Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school

Figures & data

Table

Practice points

Medical schools that implement a socially accountable curriculum and community-engaged rural clinical placements are more likely to produce graduates who have positive attitudes to servicing the health needs of the community and to health equity. Medical schools which select students from lower socioeconomic strata and provide them with return-of-service scholarships are more likely to produce graduates who stay longer in their first medical position and work as rural or municipal health officers. The Ateneo de Zamboanga University, School of Medicine is meeting the local rural and urban health workforce needs of the Western Mindanao region by producing graduates who choose careers as Rural or Municipal Health Officers, or as generalist Medical Officers in government hospitals.

Table 1. Strategies used by the medical schools for contacting their graduates, showing the number of surveys collected via each method.

Collection method	ADZU-SOM	Conventional SCHOOL
Hard copy via physical  distribution & retrieval	41	31
Google Internet forms	154	60
Survey Monkey	28	28
Total	223	119

Table 2. Undergraduate comparisons of graduates from two Philippines medical schools.

Variable	n	Conventional graduates	n	ADZU-SOM graduates	p Value^a
Age in years	117	32.6 ± 3.5	217	32.1 ± 26.0	0.240
Female gender	119	59%	221	56%	0.630
Financial support
Parents or relatives	107	47%	192	42%	0.448
Scholarship	–	53%		58%	–
Won a scholarship to attend	119	49%	223	46%	0.653
Gross family income
<Php 100,000	119	18%	219	27%	0.001
100,001–200,000	–	18%	–	24%	–
200,001–300,000	–	22%	–	19%	–
300,001–400,000	–	12%	–	12%	–
400,001–500,000	–	7%	–	8%	–
>Php 500,000	–	24%	–	10%	–
Motivated to undertake a MD course because of family	119	44 (37%)	215	102 (48%)	0.060
Motivated to undertake a MD course because of it is a prestigious profession	119	43 (36%)	215	84 (39%)	0.597
Motivated to undertake a MD course because of a desire to help others	119	0 (0%)	215	16 (7%)	0.002
Motivated to undertake a MD course because of a desire for community service	119	60 (50%)	215	126 (56%)	0.149
Motivated to choose their medical school because of parents or relatives	119	33 (28%)	215	79 (37%)	0.095
Motivated to choose their medical school because of curriculum	119	29 (24%)	215	92 (43%)	0.001
Motivated to choose their medical school because of its prestige/International standard	119	37 (31%)	215	39 (18%)	0.007
Motivated to choose their medical school because there was little option	119	4 (3%)	215	32 (15%)	0.001
Discipline practice intention was Family Medicine/GP	115	42 (36%)	220	107 (49%)	0.034
Discipline practice intention was Surgery	115	18 (16%)	220	16 (7%)	0.016
Discipline practice intention was Pediatrics	115	12 (10%)	220	29 (13%)	0.466
Discipline practice intention was Adult Internal Medicine (AIM)	115	20 (17%)	220	24 (11%)	0.095
Discipline practice intention was a Medicine specialty (not AIM)	115	17 (15%)	220	25 (11%)	0.370
Discipline practice intention was Obstetrics & Gynecology	115	7 (6%)	220	11 (5%)	0.682
Discipline practice intention was Psychiatry	115	1 (1%)	220	4 (2%)	0.497
Discipline practice intention was Public Health	115	0 (0%)	220	2 (1%)	0.305

^a Chi-square test, Chi-square test for trend or t-test, as appropriate.

p values in bold highlight significant results.

Table 3. Postgraduate comparisons of graduates from two Philippines medical schools.

Variables	n	Conventional graduates	n	ADZU-SOM graduates	p Value^a
Pursued advanced studies	119	85 (71%)	106	62 (59%)	0.042
Current specialization is Family Medicine/General Practice	100	26 (26%)	60	3 (5%)	0.001
Current specialization is Surgery	100	13 (13%)	60	7 (12%)	0.805
Current specialization is Pediatrics	100	12 (12%)	60	16 (27%)	0.018
Current specialization is Anesthetics	100	7 (7%)	60	8 (13%)	0.183
Current specialization is Adult Internal Medicine	100	21 (21%)	60	12 (20%)	0.880
“Strongly agree” that community physicians should cater holistically to the needs of the community	119	41 (34%)	215	116 (54%)	0.007
“Strongly agree” that community healthcare entails partnership with other stakeholders	119	46 (39%)	215	129 (60%)	<0.001
“Strongly agree” that community service is both a duty and an obligation for HP	119	64 (54%)	215	135 (63%)	0.177
“Strongly agree” that healthcare requires prioritizing community health needs	119	68 (57%)	215	157 (73%)	0.008
“Strongly agree” that community healthcare should promote health equity	119	71 (60%)	215	157 (73%)	0.029
“Strongly agree” that working in the community can make an impact on population health outcomes	119	77 (65%)	215	162 (75%)	0.039
First position was a Rural/Municipal Health Officer	73	0 (0%)	78	12 (15%)	0.001
Currently working in a Government Rural Health Unit	160	3 (2%)	94	16 (17%)	<0.001
Currently working in a Private Primary Hospital	160	27 (17%)	94	7 (7%)	0.033
Currently working in a Government Tertiary Hospital	160	117 (73%)	94	66 (70%)	0.618
Currently working in a Government Specialist Hospital	160	7 (4%)	94	0 (0%)	0.040
Current position is generalist Medical Officer (MO/Resident/Consultant levels)	124	64 (52%)	213	153 (72%)	<0.001
Current position is a Surgical specialist	124	7 (6%)	213	2 (1%)	0.010
Current position is a Non-Surgical (Medical) specialist	124	37 (30%)	213	21 (10%)	<0.001
Current position is a Rural/Municipal Health Officer	124	2 (2%)	213	22 (10%)	0.003
Current position is Family Medicine/GP	124	10 (8%)	213	9 (4%)	0.141

^a Chi-square test, Chi-square test for trend or t-test, as appropriate.

p values in bold highlight significant results.

Table 4. Postgraduate comparisons of graduates from two Philippines medical schools with regards responses to questions on current attitude toward community practice (Likert scale questions used from “strongly disagree” (SD) to “strongly agree” (SA)).

	Conventional graduates (n = 119)					ADZU-SOM graduates (n = 223)
Variable	SD	D	N	A	SA	SD	D	N	A	SA	*p Value
“Community physicians should cater holistically to the needs of the community”	–	4	14	60	41	–	4	15	80	116	0.001
“Community healthcare entails partnership with other stakeholders”	–	1	20	52	46	–	3	11	72	129	<0.001
“Community service is both a duty and an obligation for health professionals”	–	–	10	45	64	–	2	12	66	135	0.129
“Healthcare requires prioritizing community health needs”	–	–	8	43	68	–	1	8	49	157	0.006
“Community healthcare should promote health equity”	–	–	3	45	71	–	1	7	50	157	0.050
“Working in the community can make an impact on population health outcomes”	–	–	9	33	77	–	2	8	43	162	0.042

* Chi-square test for trend.

p values in bold highlight significant results.

Table 5. Graduate respondents classified by year of graduation.

Year of graduation	ADZU-SOM	Conventional school
2003	12	8
2004	12	18
2005	31	12
2006	12	12
2007	21	24
2008	20	10
2009	22	17
2010	20	6
2011	24	6
2012	39	6
Graduating year not reported	10	–
Total	223	119