Post-training Reflection
Alfred D. Troncales, M.D.
November 13, 2003
Introduction
Right after passing the Philippine
Board of Medicine in August 1997, I immediately went into residency
training. I applied in a number of hospitals
in Metro Manila but my career in General Surgery began when I got accepted at
Ospital ng Maynila Medical Center. It
was on January 1, 1998. For six years I
have been with the Department of Surgery and this coming December 2003 it is
time to bid farewell to OM. An
institution that has helped mold me into what I am now. The institution that has taught me the
knowledge and the skills that is required of a General Surgeon. These are the basic tools that I will be
using in an entirely new environment. An
environment far from the settings that I have gotten used to, cases that I have
learned from and family that I have grown with.
Objectives of paper:
Results:
Basic frameworks:
Patient management process
Never in my entire med school and early
into my residency did I appreciate case presentations, not until I learned and
familiarized myself with your manual on the, “Patient Management Process.” The manual has taught me the simplest and
most logical way to analyze a case in order to arrive at the most rational
diagnosis, work-up and treatment. The
best part of it was that its use was not confined to the conference room but can
be applied to actual practice. It is extensive
that the process begins at the time you first see the patient and ends at the
time you last followed him up. However,
knowledge and familiarization with the process does not end there. With the “Patient Management Process,” I
have learned that there are a number of ways on how to approach a case and that
is why continuous reading, researching and learning is necessary.
Operation-surgery process
Throughout my six years stay at
Ospital ng Manila, I have learned that surgery is not all operation. It entails not only the technical aspect of a
procedure but also knowing its indications, goals and outcome (benefits and
risks). Be it a minor or a major procedure,
one must familiarize himself with what to do, what to look for and what to
watch out for. One strategy was through
the “How I will do it” and the “How I did it” program. This policy of “learning before doing” has
helped me develop familiarization and confidence. And as a future surgeon, being trained in a government
institution was an added benefit. I was
complemented with a variety of cases with a number of unusual ones and consultants
who are ready to help and are considered experts in their own field. With this background in hand, I believe that
I can face the outside world with confidence and conviction.
Problem-based and self-directed learning process
A surgeon must not be confined to
what we he has learned and what he has been familiar with. General Surgery is a never ending learning
process and a surgeon will always yearn for more information. He will always search for new knowledge and
new techniques and as one of your students, you sir have taught me to be
critical about it. You have taught me
how to search as well as analyze data before accepting it. From using the internet as a mode for literature
search to assessing journals as supporting evidences, it is at Ospital ng
Maynila where I learned how to assess available data. Through our debates and case conferences, I was taught to be critical
in accepting new ideas without closing my mind to reliable and valid
information. This can very well serve
as a basic guide to my future practice of General Surgery.
Physician-teacher process
It is during my residency that I
realized that the process of learning is not a passive activity. Unlike in med school wherein teaching is a
unidirectional process, in residency we were trained to become students and
teachers as well. We were the students
to our consultants and seniors, while we were the teachers to our juniors as
well as the medical interns and clerks.
Through our conferences, we were encouraged to become active
participants by asking questions, sharing information and relating
experiences. Being able to teach and
impart to others what we have learned and experienced is a good foundation to
knowledge.
Physician-researcher process
Research has been a part and parcel
of surgical residency training at Ospital ng Maynila. Each resident must be able to submit at least one research paper
per year as a prerequisite for promotion.
This standing policy has opened a sleeping giant in all of us. Never did we imagine that we will be able to
write contest-quality and publication-potential researches. This we have proven for the last two
years. Also, through our research program
we have realized that researches are not just waste materials. It is very useful that it has been used to
formulate our department’s clinical practice guidelines and treatment
protocols.
Physician-manager process
My management skill was tested when
I started to become the team leader of our GS team. Being a team leader, a lot of responsibilities were passed on to
me by my seniors which included referring all patients to our service
consultants, arranging OR schedules, lining up residents on cases and
mobilizing junior residents to assist us in our day to day activities. This responsibility was further broadened
when I became the chief resident from July to September of 2003. My duty did not only cover my team but the
whole department as well. However,
despite the difficulty and challenge, it made me stronger and more responsible. The experience taught me a lot. It taught me the meaning and the importance
of duty, responsibility and service. The
qualities that should be present in every surgeon.
Community surgical health management process
Surgical residency training at Ospital
ng Maynila is not confined to the four walls of the operating room. It involves both in-hospital and community
directed basic surgical educational program.
This is what we call, “Social Responsibility.” Through the print media, radio and TV, we have disseminated basic
information on different surgical related issues to a lot of people. A very good example of which is our
information drive on: “Tule or not Tule,” Beware of Santol Seeds,” Cancer sa
Suso” and “Bosyo Program.” Through
this, we have realized that there are a lot of surgically related health
problems which can be immediately addressed and be very well prevented.
Core values:
Respect for human lives and human being
I was made to believe that being in
a government institution, we in time become numb to the pressures and demands
of our chosen profession. At Ospital ng
Maynila, despite the exposure and experience we were still trained to be
sympathetic to our patients. Our
respect for the value of human life was enhanced by our training. With the variety of personalities that we
encounter day in and day out, we have learned and mastered the art of patience
and respect and these are factors that we still can develop and improve on and
eventually use in our future practice of surgery.
Honesty and sincerity
Honesty
and sincerity are values that are sometimes the hardest to achieve. Most especially when one is faced in
compromising situations like a morbidity or a mortality. However, we must remember that mistakes is
part of the learning process and being able to accept ones mistake is the first
step to self improvement.
Ethics and integrity
With
honesty and sincerity comes ethics and integrity. Trust can be established only if one has already proven himself
and it takes time to prove oneself. At
Ospital ng Maynila, dealing with various people from various social classes and
backgrounds help us develop and improve on these core values.
Professionalism
During residency training,
oftentimes we are so exhausted and stressed out that our moods and attitudes
come in the way of our work. Sometimes,
we reach a point where tempers dominate that we forget our chosen vocation and
that is, to heal our patients.”
Professionalism is being able to know our role as healers and act out
our duties and responsibilities as doctors to our patients. It means being there for them always and at
anytime of the day. We must make sure
that they are okay and have no problem. We must try to improve their well being
despite the difficulties and our limitations.
Continual improvement to achieve quality and excellence
I believe that humility is the first
step to learning and that is being able to accept that we do not know
everything. With this in mind, there
will always be room for improvement and we will have that drive for a never
ending quest for knowledge. During
residency, I have learned that there are activities that I can use for my
personal growth and improvement such as our morbidity/mortality quality
analysis, medical informatics and debates on surgical issues. These are tools which I can use and apply in
my future practice in pursuit of professional development to achieve high
quality and excellence.
Teamwork
The success and failure of an
operation will depend not on the surgeon alone but the team as a whole. A surgeon will not be able to function
without the anesthesiologist, the first and second assists and the nurses. Everyone in the team must work as a unit and
must complement each other in order to achieve a common goal which is to heal
the patient. At Ospital ng Maynila,
teamwork does not work within the operating room only. It also applies in our duties, during
conferences and other hospital related
work.
Social consciousness
Being able
to deal with people from different background and social classes has made us
aware that each one of them has their own need and expectations. It made us aware of our role as surgeons in
the hospital, in the community and at home.
Residency has made us aware of the prevailing problems in our society
and therefore acquire the necessary skills and knowledge to determine what
needs to be done and thus improve our community’s health condition.
Discussion:
To sum it all up, surgery is not all
operation. In order to become a good
surgeon you must not just acquire the necessary skills in operating but you
must also have the maturity and experience in your work. It is not just the maturity and experience in
diagnosing diseases, doing accurate yet cost-effective work-ups, most effective
treatment and doing post-op care. It is
also instilling in ourselves and in our work the Basic Frameworks and Core
Values of Surgery which we have learned during our surgical residency
training. Our ultimate goal is to excel
in our field and chosen profession and to attain this we must be well rounded
surgeons. We must not just know and
memorize by heart the basic frameworks and core values but rather, we must also
understand it and put it into action to attain personal development and
eventual self fulfillment.
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.