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Molding the Future of the Philippine Ophthalmology
"True teachers are those who use themselves as bridges over which they invite their students to cross; then, having facilitated their crossing, joyfully collapse, encouraging them to create their own." - Nikkos Kazantzakis, Greek writer and philosopher
Reading through the resumes of Drs. Jose Ma. Martinez and Joseph Anthony Tumbocon is like reading the same book twice.
Glaucoma specialist. Check.
Officer, Philippine Glaucoma Society. Check (Biboy is currently PGS President; Tony is the Vice President)
Councilor, Philippine Academy of Ophthalmology. Check.
Residency Training Officer. Check.
Out of all their lofty credentials, both agree that it is their role as Residency Training Officer that they relish most. Biboy Martinez has been training the residents of the DOH Eye Center at the East Avenue Medical Center for the last 8 years, while Tony Tumbocon has been RTO of the Eye Institute of St. Luke's Medical Center since 2008. As Training Officers of two of the leading teaching institutions in the country, Dr. Martinez and Dr. Tumbocon have witnessed many of their residents advance to become experts in their respective fields.
Here are Biboy and Tony on the challenges and triumphs of being mentor.
Jose Ma. Martinez, MD
RTO DOH Eye Center, East Avenue Medical Center
Joseph Anthony Tumbocon, MD
Residency Training Officer, Eye Institute, St. Luke's Medical Center - Quezon City
Since when did you have an interest in residency training or medical education?+
I guess it started even during residency when I was teaching interns and junior residents. I always thought that teaching validated what I learned. It made my work easier and brought a certain sense of satisfaction that at that time was difficult to define. I can't really recall. However, when I was a resident I realized that I had some personal gratification in teaching. Furthermore, I realized that teaching my junior residents and medical students reinforced my medical knowledge.
Who or what was your inspiration or influence to become active in the training / education of residents?+
I had a memorable patient in my senior year as resident whom I did cataract surgery on. She was a retired teacher who could afford private care but chose to have her surgery in a government training hospital. She believed that her surgeries not only benefit her but also the resident surgeons and eventually numerous patients after her. This was one of my most vivid encounters with the concept of sharing and legacy – the foundations of teaching.
I also remember the words of my glaucoma fellowship program director Dr Julian Rait when he visited our department – "We taught Dr Martinez maybe 10% of what he knows in glaucoma. The rest he learns here with you" This reinforced to me the value of continuous learning with others.
There were many people who influenced me to become a trainor. I had many effective teachers who mentored me at different stages of my career, and even up to present time. They are too many to mention but they know who they are and they helped me become what I am now. A significant person who influenced me during my formative years as an ophthalmology resident would be Dr. Karen Rivera-Francia who was my chief resident when I was a first year trainee. She went out of her way to patiently teach and mentor me while carrying a very pleasant demeanor. All she asked in return was to teach those who will come after me…. and so I did. I realized that properly teaching and motivating a trainee/ student has both a "domino and multiplier effect". Teaching increases the level of competence of the trainees, who in turn can potentially train more junior doctors, who collectively can help more patients, and all these can contribute in elevating our profession. I also encourage my trainees to spend some time training those who come after them.
Since when were you a residency training officer (RTO)?+
It was Dr. Angeles de Leon who first appointed me in 2005. I then continued on under Dr Reynaldo Santos up to the present. That makes it 8 years running. I was appointed as the residency training officer in ophthalmology at the St. Luke's Medical Center in 2008 by Dr. Ruben Lim Bon Siong, the head of the Eye Institute. I was quite fortunate that I had a superior who guided me in the intricacies of being an RTO and was supportive of my ideas, even though some weren't mainstream at that time.
What is the difference in the ophthalmology residency training now as compared to when you were a resident?+
There are more learning opportunities now because of technological advancements. These are my favorite ones: 1. The Internet - allows access to information worldwide 2. Medline - makes research easy (goodbye Index Medicus) 3. Digital photography and videography - adds a new dimension to learning 4. Powerpoint and LCD projectors - allow us to convey teaching material effectively.
There is also more structure now in the training programs, the subspecialties and the PBO. There are more teachers and more scientific meetings. Residents of today certainly have the potential to learn more if they put their hearts into it.
The present residency training is more structured than during my time as a resident. Part of the credit should go to the Philippine Board of Ophthalmology (PBO). The better structure has led to a more equal exposure to learning experiences among trainees. There is also shift to competency based education, which focuses on learner performance and outcome oriented measures (e.g., how well a trainee completed a procedure) rather than process oriented measures of education (e.g., how many procedures a trainee completed). It focuses more on the quality of execution (e.g., beginner, novice, proficient or expert level) as a proof of competence. The old perspective in the pyramid of competence is "Know How, Tell How and Show How". The new perspective adds a 4th element "Do", so it is now "Know How, Tell How, Show How and Do". It means that whatever a trainee learns should be applied and practiced even after his training.
During my time as a resident, only the medical knowledge, clinical and surgical skills were actively taught, and only the medical knowledge competency was formally assessed. In 2008, the PBO Residency Training Officer (PBO-RTO) group in collaboration with the PBO set out to teach and assess the core competencies for residency education. All six core competencies were adopted from the International Council of Ophthalmology and the U.S. Accreditation Council for Graduate Medical Education (ACGME). These are: Patient Care (clinical and surgical skills), Medical Knowledge, Professionalism, Practice Based Learning and Improvement, Interpersonal and Communication Skills, and Systems Based practice. It is now being implemented and we have seen good outcomes in producing well-rounded competent graduates.
What is your vision when training a resident?+
My vision is to develop active, continuous learners. The medical profession is dynamic and what residents take up during residency may lose relevance later on. Residents should be tolerant to change. The good ones get ahead by initiating change. I always mention to my residents that I want them to eventually become better than their trainors (including me), at least in their field of interest. In this way, our specialty, and the medical profession in general, will continuously improve over time.
What are the challenges of an RTO?+
Not all residents are the same. They come with different learning styles, personalities, attitudes and motives. The greatest challenge for me is getting the residents to perform to their maximum capabilities. They may not conform to "standards" at some points in their residency but what I'd like to see is the drive to improve and do better than last time.
Being an RTO also eats up a lot of time. Another challenge is encouraging other staff members to participate productively in training and share the work.
The PBO in 2008 formed a technical working group for eye residency training composed of training officers of select institutions. As a member of this group we were tasked with formulating guidelines and recommendations aimed at standardizing the training amongst the different institutions. This created an even bigger challenge of collaboration and getting institutions to share resources and work towards a unified goal. The PAO in 2012 created a committee on Members-in-training concerns that looks after the needs and learning activities of residents during their training. It is working with the International Council of Ophthalmology to develop courses to enhance the skills of educators. Challenges abound for people new to being an RTO. It's comforting to see that there is a lot of support from people with the same passion. You are not alone in this thankless job!
Time... or the scarcity of it... As you well know, time commitment is necessary to be an effective RTO. As we go on with our professional and personal lives, other commitments/responsibilities arise that require our attention: patients, organizational responsibilities, family, etc. The key is to manage our time and efforts properly, and know when to delegate once multiple duties come up.
Another challenge is finding the right team to help in training the residents since it cannot be done by one person. Again, I was quite fortunate to have a good organizational structure, dedicated sub-specialty heads and enthusiastic members of the medical staff when I became RTO. Quite a number of our medical staff have good morale, are approachable and willing to spend some time to teach, whether they are an active or affiliate consultant. They contribute to the training of the residents depending on their capacity and availability to teach. I attribute this to the good learning and work atmosphere in our hospital. The organizational structure, favorable work culture and environment was set up by Dr. Mario V. Aquino when he was director of the Eye Institute in our hospital, and is being continued and enhanced up to now.
What would you consider as a rewarding moment as a trainor?+
Referring a patient to a former student and knowing that the patient will get the best care possible. Listening to a former trainee give a lecture and learning from him/her, and there has been a number of them.
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