Status of pediatric education in the Philippines

Media

Part of The Journal of the Philippine Medical Association

Title: Status of pediatric education in the Philippines
Creator: Del Mundo, Fe
Language: English
Source: Volume 52 (Issue Nos. 3-4) March-April 1976
Year: 1976
Subject: Pediatrics -- Philippines; Medical education; Pediatricians; Social indicators
Rights
Fulltext: Stauts of Pediatric Education in the Philippines * **Medlcal Director, Children's Medical Cen ter Philippines. 'Read in the Confethance on Pediatric Prob lems in Tropical Countries sponsored by South Asian Regional Seminar on Tropical Medicine and Public Health (SEAMEO), Bangkok, Thailand, November 27, 1975. FE DEL MUNDO, M.A., M.D.— MEDICAL AUTHORITIES and educa tors in the Philippines have in recent years been more encouragingly respon sive than in the past, to the increasing requirements of Pediatrics in the medic al curriculum. It has taken time and ef fort to attain these aspirations for Pe diatrics but now favorable and encour aging trends are evident. In this country, four important con ferences have favorably influenced the teaching of Pediatrics: namely, the Pe diatric Education Seminar of the West ern Pacific Region, WHO, in February 1967 the First and Second National Con ference on Medical Education under the asupices of the Association of Philippine Medical Colleges (APMC) in 1968 and 1972 respectively, with logistic support from the Josiah Macy Foundation: and the Nutrition Seminar for Medical Edu cators in 197?, also under the auspices of APMC. These conferences have, di rectly or indirectly, accelerated revision and changes in pediatric education, with ** fruitful and far-reaching effects. An outstanding factor in the progress of Philippine pediatric education has been the Philippine Pediatric Society, with its annual conventions, its Qualifying Board, and its varied activities to upgrade the teaching and practice of pediatrics. Social awareness and involvement in communities now pervade all disciplines. Medical education in general, but pedia trics in particular, has been very much influenced by this trend. Concern for the rural population has increased, al though implementation of measures in their behalf has not been as fruitful as desired and hoped. In the Philippines, noteworthy is the fact that the nine medical schools (two were opened in 1975), collectively and individually have taken valuable meas ures and formulated revisions and re commendations to upgrade pediatric edu cation . BACKGROUND Significant in justifying changes in pediatric education in the Philippine are day to day observations on trends in the country as well as information obtained from current Philippine Health Statis tics and Demographic Data thus: 67 68 del Mundo March-April, 1976 J. P. M. A Table I. HEALTH AND DEMOGRAPHIC DATA PHILIPPINES, 1973 Total Population Total children under 15 (43% of the total population) Registered Births Ave. birth rate (1963-73) Crude death rate Growth rate Fertility rate Infant Mortality rate 40,219,000 17,385,000 1,049,290 26.1/100 live-births 7.0 2.8% 119.9% 64.7/1000 live-birifchs The latest statistics show a total of 17,385,000 children under 15 years or 43% of the total population, as compared to 25% in developed countries. The average birth rate for the past 10 years (1963-1973) is 26.1 per 1000 popu lation. The figure 1,049,290 represents the total number of births registered in 1973. Of this number, 49 .6% did not have the benefits of medical attendance. Among those who were medically at tended 45.4% were delivered by physi cians; 6.2% by nurses and 48.4% by midwives. In 1973, 23.3% were delivered in hospitals while 76.7% were home de liveries. The neonatal mortality rate is 32.5 per 1000 (Table II) which is 2 to 3 times that of developed countries. It has also been noted that pre-school mortality rate in the Philippines is 60 to 80 times that of Australia and New Zealand. It is accepted that pre-school mortality rates are more sensitive indices of the socio-economic status of a country and the efficiency and organization of child health services than the infant mortal ity rates. Table II. NATALITY STATISTICS, PHILIPPINES 1973 Neonatal Mortality Rate Maternal death Tate Birth attendance Assisted by Physicians Nurses Midwives Place of birth In hospitals Home deliveries 30.3/1000 1.4% 57.3% of births 45.4% 3.9% 24.3% 23.3% 76.7% Volume 52 Nos. 3-4 Although the present maternal death rate of 1.3% was reduced by 83.3% in the past 50 years, this rate is still three times that of progressive countries. Medical Manpower There are approximately 13,600 active physicians in the Philippines today. More than half are based in the cities. Onethird are concentrated in Metropolitan Manila. Overall ratio in 1970 was approximate ly 1 physician per 2,800 population. Mal distribution continues to be a serious Pediatric Education 69 problem and the solution to medical man power loss is far from satisfactory. A compulsory six-month service in rural areas before granting medical licensure may to some extent help our masses. The bulk of pediatric practice in the Philippines is in the hands of the gen eral practitioner. The majority of those who limit their practice to pediatrics or who spend considerable time to children, are registered in the Philippine Pediatric Society and so the membership of this Society may well be taken as represent ing the pediatric manpower supply of the country. Table ni. PHILIPPINE PEDIATRIC SOCIETY MEMBERSHIP 1975 Total Members Classification: Fellows 111 Specialists 109 Active 266 Affiliate fellows 8 Associates 70 Distribution Greater Manila 435 Provinces 129 The maldistribution of physicians who have had additional training in Pediatrics and Child Health is evident. Thus 4/5 of pediatricians are in and around Mani la while 1/5 are spread in the rest of the country. Some countries have reported a ratio of 1 pediatrician to 1000 child ren. In the Philippines the average pro portion is approximately 1:30,000 child ren. Table IV. RATIO OF REGISTERED PEDIATRICIANS TO CHILDREN, PHILIPPINES (1975) Number of Pediatricians Registered in PPS Ratio Greater Manila 2,602,200 435 1:6000 Provinces 14,200,000 129 1:110,000 Total Average 16,802,200 564 1: 29,800 70 del Mundo UNDERGRADUATE PEDIATRIC EDUCATION In recent years both the status and hours allocated to Pediatrics in the me dical curriculum have improved signific antly (Tables VI, VII, and VIII). To a large extent these have resulted from recommendations of medical education seminars and conference previously mentioned. Fundamental Principles One of the guiding principles in thepreparation of the pediatric curriculum in the nine medical schools of the coun try, is the basic objective of a medical school in the Philippines as defined in the First National Conference on Me dical Education, thus: “The basic objective of a medical school is the production of a basic physician, that is, one who is well rounded in all aspects of medicine, who can take care March-April r \97& J. P. M. A of his patients adequately in general practice in his particular environment, and who is all prepared to take up any bianch of medical science after gradua tion.” Another fundamental principle is the realization of a need for comprehensive and continuing care of a growing and developing subject, highly sensitive and vulnerable to the environment. We subscribe to the central concept of pe diatrics and child health as a concern for normal child development; that the stu dent should be introduced to the study of growth and development (physical, intellectual, emotional and social) and those factors which cause significant de viations from the accepted norms. Apportionment of Clinic Hours It is encouraging to note that present ly Pediatrics ranks third (Table VII) in the apportioning of total cHnrc hours and this comes close to Surgery. Table V. *HOURS IN MEDICAL SCHOOLS, PHILIPPINES (197<V Total hours 4,000 ** Apportioned into Basic 1/3 Clinical 2/3 Apportionment of Clinic Hours Medicine 30 — 32% Surgery 20 — 22% Pediatrics 15 — 18% OB-Gyn 12 — 15% Psychiatry & Neurology 10 — 12% EENT 5 — 8% *From the Association of Philippine Medical Cofleges (APMC) *Excluding the 2 months of full clinical clerkship in Pediatrics and the duties at night, also Sundays and holidays. Volume 52 Nos. 3-« Pediatric Education 71 It is also an observation that a good portion of Community Medicine is taken up by Pediatrics since children constitute about 47% of the population in most Table VI. IVTH YEAR 10-12 Medicine Surgical Pediatrics OB-Gyn Psychiatry Community Medicine EENT communities. Further as recommended by the WHO Pediatric Education Semi nar, Pediatrics is integrated with the other clinical disciplines. MONTHS ROTATING FULL-TIME CLERKSHIP1' 3 months 2 — 21/2 months 2 months 1 — 11/2 months 1 month 1 month (extramural) 1/2 — 1 month (APMC) program schedule as follows?: All the medicel schools presently give much more than the recommended 300 hours; some have more than doubled the time for Pediatrics, which also is started earlier, with the basic Subjects. Table VIII. TIME ALLOTED TO PEDIATRIC (1973-75) MCU FEU UP CIM U * E OST swu First 3 years 204 169 137 170 168 197 94 Fotirth Year 2 mo. 2 mo. 2 mo. 11/2 mo. 2 mo. 2 mo. 2 mo. (Clerkship) Total Pediatric hours 650 432 549 Total hours medical curric. 4815 5468 4104 *rrom the Association of Philippine Medical Colleges The number of hours alloted to under graduate pediatric teaching as recom mended by different pediatric education seminars are 300 to 400 hours excluding of the internship period. The 1963 con ference in Manila suggested a minimum Students and Faculty members The student enrollment in medical schools has been reduced in recent years so that classes are now less congested than in the past. Nevertheless there are still more students than abroad * so that three sections per year with 40 to 50 students each, are still observed. Table IX. ENROLLMENT IN MEDICAL SCHOOLS, PHILIPPINES Medical School Univ, of Sto. Tomas Univ, of the Philippines Manila Central Univ. Far Eastern Univ. Southwestern Univ. Univ, of the East Cebu Inst, of Med. Ave. Undergraduate Med. Students Per Academic Year 1968-73 1,250 400 825 1,150 950 850 725 Freshmen Quota 300 None; usually 85-100 200 but will admit 100 in 1974-75 300 100 beginning 1974-75 300 but admits 250-270 200 72 del Mundo The proportion of faculty to students is still unsatisfactory. To some extent this had been improved by affiliating with some accredited teaching hospitals and providing pediatric supervisors from the medical school. This has also increased bed capacity for teaching purposes. Full time staff have been appointed in 4 schools while in 3 schools all teaching staff are on part time basis. The salaries of the staff leave much to be desired and in fact are unrealistic to current cost of living; hence it is not easy to obtain full time staff. Topics, Time alloted, and methods The departments of Pediatrics of the seven medical schools have availed of a list of topics and time per topic as re commended by a Committee of the APMC in its First National Conference on Medical Education (Annex A). De tails as to methods and on what year to take them up have been left to each school. Topics that have been allocated more hours are as follows: Characteristics and Problems of Vari ous Age Periods (up to 14 hrs.) Growth and Development (6 to 14 hours) Physiology and diseases of the new born (6 to 16 hours) Communicable Diseases (20 to 30 hours) Digestive System (4 to 15 hours) The trend is to introduce Pediatrics earlier in the second year, starting with such topics as Growth and Development, Genetics, Nutrition and Social and Pre ventive Pediatrics. Steps have been taken to integrate Pediatrics into some of the basic subjects and other clinical disciplines. Didactic lectures have been reduced in March-Aprlt, 1976 J. P. M. A. favour of bedside and extramural acti vities. Preceptorship of small groups is commonly observed. Assignment with pay patients has been started in at least one school. Health education of parents and teach ing them some procedures in the care of sick children are activities of medical students in the hospital or in communi ty projects. Family planning and maternal and child health have been emphasized both in urban and rural setting so that me dical students now have opportunities to do motivational work and give family planning services. A health center in an urban poor lo cality or in a rural area is now under a medical school and child care in such a center is under a staff of the Depart ment of Pediatrics. Although the past three years have been years of adjustment and revisions to meet the new 4 year medical curricu lum (Annex B), it may be said that there have been aggressive and positive steps to tailor pediatric curriculum to Philip pine needs. Research A deplorable aspect in medical educa tion in the Philippines is the lack of in centives for students or faculty to do commendable research work. Student re search is encouraged in 3 schools and the students themselves have taken the ini tiative of developing a research fund. The Philippine Pediatric Society during its annual convention offers research contents, a motivating factor to do re search. One company awards a yearly research fellowship per school which may be for Pediatrics. Votame 52 Nos. 3-4 Evaluation of Students There has been very little change in the evaluation of medical students; we still depend to a large extent on exa minations and recitations and at times evaluation of preceptors. In the clinical years, presentation of cases, participation in conferences and performance in patient care are assessed. A final qualifying examination is given at the end of clerkship. Oral examina tions have been discontinued. The Medical Board Examination to some extent allows individual evalua tion of students and a comparison of stu dents from the different schools. A Pediatric Residency Training Pro gram usually consists of 3 to 4 years training in the Department of Pediatrics of a University hospital or in some ac credited training center or hospital un der a certified Fellow in Pediatrics. As formal residency programs are limited to teaching hospitals in bigger cities, there are not enough opening for all graduates who wish to specialize in Pe diatrics. Therefore, a big number of graduates start a year or two in any local hospital but subsequently leave for abroad. In fact even residents in uni versity and teaching hospitals seldom re main longer than one or two years in the country. Pediatrics is one of the most popular fields among graduates who leave. Unfortunately those who return to practice can be counted with the fin gers. Some information on residencies in the seven Philippine medical schools are summarized in Table X. An example of a residency training program leading to a specialist certific ate of the Philippine Pediatric Society Pediatric Education 73 is summarized in Table XI and the dis tribution of residents’ assignments in the 3 or 4 years residency program is shown in Annex C. It is gratifying to note that those who complete 3 to 4 years under a residency training program in the country succeed as pediatricians whereever they practice, particularly when the practice is outside of Greater Manila. POST-GRADUATE AND CONTINUING PEDIATRIC EDUCATION During the one-year rotating intern ship after the M.D. degree is confer red, a two-month assignment in Pedia trics may be considered as a post-gradu ate course before licensure of practice. This prepares the physician for general practice, of which 40% to 60% is pedia trics. Since 1968 the University of the Phi lippines has given 2 to 3 week annual courses in Pediatrics for practitioners. The University of Sto. Tomas has also given such courses since 1971; the FEU started a Community Pediatrics Course with Community Obstetrics last year. Hie other schools give annually short courses for their own alumni. Medical societies have offered half to one-day courses in pediatrics for practi? tioners. In fact pediatric refresher cours es are popularly requested by practitio ners and the Philippine Pediatric Society has annual courses in different regions of the country. SUMMARY AND CONCLUSIONS While Pediatrics or Child Health has been recognized as an autonomous de partment in all the medical schools in the Philippines for about 50 years now, significant gains have been attained only in the past eight years, following a Pe74 del Mundo Aarch-April, 1976 J. P. M. A. o c b- © b" RIC RESIDENCY TRAINING PROGRAMS IN UNIVERSITY HOSPITALS, PHILIPPINES 1974 a P I 8 >» >• 8 § § s p s s 3 8 8 I CM iH © CM o co £ CD 8 bi 2 to •rA T5 03 CO VI th CD >< a co rH 8 £ O 1/5 3 44 CD CD bi £ § £ w> 0) £ 00 © 00 co CM M 8 t X 8 JS £ 8 •§ £ in CD <s> 40 in CM co $ eM s 8 T5 CM £ 00 CM s T—i 8 O co 8 t-I © £ 8 T? LO gm co * Volume 55 Nos. 3-4 Pediatric Education 75 Table XI. A PEDIATRIC RESIDENCY TRAINING PROGRAM * (3 or 4 YEARS) I. Clinical Training A. General Pediatrics (b. Pay 1. In-Patients (a. Service (b. Pay 2. Out-Patients (a. Service B. Care of Newborn Infants General Nursery Neonatal Intensive Care Unit (NICU) C. Preventive Pediatrics Child Health Clinic School Health Service D. Outpatient Subspecialty Clinics 1. In the hospital Neurology Hematology Allergy Cardiology Radiology Surgery Pathology II. Clinical Laboratory for Pediatric Procedures m. Community Pediatrics — Attend a 3-week Course at the Institute of Maternal and Child Health for training in Maternal and Child Health and Family Planning, prior to — Community Health and Medical service (outside headquarters). 1. San Luis, Pampanga 55 Km. 2. Niugan, Malabon 10 Km. IV. Research and/or Case Report V. Teaching: Tutoring of affiliate medical students •At the Children’s Medical Center Philippines. 76 del Mundo diatric Education Seminar in the Region under the auspices of World Health Or ganization in 1968, two National Con ferences on Medical Education in 1968 and 1972, and a Conference on the teach ing of Nutrition in Medical Schools, the last three assisted by the Josiah Macy Jr. Foundation, through the Association of Philippine Medical Colleges. Worthy of mention among recent changes in undergraduate pediatric education are: — More teaching hours for Pedia trics ] Child Health, above the recommended 300 or 400 hours so that some schools are giving up to 800 or more hours. — Introduction of the subject earlier in the medical curriculum, mostly in the second year or even in the first year. — Full time staff so that only two schools have none; before 1968 practically there were no full time staff in any of the schools. — Classes are small and more ma nageable as a result of a reduc tion of total enrollment for pur poses of accreditation. Whereas there were 200 to 250 students taking up pediatrics per year, the number has diminished to less than half so that there are only 2 or at most 3 sections instead of 5 or 6 sections per class. — Closer relations and integration in the basic subjects as well as cli nical departments are now imple mented. — Community pediatrics is very much emphasized so that extramural teaching and community involve ment have increased strikingly. In March-April, 1974 J. P. M. A this connection: * Medical schools have communi ty projects both in urban poor and rural areas with one center under its charge and a pediatrician staff supervising child care. * Maternal and Child Health and Family Planning have received special attention with the students and residents actively participat ing.. * Nutrition is now taught with greater emphasis and more at tention given to practical aspects and current problems. — Almost all of the Pediatric facul ty members have undergone teacher training courses including live-in and sensitivity training. — Evaluation methods have been de vised which include minimum pass level and quartile deviation; stu dent counselling by faculty advi sers concerning problems on scho lastic performance and related contributory factors; the use of standard performance evaluation sheets, feedback evaluators of the services and staff by the students and periodic assessment of the se nior students totality of knowledge in clinical pediatrics though an oral and written exams at the end of their pediatric training. In the residency training programs, there are more systematic programs. Extramural activities constitute an im portant part of the program. Re idents have been increased an stipends are slightly more reasonable. Evaluation methods have been improved. As regards post-graduate and continnVolume 52 Mos. 3-4 Pediatric Education 77 ANNEX A PEDIATRIC TOPICS AND TIME ALLOTED Subject Matter Time Allotment in Different Schools Rec. by APMC * MCU FED UP CIM UB US® swu Characteristics & Problems of Various Age Periods 4 12 1 1 9 2 14 2 Physiology & Dis. of Newborn 12 16 11 9 13 6 16 8 Social Pediatrics Including Family Planning 3 2 8 3 0 4 5 4 Preventive Pediatrics 2 3 2 4 3 5 2 Growth & Development 10 11 9 10 6 13 14 6 Genetics 3 2 1 5 3 2 History Taking & P. E. 4 2 12 3 6 1 4 Therapeutics & Pediatric Procedures 3 8 5 3 1 3 Infant Feeding & Problems 6 5 6 3 6 12 6 6 Nutrition &. Its Disturbances 6 7 6 2 7 12 6 8 Psychopathologic Problems 3 4 2 4 3 2 Fluid & Electrolyte 5 7 5 3 7 7 7 4 8 Communicable Diseases 25 20 30 Respiratory System 6 15 13 5 11 1 3 4 Digestive System 5 15 10 4 6 9 7 6 Genito-Urinary 5 9 7 4 4 1 3 4 Nervous System & Convulsive Disorders 10 10 6 5 10 1 3 6 Cardiovascular Disease 8 10 9 11 6 8 3 4 Blood & Blood Forming Organs 6 10 6 5 6 4 3 5 Inborn Errors of Metabolism 2 2 5 2 7 2 0 3 Collagen Diseases 2 6 2 3 0 0 3 2 The Skin 2 4 0 2 4 0 1 Musculoskeletal System 2 2 0 3 6 0 2 Neoplasms 2 4 0 6 1 2 2 Pediatric Emergencies 5 2 3 1 1 1 Allergy Immunology 4 0 5 7 4 0 1 Endocrine Glands 5 8 5 7 14 3 3 2 Spleen, Thymus, & R-E System 4 2 5 1 7 1 3 2 Unclassified Diseases 2 2 9 Total Hours 203 161 132 162 101 100 114 *First National Conference on Medical Education. Asso elation of Philippine Medical Colleges 1968. March-April, 1976 J. P. M. A. 78 del Mundo ANNEX B REQUIREMENTS FOR M.D. IN THE PHILIPPINES (1972) — Baccalaureate Degree: 4 years AB or BS — Four years in a recognized Medical School, the 4th year of which is 10 to 12 months full clerkship with 24 hour duties, including Sundays and holidays. — M.D. degree is conferred — One year rotating internship in a hospital or medical eenter accredited by the Board of Medical Education. — Licensure Examination to qualify for practice — Six months of service in rural areas under the auspices of the Department of Health before the Certificate of Licensure is awarded. ing education, the rotating internship after the M.D. degree has added to the practice and experience of the new gradu ate before practice. A rural assignment of 6 months by the Department of Health exposes the new graduate to community medicine and public health, both for service and gain ing experience on practice in less privil eged areas. The problems encountered show that there are still many steps and measures to take before reaching close to satis? factory pediatric education, the principal problems of which are logistics, materials and teaching aids; large classes; lack of full time and more staff resulting in in adequate supervision; and implementa tion of satisfactory evaluation of stu dents, staff, and school. ACKNOWLEDGEMENT The author acknowledges with deep appreciation the help extended by Dr. Jo$q Cuyegkeng, Executive Director of the Association of Philippine Medical Colleges (APMC) for valuable data, in formation and APMC reference books on Medical Education in th© country. Dr. Leticia S. Cordero of the Far East ern University and Dr. Juanita Yadao of the Children’s Medical Center Philip pines, helped gather data from medical schools and some teaching hospitals. Dr. Franz Rosa, MCH Adviser of WHO Western Pacific Region made available some WHO references on medical ed ucation. This paper would not have been pos sible without the valuable cooperation of the chairmen and assistants of Pe diatrics of tliA seven medical schools^ namely: Dr. R. G. Arellano of the Uni versity of Sto. Tomas; Drs. L. Mafrilangan and R. Mendoza of the University of the Philippines; Dr. Pablo Abella of the Southwestern University in Ctebu City; Dr. S. Alikpala of the University of the East; Dr. L. Cordero of Far East ern University; and Dr. Purification Es pinosa of the Cebu Institute of Med cine^ and Dr. Rosita C. Brillaptes of the Ma nila Central University. Volume 51 N.:s. 3-4 Pediatric Education 79 Q < 3 O O rH 03 rd 03 S >> cd S & x Z 's "cd ’S X o •rK .s G & co ci 5 co Radiology Allergy-PGH (2 weeks) Neurology-UE or PGH (2 weeks) X cd Q <u 8 £ > .s 8 5 cd oo co in cd r- <x> CO* 'CH in <D vi L* □ O ’£ o O CD tJ 3 2 <3 on c 'c cd F—< >» ci cx5 ci 80 del Mundo March-April, W7* X P. M. A. 10. Clinical Laboratory 10. Subspecialty Clinics 10. Elective (1 month) Hematology Infectious Diseases Cardiology SLH (2 weeks) I 5 42 c Q I £ Q 2 Volume 52 Nos. 3-4 Pediatric Education 81 Q ■TRIG RESIDENCY TRAINING PROGRAM (THACHING HOSPITALS) Q 8 Q 75 t»n C cd £ ct> O Q r~1 T5 +-> l o £ o T—1 T~1 g CM > Cl in CT) cd T—I 'o5 4-> o J-i o g +-» 0 CO 0 CT> T—1 co 0 LO (N CT> co in cO +-> o +-» in in o in b- co r * S-( cd if i rd Tt< % 2 > 75 cd 3 I Q & o O 0 Cardiology : Cardiovascular : Cardiology — 88 : Cardiology : ER — 4,500 : Cardiology 5/m< March-April, J. P. M. A 82 del Mundo >» s-> b o — E Ct d 2 o O o c £ I. o X tC o .2 o T3 <D CO o to ’co tn 3 6 x> C rt E fl m 4u in o W) o a in T—< 1 fl .2 ’■fl in & a 03 n H4 CO fl in N >» o Oi >-> S ‘fl o +-> CO S fl ^4 X ‘45 o s o E cT o o o o o in o £ r o q o o 5 ?0 o o o o o 00 in | o Ln rH o rH 1 & 1 & 4-» o X •2 o bJO £ o CD o X Cfl 5 < cu t* 3 .2 fl 3 'fl C/1 42 fl 3 c/1 >-» O o o I « to 00 + + w O *01 2 o a o •fl fl *s fl a X fl <D X fl o X fl X <d ’fl 4-» .2 jfl i -M C/1 ■g 'E fl JD E fl 3 *cn C/1 ’43 rH O1 co 05 co in 3 Z <D & fl »8 fl 0 CO oi co in CO . Duration : : s : : : Residency 4 years : 3 years : 3 years : 3 years : 4 years : 3 years Volume 52 Nos. 3-4 BIBLIOGRAPHY ). Cagas, C.R., Purugganan, H.G., and Abrio-Lopez, S.: Pediatric Education in tne Philippines Past Present Future, Phil. J. of Pediatrics, XX.764, 1971. 2. del Mundo, F.: Identifying and Meeting Priorities for Better Child Care In the Philippines, Phil. Jof Pediatrics, XX: 197, 1971. 3. Population. Produced by the National Media Pro duction Center, Manila, Philippines, 1973. 4. Papers and Proceedings of the First National Conference on Medical Education. Published by the Association of Philippine Medical Colleges, Manila, Philippines, 1969. 5. MacDonald, W.B.: Paediatric Education Priorities In Asia and the Western Pacific Regional, Aus tralian Pediatric Journal, Dec. 1967, 3:4-181. 6. Physician and Nurse Manpower Survey Report. Association of Philippine Medical Colleges, 1967. Pediatric Education 83 7. Philippine Health Statistics 1971. Disease Intelli gence Center, Department of Health, Manila. 8. Runaway Population. 1974 World Population Year. Produced by PIEO/NMPC, Manila. 9. del Mundo, F.: A Report on the Pediatric Edu cation Seminar Western Pacific Region, WHO, Manila. February 13 to 18, 1967, J. of the Phil. Med. Asso. 43:12, 976-978, Dec. 1967. 10. Report of the Meeting on Paediatric Education India World Healt hHouse, New Delhi, WHO Re gional Office for Southeast Asia. Oct. 1968. 11 Mettrop, G., M.D.: Future Pediatric Education. Undergraduate and Postgraduate. European Con ference on Paediatric Education. Netherlands, April 22-29. (Handout) 12. Keeve, PJ.: Observations of a Visiting Physician, Phil. J. of Pediatrics, V. XX, 158, 1971. 13 King, M (ed): Medical Care In Developing Coun tries, Oxford University Press: 1966.