Journal of the National Institute of Public Health 2015

Vol.64 No.5 p.511−517＜Practice Report＞
Competency-led overseas field training programby team in the Philippines
Jonathan P. Guevarra 1 ），Nobuyoshi Watahiki 2 ）Department of Health Promotion and Education, College of Public Health, University of the Philippines Manila
Department of International Health and Collaboration, National Institute of Public Health1）2）

Abstract
In order to improve competency items in public health using the team learning approach, a fieldtraining program of the National Institute of Public Health (NIPH), Japan was conducted in thePhilippines in collaboration with the College of Public Health (CPH), University of the Philippines Manila(UPM).
This field training was carried out by the trainees of International Health Course at the National
Institute of Public Health, Japan using problem-solving approach for six weeks. Moreover, an over-all
evaluation of the overseas field training program was done, and pre- and post- tests were also conducted
to assess the achievement of the field practice objectives using six specific behavioral objectives (SBOs).
The overall review of the field practice showed that its contents, usefulness and subject (understanding
for field training), teamwork and instruction were highly evaluated. However, a few team members feltthat there was still room for improvement for teamwork and instruction. Using the six-point scale of each
SBO in the pre- and post-tests, the trainees rated themselves to have improved in all of the SBOs in termsof enhancing their knowledge and skills.
The specific behavioral objectives are important measures to promote practical ways of thinking aboutproblem solving. Providing a learning opportunity and achieving the objectives set as a team in the fieldpractice was found helpful in improving the traineesʼ level of competencies.

keywords: competency-led, field practice by team, specific behavioral objectives, evaluation(accepted for publication, 5th September 2015)

I.

Introduction

The eight Millennium Development Goals (MDGs)
were enacted in 2000 to achieve world-wide action,equality, and justice by 2015. Major international
conferences held during the 1990s led to the MDGs.
Three of these Millennium Development Goals (MDG4:
reduce child mortality, MDG5: improve maternal health,and MDG6: combat HIV/AIDS, malaria, and otherdiseases) are directly related to health. However, thediversification of health problems under the impact ofhigh-speed social change is accompanied by changing
health needs of people, and it seems to be difficult toachieve goals of MDGs by 2015, particularly in subSaharan Africa [1, 2].
In response to this changing situation, improving thequality of current health workers who are responsible forproviding good quality of health care services is an urgent
issue as part of heath care systems. And the WHO HealthReport 2006: Working Together for Health, presented
challenges to health workers, challenges which, it can beclaimed, are urgent and vital problems [3].
While referring to Master of Public Health (MPH)
equivalent course with concentration on International
Health at the National Institute of Public Health (NIPH)
intended to produce competent international healthprofessionals to deal with such circumstances, we
examined the most effective way of Overseas Field
Training Program from the perspective of competencybased education (trainees-centered with the degree ofacquisition of knowledge and skills suited to the working
situations, duties and roles as the units).

Corresponding author: Jonathan P. Guevarra
E-mail: jpguevarra2@up.edu.ph

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Jonathan P. GUEVARRA，Nobuyoshi WATAHIKI

II. Overseas Field Training Program byTeam
The training period of MPH equivalent with concentrationin International Health course, has been one year since2004 and was held for the seventh time in 2010. The
lectures and exercises of this course are conductedentirely in English. The number of trainees ranged from 5
to 11 (Table 1) and these are long-term JICA trainees,
WHO fellows and Japanese trainees. The Field Training
Program was held in Japan until 2005, but difficulties were
faced in Japan since English is the form of communicationin the field training program and this was noted to be ahindrance in achieving the objectives during theimplementation of the field training program. The Field
Training Program, therefore, has been held in thePhilippines with the cooperation of the College of Public
Health of the University of the Philippines Manila since
2006.
The Overseas Field Training Program is intended tohelp improve the qualities required by global publichealth professionals using a team-learning approach. In
particular the acquisition of learning objectives of theOverseas Field Training Program are based on 1) teamlearning, 2) process-oriented study, 3) facilitation skills, 4)team building, 5) leadership, and 6) communication skills.
The Overseas Field Training Program is conducted using
the team-based problem-solving approach composed oftrainees from different countries including Japan and fromvarious professions.

III. P l a n n i n g , I m p l e m e n t a t i o n , a n d
Evaluation of Overseas Field Training
Program1.

Planning and Implementation of Overseas Field
Training ProgramThis part explains the Overseas Field Training Program

Table 1

512

for 2006-2010. This program took a total of six weeks: fourweeks in preparation in Japan (National Institute of Public
Health) and two weeks of field training in the Philippines.
During the period of preparation in Japan, the backgroundto and goals of the overseas Field Training Program wereexplained to the trainees, with particular efforts made toaggressively urge them to take part in overseas Field
Training Program to achieve the learning objectives cited
above.
It included activities in the lecture hall and in the field.
In the lecture room, documents and Field Training
Program reports were used, field reports presented on
DVD, web-site searches conducted on the Internet andviews exchanged with the coordinator from the College of
Public Health of the University of the Philippines Manila,
and challenges facing public health in the Philippines
were identified and selected.
The purpose of the practice in the field in the Philippines
is to learn to work as a team to identify problems of publichealth importance, search for solutions, and offer
proposals in the field. Particular emphasis is placed not onfield work by individuals, but on trainees with different
cultural practices, knowledge, skills and experience
forming a team to solve address issues affecting thehealth of the public.
Table 1 shows that for the past 5 years (2006-2010) the
total number of trainees that underwent Field Training
Program is forty (40). Public health issues tackled by thetrainees were human resource development (2006),
training needs of midwives (2007), risk assessment of TB
transmission (2008), motivating factors behind highdelivery rates of the birthing facility (2009), and youth
smoking prevention program (2010).
2.

Evaluation of Overseas Field Training Program
An overall evaluation of the Overseas Field Training
Program was made based on individual evaluation madeby the trainees. In addition, trainees were also asked toOverseas Field Training Through the Years

Year

Title

No. of Trainees

2006

Human Resource Development in Rural Health Units and City Health Offices in thePhilippines

11

2007

Training Needs among Midwives in Two Cities in the Philippines

5

2008

Risk Assessment of TB Transmission in Health Centers of Marikina and Paranaque ,Philippines

10

2009

Investigating the Motivating Factors Behind High Delivery Rates of the Urban HEART
Birthing Facility in San Martin de Porres, Philippines

7

2010

Youth Smoking Prevention Program: Influence on Smoking Prevention Program Among
Secondary School Students in Paranaque City, Philippines

7

J. Natl. Inst. Public Health, 64（5）: 2015

Competency-led overseas field training program by team in the Philippines

rate themselves before and after the training using theSpecific Behavioral Objectives (SBOs), with six target
areas of educational achievement, which they need toachieve in the duration of their overseas field training.
Table 2 presents the traineesʼ evaluation of theoverseas training program. Regarding challenges andcontents of the Overseas Field Training, most replied“Very satisfied” and “Satisfied.” Concerning usefulness,most of the trainees responded either “Useful” or “Veryuseful.” When asked about the degree by which they
understood the subject, majority answered “Wellunderstood.” About the team work, the commonest
answer given by the trainees was “Good”. Finally,
regarding instruction, most trainees answered either“Good” or “Very good”.
The utilization of specific behavioral objectives started
in 2008 where only 4 objectives were used. From 20092010, six (6) specific behavioral objectives were used in
the Field Training Program. We added SBOs No. 3 andNo. 4 to intensify the process of field practice by a teamand contribute to solving the problem in the field throughlessons learned and traineesʼ individual reports of the fieldpractice. Only the results from 2009-2010 are included inthis report.
The six achievement goals which should be improved
through the Overseas Field Training Program are: 1. Able

to practice team work effectively with understanding andrespecting various backgrounds (occupations, specialty,
culture, etc.) of team members and different opinions; 2.
Able to find your own role positively and take the initiativein teamwork; 3. Able to conduct and manage activities
effectively in given conditions in the process designed; 4.
Able to set a theme to meet needs in the field after
considering intention of the authorities concerned; 5. Able
to select a productive problem-solving and tackle theproblem to be solved; and 6. Able to present (results andrecommendations) to the people concerned in the field byusing communication skills (by oral and paper) andconcepts. Six scales were used in rating the abovementioned goals which ranged from ①Do not know anyof the concepts and way of thinking, to ⑥Able to use therelated knowledge and skill comprehensively and review
critically and also instruct other persons). The evaluations
were carried out before and after the training.
The results show that despite some scattering,knowledge and technical skill levels in all achievement
goals were higher in the post-training evaluation results
than in the pre-training evaluation results. Most of the
trainees answered either 5 or 6 for all of the SBOs/level ofknowledge and skills in their post-training survey (Table
3).

Table 2 Evaluation of Overseas Field Training Program
2006

2007

2008

2009

2010

(n = 11)(n=4)(n = 10)

(n=7)

(n=7)

Challenges andVery satisfied

7

2

4

2

6

Contents

Satisfied

3

2

6

4

1

Dissatisfied

1

1

Very Dissatisfied
Usefulness

Very useful

7

6

2

5

Useful

3

4

4

5

2

7

Not very usefulNot useful at all
Subject

Well Understood

8

2

6

5

(Understanding

Understood

3

2

4

2

for Field Training)Not very understood
2

1

5

6

6

2

Could not understood
Team work

Very good

2

Good

7

Bad

2

2

Very good

5

5

2

5

Good

5

5

5

2

Bad

1

4

Very bad
Instruction

4

Very bad

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Jonathan P. GUEVARRA，Nobuyoshi WATAHIKI
Table 3

Changing Levels of Knowledge and Skills Concerning SBOs of Overseas Field Training in 2009 and 2010

SBOs / Level of knowledge and skills
1. Able to practice team work effectively with understanding and respecting various
backgrounds (occupations, specialty, cultures etc.) of team members and different
opinions.
2. Able to find your own role positively and take the initiative in teamwork.

3. Able to conduct and manage activities effectively in given conditions in the process
designed.

4. Able to set a theme to meet needs in the field after considering intention of theauthorities concerned.

5. Able to select a productive problem-solving and tackle the problem to be solved.

6. Able to present (results and recommendations) to the people concerned in thefield by using communication skills (by oral and paper) and concepts.

①
2009
(n=7)
2010
(n=7)
2009
(n=7)
2010
(n=7)
2009
(n=7)
2010
(n=7)
2009
(n=7)
2010
(n=7)
2009
(n=7)
2010
(n=7)
2009
(n=7)
2010
(n=7)

BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
BeforeAfter
Before
After

②
2

③

4
2

1
4

1
1
1

1
2
3
3
3
2

4
1
1
3
1
1
1
1
2
2
1
2

④
3
4
2
2
3
2
2
1
1
5
1
1
1
3
2
2
1
2
1
1
2
2
1

⑤
2
3
1
1
1
3
1
1
2
4

⑥

1
1
3
1
1
1
3

5

2
1
2
1
2

4

4
2
5
1

2
4
2

2
4

Level of knowledge and skills① Do not know the concept and the way of thinking at all.
② Know the concept and the way of thinking.
③ Understand the comprehensive concept, but cannot practice in the field.
④ Able to practice in the field if you have necessary support.
⑤ Able to practice in the field and explain to other persons.
⑥ Able to use the related knowledge and skill comprehensively and review criticallyand also instruct other persons.
SBOs: Specific Behavioral Objectives

IV. Discussion
The Overseas Field Training Program was
implemented using a problem-solving approach to a teamof diverse members such as trainees from various
countries including Japan and from a variety of occupation
areas. This problem-solving approach tackled certain
public health issues in the Philippines. According toliterature review, context specific health issues are
identified and used by a CBE (Competency-based
Education) program to determine the desiredcompetencies on improving the health of the community
it serves through the available health data [4]. These may
include areas on global burden of disease; health
implications of travel, migration and displacement; socialand economic determinants of health; population,
resources and environment; globalization of health andhealthcare; healthcare in low-resource settings; andhuman rights in global health [5]. In this training
program, public health issues included the humanresource development [6], training needs of midwives [7],514

risk assessment of TB transmission [8], motivating factors
behind high delivery rates [9] and youth smoking
prevention program [10].
It was shown that the self-evaluations of the overseas
field training program (National Institute of Public Health,College of Public Health of the University of thePhilippines Manila and the selected fields) by the trainees
from 2006 to 2010 are generally high. Among the five
public health issues tackled on the program, the training
under Youth Smoking Prevention Program: Influence on
Smoking Prevention Program among Secondary SchoolStudents in Paranaque City, Philippines had the highest
satisfaction, subject understanding and usefulness asevaluated by the trainees in 2010. This does not intend toshow comparison but presents a glimpse of the feedbackof the trainees for each training period.
In general, all the covered public health issues (20062010) in the program had good evaluation in terms ofchallenges and contents, usefulness, understanding of thesubject, team work implementation and instruction as
rated by the trainees during each training period.

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Competency-led overseas field training program by team in the Philippines

Also, the results demonstrated that the trainees believethat their knowledge and technical skills improved after
the training program, as shown by the evaluation results.
Majority of the trainees for 2010 rated that they were able
to practice in the field given the necessary support and touse the related knowledge and skill comprehensively andreview critically and also instruct other persons after
undergoing the training program (from lower level ratings
to higher level ratings of Level 4 to Level 6) for all the
given achievement goals.
The field practice of this program placed a particularemphasis on the trainees with differences on cultural
practices, knowledge, skills and experience forming ateam to address problems. However, as the results
suggested, improvement is necessary in the area of
nurturing and implementing team work, which is one of
the acquisitions of learning objectives. This is a problem
related to the diversity of team members or to the displayof leadership. It is probably necessary to set learning
activity goals based on the competency criteria, underareas concerning teamwork and leadership respectively.
In addition, it is also important to set competencies which
can be understood as capacity displayed as a team; notonly based on learning at the individual level. In relation
to this, it has been emphasized in a study by Frenk et al[11] that professionals are falling short on appropriatecompetencies for effective teamwork and they are notexercising effective leadership to transform healthsystems. They also mentioned that for interprofessional
education, teamwork is needed in response to thetransformation of health systems. In infectious diseases,
non-communicable diseases or prevention and control of
injuries, the collaboration of multidisciplinary
professionals on work is necessary. Leadership, on theother hand, is the one which serves as the central focus ofa core competency model outlined for Doctor of Public
Health (Dr.PH) education. It is viewed as a critical
integrator for other skills such as advocacy, criticalanalysis, communication, management, community/
cultural orientation, professionalism and ethics [12]. A
competency-based education focusing on leadership,policy formation, management of interdisciplinary teams
is essential for the development of professionals in lowresource settings [13].
It has been pointed out that the learning acquisitionarea set in this case is a vital factor in improving traineesʼ
ability to consider the practical problem-solving process.
Therefore, studying the process of not only answering“What” questions, but also of answering “How” questions
can be considered useful when solving similar problems
that they are likely to encounter in the future. This isfound to be cohesive with the Millerʼs pyramid (Figure 1).
In this pyramid, the differing levels of educational goalstates are illustrated, from the levels of “knows” orExpertDoes

Shows how

Knows how/UnderstandKnows/Knowledge

NoviceFigure 1

Millerʼs Pyramid of Assessment (adapted from
Miller, 1990) [14]recitation of facts and “knows how” pertaining to applied
knowledge to scenario at the bottom of the pyramid, theadvanced learning is more weighted in levels of “shows”
or the demonstration of skill to the top part which is“does” or the performance. This gives importance to theprocess leading to practical problem solutions, selecting asolution to realize goals as a team, and providing
opportunities to learn by experience on improving thetraineesʼ mastery of competencies.
This study wants to support that improvements inglobal health can only be realized through thedevelopment of a workforce that has been educated topromote health and to care for those with disease,increasing attention into implementing competency-based
education and training [15]. However, in contrary to this,another study has concluded that competency-based
curriculum cannot describe what it is to be a professional.
It was emphasizing that the concept of competency-based
training is insufficient to describe the higher cognitive
skills and the structure of complex knowledge, skills andproblem-solving necessary for professional performance.
It also lacks the necessary emphasis on the experiencesof working in service alongside other professionals [15].
Therefore, this aspect which is considered a weakness
must be emphasized and given attention for developing acompetency-based training.
After being planned, implemented and evaluated, theimprovement of this competency-led training program
shall not only be focusing on the teamwork, leadershipbut to the complex knowledge and skills necessary for
professional performance which can be later fully adapted
to actual workplace. With this, a more consistent andeffective model for a competency-based education will be
developed.

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Jonathan P. GUEVARRA，Nobuyoshi WATAHIKI

V.

Limitations of the StudyIn this report, we included only the self -evaluation
made by the trainees for “Evaluation of Overseas Field
Training Program and Changing Levels of Knowledge andSkills concerning SBOs of Field Training Program in
2009-2010” which could be very limited in nature. It would
have been better if the trainees were asked why they gavesuch ratings wherein more details about the ratings given
would have been determined. Exit interviews would havealso been of help in explaining the ratings given by thetrainees, however, this was not done for the field practice.

VI. Conclusion
To plan, implement, and evaluate the Overseas Field
Training Program, it is essential to clarify the learning
objectives as a team and how these can be acquired. It is
presumed that it is possible to further improve theeffectiveness of the Overseas Field Training Program
aimed at improving competency by performing
evaluations based on criteria set for the level ofcompetency necessary under each acquisition of learning
objectives. There is still scope to verify whether and how
competency-led training can lead to more capable publichealth professionals.

Acknowledgement
The authors would like to acknowledge Ms. Maribel
Oidem for the assistance extended in reviewing theliterature.

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Report 2008. New York; United Nations: 2008. http://
www.un.org/millenniumgoals/2008highlevel/pdf/
newsroom/mdg%20reports/MDG_Report_2008_ENGLISH.pdf (accessed 2014-06-04)[2] M u r p h y C , V i a d o C . A p p l y i n g t h e l e a r n i n g
performance approach, capacity project, legacy series
5. 2009.
[3] WHO. World Health Report 2006. Geneva; WHO:2006. http://www.who.int/whr/2006/en/ (accessed
2014-06-16)[4] Gruppen LD, Mangrulkar RS, Kolars JC.
Competency-based education in the healthprofessions: implications for improving global health.
Commission paper 2010.
[5] Khan OA, et al. Global health education in U.S.
medical schools. BMC Medical Education. 2013;13:3.

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doi: 10.1186/1472-6920-13-3[6] Team No. 2, Human resource development in rural
health units and city health offices in the Philippines.
Report on field training program in 2006. Journal of
the National Institute of Public Health. 2007;56(1):4251. h t t p : / / w w w . n i p h . g o . j p / j o u r n a l / d a t a / 561/200756010008.pdf (accessed 2015-07-03)[7] Team No. 2, Training needs among midwives in twocities in the Philippines. Report on field training
program in 2007. Journal of the National Institute of
Public Health. 2008;57(1):62-67. http://www.niph.
go.jp/journal/data/57-1/200857010011.pdf (accessed
2015- 07-03)[8] Team No. 2, International health course. Risk
assessment of TB transmission in health centers ofMarikina and Paranaque Cities, Philippines. Reporton field training program in 2008. Journal of the
National Institute of Public Health. 2009;58(1):40-50.
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behind high delivery rates of the urban HEART
birthing facility in San Martin de Porres, Philippines.
Report on field training program in 2009. Journal of
the National Institute of Public Health. 2010;59(1):6470. h t t p : / / w w w . n i p h . g o . j p / j o u r n a l / d a t a / 591/201059010010.pdf (accessed 2015-07-04)[10] Team No. 2, Youth smoking prevention program:
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secondary school students in Paranque City,
Philippines. Report on field training program in 2010.
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2011;60(1):54-59. http://www.niph.go.jp/journal/
data/60-1/201160010011.pdf (accessed 2015-07-04)[11] Frenk J, et al. Health professionals for a new century
transforming education to strengthen health systems
in an interdependent world. Lancet. 2010;326(9756):
1923-1958. doi: 10.1016/S0140-6736(10)61854-5[12] Calhoun JG, et al. Core competencies for doctoral
education in public health. Am J Public Health.
2012;102:22-29. doi: 10.2105/AJPH.2011.3004691[13] Gruppen LD, et al. The promise of competency-based
education in the health professions for improving
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2012;10:43. http://www.human-resources-health.
com/content/10/1/43 (accessed 2015-03-20)[14] Miller GE. Millerʼs Pyramid of Assessment. http://
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コンピテンシー獲得を目指した海外合同臨地訓練について
抄録
チーム学習としての公衆衛生分野におけるコンピテンシーの向上を目指し，国立保健医療科学院における海外合同臨地訓練がフィリピン大学公衆衛生大学院の協力のもと実施された．
国立保健医療科学院の国際保健コ−スの研修生によって，海外合同臨地訓練は問題解決型学習アプ
ローチを用いて 6 週間実施された．また，研修生に対してその到達度をみるため 6 つの行動目標を使用して事前と事後テストが行われた．さらに，海外合同臨地訓練のプログラム全体についてのレビュ−も実施された．
海外合同臨地訓練プログラムの全体的なレビューは，訓練の内容と理解度は高く評価されていた．
しかし，チームワークと合同臨地訓練の適用性については，それぞれの年度のチ−ム構成員から満足していないことも報告され，協同的なチ−ムづくりに改善の余地があることも示された．しかしながら，合同臨地訓練を通してどのように知識やスキルを習得するかを経験し，すべての行動目標は事前時評価と比べ改善されていた．
行動目標は問題解決に至るプロセスの思考と実践的な考え方を養ううえで重要な要因となっている．
また，学習機会を提供することと合同臨地訓練の目的を達成することは，研修生の公衆衛生分野におけるコンピテンシー項目の獲得の向上と人材育成に寄与したと考えられる．
キーワード：コンピテンシーの獲得，合同臨地訓練，行動目標，評価

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