Alexander D. Deveza, M.D.
December 15, 2003
“A journey of a thousand miles begins with one small step”…as I quote a Chinese saying. I can say that my journey in General Surgery began when I made that first step at the at Ospital ng Maynila Medical Center when I got accepted as a first year resident on January 1, 1998.I have been with the Department of Surgery for 6 years and on December 2003 my journey will come to an end , to start another journey and to bid farewell.
Objectives of paper:
Patient management process
During the first three years of my residency training, I was using the traditional way of doing case presentations.I never appreciated case presentations until the “Patient Management Process” was introduced to us. The “Patient Management Process” has taught me the simplest and most logical way to analyze a case in order to arrive at the most rational diagnosis and the most cost-effective treatment option. With the “Patient Management Process,” I have learned that there are a number of ways on how to approach a case , it is practical and that it can be applied outside the confines of the conference room.
I have learned that surgery is not always operation. It entails not only the technical aspect of a procedure but also being adept with a rational preoperative preparation and postoperative management. Preoperative preparation does not only involve patient preparation but also surgeon preparation as well. “Learning before doing” through the “How I will do it” and the “How I did it” program has helped me develop and gain confidence in every operation. Being trained in a city-government hospital was a plus factor for me. I was given the chance to manage a lot of surgical cases with proper supervision of active consultants who are experts in their own field. With this solid experience in hand, I believe that I can face the challenges of the outside world with confidence and pride.
Problem-based and self-directed learning process
Knowledge is not only trying to learn what you do not know but also trying to learn what you already know. Surgery is a never ending learning-process and as a surgeon, we always yearn for more knowledge. Our debates and weekly case conferences has taught to me to be critical to new and presently accepted datas and information . I can say that I very well use them to guide me in my future clinical practice of surgery.
My residency training at Ospital ng Maynila has trained me to become a student and teacher as well. Learning is a two-way process. We learn from our consultants and in the same way they also learn from us. The same way goes with the medical interns, clerks and the rest of the parasurgical staff. During our conferences, we were encouraged to actively participate by asking questions, criticize, share information and personal experiences. Being able to teach and impart to others what you have learned is the ultimate part of the learning process.
During my first three years of surgical training, research work was done only to fulfill the requirements for promotion. With the introduction of a structured research development program, each resident was required to submit at least one quality research paper per year as a prerequisite for promotion. The research development program of the department made way for the first ever intradepartmental research paper contest. We even got funding from the North Texas Association of Filipino Physicians. As a result, we were be able to write quality research papers winning in regional and national contest and even qualified for publication in the Philippine Journal of Surgical Specialties. Research is a vital part of surgery training. It is through these researches that we were able to formulate our own treatment guidelines and protocols for the department. With the continuous improvement of the research development program, it is not impossible that in the near future, we will be able to produce research papers at par with international standards.
My residency training at Ospital ng Maynila gave me an opportunity to cultivate my skills in governance and administration. Part of being a senior resident is acting as the team leader. As a team leader, I was responsible for my junior residents and to every patients that we manage in our team. My responsibility was further expanded when it was my turn as chief resident . Being the chief resident at that time was very tasking . It was the time when we were very busy preparing for our department accreditation. However, despite the difficulties and challenges, it made me a stronger and more responsible leader and surgeon.
Community surgical health management process
Through our community directed surgical educational program, we were able to disseminate basic information on different surgical related issues to the community. Our in-hospital surgical missions, “Operasyon Pinoy” has provided quality surgical health service to manilans and non-manilans alike. These programs has awakened me of my social responsibility to the community that I will continue to promote and do so in my clinical practice outside Ospital ng Maynila.
Respect for human lives and human being
Our goal for the department is to have a live patient with no morbidity. With this, I have learned to respect the value of human life and that the essence of a physician-patient relationship is trust.
Honesty and sincerity
Honesty and sincerity are values that a good surgeon must possess but sometimes they are not easily achieved. We must remember that we are not perfect and mistakes do happen. In our morbidity and mortality conferences, residents tend to be dishonest. Part of the learning process is being able to accept ones mistake and to make the necessary steps for self improvement. Honesty to the patient is another thing. I have learned to tell the patient the truth and to include the patient and relatives in the decision-making process.
Ethics and integrity
Ethics and integrity are values that a surgeon must possess to gain the trust of your patient. A patient will not entrust his or her life on you if there is no trust. At Ospital ng Maynila, I learned to practice good interpersonal relationships with patients ,colleagues and other parasurgical staff, and maintaining a good reputation by being morally upright.
Professionalism is being able to know our duties and responsibilities as surgeons to our patients. Since the relationship between a physician and a patient is contractual, we as surgeons should abide with that contract, and should render with utmost care the services needed by the patient.
Continual improvement to achieve quality and excellence
To achieve quality and excellence one must be humble enough to be able to accept one’s mistakes and being able to tell your junior residents that that you are not adept or knowledgeable with a certain procedure. Learning is a continuous process and everybody can learn from each other. With this in mind, there will always be room for continual improvement. These are values which I think I can use and apply in my future clinical practice in pursuit of professional excellence as a surgeon..
“No man is an island”, a surgeon cannot work alone but he works with a team as a whole. Everyone in the department has a specific role and must work as a unit in order to achieve a common goal. At Ospital ng Maynila, I learned to be flexible to play my role inside the operating room, either as a surgeon or as an assistant and outside as a leader or follower.
My position as a surgeon in a city-government hospital has made me aware of the prevailing health problems and issues in our community. The departments information and education campaign and the in-hospital surgical mission has addressed some these problems facing our community. The issues on circumcision and swallowed santol seeds are examples of traditions, habits and beliefs that should be corrected and which are not being properly addressed to by the health sectors. The “Operasyon Pinoy” surgical mission has provided free surgical services to indigent manilans and non-manilans. I believe that as surgeons, we have to be aware of the real health issues and and as I leave Ospitall ng Maynila, I will continue to help address these issues as my humble contribution to the community to where I will practice.
In summary, what you have read is a reflection cum self-evaluation of my General Surgery residency training at Ospital ng Maynila Medical Center. I just described what has transpired during my 6 years of training by reflecting on how much I have imbibed the basic frameworks and core values expected of me as part of my learning. The basic frameworks consist of: 1) patient management process; 2) operation-surgery process; 3) problem-based and self-directed learning process; 4) physician-teacher process; 5) physician-researcher process; 6) physician-manager process; and 7) community surgical health management process. The core values consist of: 1) respect for human lives and human being; 2) honesty and sincerity; 3) ethics and integrity: 4) professionalism; 5) continual improvement to achieve quality and excellence; 6) teamwork; and 7) social consciousness.
Though it will be up to the consultant staff now to pass judgment on my training, I am confident enough to say that I have imbibed the required basic frameworks and core values expected of me. This I think could serve as a foundation for my being a rational, effective, efficient, holistic, and humane community surgeon as well as a springboard for my further learning and continual lifetime improvement. With my first-hand experience, I believe this reflection cum self-evaluation is another kind of learning strategy which may turn out to be the greatest but often unrecognized force to consolidate whatever learning that has been attempted as well as the starting point to propel further learning. It can fully evaluate and show how much of the training’s objectives has the student learned and imbibed. I am therefore strongly recommending that this activity be adopted and accomplished by each and every graduating resident and that it becomes a prerequisite for promotion.
To all my consultants, thank you, for all the time spent teaching me the art of surgery without thinking of benefits or rewards , for the knowledge and skills that you have imparted on me and for preparing me for the greater challenges ahead.
To my co-residents and colleagues, thank you very much for all the memories. I will surely miss all the fun, joy and laughter we had together.