 1D language. It is probab-4r best to restr:Lct student exchange to f1DBl-year students and they shouJ.cl be at .the host institutions for a sufficient period to understand local culture. Faculty exchange may be an ilqportant vehicle. for 1Dvigoration of educatioDBl and research progr8DIDes. It is d:lff1cult to establish exchange alwa;ys based on a spec1fic field. 'rhere shouJ.cl be COIIIPletel;y adequate f1DaDc:Lal support and this shouJ.cl cover :fam1.4r as well as the faculty member. It 'WIllS the consensus of the semi nar that a regional. association of med1eal schools 1D the Western Pacific 'WBS both, feasible and h1gb-4r desirable. It lBS proposed that there be a steeriIIg COJIIII1.ttee representing 1Dterested countries work1ng with a secretar:Lat 1D )l9n118 based 1D the Association of Pb1l1pp1De Medical Colleges with the WHO RegioDBl Office for the Western Pac:Lfic partiCipating 1D an advisory role.

5.1 Assessment of medical !!!:DPOWer requirements 5.1.1 Any st~ of med1cal and health lJIaD.POWer cannot be isolated from DatioDBl health planning. 5.1.2 ,'rhe recogn:1:u,on of the 1Dterdependence of all members of the health team including pl\Ys1c:Lans, nurses and paramedical personnel, shouJ.cl be a central factor 1D a.n;y JlBDpower 8t~.

- 16 5.1.' ODe of the most pressing problems facing the Western Pacific ResioD is the loss of medical lII8llpower, principally doctors and nurses, to other countries. 5.1.4 '!he metbod91ogy of lII8llpowr stwiies is still evolrtns and the collect1on of reliable data may be difficult in regard 1;0 some questions. It is recommended that: (1) Manpower studies should be conducted under the auspices of a governmental authority wi th involvement of the medical faculty. ~ physician must be familiar with contributions from other health professiorJI since he will serve as the leader of the health team.

(2)

<:~)

Manpower studies sbould explore the factors relating to loss of lII8llpowr. Positive steps to correct this problem are urgently needed. Manpowr studies should become high priority items in planning educational programmes in the field of health.

(4) 5.2

General objectives of the undergraduate medical curriculum

5.2.1 With the rapid proliferation of specialized medical knowledge and the expansion of specialty training, it is no longer possible nor deSirable to aim at imparting all factu8J. knowledge to the medical stwient. 5.2.2 An important development has been a greater emphasis on the behavioural sciences based primarily in departments of psychology, psychiatry, human biology and social and preventive medicine. 5.2., It is desirable to place all phases of medical education including the internship and post-graduate education under the aegis of the university. 5.2.4 ~ primary aim is to educate an "undifferentiated" doctor who will then spend several years in specialty training after graduat1on. It is recommended that the following general objectives be adopted: (1) (2) (,)

•

'lb encourage life-long habits of learning. 'lb develop a capacity for problem solving. 'lb understand the principles of modern medical science and bow they relate to the diagnosis and treatment of disease. ·i

(4)

'lb understand the interaction between the patient

and bis social, econom:l.c and cultural background.

• 5.3 Tne need for

- 17 -

meet

of medical. education eosr-es' to c.,..m1tY bealth needS relevan~e

5.3.1 There is 1ncree.sills recosn1tion of the 1mportant contr1but1oDs vb1ch the sbc1al sciences can D8lte to medicine. 5.3.2 Progl'8.lllDeS should be devised which are contemporaneous bavUg in m1nd the etbos, ecological aDd soc1o-econom1c situation in the country for which they are intended.

5.3.3 The core curr1culum is lIOrld.

gen~

appl1cable througbout the

5.3.4 The cOJqpetitive ele 1 ms of departmental heads for their sbare of the curriculum ~ best be resolved by a fUll-time Dean w1tbout departmental loyalties aDd responsibil1ties.

5.3.5 Assessment by outside bodies, such as the General Medical Council in the t1n1ted Kingdom, aDd WIlD, from time to time can help medical. schoole in their eff'orts to establ1sh and sustain a relevant curriculum.

5.4 Development of a curriculum committees.

medical curriculum - Role of' faculty, students

5.4.1 There is considerable variation in the size aDd powers of aim of the curriculum should be directed to support1llg an education in pr1nc1ples and the gradua,tion of an "undifferentiated" doctor.

5.4.2 The general

5.4.3 The first stage of medical education is incomplete w1thout proper arrt:.ngements be1Dg made for graduate training. 5.4.4 Tbere are 1ncreasi~-demands from students fbr participation in faculty matters. Students, sub-professorial staff and recent graduates should participate in curriculum reviews. 5.4.5 Significant changes need to be considered by medical schools in curriculum review, including (a) the balance of the various disciplines; (b) the emphasis on bedside teaching, and the teaching laboratory, vis-a...vis the fonna1. lecture; (c) the content of the core curriculum; (d) integrated teaching; (e) a preliminary degree course. It is recommended that in the development 01' curriculum there should be active participation by recent graduates and students, as well as faculty.

- 18 -

5.5 Requ1reaaeJ1ts for aam:lssion

.of students to med1cal schools

5. 5.~ There are w1cle variations of requ1raeDts 1n d1fterent countr1es for adIII1sa1on, ranging:from no reQU1.rellleDt for any specific subjects, to f1xed prel'equ1s1te subjects, part1cular~ pqysics, chemdstr,y, b10lQgy and.mathematics. 5.5.2 It 18 d1ff1c~t for a student to lave a good cbulce of &eadem1c success without & f:I.l'm basis 1n the sciences. 5.5.3 H1gh f81l.ure rates, part1cuJ..ar~ in the :first year, are costq 1n time and IIIOney to the 1nd1v1c1ual. and wbole community &114 a source of frustration to the student. 5.5.4 Requirements other tban academ:l.c achievement 1nclude motivation, health, psycholog1cal stab1llty, and f1Dan~ resources. 5.5.5 A high proport1on ot vomen &dm1tted to the course 1s not conducive to optimal IIed1cal deployment 1n the COIIIIIJIm 1 ty. 5.5.6 A~thoush it 1s evident that there 1s & slBrpened soc1U conscience of students in some countries on4r a s~ number of students with a background 1n soc1U sciences is adm:Ltted to most medical schools.

5.5.7 Where the use of the 1nterv1ev is posa1b~e, it 1s of part1cuJ..ar use 1n 1dentif'y:Lng the motivation of those with marg1nal qual.1f1cations. I t 1iU reCOJlllllf!Dded tlat: (~)

The attr1tion rate over the course should not be higher

tbaDJ.01.. (2) In sp1te of the f81r~ high drop-out rate of lI9JIIeZl after graduation, their entry 1n reasoDab~e numbers should be encouraged.

5.6 Evaluation of student performance 5.6.~ B1stor1~, the evaluation ot student performance bas been based upon a f1JIal. eX8pr1 na tion 1n each course, vh1ch determ1nes success or fa:!] ure. T~ there ls 1nerea.slDg interest in cont1nulDg evaluation of the student by &8sesslDg h1s performance 1n the lm'da, 1n. the out.patient cJ.1n1c &114 1n the teach1Dg laboratory. The DI1l.t1~e-cholce objective test bas ga1ned popularity but it ~ d1scr:Jm1Date aga1Dst students who lave not lad prev10us a,per1ence with th1s techll1que.

..

5.6.2 Wb1l.e DatiOll&l. staMards of academic achievaaent in med1c1ne are des:L1"ILb~e,un1form1ty of exam1uatlon between med:Lcal schools 18 llkel¥ to be barmful..

•

19 -

5.6.3 All tests and eJCa1II1aations shQuld be used as educat1onal. 1llstruments for feedback of information to the teacher and student resard1ng the curriculum. For the student" such cOJlllllUJl1caUons vlllhelp to detect academic weaknesses and encourage the ear~ development of remed1al lea.rn1Jls.

5.6.4 The critical factor of staff/student ratio DB¥ d1m1nish the use of oral e'l!!l.l!rl-tlons.

5.6.5 There ls less 8'lqphasls on numerlcalgrad1ng 8ZId toli8rd. rat1Dgs on the basis 01' the pass or fall. It is recommended that: (1) (2) In any system ofevaJ.uatlon the students must be fam1Ji a r with the methods eJqpJ.oyed.

It is preferable tor national. test1Ilg organizations to eqphaslze techn1ques atId developmental stud1es, leav:J.ng the content of the e:xa m1 nation to the individual institutlon. There should be continu1Jlg assessment on methods of evaluat1Dg student performance.

(3)

..

5.7 Tee.cb1rlg methods in medical scbools 5.7.1 There lsa world-wide trend towards a greater emphasls on the teach1Dg laboratory and the st~ of the patient at the bedside with a lesser emphasis on the lecture ball and the demonstration. The a1m is to encolll'llSe close contact between the teacher and the student, and to give the student greater responsibil1ty for his own education. 5.7.2 There is growing interest :Ln the appl1cation of-pedagogical methods to improve tea.ch1Dg methods in medicine. This reflects the general concern for a balance between education and research in the medical schools. 5.7.3 .Aw11ov1sual aids, espec1aJ.4r closed circuit television COJI!PUters, have developed rapidl¥ in recent years. and

5.7.4 Feedback from the student can be a valuable source of information in assess1Dg the e1'1'ectiveness of educational prqgrammes. It is recommended that: (1) (2) Medical faculties should contin~ review and appraise the effectiveness of teach1Dg programmes. Teach1ng aids should al-ways be used as supplementary mater1als and should not replace the direct contact between teacher BZId student which ls the essence of education. In all educational SituatiOns, student participation and

t

(3)

student respons1bil1ty are the essential factors. should be on lea.rn1Dg rather than teaching.

Emphasis

-

20

-

5.8 Ut1lization of cOlllllllD1,ty health resources inmedicaJ. undergraduate ;;aucation .' . 5.8.1 There is an 1nhe~ent ditf1cultyfor a large teaciWlS boap1tal to reflect common disease patterns or contribute to cOJP,Ulity medicine and its teaching. 5.8.2 Departments of Social and Preventive Medicine can make a strollg contrlbutlon within and outslde the hospltal to enlarge the ell;Per1eace of stlXlents. . ~

5.8.3 General practice attach1llent schemes can contribute to studeat understandillg of cOllllllW11ty medicine. 5.8.4 To he~ orsanize community teaching aDd mob1lize resources, hospitals require an organization which includes academic and rla1tillg specialist staff as well as general practltioners.

5.8.5 Valllable assistance can be given by paramedical personnel in coJllllllUlity health projects for students.

5.8.6 A collllll1l11ty practice area aihnin1stered

by the unlversity ls

practicable in some Situations and has any ad:vantage... It is recommended tbat cOJlllWl1ty health pl'OfP'Ulll8s sbDuld be developed for the purpose of broadenillg undergraduate education. Organized through either the Depa.r1:aents of Social and Preventive Medicine, Paediatrics or Medicine, these may include general practitioner attachment schemes; programmes to use health centres, COJmIIIUlity health surveys and involvement of paramedical personnel. 5.9 Desirability of a prelim1n8!l degree course in medicine 5.9.1 Prel1m1nary d~ee courses in medicine a1m to encourage a broader education in medicine, particularl¥ by introducillg into the earl¥ years of the medical course a study of bebavioural sclences. 5.9.2 Pre11mdnar,y degree courses in medicine afford students a choice between learlllg the medical course at the end of the p:J;'e~ clinical triennium to pursue ldgher deerees in science or alternatlvel¥ to continue the study of medicine.

5.10 Research

and electivee in medical education

5.10.1 Research encourages a student to tb1IIk cr1ti~ and to realize that there are any gaps in our knowledge of med1cal science.

5.10.2 A research eJqIer1.ence may encourage students to enter an academic career. 5.10.3 Any research experience should involve the student directl¥ and it may be desirable for him to spend a period a~ from the medical curriculum. 5.10.4 Elective periods spent in cODllll1lD1ty Service, travel or in a cl1n1cal field can JIBlte 1mportant contr1butions to student motivat1on.

•

It is recoJIIIIIeDded that: (1) (2) (3)

21

-

Research shOuld have a pace 10 medical education with research viewed 10 the widest sense. A research u;perience shOuld not be compulsory but

students shOuld be encouraged to consider such a

prasramme.

Supervised elective programes sbould be encouraged.

5.ll Train~ fP4teneral practice (undergraduate and g!!dua e as_s) 5.ll.1 There are aD locreasing number of educational progr&JI8IIes which include an experience with a general practitioner. 5.ll.2 There is some support tor the view that general. practice bas become a spec1al1ty and mould be taught ma.i~ 10 the post_ graduate period. 5.ll.3 Colleges or academics of general practice are play1ng an increasing role 10 train:Lng for general practice. 5.ll.4 Members of the medical facul.ty have a responsibil1ty to be better loformed of the role and responsibil1ties at general pract1tioners.

•

5.ll.5 RecQgnitioD by the faculty and a vigorous post~uate tra1n1ng programme 10 general. practice may he~ to increase the number entering this field. 5 .ll. 6 The study of the 1I&tient 1n his home may be an important addit10n to the curriculum. It 1s recommended that there shOuld be an expansion of instrUctIon In a11 aspects of general practice. 5.12 Co-operation and coJ.lAboration between medical schOols

5.12.1 Regional associations of medical schOols which have been established 10 several areas are able to make U8efU~ cOntributions towards 1Iqprovement of medical education, upan4ed COJIIIIIUIlications between medical schools and/or national organizations, advisory services to governments and specific educational programmes. reg1o~

5.12.2 The probl.ems llltel¥ to be encountered 10 establishing associations loclude differing systems of medical education, lArIguage, reations with existing medical associations and the need for vigorous ~ea.dersh1P.

5.12.3 The excbazlge of teachers may be valuable If they remain in the rec:l,pient country tor a suff1c1entl¥ long period to understand local opportunities and. problemsj exclmlge IIJlSt loclude adequate financial support and accoJllllOdat1ons for wife and f'amil¥.

-

22

-

5.12.4 A sUllllller vacation experience 10 ,cOJlllWlity or rural he8l.th prosra.DID8s 111 develop1Ds countries 1s attmctive to med1cal students today. 5.12.5 As a means of foster1Dg co-operation and colJ.aboration between medical. schools the present trave]l1ns seart rwr on medical. education haS proved to be a JDDre uaefUl. 1DatruJDeDt tban the usual. type ot stationazoy seminar. It is reCOJlllDelldecl tbat: (1) Wh1le recogn1z1Ds any d1:rf1culties 1I1vo1wd 111 such a proJect,

the sett1llg up ot a regional organization to effect co_operation and collaboration between medical scbcols vould be desirable. Such an organization sbould have as a maJor objective the rais1llg ot standards ot undersnAuate medical education.

(2)

(3) A _.lor respons1b1l1ty ot a regioD&l. association sboul.cl be the development ot regional tra1nins centres tor graduate and postgnduate tra;t n1 ns.

(4) A steer1Dg cOlllll1ttee be appo1l1ted fortbw1th to s'tl.ld¥ the feas1b1l1ty of a reg1ona1 associat1oD of medical schools; the COIIIII1ttee appo1oted sbould subm1t its %eport with1D one year. (5) Any ~e of faculty should be for a su1"f1cient time to perm1t an understand1llg of local. culture and probl.ellla as weU as a s1gn1t1cant academic contribution. (6) The excbanse of students should be lJ.JD1ted to t:lnal-year students. 6. K>VE TO ESTABLISH A Rl!UIOlfAL ASSOCIATIOB OF HEDICAL SCBOOIB

At the closins session of the Seminar, after the t1Dal conclusions and recClllD8Ddations bad been, appro~, the ~1C?i,pants turned their attention to the reeca.enda tlon resard1ns a feasibll1ty s'tl.ld¥ on the establishment of a regional. association of me41cal. schools. On' the suggestioD of the s-rtnar Secretary, Dr C.J. Boss-Sm1th, the SemiMr sesllion 1IU adJourned and the part1cipants, --tins as a coaa1ttee of the whole elected Dr B. Anstuaco as Cla1ran to conSider the _tter. It 1IU ~ decided to appo1l1t a steerins CoJIIII1ttee with the toJ.l.ow1ns broad terms of reference: (1) (2) To eam1ne the f-.slb1l1ty of settins up a regional association of med:.l.cal schools.

In its work 8Ild 1I1vest:l&&tlons the ComIII:l.ttee sbould seek the assistance and co-operation of the WJI) Regional Ottice for the Western !ac1t1c.

(3) To suhm1t a prel1 mi na ry report with recoJIIIIeDc!atlons within one yt!!JtJZ, look'ns t01l81'da a tiM1 consetulus at the end ot two ~.

•

- 23/24 (4) To keep the participants who attended the travelJ.1ng Seminar on medical education as well as all medical schools in the region fuJ.4r 1ntormed ot developments and progress.

It 1I&.S further agreed that such a regional association 1f estabUshed should not exclude medical schools ot Asian countries outside the Western Pacific Region as det1ned by WHO. The toll.ow1ng were elected to serve on the Steering COIIIII1ttee, as 1nd1viduals and not as :representatives of their countries or schools. Dr J. C~egkeng, Executive Director of the Association of Philipp1ne Medical COlleges (Sec:retary-convenor)

Professor G. Gordon Lennon, Dean, Faculty of Medicine UD1versity ot Western Australia Protesseur So Satta, Secretaire genera.t de lA Faculte de Medec1ne, Phnom-Penh, Cambod1a Dr H. Wei, Dean, College ot Medicine, National Taill&.D UD1versity, 'l'a.ill&.D.

,.

It 11&.8 decided that the Steering COIIIII1ttee should be given power to co-opt other persons to its membership as -.y be required.

-

25/26 A1IIIIJ I ~lOlI

'lOPlI:S DlSCllBSID III BACH 81DDJW\

Location TopioB l.. 2. ManilA Sydney

Perth

81ngapol'e I

ABBeBnent of mec11cal. mnpower :requ1remeDtB Genenl ob.1ect:1'Y8B of the med1cal. UDilergraduate cl1l'r1culum

x

x

x x x x

3. 4.

The neec1. fer nJ.evaDce of mecl1Cl&l education prosrBIIIIIe8 to meet coaam1ty health nee4a Devel.opaeDt of a mecl1cal. curr.1culum - 1'Ol.e of tacul.ty uil student8

5. 6.

Requ:lI'eIIeta fer a&d.8S:IoD of atudeot8 to mec11cal. 8chool.a BvaJ.uat1ou of atudeot p«rfO%lIIDce Tea..... ns JII8tbo4a 18 mecl1cal acbool.a

x x x x

7. 6. 9. 10. ll.

trt1l1_t1OD of ca.!DiV heal.th reaOU1'Ce8 in med1caJ. \Ul4erpa4uate education Des1rabU1ty of a preHndne,ry desree col.U'8e 1n med1c1ne Beaearch and elect1'Y8B in mec11cal. educat10n

x

x

x x x x x

!l!minins for Seoeral. pract1ce (undergraduate and graduate aspects)

12.

Co..opent1on aDd collaboration bebeen 1II8C11cal. scboOl.s 12.1 Bxctwnp of t_chel'a 12.2 of 8tu4eata 12.3 JlatiOD&l A8SOC1at1ona ot Med1Cl&l School.s 12.4 Bes10Dal A880c1ation of 1Ied1ca.l Schools . . . . . of topiC8 in each locat1on --------

x

x

--burs'0

5

5

4 '\'

5

•

..

•

.

•

- zr -

1

Mm1la Sess1on,'WIrJ Conference Ball, 30 AFll to 3 !By 1969

CHAlIJ!MAN

:

VICE-CBAJlUoWf: BAP'2OR'l!JllR :

J!wmaventum ADstuaco Professeur Bo Satta Dr Ian Maddocks

~

YedIleadaz, 30 April. Opening of the Sem1 Dar

~hursday.

Election of Cha1rDlm., Vice-Cha1rma.n and Bapporteur Orientation (SendMr Secretary) Introductory rezuazks (Semi Mr Director) Country reports Vislt to the University of Santo 'louaa aZId the Universlty of the mxL11ppines 1 Mal

-

General obJecti vee of the medical curriculum

-

Assessment of medical manpower requ1rements Requ1rements tor admisslon of students to 1I8d1ceJ. ..boola

Friday. 2

M&

(Sesslon was held at the Universlty of the Ph1l1ppines College of Mediclne Compreb.enaive CoJlllllUn1ty Health Care Unit at l!B.y, IAguna) UtiUzation of cOllll1UD1ty health resources in medical lUldergraduate education 3!1.y

Saturday. -

Co-operation and collaboration between med1cal schools .. .. .. Bxchallge Bxchallge lIational Reg101lal of teachers of students AssociaUoll8 of Medical SchoGls Association of Medical Schools of discussion

-

Summar.y -

r~

ClosinS session

.. 28 -

• •

2

VICB-CBADII\lI:

. • :

Pl'o1'esaor J. IDewetbal

BAPRUIfIW IB

Dl' I'a8arD ChartilanlUl1.1 Dr Joee ~eas

.. Opea1Dg ad4res_ by s-lth, AWltftlJA

Su

W']] 'a Bef_hause, D11'ectar.GeDeral of

.. Blect10D of Cba1rIIU,

V1ce-C~

aDlllapporteun

.. General obJective8 of the medical UDdergn4uate CNl"riculwD .. Bvaluat10n of atu4eIlt ~, perf~e

6!1l

.. !i!ea.ch1IIs methods in me41Q&l. 8choOls .. De81rab1l1ty of a preJ1 m1 rw "Y deg1"4!e COU1'IIe in medic1ne .. Tour of Med1caJ. School, UDi '¥Wslty of SydDe.y

Wec1nelKlay, 1 Mar

• .. Co-operat1on and collabQ'l'&t1on between medical 8chools -, Bxclaage of teacber8 .. Bxcmtnse of 8tudent8

.. .tiona] .Aa8oc1at1ons of Med1cal. Schools ..

Beg1oD&l. .Aaaoc1at1on of Medical. Schools

SIUIIIIIol"y.. Beport of D1acus81ons

.. Clos1Qg 8ession .. V1sit to med1cal.8choo~, UD1vers1ty of lIev South wales

.

"

...

.. 29 -

3

Perth Session, WConom1CS aDd UD1~ _of ~ 8 Ifi.i

s:vr

tOm

.ce _

BniJtBng,

CJIAl:BMUI : Professor G. 00rd0D Larmon VICB-Cl:IlI·lltMU: llZ' Buoyao Wei BAE'PORCWR :.Dl' T. Gu¥ Bawley

Thursday, 8 -

May

Br1ef:lJlg sessiOil by Professor G.G. LeiUlon, MIL1n Leoture Theatre, Royal. Perth Hospital May

J'r1daz, 9 -

0pen1ng address by the Bonou:rable M1D1ater for Health, Hr G.C. MaclC1 nnon

-

Election ot CbairDBn, V1ce-Cba1ruan and Papporleurs Beed for re~evance of medical. education programmes to meet CODIIIWlity heaJ.th needs utWzat10n of COIDIIII1Il1ty undergraduate education hea~th

resources in med1cal.

•

-

DeveJ.opment ot a med:l.cal. curriculum - role of facul.ty I students

BatUl'day. 10 May Visit to Sir Cl:;arles Ga1rdner Hospital. _ developing Perth Medical. Centre which v1ll. event\J8.l4r incorporate the med1cal. schoo~ May

M>DI1ay, 12 -

Co-operatiOil and collaboration between med1cal schoo~ ExchaDge of teachers Exchange of students lIatiODal Assoc1atioDS of Medical. Schools - lleg1cmal. Assoc1ation of Medical. Scboola SWIIIIU'y - Report of D1scuss1oDB Cl.oa1ng sessiOil -

-

•

-

30 ~"

4

• CBAIBIMB RAPPOB'.l'lUIS : : VICE-CBAlBMA1I:

Professor I4m Kok ADD Dr Sb1lII SuIt Hahn Dr Ian Msddocks Dr !r. ~ Hawley

~ad8.y, ~3

!lz

-

O'peniIlg address Need for :re~evance of JD8d1cal. education pl"Ogl'IUIID8s to meet COIIIIIIID1 ty heaJ.tb neede

-

Research aDd electivee 1n medical education !J.'ra1 n 1Dg for general. practice (\!IIdergraduate and graduate aspects)

WedDeaaa,. -

1.4 Mal ~tb

utlllat10n ofco.uD11:y UDIlergraduate education

:resources 1n medical •

-

Co-operat:Lon aDd coUAboration betweeD medical. schoou

.. ~benge of teachers _ BXcbenge of students lIat:LolBl. A880c1at1ons of MBd1cal. Scboola Reg1.oM.~

.. ..

Association of MBd1cal Schoou

SI1D8IIILr'y .. Report of Discussions

-

Cl.osiDg of S1Dgapo:re aeadon ~5 J!.y

!rhur!day,

.. Consideration ot Dl'aft Conclusions aDd Dl'aft RecOlllll8DC1atlou ot the Sem1tw r .. ClosiDg ot the 8 ·1l18r

•

•

.. 3J. .. II

•

WIS'l'J5B1I PACD'IC AU8'1'BAIJA

Professor G. Gordon Lelmon Dean, Faculty of Med1c1ne Un1versity of Western Australia Victoria Square Perth, W.A.

6000

CAMBODIA

Professeur So Satta Secreta1re g~n6.raJ. de l.a Faculte de Ml§deo1ne Pbnom..l'enh

C8iiIbOC18e

CBIl'lA (~IWAlI)

Dr Huoyao Wei

Dean, College of Med1c1ne National. !I!a:1w.n University ~,

!I!a:1~i

J ena1 Road Ta1w.n

RepAc of China Dr Chih-teb roo Director, lat1onal. Defence Med1cal. Center 'l'a1R.....e1 'l'a1l1Ul RepUbUc of Cb1IIa J'IJI Dr T. ~ Ba.w~ey

FIjI

Senior 'futor in Social and Prevent1ve Medicine Fij1 Schoo~ of Med1cine Suva Dr Hb8nar& Cbo~ Directeur, Bcoa ~ de Mli§decine

IAOS

Vientiane

raoe Professor C.W.D. Lewis Dean, Scbool. of Medicine Un!vers1ty of Auckland Auckland ReV ze;;1and

- 32 Dr Ian Maddocks Acting Dean, Faculty of Med1c1ne t1n1versity of Papua and New Gu1nea Boroko .p&pua PBILIPPIBBS

,

Dr Bueaaventura ADstuaco

Dean, laculty of MIId1c1ne and Surg8l7 Univers1.ty of BaIlto !l!oas Manila

Phlli'pp1Des Dr Jose C~eag

Bxecutive D1rector Association of Ph1JJ.P,P1De Med1cal. Colleses c/o Collese of MIId1c1De University of tbe Ph1l1ppinetJ 547 HermIl street

Dr Sb:l.m SUk Bah1l

kOrea 89-4,

Dean, Collese of Med1c1De Seoul. lIatlonaJ. Univers1.ty Seoul

1

Dr Il-Chun Chung

..

Dean, Catholic Med1cal. College K)'cmg-Wun DoDg

KOrei

Seoul.

Dr Dao Huu ADh

aqUe Dr KD.sal"n

Profuseur, Facul.'W de Hedec1De UniveraiU de Sa!son du Viet-.:tJam

ctart1kaw.n1.1

at.

Rector, University of Hecl1cal. Sc1ences

. • 2.

- 33

w

UlCAL PARXICIPAES

Dr Uldar1co C. Bacay Dean" Cebu llIst1tute of Med1cine Dr Serafin JullaDo

Dean, College of Medicine Far Eastern University Dr Iauro Panganiban Dean Bmeritus Far Bastern Un!versity

lWtUA CBRrBAL tmIYBBSrrI

Dr Jaime Aquino

Dean, College of Medicine

Man"a Central University SOOTIlWRS'IWffl' tlBIVBBSl!I!Y

Dr Venust1ano Borromeo Dean, College of Medicine Southwestern University Cebu C1ty Dr Gonzalo Aus'b:1a Dean, CoJ..lege of Medicine University of the Bast/ Bamon Magaqsay Memor1a~ Medical. Center Dr Pa~

UBIVBBSrrY 06 TBI BAST

UBIVBBSE?I OF 'rBB PBIL1PPmBS

campos

D1rector, CollllWl1ty Heal.th Care Program College of Medicine University of the E'hilippines Dr Antonio 'ran Deputy Director COJIIIIIUJl1ty Heal.th care Program College of Medicine Univerdty of the Pb1l1ppines Dr Florentino J. Herrera, Jr.

Dean, College of Med1cine Un!vera1ty of the E'h1l1ppines Dr .Aml>1'o8io !l!angco College of Medicine University of the Phil1ppines

- ".. SlDBEI - AUS'l'.RALIA

lJJII'VBBSrJ!I or DW aom!R lIlI£S l'Accm fa MBDICDE

Professor H.J. Bl.wlt Professor of AIIa~ Professor H.M. C8:'ey Professor of Obstetrics aDd Gynaecology Professor G.B. Cooper Professor of M8d1C&l Microbiology Professor J .B. Hielde Professor of Med1c1De lrotessor G.l'. lollrnaghan Professor of Burgery Dr J. Steigrad Honorary Director Post-Gra.duate Medical Education t

(N.S.W.) Professor G.D. Tracy Protessorof Surgery Professor R.J. Walsh (Act:Lng Dean) Professor of Human Genetics Professor D.L. Wilhelm Professor of Psychology Dr B.G. Wren Senior Lecturer, Obstetrics and GytIaecology URlVEBSJ!I!I O~

•

•

SllBi

FACUUl'I

(Jj'

MBDXClllE

Professor J. IDewentbal. Dean am Professor of Surgery Professor Ie.W. Cleland Protessor of HiStology and Embryology Dr W.H. McCarttw' Senior Lecturer in Surgery Professor G.W. M1lton Professor of Surger.r Protessor J .R. Read Protessor ot Med1c1ne

COJK)lIWEAIIrB DEPARrMImr O~

1lEAI/rH

Dr John S. ~ Director ot InterDatioll8.l. Health Protessor C.R.B. Blackburn Department of Medicine University of Sydney Dr V.H. CUmberland Dr Ronal4 B. Winton 1ild1.tar

ASSOClld'ION

AUSTRALIAlI MEDICAL

JOD.l! ADVISOBI COIIoU.'l"nlE OF ~ ROYAL CO:r.ta:Jl1B

MBDICAL JOUBBAL OF

AU8'BWJ.A

.. PERTH - 4\US'l!RAW • UlIVBBSl'J!Y 01 WE'll5Rii

AUS'l'BALIA 1'ACtlUl'Y OF MlDICIB

Protessor D.:B. Allbrook Professor of Allatomy

Dr M.

A~s

N.H. ,. M.R.C. Research FeJ.J.ow 1n the University, De,partment of M:I.crobiology

Professor :B.N. Catchpole Professor of Surgery Professor D.H. Curnow Professor of CllD1cal Biochem1stry Professor R.A. Josek Professor of Medicine Professor W.B. MacDonald Professor of Child Health

Dr J .A. S1mpson Thoracici Surgeon RoyaJ.. Perth Hospital Dr )f.N.I. WaJ.ters Reader 1n IathOJ.ogy

Dr J .R.H. watson Honourable Secretary RoyaJ.. Austra.Uan College of General. l?X'actitioners Perth

Dr :B. Mathieson CODDllOnweal.th Director of HeeJ.th

COlIIIIIOD.vee.lth Offices Perth, W.A. Professor W.B. MacDonald Department of Child Health University of Western Australia Professor W.:B. Ma.cDoDald Department of Chil.d Uee.J.th University of Western Australia JOlll.r ADVD30BY COHa!J!'.I.'BB

OF BOYAL COr.IIGBS

Professor John D. Mu-t1n Professor of Obstetrics and Gynaecol.ogy University of Western Austzal.1a

- 36 -

, Professor L1III Kok AnD Dean, Faculty of MaUc1ne and Professor of Bacter1oJ.osy UD1vers1ty of S1J:Igapore Dr !Dh Tee J'un Sub..Dean, Faculty of Had1c1ne aDd

Lecturer 1D Pae41atrics UD1vers1ty of S1Dgapore Professor G.A. 'Ransome Professor of Hed1c1De J'acuJ.ty of Medic1De Un1 vers1ty of SlIIgapore Professor ICbOO Con Te1k Professor ot Cl.1D1cal. Med1c1ne Faculty ot Ked1c1ne UD1versity ot S1Dp~ Dr Balla Tan

Lecturer 1D Soc:lal Med1c1De " Public Heal.th J'acuJ.ty ot Had1c1De UD1versity of B~ore Dr PbooD WB1-On Medical Adviser

Sbell Bastern Petl'ol.eum Ltd. Pulau Bukom B1nsapore l.

Protessor G.B. Wadsworth Professor of ~1ol.ogy J'acuJ.ty ot HiI!Id1c1ne Un1versity Of. s1Jlgapore Professor WODg Bock lloon Protessor of Paed1atrica J'acuJ.ty of Medicine Un1vera1ty of S1Dsa,po" Professor X.T. Chan Profusor of SUrgery J'aculty of Medicine UD1vera1ty of ~pore Protessor Protes~or

of Orthopaedic Surgery J'acul.ty of Had1cine UD1vera 1ty of S1Dppore Dr Beall Cheag Siang P1:\YS1e1an Thomson Boad General. Hospital.

V.x.

~

Singapore

•

•

Dr Sabaclor ArellaDo C~1ran, Department ot Obstetrics aDd G,y1JaecolD6Y . J'aculty ot Medicine aDd Surgery UDiverslty ot Santo !I.'oDas Dr Bew. P. Arribas

Secretary College ot Medicine _n']a Central Uni var8ity

carmen. L. Asunclon ChD1rDaD, Department of Pb;ysiology and Pbu'DacoJ.osy Faculty ot Medicine and Surgery Univers1ty ot Santo ToIIas Dr Dr Rodolto S. Duterte 3J.lI.1 MS.8s10n street SaD Francisco, Cal1fornia 941lO American Med1cal. A8sociation

Dr J'el.1x A. Estrada

•

Department of Paed1atrics Faculty of Med1cine and SUrgery Universlty ot Santo To_a Dr Antonio K. Ignac:f.o

Department of Pathology College of Med:f.c1De Un:f.verslty of Santo Tomas

Dr Vlctor A. Reyes Ph1J.:f.pp1De General Hospital 11188 !Alz Dilql.1e Medical Student ~ Faculty of Medicine 8.Dd Surgery Universlty of Santo !rouas Kr B:f.enverl:f.do Z. Angeles

Collese of Med1cine Univera:f.ty of Santo !l!ouas Kr Ramon Sal.umb:f.des UDivera!ty of the Bastl Ramon ltIgaaysay Memorial. Med:f.cal. Center ~

- 38 SYllIEI - Aum'BALIA SlDlfEY UBIVERSrl'Y NBDlCAL SOClEl!Y Mt- Keith Bartman Undergraduate Vice..President Mt- John Dunning Med VI

• I!

tmI'YBBSl!1'Y OF lIBW swm WALES MBDlCAL SOClmI tmIYBRSl!1'Y OF lDlW sw.rH WALBS I'ACUIlL'Y OF HmICID

Assoc1ate Professor A.E. David Associate Professor of Medicine Professor W.E. Gl.over Professor of P~siology DrJ. Bam Senior Lecturer in Surgery Dr T.J. Heath

Senior Lecturer in UlIIVEBSrlY OJ' BYDDI FACUIlI.'Y OJ' MlDICID (VisitiDg professors)

P~siology

Dr Robert B. Hiatt Professor of Surgery College of ~sic1aDs and Surgeons Columbia University New York, U.S.A. Dr F.R.C. Johnstone ~

Professor of Surgery University of British Col.umbia vancouver, B.C., Cenada PERrB - AUS'lllALIA

tJlfIVERSlTX' OJ' WJ!Sl!BBN AUS'l'BALIAN MEDICAL S'J.'tlIlBlf.CS t SOCIJII!I

Miss Fiona BtanJ.ey Vice-President Mr John l!a.teman Mr M. Pbil.l.1ps

Sm:lAPQRJl:

umvEBSrn

OF

SIIIGAPOlm MBDICAL STtJllEES SOCIB'l':t'

Mr Lee Hiw Peng 5th Year Medical. Student

• 39/40 -

•

4.

COBSUIlrAN'fS

I

•

Dr Jom :Bowers

Pres1dent7 Jos1ah M!Lcy Jr. FoUDdation 277 Pa.:L'k Avenue lIew York, B.Y. 10017 Umted states of.Ameriea

Dr C.J. Ross.Smith Ioknila

(Sem1.Dar Secretary) Begional Adviser on Edueation and Tra1n1ng WHO Begional Office for the western Pacific Ph1npp1nes

\

. ..

Mr J. stichelbaudt Translator/Int~eter

WHO Begional Office for the western Facific Manila

l?bli1pp1n.es M:l..ss Gloria L. Mariano

Secretary WHO Begional Office for the western :pacific Mm1la

Phllipp1nes

•

- 41fo.2 -

•

WPB/Biiuc/15 WPR/»lu.c/lfj W1!B./FAuc/17

R

New ':rreads in Medical Education by Professor R.R. Andrew

_ ':r1"'1n1ng of ':reachers for Mecl1cal Schools by Dr John Z. :Bowers R

Medical Education Fac111t1es 1n the Western Pac1t1c Reg10n of WHO by Dr C.J. Ross.Smith

WI!B./Fiiuc/l13

-

Co-ord1.nation and Colla borat1on between Medical Schools prepared by the DividoD of Educat10n and ':rra:1niDg WBD/HQ, Geneva

WPB/Educ/19

-

Bas1c CODsiderat10n 1nAssess1ng Medical z..tmpower Requirements by Dr A.A. Angara

•

..

.. •

~

1. 2.

Australla C&IIbod1a Cb1Jla

••••••••••••••••••••••••••••••••••••••

45

• •••••••••••••••••••••••••••••••••••••

49 51 53 51 59

3.

•••••••••••••••••••••••••••••••••••••••••• ••••••••••••••••••••••••••••••••••••••••••• ••••••••••••••••••••••••••••••••••••••••••

4. 5.

FiJi Korea laos

6. 1. 8.

•••••••••••••••••••••••••••••••••••••••••••

Papua and New Gu1Dea New

• ••••••••••••••••••••••••••

61 63

Zea'pm

••••••••••••••••••••••••••••••••••••

Pb1l1pp1nes

.•..•......•............•...........

61

•

• 45 -

II

II

,In AUlltrel1a theN are medioalscbools ~t the f'ollow1Dg universitie.: (1) University ot Queenalalld (Brisbane), (2) Univel'8ity ot S)'dney, (}) tJn1vel'8ity ot New S~WaJ,... (SyWley), (4) University ot Mel~, (5) Menuh University (Melboume)~ (6) University of Tasmania (Hebart), (1) UDivers1ty of Adelaide, and (8) l1n1veraity of Westem Australia (Perth). !'beee at :New South Wf,lell, Monash and'l'uman1a were founded within the put teD yeU'll aDd the Medical Schoolot We8tem Auatralia started in 1951. '!be

nulllber.·ot students seeking ""lIIluion to ,a medioal oOQrlle at present greatly exn. . the pl8(JU available in the medioal. sohools. CensequentlY, quotu ot ~oeptanoe are in operation at ,all mecUcal .schools. Fer example, at present in Wute~ Autral1a 6t students are.elected tor the Jl!8Ciioal C0UN8 attar the t _ t year at University havins oompleted studies in Ph;ralos,Cbe1ll18try, B1elog m1 Mathe. .ti~. About lJO students compete in this first year. AU IIWIt have matrioulated in Westem Australia· or be permanently resident 1n the State. BixstW,enta _und.erthe Colombo Plan ~ selected for tlrst year af'ter having matrioulated in We.tem Australla and they oompete in the quota at the end of tirst year. I t ill boped that the quota will be raised to 90 tor 1910. 'After tirst year, the med:f,oal COUI'IIe in all Universities ocnt1nues tor tive year. bef'~ gred.uati-n. 'In 1966 entrance quotas in medioine were as tollca:, (1) BriSbane l6o, (2)8Jdney 255, (,) New Seuth Wales 50 (4) Me1boume 160. (5) Mcnuh 160. (6) !l'umania 24, (1) Adelaide 120, (8) Perth 55; tota;l 1,004. Recently, a Jo:l.ftt Cent.renee· ~,MediOal Eduoatic (1967) reooanen4ed that Rthere shClUld be an obligatory CQe-year pre-registration per10d ef' hNp:f.tal training applying to all States in Australia; it should consist .esent1al.ly ot' su rnontbs' training inMed~1ne. and six months I train1n& in Surge17, 1nelud1ng maJor all1ed diee1plinu whiohc~ into the paeral HOpes of' the.. two main oategorie8} th8~.bould be 1'10 specialty tra1niDs in the tirst )'liar to11ow1ng,gredu.ationR• lfhUe II\08t States already accept thill ~l'8g:lstratlon ;year (Victoria bePJ& the main exception) the erganizaticn ot' fUrtller tra1n1ng tor the pre-reg1atrat~doctOl'll has been generally haphazard and. disorpn1P4. The aocredltatiOll. et hospitals 18 neoe88U7 tar training p\U'p08ea. Medical lIel"V'icell in Australia rely t~ heavilY on dootttrs tram cwereee.a.. llainly tram the Un1ted K1n&dem. In Western Australia 2" of the doctors in the state are migranta. A reduction could occur in the lmm1pation ot doetozoe. fer example. the United KingdOlll M1n1st~r at Health has stated that, UBl.eas the present OIltp!lt ot doetOl'8 oeuJ.d be quickly increased, Britain wu likelY. by 1915, to be 8... 11,000 &hart of' the number of practi8ing dectora that they oalculated they would need. R. B. Sootton (1967) ot the Institute ot ApplIed Eooncm1e Reaearoh ill Melbourne di8puteS the Australian shortaae et deotora (doctor to pepulation ratio 1 I 602 between 1961 and 1966) aDd stat.. : RThe b1"08d conclusion, then, i8 that by world stanc!a:tda Auatralia ill IId.equ&tely supplied with doctors and that Pl'88J'BIIIII8S tor the expansi~ ot educational f'acilltiell, i t realised, w111 be suffioient to maintain this 8ituationR••• Rthe majer problema at medloal manpower appear to oonoem dI8tribution ftther than the overall balance between supply and demandR• 1

•

.

SubmItted by Protessor O. Gordon Lerman, Dean, lPaeul.ty of Medioine.

- 46 -

"

Sootton admita the difficul.ties of obtaining exact data for hiS thesiS, a1'II1 he largely i~8 that migrant sublSid18ation of Australian medioal manponr, but he doed highlight the unequal distribution, especially in countZ'Y' areas. D18cussing tftis subJeot in a reoent number of the World Medical Journal; Dr. R. E. Davies of Sydney points out that the geosra~ of Auetralla is such that there is a good number of small cOlllll!lmities, "eae-dector tONnS". and the problem of maintaining a resident doctor is becoming gNater. He suggests that the solutim depends more on a supply of suitably trained doctors, able to deal 'with emergencies and provided with special skills, and on their cQD1:1nUing'acce8s to hospital beds, than on economic condit1411S. In other parts of the world "f'eldahers" or medical asaf:stants are used to OVel'Come the diffioulty. POl' myself, I believe that the better organisation of regional hoapital facilities and the eduoation of the community to accept the onus of cbnVeyanoe to the doctor rather than doctor to patient would solve some of the difficulties. Modern medicine 18 a co-operative exercise, not an individual one. Medical schools budget their finances in triennial aublnissions by universities to the Australian Universities C~ission (A.U.C.). !heir cla1ma are pruned first by competing faculties within Universities and I!lubeequently by the A.U.C. wh1ch v18its each University to d1scuss cla1m8. P1nslly, the A.V.C. submits to Federal Parliament the proposed total bill for Universities for each triennium and Parliament may accept or reduce. State Gov'errmIents make matching granta. 'Eighty-two ~cent of medical student!! in Western Auatra.lia hold ColtlDlmfealth scholarships. OVerall the medical sel"lTioes framework in Australia is one of urban concentration of speCialists, and an imbalance of genera1-praetitione~ lpecial18t rati_. There has been an increase of 90!' in full-tilDe salaried medical persennel between 1952 and 1965, so that they now c.mpr18e more than one-third of the profession. The honerar,v system fo~ public patients 18 being replaced by a system ot part-time sessional pa.yments. This will inereaae the ava1labU1ty ot el1n1eal teachers and lead to an 1mproVementa in the amount arJd standards ot clinioal teaching.

•

•

- 47/48 -

• 1. Davies, R. E. (1969), The Minister of Health

(U.K.),

(1968)

2. scotton. R.B •• (1967), Third Report of A.U.e. (1966)

3. World Mad. J. 16. p.9. 4. Report of the Second Conmonwealth Medioal Conference, Kampala, p.41. pp.31,32 •

5. Australian Universities 1964-1969,

•

.

COUlfl'RY REPORr" fJE OJU4BODIA l

.

•

The following progress and ohanges have taken place at the Faculty of Medioine: 1.

Education

(a) Suppression of the programme for health officers (1965-1966). No more students are aooepted for this programme. (b) There is an improvement in the standard of education, mainly as a result of: - the higher level of seoondary education, - the selection of students during the pre-medical year (preparatory certificate for medical studies). This preparatory year, which was until 1968 a responsibility of the Faculty of SCiences, was taken over by the Faculty of Medicine and is now under the control of the latter' s dean, - a more rational urganization of hospital training periods. (c) The former curriculum has been revised and up-dated so as to establish a new pattern of studies. This new pattern guides students towards laboratories and clinical practice (reduction of a number of formal lectures - increase in the nunber of hours dedicated to practical work and hospital clinics). Emphasis is also placed on the teaching of public health. (d)' postgraduate teaching has been introduced. The visits of foreign lecturers become more frequent. - Establishment of a certificate of specialty obstetrics, pediatriCS, etc. 2. Teaching staff medicine, surgery,

•

There is an improvement in the quality of teaching given by national professors ("agreges", masters of medical sciences or specialists) most of whom were trained in various French universities. Foreign professors still continue to teach and they will be replaced in the near futl.U'e by national staff.

3.

Teaching material

The number of reference works in the library has increased from 4 271 to 5 410. The following laboratories have been improved, enlarged and modernized: physics, chemistry, physiology, bacteriology, parasitology, anatomy and pathology. It is planned to build five lecture rooms and two large lecture halls.

• lSubnitted by Professeur Agrege So Satta, Secretary-General, FacuJ.ty of Medicine and Paramedical Sciences, Royal university of Cambodia.

- 50 -

lJ.

a.tdget

The operatlcnal budget roee fran Rlels 11 lJ19 550 to 15 712 196 plus RIels 1 500 000 provlded :for in the Natlcmal Five-Year Plan. The number o:f medical students increases evel'7 J88l" (trcm 1967/1968 to 700 in 1968/1969).

5:!T

in

1966/1967 to 15. n;

Exam1natlClft results are also vel'7 promising (f'ran 15.04% in in

1967/1968).

•

•

51

.. •

COUNTRY REPORT OF CHINA

1

. National Taiwan University College of Medicine Taipei, Taiwan, Republio of China

At present, there are six medical schools in Taiwan:

(1)

National Taiwan University College of Medicine Taipei National Defence Medical Centre (1945), Taipei

(1945),

(2) (:;)

Private K'aohsiung Medical College (1954), Kaohsiung Pri vate Taipei Medical College (1960), Taipei Private Chinese Medical Herbal College (1958), Taichung Private Chung-shan Junior Medical and Dental College (1963), Taichung

(4) (5) (6)

The requirements for admission of students to medical schools are:

(1) (2)

graduate from senior high school; and passing of the Joint Entrance Examination organized by all government and private universities and colleges.

•

TWo-year pre-medical, four-year medical (two-year pre-clinical and two-year clinical) courses and one year rotating internship are the standard courses except that no pre-medical course is required by Chung-shan Junior Medical and Dental College. The Chinese f.1edical Herbal College now offers two medical courses, one of "western medicine" and another of "Chinese herbal medicine". The sizes of classes of medical students of the two national medical colleges remain around seventy, but those of the private medical schools have doubled from 60 to 120 during the past few years. The National Science CounCil, organized in 1959, has been providing financial assistanoe to the two national medical colleges for improving their facilities for undergraduate teaching as well as graduate training, especially in pre-clinical disciplines, and research subsidies, fellowships for post-graduate training abroad and visiting professorship to medical schools •

. lSubmi tted by flloyao Wei, M.D., Dean, National Taiwan University College of Medicine, Taipei, Taiwan.

_." 52 - The two national medical colleges offer graduate courses in pre-clinical sciences leading to Master of Science degree and in to Ph. D. degree. Some of the graduates stay as teaching staff. Join the faculty of other medical schools and the rest go abroad fUrther studies. various a few some for

..

Nevertheless, all of the private medical schools suffer from financial difficulties for providing minimum teaching facilities and inviting adequate teaching staff. Since the initiation of ECFMG in the United states of America, "brain drain n of physicians has become a public concern and for preventing this "brain drain" the improvement of the facilities of all hospi tals and the raising of the pay to physicians working for government hospitals, health agencies am medical institutions have been strongly recommended to the govemment authorities. The reactivation and re-organization of the Medical Education COlllllission tmder the Ministry of Education has also been recolllllended by medical educators and health authorities. The Commission should have fund and at least a full-time secretary to collect information on health manpower to the Commission for recommending policies for medical edu::ation to the Ministry, and should have the authority to supervise the medical and allied schools.

•

TWo meetings for organizing a Medical Education Society have been held, attended by all the deans and some professors of the six medical colleges. It is hoped that the Society could be organized by the end of 1969.

..

or

53 -

•

Fiji School of Medicine There have been the following major DEVELOPMENl'S IN MEDICAL EOOCATION since 19631 1. 1.1 1.2 The creation of the following full-time posts: Tutor. later upgraded to Senior Tutor, in Surgery. Tutor in Obstetrics. Tutor in (Internal) Medicine. Tutor in Anatomy. (Not yet filled.)

1., 1.4

Note: '.rile posts of lecturers (tutors) in Surgery and in Anatomy were combined previously. 2. 2.1 The regrading of the follOWing full-time post: Tutor in Social and Preventive Medicine to Senior Tutor.

•

3. The creation of the following f'ull-timea.onsuJ..tant posts, ""'the consultants concerned being part-time tutors: Paediatrician. 3.2 Psychiatrist. Virologist. (Vacant at present)

3.3

4. The opening of a Department of Nutrition and Dietetics in 1966. under the immediate supervision of the Senior Tutor in Social and Preventive Medicine. The present staff is: 4.1 Two tutors in Nutrition (part-time) A volunteer from New

4.2 Tutor in DomestiC Science (Full-time. Zealand. )

In addition, teaching and research is contributed by a medical and a non-medical member of the WHO Nutrition project. and a non-medical nutritionist and a home economist from the South Pacific Health Servioe.

4.3

5. The transfer of pre-medical (first year) soience teaohing to the University of the South PaCific in 1968, and the subsequent abolition of the pre-entry course in English, Mathematics and the Sciences in 1969.

• lSubmitted by T. G. Hawley, Senior Tutor in Social &: Preventive MediCine.

6.

54 .-

• A one year internship is now undertaken by most graduates, not only those from Fiji, in one or other of Fiji's two major hospitals. The exceptions are: Western Samoan graduates, whose internship is oarried out in their otm country; Amerioan territories. whioh have had had no graduates dince the scheme became operative, and Papua New Guinea which now has its otm Medical College •.so no longer has students in Fiji.

I

7. The postgraduate course leading to the Certificate of Publio Health was designed to re-train older graduates who had had inadequate undergraduate training in that discipline. After nine years. the course was disoontinued in 1969. Postgraduate in-service training continues in all other disciplines. More advanced postgraduate training is now taken in New Zealand and other metropol1tan countries. Publio Health postgraduate training :1s taken at otago University. New Zealand (DPH). U.Hawaii (MPH), U. Philippines (CPH). U. London (Dip. H. Educ; Dip. NUtrit.) and U. Sydney (Dip. Trop. Med.). Obstetric postgraduate training is taken at U. Auckland (Dip. Obat.). Fiji graduates are now el1gi.l)le to take the examinat10ns of the Royal Australasian College of Surgeons. and have taken successfully two year condensed courses at Indian Universities leading to the granting of M. B. degrees. This paragraph is contributed to indicate the increasing.acceptance of the School's diplomates. 9. SPJlX;IAL PR<BI.EM3 IN MEDICAL EOOCATION

8.

•

These remain, as in 196" the uneven level of general and scientifiC education of new entrants, particularly those from outside Fiji. For the latter group the minimum entry level has had to remain at New Zealand or OVerseas Senior Cambridge School Certificate, or a H1gh School Graduat10n Diploma, (four years of secondary educat1on) with sometimes only one so1ence subject taken. For Fiji entrants 1t has become possible to seleot only those with five or more years of secondary educat10n and who have reached a sat1sfactory standard in Mathematics and at least two Science subjects. It is not yet possible to demand full University Entrance standard in all three basic sciences and English. Those who have reached this standard are at present adm1tted directly to the pre-clinical soience year (second year).

9.1

9.2

It is planned that the Fiji School of Medicine will be absorbed into the University of the South Pacific !Jy early 1970 or 1971. although there is no intention to upgrade the course frOm diploma to degree level in the illDll8diate future. The existing unoertainty leads to problems at teaching and administrative levels.

... 9.'

A table 1s attached showing the composit1on of' medical olasses in March 1969.

.

- 55/56 -

•

FIJI SCHOOL OF MEDICINE

Medical Undergraduates, March 1969

-

Year 1

-

Roll

Women

46 (Fiji: FiJ. 3: Ind. 5; Chin. 1 ( 1/

II III IV V TOl'~

26 16

F F F

5; I 5; I 1; I

, 5 1

... =

9) 8)

5 4 2

(

1/

.. 10) "" 2)

7 17 112

( n ( n

1 3

F F

4; I 18; I

4 18; Chi. 1

= =

8) 37)

("

15

!

(J3%) (l}.4~)

•

- 57 l. COUNTRY REroT OF KOREt~

•

College of Medicine Seoul National University Seoul, Korea Medical Education in Korea Population pressure, as well as a greater awareness of the benefits of medical care, make it necessary to increase the number of qualified doctors throughout the country. Medlcaleducation has to meet this social demand in adequate calibre. First. we shall outline the present socio-ecC?l1omio background of Korea:

1.

Population (per 1000)

1966 1967 1968 2.

29,208 29,784 Y<l.469

One thil'd of the entire populatilm is urban and the rellaining two thirds are rural. Among them 1340 were living abroad and 2050 were in military se%"ITices ... Remaining 7170 doctors were in connecti.on with civilian health service.

3. Total number of doctors was 10 560 in 1967.

4.

Around. three-fourth of the civ1lian doctors live 1tl urban area and one-fourth in rural area. to that of the population.

5. Such geograph1cal distribution of doctors is a sharp contrast

6. Some differences of opinion arise with regard to the optimal number of active dgctors. Some claim the necessity !;If making favourable atmosphere for the medical activity in rural area instead of establishing new medical schools. 7. The per capita G.N.P. of the nation was:

1965 1967

$114 $138 $165

1968

Such socie-eoonomic developments were reflected in the expansion of medical education.

ISUbmitted by Shim Suk Hahn. M.D., Dean, College of Medicine. Seoul Nat10nal University.

-

58 -

They are itemized as follows: 1. New medical college

" 160 pre-medical students 160 pre-medical students

1967 1968 2.

2 schools 2 schools

Enrolled Enrolled

Increase the class-size in established medical college

1969

(:~

sohools)

Total •••

100 students 2742

3.

The number of specialists

That is around

~

of total number of doctors.

4.

The number of post-graduate training hospitals has been expanded to 55. Their teaching faoilities are subjected to annual inspection performed under the supervision of the Korean Hospital Association. New graduates of medical oolleges were strictly screened by the National Licensure Examination and around 7t$ of them passed it in 1969. villages during the summer vacation and hUman lives and diseases were understood on the basis of socie-biological ground.

5.

6. Medical students were engaged in the health service in

..

•

-

-

59 -

COOJI&Y lCEP<Jf.f OF lAOS

.. 30 000.

BRIEF BEPOR'l' O!T MEDICAL EOO'CATION

m

IAOS

laos bas a PO'pulation of

a'p'prox:1Date~

three million.

Medica~ personne~: one hundred medi~ of'i'1cers (25 med1~ officers and 75 assistant doctors). The doctor/po'pulation ratio is thus one to

There is o~ one training centre; was established in ~958. Personne~

the Royal.

Schoo~

of Medicine which

doctors is

a~o

being trained; foreseen).

assistant doctors (the training of medi~

Objectives of ~; to form practitioners to compensate for the shortage of qUill:tteli cU officers. The 'programme bas not c~ed much since ~963 and is most~ devoted The programme of medi~ stUdies is covered in four nine months t duration. There are no optiona~ subjects and students have to fo~w the entire programme. to c~1n1ca~ training. schoo~ years, each of

is devoted to genera~ training. The subjects inc~ude The first ph¥s1cs, chemts, bio~, ph¥sio~ and anatomy I medica~ sym.ptomatology, surgi~ symptomato~ogy and minor surgery. bio~gical chelilISti'Y, phiYsio~ogy 1 histo~ogy) and an introduction to

W

The seaond year covers the basic medi~ sciences (medica~ ph¥sics, medi~

pathology and

deontology.

to~gy, patho~ogical

During the third year, basic sciences such as microbio~gy, parasianatOmy and eS'pec~ cllni~ subjects are taught. Clinica~

During the fourth year:

subjects, hygiene and

epidemio~.

Due to the lack of teaching 'personne~, education in preventive medicine is insufficient (2.7;' of the tota~ time devoted to courses). pract1ca~

The following are not inc~ded in the curric~: statistics, training in h¥giene and 'pro.ph¥lax1s, field training in 'preventive and soci.aJ. medicine.

The objectives s.pecified in the Plan of O'peration for the WHO-assisted project signed by WHO on II May and by the Government on ~7 June ~966, are as follows: "To com'p~ete and extend teaching at the SchOo~ of Medicine, particular~ in basic medica~ sciences and preventive and social. medicine by strengthening the teaching staff and co-o'perating with the Directors of the SchOo~ with a view to establlshing a balanced programme of courses and 'practi~ work for the students".

-

60 -

The opening of a course at. doctorate level foreseen in the decree establlsh1Ds the Royal. School of Med1cine will'take effect at the begj nni ng of the forthcom1ng school year (October 1969). Th1s decision is motivated by: the high cost involved in training qualified medical doctors abroad (loss of foreign currency); the number of students not returning to their country upon termination of their studies abroad;

.

-

the ~vement of secondary education in laos; the improvement of Med1cine in laos. ~cillti~s

at the Rqyal School of

.

A request for assistance has been submitted to France and to WHO for the provision of teaching personnel &rid the tra1n1ng of faculty. At the request of'the Government, a French eJljpert will visit laos to stucl¥ with the local autborities the orientation to be given to medical training. I hope that the eJq)erience I will gain during this seminar, attended by renowned speciallsts, v1ll help me plan the new programme for our school.

Since the :future medical doctors trained in laos will have to go abroad for speciallzation or postgraduate studies, after which they will have to do some research work in the field of pathology proper to their country, it will be necessary to app~ minillBl starvJerds acceptable on an international level for the training of' medical officers, as proposed by the WHO st~ grouP. Done in Vientiane on 27- April 1969,

by Dr

N~ CHOUNRAl>fIUlY, Direc~ of the Royal. School

of Medicine

•

_ 61 -

~

Faculty of Medicine, University of Soroko, Papua 1.

Papua and New Guinea

Recent developments in medical education in

Papua and New Guinea

'!he Papuan l>fedical College was established 1n 1959 as a centre for the training of doctors, nurses, medical assistants and technologists. For a variety of reasons, the initial integrated vision has not been susta1ned and sane fragmentation has occurred. In particular medical assistant and health 1nspector training has moved to Madang and medical student training has begun to move into the University of Papua and New Guinea as a Faculty of Medicine. This was anticipated by a Commission on Higher Education in Papus and New Guinea in 1964 and agreed to in principle by the Interim Council of the University in 1965. At present, a submission on projected costs of a Faculty of Medicine over the years to 1974, prepared by the present Dean of the Medical College, has been accepted by the University and is under consideration by the Department of Territories. It envisages an entry of up to fifty new students annually by the mid70's, at university matriculation level. 'lbis entry standard is already operating. First year students live at the University taking Mathematics, Chemistry, Physics, Biology and Sociology. From second year, students live in the Port Moresby Hospital area using a new medical sciences building opened in 1968. A clinical sciences wing is planned 1n association with a modern ward block to be ready by

'"

1m.

'!he undergraduate course of five years contains a number of features of interest: e.g., community health practice for three months in fourth year, a programme of village-oriented general practice; "blOck" teaching using apprenticeship-type training in clinioal subjects through fifth year. It is followed by a two-year compulsory intern programme leading to registration. '!hereafter, it is cO/llllOn practice for graduates to be posted to rural situations for at least two years before undertaking post-graduate studies. '!he present undergraduate course in medicine has attracted students from Samoa, Tonga, Nauru, the Solomon Islands and Australia. '!he establishments of a degree course will probably lead to an increase in application fran Pacific countries. At present the UniverSity reserves ~ of places for overseas stUdents. 2. Special problems ~;hich

In summary, the following problems are some staff and students in recent years:

have exercised

lSubmitted by I. Maddocks, Dean of the Faculty Board.

2.1 Appropriate curriculum The question of how much one aims to train a practical doctor capable of meeting all types of clinical, preventive and administrative problems on his own, as against the man whose undergraduate training assists him to take up specialized post-graduate study. A Curriculum Committee under a visiting consultant is envisaged as an early step in reformulating the course within the Uhiversity. '!he assessment of the effectiveness of one curriculum against another seems difficult. 2.2 Appropriate textbooks and source material The medical course is illustrated wherever possible by local material - patients (obviously). surveys, documents and reports. Textbooks prepared overseas are usually unsat1sfactory but the preparation of attractive, locally-based material for small classes is difficult. 2.3 TeaChing methods Staff who travel overseas are 1mpressed by advances in methods, especially the use of audio-visual aids for ind1vidual student use. Again, locally prepared material is deSirable. A WHO Teaching i10rkshop will be held 1n Port Moresby in September 1969. 2.4 ReCOgnition of graduates overseas At present, graduates from Ne\'T Guinea have access to a number of post-graduate training courses in Australia, New Zealand, Manila, wndon but can obtain only 11m1ted and a temporary registration in, say, Australia. It seems inevitable that full overseas recognition will follow f'ul1 Uhiversity Faculty status in time, and that many graduates may seek better paid work elsewhere.

...

-

63

• TA ......1 COU!:'IR'l ~ 01' . . ZBA...........,

The University of Auckland School of Medicine

STATEMENl' <Ml'LINING:

A.

REIBVANl' UP-TO-DATE INFORMATION ON DEVEIlJPMENl'S IN MEDICAL EOOCATIOO' IN NEW ZEALAND SINCE THE WHO CONFEREta: OF :oEAm IN 1963: ' SCHOOL OP MEDICINE, OONEDIN: 1. New Chairs:

1967 Paediatrics and Child Health 1967 Clinioal B10chemistry 1968 Human Genetics 2. New Diploma Courses: Diploma in Diploma.1n Diploma in Diploma ;in Industrial Health Clinical Pathology Clinical Psychol<gy Clinical Psychiatry

3. Change in Regulations for the Degree of Dootor of Medioine:

.. 4.

The M.D. is now awarded on Thesis alone, although the oandidate will normally be required to present himself for an oral/written examination in the field of knowledge in whioh the thesis lies •

Changes in Entranoe Regulations: Candidates for admission to the medical school who gain junior scholarships oan be admitted directly to second year classes. Candidates who gain suffioiently high marks in the Entrance Soholarship examination may be exempted subjeots of the Medical Intermediate Examination and can substitute subjeots of their choice. It 1s intended this year to change further the regulations to guarantee adm1ssion to seoond year olasses of all oandidates who reach a oertain mark in the Entranoe Scholarship Examinations and pass the Medioal Intermediate Examination or, having been exempted subjects, complete a presoribed first year oourse.

5.

Changes in Pre-clinioal Currioulum (begin 1969): Seoond Year - now oontains the. majority of Anatomy teaching, General Physiology, and General Biochemistry. There will also be a course in Statistios and introductory lectures in Human Learning and Personality. The examinations at the end of the year will be - Anatomy; Biochemistry; Physiology (inoluding Statistios) •

•

I

Submitted by Professor Ceo11 Lewis, Dean, Soho.ol of Medioine •

. -

- ------

-

64

-

Third Year ... an integrated course .f Neuro--Anatomy. NeuroPhyBiology, Anatomy of ti18 Head and Neck. Applied Physiology. Experimental Pharmacology. Clinical Biochemistry. General Pathology. Microbiology. PsyohOlogy, and Introductor:v Psychiatry, together with an introduction to clinical subjects. The examinations at the end of the year will be Pre-clinical Neurology; Applied Physiology; General Pathology; General Microbiology; Behavioural Sciences. Changea in the Clinical CUrriculum are being planned.

I I I I

6.

Administrative Changes:

1968 saw the appointment of a Olinioal Dean in addition to the Dean of the Medical Paculty. Pive University representatives were appointed to the otago Sospital Board in January of this year.

7.

Future Ch!ngea·

It is hoped to take one hundred and fifty students into the seoond year of the course in 1972 and to build up the Branch Paculties in Christchurch and Wellington to take more cl1nical students. SCHOOL OP MEDICINE. AUCKLAND:

Government permission to establish a seoond medioal sobool in New Zealand was .given in November, 1964. A Dean was appointed in August, 1965 and took up his dut1es in January, 1966. Government finance was made avaUable in JUly, 1967 for the SchOOl to anticipate its first intake of students and a group of sixty entered the first year of the medical course in March, 1968. The entry will. "t'emain at the figure of sixty until additional building are available - probably by the academic year of 1973. Then the intake will be inoreased substantially. to a number sufficient t. produce one hundred graduates at the end of the medical CO\1rse. Planning has been on the assumption that one hundred graduates enml8 ' ly will be the maximal output of the Auckland Sohool. The CO\1rse that has been introduced is of six years' duration, the majority of stUdents entering fl'Qll the tinal year 1n the Upper Sixth Porm at school. The main oriterion for entry is soholastic performance in this final sohool year and the subjects whioh the student shall have studied are not stipulated, except that he shall possess a proper knowledge and appreCiation of the English language. The tf;ret half ot the course is highly integrated and wUl lead to a Bachelor of SCience degree in Human Biology. ·Astudy of Behavioural. Soienoes is also incorporated into each of the three yeare, the amount increasing annually •.

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- 65 At present all students entering the oourse will be expected to proceed to clinical studies and graduation in Medicine. But when facilities allow the larger 1rttake, students will be given a choice of completing the six )"ear course or of deviating at the halt-wIlY' stage to proceed into other fields of biologioal soience. Por this reason, and as a consequence of the wide range of subJeots studied by the group on entry, elective courses are to be introduced in the first triennium. The subJeots for the first year of the oourse are General Biology. Physioo-Chemistry. and Behavioural Scienoe. Appropriate appointments at Senior LeCturer level were made in establ1shed departments to take charge of the teaching of students in the initial year of the oourse. Professorial appointments have been made in the following departments: Anatomy; Physiology; Biochemistry; Medioine. and Pathology. An appointment to the Chair of Surgery 18 imminent and later in

1969 we intend advertising Chairs of Microbiology, Paediatrios. Community Health and. pOSSibly, Psyohological Medicine. The clinical period has not yet beenplenned in detail. Elective periods will be introduced into this half of the course also. n.tring the sixth year students may don the traditional long white coat and undertake direct care of patients. under appropriate supervision. Instruotion will be in the torm of topic teaching follOWing an introductory course. A disadvantage in establishing the new School is the disparity existing in academic salaries in New Zealand compared with those of Britain. Canada. Australia. and the United States of America, for example. This is to some extent offset by the vigour and enthusiasm with whioh the project is being proseouted, by the strong community support which is being given. and by the excellent clinical facilities which will be available to students - between "'bree thousand and four thousand beds will be made available for teaching. and allot ;,hese are housed in hospitals which are modern and well-equipped. The University Grants Committee in New Zealand does not support medical research to any substantial degree - it ccntributes to the housing of and prOVision of services for resell1'Ch. In New Zealand there is an active Medical Research Council to which money is allocated by the Government on a triennial basis for distribution •

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B.

COfoMml'S ON ANY SPECIAL PROBIEMS IN MEDICAL EOOCATION:

Some of the problems which we face in establishing the new Medical School in Auckland are related to: (1) The future ot the family doctor 1n the medical services;

....

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(2) (,)

The future ot the general practitioner in remote rural practice; The length of the medical course;

(4)

Adequate instruction in basic sciences, without increasing the hiatus between the Pre-clinio'al and Clinical parts of the course;

(5) The definition of responsibil1ty of the AUQkland schOOl to. (a) (b) Islands in the adjacent area of the Pacific; Other developing countries overseas.

(6) The use of audio-visual aids in medical education:

(7) The assessment of the place of electronics in the education of the doctor, and the future of medical practice.

A

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67 -

Develo ents in Medical Education in the Phil1 since the WR> Conference of Deans in 1

ines

1.

Implementation of the National Economic Council-Asency for International Developnent medical education improvement progr8llllle, consisting of: (a) Allocation of $l-million commodity project with local counterpart at 14 to $1 for the procurement of equipments, apparatuses. supplies, medical books and journals for the seven medical schools. Sending of forty-eight faculty fellows to the United States of America for a period of two years for each fellow in the various basic medical sciences at the rate or twelve fellows a year.

(b)

2. The passage 01' a bill by the Congress of the Philippines with its subsequent enactment into law of Republic Act 4056 in 1965, authorizing the appropriation for subsidy to private medical schools, not to exceed. fSOO 000 per year per school. Since 1966, there had been disbursement to each private medical school in the sum of about 140 000 to )*30 000 per school per year. ,. The gradual reduction in the number of admission to the freshman class. carried out spontaneously and voluntarily by all medical schools, so that by the academic year 1967-68, no medical school would have an admitting class of more than)OO freshman. The size of the freshman class to be admitted by the medical school is dependent on the adequate facilities available for high standard of medical education. 4. Effective in the academic year 1964-65. candidates for admission to medical school must possess a baccalaureate degree in arts or in science with full compliance of the minimum number of required un1 ts in the subjects or discipline as stipulated in the Medical Act of 1959.

5.

.

The organization of the ASSOCiation of Philippine r·tedical Colleges in July 1967 with financial support from the Josiah 1-1acy Jr Foundation in New York. Implementation of a Paediatric Education Improvement ProJect supporting the full salaries of seven reSidents in Paediatrics and seven full-time faculty fellows in Paediatrics by the Josiah Macy Jr Foundation grant and under the administration of the Association •

Submitted by Dr Buenaventura Angtuaco, Dean, Faculty of Medicine and Surgery, University of Santo Tomas, and Dr Jose Cuyegkeng, Executive Director, Association of Philippine Medical Colleges, c/o College of Medicine, Uni versi ty of the Philippines, Manila, Philippines.

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68 -

6. The First National Conference on Medical Education was held in May 1968 lmder the auspices of the Association, with the principal objective of evaluating the present lmdergraduate medical currioulum, leading to the degree of Doctor of Medicine. '!he S\lllllllU'y of the conference and the various resolutions adopted therewith are herewi th attached as Annexes 1 and 2. '1be Congress of the Philippines authorized the establishment of the Philippine Centre for Health SCiences, and in 1968 through Republic Act 516}, it further authorized the appropriation of 110-million per year for five years.

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I

7.

8.

By unanimous agreement of all medical schools, by January 1970 every medical school would have been converted into non-stock, nonprofit corporation.

9. In 1968, the Ford Folmdation approved a project proposal of the Faculty of Medicine and Surgery, Uni versi ty of Santo Tomas, for the establishment of the Institute for the Study of Human Reproduction with a $ll} 000 grant. 10. Practically all medical schools are at present implementing a cOmmlmity health programme and/or rural health programme with inclusion of family planning, in their medical curriculum, e.g.: (a) The Comprehensive Commlmity Health care Project in Bay, Lagtma (College of Medicine, University of the Philippines) The Medical Missions and Sapang Palay Project (Faculty of Medicine and Surgery, University of Santo Tomas) '!be Rural Health Programme (Uni versi ty of the East,

(b)

(c)

Ramon Magsaysay Memorial Medical Centre) (d) (e) (f) (g) '!he Marinduque Project (Institute of Medicine, Far Eastern University) The San Antonio, Zambales Project (College of Medicine, Manila Central Uni versi ty) '!he Rural Health Project in Pagnaan, Cebu (Cebu Institute of Medicine) '!he Ta1isay Project in Cebu (College of Medicine, Southwestern UniverSity)

Annex 1

ASSOCIATION OF PHILIPPINE MEDICAL COLLEGES FIRST NATIONAL CONFERENCE ON UNDERGRADUATE MEDICAL EDUCATION

Summary 1. 2. There is need for detailed studies on physician manpower needs. He should work toward a more flexible requirement for admission to medical school. There is need to examine the health needs of the population and the kinds of physicians the country requires and to relate these to the re-structuring of the medical curriculum. There is need to prepare medical students so that they can participate in family planning programmes should they wish to do so after graduation. The course leading to the degree of Doctor of Medicine is no longer considered a terminal course but as preparation for further training. No clear consensus was apparent as regards the proposal to confer the Doctor of Medicine degree after four years of the medical course, but the idea of distributing interns to selected hospi tals in various parts of the country was generally accepted.

3.

4.

5.

6.

- 71 Armex 2

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ASSOCIA'f[ON OF PHILIPPINE MEDIcAL COLIEGES First National Conference on Medical Education 15 to 17 ~lay 1968 Resolution No.1 Recognizing the importance of ascertaining the medical manpower needs of the Philippines to guide medical schools and medical educators, and aware of the many variables involved in the making of estimates, the Conference resolves that the Association of Philippine Medical Colleges create a commission which shall undertake detailed studies leading to projections on physician manpower needs of the country. '!he commission shall employ the services of professional analysts and seek the assistance and co-operation of governmental and non-governmental agencies, and shall be guided by the deliberations of this Conference. Resolution No.2 Having reached a consensus that the present requirements for admission to medical school are too rigid; that the preparatory course is not a terminal course which prepares students for earning a livelihood should they be unable to proceed to a medical course; that a more flexible liberal arts course requirement would provide a wider base for selection of applicants to medical schools, the Conference resolves that the Association of Philippine Medical Colleges recommend the amendment of Section 6 of the Medical Act of 1969 as follows: 1.

Revision of the first paragraph fran: "Minimum required courses: - Students seeking admission to the medical course must have a bachelor of science or bachelor of arts degree or their equivalent which shall include the following subjects wi th their corresponding number of units:" etc. To: "Students seeking admission to the medical course must have a bachelor of science or bachelor of arts degree or their equivalent."

722. Deletion of the seoond paragrapH "As many tmits of Spanish shall be required as may be provided by law as cultural, sooial and nationalistic studies." Resolution No.3 Cognizant of the serious problems associated with the rapid rate of growth of the Philippine population, and aware of the urgent need for measures that will moderate population growth and the important role that medical sohools can play in preparing physicians for such a responsibility, the Conference resolves that the Association of Philippine Medical Colleges openly declare Itself 11. favour of family planning and formulate an adequate training progr&llllle in family planning for medical students which can serve as a guide for medical schools in the developnent of their respectIve training progr&llllles.

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