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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: erlynsana@yahoo.com.ph;easana1@up.edu.ph

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-

The Philippines used to be the only country in Asia and
one of the three countries in the world left with 10 years of
basic education. The other two are Angola and Djibouti in
Africa [1]. This educational system fell two years short of
international standards making Filipino professionals
working abroad underemployed as their degrees were not
always recognized. The first significant step done to address
this problem was the signing of Republic Act 10533: the
“Enhanced Basic Education Act of 2013” [2]. This law shifted
Philippine basic education in the Philippines to K-12. The
year old children, followed by a six-year elementary
education for 6- year olds, four-year junior high school for
12-year olds, and last two years of senior high school for
those who are 16 years old. The law also provided for
alternative basic education for those who are out of school
and with special needs. The K-12 aligned the Philippine
basic educational system with the rest of the world.
Republic Act 10533 has direct implications to higher
education institutions (HEIs). Section 5 of the law ordered
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
Technical Education and Skills Development Authority
(TESDA) in crafting the K-12 curriculum. This curricular
framework should be “harmonized with tertiary education
and prepare students for global competitiveness, college
readiness, and avoid remedial and duplication of basic
education subjects.” These steps were basically the same
procedures done by European countries in 2005 in
preparing their technical and professional courses towards
their educational qualifications framework. The framework
explicitly required graduates to show what they may be
expected to know, understand and be able to do on the basis
of a given qualification (learning outcomes) as well as how
qualifications of professionals within a system may move to
another [3]. Outcome-based education (OBE) is the
educational design that prepares students meet these
professional standards. Outcome-Based Education (OBE) as
a curriculum and instructional design and QA framework
provides Philippine Education the road map to achieve the
overall and long-term desired goal of “achieving rapid,
inclusive, and sustained economic growth: one that
generates jobs and livelihood for, and increase the income
of the poor [2].
This paper is a review article that serves as an
introduction of OBE in the Philippine health sciences
setting, as documentation of the experience of the
Technical Committee on Medical Education (TCME) and the
principal author as committee's educational consultant. It is
written to serve as a baseline resource to guide educational
leaders and managers, curriculum and instructional
designers, as well as individual faculty members to get ready
for OBE. While its main context is limited to medical
education, it presents general principles applicable to other
regulated professions. Specifically, the paper aims to (1)
Discuss the legal, political, and andragogic foundations of
OBE, and (2) Explain OBE as a curriculum and instructional
design as well as a systems framework.
Methodology
Sources of Data
The principal author provided professional services as
educational consultant to the CHED Technical Committee
on Medical Education (TCME). They refer to this paper
henceforth as the team. They worked with various
stakeholders in medical education namely the Professional
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
Regulatory Board of Medicine of the Professional
Regulation Commission (PRC), the Executive Committee of
the Association of Philippine Medical Colleges, Inc. (APMC),
the Philippine Medical Association (PMA), all the deans of
the country's medical schools, selected faculty members
from various medical fields, the Health Human Resource
Development Bureau (HHRDB) of the Department of Health
(DOH), CHED through its Office of Policies, Standards, and
Development (OPSD), and the World Health Organization
(WHO). All these offices and agencies through their officers
served as sources of first-hand data on laying down the
foundations of OBE in Philippine medical schools.
Secondary data were obtained from reviews of relevant
literature, laws and statutes, executive orders,
memorandum circulars, reports, and publications on OBE.
Materials and Instruments
In coordination with CHED's OPSD, the team conducted a
series of seminars and workshops from April 2, 2013 until
December 19, 2014. These were held for TCME to be
oriented on OBE, acquire first-hand experience in going
through OBE as a curriculum and instructional design in
medicine, as well as in appreciating OBE as a QA framework.
Basic instruments used in these activities included the laws
and statutes, as well as the Commission on Higher Education
Memorandum Circular Orders (CMOs), and executive
orders pertinent to the implementation of OBE in Philippine
higher education institutions. In the course of conducting
the seminars and workshops, the team used the various
existing curricula of medical schools, their institutional
vision, mission, and goals, and oral and written feedback
from participants and stakeholders. An informal workshop
evaluation of outputs of participants presented and
critiqued during the plenary presentations were also used.
Procedures for Data Collection and Analysis
Upon the request of TCME, the principal author,
together with other resource persons like faculty members
teaching pediatrics, internal medicine, surgery, obstetrics-
gynecology, family and community medicine, radiology, and
anesthesiology from the University of the Philippines
College of Medicine (UPCM), APMC, and CHED conducted
several seminars on OBE. Experts lectured on given pre-
assigned topics like the basic principles of OBE, how to
formulate learning outcomes, and how could HEIs start with
it especially those coming from competency-based
curriculum. Applications of OBE in the various disciplines in
medicine were also discussed. These were followed by
61

workshops where participants immediately applied the
lecturers' inputs in the context of medical education.
Outputs from these activities were refined continually in the
succeeding consultations and workshops. The final
outcomes produced were:
1. Identification of the type of professionals expected
from graduates of medicine in the Philippines
2. Formulation of sample institutional vision, mission,
goals, and objectives (VMG)
3. Development of learning outcomes (LOs) aligned
with the VMGs and type of health professionals
4. Draft program standards and guidelines (PSGs) for
medical education. CHED requires all PSGs to go
through a series of public hearings-consultations.
The final version upon approval by the CHED
Commission en Banc is then disseminated through
a public orientation
Results and Discussion
The Legal, Political, and Administrative Bases of OBE in the
Philippines: Precursors of OBE
The Philippines belongs to the ten-nation Association of
South East Asian Nations (ASEAN) which aims to build the
ASEAN Economic Community. Specifically it means
transforming the member-countries into a single market
production base, highly competitive economic region, and
one with equitable economic development, and fully
integrated into the global economy [4]. By 2015, ASEAN
Integration should be fully operational paving the way to
exchange of professional services. The integration will pilot
the exchange of professionals in medicine, dentistry,
nursing, architecture, engineering, accountancy, maritime
education, and surveying.
Towards this development target, the HEIs should
therefore prepare their graduates acquire the professional
competencies required by both the local and global labor
markets. This is the very essence of Executive Order (EO) No.
83 signed by President Benigno S. Aquino on October 2012.
EO 83 is also known as the Philippine Qualifications
Framework (PQF) [5] and it aims to :
1. Adopt national standards and levels for outcomes
of education
2. Support the development and maintenance of
pathways and equivalencies which, provide access
62
Introduction of Outcome-Based Education
to qualifications and assist people to move easily
and readily between the different education and
training sectors and between these sectors and the
labor market
3. Align the PQF with international qualifications
framework to support the national and
international mobility of workers through
increased recognition of the value and
comparability of Philippine qualifications
The PQF followed essentially the same steps that other
countries went through in developing their respective
qualifications framework. The Washington Accord
established in 1989 was formed by international bodies
responsible for accrediting engineering degree programs. It
recognizes the substantial equivalency of programs
accredited by those bodies and recommends that graduates
of programs accredited by any of the signatory members be
recognized by the other bodies as having met the academic
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
industrial partners develop international standards for their
educational qualifications [3]. The Washington Accord and
the Bologna Process use OBE in formulating the standards
and equivalences expected from various professions. The
PQF also adopts OBE in all levels of education. The
qualifications begin from basic education consistent with
RA 10533 that introduced K-12. Figure 1 presents the overall
PQF illustrating the eight levels of educational qualifications
to be recognized and awarded by the Philippines. Those
pursuing technical and vocational programs will be given
National Certificate (NC) varying from NC I to NC IV after
which a diploma can be awarded. NC IV is classified Level 4
while diploma graduates are awarded Level 5 recognition.
Recognitions of Level 6 to 8 refer to those who complete the
baccalaureate, master's, and doctoral education
respectively. The domains used in the PQF include mastery
of knowledge, skills, and values (KSV) of the professionals in
their chosen disciplines, ability to apply these KSVs in the
actual workplace, and degree of independence to perform
them autonomously.
To guide the HEIs in preparing their students towards the
practice of various professions, PQF presents the indicators
of what they should be able to demonstrate as proof of
competence (Table 1).
Consistent with RA 10533 and EO No. 83, CHED issued
CMO No. 46 Series of 2012. This memorandum order used
OBE as the basic frame of reference in determining the
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
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
vertical and horizontal typologies on how they will be
classified according to types of institutions and quality of
programs delivered. Section 3.1.4.2 of this Order said that
CHED subscribes “to a more eclectic approach that
resonates with a “weak” or “lower case” “obe” [7]. Section
3.1.4.3 further reveals that “obe” approach in Philippine
higher education mixes outcomes-based education with
other curriculum approaches and is open to incorporating
discipline-based learning areas that currently structure HEI
curriculums.” Since many HEIs in the Philippines are
competency-based, the shift to OBE should not be difficult
at all.
Andragogic Basis of Outcome-Based Education
Among Philippine medical schools, the discourse on OBE
started in 2010 when two on-line publications were
released [8,9]. Both were commissioned to commemorate
the centennial of the Flexnerian curriculum. Abraham
Flexner was the educator commissioned to review medical
education in the United States. His report published in 1910

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


Figure 1. The Philippine qualifications framework [6]
paved the way to the present subject-centered, traditional
science-based curriculum in medicine. The GCSA paper [9]
examined how medical education evolved while The Lancet
paper [8]studied the more than 100 years of curricula in
medicine, dentistry, nursing, public health, and midwifery.
Frenk, et al [8] reported that over the last 100 years,
education of health professionals notably those in medicine
only became longer and more expensive in many countries
but remained unable to address the overall population
health problems. The two articles recommended reforms
both at institutional and instructional levels. The GCSA
article [9] recommended that medical education around the
world follows the OBE design. The Lancet article [8]
recommended competency-based curriculum. However,
both papers focused on the call for transformative learning
in the health sciences. In 2011, WHO qualified the global call
through another publication entitled “Transformative Scale
Up of Health Professional Education” presented aptly in
Figure 2 [10].
Figure 2. Transformative scale up of health professional education
[9]
64
Introduction of Outcome-Based Education
WHO [10] challenges all stakeholders in health,
education, and development that “transformative scale-up
of health professional education aims to support and
advance the performance of country health systems so as to
meet the needs of individuals and populations in an
equitable and efficient manner. Driven and informed by
population health needs, transformative scale up means
delivering educational reforms that address not only the
quantity, but also the quality and relevance of health care
providers in order to achieve improvements in population
health outcomes.” Quantity refers to health science schools
tasked to produce the right number of professionals.
Quality means graduating professionals with the right
competencies while relevance pertains to those who work
where they are needed.
A perennial criticism [11,12] of Philippine health science
schools is producing too many of the same kind, they could
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
as members of locally responsive and globally
connected teams.”
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
institutions should prepare their students for the future
practice of professions in health. By transformative
learning, students develop leadership attributes and
become enlightened change agents. Frenk, Chen, Bhutta, et
al [8] explained that transformative learning involves three
fundamental shifts: from fact memorization to critical
reasoning that can guide the capacity to search, analyze,
assess, and synthesize information for decision making;
from seeking professional credentials to achieving core
competencies for effective teamwork in health systems; and
from non-critical adoption of educational models to
creative adaptation of global resources to address local
priorities. These are the same articulations of the Philippine
educational system through EO No. 83 and CMO No. 46.
OBE as a Systems Framework, Curriculum and
Instructional Design
OBE is defined as “clearly focusing and organizing
everything in the educational system around what is
essential for all students to be able to do successfully at the
end of their learning experiences. This means starting with
the clear picture of what is important for students to be able
to do, then organizing the curriculum, instruction, and
assessment to make sure that learning ultimately happens”
[13]. The schema below presents OBE (Figure 3).
Spady presented OBE as two major systems: the
curricular and instructional relating directly to the teaching-
learning process, and the support system referring to the
administrative, logistical, and resource components.
Central to the model are the culminating outcomes that
students should be able to achieve at the end of their
educational experience. From these outcomes emanate the
other instructional and curricular elements, as well as the
support system structures that any HEI should task itself to
maintain.
The team followed the basic steps in curriculum
designing [14] and in the process integrated the basic
principles of OBE as presented in Figure 3. Furthermore, the
ten steps to break down the OBE framework as written by
Davis [15] were likewise used to distinguish the actual
processes in shifting to OBE. The synthesis of these two
works is presented below.
1. Identification of the attributes of health professional
that the country needs
Designing any curriculum begins with a needs
assessment. The past and present performance of the
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
school, understanding the target client or public it wants to
serve, the overall health profile of the people and in what
ways graduates of the school will be able to bridge the gaps
serve as main considerations in doing needs assessment.
The team had exhaustive discussions on the Philippine
population health problems, the United Nations
Millennium Development Goals, where the graduates of
most medical schools were, and the desired attributes of
Filipino physicians. The final output is similar to the
attributes of the five-star doctor introduced by Boelen
(1994) [16] namely the physician as a care provider, decision
maker, communicator, community leader, and manager. The
team had consensus that graduates of medicine should
have the following attributes and competencies:
a. General (medical) practitioners: new graduates
should be able to competently manage common
clinical and public health problems and can refer
accordingly
b. Researchers: beginning physicians should be
evidence-based in their practice of their profession,
can distinguish the most effective and beneficial
regimen to manage given clients in their socio-
cultural contexts
c. Leader/Managers: graduates of medicine should be
able to lead and manage health care teams in all
settings from the hospitals, clinics, laboratories, or
communities; they should demonstrate effective
people-skills and cultural competence in dealing
with all types of clients
d. Social (Public health) advocates: general
practitioners in medicine should use the public
health approach and consider the health of the
general populations and the communities as their
primary accountability
e. Educators: physicians should effectively teach all
types of clients / patients/relatives about their
health and related issues; they should be life-long
learners engaged in continuing professional
education to effectively be able to teach others
2. Identification of the outcomes of the educational
process
Figure 4 presents the CHED OBE framework. The figure
essentially covers the same curricular and instructional
support systems determining quality as explained by Spady
in Figure 3. The two main indicators of the teaching-learning
process, e.g., standards and demands, as well as the social,
and environmental contexts refer to the various internal
and external factors discussed in the needs assessment that
65

Figure 3. An outcome-based systems framework [15]
serve as bases in identifying the type of health professionals
required by the country. Based on these attributes expected
from the health professionals, the schools are expected to
formulate their institutional vision, mission, and goals
(VMGs). In the beginning, all stakeholders argued that the
VMGs “have been with their schools since the time they
were founded.” However, these stakeholders were later
convinced that OBE is precisely designed to make the
schools respond to society's needs, to develop educational
programs geared towards the global call for transformative
scale up of health professions education.
From the VMGs, the schools define the attributes of
their graduates in form of institutional outcomes. This is
where schools will differ in the sense that some of them are
public while others are private and even sectarian,
community-based, hospital, or in combination of some
other institutional values. Institutional outcomes should be
the same across the various academic programs being
offered by a given HEI. From the series of OBE workshops,
the case of De La Salle University Health Sciences Institute
stood out for having come up with the list of Expected La
Sallian Graduate Attributes (ELGA) [17]. This list of
institutional outcomes are also further broken down into
more concrete expressions of expectations in form of
competencies: skills performed to specific standards under
specific conditions. They are also explicit responsibilities
expected of individuals in their professional practice [18].
66
Introduction of Outcome-Based Education
From the institutional, Figure 4 presents the program
outcomes. They refer to clear, demonstrable statements of
what a learner can be expected to know, understand and/or
do as a result of a learning experience. Outcomes are also
actions and performances that embody and reflect learner
competence in using content, information, ideas, and tools
successfully [13]. Program outcomes vary according to what
HEIs offer in terms of courses from Level 5 to Level 8
qualifications in the PQF. Like the institutional outcomes,
program outcomes are made more concrete by breaking
them down into competencies.
The institutional and program outcomes cover the entire
curriculum of a particular course being offered by the HEIs.
They describe the expected abilities graduates of such
courses should demonstrate. When further articulated in
terms that students have yet to take the courses, these
outcomes and competencies are put at the instructional
level.
At this point, distinguishing the continuum of educational
outcomes is imperative. Table 2 presents the features of vision,
outcomes, competencies, curricular goals, and instructional
objectives. Articulation of vision is at the institutional level while
outcomes and competencies are minimum standards of what
professionals should be able to demonstrate. Curricular goals
and instructional objectives refer to the converted articulations
of outcomes and competencies at the student level.
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

Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74 67


Distinction of these educational intents is basic in
determining levels by which the students will be taught and
assessed(Table 2).
As a continuity of RA 10533 and EO 83, the final learning
outcomes (LOs) developed by CHED for those who complete
general education are enumerated in CMO No. 20 Series of
2013 entitled “General Education Curriculum: Holistic,
Understandings, Intellectual and Civic Competencies.”
General Education (GE) refers to the common subjects at
Level 6 qualifications that deal with different ways of
knowing: from creative, to humanistic, affective, and
reflective modes of thinking. According to CMO No. 46
Series of 2012, GE aims to [7]:
“Produce thoughtful graduates imbued with (GE1)
values reflective of a humanist orientation (e.g.,
fundamental respect for others as human beings with
intrinsic rights, cultural rootedness, an evocation to serve);
(GE2) analytical and problem solving skills; (GE3) the ability
to think through the ethical and social implications of a
given course of action; and (GE4) the competency to learn
continuously throughout life-that will enable them to live
meaningfully in a complex, rapidly changing and globalized
world while engaging their community and the nation's
development issues and concerns.”
Figure 4. Outcomes-based framework [9]
68
Introduction of Outcome-Based Education
Upon completion of GE courses, students proceed to the
professional courses required by their degree programs.
CMO 46 lists the final learning outcomes expected of those
who graduate from baccalaureate degree programs
regardless of types of HEIs. These are:
B1. Articulate and discuss the latest developments in the
specific field of practice. (PQF level 6 descriptor)
B2.Effectively communicate orally and in writing using
both English and Filipino
B3.Work effectively and independently in multi-
disciplinary and multi-cultural teams (PQF level 6
descriptor)
B4. Act in recognition of professional, social, and ethical
responsibility
B5.Preserve and promote “Filipino historical and cultural
heritage” (based on RA 7722)
The team mapped the alignment of the types of health
professionals with the learning outcomes from the GE and
baccalaureate programs and integrated them in formulating
the final learning outcomes in medicine. Table 3 presents
these final programs and shows the alignment as they are
repetitively articulated in each of the outcomes in medicine
(Table 3).
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
Introduction of Outcome-Based Education
. 3. Identification of curriculum content,
4. Organization and sequencing of content
Content should only be selected after the learning
outcomes are already determined. Identification of content
refers to listing the topics that must be included in the
curriculum. Validity of curricular content can be gauged by
matching it with learning outcomes and objectives set.
Once identified, content must be organized and sequenced
according to many factors like the learners' developmental
stages, concepts serving as prerequisite of another, school's
timetable, and resources. Spady formulated the critical
domains of outcomes that should guide educational
planners in completing Davis' steps 3 and 4. These critical
domains of outcomes are [13]:
a. Literacy: Language and numeric tools for acquiring
knowledge, skills, and attitudes (KSA) and required
to develop others competencies
b. Content: Essential core knowledge, skills, attitudes
without which performance is impossible
c. Performance: Ultimate outcomes that graduates
should be able to perform
As an example, Table 3 presents Learning Outcome No. 1
in medicine referring to “demonstrate clinical competence.”
Atienza in Sana, Atienza, Abarquez et al. [14] quoted
MacLeod and Harden in identifying the components of
clinical competence. All health professionals from
physicians to dentists, nurses, etc. are expected to be
clinically competent and should therefore be able to:
a. Accumulate and record information about patients
b. Perform a complete, orderly physical examination
c. Perform skills and procedures
d. Interpret data
e. Solve scientific and professional problems
f. Communicate information reliably
g. Demonstrate attitudes to patients and the health care
team
Achieving clinical competence will not happen
overnight. Students need all the possible critical domains of
this outcome that can be identified and organized in an OBE
way. Table 4 presents a sample syllabus of a Journal Club for
medical students. In many schools, Journal Club refers to a
special class for interns that meets for 2 hours once a week.
Table 4 shows that the Journal Club can be designed in
such a way that it can target 6/10 program outcomes in
medicine. The class may look research-based (referring to
Program Outcome No. 4) but it can also be used as an
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
opportunity to achieve clinical competence even if its
setting does not really include a patient. The sample course
design shows the following critical domains of outcomes:
a. Literacy: basic principles of evidence-based
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
presentation skills (these are the enabling topics
required for students to achieve the performance
required in the plan
b. Content: Etiology, pathophysiology, diagnosis,
treatment, referral, and management of common
cases of diarrhea and diabetes mellitus (DM)
c. Performance: presentation of satisfactory critical
appraisals and formulation of management plans
on diarrhea and DM
5. Identification of appropriate educational
strategies and
6. Identification of teaching methods
The articulation of vision, learning or program
outcomes, competencies, curricular goals, and objectives
presents the whole spectrum of learning from the cognitive
to psychomotor and affective domains of learning. Each
learning outcome requires a holistic mastery of the
essential knowledge, skills, values, and attitudes and
progressing from lower order to higher order thinking skills
(HOTS). The challenge in OBE as a design is for educators and
teachers to transform the classroom and laboratory into
simulated or actual workplace where students must
perform the actual expected learning outcomes. It is for this
reason that OBE should be consistent with the Miller's
Pyramid [19]. This model challenges teachers to make sure
the facts, principles, concepts, and theories are taught in a
most effective way so learners can retain them. But such
teaching should be carried out at the higher levels, so that
they are also able to apply them where they are needed,
perform the requisite skills, and continually perform them
until they reach the level of competence (Figure 5).
Table 4 suggests that the course design on Journal Club
makes use of the basic educational strategies of integration
in interactive class settings. Vertical Integration is illustrated
by using clinical cases and correlating them with topics in
the basic sciences. This refers to integration of subjects
traditionally taught in different year levels of the curriculum
[14]. On the other hand, horizontal integration is seen
through the use organization, presentation, and
communication skills, in synchronization of problems in
Internal Medicine, Physical Diagnosis, Pharmacology, and
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
taught in different year levels of the curriculum [14].
Learner-oriented activities are seen in a variety of teaching
methods in the course through lectures, small group
discussions, presentation of actual Critical Appraisals (CAs)
and Management Plans, as well as giving and receiving
information and feedback.
7. Decisions on how the students will be assessed and
the curriculum evaluated
Spady [13] wrote the highest standards of performance
should be maintained during the teaching-learning as the
same will serve as bases for assessment. Assessment at the
highest order thinking skills (HOTS) therefore requires
situations where students will make decisions, justify their
choices, discuss insights, create, and apply theories with
actual cases and situations experienced at the workplace.
Such design as also presented in the Miller's Pyramid means
assessment of student achievement all the way up to the
level of competent performance of knowledge, skills, and
attitudes as applied in the workplace. Furthermore, an
evaluation model that fits the OBE framework in terms of
assessing student achievement at the HOTS level, as well as
in evaluating the impact of the curriculum can be done using
Kirkpatrick's Levels 1 to 4 Evaluation Model [20]. Figure 6
presents this schema. At Level 1, the school should solicit
regular feedback to improve the curricular, instructional,
and support systems of the program. Consultation with
learners at various stages of the program in formal or
informal ways, written or oral format can provide the data
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.

Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74 10

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Figure 5. Miller's pyramid [23]
Formative evaluation at Level 2 is done to improve
instruction and guide learners on their progress. Table 4
cites the blueprint of evaluating critical appraisals as a
sample of formative Level 2 evaluation. Summative
evaluation is done at the end of instruction and
accompanied by the issuance of performance ratings.
Different types of examinations from written to oral,
practical, and clinical evaluations are done at this level [18].
Table 4 shows a sample of this evaluation using the intern's
management plans. Level 3 evaluation looks at how learners
have applied their learning to their actual workplace.
Behavior Evaluation is what OBE is after because it records
the performance of learners in their workplace like the
laboratory, community, clinics, and hospital settings and its
effects on the learners themselves. Results evaluation looks
at the long-term effects of the program to the community,
school, and society. This evaluation is done at the
institutional level to guide HEIs how to sustain their
programs for quality assurance. If satisfactory, Level 4
evaluation provides justification for program and
institutional accreditations. CHED came up with a list of key
result areas (KRAs) for Level 4 Evaluation. These KRAs and
their corresponding indicators of performance are
presented below [12]:
a. Governance and management: governance,
management, and enabling features
b. Quality of teaching and learning: setting and
achieving program standards, faculty profile, and
setting and achieving program standards
c. Quality of professional exposure, research, and
creative work
d. Support for students: equity and access and
student services
e. Relations with the community: relevance of
programs, networking and linkages, extension
programs
12
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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
age and prescribes the use of information and
communication technology (ICT). Combination of virtual
and real learning environments should be designed to
provide students expanded opportunities for learning at
the highest level. These compose the logistics and resource
components in Figure 3. Table 4 suggests that the Journal
Club transform the traditional classroom into a small group
discussion venue, the information highway, and virtual
clinical settings suggested by each case featured in class.
9. Management and administration of the
curriculum
Aside from the learning environment, management and
administration of the curriculum compose the support
system the OBE systems framework mentioned in Figure 3.
This includes performance credentialing, culminating
achievement, criterion validation, and collaborative
structure [13]. In consistency with PQF, educational
credentials will be evaluated using the same international
standards and the documentation of students'
performance cannot be overemphasized. As presented in
Figure 3, the actual delivery of instruction should be as good
as the documentation so that the students' records,
transcripts, and grades will be accurately recorded and
credited. Administrative personnel proficient in using ICT is
a requirement for this component.
10. Communication of the curriculum to all
stakeholders
In the Philippine setting, displaying in tarpaulins,
posters, and social network the outstanding performance
of graduates in the licensure examination is a common
practice. While this certainly shows the initiative of the
school in communicating the effect of its curriculum, it
could be said that this is just at Level 2 evaluation. To Frenk,
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 best way to communicate the impact of the curriculum
is by establishing the matching between population health
problems and how they are solved and addressed by the
graduates of educational institutions. This can be achieved
by tracking the graduates, locating them, determining their
present professional careers, and report them to the
school's stakeholders. In the Philippines, shifting to OBE
should give the communities the aspiration that schools
can after all, be instrumental in solving the country's
population health problems.
Conclusions
Outcome-based education is now part of the political
mandate of the Philippines to keep it attuned with the
ASEAN and global community. RA 10533, EO 83, CMO 46,
and CMO 20 among others instruct higher education
institutions to develop programs that will adequately
prepare students to acquire learning outcomes and
competencies required by their professions.
OBE is a curriculum and instructional design, as well as
systems framework. It is designed to meet the challenges of
the 21st century countries, with their respective population
health problems, changing demographics, and external
environments particularly in the ASEAN region. It is also
perceived as the type of educational reform that can match
Phil J Health Res Dev March 2015 Vol.19 No.1, 60-74
the Philippines's perennial problem of mismatch between
what is needed in the labor market and what the schools
produce in their graduates.
Central to OBE are learning outcomes that students
should be able to acquire during their educational
experience. From these outcomes, the course objectives,
content, teaching-learning strategies and instructional
resources, evaluation, and management components
emanate. The design makes use of higher order thinking
skills and requires students to practice their future
profession in the classroom that is converted into a
workplace.
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