Name of Project:
Medical Anecdotal Reports
Category:
Human Resource Development
Descriptive Title:
Medical Anecdotal Reports as a Teaching-Learning Activity for Surgical Residents of the Department of Surgery of Ospital ng Maynila Medical Center
Summary
Medical Anecdotal Reports or Reporting (MAR) is a teaching-learning activity undertaken by the Department of Surgery of Ospital ng Maynila Medical Center (OMMC Surgery) starting April, 2004.
MAR is operationally defined as a brief written report on an actual medical event that involves an actual patient seen by the surgical resident. The medical observation must have an impact on the reporter as a physician in terms of insight gained and which the reporter thinks is worth sharing with colleagues as this might help improve patient care. Any aspect of patient management may be reported as an insight which is eventually categorized as predominantly physical or biological, psychosocial, or ethical issue. Reasons for reporting insights can be categorized as predominantly discovery; stimulus for investigation and research; or reinforcement or validation of previously held philosophy and principles.
Each surgical resident is required to submit one brief MAR a month, following a template, posted in the Department’s group email and trainee’s online journal and presented in the Department’s conferences.
The primary objective of MAR is to develop the surgical residents as knowledge-based workforce through reflection and sharing of information/knowledge/skills with their colleagues. The secondary objective is to develop their written communication skills.
The vision-mission for a model in surgical education, the core values of excellence and innovativeness, and the presence of the need to develop the surgical residents along the two aforementioned objectives served as the driving forces for the development and utilization of the MAR.
From April, 2004 to June, 2005, each surgical resident has been religiously submitting a MAR each month. A total of 180 MARs from the surgical residents has been accumulated so far. These MARs are mostly categorized under physical and psychosocial issues as types of insights and reinforcement as reason for reporting.
A formative evaluation using a questionnaire was done in August, 2004 which formed part of a paper presented in the 4th Asia-Pacific Conference on Problem-based Learning in Health Sciences in September, 2004. Results of the questionnaire showed all residents and consultants understood the concept of MAR as designed. Through the MAR, the trainees gained insights or learning through reflection and analysis of the event. They experienced all aspects of physician-patient biopsychosocial interaction. They were given opportunities to be expressive and to polish their written communication skills. Through the MAR, the faculty was able to evaluate the cognitive and affective levels of competency of the trainees. All residents and consultants were satisfied with the MAR. They believed it had achieved its intended objectives. They would like it continued with refinements, particularly, balancing the types of insights and reasons for reporting.
Impact of the MAR as of June, 2005, consisted of reduction of patients’ complaints against the interpersonal skills of surgical residents from a baseline of 6 in 2001 and 1 in 2002 and 2003 to zero in 2004 and June, 2005; improved written communication skills of the residents; and positive feedback by external evaluators on the importance of the MAR as a tool to develop residents’ humaneness and compassion in patient care (see below):
“I am touched by your efforts to make your resident so aware of their deeper emotional reactions to the complex situations they are in and the wonderful people they come in contact with. More so to find beauty in the midst of destruction, misery and suffering. The practice of medicine is a dangerous ground for doctors as it is a field that can make one feel so powerful, dominant, critical and insensitive to self and others. I feel embarrassed that you the surgeon has done a "sensitivity" program while I have not done my bit to contribute to make our work more humane and meaningful to others but more so to ourselves.” Psychiatrist I
“Kudos! Its something even we in the field of Psychiatry don't even do. I might just do that with the psych residents. Thanks for the heart & the inspiration.” Psychiatrist 2
“Thank you for allowing us to hear the anecdotal reports of your residents. It gives us also opportunities to "re-live our surgical residency days". May we have the kind of humane and compassionate doctors and surgeons that you are trying to mold fill up our world.” Surgeon 1
“I appreciate very much the anecdote submitted by Dr. Chan. It distinctly shows her unprejudiced attention to details and true compassion and concern for a patient whether a law breaker or any ordinary patient. I am extremely hopeful that there will be more doctors like her.” Surgeon 2
Supporting documents include:
Memos establishing and developing the MAR
Paper on MAR presented at the 4th Asia-Pacific Conference on Problem-based
Learning in Health Sciences
Selected and edited 2004 Collection of MAR
Feedback on the MAR from External Evaluators
CD: 2004 and 2005 Collection of MAR
Webpage: http://omsurg-mar.tripod.com