Post-training
Reflection
Alexander D. Deveza, M.D.
December 15, 2003
Introduction
“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:
Results:
Basic frameworks:
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.
Operation-surgery process
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.
Physician-teacher process
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.
Physician-researcher 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.
Physician-manager process
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.
Core values:
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
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..
Teamwork
“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.
Social consciousness
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.
Summary:
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.