Friday, May 18, 2018

Establishing Personal Learning Networks

SUPACA Youth Advocates Writer's Challenge


It was some years ago when Dr Iris Thiele Isip-Tan invited me to join her in a health activist writer's challenge with a topic to write about each day for a month.  Write ups don't need to be kilometric letters, just random thoughts on a blog.  I wondered if anyone would read what I wrote, and surprisingly friends started commenting that they actually read my blog.

There was once a saying "children should be seen, not heard..." we want to change that today.  It's amazing what kids think of and what kids can do. Adults can learn from kids. So let's teach them how to apply what they've learned.  We need to provide them opportunities to express higher levels of learning: understanding, applying, creating.

Here's to my SUPACA kids, learning about social media and how to maximize this powerful tool to make a positive impact on today's society.

Friday, April 27, 2018

Learning Management Systems for Outcome-Based Education

CHED Memorandum Order 18, series of 2016

The Commission on Higher Education (CHED) Memorandum Order 18 implements the shift to outcome-based education in 2016, so that medical education in the Philippines can become more socially accountable to the health needs of the population.  It specifies program outcomes expected of Doctor of Medicine graduates.  Hence, faculty of different medical schools revisited their curriculum to develop the most effective teaching strategies to adapt to outcome-based education.





Outcome-Based Education


In February 2018, the Association of Philippine Medical Colleges (APMC) held its 51st annual convention at the Pamantasan ng Lungsod ng Maynila (PLM).  The theme was “Medical Education in Challenging Times” and there were discussions about e-learning strategies, whether to adapt or adopt and the role of the professional quality framework (PQF) in harmonization in the Asean region.  There were break out sessions where faculty from different schools shared how they used learning management systems, whether as a repository of learning materials or in examination or as venues for constructive discussion.  This was a chance for us to reflect on whether we need to adapt an e-learning strategy for our school and to what extent.


Flipped Classroom


Last month, we were lucky to have Dr Iris Thiele Isip-Tan over in Cebu to talk to us about the "flipped classroom".  Traditionally, our classes consist of long lectures and students are assigned homework to submit on the next school day.  In the flipped classroom, content input is provided as homework, such as a video to watch online or reading assignments prior to class.  It then allows us to maximize our time in the classroom to supervise the student’s work, addressing questions and difficulties, which is the most crucial part of learning.  This alternative teaching strategy seems to sit well with our students, as evidence by a research paper conducted by our students where their preferred learning style was solitary (independent study time) and their preferred teaching strategy was alternative methods/small group discussions.  This pedagogy is most consistent with outcome-based education where direction is student-centered with emphasis on evidence of outcomes in objectively verifiable indicators.


Learning Management Systems like Moodle

Just this week, we were privileged to be able to attend the MoodleMoot Philippines #MootPH18 at the Manila Hotel.  We met Mr. Martin Dougiamas, the creator of moodle, an open-source learning management system which has been used by the University of the Philippines since 2003 (according to Dr Iris Thiele Isip-Tan).  Admittedly not a techie myself, but willing to learn and try new things, I learned a lot about the possible advantages of using moodle for medical education - foremost it is free of charge to use for small classes of 50 students and it is user-friendly for non-millenial technologically challenged faculty.  There were also moodle users who presented researches showing that gamification improves student motivation and that learning management systems using videos improve retention and increase test scores.

Thursday, April 26, 2018

The Bridge Epitomized: The Catalyst Personified


I was invited to give an "inspirational" talk to medical students in Cebu.  They wanted to know how one can be a sub-specialist and still be involved with public health...  Here I share my more organized thoughts on the topic.

FIND YOUR PASSION

I went to college at the University of the Philippines Los Banos and I took up Bachelor of Science in Agricultural Chemistry.  I once had that dream of owning a plot of land where I can grow herbs and vegetables and take care of cows, goats, pigs, chickens, ducks and even fisheries - for a sustainable agriculture in a microcosm.  That dream didn't florish to fruition, but I realized that this sustainable system can also be applied to healthcare, where each sector supports each other and we can all together help to improve the healthcare system make it sustainable.

I was focused on academics and research in college, but it was on my last year of college that my father was diagnosed with lung cancer.  I had planned to go abroad to pursue masteral and doctoral degrees in science and research... but I wanted to stay close to family.  So I decided to choose another course that would allow me three things:

1.  that whatever I study can enable me to serve the people
2.  that whatever I learn can be directly applied to my work
3.  that whatever I achieve will allow me to find work in the Philippines

I realized that pursuing a medical degree will fulfill these three conditions.  So I informed my mother that I intended to take up medicine, and we started looking through medical schools.  I applied at several schools, but ended up enrolling at the royal and pontifical University of Santo Tomas.  This was a good thing too, because I appreciate the Catholic and ethical medical education with attention to detail (we were often labelled as obsessive-compulsive by other medical students).


In medical school, I tried to find myself and my passions. I joined AMSA and FilChiMSA, and served in medical and surgical missions.

I joined the Terpsichorean Circle (dance club). Unfortunately, I realized that I couldn't dance.  My body parts were not coordinated and I wasn't the least bit graceful in movement. The most that I achieved was the white gloved pantomime where we formed images with our hands...

I joined athletics like the basketball team and the swim team... but then my chubbiness pulled our teams back from winning...  Finally, I joined the UST Medicine Glee Club and eventually became the musical director.  When medical students started auditioning, it was whispered that they were afraid of the terror lady at the keyboard.  This was the first time I realize that I was being endorsed to other students already.  I discovered that I can teach, and this became my passion...and I have been teaching ever since - to my residents in training, to my medical students (both in reproductive module and research) as well as to the scholars of The Share A Child Movement, Inc.

WHAT WOULD YOU DO IF MONEY WAS NO OBJECT?

I have spent childhood summers in Cebu.  I enjoy summer camps with the street children and scholars of different NGOs.  It seemed but natural for me to volunteer to ensure that Lola Sising's legacy of The Share A Child Movement, Inc continue to help poor but deserving children of Cebu to finish their education, and to be active advocates of children's rights.

There is a sense of volunteerism, that need to discover ways where your can help and offer your services for free.  During my first year of residency training, we had a lot of patients who died from pregnancy-related hemorrhage, and there was not enough blood units for transfusion.  So I walked from school to school along Taft Avenue all the way to Mendiola, getting in touch with heads of student councils to organize voluntary blood letting activities.  I approached parish priests to help announce during the masses that there were blood donation drives.  These would literally save lives of patients.  This we continue in Cebu.  We do this, not because we are required to do it, but because we want to SERVE THE PEOPLE.

I am lucky to have a jobs that make me happy.  At the hospital training residents and at school teaching research, these I would do even if money was no object.  Self-care is not about salt baths, massages and vacations.  It is about making choices that make you happy with your life, not something to run away from.  It is when you have passion for your work that it ceases to be work.  Being a physician is a vocation, not just a job, because the doctor-patient relationship is a fiduciary relationship, based on trust.



HOW TO FIND YOUR NICHE AND PROFIT FROM YOUR PASSION

People often ask me if I relocated to Cebu because of my husband.  I have to politely inform them that I am single, and that the reason I settled in Cebu was to fulfill a promise to my idol, my Lola Sising... that I would spend more time with her soon as I finish training.

So I wondered how would all my training and schooling be put to best use in the academic and clinical community in Cebu?  I keep thinking "if God brings you to it, He will lead you through it..."





WHAT ARE THE HATS I WEAR? 


  1. I am a training officer and a clinician. I train residents to become competent and compassionate obstetrician-gynecologists, especially in tertiary government hospitals where we are public servants.
  2. I am a teacher and mentor.  I teach first year residents how to make research projects.  Hopefully they learn how to assess situations and identify health problems and formulate solutions to address these.
  3. I am a social development worker.  Most determinants of health are not medical in nature.  We want to make society better for our children and Cebu a livable place.  We need to add value to education and youth-oriented activities so that they learn to claim their own rights.
  4. I am an infectious disease specialist and HIV advocate.  I am well-positioned to make an impact on prevention, treatment and care of people living with HIV to mitigate the spread of HIV infection and to reduce stigma and discrimination.


DREAM BIG DREAMS!

I was inspired by one of my clinical clerks in PGH before, who became a doctor to an under-served isolated barrio in Quezon.  Dr Lopao Medina talked during the 47th APMC Conference about reforms in medical education, and how a lot of DOH programs are carried out by one person if he is the only doctor in the locality.  So these are things which should have been taught in medical school.

My role in Cebu was somewhat clarified then.  What Dr Medina was doing at the grassroots level - reforming systems to improve healthcare... I was doing at the tertiary level.  My effort is in trying to improve health service delivery at the tertiary hospital level so that when a patient is referred from the barrio, that patient would receive the best care which the government hospital can provide, regardless of who the patient knows high up the political ladder.  So I told Dr Medina "I am preparing the tertiary level of care to receive referrals from the primary level.."  At present, we have pushed for reforms and changes to improve maternal healthcare at our tertiary government hospital.

"I'd rather have a life of oh wells'than a life of what ifs"

Working for reforms to improve health systems is not easy.  People don't always like change.  Just like in love and romance,

"It's better to have loved and lost than never to have loved at all..."

Anyway, we know that what doesn't kill you makes you stronger.  So we say to patients, colleagues, trainees and hospital administrators:

"I want to be your favorite hello and your hardest goodbye."



A good prayer to whisper to remind yourself of one's limits:

God grant me the 
SERENITY
to accept things I cannot change;
COURAGE
to change things I can;
and the
WISDOM
to know the difference.


Therefore, if you want to know whether you should become a specialist and apply for residency training or choose a public health career to work in government or go into masteral studies for research work, I say 

"You can be anything you want to be and do what you want to do so long as you put your mind, heart and soul into it!"

Take a deep breath and PUSH!

After all your birthing pains, know that your labor will give birth to a new you, ready to serve the people!





Friday, February 23, 2018

Coping with Patient Deaths


A few days ago, I experienced my first OR table death. I am still in SHOCK.

A patient bled to death during surgery while we tried to remove a ruptured bleeding tumor.  HYPOVOLEMIC SHOCK.  It was a traumatic experience to struggle with suturing to complete the surgery, during external compression of CPR.

When I scrubbed in, the estimated blood loss was already 2 liters - hemoperitoneum from a ruptured tumor.  Our usually cool anesthesiologists asked me at least four separate times in different ways: "doc, have you controlled the source of bleeding?", or "doc, have you ligated the bleeders already?", or "doc, have you successfully clamped the bleeding tumor?" and if "doc, is there any active bleeding?".  Just as calmly, the team of anesthesiologists informed me that the patient was bradycardic (heart rate slowing down)... then that the patient was almost coding... and finally that someone should initiate CPR because she flat-lined. 

All these events seem like a flurry of events happening before my eyes.  We struggled to remove the uterus and suture close the stump and ligate all bleeders with all the movement of somebody else doing CPR to revive the patient.  We heard someone say that there was blood coming out of her nose and through the oral tube.  Blood was being pushed through the IV for faster transfusion.  People were running to the blood bank to get more blood.  People were calling for help.  Residents and interns were taking turns at external compression.  We stapled the skin (OBGYNs almost never use stapler for skin closure) just to finish the surgery as soon as we could.  We continued with CPR for more than one hour, administered two shocks and gave 8 doses of epinephrine.  With somber faces, the whole team wordlessly accepted that the patient was gone, despite all our heroic efforts.  MENTAL SHOCK.

I had to face the patient's life partner to show the tumor that we had removed, and to explain that the patient's heart stopped because she had lost so much blood.  Even before I had finished speaking, the husband started sobbing.  It was heart-breaking, and all I could do was to offer him my condolences.  I could not give support, because I was in shock too, EMOTIONAL SHOCK.  As soon as we showed him the ECG reading showing a flat line, I returned to the operating room and had my own cry. It felt a part of me died with the patient.

My friends told me that it is alright to grieve and to mourn the patient "because you are human.  That was a woman who died.  Someone's wife and daughter.  So yes, you should grieve"

I had difficulty sleeping that night so I wrote a post on facebook to express my grief:



In our hospital, maternal mortality is high.  There are several mothers who die of pregnancy-related causes every month.  How does a health professional keep emotionally divorced from death and dying, especially if you wonder if the deaths could have been prevented?  Writing this blogpost may be cathartic (therapeutic) for me as a doctor, but I honestly wish to discuss with others out there who may have experienced these challenges and difficulties, so that we can help each other cope with patient deaths - so that we can serve our patients, but not at the cost of our own emotional and mental health.

1. How do you cope when you lose a patient?
2. What advice can you give to a fellow HCP who grieves over a patient's death?
3. What is the role of social media in helping HCPs cope with grief over a patient's death?

Friday, January 12, 2018

Video Tools for Public Health Promotion


With a new year upon us, our department recently presented our annual accomplishment report.  Health topics included in our advocacies are "Buntis Day" to improve prenatal care and safe motherhood, "Scarlet May" to intensify cervical cancer screening and "Watercolor Workshop for Doctors" to increase awareness for prevention of mother to child transmission of HIV infection.



I am sure other people have personal health advocacies to promote.  Imagine the impact on patient care if doctors were to bring these offline advocacies online, where most of our patients are, anyway.

The beauty of social media is that you can decide for yourself the content that you put on your social media channel, and you can control the logistics such as the duration, frequency and dissemination of short videos which you can create at the comfort of your homes.  Many of the anxiety of patients come with not knowing or understanding their condition.  With healthcare providers creating public health promotion videos, this helps them improve their communication skills, helping patients understand their diagnosis and providing comfort and support.

Dr Willie Ong is one such Filipino doctor who has maximized social media to promote public health on his youtube channel with 338K+ followers and facebook page with millions of followers.

Our every own Dr Iris Thiele Isip-Tan has started her own youtube channel "Isang Minuto para Matuto kay Dok Bru" (one minute to learn from Doc Bru) which shares about common endocrinologic disorders like diabetes mellitus.  We draw inspiration from this personal initiative to promote public health through videos.

EMPOWERMENT of both healthcare professionals and patients as one of our goals in #HealthXPH
  1. What health topic needs the most help from health promotion videos in your area?
  2. What video editing apps do you use for health promotion videos?
  3. What tips can you share to make your health promotion videos attract attention?

Friday, November 3, 2017

SMOKING left me DADDYless





I remember my brother hiding my dad's rim of Camel cigarettes in every nook and cranny in his innocent attempt to get him to stop smoking.

I remember being asked to light his next cigarette for him from the stove.  Other days he would simply light his next cigarette from the last one.

All his photos at work showed a cigarette between his fingers or between his lips. He added the words "Bitching about" to signs that read "SMOKING is hazardous to your health".

I was in my last year of college when he was diagnosed with stage IV lung cancer.  No surgery. No chemotherapy.  They agreed to radiotherapy due to SVC syndrome, and to alleviate his pain from hip bone mets, liver mets, and brain mets.  I watched him lose weight, unable to walk without assistance, and gnaw his teeth in pain, and have difficulty sleeping at night afraid that he might not wake up in the morning.

I took a leave of absence for a month off college to take care of him.  I would rub his back at night when he would cry out in pain.  I would coach him to breathe and pray when his bones hurt.  That one Monday morning, through his hallucinations, we prayed the rosary and bid our final farewell.  I watched his breathing become labored and his pupils start to dilate. 

It was at that moment when I decided that I never want to feel that helpless ever again.  I decided to take up medicine that year.  My dad will forever be 47 years old.  He never grew old because he died young.  Forever young.

Each milestone we have, we whisper "daddy would have enjoyed this" or "I wish daddy were here..."   I am undoubtedly daddy's girl, but it was his death that brought me and my mom together closer.


Treasure your health.  Stop smoking.  Don't even think about starting.

I started writing this post to share how tobacco changed our lives.  I ended it with tears running down my cheeks.  The pain of losing my dad is as fresh as that morning when I watched him breathe his last.

Friday, October 27, 2017

Online Tools for Teaching


I recently enrolled in a basic course in Health Professionals Education to help me improve how I teach research to medical students.  I learned that medical curriculum has evolved from the traditional classroom type of teaching to problem-based learning, and most recently to outcome-based education.  With the changes in student learning styles, so did teaching strategies evolve especially to include use of new technologies to adjust for maximum learning.
Just like what telemedicine does for healthcare service delivery, online tools can be used to aid teaching.  This will help improve intended learning outcomes through online courses.  It allows us overcome the geographic, economic and opportunity cost of education.  It ensures technical support of seasoned educators from university.  The main limitation would be the availability and accessibility to reliable internet.
Flipping the classroom involves initiating learning online by providing content outside the classroom,.  More time is freed up to reinforce the content.  Blended learning combines online provision of content with face to face classroom instruction.  These are some ways to apply online tools for teaching.  Open Education Database provides a comprehensive list of Web 2.0 Teaching Tools for a variety of functions.  At first glance, this list overwhelms, but it may be confusing as it is exciting.
Costello describes five ways to connect with online students:
  1. Forge a personal connection by providing a picture or video introduction.
  2. Enhance your lessons by integrating video clips and other types of media.
  3. Set realistic expectations for response time.
  4. Encourage your students to connect with each other through meaningful discussions.
  5. Explore interactive communication such as live chats, instant messaging, and online office hours.