POST TRAINING REFLECTION
CUM SELF-EVALUATION
Nolim’t-Jay
T. Raquel
December
16, 2002
I started
my surgery my surgery residency training since January of 1997 and had been in
the program for 6 years
1.
To reflect onhowmuch I have imbibedthe basic framework and
core values expected of me as part of my learning objective in the training
program
2.
To formulate strategies for continuos improvement on the
basic frameworks and core values after graduation
Results
Basic frameworks:
During my first
three years in training I was using the traditional way of obtaining complete
history and physical examination but could not discern how to process these
voluminous data to arrive at a diagnosis. With this patient management process
I found out that there is a systematic way of using these data to formulate the
most probable primary and secondary diagnoses. It is from these diagnoses in
which treatment options are formulated. Choosing the best treatment option will
be based on the benefit-cost-risk-availability parameters. It is this same
process that I can give the best advise to my patients thereby making them
understand what is happening and is being done to them. It is my best tool to
avoid complaints and medical malpractice suites.
There are
still lots to learn so I can improve. I need to learn more about the benefits,
risks and cost of every treatment or diagnostic options and these requires
constant search from literatures because the best option at present may just be
a better option tomorrow.
Success of
the operation lies first on preoperative preparation. I was taught of the
importance of determining co-morbid problems, prepare things/materials to be
needed, and doing selective laboratory work up. It is also important not to
forget securing informed consent and to provide patient with psychosocial
support.
The
operation should be well planned. Setting the objectives and knowing how to
accomplish them by using the benefit-risk-cost-availability parameters to every
maneuver/step during of the operation also have a great impact on the result of
the opeartion.
This process will still be very useful after my
graduation. If ever given the chance to be connected to an institution with
residency training I will propagate this process.
My idea
before about learning the diagnosis and treatment is by looking into available
literatures about the topic regarding the disease and read everything about it.
I ended up confused and still feels that the information was not sufficient.
Setting the objective on what is needed to be learned and search for its answer
makes learning easier and more fulfilling.
Two
patients with same diagnosis may not need same management. Patients with choledocholithiasis
receive different form of management depending on their co-morbid factors,
capability of the patient for financial support and availability of the
treatment in the locality. That is why learning the disease and its management
should be patterned on the specific patient.
After my
graduation, the management I had learned which I think is the best for the
patient may not be the best later depending on the individual characteristic of
my patient and the availability of diagnostic tests and form of treatment.
I felt not
qualified to become a teacher – educator but I realized that to be surgeon I
could not escape the responsibility to educate my patients, their relatives,
medical students and junior colleagues. Our residency training provided us
venues to cultivate this aspect through daily rounds, conferences, during the
operations and even in the follow-up of patients in the OPD. Upon graduation I
need to pursue being a surgeon-educator so I can help in promoting the patient
management process and the use of selective laboratory work-up just to mention
some of the things I have learned that needs to be promoted.
One of the most difficult aspects in the medical field is
the research because of difficulty to do statistical analysis. I thought I had
to be a statistician first before I could do these. I just tried finishing
research papers as requires by the hospital for promotion to higher year. With
of our chairman who set the goal of publishing good research papers even
outside our institution and his help in improving our research studies we were
able to experience joining in research contests even winning prizes.
Research is
a vital part of surgery. Through research that management of patients are
improved. There are lots of studies that can be undertaken even for the common
diseases like appendicitis and hernia. After graduation there is a pressing
need to continue research for patients’ welfare.
Our
training provided us venue to cultivate our administrative capabilities. Being
the surgeon in a particular case especially in difficult situations already
developed my administrative ability because as the captain of the ship I was
already given the opportunity to decide on what is best for my patient. In my
senior years I was given enough time to become chief resident providing me
chance to tackle administrative problems and acting as liaison officer between
our department and the hospital. It taught me accepting my limitations and to
know when to refer to others for help especially to higher authorities and how
to delegate important works to others with the result of achieving best
solutions.
In line
with the vision of Healthy Urban Poor and Health for All Filipinos, we took
part in the fulfillment of this vision because we too believe the community
health is an asset and would bring productivity to the community. We identified
diseases that affect much of our community population and tried to find ways to
solve these issues through our operasyon pinoy which provided fast, cheap if
not free, and effective treatment not only once a year but everyday in a year.
I feel
adequate to take lead in addressing community surgical health management if
ever I will be assigned to a certain locality. Informing the public of free
medicines is an essential way of enticing patient to come out for treatment so
I would try means to seek donors for such materials.
Core Values
Respect for human lives
During
presentation of cases whether on conferences, referral to consultants or
bedside rounds, I was used to begin introducing my patients with this
statement- “This is a case of a _ year old. This attitude was changed since Dr.
Joson introduced the management process. Since then I started my statement as
“This is Mr. Juan dela Cruz, my patient.” With this I found and felt the
essence of a patient-doctor relationship. I have learned to treat them not just
as a case or a problem but as a real living patient. I have learned to treat
them the way I should treat my closest relative.
Respect for
human lives also means knowing when to and when not to offer treatment
especially to cancer patients. Though they have terminal illness they still
have their right for a good quality of their remaining lives and this should be
respected.
I am very
proud and grateful with this value and I will propagate it by teaching others
as I leave this institution.
The ability to do grave dishonesty
comes from the ability to do slightest dishonesty. I was involved in the
so-called intellectual dishonesty which I thought it was not at all a
dishonesty but I realized that it can destroy my good values as a surgeon if
not been corrected.
I also learned the importance of
being honest to my patients. They have the right to know about their disease
and what is being done to them.
Sincerity can be shown if I
believe in the things that I do to my patients.
Respect to my colleagues is an
important value. If ever my colleague will refer his patient to me I will
explain my plan of treatment to him and to the patient but not to the extent of
taking the patient as my private patient.
Scheduling of patients for
operation will be based objectively and not because they are pay patients that
they will be prioritized over charity patients.
Being a surgeon my responsibility
to offer healing will be my primary intention and financial reward will just be
secondary.
I have
learned to be punctual. Every time the scheduled cutting time of the operation
is 7 AM, I had to make sure that the patient should have been wheeled in the OR
at 6:30 or earlier. I also have learned to respect my colleagues (which
includes the clerks and the interns and the doctors in other hospitals who
referred the patient) not to make bad remarks about them when I am with the
patient. These bad remarks create distrust from these patients to my
colleagues.
My stay in
our department also taught me how to develop a good working relationship with
the anesthesiologist and nurses. They are part of the team and should be
respected.
The quality
analysis of morbidity and mortality is a way to have a better quality of
service and excellence in the management of patients. It is a self-assessment
of where I failed and where I can improve. This is not only applicable during
my training but even into my private practice. I should have the continuous desire
for improvement and excellence.
As a junior
resident I have learned to follow and perform the duties assigned to me by my
seniors. As a senior resident later I have learned to assign duties to my juniors
that I think they can do and yet taking the responsibility whatever the result
of their performance of their duties. I have learned to function not just as an
individual but to give my part to the team to achieve a common goal.
Teamwork
does not only exist within our department but also with the other department
during referrals for co-management. This was done through direct communication
and made myself approachable thereby removing barriers for fast and effective
results.
The issues
on circumcision and swallowing of santol seed made me aware of my
responsibility to society of giving beneficial information even to the point of
breaking their tradition, beliefs and habits. I have learned the necessity of
getting out from the comfort of the conference room and operating room to be
able to inform the public regarding important issues through lectures and
interviews through television and radio. As a result the public did not only
become aware about these issues but also have let them aware that the
institution/department is active and existent.
SUMMARY
I chose
Ospital ng Maynila Department of Surgery where to acquire my training because
it offered only four years. I was sad when I have learned that the training was
suspended and it would take us about six years. I thought six years was a very
long span of time but reflecting on what happened during these years seemed
like I had only spent 6 short months. This was because I enjoyed my stay in
this department and in the hospital as a whole. Training was made easy since I
was not counting my stay here per day. I thought that I have to come regularly
because I felt I was a part of this institution. I felt I was a part of a
family with a responsibility to perform aside from my training. I had all these
feelings because the institution had let me feel such. I would like to thank
then the people who had shared their time and without them I would not be a
graduate of this prestigious institution.
First I
would like to thank all the nurses for their support. Because of them I have
learned to be more mature in my decisions especially which patient should be
prioritized for operation. They were so willing to bend from the OR policies
just to be able to accept my requests.
To my
co-residents thank you for the camaraderie. I have learned a lot from you guys.
I hope you also have learned even a bit from me. You made my life here so easy
and yet so fruitful.
To all the
consultants thank you for accepting my referrals especially during late at
night. Thank you for the knowledge you have imparted more so for showing me
what a surgeon really is.
To Dr.
Joson- Sir, thank you very much for. You made my training so structured. With
that I have learned and understood what a surgeon must have. The patient
management process that you have taught was to me the cornerstone that I was
able to acquire the basic frameworks and core values a surgeon should have. You
made me a well rounded surgeon. Thank you for helping me in the research area –
my waterloo. I still could not believe that I was able to present a study
outside the hospital - PCS at that!
To my dear
patients – the very reason of my existence in this hospital, who put their
trust to me as their surgeon thank you very much.