Post-training Reflection

Rolando V. de Guzman, M.D.

November 27, 2003


            I started my residency training in General Surgery at OMMC on January 1, 1998.  It’s been six years since then, years of hard work and training.  I am lucky because during my training I have seen how the department has evolved to have a structured training program.  So as I go out of my training I would like to admit that I was not able to learn everything there is to learn in general surgery.  However, I hope I have acquired and imbibed the basic frameworks and core values expected of me to be a rational, effective, efficient, holistic and humane community surgeon.                                                     

This reflection paper would show how much I have learned during my training.

Objectives of paper:

  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 frameworks and core values after graduation.


Basic frameworks:

Patient management process

            During the early years of my training, my approach to patient management was not structured. There were times that I was able to arrive to a correct diagnosis but the process was not clear and the approach was often not rational. With the introduction of this process in my training, patient management became so easy, systematic and structured.  Recognizing the beauty of this process made me adhere to its principles and from there it became a habit that I used in every patients that I had. There were times that my diagnoses were wrong but with this approach to patient management I can always have a sound and rational one. Mastery of the principles of patient management process has made me a better physician.

Operation-surgery process

            Part of being a good surgeon is the mastery of operation surgery process.  My six years training at OMMC has made me realize that surgery is not just the act of operation.  My training has provided me with strong foundation to handle different surgical problems. This process has taught me the following: formulation of a rational preoperative surgical plan with adequate preparation, precise intra-operative execution of the operative plan with rational decision making and adequate post-operative management.  Our “How I will do it” and the “How I did it” program has helped me to master a surgical procedure before even trying to do one.  As a surgeon trained in this institution and with adequate training in operation surgery process, I believe I am ready to face the challenges outside OMMC with pride.          

Problem-based and self-directed learning process

            Medicine is not an exact science, it is dynamic and there are many controversies.  My training has taught me how to handle and process controversies and how to cope up with the advances of medicine, with me as the principal actor in the learning process.  Medicine is a never ending learning process and residency has taught me to be always open and critical to new information.  Our debates and action researches are examples of problem based and self directed learning activities of the department which helped me improve my clinical performance.             

Physician-teacher process

            During my training I realized that teaching is part of my profession and I believe that the optimal learning process can be achieve through interactive exchange of ideas.  My training has provided me enough opportunities to teach and educate my patients, junior residents, medical students and myself.  For me, one can never claim that he has learned a lot unless he’s able to pass on the knowledge to his subordinates.  I may not end up being a formal educator in the future but I will certainly use this physician teacher process for my continuing medical education. 

Physician-researcher process

            Research was the least appealing field of medicine to me, maybe because of the statistical side of it.  Before, I have never imagined myself doing research but with structured training and dedicated teacher I was able to produce 3 action research papers.  The introduction of the action research methodology in my training has made me realize and appreciate its usefulness to clinical practice.  My training has definitely laid down the foundation for me to pursue to become a physician researcher.

Physician-manager process

            Residency has given me a chance to develop my leadership attribute, we were provided with small scale venue to harness our administrative capabilities.  We were taught how to run a department, how to handle administrative problems and most of all how to encourage others to work towards the fulfillment of the goals and objectives of the department.  You have shown us the attributes of a good leader, an animator and a change agent.  

Community surgical health management process

            Our training has provided me with enough exposure in dealing with community surgical health problems and the process involved in providing the solution.  Our advocacies and information dissemination programs have awakened my social consciousness.  As part of our social responsibility program we provided quality surgical health service through operation pinoy. With this framework that I have imbibed I am now ready to participate in community surgical health management in my locality.

Core values:

Respect for human lives and human being

            “Primum Non Nocere” is one of the policies of the department.  During the course of my training, we were always taught to respect human lives by always being humane in our approach to patient management with a goal of having a live patient. Our regular morbidity and mortality conferences with quality analysis were a constant reminder to us how valuable life is. 

Honesty and sincerity

            Our residency has been extended due to intellectual dishonesty and we suffer the consequence.  “No dishonesty” has been the policy of the department since the new stewardship; with this policy I learned the importance of honesty and sincerity in medical practice and the repercussions for not doing so.  I always tried to be honest to myself and humbly accept my limitations.

Ethics and integrity

            My training has given me the opportunities to develop a good work ethics and to value the integrity of my profession by not engaging in any act that would destroy my reputation. Good interpersonal relationship with patients and colleagues has helped me developed and gain their trust and confidence.  I tried to live the ideals of my profession and act accordingly.


            Residency has taught me to follow certain rules and regulations. I have learned to respect my patients, colleagues and myself. We were trained to perform our duties and responsibilities as a person, doctor and surgeon and sometimes even beyond the call of duty.

Continual improvement to achieve quality and excellence

            Setting standards with regular monitoring and evaluation has pushed me to the limits and helped me in improving my craft.  Residency has taught me the importance of continual learning for improvement to achieve quality and excellence in medical practice. OM has provided me with good environment for professional growth.


            During residency, I learned how to work with others, either as a follower or as a leader. We were given group activities and projects to develop our teamwork and interpersonal skills.  Most of all, we were trained to act collectively to achieve a common goal.  Through teamwork we were able to regain our accreditation and build up the reputation of the department.

Social consciousness

            Our department is known to have sense of social consciousness.  My training has made me aware of my social responsibilities. We were constantly reminded of our obligation to the community.  We were taught how to develop a community surgical health programs from simple information dissemination and health advocacies to medical assistance program for indigent patients in the form of free surgical mission for the urban poor.




I have presented a reflection cum self-evaluation paper after my training in general surgery at the Ospital ng Maynila Medical Center. The objectives are 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 and to formulate strategies for continual improvement after graduation. The basic frameworks consisted 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 consisted 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.            

This reflection cum self-evaluation is a good learning activity for the graduating residents to review and consolidate whatever learning have we acquired and to reassess ourselves how far we have gone based on the structured standards, in short it is a summative evaluation of our training.  The other benefit that I got from the self evaluation was getting an idea where I stand which in turn motivated me to go for continual improvement. Although you will have the final judgment on my evaluation, I believe I have imbibed the basic frameworks and core values needed for me to become what you have envisioned us to be, a rational, effective, efficient, holistic, and humane community surgeon.                                     

To all my consultants, thank you, for your untiring and unselfish efforts to teach me the art of our profession, for the knowledge and habits that you have inculcated in me and for the totality of what I have become. Again thank you very much.                                                                                                                                  

To my co-residents and colleagues, thank you very much for the memories and for being a family, it’s been wonderful working with you.  I will surely miss you, I love you all.