Week 1
My first week, I arrived in Annapolis, Maryland and got settled in my new home for the summer. I went down to the Anne Arundel Medical Center for the first time, where I met my mentor, Dr. Helena Mentis. I got some introductory information on the research project I will be working on and a brief introduction to the SAIL center. The SAIL center, or the James and Sylvia Earl Simulation to Advance Innovation and Learning Center, is a center at the hospital dedicated to medical research, training, and innovation, and it is where I will be spending most of my time. I was able to meet the SAIL directors and some of the other interns working at the hospital.
I also visited UMBC (the University of Maryland, Baltimore County) for the first time and met with a graduate student involved with the project. He gave me a demo of the equipment we will be using for the research project; I learned how to set up and use the Kinect-based telestration system and the eyetracker.
I also visited UMBC (the University of Maryland, Baltimore County) for the first time and met with a graduate student involved with the project. He gave me a demo of the equipment we will be using for the research project; I learned how to set up and use the Kinect-based telestration system and the eyetracker.
Week 2
This week, I attended the official orientation for the SAIL center interns at the hospital. I went through hospital training, took a tour of the relevant areas of the hospital, got my hospital ID and badge, and completed other logistical tasks/paperwork. In addition, throughout the week, I attended a number of lectures on research and healthcare, which were arranged by the SAIL center.
The other intern working on my research project and I met up at UMBC and tried to set up the telestration system and eyetracker (without the laparoscopic machine) to get ourselves accustomed to the equipment. Unfortunately, we ran into errors that caused the program to crash. We were able to get the system running later in the week when we realized we were making a mistake during set-up. Although frustrating, I think that these hurdles are ultimately constructive steps in the process of familiarizing ourselves with the system.
On Thursday, my intern partner and I met with Dr. Mentis and Dr. Kleinsmith at the SAIL center. I was able to see the entire system - the laparoscopic machine connected to the Kinect and the eyetracker - for the first time. We tested the efficacy of the machine/telestration system and discussed our goals for the upcoming week. One of the problems that we encountered was a lag on the laparoscopic monitor. When the laparoscopic camera or instruments are moved, there is a noticeable lag between the actual motion and the change appearing on the monitor. We think that the lag, which is large enough that it is impairing the machines use, is caused by the Epiphan converter being used to capture the laparoscopic monitor screen. One of the main priorities moving forward will be to find a solution to this lag. My partner and I also wrote up a detailed instruction guide on how to set up and use the telestration system and the eyetracker with the laparoscopic system.
Outside of work, I visited downtown Annapolis for the first time. It's a very lovely, picturesque place with a plethora of cute stores and restaurants that I plan to try out throughout the summer. I really enjoy places that have a sense of history to them, so I especially liked walking around the historic district of Annapolis.
Week 3
At the beginning of this week, the other interns and I received a tour of the OR and Surgery Unit of the hospital. We'll have opportunities throughout the summer to shadow surgeons, so to prepare, we learned how to get dressed and scrub in. I was actually able to sign up to follow a laparoscopic general surgeon in the OR next Friday; I felt out of my element even just touring the OR, so I'm both nervous and excited at the prospect of watching an actual surgery.
I also went to my first FIKA meeting this week - FIKA is a hour-long, weekly meeting held at UMBC, where the summer research interns, grad students, and professors gather to discuss their projects, progress, and goals.
I also met with the research team that I am working with this summer, which includes Dr. Mentis, Dr. Kleinsmith, a graduate student, and two other undergraduate research interns; it was decided that we would have our own weekly meetings, after FIKA, to regroup and discuss our objectives for the coming week.
The main goals this week were to continue to familiarize ourselves with the telestration system, to figure out why the Kinect program keeps on crashing, and to create an instruction manual for a laparoscopic cholecystectomy.
I also went to my first FIKA meeting this week - FIKA is a hour-long, weekly meeting held at UMBC, where the summer research interns, grad students, and professors gather to discuss their projects, progress, and goals.
I also met with the research team that I am working with this summer, which includes Dr. Mentis, Dr. Kleinsmith, a graduate student, and two other undergraduate research interns; it was decided that we would have our own weekly meetings, after FIKA, to regroup and discuss our objectives for the coming week.
The main goals this week were to continue to familiarize ourselves with the telestration system, to figure out why the Kinect program keeps on crashing, and to create an instruction manual for a laparoscopic cholecystectomy.
Week 4
We went through the protocol this week and went into the specifics of the trial design for data collection. It was decided that each participant will perform four laparoscopic tasks - relating to a laparoscopic cholecystectomy - while being mentored by a trainer. Two of the tasks will be mentored with telestration and two, without. After each task, both the trainee and trainer will complete questionnaires to assess their cognitive load, their perception of the trainee’s performance, and the perception of trainer efficacy.
At this week’s Tuesday meeting, I was introduced to the cognitive load aspect of the project. As I just mentioned, we’ll be looking at how the trainer and trainee perceive and assess their own cognitive load; so, basically, we’ll be able to see how their stress levels and cognitive load are affected by different conditions (i.e with and without telestration). We’ll also be using physiological sensor wristbands that measure heart rate, blood pressure, electrodermal activity, and other physiological responses. I think it’ll be really interesting to see the correlation between a participant’s perception of their cognitive load and the actual data. For instance, will a more experienced surgeon still register physiological responses related to increased stress? How will a trainee’s perception of their performance compare to the trainer’s perception? Will the use of telestration facilitate communication or cause more cognitive load? These are all important questions that we hope to have answered by data collection.
In other news, the research librarian at the hospital helped me find tons of papers on similar studies and previous uses of telesurgery. I will be reading through these throughout the next few weeks, so I can better contextualize the project and learn what has already been found about the effects of telestration in medicine.
I know that data collection is still a ways off, but now that I have a better understanding of the project’s primary goals and the implications of good data, I am more excited than ever.
At this week’s Tuesday meeting, I was introduced to the cognitive load aspect of the project. As I just mentioned, we’ll be looking at how the trainer and trainee perceive and assess their own cognitive load; so, basically, we’ll be able to see how their stress levels and cognitive load are affected by different conditions (i.e with and without telestration). We’ll also be using physiological sensor wristbands that measure heart rate, blood pressure, electrodermal activity, and other physiological responses. I think it’ll be really interesting to see the correlation between a participant’s perception of their cognitive load and the actual data. For instance, will a more experienced surgeon still register physiological responses related to increased stress? How will a trainee’s perception of their performance compare to the trainer’s perception? Will the use of telestration facilitate communication or cause more cognitive load? These are all important questions that we hope to have answered by data collection.
In other news, the research librarian at the hospital helped me find tons of papers on similar studies and previous uses of telesurgery. I will be reading through these throughout the next few weeks, so I can better contextualize the project and learn what has already been found about the effects of telestration in medicine.
I know that data collection is still a ways off, but now that I have a better understanding of the project’s primary goals and the implications of good data, I am more excited than ever.
Week 5
This week’s FIKA meeting focused on graduate school and what it’s like to be a graduate student, in general. I, personally, found the meeting to be very helpful because this is my first formal research experience and I was previously unfamiliar with not only, what working in research looks like, but also what graduate students really do. I had always considered grad school as a potential, but pretty distant possibility; hearing the experiences of current grad students at FIKA prompted me to seriously consider what I wanted to do after graduating from undergrad (which seems to be coming at me faster than I’d like to admit!) and if grad school was the right path for me.
Throughout the rest of the week, the other interns and I looked for validated cognitive load and stress level questionnaires and compiled a list of the ones most relevant to our project. We also set up the telestration/eyetracker/laparoscopic machine system in a simulation room at the SAIL center for the first time. We usually set up shop in a large, open room in the back, where several laparoscopic machines are located (amongst other big, slightly intimidating medical devices). While the back room has lots of room and is very convenient, the SAIL center also has two simulation rooms that are set up to look like real ORs. We were able to set up our system in one of these rooms, in case we decide to do data collection there.
One of the simulation rooms has a 3D motion capture system that Dr. Turner, the director of surgical research in the SAIL center, demonstrated for us. There are infrared cameras set up along the perimeter of the room and the system uses little rubber balls to track and map the room. I love to watch behind-the-scenes videos that show how computer graphics make “movie magic” possible and I had never before seen a motion capture system first-hand, so I was fascinated by the whole set-up. It was really interesting to see how technology, that I usually associate with movies and entertainment, was being used in innovative ways in the medical field.
Throughout the rest of the week, the other interns and I looked for validated cognitive load and stress level questionnaires and compiled a list of the ones most relevant to our project. We also set up the telestration/eyetracker/laparoscopic machine system in a simulation room at the SAIL center for the first time. We usually set up shop in a large, open room in the back, where several laparoscopic machines are located (amongst other big, slightly intimidating medical devices). While the back room has lots of room and is very convenient, the SAIL center also has two simulation rooms that are set up to look like real ORs. We were able to set up our system in one of these rooms, in case we decide to do data collection there.
One of the simulation rooms has a 3D motion capture system that Dr. Turner, the director of surgical research in the SAIL center, demonstrated for us. There are infrared cameras set up along the perimeter of the room and the system uses little rubber balls to track and map the room. I love to watch behind-the-scenes videos that show how computer graphics make “movie magic” possible and I had never before seen a motion capture system first-hand, so I was fascinated by the whole set-up. It was really interesting to see how technology, that I usually associate with movies and entertainment, was being used in innovative ways in the medical field.
Week 6
The summer is really just flying by. The Fourth of July was this Tuesday, so we had a long weekend. Although I really wanted to visit Washington DC for Independence Day, I actually ended up driving home for the weekend, so I could spend the holiday with family and friends back home.
It ended up being a pretty toned down week at work. I read through and took notes on the rest of my papers that I had found, relating to laparoscopic surgery and telesurgery. Reading about the background of laparoscopic surgery, and the process that goes into learning how to operate laparoscopically, helped me understand why it was important to try and improve communication in the OR. While laparoscopic surgery has benefits on the patient side because it is minimally invasive, it has a pretty steep learning curve and is arguably more difficult for the surgeon compared to open body surgery. Telestration and telementoring has the potential to positively impact instruction and communication, which can lead to more accurate mentoring, better learning, and overall improved patient outcome.
We also updated both the direction sheet and information sheet to better reflect the needs of the project. The direction sheet had to be made clearer and more detailed, so that essentially, anyone could read it and successfully set-up and use our telestration+laparoscopic system. Meanwhile, the laparoscopic cholecystectomy information sheet had originally just been a basic step-by-step guide, but now that we had finalized the four tasks we were having the participants perform, it was pretty useless. We updated it to a simple, one-page sheet containing information needed to perform the four specific tasks. It is important that we continuously review our materials and update as needed, so we are organized and fully prepared for data collection.
It ended up being a pretty toned down week at work. I read through and took notes on the rest of my papers that I had found, relating to laparoscopic surgery and telesurgery. Reading about the background of laparoscopic surgery, and the process that goes into learning how to operate laparoscopically, helped me understand why it was important to try and improve communication in the OR. While laparoscopic surgery has benefits on the patient side because it is minimally invasive, it has a pretty steep learning curve and is arguably more difficult for the surgeon compared to open body surgery. Telestration and telementoring has the potential to positively impact instruction and communication, which can lead to more accurate mentoring, better learning, and overall improved patient outcome.
We also updated both the direction sheet and information sheet to better reflect the needs of the project. The direction sheet had to be made clearer and more detailed, so that essentially, anyone could read it and successfully set-up and use our telestration+laparoscopic system. Meanwhile, the laparoscopic cholecystectomy information sheet had originally just been a basic step-by-step guide, but now that we had finalized the four tasks we were having the participants perform, it was pretty useless. We updated it to a simple, one-page sheet containing information needed to perform the four specific tasks. It is important that we continuously review our materials and update as needed, so we are organized and fully prepared for data collection.
Week 7
On Monday, we had our first test-run and full run through with Dr. Reza - Dr. Reza acted as the trainer, while Dr. Mentis acted as the trainee. The other interns and I had practiced test-runs between ourselves last week, so we would be ready for Monday’s test-run. I knew that there were some kinks that still had to be ironed out, but I thought that we were relatively prepared. Thinking back, my confidence was actually pretty baseless, so it makes sense that the test-run didn’t go as smoothly as expected. There were just so many things that we had missed and it was crazy how nervous I got, even though it wasn’t a real trial. However, in the end, the run ended up being extremely helpful because we got back vital information and much-needed constructive criticism.
We basically had our work cut out for us for the rest of the week. We polished the trial design and addressed every suggestion that had been made during the test-run. We created a pre-trial checklist and a script with clearly defined roles and actions to establish consistency for every participant and to help us remember every little necessary detail. In addition, we also ran through the script countless times and practiced test-runs on the other research interns. Our prospective participants are surgical residents and fellows, who already have very busy schedules, and one of the hardest aspects of this project has been coordinating with everybody's schedules. Thus, it’s crucial that we act as a well-oiled machine to ensure that the trials run as efficiently as possible and to minimize any possibility for error. I think, by the end of the summer, I’ll be able to run a trial in my sleep!
We basically had our work cut out for us for the rest of the week. We polished the trial design and addressed every suggestion that had been made during the test-run. We created a pre-trial checklist and a script with clearly defined roles and actions to establish consistency for every participant and to help us remember every little necessary detail. In addition, we also ran through the script countless times and practiced test-runs on the other research interns. Our prospective participants are surgical residents and fellows, who already have very busy schedules, and one of the hardest aspects of this project has been coordinating with everybody's schedules. Thus, it’s crucial that we act as a well-oiled machine to ensure that the trials run as efficiently as possible and to minimize any possibility for error. I think, by the end of the summer, I’ll be able to run a trial in my sleep!
Week 8
This week, we were finally able to start data collection. We ran our first real trial after much practice. The beginning of the week consisted of making all of the necessary final arrangements. We updated the script, prepared and labeled all trainee/trainer forms and surveys, made the models for the different cholecystectomy trials, etc. We also spent some time trying to troubleshoot with the telestration code because the telestration system is still jerky sometimes when following the trainer's movements.
The most difficult aspect of organizing was probably coordinating schedules. We have been trying to schedule trials for the past couple of weeks, but it's been challenging to find a block of time that worked with the residents' schedules, the attending's schedule, the room schedule, and our time deadline - especially since most of the residents and surgeons don't know their schedules weeks in advance. We were able to get one trial in on Thursday and luckily, we were able to get four trials in on Friday. Friday was pretty hectic because we weren't sure what the participant availability was until 30 minutes before the actual run, but thanks to our preparation, we were able to get through all trials smoothly.
I'm so excited that we have finally been able to start getting data, something that we have been working toward all summer. I hope that by the end of the summer, we'll be able to begin analyzing the data and see what it says about the effects of the telestration system.
The most difficult aspect of organizing was probably coordinating schedules. We have been trying to schedule trials for the past couple of weeks, but it's been challenging to find a block of time that worked with the residents' schedules, the attending's schedule, the room schedule, and our time deadline - especially since most of the residents and surgeons don't know their schedules weeks in advance. We were able to get one trial in on Thursday and luckily, we were able to get four trials in on Friday. Friday was pretty hectic because we weren't sure what the participant availability was until 30 minutes before the actual run, but thanks to our preparation, we were able to get through all trials smoothly.
I'm so excited that we have finally been able to start getting data, something that we have been working toward all summer. I hope that by the end of the summer, we'll be able to begin analyzing the data and see what it says about the effects of the telestration system.
Week 9
This week, we were able to complete a few more trials for data collection. It's still not as many as we would like, but we don't think that we'll be able to get any more residents by the end of the summer. We uploaded and organized all our video files and raw data that we collected, and started talking with the graduate student leading the study about how she wanted the video coding format to be done. I started watching the external recordings of the trials and transcribing the trainer/trainee utterances and movements.
Week 10
I can't believe that this is already my last week! This summer really flew by. I'm going to miss working on the project and above all, I'm going to miss all the lovely people I had the pleasure of getting to know this summer.
This week, we finished uploading all of the raw data and I finished transcribing the external recordings for all of our trials. The transcription process took longer than anticipated because we had some difficulty getting the video files to run smoothly and the audio was pretty low quality at some parts. It was interesting to see the communication patterns and how the telestration system affected how the trainer directed the trainee. We also started looking at the data collected from the wristbands that collected physiological data from the trainer and trainee, which was really interesting because you can determine when the trainer/trainee's stress levels rise and explore the impact of the telestration on the participants' stress levels. Unfortunately, I have to leave before we really start analyzing the data and looking at the implications of the telestration system, but I hope to hear about what the data has revealed in the future!
The other research interns in the hospital's research program are presenting their research projects this weekend. Unfortunately, I wasn't able to attend the actual event, but I was able to sit in on the interns rehearsing their presentations. It was super cool to see what everyone has been working on all summer - everyone has been doing such great work and I was just so grateful to have been able to have been a part of such an amazing and encouraging group of people. All of the fellow interns, hospital staff, and UMBC faculty - especially my mentor and supervising graduate student - have been so welcoming and I can't thank them enough for making my time here an unforgettable experience.
This week, we finished uploading all of the raw data and I finished transcribing the external recordings for all of our trials. The transcription process took longer than anticipated because we had some difficulty getting the video files to run smoothly and the audio was pretty low quality at some parts. It was interesting to see the communication patterns and how the telestration system affected how the trainer directed the trainee. We also started looking at the data collected from the wristbands that collected physiological data from the trainer and trainee, which was really interesting because you can determine when the trainer/trainee's stress levels rise and explore the impact of the telestration on the participants' stress levels. Unfortunately, I have to leave before we really start analyzing the data and looking at the implications of the telestration system, but I hope to hear about what the data has revealed in the future!
The other research interns in the hospital's research program are presenting their research projects this weekend. Unfortunately, I wasn't able to attend the actual event, but I was able to sit in on the interns rehearsing their presentations. It was super cool to see what everyone has been working on all summer - everyone has been doing such great work and I was just so grateful to have been able to have been a part of such an amazing and encouraging group of people. All of the fellow interns, hospital staff, and UMBC faculty - especially my mentor and supervising graduate student - have been so welcoming and I can't thank them enough for making my time here an unforgettable experience.