Face to face

As alert levels go down, thousands of schools have resumed face-to-face classes. Medical education is a topic of interest, as it is thought to be heavily dependent on physically present, clinical work. The desire to produce new medical graduates is also high, as presidential aspirants have mentioned the importance of encouraging young people to pursue medicine and allied professions to fill the country’s needs.

The interest in medical education post-pandemic is reflected in Dr. Leonard Leonidas’ commentaries, “The eMedical education of the near future” (1/30/22) and “New way to educate a medical student” (3/7/22), and in a rejoinder by Dr. Ida M. Tiongco (“Online medical education won’t work in the Philippines,” 3/15/22). Leonidas proposes that as early as high school, students may shadow practitioners and should benefit from advancements in online medical education, such as videos and presentations. This is to be followed by four years of online pre-medical courses, two years medical school, and two years clinical experience. The proposed benefits are cost reduction and greater availability of medical education in rural areas.

Tiongco brought up valid concerns, such as the quality of internet in the Philippines posing a real challenge to online learners; balanced work and compensation for junior physicians who may end up handling much of the work; and a loss of the part of medicine that focuses on physical presence, such as palpation. She also suggests that interaction with colleagues is an important part of growth, learning, and personality development.

It is not the intention of this column to suggest that the quality of our medical graduates is necessarily inferior if they have spent the majority of their clinical years in distance learning. I also recognize the benefits of creating, for the long-term, a hybrid curriculum that minimizes cost while maximizing learning. No doubt experts in medical education are working on such innovations as the pandemic has changed the landscape of learning for good. I would only like to add that an important reason to value long exposure to face-to-face work has to do with the state of the health care system in the Philippines.

We all know how disadvantaged patients are in the abstract; every medical student, in distance learning or not, must know the challenge for ordinary Filipino patients to access adequate nutrition, health education, medicine, and health services. And yet it is a different thing to be able to sit beside a patient who has trekked six hours to arrive at one’s clinic; to feel up close their tiredness and frustration; to hear the rumbling of their stomachs because they didn’t eat so they can afford their consult.

It is a great tragedy of the pandemic that while it has shone a light on the bravery of frontliners, it has also exposed personalities in the medical profession who are out of touch with the realities and what it means to be a sick person in the Philippines.

There are those who blamed people for leaving their homes and risking COVID-19 exposure, oblivious to the fact that for many, not leaving the house to work is to risk starvation.

There are those who are under investigation for enabling or participating in corruption. How much easier it must be to profit from government funds when one no longer has to directly interact with patients worrying about the day-to-day cost of medicine, mechanical ventilation, physical therapy, or food.

There are those who sat in their ivory towers and eschewed the expertise of professionals in other fields. This medical hegemony, this conviction that physicians and only physicians must know best and that those in other fields must sit down and shut up, is still another reflection of medical workers being out of touch. While face-to-face education may not counter this, I would expect that exposure to close and collaborative work within communities can only help medical graduates to see up close how much we rely on others for a health care system to function.

However the course of medical education may change in the Philippines after the pandemic, it is clear that exposure to communities is irreplaceable. This column has recently described those who worked closely with communities at the cost of their own comfort and safety: Dr. Naty Castro and “lumad” volunteers, who embodied what it means to serve the underserved. As the pandemic has taught us new lessons about how best to optimize medical education, it has shown more than ever the importance of hearing, touching, and listening to sick Filipinos directly. It should also help us to prize more than ever community medicine—an often overlooked and undervalued specialty—and of interpersonal collaboration. Some lessons may best be learned outside of a screen.

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