Miguel D. Galvez, M.D.
December 17, 2003
I started my residency training in General Surgery at OMMC on January 1, 1998. It’s been six years since then, and I have to admit that it has taught me a lot about myself and surgery. With the help of our chairman our training has turned into something more structured- more defined. Now that I am allowed to graduate, I leave this institution armed with the essentials of my training that has prepared me to be a rational, effective, efficient and compassionate surgeon.
Objectives of paper:
Patient management process
As anyone who would encounter this for the first time I felt skeptical about the whole process. I have been diagnosing patients correctly, applying what I have learned and simply institute the appropriate management without regard to whether it was the rational approach or not.
As I got accustomed to the process it became clear to me that if it is applied properly, diagnosing, managing and treating patients would be more efficient as well as cost saving for the patient. I am glad that a rational and structured approach was introduced that could be applied to everyday decision making as well.
Now I deviate from the traditional way of medicine-“de-kahon”, and apply the process to guide me and systematize my approach to any problem. At the same time it helps me to explain matters to my patient in such a way that it is easily understood.
Being a physician carries a lot of responsibility such that one can not be too complaisant in approaching any medical problem. Similarly, as a surgeon I can not just operate on patients for the sake of operating. We were taught that whatever we do has to have a basis and we should do it well. We start with a problem and from there we derive the appropriate plan of management and treatment from various options suited for a particular problem. After planning we try to envision the procedure as in our ‘HOW I DO IT’ or ‘HOW I WILL DO IT’ exercises. From there, execute the appropriate intraoperative management and make quick, rational decisions if problems arise.
This training has set me apart from the rest and I am proud to say that I operate only if needed and if t will benefit the patient. As far as the department is concerned, it has helped us steer away from legal suits.
Problem-based and self-directed learning process
As I am unique, so are my patients and their problems. Treatment varies accordingly. Because of this I should always be abreast with the most recent innovations and trends to keep up with the ever-changing discipline.
My stay in the department has taught me such thru journal appraisals, debates and other problem based discussion. Though I benefit from this as being more efficient and effective. The end point is still the patients whom I guarantee will receive the best surgical care.
As I interact with my patients, part and parcel of this interaction is educating them of their disease in turn helping them to understand their ailments and its management. This carries a load of responsibility in that if we impart the wrong message, it may only cause misunderstanding and anxiety. Remember that most of the patients think so highly of physicians that they will believe anything we say even if it is wrong. Such is our responsibility that we have to master our craft in order that we could educate other doctors, students and patients so that we are not mislead by wrong practices that would only result in morbidity or mortality –even legal suits.
In the department we try to reach the masses and educate them thru mass media and OPD lectures like the anti-circumcision and warning against santol seeds.
I went in to medicine hoping that a research paper would not be required of me. It has never been a walk in the park for me.
My stay in the department has exposed me enough of studies to help me understand its relevance. For me it is self directed learning, helping me to appraise journals at the same time helping me to develop my analytical skills. It made me realize that what I am doing will not only make me a better surgeon but would also help my patients to receive optimal surgical care at the least cost.
From these researches protocols have been made that I use on my patients. It has taught me when to operate, why operate and how to operate. This forms part of the basis of everything we are doing.
The aforementioned processes would culminate in to what we are to become- leaders who are responsible and compassionate- a well rounded surgeon. All the outgoing seniors are given a chance to be a chief resident in order that what was learned in the past years be applied.
This was a chance for me to prove to myself that I have acquired the intellect and skill worthy of a leader. At the same time help improve the department as it has improved me. It gave new meaning to what responsibility meant to me- responsible not only to one’s self but to others.
Soon I will have my own clinic and hopefully run a department. With my training I can say I am ready for the task ahead.
Community surgical health management process
Being exposed to the problems of the urban poor, we can’t help but think of ways to provide quality surgical care to those in need. The concept has taught us to think of what would benefit others rather than what we can get out of it. As such we continually hold monthly surgical missions to address the common surgical diseases in the community.
With the training I got, I would be more than willing to lend a helping hand if called for. I have never refused a call for service and I guess I never will.
Respect for human lives and human being
A dictum of every physician is “DO NO HARM”. I guess it speaks for itself.
In the department, I was taught to prepare for every case and bear in mind that an operation resulting in no morbidity nor legal suit with a satisfied patient is of utmost importance. Respect entails providing quality surgical or medical care to all patients- addressing their needs if possible and preparing them for transfer to other institutions if need be.
Honesty and sincerity
It goes without saying that if your intentions are pure honesty will never be questioned. In the department, Honesty was of true value in that dishonesty can never be tolerated and its repercussions can never be over emphasized. Logically, if we hide the truth we may never learn from that experience and soon enough may commit the same mistake.
Our weekly census as well as our daily activities and interactions are based on trust and honesty. I am proud to say that almost all of the residents declare their morbidities freely hoping that since it is a result of an error, this error could be corrected ending up again in developing good values and providing quality service.
Ethics and integrity
Though I have worked in so many offices before, I have never experienced so much interpersonal relationships as to develop work ethics. Respect for other physicians and their management, informing referring physicians as to our plan of management before treating, updating consultants or just simply taking the worse in stride are some ways we develop work ethics. Together with this I uplift the integrity of my chosen profession.
As a surgeon, I am expected to act accordingly likewise relate to my colleagues, other staff members and patients within the boundaries of my profession.
I was trained to come early for operations- to accompany the patient to the OR, discipline the juniors, approach and discuss matters with ADMINISTRATION, and to face the firing line when I am found at fault in important matters. These are but a few of what we go thru everyday and we are expected to handle each with diplomacy, respect – with professionalism.
It may seem that my life as a surgeon is never fun and games-it is. We try to put fun in its proper place, never going overboard and always ready to get back to serious business .
Continual improvement to achieve quality and excellence
If one were not used to our form of training, one would exclaim that we might be over doing things, always changing protocols, introducing new parameters, and developing new protocols.
That is surgery in our department. It is a way of life and as such we are encourage to contribute to the development of our department and achieving the goals and provide quality care in an ever changing time as we would, in ourselves develop our mind and body and develop our skills to be better physicians.
Adapting new ways and finding areas that need improvement are as important to the department as updating ourselves with new trends is to us to develop our craft. Again an efficient department is run by efficient surgeons whose goal is to provide quality care to the patients. How else can we become a model department?
During ancient times, command responsibility was used only by the military. Now it is an essential part in any endeavor as “team work”.
A harmonious interpersonal relationship is important in achieving any of our goals. Though it may seem that we can do it alone, if we become humble enough, we would see that a lot of people had helped to make our goals a reality.
The training has taught me to work in a team. It has taught me to be responsible for the team and whatever happens to any member of the team. We work as a team, learn as a team, we expect to improve as a team.
The training has imbibed in me the sense of social responsibility. We were exposed to various community-based activities and surgical missions (OPERASYON PINOY) that having compassion for the needy and wanting to help becomes second nature to us. Our goal is for a healthy urban poor and I guess even after OM we will still be trying to make that goal a reality.
This paper is a post-training reflection cum-evaluation. There is such a thing as learning through reflection as well as learning through self-evaluation.
In the process of reflecting on the learning that I may have acquired during my training years to become a general surgeon, I was able to resynthesize and reorganize.
Resynthesize in the sense that I was able to put parts together to form a new whole. At the start of my training, I was made aware of my learning objectives. However, with the learning period spanning 6 years and with the learning objectives necessitating repeated readings and practices, the learning activities that I went through can be described as piecemeal and supposedly cumulative. Before this reflection paper that I did, I just have a general feeling that after 6 years of residency, I learn new things and many things at that. If I were to be asked what I learned, I will have difficulty answering the question in a concise manner will probably try to enumerate all the things that I think I learned, that come spontaneously to mind, even the smallest things, with the tendency to repeating the same things over and over again, and to the point that I cannot enumerate them all and in exasperation, just say “and other things.” With this reflection paper, I was able to have a clearer idea of what I have learned by grouping or categorizing the bits and pieces that I have learned.
Reorganize in the sense that I was able to relate the values of the department to those that I previously held before I joined the department and before the new steward came in and then to bring them into a harmonious and internally consistent philosophy. I have imbibed the basic frameworks and core values as spelled out by the present department chairperson. I am sure that there are other frameworks and core values that may prop out in the future. However, for the moment, these frameworks and core values are sufficient to serve as my foundation to be a rational, effective, efficient, holistic, and humane community surgeon as well as a springboard for my further learning and continual lifetime improvement. Before the present department chairperson taught these basic frameworks and core values, I was just concerned with my training to be a general surgeon, just to be able to operate. I had a vague idea of what a quality general surgeon and a quality surgery department should be. With this reflection paper, I now have a clearer idea what a quality general surgeon and a quality surgery department should be. I fully concur with the values of the present Department of Sugery of OMMC and its present chairperson and I have imbibed them.
After reflecting on what I should have learned, I did a self-evaluation. In the process of doing the self-evaluation, I was able to get a much clearer picture of what I should have learned. Before I made a self-evaluation on certain basic frameworks and core values and gave concrete examples and situations to show how much I had learned, I had to know very well the concept of each of the frameworks and values. Thus, in the process of doing the self-evaluation, I learned the nitty-gritty or details of what I was supposed to learn.
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 improvement.
This reflection cum self-evaluation is really a kind of learning strategy which may turn out to be the greatest but often unrecognized force to consolidate whatever learning that has been attempted (through the process of synthesis, organization, and self-evaluation) as well as the starting point to propel further learning (through motivation brought about by the self-evaluation).
As a graduate of the general surgery program of the Department of Surgery of the Ospital ng Maynila Medical Center, with my first-hand experience and with my belief of its usefulness, I strongly recommend that this procedure of asking all prospective graduates of all departments of surgery to do a reflection cum self-evaluation paper be adopted.
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 encompasses the 6 years of training all the residents have and will be undergoing. Though I feel that I was trained well and I have imbibed the basic frameworks and core values needed to become an ideal and model surgeon, only time can tell if I might truly be called as such.
Thank you Dr. Joson for having the patience to teach me and believing that I can still learn alot despite my shortcomings. Thank you my consultants, residents and staff. Thank you to the patients who had to endure the brunt of my training. Finally I thank my family for standing by me through thick or thin.