Post-training Reflection for Non-Graduating Residents
Oliver Leyson, M.D.
November 25, 2004
Introduction
I started my residency training in General Surgery at OMMC on January 1, 2001. It’s been four years since then, years of hard work and training. I am very lucky to be part of the “Model” Department of Surgery under the tutelage of our Chairman. I am on my third year of my training and this reflection paper would show how much I have learned during my years of training.
Objectives of paper:
1. To formulate strategies for continual improvement on the basic frameworks and core values
2. 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.
Results:
Basic frameworks:
Patient management process
In my first year of training, my approach to patient management was not structured. There were times that I was able to arrive at a correct diagnosis but there was no process involved and the approach seemed irrational. After one year, under a new stewardship, the Patient Management Process was introduced in my training, and my way of management of patient was never the same again. It became more 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. Nevertheless, grasping the art of these principles was never a ‘walk in the park’’ for me. I always tried very hard during case presentations and I believed that there was still room for improvement. There were times that my diagnoses were wrong but with this approach to patient management, I could always have a sound and rational one.
Operation-surgery process
My four years of training at OMMC has opened my eyes to every aspect of surgery, not just to 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. Decisions were based on the benefit, risk, cost, availability table to rationalize what is the best treatment option for the patient.
Our “How I will do it” and the “How I did it” program has helped me to master surgical procedures. As a third year resident-surgeon training in this institution with adequate training in operation-surgery process, I believe that my skills are at par if not better than those of other residents belonging in my year level from other institutions.
Problem-based and self-directed learning process
Medicine is a never ending learning process and residency has taught me to be always open and critical to new information. My training has taught me how to handle controversial issues and how to look for the best evidences available (e g: surfing internet). Finding the right search engines and keywords are the ingredients in making a good research. Appraising the right article for research topic is not as easy as it may seem. That is why our chairman developed the teaching modules such as debate, problem-based learning issues and action researches to improve our research skills. These modules are examples of problem based and self-directed learning activities of the department which helped me improve my clinical performance.
Physician-teacher process
My training made me realize that teaching is part of my profession and I believe that the optimal learning process can be achieved through interactive exchange of ideas. My training has provided me enough opportunities to teach and educate my patients, junior residents, medical students and myself. Sharing what I have read to my colleague will not only reinforce the knowledge I gained clinically but it will also enhance my oral communication skills as well.
Physician-researcher process
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 basis for me to pursue becoming a physician-researcher. We were taught to find controversial issues through the internet to settle differences and to standardized patient management among residents.
Physician-manager process
Residency has given me a chance to develop my leadership whenever we are provided with responsibility to harness our administrative capabilities. Although, I am not yet taught how to run a department and how to handle administrative problems, being a surgical resident has taught me how to be responsible for my own actions towards the fulfillment of the goals and objectives of the department. Our beloved Chairman has shown us the attributes of a good leader- both humble and merciful, both of which we all try to become.
Community surgical health management process
The department 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” as our chairman would put it, or in more understandable phrase, “Do No Harm” has become one of the important policies of the department. My training has always taught us to respect human lives by being humane in our approach to our patients with the goal of having a live and satisfied patient with no complaint and no medico-legal suit. Our weekly surgico-aneshthesia conference includes morbidity and mortality conferences in which we present our quality analysis of what transpired to the patient and what went wrong in our management.
Honesty and sincerity
“Honesty is the best policy” that is the most important policy in the department because you cannot be totally sincere if you are “dishonest”. Acceptance of one’s fault is one way of maturing to become a great surgeon. We were once disaccredited because of dishonesty; never again shall we fall to the same grounds again.
Ethics and integrity
My training has given me the opportunities to develop 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 develop and gain their trust and confidence.
Professionalism
My training has taught me to follow rules and regulations of the hospital and the Department. I have learned that in order to gain the respect of others, we must learn to respect ourselves and learning to respect the rights of others like our patients, co-residents, consultants, nurses and nursing aids, DPS and all the people we encounter everyday. They all deserve to be respected and gain trust and respect from others.
Continual improvement to achieve quality and excellence
The Department of Surgery aim high in setting standards with regular monitoring and evaluation of patient care. We held weekly conferences to enable to monitor the quality of care we rendering to our patient and often times this helps us a lot in improving our 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.
Teamwork
My training has taught me how to work with others, as a team. Last year we were divided into three teams, not much different from what we used to call it. All of us are tasked to do something to be efficient and to serve more patients in less time possible. Team work promotes camaraderie among residents as well as the post graduate Interns and junior Interns. Most of all we were trained to act collectively to achieve a common goal “patient satisfaction”.
Also through teamwork we were able to regain our accreditation and build up the reputation of the department.
Social consciousness
My training has made me responsive to my social responsibilities. We were continually reminded of our obligation to the community. Our beloved Chairman developed the Social Responsibility Program for each resident and this is done annually. My social responsibility was the education of the general public that routine circumcision was no longer necessary and to give a comment on the picture of a child about to be circumcised entitled “ Rites of Summer” published in the Philippine Daily Inquirer last May of this year.
My training taught me how to develop 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. Other health advocacy included in the department were unnecessary surgical operation such as “excision of fibrocystic breast changes” and Public health awareness of “bawal lumunok ng buto ng santol”
Discussion:
This paper is a post-training reflection cum-evaluation. This is a good venue to reflect what has transpired during the last few years of our training. Reflective learning, exemplified by this post training reflection helped me improve my work ethics, study habits and patient care.
In doing this reflection, I was able to evaluate myself. Through the mistakes, hardships and bad decisions made, I must say, I am a better surgeon now than last year. Basic framework and the core values should be our guide to enhance your knowledge and skills.
Summary:
I have presented a reflection cum self-evaluation paper after my four years of 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. 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.
This post training reflection described my four years of training in this department. I hope I was able to imbibe all the basic framework expected of me as a general surgery resident of OMMC Department of Surgery.
The Basic frameworks and core values will serve as a foundation for my being a rational, effective, efficient, holistic, and humane surgeon.