Post-training Reflection cum
Self-Evaluation
Vivian
P. Enriquez, MD
December
14, 2002
Introduction
I
started the surgical residency program on January 1, 1997 after undergoing pre-residency training for two
months.
My
objectives at that time were to acquire the knowledge, skills and attitudes to
practice surgery in an exemplary manner through outstanding, cutting-edge
training in an ideal environment.
I
have been in the program for 6 years, and I am proud to say that I got more
than what I expected.
This reflection paper cum
self-evaluation would show just how much I have learned for the past 6 years.
Objectives
1.
To reflect on how much I have imbibed the basic
frameworks and core values expected of me as part of my learning objectives in
the training program.
2.
To formulate strategies for continual improvement on
the basic framework and core values after graduation.
Results
Basic frameworks:
Patient management process
I have learned some basic steps in managing a
patient and it starts with a good bedside manner, rapport as we call it. Clinical
diagnosis should be based primarily on history and physical examination through
pattern recognition, paraclinical disgnostic procedure should help you, and not
confuse you, one must have a basis for requesting an examination, it should be
selective not mandatory, one must correlate the results in order to come up
with a pre-treatment diagnosis so that one can decide on the most
cost-effective treatment procedure. The outcome of one’s decision making would
be judged by the following criteria: rational, effective, efficient and humane.
All of these need good communication with one’s
patient. Good communication makes or breaks patient-doctor relationships. We
learned this in medical school. It was drilled into our brains repeatedly.
However, when faced with 20 sick patients, all demanding immediate attention, what
usually happens, and I’m sure we are all guilty of this, is we treat the
patient in the shortest time possible and jump to the next and not even know
their name. You have reminded me the importance of such trait. Good
communication, or the lack of it, has ended up in problems, which primarily
affect delivery of proper health care. If I have learned anything at all, this
would be it: To put more effort into developing good patient-doctor
relationships, specially now when I will be on my own.
Operation-surgery process
With our institution being a large referral center
for the city of Manila, I have been presented with plenty of opportunities for learning
in the form of patients, which we never were lacking in. Others may view this
as too demanding physically and mentally. I welcomed it. Starting from the most
routine of procedures to those imbued with risks inherent to the procedure and
to factors attributable to the patient himself. Quantity buttressed with quality.
Done through studying before, during and after each procedure so that every
nuance of the procedure is learned and remembered, from pre-op evaluation to intra-operative
procedures, wherein you taught us that every move should have a rationale to discharge
planning. I realize that this should be part of my lifelong process of
learning.
Problem-based and
self-directed learning process
Residency has taught me to be always open to new ideas
or concepts being introduced and not just rely on what I have learned in the
past. But rather than embracing new knowledge at face value, I have learned how
to be more inquisitive and critical of new information before adapting them
into my daily practice.
Physician-teacher process
I have learned that being taught does not mean just
always being at the receiving end of information but rather being allowed to
participate in a two-way discussion, sharing of information, such that the
roles of teacher and student is not always exclusive to one person. Teaching
others is part and parcel of being a physician whether they be medical
students, interns, residents, patients, or colleagues. Thanks to the experience of being under the
tutelage of many excellent surgeons and teachers I could not ask for better
role models.
Physician-researcher
process
Inquisitiveness is in all of us but residency has
taught me how to direct this natural inquisitiveness towards the pursuit of
groundbreaking, potentially life-saving, novel information. Example of this was
our paper entitled “Selective versus
Mandatory work ups in patient for thyroidectomy”, never in my wildest dream did I imagine that I could write such a
paper, but with your help and that of my
co-authors we were able to prove a point that selective evaluation is safe and
cost – effective. Being “forced” to write our own research papers as a
graduation requirement has definitely laid down a strong foundation in me that
will definitely keep research work part of my armamentarium as a well-rounded
physician
Physician-manager process
To be a surgeon is to be a natural leader. Residency
has taught me independence, self-reliance, the ability to get other peoples’
trust, compassion and empathy. Traits, I feel, requisite of a good leader.
Being chief resident helped cement these traits in me.
Community surgical health
management process
Residency at the OMMC has fortunately exposed me to
a large number of people coming from different backgrounds and as such has made
me aware of the health needs of the different communities at least in the
Manila metropolitan area. Knowing about these community health needs may be the
first step in finding a way to solve these problems.
Example of which is our information dissemination
regarding the danger in swallowing santol seeds.
Core values:
Respect for human lives
and human beings
My respect for the value of human life was never
made more distinct than during the course of residency training when, day in
and day out, we treat victims of violence and those suffering from other
pathology. You immediately see how precious life is. Continuing to practice
medicine will no doubt continue to reaffirm this respect as we continue our
role as life nurturers.
Honesty and sincerity
These are values that have proven to be sometimes
difficult to adhere to when faced with certain situations where owing up to
mistakes will lead to serious repercussions. Mistakes happen; they are part of
the learning process. Also part of the process is owning up to and learning
from these mistakes. Residency, unfortunately, can be fraught with them. It is up to the resident which path he
should take. The easy one, which
involves dishonesty or the difficult one. I never liked easy.
Ethics and integrity
Ethics and integrity goes hand in hand with honesty
and sincerity. You cannot have integrity without honesty. Being a doctor places
you in a position of power. Power, which
can be abused. Ethics and integrity dictate the necessary prerequisites so that
power is not abused and keeps your feet firmly planted on the ground.
Professionalism
It is in residency where I learned what
professionalism really is. It means being on time for meetings. Following rules and regulations. Having respect for teachers and colleagues.
Having empathy and compassion for
patients. Small things, but things, which will earn the respect of others.
Continual improvement to
achieve quality and excellence
Practice of medicine, whatever field, requires
constant learning. It is never ending because if you stop learning, that means
the end of your career. Residency in
OMMC has given me the tools to continue the process because it is during this
time where I learned the basic frameworks and core values expected from a
quality surgeon.
Teamwork
Residency fostered independence, yet, working with
co-residents emphasized the fact that more can be done in a shorter period of
time when there is teamwork. I learned to put aside “me” and learned about
“we”. Basically, I learned how to work with others. Others, who invariably will
have different personalities and different agendas.
Social consciousness
As I’ve mentioned before, our interactions with a
multitude of people of different backgrounds; different needs; different everything,
has made me aware of the existence of a whole world outside the hospital walls.
This knowledge has made me aware of the roles a physician must undertake to be
able to serve my community in whatever capacity, not necessarily limiting
myself to health care delivery, for instance. Residency has given me the
ability to become more aware of the conditions prevailing within the community
I live in, the knowledge to know what is needed to be done to improve the
social conditions and the confidence to put words into action.
Discussion/Summary
In performing this exercise of post-training
reflection as a tool for self-evaluation, I have come to realize that I have
done a lot of growing up during these past 6 years. Growth, not only in the
physical sense, but more importantly, in the professional sphere of my being. My chairman has
conveniently subdivided the goals of my training into several basic frameworks
as well as core values, attainment of which is a requisite for graduation.
However I feel that there is really only one term necessary and will encompass
all these and that is EVOLVE. In
writing up all these frameworks, I needed to ask myself just one question: Have
I evolved to become a better physician, a quality surgeon, after my training? The answer is a definite YES.
Maybe not to perfection, but I still have a lifetime ahead of me to try and
attain that which admittedly is unattainable. I have the tools. Training at
OMMC has assured me of that and I will definitely try.
Thank you very much, sir