The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce

Figures & data

Table

Practice points

Medical schools with equitable selection criteria and socially accountable, community engaged placements in underserved areas are more likely to produce graduates who have positive attitudes to servicing the health needs of the community and stronger beliefs their course has prepared them for community practice. The University of Manila – School of Health Science program is meeting the local rural health workforce needs of the Central Philippines through a competency-based step ladder curriculum where students can opt to progress from midwifery into nursing and then onto medicine. Medical schools who provide service learning via living in and working for the community are effectively training students for their future work through competencies in provision of health care, patient communication skills, community planning, community organizing, health education and training skills, and health service management.

Figure 1. The SHS-Palo continuous and sequential step ladder program.

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

Collection method	SHS-Palo	Conventional school
Hard copy via physical distribution and retrieval	58	78
Google Forms	3	2
Facebook^TM and other social media	11	0

Table 2. Undergraduate comparisons for medical schools located in the central Philippines.

Variable	n	Conventional medical school graduates	n	SHS-Palo medical graduates	p-value^a
Age in years	75	32.9 ± 4.3	69	42.9 ± 9.9	<0.001
Female gender	79	52 (66%)	71	51 (72%)	0.428
NMAT score (mean, ±SD)	20	67 ± 16	28	51 ± 27	0.014
Physician Licensure exam score (mean, ±SD)	11	80.2 ±.3.2	19	79.2 ± 2.8	0.377
High school attended
Public	80	40 (50%)	71	47 (66%)	0.044
Private		40 (50%)		24 (34%)
Primary financial support
Parents or relatives	79	63%	71	39%	<0.001
Spouse/partner		35%		4%
Scholarship/Bursary		2%		57%
Won a scholarship to attend	80	3 (4%)	71	38 (54%)	<0.001
Gross family income
<Php 100,000		13 (18%)		40 (57%)
100,001–200,000	72	15 (21%)	69	17 (25%)	<0.001
200,001–300,000		11 (15%)		6 (9%)
300,001 or more Php		33 (46%)		6 (9%)
Motivated to undertake a MD course because of family	77	40 (52%)	70	17 (24%)	0.001
Motivated to undertake a MD course because of it is a prestigious profession	77	21 (27%)	70	16 (23%)	0.538
Motivated to undertake a MD course because of a desire for community service	77	17 (22%)	70	21 (30%)	0.273
Motivated to undertake a MD course because of a need for doctors in Philippines	77	14 (18%)	70	25 (36%)	0.016
Motivated to undertake a MD course because of the community-orientated curriculum	77	0 (0%)	70	15 (21%)	<0.001
Motivated to undertake a MD course because I received a scholarship/grant	77	3 (4%)	70	53 (77%)	<0.001
Motivated to undertake a MD course because I was nominated by my community	77	0 (0%)	70	25 (36%)	<0.001
Motivated to choose their medical school because of parents or relatives	79	33 (42%)	71	19 (27%)	0.054
Motivated to choose their medical school because of curriculum	79	0 (0%)	71	28 (39%)	<0.001
Motivated to choose their medical school due to its prestige/international standard	79	0 (0%)	71	11 (16%)	<0.001
Motivated to choose their medical school because it was nearest school in region	79	46 (58%)	71	11 (16%)	<0.001
Motivated to choose their medical school because of scholarship/grant	79	4 (5%)	71	55 (78%)	<0.001
At graduation, intended to work in		10 (13%)		11 (16%)
Remote village	79	10 (13%)	70	39 (56%)	<0.001
Small rural town		8 (10%)		16 (23%)
Large rural town/major center/capital city		61 (78%)		4 (6%)

^a Chi-square test, Chi-square test for Trend or Student’s t-test, as appropriate.

Table 3. Postgraduate comparisons for medical schools located in the central Philippines.

Variable	n	Conventional medical school graduates	n	SHS-Palo medical graduates	p-value^a
Disciple practice intention is Family Medicine/GP	79	5 (6%)	70	13 (19%)	0.022
Disciple practice intention is Surgery	79	20 (25%)	70	7 (10%)	0.015
Disciple practice intention is Pediatrics	79	11 (14%)	70	4 (6%)	0.096
Disciple practice intention is Adult Medicine/Internal medicine	79	13 (17%)	70	4 (6%)	0.040
Disciple practice intention is Obstetrics and Gynecology	79	15 (19%)	70	5 (7%)	0.034
Disciple practice intention is Public Health	79	2 (3%)	70	36 (51%)	<0.001
Current practice is in Family Medicine	79	14 (18%)	69	12 (17%)	0.958
Current practice is in Public Health	79	1 (1%)	69	32 (46%)	<0.001
Current practice is in Adult Internal Med	79	18 (23%)	69	1 (1%)	<0.001
Current practice is in Surgery	79	12 (15%)	69	7 (10%)	0.360
Current practice is in Obstetrics and Gynecology	79	12 (15%)	69	6 (9%)	0.228
Current practice is in Anesthesia	79	6 (8%)	69	2 (3%)	0.208
Current practice is in Ear, Nose and Throat	79	36 (4%)	69	0 (0%)	0.102
Pursued advanced studies (yes/no)	74	57 (77%)	69	39 (57%)	0.009
Pursued advanced studies for Continuing Professional Development	64	56 (88%)	40	22 (55%)	<0.001
Pursued advanced studies because of additional practice competencies required	64	7 (11%)	40	7 (18%)	0.340
Pursued advanced studies because of Institutional need	64	1 (2%)	40	7 (18%)	0.003
“Strongly agree” that community physicians should cater holistically to the needs of the community	79	19 (24%)	67	47 (70%)	<0.001
“Strongly agree” that community healthcare entails partnership with other stakeholders	79	11 (14%)	66	44 (67%)	<0.001
“Strongly agree” that community service is both a duty and an obligation for health professionals	76	22 (29%)	66	41 (62%)	<0.001
“Strongly agree” that healthcare requires prioritizing community health needs	78	28 (36%)	66	49 (74%)	<0.001
“Strongly agree” that community healthcare should promote health equity	78	32 (41%)	65	47 (72%)	<0.001
“Strongly agree” that community work provides clinicians the opportunity to perform important healthcare skills	79	24 (30%)	66	42 (64%)	<0.001
“Strongly agree” that community work provides clinicians the opportunity to perform varied skills	77	15 (20%)	65	37 (57%)	<0.001
“Strongly agree” rural communities need more help from clinicians than urban	79	16 (20%)	65	29 (45%)	0.002
“Strongly agree” there are many health needs in the community still unmet.	78	32 (41%)	67	38 (57%)	0.059
“Strongly agree” that working in the community can make an impact on population health outcomes	79	33 (42%)	64	45 (70%)	0.001
“Strongly agree” that course prepared me well in ability to apply clinical skills	77	20 (26%)	70	31 (44%)	0.020
“Strongly agree” that course prepared me well for clinical skills	77	18 (23%)	67	25 (37%)	0.068
“Strongly agree” course prepared me well for my readiness to work in first week of internship	77	12 (16%)	67	24 (36%)	0.005
“Strongly agree” course prepared me well for communication skills	39	2 (6%)	35	14 (36%)	0.002
“Strongly agree” course prepared me well for community planning	77	8 (10%)	66	37 (56%)	<0.001
“Strongly agree” course prepared me well for critical thinking/clinical DM	76	14 (18%)	66	26 (39%)	0.006
“Strongly agree” course prepared me well for diagnostic skills	75	11 (15%)	63	11 (18%)	0.655
“Strongly agree” course prepared me well for health education and training skills	76	9 (12%)	69	38 (55%)	<0.001
“Strongly agree” course prepared me well for problem-solving skills	77	8 (10%)	66	27 (41%)	<0.001
“Strongly agree” course prepared me well for research skills	76	4 (5%)	62	5 (8%)	0.507
“Strongly agree” course prepared me well for health service management	77	10 (13%)	67	24 (36%)	0.001
Number of years worked in First job	52	2.2 ±.1.7	45	3.7 ± 4.3	0.028
Number of years worked in Current job	32	2.1 ± 1.4	51	6.8 ± 6.7	<0.001
Location of current employment
Remote village		0 (0%)		6 (9%)
Small rural town	64	1 (2%)	50	17 (27%)	<0.001
Large rural town		3 (6%)		20 (31%)
Major regional center/major city		46 (92%)		21 (33%)
Current job is in a Rural Health Unit	44	0 (0%)	63	25 (40%)	<0.001
Current job is in a Gov District or Provincial Hospital	44	3 (7%)	63	14 (22%)	0.032
Current job is in a Gov Regional Hospital	44	30 (68%)	63	6 (9%)	<0.001
Current job is in a City Health Office	44	0 (0%)	63	9 (14%)	0.009
Current position is Medical Officer/Resident/Consultant	46	37 (80%)	61	24 (39%)	<0.001
Current position is non-surgical specialist	46	6 (13%)	61	4 (7%)	0.254
Current position is Physician-General Practitioner	46	3 (7%)	61	1 (2%)	0.312
Current position is Municipal/City Health Officer	46	0 (0%)	61	30 (49%)	<0.001

^a Two-tailed Chi-square test, Chi-square test for Trend, or two-tailed Student’s t-test, as appropriate.