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The Pupil: The Making of a Pro

By Peter Paul "Pipo" Ronque, MD

"In learning you will teach, and in teaching you will learn." - Phil Collins

In this issue, we share with you the views of our fellow eye MDs on the basic education – residency training – which medical professionals like you and I receive.

Be inspired by this year's PBO board exam topnotcher, as she talks about her journey towards being a full-pledged ophthalmologist. Dr. Eleonore Iguban describes the road being filled with "tall brick walls and deep potholes." For her, our profession as eye healthcare providers is not for those who "don't want it badly enough," nor for those who are "faint of heart." As she receives the distinction of being the most successful board examinee this year, she admonishes future exam-takers to have the "determination to make it to the finish line." As she congratulates other new diplomates like her, she also reminds them to be grateful to those who have helped them along the way, most especially their patients – the "unsung heroes of our training." As she continues on her journey, she makes a pledge to her mentors – to be "worthy of the honor of being called your colleague" by placing the "welfare of our patients foremost in our minds" by committing to a "practice of Ophthalmology that is both competent and ethical."

On the other hand, look into the psyche of an anonymous fellow eye MD as he narrates his roller-coaster ride towards eventually getting that much-touted appendage – the initials DPBO – to one's name. From a fearful outlook that prevented him from plunging in to take the exams, to anxiety-ridden and exhausting attempts to pass the tests, to a pervasive interior struggle as he tries to carry on with life, to an epiphany brought about by decisive and real support from colleagues, to eventually having the "focus and determination" that paved the way for him to reach that "sense of completeness and satisfaction." His story is as real an experience as has been faced by many of our colleagues and possibly several more taking the board exams in the future. Take heed, then, for there is wisdom in "studying for it like my life depended on it." I dare say that all of us who have conscientiously prepared for these exams and succeeded eventually realize that all the hard work does serve us well in clinical practice.

Be amused as you find yourself identifying with some, if not most, of this current senior resident's ranting and realizations going through ophthalmology residency training. Has there been a time, while you were mulling over what residency program to take up, when you considered our specialty – ophthalmology – as "sacred?" How did you feel about having to attend a month-long course on basic ophthalmology as a pre-requisite to residency? (Was this already around when you were about to enter residency?) When you were starting out as a novice resident, have you ever been awestruck by those "blind patients" who, after a few visits at your general clinics, "would miraculously ambulate," and make you wonder whether "Jesus came down from the heavens" and restored their sight? Who among your training institution's faculty did you consider as "mentors?" Or, um, perhaps "tormentors?" Read Dr. Alex Pisig's almost irreverent but certainly candid discourse on ophthalmology residency training, as he sees it – an insider's viewpoint, so to speak, about this "improvised personality development program" we otherwise call residency training.

So what does residency training have to do with forming the professional Eye MDs of the country?

A lot.

Whoever said "Those who can, do; those who can't, teach" must have never encountered teacher-ophthalmologists. For in our specialty, the best teachers are actually those who can. As you will read in our Special Feature for this issue, the old paradigm of developing competence is the progression: Know how, Tell how and finally Show how. There is now a fourth dimension: Do. This means "whatever a trainee learns should be applied and practiced even after his training."

It is our pleasure to present to you two dynamic and dedicated Residency Training Officers (RTO) as they share with us their inspirations and motivations for taking up the difficult job of formally training residents in our specialty. Dr. Joseph Anthony Tumbocon and Dr. Jose Ma. Martinez are two extraordinary teacher-mentors. I have had the pleasure and privilege of learning from these two eloquent and engaging consultants. There are decidedly distinct differences in residency training programs of generations past and present, and these two RTOs are clearly equipped to usher in the modern approaches to learning the specialty while still retaining the sound teaching principles established over the years. Get a glimpse of their respective visions on what a successful pupil-resident should be and what it takes to make this happen. They both agree that more than just acquiring the core competencies for residency education (there are six) identified by the International Council of Ophthalmology and the U.S. Accreditation Council for Graduate Medical Education, a pupil must be imbibed with the spirit of sharing and have a clear concept of legacy. For it is in this spirit of passing on our knowledge and assisting others hone their skills that we can assure ourselves that quality eye healthcare will continuously be provided to many more generations of Filipinos to come.

Finally, I encourage you to read Dr. Prospero Tuaño's article on "The Challenges of Ophthalmic-Residency Education in the Philippines" which was delivered as the 27th Jose Rizal Memorial Lecture during the annual meeting of the Philippine Academy of Ophthalmology in 2007. Cognizant of the role that the Philippine Board of Ophthalmology (PBO) plays in the "development of eye specialists," Dr. Tuaño identifies the challenges and assesses the system of ophthalmology residency training in the country. He lists down the core training objectives (there are at least four) that must be met as minimum requirements for residency programs to be accredited by the PBO – to produce ophthalmologists with clinical and surgical competence, capable of undertaking research and teaching, aware of the need for continuing professional growth; and aware of their ethical and social responsibilities. This lecture is also published in the Philippine Journal of Ophthalmology; indeed, the article is a well-researched and well-written report on the ongoing evolution of Philippine ophthalmology training programs. It drives home the point that "ophthalmic education is directed towards a widely diversified audience that includes residents, undergraduate medical students, fellows, and practicing ophthalmologists."

I hope you enjoy this issue, and continue to see yourself as an eternal pupil, ever gripped by the drive to become a competent and ethical professional.

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