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Introduction of Outcome-Based Education in Philippine Health Professions

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 Philippine Journal of Health
Research and Development

Introduction of Outcome-Based Education in Philippine Health Professions

Education Setting
Erlyn A. Sana*1, Alberto B. Roxas2, Alfaretta Luisa T. Reyes3

*Corresponding author’s email address: [email protected];[email protected]

1
National Teacher Training Center for the Health Professions, University of the Philippines Manila
2
College of Medicine, University of the Philippines Manila
3
College of Medicine, University of the East - Ramon Magsaysay Memorial Medical Center

R E V I E W A R T I C L E

Abstract

Background: As the world is becoming a global village, international exchange of goods and services is likewise
unfolding. Countries develop the international educational qualifications framework to ensure that professionals
participating in the exchange have the same standard competencies. These qualification frameworks follow
outcome-based education (OBE).
Objectives: This paper describes the legal, political, and administrative foundations of OBE in the Philippines, as
well as the basic principles of OBE as a quality assurance, curriculum, and instructional design.
Methodology: Outputs presented and critiqued during seminars and workshops organized by the Technical
Committee on Medical Education (TCME), consultations with stakeholders, review of existing health sciences
curricula and relevant literature were done. This is a documentation of the TCME journey.
Results: The Enhanced Basic Education Act of 2013, Philippine Qualifications Framework, the Commission on
Higher Education Memorandum Order Number 46, and the global call for transformative education serve as
precursors of OBE in the Philippines. OBE is the educational system preparing students to meet the highest
standards of a particular profession. These standards are designed back into program outcomes, competencies,
and converted into instructional goals and objectives. These same components serve as the bases for selecting
what topics to include, how to teach, and assess them at the highest standards required by the actual workplace.
Conclusion: OBE is designed to match education with actual employment. Philippine higher education institutes
are encouraged to implement OBE not only to be locally and globally competitive but also to work for
transformative education.

Key words: outcome-based education, medical education, transformative education, Philippine qualifications
framework, curriculum planning

Introduction change included a required one-year kindergarten for all 5-

year old children, followed by a six-year elementary
The Philippines used to be the only country in Asia and education for 6- year olds, four-year junior high school for
one of the three countries in the world left with 10 years of 12-year olds, and last two years of senior high school for
basic education. The other two are Angola and Djibouti in those who are 16 years old. The law also provided for
Africa [1]. This educational system fell two years short of alternative basic education for those who are out of school
international standards making Filipino professionals and with special needs. The K-12 aligned the Philippine
working abroad underemployed as their degrees were not basic educational system with the rest of the world.
always recognized. The first significant step done to address
this problem was the signing of Republic Act 10533: the Republic Act 10533 has direct implications to higher
“Enhanced Basic Education Act of 2013” [2]. This law shifted education institutions (HEIs). Section 5 of the law ordered
Philippine basic education in the Philippines to K-12. The the Department of Education (DepEd) to coordinate with

60 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74

Introduction of Outcome-Based Education

the Commission on Higher Education (CHED) and the Regulatory Board of Medicine of the Professional
Technical Education and Skills Development Authority Regulation Commission (PRC), the Executive Committee of
(TESDA) in crafting the K-12 curriculum. This curricular the Association of Philippine Medical Colleges, Inc. (APMC),
framework should be “harmonized with tertiary education the Philippine Medical Association (PMA), all the deans of
and prepare students for global competitiveness, college the country's medical schools, selected faculty members
readiness, and avoid remedial and duplication of basic from various medical fields, the Health Human Resource
education subjects.” These steps were basically the same Development Bureau (HHRDB) of the Department of Health
procedures done by European countries in 2005 in (DOH), CHED through its Office of Policies, Standards, and
preparing their technical and professional courses towards Development (OPSD), and the World Health Organization
(WHO). All these offices and agencies through their officers
their educational qualifications framework. The framework
served as sources of first-hand data on laying down the
explicitly required graduates to show what they may be
foundations of OBE in Philippine medical schools.
expected to know, understand and be able to do on the basis
Secondary data were obtained from reviews of relevant
of a given qualification (learning outcomes) as well as how literature, laws and statutes, executive orders,
qualifications of professionals within a system may move to memorandum circulars, reports, and publications on OBE.
another [3]. Outcome-based education (OBE) is the
educational design that prepares students meet these Materials and Instruments
professional standards. Outcome-Based Education (OBE) as
a curriculum and instructional design and QA framework In coordination with CHED's OPSD, the team conducted a
provides Philippine Education the road map to achieve the series of seminars and workshops from April 2, 2013 until
overall and long-term desired goal of “achieving rapid, December 19, 2014. These were held for TCME to be
inclusive, and sustained economic growth: one that oriented on OBE, acquire first-hand experience in going
generates jobs and livelihood for, and increase the income through OBE as a curriculum and instructional design in
of the poor [2]. medicine, as well as in appreciating OBE as a QA framework.
Basic instruments used in these activities included the laws
This paper is a review article that serves as an and statutes, as well as the Commission on Higher Education
introduction of OBE in the Philippine health sciences Memorandum Circular Orders (CMOs), and executive
setting, as documentation of the experience of the orders pertinent to the implementation of OBE in Philippine
Technical Committee on Medical Education (TCME) and the higher education institutions. In the course of conducting
principal author as committee's educational consultant. It is the seminars and workshops, the team used the various
written to serve as a baseline resource to guide educational existing curricula of medical schools, their institutional
leaders and managers, curriculum and instructional vision, mission, and goals, and oral and written feedback
designers, as well as individual faculty members to get ready from participants and stakeholders. An informal workshop
for OBE. While its main context is limited to medical evaluation of outputs of participants presented and
education, it presents general principles applicable to other critiqued during the plenary presentations were also used.
regulated professions. Specifically, the paper aims to (1)
Discuss the legal, political, and andragogic foundations of Procedures for Data Collection and Analysis
OBE, and (2) Explain OBE as a curriculum and instructional
design as well as a systems framework. Upon the request of TCME, the principal author,
together with other resource persons like faculty members
Methodology teaching pediatrics, internal medicine, surgery, obstetrics-
gynecology, family and community medicine, radiology, and
anesthesiology from the University of the Philippines
Sources of Data College of Medicine (UPCM), APMC, and CHED conducted
several seminars on OBE. Experts lectured on given pre-
The principal author provided professional services as assigned topics like the basic principles of OBE, how to
educational consultant to the CHED Technical Committee formulate learning outcomes, and how could HEIs start with
on Medical Education (TCME). They refer to this paper it especially those coming from competency-based
henceforth as the team. They worked with various curriculum. Applications of OBE in the various disciplines in
stakeholders in medical education namely the Professional medicine were also discussed. These were followed by

Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74 61

 Introduction of Outcome-Based Education

workshops where participants immediately applied the to qualifications and assist people to move easily
lecturers' inputs in the context of medical education. and readily between the different education and
Outputs from these activities were refined continually in the training sectors and between these sectors and the
succeeding consultations and workshops. The final labor market
outcomes produced were: 3. Align the PQF with international qualifications
framework to support the national and
1. Identification of the type of professionals expected international mobility of workers through
from graduates of medicine in the Philippines increased recognition of the value and
2. Formulation of sample institutional vision, mission, comparability of Philippine qualifications
goals, and objectives (VMG)
3. Development of learning outcomes (LOs) aligned The PQF followed essentially the same steps that other
with the VMGs and type of health professionals countries went through in developing their respective
4. Draft program standards and guidelines (PSGs) for qualifications framework. The Washington Accord
medical education. CHED requires all PSGs to go established in 1989 was formed by international bodies
through a series of public hearings-consultations. responsible for accrediting engineering degree programs. It
The final version upon approval by the CHED recognizes the substantial equivalency of programs
Commission en Banc is then disseminated through accredited by those bodies and recommends that graduates
a public orientation of programs accredited by any of the signatory members be
recognized by the other bodies as having met the academic
Results and Discussion requirements for entry to the practice of engineering [6].
European countries through the Bologna Process also went
through the process of engaging various agencies and
The Legal, Political, and Administrative Bases of OBE in the industrial partners develop international standards for their
Philippines: Precursors of OBE educational qualifications [3]. The Washington Accord and
the Bologna Process use OBE in formulating the standards
The Philippines belongs to the ten-nation Association of and equivalences expected from various professions. The
South East Asian Nations (ASEAN) which aims to build the PQF also adopts OBE in all levels of education. The
ASEAN Economic Community. Specifically it means qualifications begin from basic education consistent with
transforming the member-countries into a single market RA 10533 that introduced K-12. Figure 1 presents the overall
production base, highly competitive economic region, and PQF illustrating the eight levels of educational qualifications
one with equitable economic development, and fully to be recognized and awarded by the Philippines. Those
integrated into the global economy [4]. By 2015, ASEAN pursuing technical and vocational programs will be given
Integration should be fully operational paving the way to National Certificate (NC) varying from NC I to NC IV after
exchange of professional services. The integration will pilot which a diploma can be awarded. NC IV is classified Level 4
the exchange of professionals in medicine, dentistry, while diploma graduates are awarded Level 5 recognition.
nursing, architecture, engineering, accountancy, maritime Recognitions of Level 6 to 8 refer to those who complete the
education, and surveying. baccalaureate, master's, and doctoral education
respectively. The domains used in the PQF include mastery
Towards this development target, the HEIs should of knowledge, skills, and values (KSV) of the professionals in
therefore prepare their graduates acquire the professional their chosen disciplines, ability to apply these KSVs in the
competencies required by both the local and global labor actual workplace, and degree of independence to perform
markets. This is the very essence of Executive Order (EO) No. them autonomously.
83 signed by President Benigno S. Aquino on October 2012.
EO 83 is also known as the Philippine Qualifications To guide the HEIs in preparing their students towards the
Framework (PQF) [5] and it aims to : practice of various professions, PQF presents the indicators
of what they should be able to demonstrate as proof of
competence (Table 1).
1. Adopt national standards and levels for outcomes
of education Consistent with RA 10533 and EO No. 83, CHED issued
2. Support the development and maintenance of CMO No. 46 Series of 2012. This memorandum order used
pathways and equivalencies which, provide access OBE as the basic frame of reference in determining the

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Introduction of Outcome-Based Education

Table 1. Distinctions of undergraduate, graduate, and doctoral degree programs in the Philippine qualifications
framework [5]
Domains Baccalaureate Degree Master’s Degree Doctoral Degree (Level 8)
(Level 6) (Level 7)
Knowledge, Skills, Demonstrate broad and Demonstrate Demonstrate highly
& Values (KSV) coherent knowledge and advanced knowledge advanced systematic
skills in fields of study for and skills in knowledge and skills in
professional/creative work, specialized or multi- highly specialized and/or
innovations and lifelong disciplinary field of multidisciplinary field of
learning study for professional learning for complex
practice, creative research, creative work
work, self-directed and/or professional
research and/or practice and leadership
lifelong learning for the advancement of
learning and development
of innovations
Application of KSV Application in professional Applied in Applied in highly
work in a broad range of professional work that specialized or complex
discipline and/or for further requires leadership multi-disciplinary field of
study and management in a professional work that
specialized or multi- requires innovation,
disciplinary and/or leadership and
professional work management and/or
and/or research research in a specialized
and/or for further or multi-disciplinary field
study
Degree of Substantial degree of High degree of Substantially high to full
Independence independence and/or in independence that independence in
teams of related fields with involves exercise of individual work and/or in
minimal supervision leadership and teams of multi-disciplinary
initiative individual and more complex setting
work or in teams of that demands leadership
multidisciplinary field for research and creativity
for strategic value added.
Significant level of
expertise-based autonomy
and accountability.

curriculum and instructional methods of HEIs, as well as the competency-based, the shift to OBE should not be difficult
vertical and horizontal typologies on how they will be at all.
classified according to types of institutions and quality of
programs delivered. Section 3.1.4.2 of this Order said that Andragogic Basis of Outcome-Based Education
CHED subscribes “to a more eclectic approach that
resonates with a “weak” or “lower case” “obe” [7]. Section Among Philippine medical schools, the discourse on OBE
3.1.4.3 further reveals that “obe” approach in Philippine started in 2010 when two on-line publications were
higher education mixes outcomes-based education with released [8,9]. Both were commissioned to commemorate
other curriculum approaches and is open to incorporating the centennial of the Flexnerian curriculum. Abraham
discipline-based learning areas that currently structure HEI Flexner was the educator commissioned to review medical
curriculums.” Since many HEIs in the Philippines are education in the United States. His report published in 1910

Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74 63

 Introduction of Outcome-Based Education

Figure 1. The Philippine qualifications framework [6]

paved the way to the present subject-centered, traditional WHO [10] challenges all stakeholders in health,
science-based curriculum in medicine. The GCSA paper [9] education, and development that “transformative scale-up
examined how medical education evolved while The Lancet of health professional education aims to support and
paper [8]studied the more than 100 years of curricula in advance the performance of country health systems so as to
medicine, dentistry, nursing, public health, and midwifery. meet the needs of individuals and populations in an
Frenk, et al [8] reported that over the last 100 years, equitable and efficient manner. Driven and informed by
education of health professionals notably those in medicine population health needs, transformative scale up means
only became longer and more expensive in many countries delivering educational reforms that address not only the
but remained unable to address the overall population quantity, but also the quality and relevance of health care
health problems. The two articles recommended reforms providers in order to achieve improvements in population
both at institutional and instructional levels. The GCSA health outcomes.” Quantity refers to health science schools
article [9] recommended that medical education around the tasked to produce the right number of professionals.
world follows the OBE design. The Lancet article [8] Quality means graduating professionals with the right
recommended competency-based curriculum. However, competencies while relevance pertains to those who work
both papers focused on the call for transformative learning where they are needed.
in the health sciences. In 2011, WHO qualified the global call
through another publication entitled “Transformative Scale A perennial criticism [11,12] of Philippine health science
Up of Health Professional Education” presented aptly in schools is producing too many of the same kind, they could
Figure 2 [10]. not be absorbed by the local health system and so they
eventually leave the country. To respond to this call, Frenk,
et al [8] presented a vision to:

“Encourage all health professionals, irrespective of

nationality and specialty, to share a common global
vision for the future: that health professionals in all
countries are educated to mobilize knowledge, and
to engage in critical reasoning and ethical conduct,
so that they are competent to participate in patient-
centered and population-centered health systems
Figure 2. Transformative scale up of health professional education as members of locally responsive and globally
[9] connected teams.”
64 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
Introduction of Outcome-Based Education

This vision describes the way higher education school, understanding the target client or public it wants to
institutions should prepare their students for the future serve, the overall health profile of the people and in what
practice of professions in health. By transformative ways graduates of the school will be able to bridge the gaps
learning, students develop leadership attributes and serve as main considerations in doing needs assessment.
become enlightened change agents. Frenk, Chen, Bhutta, et The team had exhaustive discussions on the Philippine
al [8] explained that transformative learning involves three population health problems, the United Nations
fundamental shifts: from fact memorization to critical Millennium Development Goals, where the graduates of
reasoning that can guide the capacity to search, analyze, most medical schools were, and the desired attributes of
assess, and synthesize information for decision making; Filipino physicians. The final output is similar to the
from seeking professional credentials to achieving core attributes of the five-star doctor introduced by Boelen
competencies for effective teamwork in health systems; and (1994) [16] namely the physician as a care provider, decision
from non-critical adoption of educational models to maker, communicator, community leader, and manager. The
creative adaptation of global resources to address local team had consensus that graduates of medicine should
priorities. These are the same articulations of the Philippine have the following attributes and competencies:
educational system through EO No. 83 and CMO No. 46.
a. General (medical) practitioners: new graduates
OBE as a Systems Framework, Curriculum and should be able to competently manage common
Instructional Design clinical and public health problems and can refer
accordingly
OBE is defined as “clearly focusing and organizing b. Researchers: beginning physicians should be
everything in the educational system around what is evidence-based in their practice of their profession,
essential for all students to be able to do successfully at the can distinguish the most effective and beneficial
end of their learning experiences. This means starting with regimen to manage given clients in their socio-
the clear picture of what is important for students to be able cultural contexts
to do, then organizing the curriculum, instruction, and c. Leader/Managers: graduates of medicine should be
assessment to make sure that learning ultimately happens” able to lead and manage health care teams in all
[13]. The schema below presents OBE (Figure 3). settings from the hospitals, clinics, laboratories, or
communities; they should demonstrate effective
Spady presented OBE as two major systems: the people-skills and cultural competence in dealing
curricular and instructional relating directly to the teaching- with all types of clients
learning process, and the support system referring to the d. Social (Public health) advocates: general
administrative, logistical, and resource components. practitioners in medicine should use the public
Central to the model are the culminating outcomes that
health approach and consider the health of the
students should be able to achieve at the end of their
general populations and the communities as their
educational experience. From these outcomes emanate the
other instructional and curricular elements, as well as the primary accountability
support system structures that any HEI should task itself to e. Educators: physicians should effectively teach all
maintain. types of clients / patients/relatives about their
health and related issues; they should be life-long
The team followed the basic steps in curriculum learners engaged in continuing professional
designing [14] and in the process integrated the basic education to effectively be able to teach others
principles of OBE as presented in Figure 3. Furthermore, the
ten steps to break down the OBE framework as written by 2. Identification of the outcomes of the educational
Davis [15] were likewise used to distinguish the actual process
processes in shifting to OBE. The synthesis of these two
works is presented below. Figure 4 presents the CHED OBE framework. The figure
essentially covers the same curricular and instructional
1. Identification of the attributes of health professional support systems determining quality as explained by Spady
that the country needs in Figure 3. The two main indicators of the teaching-learning
process, e.g., standards and demands, as well as the social,
Designing any curriculum begins with a needs and environmental contexts refer to the various internal
assessment. The past and present performance of the and external factors discussed in the needs assessment that

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 Introduction of Outcome-Based Education

Figure 3. An outcome-based systems framework [15]

serve as bases in identifying the type of health professionals From the institutional, Figure 4 presents the program
required by the country. Based on these attributes expected outcomes. They refer to clear, demonstrable statements of
from the health professionals, the schools are expected to what a learner can be expected to know, understand and/or
formulate their institutional vision, mission, and goals do as a result of a learning experience. Outcomes are also
(VMGs). In the beginning, all stakeholders argued that the actions and performances that embody and reflect learner
VMGs “have been with their schools since the time they competence in using content, information, ideas, and tools
were founded.” However, these stakeholders were later successfully [13]. Program outcomes vary according to what
convinced that OBE is precisely designed to make the HEIs offer in terms of courses from Level 5 to Level 8
schools respond to society's needs, to develop educational qualifications in the PQF. Like the institutional outcomes,
programs geared towards the global call for transformative program outcomes are made more concrete by breaking
scale up of health professions education.
them down into competencies.
From the VMGs, the schools define the attributes of The institutional and program outcomes cover the entire
their graduates in form of institutional outcomes. This is curriculum of a particular course being offered by the HEIs.
where schools will differ in the sense that some of them are They describe the expected abilities graduates of such
public while others are private and even sectarian, courses should demonstrate. When further articulated in
community-based, hospital, or in combination of some terms that students have yet to take the courses, these
other institutional values. Institutional outcomes should be outcomes and competencies are put at the instructional
the same across the various academic programs being level.
offered by a given HEI. From the series of OBE workshops,
the case of De La Salle University Health Sciences Institute At this point, distinguishing the continuum of educational
stood out for having come up with the list of Expected La outcomes is imperative. Table 2 presents the features of vision,
Sallian Graduate Attributes (ELGA) [17]. This list of outcomes, competencies, curricular goals, and instructional
institutional outcomes are also further broken down into objectives. Articulation of vision is at the institutional level while
more concrete expressions of expectations in form of outcomes and competencies are minimum standards of what
competencies: skills performed to specific standards under professionals should be able to demonstrate. Curricular goals
specific conditions. They are also explicit responsibilities and instructional objectives refer to the converted articulations
expected of individuals in their professional practice [18]. of outcomes and competencies at the student level.

66 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74

Introduction of Outcome-Based Education

Table 2. Continuum of educational outcomes

Dimensions Vision Outcomes Competencies Goals Objectives

Scope Broad Terminal, at the Terminal; achieved Moderate Narrow

end of the usually at the end
program or of the program
educational
experience
Time needed Multi-year, Multi-year Multi-year Weeks, months, Hours or days
sometimes a depending on depending on the or semester
lifetime the program program
Purposes Provide a Define what are Knowledge, skills Design a Prepare a lesson
reason to essential for and attitudes that curriculum, plan, refer to
exist, learners to enable one to convert statements of
philosophy achieve and successfully professional what learners
begin perform his/her outcomes and should be able
professional work, refer to competencies to do when they
practice, refer to habitual and into student-level have completed
broad aspects of judicious use of learning goals a segment of
behavior that communication, instruction [16],
are transferable knowledge, learner-
to a wide range technical skills, oriented,
of work settings clinical reasoning, learning-based,
[15] emotions, values, explicit,
and reflections in assessable
daily practice for statement of
the benefit of the intended
individual and the learning
community being outcomes [28]
served [10]
Examples Health for All Demonstrate Competently assess Given sample At the end of 2-
clinical patients, arrive at a patients: month clinical
competence logical diagnosis Obtain accurate rotation at the
and differentials, history, perform Department of
appropriately thorough physical Medicine, 4th
manage patients examination, year medical
correctly interpret students should
diagnostic be able to
examinations, systematically
give logical assess assigned
diagnosis and patients
differentials,
formulate
appropriate plan
of management,
conscientiously
monitor progress
of patients

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 Introduction of Outcome-Based Education

Distinction of these educational intents is basic in Upon completion of GE courses, students proceed to the
determining levels by which the students will be taught and professional courses required by their degree programs.
assessed(Table 2). CMO 46 lists the final learning outcomes expected of those
who graduate from baccalaureate degree programs
As a continuity of RA 10533 and EO 83, the final learning regardless of types of HEIs. These are:
outcomes (LOs) developed by CHED for those who complete
general education are enumerated in CMO No. 20 Series of B1. Articulate and discuss the latest developments in the
2013 entitled “General Education Curriculum: Holistic, specific field of practice. (PQF level 6 descriptor)
Understandings, Intellectual and Civic Competencies.” B2.Effectively communicate orally and in writing using
General Education (GE) refers to the common subjects at both English and Filipino
Level 6 qualifications that deal with different ways of B3.Work effectively and independently in multi-
knowing: from creative, to humanistic, affective, and disciplinary and multi-cultural teams (PQF level 6
reflective modes of thinking. According to CMO No. 46 descriptor)
Series of 2012, GE aims to [7]: B4. Act in recognition of professional, social, and ethical
responsibility
“Produce thoughtful graduates imbued with (GE1) B5.Preserve and promote “Filipino historical and cultural
values reflective of a humanist orientation (e.g., heritage” (based on RA 7722)
fundamental respect for others as human beings with
intrinsic rights, cultural rootedness, an evocation to serve); The team mapped the alignment of the types of health
(GE2) analytical and problem solving skills; (GE3) the ability
professionals with the learning outcomes from the GE and
to think through the ethical and social implications of a
baccalaureate programs and integrated them in formulating
given course of action; and (GE4) the competency to learn
the final learning outcomes in medicine. Table 3 presents
continuously throughout life-that will enable them to live
these final programs and shows the alignment as they are
meaningfully in a complex, rapidly changing and globalized
world while engaging their community and the nation's repetitively articulated in each of the outcomes in medicine
development issues and concerns.” (Table 3).

Figure 4. Outcomes-based framework [9]

68 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74

Introduction of Outcome-Based Education

. 3. Identification of curriculum content, opportunity to achieve clinical competence even if its

4. Organization and sequencing of content setting does not really include a patient. The sample course
design shows the following critical domains of outcomes:
Content should only be selected after the learning
a. Literacy: basic principles of evidence-based
outcomes are already determined. Identification of content
m e d i c i n e ( E B M ) a n d o rga n i zat i o n a n d
refers to listing the topics that must be included in the
presentation skills (these are the enabling topics
curriculum. Validity of curricular content can be gauged by
required for students to achieve the performance
matching it with learning outcomes and objectives set.
required in the plan
Once identified, content must be organized and sequenced
b. Content: Etiology, pathophysiology, diagnosis,
according to many factors like the learners' developmental
treatment, referral, and management of common
stages, concepts serving as prerequisite of another, school's
cases of diarrhea and diabetes mellitus (DM)
timetable, and resources. Spady formulated the critical
c. Performance: presentation of satisfactory critical
domains of outcomes that should guide educational
appraisals and formulation of management plans
planners in completing Davis' steps 3 and 4. These critical
on diarrhea and DM
domains of outcomes are [13]:
a. Literacy: Language and numeric tools for acquiring 5. Identification of appropriate educational
knowledge, skills, and attitudes (KSA) and required strategies and
to develop others competencies 6. Identification of teaching methods
b. Content: Essential core knowledge, skills, attitudes
The articulation of vision, learning or program
without which performance is impossible
outcomes, competencies, curricular goals, and objectives
c. Performance: Ultimate outcomes that graduates
presents the whole spectrum of learning from the cognitive
should be able to perform
to psychomotor and affective domains of learning. Each
As an example, Table 3 presents Learning Outcome No. 1 learning outcome requires a holistic mastery of the
in medicine referring to “demonstrate clinical competence.” essential knowledge, skills, values, and attitudes and
Atienza in Sana, Atienza, Abarquez et al. [14] quoted progressing from lower order to higher order thinking skills
MacLeod and Harden in identifying the components of (HOTS). The challenge in OBE as a design is for educators and
clinical competence. All health professionals from teachers to transform the classroom and laboratory into
physicians to dentists, nurses, etc. are expected to be simulated or actual workplace where students must
clinically competent and should therefore be able to: perform the actual expected learning outcomes. It is for this
reason that OBE should be consistent with the Miller's
a. Accumulate and record information about patients
Pyramid [19]. This model challenges teachers to make sure
b. Perform a complete, orderly physical examination
the facts, principles, concepts, and theories are taught in a
c. Perform skills and procedures
most effective way so learners can retain them. But such
d. Interpret data
teaching should be carried out at the higher levels, so that
e. Solve scientific and professional problems
they are also able to apply them where they are needed,
f. Communicate information reliably
perform the requisite skills, and continually perform them
g. Demonstrate attitudes to patients and the health care
until they reach the level of competence (Figure 5).
team
Achieving clinical competence will not happen Table 4 suggests that the course design on Journal Club
overnight. Students need all the possible critical domains of makes use of the basic educational strategies of integration
this outcome that can be identified and organized in an OBE in interactive class settings. Vertical Integration is illustrated
way. Table 4 presents a sample syllabus of a Journal Club for by using clinical cases and correlating them with topics in
medical students. In many schools, Journal Club refers to a the basic sciences. This refers to integration of subjects
special class for interns that meets for 2 hours once a week. traditionally taught in different year levels of the curriculum
[14]. On the other hand, horizontal integration is seen
Table 4 shows that the Journal Club can be designed in through the use organization, presentation, and
such a way that it can target 6/10 program outcomes in communication skills, in synchronization of problems in
medicine. The class may look research-based (referring to Internal Medicine, Physical Diagnosis, Pharmacology, and
Program Outcome No. 4) but it can also be used as an Family and Community Health, among others.

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 Introduction of Outcome-Based Education

Table 3. Program outcomes in medicine

Program Outcomes in
Type of Health Operational Definitions of Program
Medicine (Matching GE and
Professionals Outcomes
Baccalaureate Outcomes)*
General Practitioner, 1. Demonstrate clinical Competently manage clinical conditions
·
Researcher, Social competence (GE1-GE3; B1- of clients in various settings
(Public) Health B5)
Advocate
General Practitioner, 2. Communicate effectively Convey information, in written and oral
·
Leader/Manager, (GE1-GE3; B2, B3, B5) formats, across all types of audiences,
Public Health venues and media in a manner that can
Advocate, Educator be easily understood
General Practitioner, 3. Lead and manage health Initiate planning, organizing,
·
Leader/Manager, care teams (GE2, GE3; B1- implementation, and evaluation of
Social (Public Health) B5) programs and health facilities,
Advocate Provide clear direction, inspiration, and
·
motivation to the healthcare
team/community
GP, Researcher, 4. Engage in research Utilize current research evidence in
·
Educator activities (GE1, B1, B2, B3) decision making as practitioner,
educator or researcher,
Participate in research activities
·
GP, Leader/Manager, 5. Collaborate within inter Effectively work in teams with co-
·
Social (Public) Health professional teams (GE1, physicians and other professionals in
Advocate B1, B2, B3) managing clients, institutions, projects,
and similar situations
GP, Leader/Manager, 6. Utilize systems-based Utilize systems-based approach in
·
Social (Public) Health approach to healthcare actual delivery of care,
Advocate (GE1-GE3, B1-B5) Network with relevant partners in
·
solving general health problems
GP, Leader/Manager, 7. Engage in continuing Update oneself through a variety of
·
Social (Public) Health personal and professional avenues for personal and professional
Advocate, development (GE1, GE3, growth to ensure quality healthcare
Researcher, Educator B1, B4, B5) and patient safety
GP, Leader/Manager, 8. Adhere to ethical, Adhere to national and international
·
Social (Public) Health professional and legal codes of conduct and legal standards
Advocate, standards (GE1-GE3, B1- that govern the profession
Researcher, Educator B5)
GP, Social (Public) 9. Demonstrate nationalism, Demonstrate love for one’s national
·
Health Advocate internationalism and heritage, respect for other cultures and
dedication to service (GE2, commitment to service.
B4, B5)
GP, Leader/Manager, 10. Practice the principles of Adhere to the principles of relevance,
·
Social (Public) Health social accountability (GE1- equity, quality, and cost effectiveness in
Advocate, GE3, B1-B5) the delivery of healthcare to patients,
Researcher, Educator families, and communities
*GE learning outcomes are labelled as GE1, GE2, and GE3 while the baccalaureate program outcomes are B1-B5.

70 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74

Introduction of Outcome-Based Education

This refers to the integration of subjects traditionally choices, discuss insights, create, and apply theories with
taught in different year levels of the curriculum [14]. actual cases and situations experienced at the workplace.
Learner-oriented activities are seen in a variety of teaching Such design as also presented in the Miller's Pyramid means
methods in the course through lectures, small group assessment of student achievement all the way up to the
discussions, presentation of actual Critical Appraisals (CAs) level of competent performance of knowledge, skills, and
and Management Plans, as well as giving and receiving attitudes as applied in the workplace. Furthermore, an
information and feedback. evaluation model that fits the OBE framework in terms of
assessing student achievement at the HOTS level, as well as
7. Decisions on how the students will be assessed and in evaluating the impact of the curriculum can be done using
the curriculum evaluated Kirkpatrick's Levels 1 to 4 Evaluation Model [20]. Figure 6
presents this schema. At Level 1, the school should solicit
Spady [13] wrote the highest standards of performance regular feedback to improve the curricular, instructional,
should be maintained during the teaching-learning as the and support systems of the program. Consultation with
same will serve as bases for assessment. Assessment at the learners at various stages of the program in formal or
highest order thinking skills (HOTS) therefore requires informal ways, written or oral format can provide the data
situations where students will make decisions, justify their for Level 1 Evaluation (Figure 6).

Table 4. Sample course design for a journal club

Program outcomes: Clinical Competence, Management of research findings, inter professionalism, Ethical, legal,
and professional practice, Effective communication, and Multi professional practice
Course objectives: Given sample clinical problems, formulate the most effective plan of management
Specific Teaching-Learning Instructional
Content Assessment
Objectives Activities Resources
Present satisfactory Principles of Lecture on EBM; Consultant, Blueprint for
critical appraisal Evidence-Based exercises and selected journal appraisal of
(CA) of a given Medicine (EBM) actual CAs articles, internet, literature
literature conference room

Basic organization Organization of Based on quality of Blueprint for

& presentation concepts and CA, determine assessing quality of
skills findings, Explaining, organizational skill microteaching and
questioning, of learner instructional media
facilitating, making (diagnostic test), used
presentations, Seminar-workshop
instructional media on microteaching,
including media,
microteaching
sessions
Formulate sample Etiology, Individual Conference room, Blueprint for
Management plans pathophysiology, presentations of consultant- appraisal of
for the following: diagnosis, CAs depicting a preceptor, journal literature, quality
1. Common treatment, referral, variety of cases of articles for CAs, of management
diarrhea and management diarrhea and DM, common cases, plan, and
2. Diabetes of common cases in small group SGD tasks submission of
Mellitus (DM) of diarrhea and DM discussion (SGD), salient documents
presentation of like correct
actual case, laboratory
formulation of requests,
management plan prescriptions, etc.

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11
71
 Introduction of Outcome-Based Education

8. The educational environment

OBE gives premium to the learning environment

because this is where the students are expected to
experience transformative learning. Spady explains that the
learning environment in OBE is defined by outcomes where
students actually perform until they achieve the level of
competence [13]. Such environment should therefore allow
students to engage in cooperative learning, practice the
skills in all expanded opportunities, and integrate various
concepts in practice setting. OBE is a curriculum and
instructional design that evolved during the information
Figure 5. Miller's pyramid [23] age and prescribes the use of information and
communication technology (ICT). Combination of virtual
Formative evaluation at Level 2 is done to improve and real learning environments should be designed to
instruction and guide learners on their progress. Table 4 provide students expanded opportunities for learning at
cites the blueprint of evaluating critical appraisals as a the highest level. These compose the logistics and resource
sample of formative Level 2 evaluation. Summative components in Figure 3. Table 4 suggests that the Journal
evaluation is done at the end of instruction and Club transform the traditional classroom into a small group
accompanied by the issuance of performance ratings. discussion venue, the information highway, and virtual
Different types of examinations from written to oral, clinical settings suggested by each case featured in class.
practical, and clinical evaluations are done at this level [18].
Table 4 shows a sample of this evaluation using the intern's 9. Management and administration of the
management plans. Level 3 evaluation looks at how learners
curriculum
have applied their learning to their actual workplace.
Behavior Evaluation is what OBE is after because it records
Aside from the learning environment, management and
the performance of learners in their workplace like the
laboratory, community, clinics, and hospital settings and its administration of the curriculum compose the support
effects on the learners themselves. Results evaluation looks system the OBE systems framework mentioned in Figure 3.
at the long-term effects of the program to the community, This includes performance credentialing, culminating
school, and society. This evaluation is done at the achievement, criterion validation, and collaborative
institutional level to guide HEIs how to sustain their structure [13]. In consistency with PQF, educational
programs for quality assurance. If satisfactory, Level 4 credentials will be evaluated using the same international
evaluation provides justification for program and standards and the documentation of students'
institutional accreditations. CHED came up with a list of key performance cannot be overemphasized. As presented in
result areas (KRAs) for Level 4 Evaluation. These KRAs and Figure 3, the actual delivery of instruction should be as good
their corresponding indicators of performance are as the documentation so that the students' records,
presented below [12]: transcripts, and grades will be accurately recorded and
credited. Administrative personnel proficient in using ICT is
a. Governance and management: governance, a requirement for this component.
management, and enabling features
b. Quality of teaching and learning: setting and 10. Communication of the curriculum to all
achieving program standards, faculty profile, and
stakeholders
setting and achieving program standards
c. Quality of professional exposure, research, and
In the Philippine setting, displaying in tarpaulins,
creative work
d. Support for students: equity and access and posters, and social network the outstanding performance
student services of graduates in the licensure examination is a common
e. Relations with the community: relevance of practice. While this certainly shows the initiative of the
programs, networking and linkages, extension school in communicating the effect of its curriculum, it
programs could be said that this is just at Level 2 evaluation. To Frenk,

12
72 Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
Introduction of Outcome-Based Education

Figure 6. Levels 1-4 evaluation of educational programs [25]

Chen, Bhutta, et al [8], the WHO [9,10], and Kirkpatrick [20], the Philippines's perennial problem of mismatch between
the best way to communicate the impact of the curriculum what is needed in the labor market and what the schools
is by establishing the matching between population health produce in their graduates.
problems and how they are solved and addressed by the
graduates of educational institutions. This can be achieved Central to OBE are learning outcomes that students
by tracking the graduates, locating them, determining their should be able to acquire during their educational
experience. From these outcomes, the course objectives,
present professional careers, and report them to the
content, teaching-learning strategies and instructional
school's stakeholders. In the Philippines, shifting to OBE
resources, evaluation, and management components
should give the communities the aspiration that schools emanate. The design makes use of higher order thinking
can after all, be instrumental in solving the country's skills and requires students to practice their future
population health problems. profession in the classroom that is converted into a
workplace.
Conclusions
References
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