MRMAULION’S MAR [15-10]:Preparing a Junior Resident to Seniorship

MEDICAL ANECDOTAL REPORT
Indexing Title: MRMAULION’S MAR [15-10]
MAR Title: Preparing a Junior Resident to Seniorship
Date Of Medical Observation: November 1, 2015
Tag: How to become a senior surgery resident
Category: Professional/Ethical/Reinforcement
 
NARRATION:
 
It was supposed to be a usual weekend duty for our team, however, our team leader realized that it is the first day of November. When he reiterated that it was already November and the seasons were changing, I knew what he meant. I felt nervous at the time for I have been anticipating it since we were promoted. He told me and my fellow batchmate that one of us will be the team leader for that duty day. I asked my batchmate how can we choose. After a moment of discussion, it has been decided that I will be the team captain for the duty day. My seniors instructed me how to start my day. After which, we made our rounds to the ward patients, then to the emergency patients. In the emergency room, together with my seniors, we examined each patient and decided which among them must be admitted and operated on. They gave me pointers to remember for each patient. A referral from the pediatric department came for evaluation and possible management of acute abdomen probably acute appendicitis. We went to see and examine the patient. One of my seniors asked me if the patient has surgical abdomen. As I relay to them my history and physical examination, my diagnosis is non-surgical. They asked me if I was sure, I then wavered. I became unsure of myself. I asked them to do physical examination of the patient too. As we left the pediatric emergency room, they asked me again what my diagnosis was. I told them that my diagnosis is acute gastroenteritis and urinary tract infection, and that the patient has non-surgical abdomen. My seniors told me that they agree with me, however, I must not clear the patient right away and still do serial abdominal examination because the case may later evolve into a surgical abdomen. They said that in entering to seniorship, it will be my call if the patient is non-surgical or surgical. If a patient needs to be operated on or not, for my junior residents will depend on my judgement and they will follow it. All the consequences of my judgement will be my burden. Despite the unremarkable weekend duty, I was still nervous because that was the start of something new in my life as a resident.
 
INSIGHT:  (Physical, Professional/Ethical, Psychosocial)  
(Discovery, Stimulus,Reinforcement)
 
Our culture espouses the senior resident as the primary leader of the medical or surgical team. In our department, a senior resident must have the core values that are being inculcated in the department. He or she must be a good example to the junior residents of the department. He or she must teach to have compassion for the patients, understands patient’ s need and has developed good communication skills with patients. The senior resident assists and supervises the junior residents. He or she will also assist the chief resident in the orderly running of the services in all aspects of daily patient care and will maintain continuity of care in the Emergency Room, in the Operating Room and in the Intensive Care Unit. The senior resident increases his/her knowledge base and develops skills for higher acuity patient care. He or she should be able to recognize, manage and make decisions on patients who need hospitalization and surgical intervention on either in the Emergency Department or on other services. Teaching is also an important privilege and responsibility of a senior resident. Not only medical students and interns look to the senior resident as the primary decision-maker for the patients on their service, but also the junior resident of the team. 
To be a senior surgical resident is a big leap from a junior resident. It may be a difficult experience, but for the past three years in training, we are being molded to be a leader of a team. We are being trained to be a senior resident. A lot of things are expected. But the ability to ask for help when needed is a sign of good senior resident. For in our department, there is never a one-man show, what we have is a team. We are expected to work as a team, senior residents being the leader of team. Senior residents should be thankful for they work hand in hand with our service consultants who are always there to support and guide us in our journey in becoming a senior resident.
ROJoson’s Notes (16aug30):

Senior residency in a 5-year general surgery residency program is equivalent to a 4th or 5th year level.
Dr. Maulion has clearly spelled out what are expected of the senior resident, the challenges, the opportunity to grow and the help that one can get from the team of co-residents and consultants.
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