Post-training
Reflection
Miguel D. Galvez, M.D.
December 17, 2003
Introduction
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:
Results:
Basic frameworks:
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.
Operation-surgery process
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.
Physician-teacher process
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.
Physician-researcher process
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.
Physician-manager process
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.
Core values:
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.
Professionalism
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?
Teamwork
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.
Social consciousness
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.
Discussion:
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.
Summary:
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.