Thursday, 01 August 2013 13:45

ACS International Scholarship

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Hello everyone!

This year I was privileged to be awarded an International Scholarship to the American College of Surgeons National Surgery Quality Improvement Program.

It's actually my second such award from the ACS. The first one was in 2002, where I focused primarily on refining my own clinical and surgical skills.

This present scholarship is different in the sense that it focuses on programs and policies to improve the quality of surgical care within institutions and organizations. (Quite appropriate I suppose for my age).

I look to this award as also a responsibility for me to share my experiences with other Filipino surgeons and surgical societies. 

I have decided therefore to blog about the program, sharing my learning experiences and insights.

Let me begin by posting below the original essay I submitted as part of the application process for the international scholarship, as a way for you to understad where I am starting from. 

The convention starts in a few hours and ends on July 16. I will then visit the University of California San Diego Medical Center to have a first-hand view of how the NSQIP is implemented. Hopefully I will able to give a daily blog of my experiences.


Dr. Ramy Roxas


I am Dr. Manuel Francisco T Roxas , a clinical associate professor and colorectal surgeon from the University of the Philippines College of Medicine. In 2002 I was fortunate to have been awarded the ACS International Guest Scholarships, gaining first-hand experience of how such a prestigious award broadens one's outlook on surgical practice, as well as opens new opportunities for leadership roles. Since then my career focused on sharpening my skills as a colorectal surgeon, particularly in the areas of minimally invasive and robotic surgery; as well as in establishing programs for improving rectal cancer outcomes through multidisciplinary pre-treatment planning, neo-adjuvant chemoradiotherapy, total mesorectal excision and pathologic audit. I was given the privilege to serve in 3 concurrent positions: as President of the Philippine Society of Colorectal Surgeons; Chief of the Division of Colorectal Surgery at the Philippine General Hospital; and Director of the Medical City Cancer Center (a tertiary, JCI-accredited, private hospital). Now that my terms in these three positions are coming to an end, new areas of personal development are opening up for me. I am specifically interested in 3 programs of quality improvement in the ACS to guide my next endeavors, namely the NSQIP, the Cancer Accreditation Program, and Simulation-based Training.
As the newly appointed Consultant Director of the Colorectal Clinic in The Medical City, it is my responsibility to improve quality of colorectal surgical care beyond present JCI requirements. I am interested in witnessing first-hand how enhanced recovery after surgery (ERAS), infection control, and other colorectal surgery quality programs are implemented in an ACS collaborative hospital so that I can adopt similar programs for our colorectal patients.
Another pressing concern for me is the lack of standardized quality of care measures for cancer treatment in my country, even in the Philippine College of Surgeons. I have come to understand that satisfactory compliance with patient safety programs/policies do not necessarily translate to better oncologic surgery (although high quality oncologic surgery includes strict compliance with basic patient safety and surgical quality standards). I am therefore interested in learning how the ACS, through its Committee on Cancer, accredits cancer programs, and implements policies to improve the quality of cancer care nationwide.
Furthermore, I have recently been involved in the strategic planning and creation of clinical simulation training programs in both private and government sectors. We envision programs to train medical and paramedical personnel on newer invasive/surgical techniques and technology, while constantly assuring patient safety. I am therefore very interested in the ACS accreditation and standardization process for simulation-based training.
Finally, I am in line for nomination to the Board of Regents of the Philippine College of Surgeons this December. As a potential Regent, it will be my advocacy to set in place the quality assurance programs that I will hopefully learn in the ACS, should I be fortunate enough to receive the scholarship. I hope to visit two accredited hospitals in California where NSQIP programs are institutionalized. I also want to visit the main headquarters of the ACS so I can gain a better understanding of how it implements and monitors such quality improvement programs.

Briefly describe your clinical practice

My clinical practice is 98% focused on colorectal surgery. While I receive a small allowance from the govenment for the part-time work I do in the Philippine General Hospital - mainly for training residents in surgery and research - my main source of income is from my clinical work in the Medical City, the second largest hospital network in the country, where I am currently the Director of the Colorectal Clinic, as well as the Stoma and Wound Care Clinic.

Briefly describe your teaching contributions

1. As a teacher:

I am a clinical associate professor of the Department of Surgery, University of the Philippines College of Medicine and Philippine General Hospital. Part of my responsibilities has been to lecture to medical students, my assignment being specifically on gastrointestinal bleeding, as well as hold preceptorships with them in the clinics.

Much of my teaching load has been on the training of general surgery residents and colorectal surgery fellows. I initiated the training of Total Mesorectal Excision and Laparoscopic Colorectal Surgery in the Philippine General Hospital, particularly when I became Chief of the Division of Colorectal Surgery in 2007.

I am a frequent lecturer in the Philippine College of Surgeons on topics such as endorectal ultrasonography, intestinal staplers, laparoscopic colorectal surgery, total mesorectal excision (TME), extralevator abdominoperineal resection, and robotic rectal cancer.

2. As a course/program leader or developer:

As a two-term chief of the Division of Colorectal Surgery at the Philippine General Hospital, I initiated the Colorectal Polyp and Cancer Study Group funded by the National Institute of Health; the Rectal Cancer TME Program; and the Multidisciplinary Team Approach. I also expanded the Colorectal Fellowship Program from one year to two years, specifically to improve training in laparoscopic colorectal surgery. I also improved the financial status of the Division, making it now self-sufficient.

During my two terms as President of the Philippine Society of Colon and Rectal Surgeons, we expanded the colorectal surgery curriculum to a two-year program, incorporating laparoscopic colorectal surgery in the training. We also started a fellowship training program in Davao City, only the third such program in the country, and the first outside of Manila.

Under my leadership as the first Director of the Cancer Center, The Medical City, we established highly specialized cancer units for Breast, Head and Neck, Liver, Bone, Prostate, and Colorectum, moving the hospital away from the more generalist approach of its past.
Briefly describe your professional leadership contributions:

1. Society or College

As a two-term president of the Philippine Society of Colon and Rectal Surgeons (PSCRS), I initiated the Rectal Cancer TME Certifying Course held during the Philippine College of Surgeons (PCS) Annual Conventions. I also started the Annual and Midyear Conventions of the PSCRS, attracting surgeons from all over the country. By the end of my term, this March, 2013, I increased the funds of the PSCRS ten-fold (from P 200,000 to P 2,000,000).

2. Committee leadership

As Chair of the Committee on Research of the Philippine College of Surgeons, from 2005 and 2006, I organized several courses on research methodology and evidence-based medicine for residents and consultants. I also initiated recognition awards for researches by members/fellows that were published internationally.

Provide a brief description of your research work:

My research work initially focused on the development of clinical practice guidelines for the Philippine College of Surgeons. My participation included being one of the main authors of the Guidelines on Pre-operative Cardiac Clearance, as well as on Curable Rectal Cancer. I also participated as a consultant on methodology in Guidelines for Breast Cancer, Colonic trauma and Surgical Critical Care.

I am the main author of two internationally published randomized controlled trials on local anesthesia for hemorrhoidectomy, both of which were done to try to facilitate faster turn-over time for our out-patient hemorrhoid surgery at the Philippine General Hospital. I am also a co-author on an internationally published randomized controlled trial evaluating the role of antibiotics for hernia surgery. All three are cited in Medline and Cochrane.

At present, my clinical research has focused more on colorectal surgey concepts that are relatively new in our country, such as laparoscopic surgery, Total Mesorectal Excision, the multidisciplinary team approach for colorectal cancer, and extralevator abdominoperineal resection.

Awards, Prizes:

A. International

1. International Guest Scholar, American College of Surgeons, 2002

2. Lions for Stoma Care International Scholar, Modena, Italy, June 7 - 11, 2007

3. 2nd Prize, Research Poster Presentation, 10th Congress of the Asian Federation of Coloproctology, Singapore, March 24-26, 2005

B. National

1. International Research Award, Philippine College of Surgeons, December 7, 2004

3. 1st Prize , Teodoro P Nuguid Research Award, Philippine Society of Colorectal Surgeons, February 28, 2002

C. Local/Regional

1. Academic Citation, Leadership and Management Development Program, Ateneo De Manila University Graduate School of Business, March 2012

2. Outstanding Faculty Research Paper, 21st Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2007

3. Outstanding Faculty Research Paper, 19th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 2005

4. Outstanding Faculty Research Paper, 14th Faculty Research Forum, University of the Philippines College of Medicine and Philippine General Hospital, 1999

5. De La Salle University College of Medicine, Class 1988 Graduation Awards:
- Valedictorian
- Dean's Special Award
- Leadership Award
- Outstanding Clinical Clerk
- Outstanding Clinical Clerk in Pediatrics
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