Transcript surgery.med.ncku.edu.tw

住院醫師六年的回顧與
感想
CVS R6 阮俊能
Contents
►Why
I chose to be a surgeon?
►What had I learned?
►Researches
►Plans in the future
►Acknowledgement
 Colleagues in the department
 My Family
►Suggestions
Why I Chose to be a Surgeon?
► 外科醫師
► 內科醫師
► 病理科醫師
► 精神科醫師
► 放射科醫師
Know nothing but do everything?
Know everything but do nothing!
Know everything and do everything,
but always too late!
Know nothing and do nothing!
See nothing and rule out everything!
► 我在成大所見到的外科醫師
 Surgeons know everything and do something
What Had I Learned?
► R1~R2
records
► R3~R6 records
► Teach and Learn
 Clerks & Interns
 Nursing
► Papers
 Submitted & Accepted (3)
 Rejected or not-yet-submitted (7)
 Conference papers (23)
R1與R2外科住院醫師訓練紀錄表
Case Number
outcome
Appendectomy
30
Wound infection:1 case
Mucocele: 1 case
Prolonged ileus after partial cecum
resection: 1 case
Port-A-Cath implantation
39
Pneumothorax: 1case
Difficulty insertion: 1case
Tracheostomy
29
Insertion difficulty:1
Dislodged: 1
EVD
1
Mortality
Burr hole
2
well
Herniorrhaphy
1
well
Simple closure + patch for PPU
1
expired
Feeding gastrostomy/jejunostomy
1
Median sternotomy
2
Median laparotomy
2
項
目
Laparoscopic cholecystectomy
R3 ~ R6 in
Cardiovascular Surgery
2003 Aug. ~ 2007 May
Adult HeartAdult&
Ascending
Aorta
heart and
ascending aorta
50
40
30
20
10
0
45
CABG
4
5
CAB
AVR
10
MVR
1
1
TVR
MVP
1
1
LA myxoma LV aneurysm
Records in CVS NCKUH 2006,Aug 1~ 2007, May 31
1
3
Heart
procurement
Bentall
ECMO
Mode
Total
VV
2
VA
9
Weaned &
Survived
1
7
Records in CVS NCKUH 2004,Aug 1~ 2007, May 31
Vascular
VascularSurgery
surgery
132
150
100
50
50
7
2
AAA
ruptured
AAA
14
0
AVF
GorTex
Permanent
cath
Records as an Operator in CVS NCKUH 2003, Aug 1~ 2006, Oct.
Congenital
Heart Surgery
Congenital
Heart
4
3
2
1
0
3
2
1
VSD type1
ASD
Coronary
fistula
1
1
IAA type B
BDG
Records as Operator in CVS NCKUH 2006,May 1~ 2007, June 6
Palliative Congenital
Palliative Pediatric Cardiovascular Surgery
Cardiovascular
Surgery
15
10
10
5
2
2
1
PA banding
Coarctation of
Ao
0
BT shunt
PDA
Records in CVS NCKUH 2006,May 1~ 2007, June 6
Teach and Learn
► Clerks
and Interns
 Minimal requirements in CVS
 病例書寫 SOAP
 Meeting preparations (晨會,科會..)
► Nursing
(SICU & General Ward)
 Post-op care in CVS (adult & congenital)
 Transplantation Care
►Donor
care
►Recipient evaluatoin
►Post-op Care
Papers & Books (6)
►
「成大醫學中心心臟移植患者治療實用手冊醫院--醫護人員指引」成大醫學中
心移植小組 August 2005
►
ECMO護理照顧準則「體外循環生命支持系統病人的護理」Nursing care of
the patient with Extracorporeal Membrane Oxygenation（ECMO）國立成功
大學醫學院附設醫院護理部 94年12月
►
Jun-Neng Roan, et al. J Formos Med Assoc 2006;105(4):329-333.
►
Jun-Neng Roan, et al Emerg Crit Care Med. 2004;15(4):148-150.
►
Kan CD, Jun-Neng Roan, Yang YJ. Ann Thorac Surg 2006;81:742-4.
►
Ting-Tsung Chang, Tsuey-Yu Chang, Cheng-Chen Chen, Kung-Chia Young,
Jun-Neng Roan, Yen-Chien Lee, Pin-Nan Cheng, and Hua-Lin Wu. . Journal
of Clinical Microbiology 2001;39(9):3353-55.
Papers unpublished (7)
►
►
►
►
►
►
►
Secular Trends of Primary Nosocomial Bloodstream
Infection in a Surgical Intensive Care Unit of Medical
Center
The Surgical Experience of Esophageal Atresia: To
Minimize Occurrence of Anastomotic Stricture and GE
Reflux
Esophageal Perforation Caused by Blast Injury- A Case
Report and Literature Review
Abdominal septic aortic pseudoaneurysm caused by
Campylobacter jejuni infection: a case report
Extra-anatomical Bypass for Pseudoaneurysm of
Innominate Artery Infected by Melioidosis
Coronary Arteriovenous Fistula with Aneurysm Formation
Pneumoesophagogastroticus
Conference Papers (23)
►地方月會(4)
►心胸外暨體外循環季會(8)
►心胸外學會(6)
►外科醫學會(4)
►世界外科醫學會
(1)
Researches
► 院內計劃
(R3)
 Does the use of skeletonized internal thoracic
artery as conduit of coronary bypass surgery
compromise the vessel integrity?- Swine animal
study Jih-Sheng Wen , Jun-Neng Roan, Chwan-Yau Luo
► Cardiac
transplantation (R6)
 Therapeutic drug monitor of Mycophenolate
mofetil
 Markers of Cellular Rejection—CV +CVS
Plans In the Future
► Service
 Surgery & Care
 Heart failure (MVP, CABG..)
► Heart
Transplantation
 Donor care protocol and education
 Patient Care
►Surgical
techniques
►Postoperation care
►Data collection
► Research
MVP: mitral valve plasty, CABG: coronary artery bypass grafting
Acknowledgement
外科部大家族
Mentors-2
Mentors-1
Mentors-1
外科部大家族
Coordinators
Nursing
practioners
感想與建議
►在這競爭激烈的時代
 各位學弟妹要更加努力學習
►外科加護病房應分科照顧
 醫療不是通識教育
 Pro-active > re-active
►及早發現問題intervention
Emily Dickinson
►Surgeons
1830-1886
must be very careful
►When they take their knife!
►Underneath their fine incisions
►Stirs the Culprit-Life!
如果依 A, B, C, ...., X, Y, Z 字母排列的順序，
一次給予 1, 2, 3, ...., 24, 25, 26 的配分
英文單字
正向計分
中文意義
字母個數
Attitude
100
8
態度
Work Hard
98
8
努力工作
Knowledge
96
9
知識
Leadership
97
10
領導力