Medical education in the Philippines: medical students' perspectives

BACKGROUND: Despite advances in medicine and public health, glaring inequalities in access to health care and health outcomes within and between countries persist and have even widened in some countries, including the Philippines. A major contributor is the mismanagement of human resources for health, including doctors, nurses, and community health-care workers. 60% of Filipinos die without seeing a doctor, and the Philippines has a shortage of trained doctors. Furthermore, doctors in the Philippines are distributed unevenly and emigration is high. Poor medical education partly causes the mismatch between competencies of health professionals and the health needs of the population. Such mismatch leads to mismanagement of human resources for health and reduces access to the health-care system. We aimed to gain insights from current medical students about the present situation and future direction of medical education in the Philippines. METHODS: In response to the 2010 Lancet Commission Health professionals for a new century, we organised a 3 day workshop that covered the current state of medical education and human resources for health in the Philippines, and existing and emerging global and national health challenges. 47 medical students from several medical schools in the Philippines were selected through an open application process. The sessions, which included interactive lectures and field visits, culminated in small group discussions about the present state of medical education in the Philippines and the participants' recommendations for scale-up. FINDINGS: The participants came up with three types of recommendation. First, reforms in human resources for health, from recruitment and training to certification and deployment. Second, reforms in the different components of medical education: framework, content, and method. And third, reforms of the different levels of physician training: medical school, health system, and broader societal determinants, such as the living and working conditions of doctors. Some specific changes suggested include: early, prolonged exposure to the community; inclusion of more social science, public health, and leadership and management subjects in the curriculum; and provision of environments conducive to interprofessional learning. The students also proposed institutional reforms such as including students in the design of the curriculum, and social accountability as a measure of success of medical schools, instead of traditional licensure exam pass rates. INTERPRETATION: Medical education needs to change, as more medical graduates aspire to work abroad or in urban centres, or become specialised. However, the overall approach to and management of human resources for health in the country should also be reformed, not just the content and method of medical education. Scale-up of medical education will need the involvement of the Filipino Government, the Department of Health, medical schools, and even medical students. The Philippines should commit to transforming medical education, which is an important step towards production of new health leaders for national and global health equity. FUNDING: International Federation of Medical Students' Associations.