Ospital ng Maynila Medical
Center, Philippines
Discussion
Search
of the Medline and HERDIN (1) in August, 2004 did not yield any paper on the use
of “medical anecdotal reporting” as a teaching-learning activity for medical
students and clinical trainees. The types of teaching-learning activity that
are closest to the objectives of the medical anedoctal reporting are the
learning portfolio (2-3), medical case reporting and discussion, and reflection
papers.
Both
learning portfolio and medical anecdotal reporting promote reflective learning.
A collection of medical anecdotal reports may constitute a learning portfolio.
However, a learning portfolio per se may not necessarily be medical anecdoctal
reporting as the former is simply a purposeful and selective collection of
learning activities of a student which may not include the latter.
Both
medical case reporting and discussion and medical anecdotal reporting deal with
one-patient experience. The main difference between the two is that the former
traditionally focuses on the processes of conventional medical management of a
patient while the latter focuses on the insights gained during the management.
The insights are derived from a reflection of what transpired in the
physician-patient interaction and this reflection is not limited to the physical
aspect of health care but can stretch to the psychosocial and ethical aspects of
health management.
Reflection
papers (4-5) in medicine are closest and similar to the medical anecdotal
reporting of OMMC Surgery. The only difference that may differentiate the two
will be the objectives formulated by the facilitators for such a reflective
learning activity. In OMMC Surgery, the primary objectives are to record the
insights of the trainees and share them and in the process learn from them, both
an individual and group bases. Secondary objectives are to improve English
composition and to complement the evaluation tools of the faculty.
In the
formative evaluation, majority if not all of the residents agreed that the MAR
facilitated improvement in the management of even the physical aspect of their
patients’ problem, not just the psychosocial and ethical aspects. This was
despite the residents being taught in their respective medical schools not to
rely on anecdotes in patient management. Even with evidence-based medicine
being in vogue nowadays, it seems that the use of anecdotes and lived
experiences cannot totally be delegated to the background (6-7).
Another
significant observation during the formative evaluation was that majority of the
insights of the residents dwell on the psychosocial and ethical aspects of
medical practice. This finding was heartwarming to the Department’s
administration considering that for the past 20 years, there has been difficulty
in developing and integrating social health sciences and bioethics in medical
education (8-13). Most of the time, the advocacy focuses on the undergraduate
years. There are infrequent reports advocating their use in the clinical
residency, most of them in family medicine (14-15), and practically none in
surgery. The way it has been designed and based on the nature of its outputs,
MAR can very well be a practical innovative strategy and model towards
integrating social health sciences and bioethics in clinical medicine.
Thus, with
all its benefits in terms of reflective learning, improving competency in
biopsychosocial management of the trainees and a valuable evaluation tool for
the faculty, the authors recommend its adoption in the clinical training
departments.