Community Health Management Courses: A Design (ROJoson – Circa 1995)

Community Health Management Courses: A Design

Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg

The innovative medical curriculum contains several Community Health Management (CHM) courses that make it truly a community-oriented, if not community-based curriculum.

There are a total of seven CHM courses in the entire 4-year curriculum (see diagram below).  In the first three years, there is a one-month CHM course in each semester.  On the last year, the CHM course runs for a minimum of 8 months and a maximum of 10 months (see description under Year IV Medicine – CHM VII).

commnity_health_mgt_courses

A small group of students (5-10) are assigned to a community for the CHM courses.  The community assignment for a particular group is the same all throughout the CHM courses.

For each group, there is a community preceptor.  This preceptor is part of the faculty of the medical school.

Each group of students is assigned a barangay (smaller groups are assigned puroks within a barangay) to minister under the guidance of the preceptor.

The general activities consist of a community diagnosis and formulation of a 4-year comprehensive community health plan in CHM I, a design of an action-research proposal on an identified community health problem in CHM II, and implementation in CHM III – VII.  The expected output at the end of the CHM courses is a documented solution of a health problem in the community.

Beside the community health management activities, the students are expected to apply the various biomedical and social health sciences they have learned in the school.  They practice medicine in the community.  They manage a health care unit.  They conduct public health education.  They continue to learn through problem-based and self-directed approaches.

Below are descriptions of the various CHM courses including the Year IV Medicine which is essentially Community Health Management Course VII:

Community Health Management I 

Learning Objectives:

At the end of the course, the student must be able to:

1. Make a community diagnosis of his assigned community.

2. Formulate a 4-year comprehensive plan to solve the health problems of  his assigned community.

3. Conduct public health education on hygiene as a promotive and preventive factor in health.

4. Train a group of barangay health workers in his assigned community on basic promotive, preventive, curative, and rehabilitative care.

5. Manage a health care unit in his assigned community.

6. Demonstrate skills of a primary health care physician in his assigned community.

7. Demonstrate problem-based learning skills.

8. Demonstrate self-directed learning skills.

Learning strategies and activities:

1. Under the guidance of the community preceptor,

1.1 Make a courtesy call on the community leaders and the health sector.

1.2 Make a community diagnosis.

1.3 Formulate a 4–year health plan.

1.4 Accomplish all the prescribed learning objectives.

2. Group meeting once a week or more often with the preceptor to discuss problems and progress of projects and programs.

3. Submit a logbook to contain

3.1 All patients seen and handled.

3.2 All activities undertaken.

3.3 Experiential learning report

4. Submit accomplishment reports.

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Community Health Management II

Learning Objectives:

At the end of the course, the student must be able to:

1. Formulate an action research proposal on an identified and prioritized health problem of his assigned community with a timetable within the medicine course.

2. Start or continue to implement the 4-year comprehensive community health plan formulated in CHM I.

3. Implement a community health program on

3.1 Trauma

3.2 Infections and Infestations

3.3 Maternal and Child Health Problems

4. Conduct public health education on

4.1 Trauma

4.2 Infections and Infestations

4.3 Maternal and Child Health Problems

5. Continue to train a group of barangay health workers in his assigned community in basic promotive, preventive, curative, and rehabilitative care.

6. Manage a health care unit in his assigned community.

7. Demonstrate skills of a primary health care physician in his assigned community.

8.Demonstrate problem-based learning skills.

9. Demonstrate self-directed learning skills.

Learning strategies and activities:

1. Under the guidance of the community preceptor, accomplish all the learning objectives prescribed in CHM II.

2. Group meeting once a week or more often with the preceptor to discuss problems and progress of projects and programs.

3. Submit a logbook to contain

3.1 All patients seen and handled.

3.2 All activities undertaken.

3.3 Experiential learning report

4. Submit accomplishment reports.

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Community Health Management III-VII

Learning Objectives:

At the end of the course, the student must be able to:

1. Continue to implement the

1.1 4-year comprehensive community health plan formulated in CHM I.

1.2 Action research proposal formulated in CHM II.

2. Implement community health programs on:

(see list of programs below)

3. Conduct public health education on:

(see list of programs below)

4. Continue to train a group of barangay health workers in his assigned community in basic promotive, preventive, curative, and rehabilitative care.

5. Manage a health care unit in his assigned community.

6. Demonstrate skills of a primary health care physician in his assigned community.

7 .Demonstrate problem-based learning skills.

8. Demonstrate self-directed learning skills.

Learning strategies and activities:

1. Under the guidance of the community preceptor, accomplish all the learning objectives prescribed in the course.

2. Group meeting once a week or more often with the preceptor to discuss problems and progress of projects and programs.

3. Submit a logbook to contain

3.1 All patients seen and handled.

3.2 All activities undertaken.

3.3 Experiential learning report

4. Submit accomplishment reports.

List of  Community Health Programs and Public Health Education Topics (Partial List)

Courses                                                                                  Programs/Topics

Trauma                                                                 National Health Emergency  Preparedness  and Response

Management Program

Iwas Paputok

Infections and Infestations                                               Control of  Diarrheal Diseases

Control of Acute Respiratory Infections

Environmental Health

Maternal and Child Health                                               Family Planning

Maternal Care and Under Five Clinic

Mother and Baby Friendly Hospital Initiatives

Immunization Program

Cancer                                                                   Cancer Control Program

Gastrointestinal Problems                                  Nutrition

Parasitism Control Program

Cardiopulmonary Problems                              Preventive Cardiology Program

Anti-smoking Program

Tuberculosis Control Program

Endocrine Problems                                            Diabetes Control Program

Goiter Control Program

Nervous System Problems                                 Stroke Control Program

Mind Problems                                                     Mental Health Program

Eye Problems                                                       Blindness Prevention Program

Ear, Nose, Throat Problems                               Preventive Dentistry

Deafness Prevention Program

Renal Problems                                                    Preventive Nephrology Program

Skin Problems                                                      Environmental Health

Hematologic and Immunologic Problems      Voluntary Blood Donation Program

Musculoskeletal Problems                                 Occupational Health

Disability Prevention Program

Sexuality Problems                                             AIDS Prevention, Education and Care

Sexually Transmitted Disease Control Program

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Year IV Medicine (Community Health Management VII)

Duration: 12 months

Expected Output:

1. Solution of a health problem in an assigned community

2. Full development of a competent community primary health care physician

3. Potential passer of the Philippine Board of Medicine exam

Assessment Parameters:

1. Satisfactory grade in action research project on a community health problem utilizing primary health care approach emphasizing on multisectoral collaboration with trained barangay health workers who will carry on health promotion and  disease prevention program when the students are out of the community.

2. Satisfactory grades in simulated patient management problem solving and actual patient management.

3. Satisfactory grades in written examinations covering the subjects in the Philippine Board of Medicine Examination.

Places of Learning:

Assigned Community

minimum of 8 months and maximum of 10 months if the students can complete their community action research project in 8 months, they can spend the remaining 4 months in areas outside their assigned community.

Area Outside Assigned Community

may be in the city where the medical school is located or elsewhere, such as Manila or abroad, minimum of 2 months and maximum of 4 months

Learning activities in assigned community

1. Community health plan and action research project

1.1 Implement

1.2 Write report

1.3 Present

1.4 Finalize

2. Community physician

2.1 Actual patient management duties at barangay health stations, rural health units, and district/provincial hospitals

2.2 Simulated patient management problem solving using distance learning

3. Philippine Board of Medicine Examination

3.1 Independent study

3.2 Written examination

Elective (outside assigned community)

Students can have electives for a minimum of 2 months to a maximum of 4 months.

In the electives, the students

1. are in areas outside their assigned community and

2. pursuing learning in a field of medicine which they think they need to develop further their competencies as a community primary health care physician.

They may choose any area they want, subject, however, to the approval of the school authorities.

The students can have a maximum of 4 months in electives only if they have satisfactorily completed their community action research project in 6 months.

When the students are in their electives, they still do distance learning on simulated patient management problem-solving and Philippine Board of Medicine subjects.  They are expected to take all the prescribed written examinations during the time of their electives.

Simulated Patient Management Problem Solving

During the 12-month period, the students will be given at least 50 simulated patient management problems to solve at the rate of 1 problem per week.  They will be evaluated based on the following criteria:

– Rational, effective, efficient, and humane management process

– Quality of learning issues and learning acquired

Actual Patient Management

During the 12-month period, the students will be expected to manage at least 50 actual patients under supervision.  They will rotate in the barangay health stations, rural health units, and district/provincial/regional hospitals.

They will be submitting a report on each of the 50 actual patients they have managed.  The reports will be evaluated based on the following criteria:

– Rational, effective, efficient, and humane management process

– Quality of learning issues and learning acquired

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Actual patient management report format:

Name of patient

Age/sex

Chief Complaint

Diagnosis

Basis

Treatment Done

Basis

Health Education

Learning Issues

Learning Acquired

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Philippine Board of Medicine Subjects and Comprehensive Written Examinations

There are 12 subjects covered in the Philippine Board of Medicine Examination.  Each subject will be allotted one month for students’ independent study.  At the end of the month, the student will take a written examination on the subject.

There will be comprehensive written examinations at 6 and 12 months respectively beside the written examination for each board subject.  Comprehensive examinations will cover everything in medicine.

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Action Research

Action research as defined by Cohen and Manion (1) is a “small scale intervention in the functioning of the real world and a close examination of the effects of such intervention.”

Action research is situational – it is concerned with diagnosing a problem in a specific context and attempting to solve it in that context.

It is usually (though not inevitably) colloborative – teams of researchers and practitioners work together on a project.

It is participatory – team members themselves take part directly or indirectly by implementing the research.

It is self-evaluative – modifications are continually evaluated within the ongoing situation, the ultimate objective being to improve practice in some way or another.

While experimental research is concerned mainly with establishing relationships and testing theories, action research has as a focus a specific problem in a specific setting.  It makes no attempt to identify one particular factor and study it in isolation divorced from the context giving it meaning.

As Margules (2) points out, “in combining action processes (planning, implementation, and evaluation) with research processes (problem identification, hypothesis formation, and testing), the result is a sequence of steps and activities that identify the relevant events that must happen in the initiation and implementation of change.”

The essential steps in action research are the following:

1. Analysis of the problems

2. Research designs on how to solve the problems

3. Implementation of action plan

4. Evaluation of results of implementation

The following is an excerpt from a journal article entitled: The struggle for relevance in medical education: Experience at the University of Gezira by Magzoub and Hamad (3):

We are a group of ten medical students, posted to village 27, some 35 kilometers from the University of Gezira.  Our task was to identify health as well as other problems; to identify a priority problem; and to implement a project with community participation to resolve that problem.  Our research revealed that scabies affected 17% of the population, mainly due to poor hygiene as a result of the unaffordably high cost of soap.  With the involvement of the community, we decided to establish a small-scale soap factory, with the aim of making soap available at a reasonable price and as an income generating project.  We succeeded in raising funds to establish the soap factory.  Our evaluation has revealed that the project accomplished its objectives of decreasing the prevalence of scabies to 7% and a remarkable outcome was the conspicuous satisfaction for the students and the community.  For us, it was a spectacular experience which we will never forget and we learned a lot from it.

The excerpt gives an idea of what action research is.

1. Analysis of problem

Scabies – 17% due to poor hygiene due to unaffordable soap

2. Research design on how to solve the problem

Community-based soap factory

Other strategies

3. Implementation of action plan

4. Evaluation of results of implementation

Scabies – 7%

The excerpt also gives an idea of what the Community Health Management courses of an innovative medical curriculum expect the students to accomplish.

References:

1. Cohen L, Manion L: Research Methods in Education.  London, Croom Helm, 1980.

2. Marguiles N: Managing change in health care organization.  Medical Care 15:693-704, 1977.

3. Magzoub MEMA, Hamad B: The struggle for relevance in medical education: Experience at the University of Gezira.  Education for Health 9(2):179-188, July, 1996.

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I wrote this for Zamboanga Medical School Foundation (circa 1994), Bicol Christian College of Medicine and Southwestern University College of Medicine circa 1995.

Sometime later, the total number of community health management courses became 8 because of the breakdown into 2 courses in Year Level IV as illustrated in the tables below.

Year Level IV (1st  Semester – 24 weeks)

Course No.

Course Name

Weeks

Place of Learning

XXXVI Elective I

4

CM-H-External

XXXVII Elective II

4

CM-H-External

XXXVIII Community Health Management VII – Distance Learning in Anatomy

3

AC

XXXIX Community Health Management VII – Distance Learning in Physiology

3

AC

XL  Community Health Management VII – Distance Learning in Pharmacology

3

AC

XLI  Community Health Management VII – Distance Learning in Biochemistry

3

AC

XLII Community Health Management VII – Distance Learning in Microbiology and Parasitology

2

AC

XLIII Community Health Management VII – Distance Learning in Pathology

2

AC

AC – Assigned Community; CM – College of Medicine; H – Hospital

Year Level IV (2nd  Semester – 24 weeks)

Course No.

Course Name

Weeks

Place of Learning

XLIV Elective III

4

CM-H-External

XLV Elective IV

4

CM-H-External

XLVI Community Health Management VIII – Distance Learning in Legal Medicine, Bioethics, and Medical Jurisprudence

2

AC

XLVII Community Health Management VIII – Distance Learning in Preventive Medicine

2

AC

XLVIII Community Health Management VIII – Distance Learning in Pediatrics

2

AC

XLIX Community Health Management VIII – Distance Learning in Internal Medicine

2

AC

L Community Health Management VIII – Distance Learning in Obstetrics-Gynecology

2

AC

LI Community Health Management VIII – Distance Learningin Surgery, Ophthalmology, and Otorhinolaryngology

2

AC

LII Community Health Management VIII –  Summative Evaluation Month

4

AC-CM

Yr Level

I

II

III

IV

Semester

1st

2nd

1st

2nd

1st

2nd

1st

2nd

Month

1

CM

CM

CM

CM

CM

H

EL

EL

2

CM

CM

CM

CM

CM

H

EL

EL

3

CM

CM

CM

CM

CM

H

AC

AC

4

AC

AC

AC

AC

AC

AC

AC

AC

5

AC

AC

6

AC

AC

EL – Elective

Links: http://rjoson.tripod.com/bccmcomhmgtcourse/comhmgtcourse.htm

Reynaldo O. Joson, MD

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One Response to Community Health Management Courses: A Design (ROJoson – Circa 1995)

  1. Pingback: Community Health Management Courses: A Design (ROJoson – Circa 1995) | ROJOSON's Blog on Medical Education

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