81 replies to this topic

[lonesome]

thats why some independent organization should be involved in making long-term plans for development of health manpower... something like an accreditation council for graduate medical education....

[lonesome]

is it too much to ask for all the hospital residency programs in the philippines have a covenant or statement against sexual harrassment? this can be a policy by the accreditation council for graduate medical education... sure there are remedies in the various courts and administrative institutions.... the definitions and guidelines of the civil service commission can be a guide or template.... are there incidences? any stories? we're listening....

[lonesome]

this can be institutionalized as policy by the accreditation council for graduate medical education.... any takers from the specialty organizations?

[lonesome]

any ideas on how to lobby our senators and congressmen for reforms in graduate medical education are very welcome...

[StokedMD]

There are insitutions that claim to follow the academic standards of the ACGME. However, when it comes to the part that the ACGME talks about resident welfare particularly the regulated duty hours, tumatahimik mga consultants.

[StokedMD]

Another thing that is a problem with the ACGME is that puts too much responsibilities on the attending staff. Sa private siguro pede, pero sa public, asa ka pa. Regular journal clubs, lectures, academics, etc., asa ka pa that most consultants will waste their precious time on this.

[lonesome]

the american medical students association still report problems on the regulated working hours of hospital residents. there are some violations... its still a work in progress... but nobody wants to go to the old style and days... maybe that is what is most important...

[StokedMD]

The reduced resident working hours is still a work in progress and the ACGME is continously re assessing and re evaluating it and making adjustments. Sa Pilipinas kasi were kinda poor on trouble shooting and we expect changes to work like a charm immediately.

With regards to violations naman, the ACGME is basically on the right track, but it does not necessarily mean that we have to adapt 100% of the changes they instituted. Although I favor the route to a reduced working time for all residents, I also see the point of those who approach this conservatively because as has been stated there will be problems with "continuity of care" and "number of cases" seen. However, in our scenario, 36 hrs every 3 or every other day without even "from duty" status is just too much without any single break given within the week is just practically ludicrous and frankly speaking idiotic. The human body can basically adapt to a 24 hours duty even a 36 hours duty status however, it is essential that the resident be given at least 24 to 48 hours of in a single week. There are a lot more of possible combinations, kaya lang the status quo is very much resistant to change.

[lonesome]

we believe in change..... i agree, there is a problem with "continuity of care" and "number of cases seen" is an issue which needs some resolution... but there are factors like the number of horrible cases of accidents and diseases are affected by good preventive care or better standards of health care in preventive care and others bring down cases needed for learning... but nature has a way of making things even... old diseases are back... tb is still morphing to another entity... so how many should one see in order to learn? or how should we learn? what should we learn?

[StokedMD]

"Good Preventive Care" and "Better Standards of Health" cost money. When something in this country costs money, asa ka pa ma implement yan. Thats why I don't delve on the issue of improved wages for residents or the lack of equipment and medicines (although these too are important but are dictated by the funds the government is willing to give or the profits the private hospitals are willing to lose) and instead focus on professionalism, better training by ensuring sound academics go hand in hand with clinical training, proper and objective evaluation of resident performance, and proper and adequate rest and "me" time for the resident (as mandated sa ACGME). These factors are within the control of the particular department you are training under and thus possess less hindrance to implementation. The only thing needed is the intelligence and the will to carry out these changes. These things are much more easier to implement since it really does not cost any money or if it does, napakaliit lang. Andami kasi "time wasters" sa residency thats why the training is often compromised. Ano ba talaga gusto nating maging? Gusto natin maging consultants or gusto nating maging magaling na consultants? Mediocre and unsystemic training will eventually catch up with you when you are a a full fledge specialist and the worse part here is that damay ang magiging pasyente mo. Bear in mind that you become a specialist to deliver better healthcare to your patients and not for you to just enjoy the privileges that the title brings.

Bear in mind also that despite our efforts to brag about how good the Filipino doctor is, the rest of the 1st world where we try to get into doesn't exactly think so. Consultants who practice in Singapore are ranked the same as your average Pinoy GP. Australia, New Zealand, and UK needs doctors but the heck they really make it hard for us to enter plus the costs you have to shoulder and if ever you do get to enter your relegated to the jobs that their own doctors don't want. In the US despite the fact that we were a former colony, despite the fact that we are probably one of the few countries that adopt an American style medical education and residency program, limit us to taking the least wanted specializations in the US. We are not able to compete. Yung mga latak na lang ang tira sa atin and its because just like what happened to nursing they know that training here for medicine has been compromised. Hindi laro ang residency, it is serious stuff, however, yung mga naka pwesto ngayon treat it as a mere game and have the all too common "pwede na yan" mindset.

Edited by StokedMD, 07 November 2012 - 11:26 AM.

[StokedMD]

Anyone here knows what has happened to the medical residency act?

[lonesome]

i agree.... because of improper conditions in formation and training... we get what we deserve...

[lonesome]

the medical residency act of senator legarda has been archived... it needs sponsors and lobbyists to make it into the senate agenda next year... you can see the status in the senate website... this kind of legislation is not a high priority since like everything in this world and according to me and you, money is a big factor....

[StokedMD]

I wonder why the training is as it is. I've been an educator before I went into med, and I'm also into sports so I did some occassional coaching. If you look at the way sports and academics are taught, it also applies to medicine. Different topics, but they basically fall into the same training principles. A consultant from a very older generation already told me na iba na nga daw ang training ngayon unlike their time. Even in government hospitals during their time the academic performance of the residents was also priority and the consultants during this time frame were very engaged in the training of their residents. Ngayon the way I've seen it go, ang dami makakatapos ng residency ng hilaw na hilaw kasi the focus now is to survive and then make a lot of money after. Wala na yung continous desire to improve and excel in one's chosen profession. I've seen these kinds of residents and mapapailing ka na lang talaga. In fact I once went to a program where one of the pre-res was better at reading the ecg and chest xrays than the 4th years. Kulang na lang nya is experience, and sa sipag mag aral at mamasyente ay mukhang isang taon lang kailangan nya to overlap the 4th years who didn't even know the rationale for the management they were doing. Parang a lot of the residency training these days is more on "monkey see, monkey do". How much will it cost ba for the training staff to be more engaging in the training of their residents, particularly when the training staff is supposed to be there at that moment in time. I was once in a program where the RTO told me to present my 60 slide case na pinag aralan ko talaga "15 minutes lang may gagawin pako".

There is also this current notion na okay lang mamasyente ka ng mamasyente tapos magbasa ka ng libro. Problem is you go to residency nga to also gain the consultants experience and perspective. The criticism and scrutiny of your management and current medical knowledge by experts in the field is what refines your pathway to being a consummate specialist. The book cannot give you everything. If that was the case why do we even bother with a formal residency program? Why don't resident programs just put up office in the hospital and we can do this open university style. I enroll, I pick my hospital, I study on my own, then we can meet once a week or once a month to talk about cases and you can give me exams to evaluate my progress. Mas maganda ata yun. I can pick a toxic hospital with a relaxed schedule which gives me the right amount of pressure and the right amount of stress, balanced with enough rest and relaxation.

[lonesome]

i agree with you but to make this into into a institutionalized policy is one thing... implementing it is another. this can't be translated into a hospital policy on training and human development but it should be more... like a government policy... since manpower development of specialists affects all filipinos....

[lonesome]

one question that need answering is that is the hospital the only way where one can learn about medicine? for me the answer can be yes or no... in america, occupational medicine practitioners are trained in the hospital and university settings since some of the residency programs have masters components like an mph program. what about wilderness medicine? other emerging specializations?

[lonesome]

residency program is dignified work. it should be considered decent work. there are standards and concepts according to the international labour organization on what is decent work.

[lonesome]

i mean there is an decent work agenda of the international labour organization. residency work should be considered decent work by everyone....

[StokedMD]

Problem is they always say it is not "work". It is training, the reason for the awful salary that residents get that is not commensurate to the time spent and amount of work a resident gets in the hospital. I believe in keeping things simple for the meantime to ensure changes are easier and more palatable to meet for the status quo. 1) Reduced work hours or adequate leaves within the week, 2) a structured and enforced curriculum where the training staff is actually required to be engaged with the training of the residents, 3) An the establishment of a "hierarchy of responsibility" and not a "hierarchy of privilege" to stop and prevent residency hierarchies from looking like a miniature version of the Philippine banana government (probably instituting an objective and transparent method of a pyramidal system will ensure that all residents are on their toes during the whole duration of residency.

[StokedMD]

Offtopic but what is this physicians act ive been hearing about?

[lonesome]

the physician act of 2011 was crafted in order to modernize the old medical act of 1959. one of the features of the bill is the mandatory membership in the philippine medical association of all physicians who will practice medicine. there are still a lot of controversies in this bill.

[lonesome]

there is problem in our hospital residency programs in our country. there is a problem of not having enough mentors, diplomates, and fellows to go around. most of them congregate around mega medical centers in the private sector and there is not much full time specialists in government medical centers most especially in local government hospitals. no one wants to get involved in government hospitals since the big bucks are in the super specialized medical centers and in the talent market, the public sector (especially the local government hospitals) can't compete. it wasn't like this before. a long time ago, the government had their own specialty boards which were separate from the specialty societies in the public sector. the military hospitals had their own specialty boards. then came a time when all residency programs were unified under the supervision and control of the specialty societies. its a big responsibility. just ask the team who visits different hospitals come accreditation time. this really needs some government intervention and can't be left to the private sector alone. so far, nobody thought of privatization or outsourcing this problem.

[lonesome]

the philippine medical association took upon itself the regulation and policy making organization with concerns regarding the post graduate education of the filipino physician. i hope it is not serious in taking this task alone and refusing to see public sector concerns in this matter. there are public interests involved. i hope that in this matter, we need to see and involve all sectors in society most especially our financial institutions like the philhealth, gsis, sss, and maybe also the afpslai. i think all help should be accepted since the pma has also its own internal problems like financial problems and a lot of doctors are still not members of the pma. so the accreditation council for graduate medical education is very relevant. organizational cultures and policies need to change... in a big way....

[Green]

hi pnoymd! off-topic.. what would be the outcome if you enter a non-accredited residency training program? will you not be able to practice after training? thank you!

[lonesome]

its like looking for work and your credentials are coming from an unrecognized school... you might have the skills but your school is not recognized....

[lonesome]

this is an old story. it is about a story who tried to make a change in our medical care system and made a residency training program to meet the needs of a changing society. it is not the only story available for those interested in change. the questions are still the same then and now...



http://philippines.v...k/medicine.html

[lonesome]

there has been no update on the medical residency act of 2010 of senator loren legarda... hope it will be part of the agenda in next congress.....

 

 

 

http://www.senate.go...s=15&q=SBN-1395

[lonesome]

here is the version from the lower house sponsored by congressman quisumbing....  hope it becomes part of the agenda of the next congress.... 

 

 

 

 

 

http://www.congress...._15/HB05160.pdf

[lonesome]

some policy on a rationalized pre residency program should be made... i think a month with some 24 hour duty without meals or compensation is a bit too much... 

[BenGurion]

lonesome: I agree with you 1000% percent

[lonesome]

thank you... now if you want to implement changes so that applicants won't be exploited, what office do you address this concern?  to the residency committee of the specialty organization?  the pma?  that is why the accreditation council for graduate medical education of the philippines is still needed.... 

[lonesome]

if there are infractions of legal or ethical nature by hospital residents, where do you complain aside from the chairman and training officer?  the standard training contract is not clear....