1. 1. Ahmed Salem MD Associate Research Specialist Section of Surgical Oncology Division of General surgery University of Wisconsin School of Medicine and Public Health Disclosure: Financial No relevant financial relationship exists. Nonfinancial No relevant nonfinancial relationship exists
2. 2. Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond imagination. It is our light more than our darkness which scares us. We ask ourselves who are we to be brilliant, beautiful, talented, and fabulous. But honestly, who are you to not be so? You are a child of God, small games do not work in this world. For those around us to feel peace, it is not example to make ourselves small. We were born to express the glory of god that lives in us. It is not in some of us, it is in all of us. While we allow our light to shine, we unconsciously give permission for others to do the same. When we liberate ourselves from our own fears, simply our presence may liberate others. By, Marianne Williamson, In Return to Love; Reflections on a Course in Miracles The Fear in our Life
3. 3. University of Wisconsin
4. 4. Wisconsin Institute for Medical Research (WIMR)
5. 5. Wisconsin Institute for Medical Research (WIMR)
6. 6. -Research with human subjects that is: -Patient-oriented research. -Research conducted with human subjects (or on material of human origin such as tissues, specimens, and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects. NIH Definition of Clinical Research
7. 7. A research study involving human subjects. Designed to collect data in a forward timeline. Prospective: ongoing collection of information. Retrospective: collecting of existing information. Randomized: each study subject is randomly assigned to receive study treatment. Clinical Trials Daniel J Ostlie: Evidence Based Care and Personal Bias
8. 8. Carried out using protocols that adhere to accepted standards of safety, patient care and data interpretation. Ultimately determine whether new clinical care interventions are safe, efficacious and effective. Clinical Trials (Cont.) Daniel J Ostlie: Evidence Based Care and Personal Bias
9. 9. (also called pure research or fundamental research) is a systematic study directed toward greater knowledge or understanding of the fundamental aspects of phenomena. Basic research is executed without thought of a practical end goal, without specific applications or products in mind. Wiki Definition of Basic Science Research
10. 10. It aims to "translate" findings in basic research into medical and nursing practice and meaningful health outcomes. Translational Research
11. 11. Our basic human cognitive structure gives us a tendency to incorrectly learn from our experience. The majority of time we study a problem we do so in a way that doesnt lead to the correct answer. Even in these rare instances where we know the correct answer we dont chose to use it. Why Research Daniel J Ostlie: Evidence Based Care and Personal Bias
12. 12. Our basic human cognitive structure gives us a tendency to incorrectly learn from our experience. The majority of time we study a problem we do so in a way that doesnt lead to the correct answer. Even in these rare instances where we know the correct answer we dont chose to use it. Why Research Daniel J Ostlie: Evidence Based Care and Personal Bias
13. 13. Tonsillectomy For > 50 years to prevent pharyngitis. In 1959 ---> 1.4 million tonsillectomies in the USA No single study has ever showed an evidence to support this practice. A review of 7765 papers revealed unequivocal effectiveness. In 2006, 535,000 tonsillectomies (US population doubled since then!!!) Why Dont We Learn the Right Way? Daniel J Ostlie: Evidence Based Care and Personal Bias Because We Chose to learn in our own Way
14. 14. What Really Happens in our Minds My patient had sore throat -- > I gave him/her penicillin -- > my patient got better -- > Conclusion: penicillin is a cure for sore throat. Induction Tells You Nothing about the Actual Reason for the Observation
15. 15. Our basic human cognitive structure gives us a tendency to incorrectly learn from our experience. The majority of time we study a problem we do so in a way that doesnt lead to the correct answer. Even in these rare instances where we know the correct answer we dont chose to use it. Why Research Daniel J Ostlie: Evidence Based Care and Personal Bias
16. 16. We Did it Wrong!!!
17. 17. Our basic human cognitive structure gives us a tendency to incorrectly learn from our experience. The majority of time we study a problem we do so in a way that doesnt lead to the correct answer. Even in these rare instances where we know the correct answer we dont chose to use it. Why Research Daniel J Ostlie: Evidence Based Care and Personal Bias
18. 18. It is estimated that washing hands with soap and water could reduce diarrheal disease-associated deaths by up to 50%. Researchers in London estimate that if everyone routinely washed their hands, a million deaths a year could be prevented. Hand washing can reduce the risk of respiratory infections by 16%. The use of an alcohol gel hand sanitizer in the classroom provided an overall reduction in absenteeism due to infection by 19.8% among 16 elementary schools and 6,000 students. CDC Facts about Hands Washing Daniel J Ostlie: Evidence Based Care and Personal Bias
19. 19. We like to see a problem with an answer available Lack of an answer irritates us,, Find me an answer ,, Thats it ,, End of the story ,, Let the rest of the day pass in peace. Why did that happen this way!!! Daniel J Ostlie: Evidence Based Care and Personal Bias
20. 20. We tend to accept rather than to reject (specially) when we are talking about our own cases in the medical practice -- > LOOK at PubMed titles ,, most of them say: (Are we good at ? ,, few say are we bad at .. ?) Why did that happen this way!!! (Cont.) Daniel J Ostlie: Evidence Based Care and Personal Bias
21. 21. Genetic predisposition Severity of the disease Original anatomy Choice of medications Emotional status of the patient Random chance Technical skills of the surgon Co-existence of a disease that is not recognized Elements of the Game Daniel J Ostlie: Evidence Based Care and Personal Bias
22. 22. Co-existence of a disease that is recognized Quality and type of anesthesia Choice and rate of IV fluids Innate immune status Choice of operation Virulence factor Quality of post-operative care Elements of the Game (Cont.) Daniel J Ostlie: Evidence Based Care and Personal Bias
23. 23. And more of what we dont know Elements of the Game (Cont.) Daniel J Ostlie: Evidence Based Care and Personal Bias
24. 24. Our cognitive structure needs a role to explain the world. We are more likely to accept to continue believing in A WRONG role rather than accepting that there is NO role Why do we struggle! Daniel J Ostlie: Evidence Based Care and Personal Bias
25. 25. People have deterministic minds in a probabilistic world!! Determinism: If A then B Probabilism: If A then a 70% chance of C, a 20% chance of D and a 10% chance of E. Why do we struggle! (Cont.) Daniel J Ostlie: Evidence Based Care and Personal Bias
26. 26. Subjects will develop a deterministic rule to explain any series of observation (Brehmer 1974) Increasing the complexity of the problem doesnt reduce the tendency to develop deterministic rules (Kuylenstierna 1979) When the selected role fails they will develop another deterministic rule (Dawes 1974) When a series of deterministic rules fail, subjects will give up and guess rather than try a probabilistic rule(Tversky 1987) Even when subjects are specifically told that the outcome is probabilistic, they will still develop persistently try deterministic rules (Johansson 1987) Determinism vs Probabilism Daniel J Ostlie: Evidence Based Care and Personal Bias
27. 27. Mortality in 39,007 patients with acute MI 4546 cardiologists, interns, GPs Controlled for severity of disease hospital location, practice type, physician specialty, board certification, physician volume The surprise -- > 0.5% increase in mortality rate for every year since doctor graduated from medical school Experience vs Evidence Does Experience Matter
28. 28. Clinical Research: Fair understanding of different types of clinical researches. Developing the right research question and building a study design Confounding and bias Biostatistics Mastering analysis software Writing IRB application Ethical consideration in research Writing abstracts and manuscripts Writing a review What do I need to get started?
29. 29. Basic Research: Highly dependent on the nature of basic science research. Human vs animal subjects PCR ELISA ,, etc Understanding the theoretical knowledge and the available literature on the current playground. What do I need to get started? (Cont.)
30. 30. Get your steps done Start searching no less than 6 months in advance When to look for the opportunity?
31. 31. -Know the specialty of your interest. -Go to: http://health.usnews.com/best-hospitals/rankings How to search for the opportunity the right way?
32. 32. How to search for the opportunity the right way? (Cont.)
33. 33. How to search for the opportunity the right way? (Cont.)
34. 34. How to search for the opportunity the right way? (Cont.)
35. 35. How to search for the opportunity the right way? (Cont.)
36. 36. How to search for the opportunity the right way? (Cont.)
37. 37. How to search for the opportunity the right way? (Cont.)
38. 38. How to search for the opportunity the right way? (Cont.)
39. 39. How to search for the opportunity the right way? (Cont.)
40. 40. How to search for the opportunity the right way? (Cont.)
41. 41. How to search for the opportunity the right way? (Cont.)
42. 42. What to expect from research? -Learn the basics of research that will help you not only get into a residency but also make your future practice evidence based -Publications -Oral and poster presentations -Establish connections inside both the research community and the medical one -United States clinical experience -Good letter of recommendation
43. 43. My personal experience with that -Research question -Literature -Database -Data analysis -Generation of an abstract -Submission of the abstract for presentation (Poster/Oral) -Writing the manuscript
44. 44. Research Question! What is the outcome of Robotic-assisted Ivor Lewis (RAIL) esophagectomy in the obese patients?
45. 45. Literature
46. 46. Database
47. 47. Data Analysis
48. 48. Generation of an abstract If you want to write an abstract, you need to read several abstracts
49. 49. Writing the manuscript Read several manuscripts to write your first manuscripts Learn from your mistakes
50. 50. Submission of the abstract for presentation (Poster/Oral)
51. 51. Submitting the manuscript
52. 52. Interview Questions to Answer -Why would you like to join my research? -For how long are you willing to stay here? -What are your future career goals? -Do you have previous background in research? -How are you going to fund yourself?
53. 53. Interview Questions to Ask What is the project Im going to participate in Is it IRB approved! What is my role in this study How many patients are included in the study How many authors are going to participate in the study Where my name is going to be listed on the paper How do you do data collection How do you do data analysis What journal will you submit this study to?
54. 54. Where to go? To the place where you intend to match General surgery ,, IMG friendly programs Cleveland Clinics University if Toledo
55. 55. The cost of my Investment Things to have in mind when thinking about the cost: Cost of the visa: Sevis fee: 180$ (one time payment) Visa Interview: 160$ Air tickets: highly variable , around 500$ one way trip Cost of health insurance: Highly variable 300-2500$/annually Cost of living 500-1000$/month
56. 56. Tips to consider The world makes way for the man who knows where he is going Be creative ,, America is based on diversity ,, you are there to learn from others and others expect to learn something form you. Help others ,, this is an everlasting deed ,, Its just like helping yourself in another world Doubt everything you read, see or hear ,, this is a how you learn and avoid induction Google translate everything ,, dont make trivial grammatical mistakes while you can avoid them Be nice to you colleges, you are expected to be a teamwork player
57. 57. Acknowledgement My Mentor: Professor: Sharon M Weber Great role model and a supportive person
58. 58. Acknowledgement My home School of Medicine Suez Canal University
59. 59. Acknowledgement EAMTAR Organization and the EAMTARian family that have always supported me and gave me the chance to learn from the thousands of experiences included now in our network ,, giving another good example to the world how diversity is the key to success. Once upon a time I was a SCMSA member and a board member. That was a lifetime experience for me ,, & thanks for the awesome organization for todays event
60. 60. Acknowledgement On behalf of EAMTAR organization Thanks for our speakers today ,,
61. 61. Questions
62. 62. Hope it Could Help Iwillbehappytoanswer yourquestions