Post-training Reflection cum Self-Evaluation
Vivian P. Enriquez, MD
December 14, 2002
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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