Post-training Reflection

JANIX M.DE GUZMAN, MD

INTRODUCTION:

          At the start of the new millennium, I began my quest to be a General Surgeon. This quest is a privilege and honor served not in a silver platter but an Everest to climb. Before I was fully inducted as a trainee in General Surgery Training Program of Ospital ng Maynila Medical Center in January 2000, I previously underwent three months of rigorous pre-residency selection process. I will not go into the full detail of it but back then the competition was very stiff in order to be included in the family. However the perseverance in me regurgitated in my veins to go on, luckily or by purpose I got accepted and had the chance to seize this dream.

          In this world where change is constant we were not spared. In 2002, a major event occurred that costs as one year of retention but it turned out to be a blessing in disguise. After the storm had passed the Department of Surgery, OMMC was resurrected as one of the most organized and structured residency training program in the Philippines.

It was been five years since I started my journey and here I am still, holding on, building my foundation, and believing that someday victory will be mine.

OBJECTIVES:

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.

RESULTS:

BASIC FRAMEWORKS:

Patient Management Process

The introduction of patient management process into our system finally filled the gap between the problem and the answer. I likened it to a solution in mathematical point of view for it explains how one arrived to an answer. In medicine, knowing the correct diagnosis to a certain problem is nothing if a clinician can not explain how he arrived at his diagnosis. This process simplified medicine in its context. I have not encountered such during my medical school years and my previous mentors never mentioned one. Hence oftentimes I was overwhelmed by so much information that leads to confusion. Acquiring this process had given me an armament in tackling various medical problems, provides understanding and enhances my decision making. It builds a foundation towards a rational, efficient, and effective physician.

Operation-surgery process

          See one, do one, and perform as many procedures as you can are the basic principles in the mastery of practical skill most especially in the field of surgery. These are even more supplemented by “How I will do it” and “How I did it” program in our institution to augment our knowledge in as many surgical procedures as we can.  However, the Department of Surgery, OMMC never conceptualized surgery as an act of doing operation alone. Our department has also included in this process the formulation of rational pre-operative plan, accurate intra-operative execution guided by sound decision making, and adequate post-operative management.

 Problem-based and self-directed learning process

          In the ever changing world of medicine new informations are being added each day. This is most immortalized by the cliché what is true today may be false tomorrow or vice versa. Therefore we as surgical residents at our institution are encouraged and stimulated to explore the world wide web of medicine. Most importantly we are taught not to just swallow new informations but to fully critically appraise them and utilize what is most important in our practice and setting. This process is most often used during debates of controversial issues, and issues not settled during conferences labeled as problem-based learning issues. These not only increase our knowledge but most importantly to apply this acquired knowledge to our patient and eventually improve our clinical performance.

Physician-teacher process

          Our duty as a physician towards our patient does not end on giving treatment alone, we must also educate them. Giving advice on health maintenance and health prevention is a way of educating our patient. Remember it is their right to full disclosure. At our department we are continuously trained as part of our holistic patient management to educate our patient.

Physician-researcher process

          To promote quality research being part of the vision-mission-objective of our department, physician-researcher process is included in the development of a holistic surgical resident in the Department of Surgery, OMMC. We believe that through continuous research we improve our service to the community. Since the re-organization we were able to produce researches in the field of surgery and have claimed recognition. As an individual I was able to make my own action research and had applied it to my clinical practice. I appreciated the clinical importance of doing a research for my personal growth and improvement.

Physician-manager process

          As a physician and aspiring surgeon-to-be at that we were always in the place of being a leader. It is never obvious but during operation and you are the surgeon you are the captain, the leader and the manager. Being a surgical resident has given me the opportunity to act as one and our department through our chairman, consultants, and previous senior residents taught and showed how to be a responsible one.

Community surgical health management process

          Through our social responsibility program we were able to involve the community in our advocacy of health. Keeping up with the time through mass media we disseminated public awareness on the likes of unhealthy swallowing of santol seeds, unnecessary routine circumcision, and staging of year-long operasyon pinoy in the Department of Surgery, OMMC.

Thorugh Operasyon Pinoy, quality surgical care were delivered to our less fortunate brothers and sisters.

CORE VALUES:

Respect for human lives and human being

          It is always our inherent duty as doctors to value life and treat every patient humanely. We doctors are also human and not impossible that we may put in place of being a patient. Hence at the Department of Surgery, OMMC we follow the golden rule, “Do unto others what you want others to do unto you”. Through our patient management process we have treated our patients with utmost respect. We always involve them by seeking their consent in all action we do.

Honesty and sincerity

          Honesty is the best policy. The department does not tolerate any dishonesty in the ranks. I always dealt my patient with sincerity and honesty. This way I feel no remorse for whatever the result may be. For if I speak the truth it does set me free.

Ethics and integrity

          To be a doctor is an exemplary in every way. I still believe that it is one of the most noble profession and to be one we must act as one. Our forefathers in medicine had build this reputation and we owe to them to protect this integrity. In the Department of Surgery, OMMC we are constantly reminded to respect our patient and be able to show them that Surgical Resident in this institution have ethics.

Professionalism

          Being a surgery resident a lot is expected of me. And as aspiring surgeon I should act accordingly. In the department of surgery various tasks are performed and must be performed. Each resident is expected to be responsible enough to do his duty. First and foremost we are duty-bound to take care of our patient not only during operation but throughout his stay in the wards. As we do our day to day activities we can not avoid working with other health professionals and we should give them also proper treatment.

Continual improvement to achieve quality and excellence

          Keeping up with vision-mission of the department had inspired us to work for more. We should not contend ourselves just to deliver but strive and do our best to serve quality and excellence in all we do. There are so much to accomplish and achieve if we set our mind into it.

 Teamwork

          To be part of the Department of Surgery is like being in the family. Learning how to work with others or teamwork is the essence in order to achieve our set goals. As a surgeon our line of work entails team effort and during this period of residency we are being trained not to be egoistic. During each operation learn to appreciate the effort contributed by your team. You may be the captain of the ship that direct the sail but without the help of the crew you will get to nowhere.

Social consciousness

          In the Department of Surgery, OMMC, doctors as well as the community we serve plays a vital role. We are trained not only for self-improvement but also to be able to contribute to the community. We do not live in the confines of the hospital but we are only a part of this complex social life. We must be able to interact not only with health professionals but also to the people of the community in every walks of life. Hence our department has constantly reminded us involve the community by doing the department’s social responsibility program, and information dissemination on improving health maintenance.

Discussion:

          This paper is a post-training reflection cum self-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 5 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 my on-going residency now at 5 years, 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. I 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 thing 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 these basic frameworks and core values were taught by the present department chairperson, 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 values of the present Department of Surgery 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 trainee 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 and trainees 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 of my on-going 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 in the coming years and after graduation.   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 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.  Although my faculty will have a final judgement on my self-evaluation, I confidently say that I have imbibed the basic frameworks and core values which 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 (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). 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.