Medical Anecdotal Reports - A Legacy
(ROJoson's Notes on February 23, 2021 - first written in 2018 as part of my memoir at age 70 in January 31, 2019; being updated every now and then, while I am still on earth; updating this on February 23, 2021 for ROJoson @72 Memoir)
I established and developed the Medical Anecdotal Reports or MAR in 2004 in the Department of Surgery of Ospital ng Maynila Medical Center. It was an additional innovative teaching-learning activity that I had designed for the Department during my term as Chairman from 2001 to 2009.
As to objectives, the MAR is primarily a learning activity in the development of holistic, professional, and compassionate physicians among the surgical residents of OMMCSurg. The second objective is to enhance the residents’ English writing skills. The third objective is to reinforce the Department’s knowledge management system through the issues raised and resolutions made in the MAR activity.
I have published the MARs in two booklets (Volumes 1 and 2) and the rest online (2004 to 2018): 1562 MARs as of March 2018 [more as of November 2018]
The MAR is still ongoing (as of November 2018) after my retirement from the Department of Surgery of Ospital ng Maynila Medical Center in 2014.
The Medical Anecdotal Reports Project is a legacy that I leave and will leave behind as an innovative teaching-learning activity for surgical residents (as well as medical students) in the development of holistic, professional and compassionate physicians.
History
In April 2004, I started a project which I named Medical Anecdotal Reports or MAR for short, in the Department of Surgery (Surg) of Ospital ng Maynila Medical Center (OMMC)[OMMCSurg]. The MAR was an additional innovative teaching-learning activity that I had designed for the Department during my term as Chairman from 2001 to 2009.
The MAR was operationally defined as a brief written report on an actual medical event that involves an actual patient seen by a surgical resident or trainee. The medical observation must have an impact on the surgical resident as a physician in terms of insight gained and which he/she thinks is worth sharing with colleagues as this may help improve patient care and may be useful for the knowledge management system of the Department. In essence, the MAR is a reflection paper and writing it is a reflective learning activity for the surgical residents or trainees.
From April 2004 up to the time of my retirement in January 31, 2014, the objectives, policies and implementing instructions on the MAR have been continually refined. Below are key information on the MAR.
As to objectives, the MAR is primarily a learning activity in the development of holistic, professional, and compassionate physicians among the surgical residents of OMMCSurg. The second objective is to enhance the residents’ English writing skills. The third objective is to reinforce the Department’s knowledge management system through the issues raised and resolutions made in the MAR activity.
As to policies and implementing instructions on the MAR, each resident is required to write and present one MAR a month, except in January and December, the respite period. A template is used for the writing and presentation of the MAR which consists essentially of a one-page paper with narration followed by insight and categorization of the latter into physical, professional /ethical, and psychosocial domain. For every presentation of a MAR, at least 2 residents are required to react with a consultant moderating and facilitating discussion. Feedback and discussion cover both the contents and the technical writing of the MAR. At the conclusion of each MAR presentation and discussion, resolutions are made on measures to be adopted by the Department staff in enhancing the development of holistic, professional, and compassionate physicians as well as in improving the system of care, not only of the Department but also of the entire hospital.
Project MAR is still ongoing and continued by the current Chairperson, Dr. Hazel Z. Turingan and Dr. Edgardo Penserga (as of November 2018). [Updating Notes - 2021 Feb23 - still ongoing under the chairmanship of Dr. Penserga - 7 years after my retirement in 2014.]
A total of 50 surgical residents have written a MAR since 2004 (as of 2014). A resident who completed 5 years of training in OMMCSurg is expected to have written 50 MARs (10 MARs per year x 5).
Since April 2004 (when I started the Project) up to November 2014, we have roughly 1700 MARs currently in our archive.
There have been a series of evaluations done on the Project MAR since 2004 up to present. The result of the first formative evaluation was presented in the 4th Asia-Pacific Conference on Problem-based Learning in Health Sciences in September of 2004. Subsequent ones, in 2006, 2012 and last month. There were also delightful feedback from external sources. I shall present these evaluation results and feedback in a little while.
With the positive findings of usefulness in improving trainees’ competency in biopsychosocial management of patients and with delightful feedback on the MAR, I decided to publish the MARs into a book or books. I have published two books so far, one in 2013 and another one in 2014. I intend to publish more. [Updating Notes - 2021Feb23 - I learned that OMMC Surgery is still continuing with the MAR as of February 2021 - that's 17 years after I started it in 2004 and 7 years after my retirement from OMMC Surgery in 2014. Happy indeed. I have asked the surgical residents to compile their MARs and publish them online. Although I have published the MARs online up to 2018 or 2019 - see below - I don't promise to continue to be a ble to publish all the MARs for 2019 onwards. I am convincing the surgical residents and staff to do the work.]
Some Delightful Feedback:
Daniel Ong Kian Kok (Jose Reyes Memorial Medical Center) 2014: He asked for an extra copy of Volume 1 and will ask the Department of Surgery of JR to adopt it.
Edgardo Penserga (General Surgeon) – 2014: MAR should be part of the General Surgery curriculum.
I am touched by your efforts to make your residents 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, surgical and non surgical, 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. You are an inspiration. Thank you. You deserve the accolades and recognition.
Connie Salazar-Aleta, MD
Psychiatrist
Feb 16. 2005
Hi! I rarely open my email. Just got to read your anecdotal reports. Kudos! It’s 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.
Laureen Conanan, MD
Psychiatrist
April 25, 2005
Convey to Dr. Guerra that I was impressed and liked very much his anecdote “Beyond Hospital Walls.” It is very true that good patient care transcends hospital walls!! His article coincides perfectly with what I have always been teaching my students and residents on the ethical values of personalized patient care. Unfortunately, today, as I saw it in our own PGH, patient care by some of our doctors has become too mechanical and the human touch is LOST. I hope more residents will read Dr. Guerra’s article and again. Kudos to you for stimulating your residents to come up with much needed and thought provoking anecdotes like Dr. Guerra’s.
Antonio Limson, MD
General Surgeon
March 1, 2005
The history of the MAR can be seen in the following website: (https://sites.google.com/site/medicalanecdotalreports/history-of-mar-in-ommc-surgery).
Others:
MAR Volume 1: https://medicalanecdotalreportsvol1.wordpress.com
MAR Volume 2: https://medicalanecdotalreportsvol2.wordpress.com
https://www.facebook.com/Medical-Anecdotal-Reports-285148858182710/
Wordpress.com (See URLs of the MARS on Wordpress.com)
The MAR is still ongoing (as of November 2018) after my retirement from the Department of Surgery of Ospital ng Maynila Medical Center in 2014.
The Medical Anecdotal Reports Project is a legacy that I leave and will leave behind as an innovative teaching-learning activity for surgical residents (as well as medical students) in the development of holistic, professional and compassionate physicians.
References:
https://www.scribd.com/document/251392007/Medical-Anecdotal-Reports-Volume-1
https://www.scribd.com/document/251391679/Medical-Anecdotal-Reports-Volume-2
https://medicalanecdotalreports.wordpress.com/
https://sites.google.com/site/medicalanecdotalreports/home
MARs edited by Dr.Elvie Razon
http://omsurg-mar.tripod.com/MAR%20files/2004/edited_2004_mar.htm
http://ommcsurgerymar2012.wordpress.com/
http://ommcsurgerymar2011.wordpress.com/
https://rojosonommcsurgeryfilesandnotes.wordpress.com/category/medical-anecdotal-reports/
Others: Google Medical Anecdotal Reports or MAR or MARs ROJoson
Other references - see below:
Completion of ROJoson’s Project Medical Anecdotal Reports – March 29, 2018
Today, March 29, 2018, I declared formal completion of the ROJoson’s Medical Anecdotal Project.
What this means is that I am done with the online publication of the Medical Anecdotal Reports of the Department of Surgery of Ospital ng Maynila Medical Center from 2004 (when this project started) up to 2014 (the year I retired from Ospital ng Maynila Medical Center).
This also means that I am done with one of the remaining projects that I promised myself to complete before I reach 70 years old (January 31, 2019).
Outputs and Accomplishment:
In 2013 and 2014, I was able to publish in book form 2 volumes, each volume containing 25 Medical Anecdotal Reports. Then, I stopped hard copy publication (as it was so difficult and tedious). However, I continued the online publication in WordPress.com and disseminated through my Facebook Timelines. I went beyond 2011. I published the MARs still be done by the surgical residents even after my retirement in January 31, 2014. As of March 29, 2018, I published online the MARs from 2004 to 2018.
Thus, from November 2011 up March 29, 2018, aside from the 2 volumes of book form publication, I have completed the following online publication:
2004 = 131 posts
2005-2009 = 477 posts
2010-2011 = 188 posts
2012 = 169 posts
2013 = 155 posts
2014 = 158 posts
2015 = 80 posts
2016 = 129 posts
2017 – 2018 (as of March 29, 2018) = 75 posts
The average number of MARs being done by the surgical residents per year is 140 MARs (10 MARs per resident and 14 residents per year).
I have published online a total of –
1278 MARs (from 2004 to 2014)
1358 MARs (from 2004 to 2015)
1487 MARs (from 2004 to 2016)
1562 MARs (from 2004 to 2018 – as of March 2018)
If I were to use 2014 and 2015 as the cut-off of my “commitment,” my output is 83% and 80% respectively I personally think this is enough. It is impossible to publish online all the MARs written by the surgical residents during these periods, one, not all submitted by the residents through the email group of the Department despite instructions, and two, some MARs are “defective” in form and substance.
I AM OFFICIALLY DONE WITH THIS PROJECT.
HOWEVER, I MAY CONTINUE TO PUBLISH AT MY OWN PACE THE MARS IN 2018 AND BEYOND (IF THIS WILL NOT BE DONE BY THE DEPARTMENT OF SURGERY OF OSPITAL NG MAYNILA MEDICAL CENTER. I MAY ALSO ADD THOSE MARS FROM 2004 TO 2016 WHICH I MISSED.
Below are the URLs of the MARS on Wordpress.com
https://wordpress.com/view/ommcsurgerymar2004.wordpress.com
https://wordpress.com/view/ommcsurgerymar2005.wordpress.com (contains MARs of 2005 to 2009)
https://wordpress.com/view/ommcsurgerymar2011.wordpress.com (contains MARs of 2010 and 2011)
https://wordpress.com/view/ommcsurgerymar2012.wordpress.com
https://wordpress.com/view/ommcsurgerymar2013.wordpress.com
https://wordpress.com/view/ommcsurgerymar2014.wordpress.com
https://wordpress.com/view/ommcsurgerymar2015.wordpress.com
https://wordpress.com/view/ommcsurgerymar2016.wordpress.com
https://wordpress.com/view/ommcsurgerymar2017.wordpress.com (contains MARs of 2017 and 2018) [Updating Notes - 2021feb23 - have included some 2019 MARs]
Other updates after January 31, 2019:
https://rojosonedhedephi.wordpress.com/2021/02/23/roj-ocil-surg-soft-skills-for-surgeons/
February 23, 2021
ROJ@18nov19; 21feb23