Nolan Ortega Aludino, MD
Jan 2003-Dec 2004
Introduction
I entered the Department of Surgery of OMMC on January 2003. I just passed the board exams and I was still coming to grips with the fact that I am now a physician. I was quite hesitant to enter into residency training right away; I still wanted to savor the moment. But there was a constant nagging inside me. Something kept telling me to go ahead and explore the possibilities. So I did. I signed up for residency training in surgery.
It is now almost three years since I made that decision. Honestly, I have no regrets. Though, residency training has exposed through hardships and trials, I am still glad I made that decision.
Only through training was I able to hone my skills. I learned the effective way of diagnosing and treating patients. Something I might not have learned without the proper guidance.
Yes, I am glad I made that decision.
Objectives of paper:
Results:
Basic frameworks:
The patient management process gave structure to my somewhat disorganized ideas. It was one of the guides that I was hoping would be passed on to me, being a neophyte physician. The process became a tool for me, a useful tool to effectively diagnose and treat a patient. Through it, the efficient way of treating as patient has been dissected from those which are not.
Although I have come to grasp the concept of the Patient management process, I still feel that I have much to learn and to improve.
I have improved, both in my understanding and in my application of the patient management process. As I am investing more years as a surgeon in training I find it more and more easier to apply in my everyday life as a clinician. I am already trying to teach younger doctors what the concept is all about, hoping to spark their interest.
“A safe surgeon”. One of the guiding principles I want to live by. There is no one great lesson I want to learn in this department than how to be a safe surgeon. Through constant studying of techniques, by using the “how I do it” and by having consultants assist us at the operating room, we can become safe surgeons.
One cannot totally avoid mistakes. However we must learn to minimize their occurence and maximize the lessons learned from each mistake made. We should not repeat the same mistakes. In the process we must be able to stop and thank all the patients that came our way. Without them we can never be.
There are more than enough cases being handled in our department to facilitate training.
Problem-based and self-directed learning process
By introducing problem based learning in our department we are being stimulated more to learn. We must have the drive to seek out new knowledge. This has been constantly reinforced in us through different exercises. We constantly use Problem Based Learning Issues (PBLI) to stimulate learning. This is the advantage we have and must maintain.
The use of PBL culminated in our participation in t eh 4th Asia-Pacific Conference on PBL.
After participating in the 4th Asia-Pacific Conference on PBL, the quest for knowledge and self improvement through problem-based learning continued and has enriched our stay in the deparment.
Physician-teacher process
As surgery residents it is part of our responsibility to guide the medical clerks and interns that are rotating under the department. As such, we must strive to inculcate in them the right practices and the right knowledge. We do this by being good examples. Constant supervision and bedside rounds helps in training the medical interns and clerks.
It is our responsibility to teach the medical clerks and interns the practices of the department and to inculcate in them the vision mission of the hospital and the department.
For 2006, I was assigned the responsibility of being the clerks and interns monitor. I relished this position because it put in the spotlight. Not I am seeking fame and fortune, but I wanted to have the free hand, to teach the clerks, all about the department of surgery and the patient management process.
Now that I am graduating from the department, I will now bring forth with the knowledge gained from my experience in Ospital ng Maynila and enlighten those that I will meet.
Physician-researcher process
There should be constant learning through research. Knowledge has to be updated. What better way to do that than through research? By doing research we constantly challenge old ways of doing things in order to propose new and better ways. The department has been at the forefront of research. We have produced quite a number of researches and have been very active in joining contests and winning some.
I was fortunate enough to present my research in a forum sponsored by the Manila Medical Society. Although I did not win, the fact that two of my co-residents won, was enough to vindicate the efforts put in by the department head and my co-residents in research.
Try and try, never quit. Words to live by in the quest to become better researchers. Reading other papers and applying what we have learned to our present practice makes the idea of research worthwhile.
Physician-manager process
As a resident it is not uncommon to find ourselves cramming for time. Burdened with a lot of responsibilities, we must constantly find ways to beat deadlines. That is where time management comes in. With the guidance of the department, I have found ways to manage my time to come up with the most efficient performance I could possibly give.
As we spend more time in the department we gain new responsibilities. By gaining new responsibilities we must constantly adjust and perfect our time management skills. Yet I know I have much to learn. Putting on the shoes of a senior resident, we will have to fulfill the roles of part managers. We will now have to guide the team of residents, show the path which we think will provide them with greater avenues for learning.
As I go out into the world, outside the walls of Ospital ng Maynila, I can apply the things that I have learned to further improve those organizations which I would join.
Community surgical health management process
Being part of the community, we must also find ways to take care of the other members. Through community education, by using the different media, the department has been doing just this. Being made aware of the needs of the community and providing solutions though the different aspects of Operation Pinoy, we have tried to provide quality care to the community. We must continue providing solutions to the problems of the community without promoting a dependent attitude among them.
By sending articles for publication we are providing community with knowledge, an armamentarium they will most certainly need in their constant battle against disease.
Core values:
Respect for human lives and human being
Commiting mistakes is part of training. What we must do as residents is to try to minimize these mistakes, and control the damage brought about by these mistakes. I had my share of mistakes and patients have suffered because of these. I am glad that we have these patients. Although we must not lose sight of the fact these are human beings and must be afforded the respect that deserve. That’s why for every mistake we make, we must make it a point to learn from it.
Respect for the dignity of human life, is one of the principles we must not lose sight of as physicians.
Sometimes our mistakes will cost the patient his or her life. This is one mistake that is quite hard to bear and in the department we help ease this pain by offering a prayer to those we have wronged
Learn, learn, learn..... Learning should be exponential and mistakes should be on a constant decline.
Honesty and sincerity
Being a doctor has its perks and responsibilities. Training to become surgeons doubles those responsibilities. We must be beacons of honesty and sincerity. We must always be upfront when dealing with patients and other physicians. We must not keep the patient in the dark about his problems and to always present to the patient all the possible course of treatment.
Honesty extends to the way we deal with our co-residents and consultants. This also mandated by the code of conduct expected of a surgery resident.
Indeed, by taking on the role of physicians, we must be more than careful in maintaining our credibility. What better way to do this than being honest to the multitude of people we deal with. A physician who has lost his credibility will certainly not be trusted by his patients. A physician who does not enjoy the trust of the patients will see the number of his patients dwindle. A physician who does not have hid patient's trust will soon lose his practice.
Ethics and integrity
Since medical school, we have been constantly told what is ethical and what is not. Being in surgery, those lessons we were taught become even more important. Such as in the case of circumcision. The department has taken a stand that circumcision is unethical. By closely examining the reason behind circumcision I have personally come to the conclusion that it is indeed unethical.
It is also fortunate that we have medical anecdotal reporting in the department. Through the MAR, we as residents can review different ethical and psychosocial issues, thus reinforcing our database on medical ethics. Using the MAR as an instrument of introspective learning, the resident together with his colleagues is given the chance to review to decisions he made.
Professionalism
As doctors in a government hospital we constantly bombarded with different kinds of people. As professionals, we are expected to give equal opportunities to all patients and to treat all of them as equals.
Professionalism encompasses all the previously mentioned topics. Being professional means being honest, sincere, and having the right ethics.
Continual improvement to achieve quality and excellence
By living up to my responsibilities and to those expected of a surgery resident, I will try to improve all the aspects of my training with respect to governance, service and research.
I believe that as surgeons we must strive constant self improvement.
Teamwork
No man is an island; no surgeon can do it alone. Teamwork is they key to making life as a surgery resident easier. We must abide by the rules set for the department, because we are part of the organization. This does not mean however, that self expression should be curtailed. In fact this should be encouraged as long as it does not run contrary to the goals of the department.
We as residents underwent a lot through the past few months. There were a lot of incidents testing each others resolve. Fortunately we are made it through. What does kill us only makes us stronger. Right?
Social consciousness
Doctors have a social responsibility to try to uplift the health status of the community. We must achieve this through constant community education and proposing projects which are beneficial to the community.
We utilize all the available means to disseminate useful information to the community.
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 (1,2,3,4) 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 (1, 2, 3, 4) 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. 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 resident 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 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.