Simulation is 1. Imitation or enactment, as of something anticipated or in testing, or 2. The act or process of pretending; feigning.
The art of simulation has probably been with us for thousands of years. Early acts of simulation revolved around hunting parties, preparing for great festivals, and entertaining. Today, in health care, simulation is a big part of how we "practice" specialized procedures before a surgeon's hands ever remove an appendix or perform exploratory laprascopic surgery. We also use simulation to practice highly organized team approaches to trauma care and working together as a coordinated unit in the operating room.
Last Monday I had the opportunity to visit and tour our National Capital Simulation Center located in Silver Spring, Maryland. Considered a simulation center of excellence by the Agency for Health Care Research and Quality (AHRQ), the simulation center trains hundreds of medical students every year in "virtual" suturing, laprascopy, and manipulation of specialized surgical instruments as they prepare for a career in medicine.
I was interviewing with Dr. Gill Muniz, Deputy Medical Director of the facility to explore possible research opportunities in the future.
Sunday, September 27, 2009
Tuesday, September 15, 2009
Possibilities
Dissertation possibilities, that is. Four topics to explore:
- Inflammation and cytokines
- Traumatic Brain Injury, of which I have a personal connection while working in Anbar Province, Iraq. Our combat engineers, B-321, were responsible for keeping Route Mobile and Route Golden open at all times as these were our logistical ground routes to Fallujiah and Taquaddumm.
- Simulation. I am due to schedule a tour of the Capitol Simulation Center located here in Washington D.C.
- Competencies specific to critical care nursing and readiness to deploy.
Nourishment
It's been three weeks and I have made a few observations I wish to share.
Observation #1: I have always been the active type. Running, walking, lifting, etc. However, the stress of the "unknown" has resulted in an immediate need to eat my way through those crucial weeks. That is going to stop now. It's time to get with the program. Back to running and biking. Daily. For as long as the weather holds out.
Observation #2: the pure discipline needed to sit and read for hours on end is staggering. Razor focus I crave, and flights of occasional concentration is what I have. Yesterday in the library was the first time I was really able to zone out and study meaningfully. Before that it has been a challenge. Is it time for another cup of coffee? Will it be OK if i go to two pots a day? Is this third diet Coke going to push me over the edge into early Alzheimer's?
Tonight I lead the discussion on Galileo and Courage in Science. My presentation is complete, and I just need to study and memorize some of the details. Galileo, faithful Copernicus follower skirting ever close to Vatican wrath for heresy, ushered in the scientific age of Mechanism where empirical observation and measurement reigned supreme.
Observation #1: I have always been the active type. Running, walking, lifting, etc. However, the stress of the "unknown" has resulted in an immediate need to eat my way through those crucial weeks. That is going to stop now. It's time to get with the program. Back to running and biking. Daily. For as long as the weather holds out.
Observation #2: the pure discipline needed to sit and read for hours on end is staggering. Razor focus I crave, and flights of occasional concentration is what I have. Yesterday in the library was the first time I was really able to zone out and study meaningfully. Before that it has been a challenge. Is it time for another cup of coffee? Will it be OK if i go to two pots a day? Is this third diet Coke going to push me over the edge into early Alzheimer's?
Tonight I lead the discussion on Galileo and Courage in Science. My presentation is complete, and I just need to study and memorize some of the details. Galileo, faithful Copernicus follower skirting ever close to Vatican wrath for heresy, ushered in the scientific age of Mechanism where empirical observation and measurement reigned supreme.
Sunday, September 6, 2009
Ill-Informed Subjects
USU wants a dissertation topic soon. This is mutually exclusive from the fact that I have no idea yet what I will do.
It's not to be taken lightly. My chosen topic will stay with me as I eat, study, breathe, and sleep for the next three years. A poor choice will haunt and taunt me without mercy and make my time seem better suited to purgatory.
Whether it is a good one or not: I have a plan. This week I contact a researcher across the street at NIH who is doing research with cytokines (immumodulators that affect cell to cell communication and play a big role in the inflammatory response and septic shock). I need to "get smart" about current cytokine functions and promise as we know it now. Additionally, I will be meeting with another full-time PhD student who has chosen traumatic brain injury (TBI). With both of these, I have personal investments and a high interest in furthering our knowledge of these two high priority and mysterious complexes. The third prong of my quest for suitable research topics will take me to the current labs running at USU. There are a wide variety of researchers here on campus already, and I plan to visit labs in the coming two weeks to get a feel for what is possible and what is out of the realm (and out of my league).
How this plays out is anyone's guess (mostly mine) at this point.
It's not to be taken lightly. My chosen topic will stay with me as I eat, study, breathe, and sleep for the next three years. A poor choice will haunt and taunt me without mercy and make my time seem better suited to purgatory.
Whether it is a good one or not: I have a plan. This week I contact a researcher across the street at NIH who is doing research with cytokines (immumodulators that affect cell to cell communication and play a big role in the inflammatory response and septic shock). I need to "get smart" about current cytokine functions and promise as we know it now. Additionally, I will be meeting with another full-time PhD student who has chosen traumatic brain injury (TBI). With both of these, I have personal investments and a high interest in furthering our knowledge of these two high priority and mysterious complexes. The third prong of my quest for suitable research topics will take me to the current labs running at USU. There are a wide variety of researchers here on campus already, and I plan to visit labs in the coming two weeks to get a feel for what is possible and what is out of the realm (and out of my league).
How this plays out is anyone's guess (mostly mine) at this point.
Unexpected Risks of Clinical Research
This weekend I not only answered "collapsing variables" for Stats, but read a chapter from Clinical Research regarding research risk. The chapter was written by Dr. , a long-time NIH researcher, who ended up mired in controversy regarding experimental nucleoside antiviral agents during the dawn of one of the biggest scare of the twentieth century: HIV and AIDS.
The chapter was formulated and refined over a decade and is modeled after a research lecture given by Dr. at NIH after his experience with having his entire program shut down for over two years while the FDA, NIH leadership, the Institute of Medicine (IOM), and congress all had their own independent full blown investigations into the unfortunate deaths of patients enrolled in this experimental phase III trial for hepatitis B (HBV).
Wednesday: meet with the senior Navy adviser on my proposed research topics. With only three years to earn, the dissertation process starts right out of the gate in the first semester. The expectation is that you have your topic and are performing the field of inquiry before December. No fooling around at this pace.
The chapter was formulated and refined over a decade and is modeled after a research lecture given by Dr. at NIH after his experience with having his entire program shut down for over two years while the FDA, NIH leadership, the Institute of Medicine (IOM), and congress all had their own independent full blown investigations into the unfortunate deaths of patients enrolled in this experimental phase III trial for hepatitis B (HBV).
Wednesday: meet with the senior Navy adviser on my proposed research topics. With only three years to earn, the dissertation process starts right out of the gate in the first semester. The expectation is that you have your topic and are performing the field of inquiry before December. No fooling around at this pace.
Grasping for Air
It's been two weeks and I'm trying to enjoy this Labor Day holiday with family.
Here's how this is a more difficult task than one would expect: I have time, but no real idea of how I should be managing it. Having just begun this process, I want to exceed beyond my expectations. Given this extraordinary opportunity, I have no time nor little patience with not challenging myself to reach my fullest potential.
Therein lies the problem: I want to read and study all the time, yet it not physically possible nor realistic. So I feel as if I am trying the impossible task of grasping for air with a pair of tweezers. It's all around, but not to be held in one's hands. With an afternoon open, I jump from reference book to reference book and assess the varied projects due this summer. Should I be reading Bad Blood right now? Will Stats be my weakness, so focus on nailing validity, central tendency, and collapsing variables now before it's too late? Or better yet, should I be studying the lecture powerpoints for the coming week?
Here's how this is a more difficult task than one would expect: I have time, but no real idea of how I should be managing it. Having just begun this process, I want to exceed beyond my expectations. Given this extraordinary opportunity, I have no time nor little patience with not challenging myself to reach my fullest potential.
Therein lies the problem: I want to read and study all the time, yet it not physically possible nor realistic. So I feel as if I am trying the impossible task of grasping for air with a pair of tweezers. It's all around, but not to be held in one's hands. With an afternoon open, I jump from reference book to reference book and assess the varied projects due this summer. Should I be reading Bad Blood right now? Will Stats be my weakness, so focus on nailing validity, central tendency, and collapsing variables now before it's too late? Or better yet, should I be studying the lecture powerpoints for the coming week?
Thursday, September 3, 2009
Generator of RVUs
The end-product of a quick journey through the medical customer service continuum by Dr. Ed Gabriele. What started off years ago as "patient" has moved through a range of coined terms. Patient became the Client, and moved with the service revolution to "Customer". Finally, in this age of "too many patients and far little time to spend with them", we have simply moved to "Generator of Relative Value Units". And this is how we started The Philosophy of Science.
Pearls
"Think of those people who tick you off the most, because they are the shadow of you."
"This is process vs. content and training vs. the meaning of education."
"So Adam was created from the earth, and Eve from his rib. For anyone who cares to comment on the fact that woman came from man remember this: Adama is Hebrew for earth. Read: dirt. Where would you rather come from?"
Philosophy: Lover of Wisdom. To observe our journey of knowing. Humans are perpetually in the act of completion. Looking for "the garden" so to speak."
Jeung and Freud had it right: we continually long to know and to be.
"It is the mark of an educated mind to be able to entertain a thought without accepting it." -Aristotle
Pearls
"Think of those people who tick you off the most, because they are the shadow of you."
"This is process vs. content and training vs. the meaning of education."
"So Adam was created from the earth, and Eve from his rib. For anyone who cares to comment on the fact that woman came from man remember this: Adama is Hebrew for earth. Read: dirt. Where would you rather come from?"
Philosophy: Lover of Wisdom. To observe our journey of knowing. Humans are perpetually in the act of completion. Looking for "the garden" so to speak."
Jeung and Freud had it right: we continually long to know and to be.
"It is the mark of an educated mind to be able to entertain a thought without accepting it." -Aristotle
Wednesday, September 2, 2009
Giant Leap
It has been a week, and I can not believe they are letting me do this. The Navy, most generously, has allowed me to pursue my doctorate. Full-time. Full paycheck. I am a fortunate son.
Three classes this semester: Research Design I, Statistics I, and Theory of Science. I have an ambitious plan and lofty goal: document this mysterious process from start to finish.
It's 11PM and I'm just getting started. I am going to have to get back with you on the first post. Obviously, here is where that aforementioned lofty goal immediately flies off the track. Tomorrow is full of promise and a legitimate post.
Three classes this semester: Research Design I, Statistics I, and Theory of Science. I have an ambitious plan and lofty goal: document this mysterious process from start to finish.
It's 11PM and I'm just getting started. I am going to have to get back with you on the first post. Obviously, here is where that aforementioned lofty goal immediately flies off the track. Tomorrow is full of promise and a legitimate post.
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