What did I do during M1 summer?

The summer is coming to a close and M2 starts next week.  Over the summer, I went on vacation to the Caribbean, which was a very relaxing time.  I went jet skiing, swimming, sat by the pool, went kayaking, ate a lot and slept a lot.  I left for the islands just after school ended, and it was one great week.  After returning, I had one week to get my things together again to move back to school, as I was about to start a summer research project with my medical school.

During this project, I would collect data some days at a clinic, and then do some reading, data entry, etc on my own time.  In addition, I had plenty of time to watch a whole bunch of movies, catch up on TV shows, and sleep some more.  I didnt do any studying for a good part of the summer.  I would drive up to see my family and friends almost every weekend.  I even went on a mini-vacation to Dallas for a couple of days to meet with friends and spend time with family.  But, for the most part, I spent it just relaxing and working on the research project.

I did start studying a little during the middle of the summer.  I would read a chapter in my biochem lippincotts book, or in the big Costanzo Physiology book.  I would make some flashcards of things that I found hard to remember, so that I have them ready if I ever needed them for M2 year.  I studied Behavioral Science from the BRS series, as this subject was taught all over the place during my M1 year, and wasn’t very cohesive.

I made a list of books (and bought some of them) for my “Step 1 box” in which I store the materials I’m going to use to study for boards.  I read up on the actual exam, what’s involved, and also looked through First Aid for the USMLE Step 1 book, to get an idea of the depth of material.  This usually keeps me on my feet and emphasizes the amount of work I will need to put into M2 year to learn the material.

Currently I’m in the process of moving to my new apartment.  The summer has been great for the most part, especially because I just took it easy.  I’m slowly getting into the mental state for next year.

Administering the survey

After the IRB application, training, approval, and pre-research preparation (see previous post) has been completed, it comes time to collect data.

This involved, for me, sitting at a desk in a clinic waiting room, with a small sign that encourages volunteers to approach my desk.  When someone does stop by, I would briefly introduce myself and the project to them, then hand them an informed-consent form and a survey.  Most people took about 5 minutes to complete it, and the majority were enthusiastic about filling out the survey.  Occasionally, people would frown and walk away.

The hardest part is to get people interested in your project and approach the desk.  The staff members in the department I was working were supposed to suggest to their patients to visit my desk and fill out a survey.  However, it doesn’t always go according to plan – those staff members become extremely busy, and patients don’t approach you.  My project did not involve any type of remuneration for participants as I did not have funding of that magnitude.  This made it exceptionally hard to attract people to your project.

Imagine walking into a clinic for an appointment – you are worried about your health, you are worried whether or not insurance will cover the visit (or the results of the visit), you have taken time off from work/school to make this doctor’s appointment happen.  The last thing on your mind would be to find out what that person is doing at the extra desk in the waiting room, let alone help with the survey project.  So, for those who did approach me (the minority of the participants), I am thankful.

For the rest, although I am still thankful, it came with a little bit of effort.  I had to strike up a conversation with those sitting closest to me, waiting to see a doctor.  I would try to steer the dialogue to favor their interest in my purpose in the waiting room.  This is how I would get the majority of participants – make small talk with them, establish rapport, give them a little background information about myself, and request five minutes of their precious time.

Collecting data is one thing, but analyzing them is the interesting part of the project – its what all scientists are most interested in – What are the results? How can we synthesize our findings into the current working body of knowledge? To what extent will these results be useful, and to what end?

I’m a couple of weeks away from starting my analysis, and will write about that experience as well, when the time comes.

Preparing to administer a survey research project

After IRB approval has been obtained, the next step is to set a starting date.  After this, a little preparation is required to start administering the survey at the chosen location.

First, copies of the actual survey needs to be made, along with copies of the informed-consent forms, letters to the staff of the department where the survey will be administered (so all the staff know what you are doing in their waiting room), and copies of the flyer to advertise.

In addition, you have to prepare a small sign to set on your table to attract people to your desk in the waiting room.  You will also have to obtain a couple of clipboards and a dropbox with a lock/key, where patients can deposit their surveys.

Next, you will have to attend a meeting with the hospital manager, the physician you are assigned to, the head nurse, and the research coordinators of the program through your college of medicine.  Here, you discuss how you will approach patients, what days and times the survey will be administered, where your desk may be placed in the waiting room, and the like.

Finally, someone from the hospital department where you are conducting your research will give you a tour of the facilities and the staff.

Once these responsibilities have been met, the survey administration can start.

Navigating the tangles of the Institutional Review Board (IRB)

For my summer (my last official one ever) between M1 and M2 year, I designed a clinical research project where I try to get a better understanding of why or why not, patients tend to exercise. My argument was that understanding this would enable healthcare providers to find different and more effective ways of conveying the benefits of exercise to their patients. It would essentially enable healthcare workers to address concerns that some patients may not necessarily feel comfortable asking, while gaining insight as to why some patients don’t exercise regularly. Arming oneself with this information can help the clinician convey the importance and value of regular excerise to patients, instead of simply asking them to pay a visit to the gym for health reasons.  Also, clinicians can gain a better idea of why patients who exercise do so, and incorporate this advice into conversations with other patients.

This is my first clinical research project, and I’d like to inform you of the process that’s involved, starting with the arduous task of fulfilling the mountain of IRB requirements.  IRB stands for the Institutional Review Board.  There is usually an IRB established for each institution that conducts research, and their main goal is to make certain that fair and ethical protocols are followed in the use of human research subjects.

IRB application involves a long, boring application that asks you to detail how you plan to collect data and secure patient confidentiality, the length of the project, and other details like available remuneration, etc.  It also demands an informed consent form designed by the investigator (the researcher), which details the rights and responsibilities of the subjects and the researcher.  Basically, IRB wants to make sure that the patient knows exactly what they are getting themselves into, the reasons why, the benefits and risks involved, and the like.  If deception is an integral part of the project, then IRB needs to make sure that the benefits from deceiving patients temporarily outweighs any harm that is caused by the deception.  IRB exists to make sure that research projects like the Tuskeegee study does not happen again.

After this initial application is submitted, it goes through a pre-review.  A member of IRB reviews your application to make sure it’s filled out properly, with all the required information, along with suggestions for improvement.  This process goes back and forth a few times, after which your application is ready to undergo official review by the IRB board.  You cannot start your project until and unless you get the final approval letter after this review process is complete.

How long does all this take? About 4 months for a simple project involving human research subjects taking a 5-minute survey (not involving any drug administrations or hospital stays, which I’d assume takes longer and is a more cumbersome process).  So, if you are looking to conduct research during your M1-M2 summer, you need to have submitted your project to IRB by early March.  Don’t forget it takes some work to fill out the application and design the study prior to seeking IRB approval.

Further, the approval process cannot proceed until and unless you finish the IRB required training, and provide the review committee with certificates of completion.  This includes a handful of IRB training modules that takes a few hours to read and complete, and a HIPAA training that is required to help maintain patient confidentiality.

After the IRB approval letter was granted, it took me a week to prepare before starting the project.  Since my project is pretty simple, I’d imagine it could take longer to prepare for a more complicated project.

What’s involved in preparing to conduct a survey research project?  That’s the topic of my next research-related post.