It was towards the end of a marathon BOR meeting when Dr. Max Simbulan asked a seemingly innocent question: “Who would like to go to Singapore to attend the ATLS Provider & Instructor Courses?”. ATLS (Advanced Trauma Life Support) is an educational initiative of the American College of Surgeons (ACS) aimed at reducing death or disability following traumatic injuries. It is a standardized program taught in 60 countries with over a million doctors (surgeons and non-surgeons) already trained worldwide. It targets the initial “golden hour” when a trauma patient is first seen by a doctor in a medical facility and which may spell life or death for the patient. Together with Dr. Jojo Almonte, Dr. Simbulan had this vision of making the Philippines part of the ATLS family.
ATLS is not only for GS, it is also for the other surgical specialties. In fact, it is for ALL doctors if they decide to take the course. In other countries, ATLS is a pre-requisite to residency training or hospital employment in the same fashion as BLS or ACLS. There is a long waiting list for ATLS in countries like Australia, Singapore or Hong Kong stretching to two, even three years. The PCS has been designated as the sole organization that can conduct ATLS courses in the country. But before we can conduct our courses (foreign participants may also enroll), we need instructors.
The idea was for a core group to qualify as instructors so we can conduct our own courses. PCS has allotted funds for the Singapore pioneer group. This was generously augmented by a grant from UNILAB. So, who wanted to go to Singapore for 5 days (2 days for the student course-rest day-2 days for the instructor course)? The BOR identified our Fellows active in trauma: Drs. Jorge Concepcion, Joseph Juico, Orlando Ocampo, and Ray Resurreccion. These guys formed the core faculty of our very own trauma courses, the BEST and the BETTER. Dr. Simbulan also wanted fellows with sufficient experience and credentials to ensure the acceptance and success of ATLS in the Philippines. It was decided that some of the regents should go: Drs. Alfred Belmonte, Jess Valencia, Art Mendoza, and Dondi Dizon as members of the Execom. Dr. Belmonte was designated as the Course Director for the inaugural ATLS Philippines course and was to train as such in Singapore. To represent DoH doctors, I and Dr. Monching Magnaye (Regent-in-Charge Trauma Committee) were selected. To qualify as Course Educator, we needed a fellow with a Masters degree in education. The hands down choice was our very own past president, Dra. Jojo Almonte. Rounding up the group was Christine Borlongan, a nurse, who was to train as Course Coordinator.
As fate would have it, Drs. Belmonte, Valencia, and Dizon were not able to join the pioneer group for various reasons. Dr. Art Mendoza was then designated Course Director in lieu of Dr. Belmonte. Art declined the post as he was not sure he could make it on time as he was flying to Singapore on a later flight. The position of Course Director thus fell on my lap. Dr. Max Nadala, our regent from Iloilo and a classmate of mine, was offered a slot which he graciously accepted. He was a model of self-assurance and calmness during the whole 5 day course. He was the last person to join us, but he was the most prepared. Well, at least as prepared as Dra. Almonte!
Tan Tock Seng is a public hospital. It is a huge medical complex, the third largest in Singapore after the Institute for Mental Health and the Singapore General Hospital. Being centrally located, it has the busiest accident and emergency department in the whole of the city-state.
The ATLS student course (October 12 & 13) was held at the TanTock Seng Hospital. Our Course Director was Dr. Vijayan Appasamy, also the Director of the General Surgery Residency program of Tan Tock Seng. I guess he enjoyed his short experience with us at the Bacolod midyear convention as he was a very good host to the group. It was supposed to be a two and a half day course but this was condensed into an intensive 2- day course to accommodate the instructor course (October 15 & 16) conducted just for us Filipinos. There were a lot of foreign participants that attended the student course, but not all were fortunate enough to be given a certificate as an ATLS course provider. To pass, one had to answer correctly 80% of the MCQ examination. This was an absolute requirement to be certified as an ATLS course provider. Of course, one also had to pass the practical examination-managing an actor/patient/trauma victim-under the critical eye of an instructor.
Far from being a walk in the park, the student course proved to be a huge challenge (at least for me!) to hurdle. I had ceased to do trauma since a few years out of PGH, aside from the occasional rectal trauma patients I saw. I had to relearn my ABC’s of trauma management, review how to do a primary and secondary survey. The Glasgow coma scale was alright, but to remember all those cranial and spinal nerves and do a good neuro exam was so alien to a colorectal surgeon above 50 years old. Add to this a proper understanding of the Monro-Kellie doctrine, and the experience becomes utterly frightening. During the airway skills station, I was intubating as if I was doing a proctosigmoidoscopy, with the patient on my left and my head tilted sideways. To rub salt into an already festering wound, I had to cram overnight the ATLS manual that was as thick as a telephone directory. I had to pass the student course if I wanted to advance to the instructor course. I was the assigned Course Director of the Inaugural ATLS-Philippines Course-I HAD TO PASS! So for one brief interval in a spartan room with a clear-glass bathroom wall, Monching Magnaye and I relived our board exam days as we crammed the whole night.
I barely made the grade, but I passed and so did all the others in our group. Normally, even if one passed the provider course, he/she still had to be chosen as an instructor potential in order to take the instructor course. But we were a blessed group, the anointed ones chosen to spread the ATLS gospel in the Philippines. Hence, all of us went to instructor school after one rest day, Sunday. In fact, the instructor course was open only to us Filipinos.
The instructor course was held at the Nee Soon Military Camp. It had state-of-the-art facilities like a simulation room with a mannequin so lifelike that shed tears, grimaced in pain and even showed a cremasteric reflex! Leslie Dunstall, ATLS Nurse Coordinator from Australia, upon seeing this, wanted to take the mannequin home. Our Course Director was a young surgeon by the name of Charles Quah. He was a colonel in the Singapore Medical Corps. He was, in fact, the chief of the Army Medical Corps. Our Course Educator was the lady doctor chief of the Tan Tock Seng emergency department, Ms. Tham Kum Ying. Her petite appearance hid a fiery personality so full of enthusiasm as she gave us a series of lectures that we relished to the end.
The student course taught us what to teach. The instructor course was meant to teach us how to teach. Shades of PATOS!! All of us were veteran teachers and I cringed at the thought of 2 days of lectures we already heard before or even delivered ourselves. I was proved so very wrong.
Ms. Tham was such an engaging educator that we actually enjoyed (and learned) from her wealth of wisdom culled from 20 years of teaching ATLS. Someone once said that “the medium is the message”. Well, Ms. Tham was such a great medium during those 2 days that she delivered her message.
As a fitting microteaching finale, we were each assigned to give a very short lecture consisting of just 5 slides chosen from the different ATLS lectures. Emphasis was on the manner of delivery and its audience impact. The principles of ENVIRONMENT-SET-DIALOGUE-CLOSURE must be evident in our talk. All these were captured on video and shown to us immediately after our talk as we took turns critiquing each other. It was an eye-opener seeing ourselves on the big screen as we lectured. In the end, she asked permission from the group to show our videos to her future classes. She said our group was the best she had ever taught. She may be pulling my leg, but, hey, who am I to disagree?
Philippine College of Surgeons (PCS) Introduces ATLS
The PCS, in agreement with the ACS, has invited 16 surgical leaders across the country to participate in the ATLS inaugural course on March 14-15 (student course) and March 17-18 (instructor course). Renowned doctors from Australia, Philippines, Singapore and the USA have served as faculty for the course.
Course Director for this initial course is Prof. Michael Hollands, President of the RACS and ATLS Region 16 Chief. Local Course Director is Dr. Enrico Ragaza, Secretary of the PCS Board of Regents. Course Educator is Ms. Debbie Paltridge of Australia. Local Course Educator is Dra. Josefina Almonte, Past PCS President. Course Coordinator is Ms. Leslie Dunstall, National Course Coordinator ATLS RACS. Local Course Coordinator is Ms. Christine Borlongan.
International faculty and staff include: Dr. Michael Hollands, Dr. John Fildes, Dr. Deb Paltridge, Dr. Vijayan Appasamy, Dr. Kate Martin, Dr. Wai Key Yuen, Ms. Lesley Dunstall, Ms. Monique Evelyn, Ms. Jasmine Alkhatib Nickow and Mr. Will Chapleau .They are complimented by our local faculty comprised of Drs. Jorge Concepcion, Joseph Juico, Ramoncito Magnaye (Regent PCS), Arturo Mendoza (Regent PCS), Maximo Nadala (Regent PCS), Orlando Ocampo, and Ray Resurreccion.
Similar courses across the nation are in the pipeline in the hope of reducing the ever-increasing deaths from trauma.
Seated left to right: Dr. Wai Key Yuen (Instructor), Dr. Josefina R. Almonte, Dr. Deb Paltridge, (Medical Educators), Ms. Lesley Dunstall (ATLS Senior Coordinator), Dr. Vijayan Appasamy, Dr. John Fildes, Dr. Kate Martin and Dr. Enrico P. Ragaza (Local Course Director).
Standing left to right: Dr. Lister Leonida (Participant), Ms. Jasmine Alkhatib-Nickow (ATLS International Program Coordinator), Ms. Monique Evelyn (Trauma Educational Programs Manager), Ms. Christina Borlongan (Coordinator in Training), Dr. Guada Villaret Matejka, Dr. Warren Roraldo (Participants), Dr. Joseph Juico, Dr. Jorge Concepcion, Dr. Ray Resurreccion (Instructors), Dr. Dures Fe Tagayuna, Dr. Samuel Cosme, Dr. Joel Macalino, Dr. Shawn Euclid Gandhi Espina, (Participants), Dr. Orlando Ocampo (Instructor), Dr. Emmanuel Baes, (Participant), Dr. Maximo Nadala (Instructor) and Dr. Andrew Jay Pusung (Participant).
The Philippine College of Surgeons publishes its regular newsletter: Incisions. The newsletter contains all news pertaining to the College and advances to the field of Surgery. Click below to download the digital copy of the newsletter.