A PhD thesis in knowledge translation: Improving medical management through research and training

When I tell people that I have been doing clinical research for the better part of my last decade of life I usually get a few or more of the standard questions that are asked of higher degree research students like, “what did you do your PhD on?”, “what did you find?”, “was it hard?”, “why did you do it?”, and “what’s next?”.

These questions can be asked in a matter of seconds, but to answer them even briefly can take from 15 minutes to hours, depending on the level of interest. Now that the PhD is finally wrapped up, I feel inspired to write down some of the answers to these questions. I write in the spirit of what my thesis was all about “knowledge translation”, in other words, getting research off the shelves and into practice.

What was your PhD thesis on?

The title was “Improving the medical management of organophosphorus poisoning (OP) throught health services research and training”. Self harm is a big problem worldwide, and anyone working in an emergency department will be no stranger to this problem whether it is from people cutting themselves or taking overdoses. In many parts of rural Asia people drink pestices as a means of self harm resulting in over 300,000 deaths annually.

The vast majority of these pesticides are a particular form called organophosphate agents. This is much more toxic that the common weed killers used in Australia, such as round-up which is a glyphosate, and organophosphorus agents result in high case fatality rates, in the order of 15-30%, despite best practice.

The research collaboration that I worked with to conduct my research, the South Asian Clinical Toxicology Research Collaboration (www.sactrc.com), was a project that aimed to address many aspect of the public health problem of pesticide self-poisoning.

My work focussed specificially on two areas;

1) Improved medical management through the use of point-of-care tests that could provide information (acetylcholinesterase, ACHE, levels) that was thought to be useful in guiding antidote therapy
2) The evaluation of a train-the-trainer system of education to address training deficits in resuscitation education in the rural Sri Lankan setting

Both of these streams of study were different vehicles on the same journey of aiming to close the knowledge practice gap surrounding the management of OP poisoning. Thus the overall theme of my thesis was to do with this process of “knowledge translation”. The studies have been liked together using this conceptual framework.

They say a picture says a 1000 words so perhaps a figure from the introduction section of the thesis of the conceptual frame work , and two figures from the conclusions sections would aid to this strategy (ie 3000 words!?)

fig1

fig2

fig 3

Was it hard? Why did you do it?

These two questions are perhaps best answered together.

Yes it was hard.

I did it for multiple reasons, but most of all, it was the journey of trying to make a difference in the world. I have always wanted to do this, and when I started doing educational research I realised that there is an immense potential to improve the world by creating, and then assessing different systems of education.

The following video/slideshow shows how this happened in a poetic format.

The course of the PhD offered many challenges for my Emergency Medicine training that I was doing concurrently, as well as the ups and downs of life.

However, despite the knocks and triumphs, I strengthened my resolved to follow the dream I initially had with making a difference through training in Emergency Medicine training and International Research, and so far it has paid off in ways that I cound’t have imagined.

What’s next?

The first step was to stop, appreciated, and then reflect upon lessons learned, and wisdom gained that will hopefully help myself and other in the future. The next step is to become an Emergency Medicine consultant by finishing off the training, through training and sitting a fellowshop exam next year in 2016.

As for the future, I have some dreams and visions. I would like to continue as a clinical academic, teaching medical students and junior doctors. The vision I have is to help address many challenges in health care training, by fostering better “systems of training and education”. Perhaps one way this could be done is through research that also takes into account the important human factors of communcation and compassion, but who knows – tomorrow is still a mystery?

Some key publications;

The Effectiveness of a ‘Train the Trainer’ Model of Resuscitation Education for Rural Peripheral Hospital Doctors in Sri Lanka – Plos One (2013)

Evaluation of the Test-mate ChE (Cholinesterase) Field Kit in Acute Organophosphorus Poisoning – Annals of Emergency Medicine (2011)

Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka (2014)

PDF of Thesis

Current research projects;

Enhancing employee engagement and wellbeing in at risk units

 

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Meditation, Surfing and Thesis writing

This morning whilst having my breakfast I watched a great Ted talk on Vipassana

Vipasanna – it’s a Pali word meaning “seeing things the way that they are”. 

This talk by Buddy Wakefield was entertaining, inspiring and informative. With this post I hope to send out a message of gratitude to Buddy for the talk and to the nice person whom I met in a cafe recently that recommended I watching it!

 

 

Watching the breath and staying present 

I relate to many things in the talk, but perhaps the theme that strikes me the most right now, when reflecting on the bigger picture of life, is that perhaps most of us are surrounded by gold, and all of us have inner gold. The dirt is usually on the surface, created by our minds. 

Every moment has Beauty even if we don’t see it, even pain, and death. They say that pain is inevitable, but suffering is a choice. This is not to trivialize our external experience, it can be very tricky to navigate suffering in many instances but usually it is related to the “resistance” to “what is”, rather than the letting go and acceptance of what is. Also, I don’t mean to trivialize death, but there are many cultures that are much more at peace with death, and than the cultures that I have grown up with – I learned this in Sri Lanka when we would remember death of loved ones with relatives and the community with a regular annual ceremony where their life was celebrate for years after the death, a custom know as Banna. After returning to Sri Lanka, I learned and lived more eastern philosophy and experienced much more peaceful ways of relating to death, both professionally, as a doctor, but also personally.   

Death and pain aside, the purpose of this discussion and this blog post was to share a little about my reflections about how I have found meditation a helpful tool for staying present, something I find incredibly difficult!

I guess for me, meditation is the practice of being open to what is. Taking a breath in and observing the body sensations is a simple concept, but to be deeply aware during that breath is challenging. The beautiful thing is that we have plenty of opportunity to try, again and again. With each new breath and new opportunity to learn more about the present moment.  

Is it interesting? Definitely! No two breaths are the same right? Right at this instant I am writing this blog post on my iphone, on the train to work, listening to some nice music by the “Subway Bhaktis” (a group recently recommended to me), I am practicing observing breaths as i pause in my writing. Whilst this is not a typical ‘sitting’ meditation session, I believe being present even from one moment in a day is better than not being present at all. It’s all in the practice, and I’m trying to find ways to practice whilst doing the things that I need to do in a somewhat busy life [Nb –  I wrote that blog post from beginning to end on the train – I did go back and correct it later on – so excuse me if there are spelling and grammatical errors everywhere!]  

Every time I fully observe the breath I learn something new. An interesting thing that I noticed today is that with each breath there is a different set of observations to the last time I practiced (in this case last night before going to sleep when my mind was all over the place!).

 

Surfing the waves 

This morning I missed my morning meditation because I wanted to get out to the ocean for a sunrise surf. Surfing is another form of meditation or me. Each wave is like a breath. Again the goal can be to achieve something, to stand up on the board, and elegantly navigate the ocean shore, but this isn’t really the true nature of things, sometimes you have a good session, and other times you don’t. However if you are prepared to go with the flow, then you will usually enjoy and be at peace. 

I find the best surfs I have ever had were when I have just gone out there and enjoyed the moment, with no expectations, without trying to achieve anything. I was blessed to have one if those such mornings today.

By having no expectations it is easier to stay focused on the present, whilst still loosely holding a goal somewhere in my being (in this case the goals was simply to try and stand up, turn the board and ride along the wave). 

 

Bondi-wildmen

(Photography: courtesy of Eugene Tan, Aquabumps (c) http://www.aquabumps.com )

Planting the seed and tending the garden

To me it’s almost like the goal is planting the seed, and the “process” is the applying the fertilizer and watering the garden. This is where we need constant attention, after all there is no point continually replanting the seed. 

I see the same challenge with the writing up of my thesis. It is the constant attention to the manuscript (something that is quite challenging as there is a lot of resistance to looking at something you have seen before many times) that will allow the plant to grow. Sometimes when you expect to see a tree pop up straight away after planting a seed it is easy to get disillusioned and feel like you are no good at what you are doing, but this is only the fallacy of perspective, all well nurtured plants will grow into bigger ones with patience and dedication. 

Meditation and writing 

Perhaps the other challenge with a research thesis is that you actually don’t know what the plant is meant to look like until you get close to the end. It’s easy to feel as if you’ve made a mistake with your seed as the plant grows, and nobody else is growing the same plant, so comparing your plant with others is of limited benefit. 

Rpa_office

 

The vision and the dream

Perhaps the key message to me is that if we enjoy the process of gardening, and have a vision of what general kind of plant we want to grow – then it can mostly be an enjoyable adventure- this is my dream for education in general.

So in an attempt to practice this, my new philosophy for life is to plant the seed, go with the flow, and stay interested!   

I don’t know if it is the answer but I think it’s worth a crack! 

Enjoy your day 🙂

Bish_koggala

 

 “dare to be the person you’ve dreamed of because in one breath you are already there”