TITLE OF INNOVATION :

SELF – DIRECTED LEARNING PROGRAM for RESIDENCY TRAINING

Department of Rehabilitation Medicine
College of Medicine – Philippine General Hospital
University of the Philippines Manila

THEORETICAL BASIS :

The basic assumption is that the residents are adult learners and therefore
possess the following characteristics :
1. The residents are becoming more mature, developing balanced
judgments about themselves and others and enjoy increasing
independence
2. They are in a continuing process of growth, not at the start of a
process
3. They bring with them a package of experience and values
4. They come to education with intentions
5. They bring expectations about the learning process, require active
involvement in learning and need clear goals and objectives to be set
6. They have their own patterns of learning

DESCRIPTION OF INNOVATION / METHODS USED :

For the past several years, the residents were complaining that the skills and
knowledge base required to complete residency were overwhelming
considering that the time allotted for studying was almost always eaten up
by patient load and other services provided by the resident to the hospital. In
addition, the residents perceived that there were too many lectures to
attend. Also, the coverage of the quarterly written and oral examinations
given was too broad such that most of the time only superficial learning was
acquired by the resident. Acknowledging that the teaching learning activities
could be improved, the department faculty discussed ways to provide a more
conducive learning environment to the residents. Among the innovations
introduced were :
1. Introduction of 24 conditions / topics which required proper skills,
knowledge and attitudes most essential to Rehabilitation Medicine
2. Arrangement of the conditions / topics from simple to complex, general
to specific ( see Table 1 )
3. Development of learning modules identifying competencies for the 24
conditions / topics identified
4. Shift from a lecture based teaching method to self – directed learning.
This move increased the resident’s time for self-study and made his
schedule more flexible
5. The clinical faculty facilitated integration of learning
 6. Focus and flexibility in assessment of competencies. The resident set
his own study schedule based on the time frames set for each module
(see Table 2 ). Competencies are assessed through theoretical and
clinical evaluations by the department faculty. The resident is given a
six-week leeway and 3 chances to submit himself for and to complete
the evaluation. He needs to pass Learning Module 1 before he can take
the examination for Learning Module 2 and so on until he completes
Learning Module 24 ( Figure 1 )

SIGNIFICANCE :

The Self-Directed Learning Program was designed in order for the

Rehabilitation Medicine residents to achieve excellence in training, research
and service through the provision of appropriate learning environment in an
institution where :
1. Training and research must not interfere with service
2. Manpower is limited
3. Time management is essential
4. Evaluation and promotion is competency based
5. Motivation for learning should be more intrinsic than extrinsic

FEEDBACK FROM THE RESIDENTS :

1. Learning modules train residents to pace their readings

2. Learning modules give a structure on what to study
3. Present curriculum is more challenging
4. Able to focus on what to study at a particular period of training
5. Learning is more complete
6. Better if this system was introduced earlier
 APPENDIX 1
Overview of the Rehabilitation Medicine Residents’ Rotation

The resident shall be rotating on a quarterly basis at the Department of Out-

Patient Services (DOPS) , Rehabilitation Ward, Ward Referral Service and
Neuromuscular Services and he/she shall:
1. Present a complete and appropriate patient census, history and
physical examination, physiatric evaluation and management pertinent
to the service rotation
2. Initiate discussion and seek guidance from the service consultant /
faculty on perceived difficult cases pertinent to the rotation

The consultant / faculty shall act as moderator, preceptor or facilitator of the

resident’s learning through :
1. Team conferences, clinics and patient rounds in relation to patient care
2. End of rotation written and/or clinical evaluation pertinent to the
service rotation

Grading System

Parameter Percent (%)

Self – directed Learning Written / Oral Examination 30
Quarterly Evaluation per Service Rotation 25
Case Management / Inter-departmental Conference 15
Presentation
Attitude Assessment 20
Research 10
Total 100

Note : Passing grade is 75%

Promotion to next year Level or graduation will require:
• Compliance with all departmental requirements
• Completion of research paper, protocol, or case report pertinent to
year level
 TABLE 1. Learning Modules in Physical Medicine and
Rehabilitation

Modul Topic
e
1 Physiatric Evaluation : Adult and Pediatric History and Physical
Examination
2 Physiatric Prescription : Therapeutic Modalities
3 Physiatric Prescription : Therapeutic Exercises
4 Kinesiology of the Upper Extremities
5 Kinesiology of the Lower Extremities
6 Kinesiology of the Temporomandibular Joint and Spine
7 Posture, Equilibrium, Normal and Abnormal Gait
8 Arthritides and Connective Tissue Disorders
9 Musculoskeletal Disorders of the Cervical/Thoracic Spine and Upper
Extremities
10 Musculoskeletal Disorders of the Pelvis, Lumbar Spine and Lower
Extremities
11 Congenital and Acquired Central Nervous System Disorders,
Spasticity
12 Congenital and Acquired Central Nervous System Disorders,
Neurogenic Bladder and Bowel
13 Motor Neuron Disorders, Neuromuscular Junction Diseases and
Myopathies
14 Electrodiagnosis, Neuropathies and Plexopathies
15 Muscle Pain and Chronic Pain Syndromes
16 Burn
17 Geriatric Rehabilitation, Immobilization and Deconditioning,
Osteoporosis
18 Cancer, HIV, AIDS
19 Cardiac and Pulmonary Conditions
20 Pediatric Conditions
21 Sports Medicine, Occupational/Industrial Rehabilitation
22 Orthotics, Wheelchairs and Assistive Devices
23 Amputation and Prosthetics
24 Visual and Vestibular Rehabilitation
 TABLE 2. Study Period and Evaluation Schedule
STUDY PERIOD MODULE EVALUATION
Theoretical Clinical
June 15 – June 29 1 June 30
June 30 – July 14 2 July 15
July 15 – July 29 3 July 30
July 30 – August 13 4 August 14
August 14 – August 28 5 August 29
August 29 – September 12 6 September 13 September 15 –
September 13 – September 7 September 28 September 30
27
September 28 – October 8 October 16
15
October 16 – October 30 9 October 31 November 15 –
October 31 – November 14 10 November 15 November 30
November 15 – November 11 November 30
29
November 30 – December 12 December 15
14
December 15 – December 13 December 30
29 February 1 –
December 30 – January 14 14 January 15 February 15
January 15 – January 29 15 January 30
January 30 – February 14 16 February 15
February 15 – March 1 17 March 2
March 2 – March 15 18 March 16
March 16 – March 30 19 March 31 March 15- March
30
March 31 – April 14 20 April 15
April 15 – April 29 21 April 30
April 30 - May 14 22 May 15 May 15 – May 30
May 15 – May 29 23 May 30
May 30 – June 13 24 June 14 July 15- July 30

Written Evaluation

>75% <75%
Written re-
Move on to next evaluation in 2
topic weeks

>75% Move on to <75% FAILING

next topic MARK*

*FAILING MARK

1. A resident who fails in the written evaluation of Physiatric Evaluation and

Prescription ( Learning Modules 1-3 ) will not be allowed to “ move on “ until
he/she gets a rating of 75%. If the resident is still unable to attain a 75%
mark after 1 month of tutorials and repeat written examination, the resident
shall be considered for possible dropping from the training program
2. A resident who fails in any 8 of the remaining 21 Learning Modules shall be
considered for possible dropping from the training program
3. A resident who fails in any 4 of the remaining 21 Learning Modules shall be
considered on probationary status
 Clinical Evaluation

>75% <75%
PASS FAIL*

*A resident who fails once or in any one of the clinical evaluations shall be
recommended for probationary status or dropping after due process, faculty
deliberation

FIGURE 1. MECHANICS of the RESIDENT EVALUATION