Post-training
Reflection
Rommel Q. de Leon, M.D.
Introduction
I started my residency training in
General Surgery at Ospital ng Maynila Medical Center on January 1, 2003. For two years I have acquired a great amount
of knowledge, not only about surgery, but also about myself and life. Through
these years, I have made decisions that greatly affect my life. This
institution has taught me the essentials and skills that are required of a
General Surgeon. Together with my colleagues, we have grown an invisible
connection as strong as a family. Every single person, instrument, disease and
operation contributes in molding and shaping me to become the surgeon I longed
to be.
Objectives of paper:
Results:
Basic frameworks:
Patient management process
In my years in
med school, I never quite appreciate the case presentations. During
presentations, you are bombarded with a lot of differentials, tons of
laboratory work-ups, and mountains of treatment options for a single disease
entity. It seems that you’re caught –up in a tangle of webs. You got confused
and sometimes got lost in the process.
When the patient
management process was introduced, I’m a little skeptical because it has an
approach very different to what I’m accustomed to. The process has taught me
the simplest and most logical way to analyze a case and to be able to come up
with the most rational diagnosis, work-ups and treatment. I am glad that a
rational approach was introduced that could be utilized in every decision we
made in our life.
Operation-surgery process
Being a surgeon comes with greater
responsibility! Surgery is not just operation.
It involves not only your technical knowledge of the procedure but also
its indications, benefits and risks. In any operation that a surgeon should
perform, he must be at least familiar with the procedure. One of the strategies
of the department to accustom the resident to different procedure was through
the “How I will do it” and “How I did it” program. This program helped me to
familiarize myself to the different surgical procedures, even though I have not
done it.
Problem-based and self-directed learning
process
General Surgery does not stop after you
have performed all type of procedure. Surgery is a continuous learning process,
it is constantly changing. A surgeon must yearn for knowledge. Residency
training has taught me how to handle controversies and how to cope up with the
advances of medicine and to be always open and critical to new
information. Our debates, case presentations, problem-based
learning issues, Journal club and MAR have helped me developed my clinical
performance.
Physician-teacher process
In my four years at OMMC, it made me
realized that I am not only a student to my consultants and seniors but I am a
teacher to my juniors, medical interns and clerks and to my patients too. Being
the interns and clerks monitor of the department, I have experienced the
hardship of handling them. I made
mistakes and bad decisions for I am not perfect and I treasured it. It was a
great experience to teach and interact with the students and to impart to them
what I have learned and experienced.
Physician-researcher process
Research is not my cup of tea, but it has been a part
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 exposes me to
different kind of researches which helped me understand its relevance and able
to helped develop my analytical skills.
And from these studies protocols and clinical practice guidelines were
formulated.
Physician-manager process
My managerial
skill is developing. Yearly, my responsibility is getting bigger, from handling
subspecialty cases, to supervising the interns and clerks, to the accounting of
the department’s money (the hardest part of it all). However, despite the difficulty and
challenge, it made me stronger and more responsible.
Community surgical health management
process
Being able to see and manage a lot of
health problems of the community. General Surgery Residency Training program of
OMMC stepped out of the confines of the walls of the hospital. Social Responsibility Program was born. The
main objective of this program is to disseminate information regarding
different surgical related issues through print, radio and television.
Core values:
Respect for human lives and human being
In the department, I was taught to bear
in mind that an operation should end up with a live, happy and satisfied
patient, no complication, no disability and no medico-legal suit. We should treat our patient as our relatives.
We should provide quality surgical and medical care to all patients regardless
of their status in the society.
Honesty and sincerity
Being honest is very hard to achieve
especially if you are in a compromising condition like morbidity and mortality.
To accept one’s mistake is a sign of maturity. And we must remember that
through mistakes comes learning.
Ethics and integrity
Residency training gave me a chance to
develop my work ethics. I always keep on
mind that every one of us is unique, differences in opinion and management
exists. Respect for other physicians decision and management, taking time to
talk to referring physician as to what would be my management before I execute
it, update consultants on the progress of the referred patients. In doing so, I earn my colleagues’ trust and
confidence and one’s integrity will be uplifted.
Professionalism
The
environment in
The
patient load is high and most of the time these patients have different
expectations from us doctors. Some of them are patient enough to wait their
turn to be seen, but mostly the patients expected to be seen at once, not
wanting to wait even for a short while. It is a common sight to see irate
patients especially at the OPD. My years of stay at
Continual improvement to achieve quality
and excellence
By regularly holding conferences with the consultants
and co-residents, I am made aware of certain aspects of my work that needs
improvement. The constant reminder of the success of an operation that entails
a satisfied patient with no morbidity and mortality has been effective in giving
me the drive to always seek self-improvement
Teamwork
In
an operating room, the importance of teamwork cannot be overemphasized. The
success of even a minor procedure entails the participation of a lot of people
and not just the surgeon. The anesthesiologist, first and second assists, and
the nurses should all work harmoniously with the surgeon to ensure that an
operation will proceed smoothly.
This
type of working relationship is important not only in the operating room. A
jam-packed emergency room full of patients shall be more manageable if there is
division of labor and delegation of work amongst the members of the team. The
ward work shall all be carried out if the doctors and the nurses will work hand
in hand with the patients and their relatives.
Social consciousness
Being a
government hospital, we see patients from different walks of life. We have to
help them find solutions to their surgical problems irregardless of their
social status. The department has a community surgical health programs; dissemination of information through
print, radio and television; medical
assistance program for indigent patients in the form of free surgical operation
for the community.
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
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.