81 replies to this topic

[lonesome]

sooner or later, there should be a central body who should be tasked in supervising all the hospital residency programs in the philippines. it is a nightmare for a hospital chief to meet the various bodies of specialty associations when they do visits to the hospitals so the various chief residents get most of the paperwork that goes along with it. for me, it is so diffused and if there is a rationalized policy on manpower development, there should be coordination between the private sector, public authorities, various regulatory bodies, philhealth and the general public.

one such body that we can emulate is the accreditation council of graduate medical education in america. it is the central body that takes much of the supervision and policy making regarding post graduate training of physicians. maybe it is time to start debate whether we can make this kind of organization for making sense in chaos during periods when various programs of hospital residency programs start applying for re-accreditation.

[mikemuin]

We may have to look at the PMA to assume such responsibilities. But I agree we need something like this.

[doc leonard]

We may have to look at the PMA to assume such responsibilities. But I agree we need something like this.

Greetings Dr. Muin:

Speaking of the "American system of training" one of the following should also be considered:

American system for medical training has :

1) No 24 hour duty (Studies have shown that a person who is sleep deprived are more prone to commit errors during work and in decision making) We have all passed this stage and no study needs to corraborate it.
2) Age Limit of residents (They are not strict with the age so long as you are still sharp and productive and efficient in your duties/work and you pass the qualifying exams) I had a friend who started her IM residency there almost 40 y.o and she is doing fine in her practice after graduating.
3) School where he/she graduated from (they dont look much on where you graduated so long as you pass the interview and exams)
4) Take note that in their system when selecting a potential resident or worker for that matter : If he/she is qualified you must accept him/her regardless of age, sex, religious affiliation and social / cultural background. It is descriminatory to do so otherwise.

With the ongoing decline in the number of enrollees in our medical educational institutions , It is imperative that a central body who supervise and do revisions should be done without sacrificing the quality of training.

[Dr_Smiley]

@ doc leonard: I have a few things to add... It had been many yrs, but I remembered that our residency program was checked at least yearly by the ACGME. They checked wethr we have our morning report daily, a journal club at least once a week, mortality reviews, etc... I remembered they check if we had decent quarters, if we had coffee, food, etc.. a lounge, a library, computers, etc. We had 'core knowledge exams' every quarter and I think the questions were more difficult than the ABIM/ American Board of Int. Med. exam! (yah I am an internist). The ACGME had a student body where complaints can be sent and heard. The ACGME can accredit and close the programs. You have to graduate of course from an accredited program to take the diplomate/ specialty exams as we call it here. So hopefully things will chnage.

[lonesome]

@ doc leonard: I have a few things to add... It had been many yrs, but I remembered that our residency program was checked at least yearly by the ACGME. They checked wethr we have our morning report daily, a journal club at least once a week, mortality reviews, etc... I remembered they check if we had decent quarters, if we had coffee, food, etc.. a lounge, a library, computers, etc. We had 'core knowledge exams' every quarter and I think the questions were more difficult than the ABIM/ American Board of Int. Med. exam! (yah I am an internist). The ACGME had a student body where complaints can be sent and heard. The ACGME can accredit and close the programs. You have to graduate of course from an accredited program to take the diplomate/ specialty exams as we call it here. So hopefully things will chnage.

i hope that the doh secretary will be part of the executive board of the accreditation council together with other agencies who will make up the board. it would not be wise to limit it to private entities.

[lonesome]

i hope dr enrique ona will create this council to rationalize our hospital residency programs.

Edited by deadlysweet, 01 July 2010 - 08:00 AM.
redundancy

[lonesome]

i hope that our medical regulators see the need for this organization to be created... but our planning is not based on foresight but mainly on hindsight. tis sad but true...

[dknight]

I believe the Medical Residency Act Bill was supposed to address such clamour....i posted a separate thread about the bill somewhere in PMD...

[lonesome]

I believe the Medical Residency Act Bill was supposed to address such clamour....i posted a separate thread about the bill somewhere in PMD...

the medical residency act will partly solve problems because the medical residents and medical students are not part of the executive board. the acgme in the united states is a good model to follow since medical residents are represented in the council and because of that, they had regulated working hours in order to prevent medical errors. there is still a lot of noise that regulated working hours will diminish the skills of future specialists and a lot of foobah... so far its still holding on... residents should be classified as post graduate students and not trainees. what kind of status are trainees? in goverment hospitals, hospital residents make life or death situations and when their judgement calls are not correct, they will receive the punishment due to them. a trainee cook can make a mistake and he won't be at the receiving end of regulatory boards which is so different from hospital residents.

there is a great disparity of status from private and goverment hospitals, from small and big hospitals, from national to local goverment hospitals, from hospitals with consultants who trained in foreign countries to consultants who trained mostly in philippine settings, from rich hospitals to economically challenged hospitals, from patient loads of just right to heavy, from adequate staffing to inadequate staffing, from the supersmart residents to the mostly academically average residents, from a research oriented hospital to a hospital with small research outputs and the like... there is a great diversity and variation and to make a single policy for all is quite chaotic and sometimes unfair... there should be more consensus among these groups to make things more harmonious.

and life is but a dream...

Edited by lonesome, 28 September 2010 - 07:48 AM.

[lonesome]

another appropriate forum where persons can discuss who or what is a specialty is the accreditation council, aside from the philippine medical association. so its good for philippines to have this organization.

[lonesome]

for more information. the website of the accreditation council for graduate medical education in america is www.acgme.org

[lonesome]

one of the more innovative features of the council is that there are programs which can't be classified under the traditional medical residency pathways... one is programs like a complementary and alternative medicine fellowship programs, another are "sandwhich" programs where one can combine internal medicine and pedia programs, internal medicine and occupational and environmental medicine programs, internal medicine and preventive medicine programs, internal medicine and family medicine programs, among others.... all are standardized and accredited...

[lonesome]

another advantage is that organizations would not encounter difficulties since there are people and systems that would evaluate and assess the various training hospitals and institutions. doctors can go on with their medical practice and not be so bothered by travelling to various hospitals and such... but for some, maybe the journey is not burdensome....

[demigod]

Has anybody read Sen. Legarda's proposed Senate Bill?

[lonesome]

there is a move to create a similar body to the acgme. its temporarily called the governing council for graduate medical education. i hope people in pinoymd will support the proposed council so that there will be proper policies, regulation, and training for our medical professionals. there can be new programs to augment the traditional pathways for specialty training.

[lonesome]

the council could address issues like why limit residency programs to one hospital in areas outside metro manila when there is need to open more residency programs. another is why put limitations where one can practice after residency training? i hope some could challenge these concepts in a court of law which is putting restrictions on certain freedoms like freedom to make associations and others.

[lonesome]

the central institution for residency accreditation would be very useful if hospitals and programs will undergo the acgme international accreditation scheme. website is www.acgme-i.org for further details...

[lonesome]

another question is why some organizations allow consortium agreements with other hospitals and why some are not agreeable? isn't it two heads are better than one? isn't it better to get the best possible experience?

[lonesome]

another problem that the council could address is what are policies regarding people who change residencies or change hospitals? much is left at the discretion of chairmen and training officers... it would be nice if there are standard policies to make such transfers easier. another is the neglected need among hospital residents to have a voice in specialist organizations. i dont know why there is no resident representative in the executive boards of these organizations.

[lonesome]

another problem that the council could address is what are policies regarding people who change residencies or change hospitals? much is left at the discretion of chairmen and training officers... it would be nice if there are standard policies to make such transfers easier. another is the neglected need among hospital residents to have a voice in specialist organizations. i dont know why there is no resident representative in the executive boards of these organizations.

if the ched has policies regarding transferees then this group should have one also?

[lonesome]

another issue is does goverment have no say regarding foreigners who do residency training in philippine hospitals? should the ones who will decide prc, dfa, cid, pma, and others? no accreditation council? no rational policy?

[lonesome]

if some of these guys want to practice here and don't want to return to their countries, they should be welcomed here, if it was up to me.... but im not a policymaker.

[lonesome]

this group should include the philhealth, sss, gsis, the hmo association, and others (like chamber of commerce, the phap, and others) in the executive board so that there will be some funding for programs in the improvement of residency programs in the philippines. there is so much reliance in pharmaceutical companies in funding for programs in hospital residency programs. is it good to cut this umbilical cord or not?

[lonesome]

if there is government policies in the administration of medical schools, then why should there be no government supervision in postgraduate/residency programs? is there no public interest at stake?, even a small amount?

[lonesome]

there is a present scramble to take foreign fellowships in supersubspecialties that are yet to be recognized in our country. it would be better if there is a clearinghouse where information about these fellowships can be accessed. this can be accomplished by the accreditation council. so that standards will be met and public interest and personal interests can be protected.

[lonesome]

one pressing issue on graduate medical education is that our residency programs are not recognized in countries where specialists are holders of masters of medicine or master of surgery degrees. i think this is one area that government and the pma should try to find a reasonable solution. it might help if the government will make some recognition that a residency certificate is an alternative to a master of medicine or master of surgery degree within reasonable limits. the pma might create another layer of bureaucracy which might get out of control if they make themselves the authority to declare regarding who is a specialist and who is not and also to supervise all the residency programs in our very efficient country. they could outsource it to the accreditation council?

[golden fork]

We may have to look at the PMA to assume such responsibilities. But I agree we need something like this.

Greetings Dr. Muin:

Speaking of the "American system of training" one of the following should also be considered:

American system for medical training has :

1) No 24 hour duty (Studies have shown that a person who is sleep deprived are more prone to commit errors during work and in decision making) We have all passed this stage and no study needs to corraborate it.
2) Age Limit of residents (They are not strict with the age so long as you are still sharp and productive and efficient in your duties/work and you pass the qualifying exams) I had a friend who started her IM residency there almost 40 y.o and she is doing fine in her practice after graduating.
3) School where he/she graduated from (they dont look much on where you graduated so long as you pass the interview and exams)
4) Take note that in their system when selecting a potential resident or worker for that matter : If he/she is qualified you must accept him/her regardless of age, sex, religious affiliation and social / cultural background. It is descriminatory to do so otherwise.

With the ongoing decline in the number of enrollees in our medical educational institutions , It is imperative that a central body who supervise and do revisions should be done without sacrificing the quality of training.

I totally agree. If we want to be globally competitive we must take actions to improve the quality of residency training in our country. Often times residents are subject to abuses, not only financially but also emotionally and physically. Actually 24-hrs duty is more than 24-hrs. I once leave a residency training in the province because I fell so used, only few consultants are helping us actually I can count them w/ one hand only, the rest are too busy to teach, and all they care about is for you to monitor their patients. I even experienced one incident when I was about to present for a pathologic case conference, my presentation was only checked by the active consultants a day prior to my final presentation. So much for their concern. After that incident, I begun contemplating of leaving Philippines to seek training in other countries. I believe residents should have a voice when it comes to training. I am currently out of country working, and seeking opportunity for a better residency training.

[lonesome]

this is one problem that begs for a solution. where do you send your complaint letter? what government entity can address this problem?

ched? prc? pma? the hospital itself? but these programs are accredited and given supervision by organizations for quality control and

others... so where will you send your letter?

[lonesome]

the accreditation council should be able to answer the nagging question on what is an equitable and fair wage to hospital resident who is considered together with the intern as one of the lowest animals in the hospital kingdom. there should be cooperation from hospital and insurance executives to implement a standard wage. the philippine hospital association and the private hospital association should be members of the accreditation council.

[lonesome]

one of the residency laws that should change is presidential decree 1424 which amends the hospital residency law of 1955. you can see it in www.chanrobles.com

[lonesome]

here is a link:



http://www.chanroble...creeno1424.html

[lonesome]

there are occupational and safety issues in training programs. nurses know that fatigue and lack of sleep increase medication errors. but i am not sure if lack of sleep and fatigue is major contribution in diagnosis errors. this is one issue the accreditation council can solve or improve. the united states and the united kingdom have taken steps to reduce errors. i am not sure if our country did also. another is the hazardous working conditions which hospital residents are exposed. the unknown infectious agents that inhabit septic patients, the viruses in trauma patients and the like....

[lonesome]

also, what part in residency curriculum does ethics play a part? how do you teach ethics in a residency program? how many hospitals have a ethics expert or department? is an ethics component implemented in a residency program? there are some hospitals who have an ethics lecture or ethics case but not in all. some residents don't even attend lectures. i' m not sure about the others but there are some problems among residents in mostly government hospitals who have trouble with referrals to other departments. some view the referrals as passing the patient instead of complementing whatever lacking knowledge they have as well as improvement of care. this issue has been discussed in bioethics fora but its not a common topic since its only for doctors and if you have a mixed audience, they might not understand issues. its a common problem that needs guidelines. but it' s not important. seasons greetings.....

[xyberdoc]

It boils down to politics, politics of the executive and legislative in the govt, politics between PMA and PHAP, and money. If you start patterning residency training like in the States, who will have to shoulder the added manpower and salaries? Govt? nope! hospitals? Nope! PMA? nope!

I only see one possible solution... Occupy PMA hahahaha

[lonesome]

well, i feel everyone is trying to do the right thing but i guess more action is needed so that the clamor of ethical professionals will be answered. at present, the walk really doesn't match the talk.....

[lonesome]

occupy pma? that is new....

[lonesome]

can i ask if occupy pma is a new topic? seasons greetings everyone.....

[lonesome]

one of the reasons why there were changes in residency working hours was the well known case of libby zion. i am not sure if we have our own versions of the libby zion case of america. try to google the case of libby zion in court tv or the internet.

[adastraperaspera]

well, i feel everyone is trying to do the right thing but i guess more action is needed so that the clamor of ethical professionals will be answered. at present, the walk really doesn't match the talk.....

My 2 cents on setting an ACGME-like institution in the Philippines. I totally agree that this is Needed, however there are so many things that makes this plan hard to execute. And as always, it is one thing to put up a similar agency of sorts, it is another thing to implement it's by-laws..

1. The biggest difference between the US and Philippine medical training is that the main source of funds for the resident's salaries are vastly different. US resident salaries comes from medicare ( govt, tax money) while the salaries of pinoy residents comes from the sponsoring hospital if it is a private hospital, the rest comes from the taxes if you are training in a government hospital. This big difference between the 2 is crucial, ACGME ( US government agency) is really empowered to dictate what needs to be done, after all they pay the residents salary, they have the power to withdraw funds from erring residency programs. While the Philippine resident's salary comes from the university hospital or the private hospital whose main interest is inherently to incur financial gains, bottom line has the final say in regards with resident policies since they are the one paying their wages.

2. Money. To implement a no 24-hour policy, or an 80 hour/ week limitation, a residency program has to be big to fill in the schedule. US residency programs are several times bigger than pinoy residencies, I can only speak for IM. The typical work schedule of pinoy residents is a grueling 24 hour duty every after 3 days, sometimes every other day in certain units. To adapt US work hours with full coverage means hiring more residents which is very unlikely and unpopular idea for the private or even the pinoy govt hospitals. They ( pinoy private Hosp) save a lot of money from residents, yet they are not willing to shell out more money to hire more people. Once again, the final say goes to the one who pays the wages.

3. Hierarchical practices. The collegial atmosphere of US residency is not seen in the philippines. The senior will have greater privileges and not necessarily more obligations compared to the newbie. Many residency programs in the Philippines requires A doctor to do a Pre-residency service, and it is by no means a guarantee that he or she will be hired into the residency program. This pre-residency service could be several weeks long or even month long commitment, where the hapless resident goes on duty for the said period of time without pay, benefits, protection nor any assurances that he/she will absorbed. The hospital will select among the applicants which one can best fit into their program, a resident applicant has to kiss-ass to the max and feed the egos of the seniors who will have the final say in their fate. This for me is a from of professional slavery. In the US you only need to apply and have the interview and get matched and sign the contract, then you instantly become empowered employee of your hospital. The pinoy hierarchical atmosphere is not in-line with the concepts of what the US ACGME has, and would be a significant obstacle in this endevour. No wonder quit rate in philippine residency is very common, I have not heard ( based on pinoy friends residency and mine) of anyone quitting residency in the US.

4. This is just my observation, correct me if I am wrong. Most of the responses of this thread clamoring for change or sharing inputs are coming from US-trained pinoy doctors like myself who are most likely practicing outside pinas? I do not see a significant amount of interest from the many pinoy residents, Drs who are here in PMD. Maybe they haven't seen this thread or they don't have the time because of their crazy schedule or maybe they don't want it, after all they went through it themselves with no problem why should the younger generation have an easier time than them? And as an open question to the responders to this thread, are you willing to set this change into motion? because I don't think I have the interest.

Until then....the best way to get a super-body who will fight and vanguard the interest of the residents and uphold the standard....is to come over to the US. That is saldy my realistic advice.

[lonesome]

i agree with the comments. i remember one time a consultant said to me that if he would recommend regulated working hours and more residents, it will mean greater cost to the hospital and he will become the most unpopular guy in the board. most of the hospitals who can afford more residents view residents as liabilities who can't contribute to the income sheet and come to think of it, they don't have overtime or vacation credits. its a tall order but the journey of a thousand miles begins with the first step.... there is no association of hospital residents in the specialty organizations who join in the board meetings, so most residents are only seen and not heard also...

[lonesome]

is the united kingdom model of hospital residency program applicable in the philippines?

[lonesome]

there is a pressing need to have a institutions to meet a world of changes and challenges and policies, guidelines, and regulations should be in place. as such, there is not much framework and structures present to meet challenges. well aside from ethics, there is problem for the new graduate to find his niche in a working environment of hmos, micromanagement of health care, cost effectiveness analyses, benchmarks of various kinds and sizes by various institutions, globalized and standardized medical practice, climate change, and others. its a crazy world out there and well the council is a good place to start discussions.

[lonesome]

the secretary of the interior and local government should be a member of the accreditation council. its not only the police who got affected by devolution. it included medical personnel, hospitals, health centers, and health programs that are used to be under the DOH but now are being operated and supervised by the local government units. not all LGUs have a functioning Local Health Board or management committee in the local hospitals. the local government code has been in effect for more than 20 years and one of the most contentious area of funding is the operating and maintenance costs of health facilities and personnel. the list of stakeholders and possible members is getting longer.....

[lonesome]

well, if you don't believe residency working hours is an issue, then, will you allow yourself to be operated by a senior resident surgery surgeon who is tired, hungry, and lacking sleep?

[lonesome]

should there be an age limit to residency applicants... i hope not...

[lonesome]

there should be guidelines on the distribution of training institutions in philippines... they should decongest metro manila.... if possible more than 1 training institution in a province....

[lonesome]

what about those who finished a residency program but who want to enter another program? why are they not given opportunities?

[lonesome]

like, for those who graduateinternal medicine but for some reason or another would like to enter psychiatry or family medicine?

[tazmd]

To answer some of your questions:

what about those who finished a residency program but who want to enter another program? why are they not given opportunities?
like, for those who graduateinternal medicine but for some reason or another would like to enter psychiatry or family medicine?

Previously there are graduates of other residency that shifted to other specialties ER Med to Geriatrics, Anesthesia into Family Medicine as the need arises. But as of now there are regulatory bodies which are incharge of these things.


should there be an age limit to residency applicants... i hope not...

35 is the usual age limit on a case to case basis, would not want to go into details.

there should be guidelines on the distribution of training institutions in philippines... they should decongest metro manila.... if possible more than 1 training institution in a province....

Residency Training in general has minimum requirements, number of specialist, number of cases, number of hours, number of bed capacities to name a few which varies on the specialization. For example you need to have certain number of surgery per year int your training which is not feasible in the province due to a number of factors like facilities, number pf patients etc.

[lonesome]

thanks for your reply. but i still feel that expansion of residency programs outside metro manila should be priorities. there are a lot of first class cities whose inhabitants can use the facilities of a academic training hospital and there are citizens who can pay also for the services offered. its just not fair to see that specialty societies limit their accredited programs to 1 hospital per region or per island. maybe 2 to 3 can level the field.