Medical Anecdotal Reports

Medical Anecdotal Reports

A Narrative Medicine to Develop Holistic, Professional and Compassionate Surgeons

Medical Anecdotal Report as envisioned by Dr. Reynaldo O. Joson in 2004:

Medical Anecdotal Report (MAR), by an operational definition, is a brief written report on an actual medical event that involves an actual patient seen by the reporter (who may be a surgical consultant, resident, or intern). 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 and as part of the knowledge management system. The insight may come in three aspects, namely: physical, psychosocial, and ethical. It may also come in three forms, namely: a discovery; a stimulus for investigation and research; and a reinforcement or validation of previously held philosophy and principles.

Medical Anecdotal Report is essentially a written case report. However, brevity and informality of the report will be used to differentiate it from the traditional case report.

Since April, 2004, Medical Anecdotal Reporting has been used in the Department of Surgery of Ospital ng Maynila Medical Center (OMMC) as a way of teaching and learning of medicine and surgery, and more specifically, as a kind of reflective learning. It has also been incorporated in the Knowledge Management System of the Department.

Each resident is required to submit at least one MAR per month. The MAR would be posted in the Department’s egroup at a frequency of at least one a month per resident. The MAR is also be posted in the e-journal of the residents. The MAR carries a specified format.

MAR as envisioned by Dr. Joson in subsequent years:

· It will be used as a take-off point for continual improvement of the residents as well as of the system in the department.

· It will promote the development of holistic, professional, and compassionate surgeons in the Department of Surgery of OMMC.

Medical Anecdotal Reports as a Teaching-Learning Tool to Develop Holistic, Professional and Compassionate Physicians

Posted on February 16, 2015by reyojoson

Medical Anecdotal Reports as a Teaching-Learning Tool to Develop Holistic, Professional and Compassionate Physicians

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Prepared on February 16, 2015 for:

Annual Conference of Tripartite Training Institution in Manila (Ospital ng Maynila Medical Center Department of Surgery, Medical Center Manila Department of Surgery, and Manila Doctors Hospital Department of Surgery); March 27, 2015; Sky Lounge, 27th Floor, Diamond Hotel, Roxas Boulevard, Malate, Manila

Greetings!

All of you have received a copy of a MAR book. I assumed you have scanned or glanced it.

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. For this, I thank her.

A total of 50 surgical residents have written a MAR since 2004. 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 4^th 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.

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

2006 Feedback on MAR

15 Residents

What do you like most in OMMC Surgery MAR and why?

It gives us the opportunity to express our actual experiences in managing and interacting to our patients. This is a good training ground for us to develop our physician-patient relationship. It is also nice that we are required to report it thru e-mail and thru actual presentation. This way others may learn and vice-versa the reporter also learns from them based on their comments.

The narration of the experience of the surgeon

The thinking process, wherein you are looking at your experience as a whole, not just the good side but also the bad side and learning from it.

The technical writing I guess because I’m not a good writer. I have some hard times putting my feelings and ideas into words.

It helps me express my thoughts and emotions as well as enriched my vocabulary in writing narrations about patients and their management

Learning what others are thinking that they usually fail to share.

Learning from the success stories of others as well as from other’s mistakes (not to commit them), MAR opens the eye to a number of perspectives on a similar scenario, mostly from the reactions from the audience after presenting a MAR

The thing I like most about MAR is that it is an avenue to for me and for the other MAR writers to share our experiences which would otherwise not be considered as informative in other for a. It breaks down barriers in such a way that we can share emotions felt, the feelings involved in being a doctor. Through this form of sharing, other persons will learn from our experiences. What would otherwise be a personal or intimate lesson becomes a lesson shared for others to digest.

As the saying goes “experience is our best teacher”. MAR gives us the opportunity to make a reflection of our own experiences in dealing with our patient and everybody in the hospital. Then we learn in the process.

It is through this project that we, residents are able to share our experiences that eventually become venue for self growth, personal and training wise. Moreover, MAR developed our English and literary writing skills.

It helps me see things from a different prospective. I was able to learn things based on my experience and the experiences of my co-resident.

It gave me the opportunity to share my stories and insights about it to other residents

MAR gives me the opportunity to express myself and share some stories about my life as a doctor. This helps me in becoming a well- rounded person.

It is a piece of writing wherein one is given the opportunity to reflect on the psychosocial aspect of our profession. The sharing of emotions that exhibits the humane facet of the mechanical world of surgery. It also brings the consultants and residents to a carefree moment during conferences thus building camaraderie between us.

It’s an effective way of learning insights from the different levels of surgery training from Level I to level V residents including the consultants. Each anecdotes presented in the MAR is viewed differently by each members of the Department and each member has an opportunity to express their views during the open discussion.

MAR serves as a very effective training tool for us residents, not just for us to discuss, analyze, and interact with one another the clinical aspect of our training. It also help us to polish our attitudes, stimulate us to change toward good behavior, serve as a constant reminder to avoid mistakes. It is also an effective tool to polish our grammar and sharpen our writing skills.

It helped me realized that treating patient is not only by giving medicine but also understanding them as well and also it helped to express my own experiences to my co residents and listen to their own stories as well.

What do you like least in OMMC Surgery MAR and why?

Residents still need to improve on English written skills.

Became a routine.

English composition skills of many are painful to the ear. After 3years of MAR, they haven’t improved since they just let others edit their compositions as needed.

It’s nice to share experience but its difficult to make because its hard to make a literary form.

Doing it on a monthly basis. mostly I ran out of interesting stories to tell.

Sometimes, I ran out of stories to share because it is done on a monthly basis.

Having to squeeze out a story when there is nothing interesting to write about. Being creative is tricky when one is out of material for inspiration.

In the hospital we have so many experiences regarding patients, but formulating a topic is somewhat difficult

Recommendations for improvement?

Every 2 mos

Should be open for discussion, and revised extensively thereafter.

Open discussion to the medical students for insights and reactions, furthermore, a MAR from their experience as a medical clerk in the hospital.

I like to see our fruits of labor (MAR) be published.

Submit stories every 2months

It is possible that we do it once in every 2 months

Longer time interval between anecdotal presentations. Time and experience brings out better MAR.

We have some of our MAR posted at the ward. I suggest we pick up some MAR that was presented this year and post it in our hospital lobby (tarpoulene).

Encourage everybody to make it a habit to prepare their MAR days before the expected presentation and avoid cramming so as to produce good compositions.

We should fast track the publication of the MARs.

MEDICAL ANECDOTAL REPORTING AS A TEACHING-LEARNING ACTIVITY IN A CLINICAL DEPARTMENT IN THE PHILIPPINES

https://rojosonommcsurgeryfilesandnotes.wordpress.com/2015/08/24/medical-anecdotal-reporting-as-a-teaching-learning-activity-in-a-clinical-department-in-the-philippines/

Nolan Aludino, MD, Reynaldo O. Joson, MD, MHPEd, MS Surg. Department of Surgery, Ospital ng Maynila Medical Center, Philippines

Up to this time, medical anecdotal reporting is used solely in research methodology discussion and is usually frowned upon when invoked in patient management. This paper reports on the use of medical anecdotal reporting (MAR) as a teaching-learning activity in the Department of Surgery of Ospital ng Maynila Medical Center. MAR is operationally defined as a brief written report on an actual medical event that involves an actual patient seen by a trainee. The medical observation must have an impact on the trainee in terms of insight gained and which the reporter thinks is worth sharing with colleagues. The insight may come in three forms, namely: a discovery; a stimulus for investigation and research; and a reinforcement or validation of previously held philosophy and principles. Each clinical trainee was required to submit at least one brief MAR one month, posted in the Department’s group email and trainee’s online journal and presented in the Department’s conference. Formative evaluation of the MAR showed that it could be used as an evaluation tool by the faculty as well as a meaningful learning activity by the trainees. 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 observe and evaluate the cognitive and affective levels of competency of the trainees.

See Feedback on MAR

Completion of MAR Project

As of August 12, 2017, I considered my above resolution completed. I have published at least 50 MARs per year from 2004 to 2016 in the Internet except for 2009 (I need 7 more because I could not retrieve the old files as of now – will still look for them in the near future). That’s a total of about 650 MARs at least (50 x 13 years).

I will continue to do the Internet publication up to my age 70 or even beyond at my leisure pace, at about 5 MARs per week or 20 MARs per month. However, as I said, I consider my MAR publication project before age 70 completely done already.

The MARs are found in the following websites:

https://wordpress.com/stats/day/ommcsurgerymar2004.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2005.wordpress.com

(Contains 2005 to 2009 MARs)

https://wordpress.com/stats/day/ommcsurgerymar2011.wordpress.com

(Contains – 2010 and 2011 MARs)

https://wordpress.com/stats/day/ommcsurgerymar2012.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2013.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2014.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2015.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2016.wordpress.com

https://wordpress.com/stats/day/ommcsurgerymar2017.wordpress.com