About Continued...
I was inspired to pursue this clinical research project at the beginning of my junior year by my previous experience witnessing live surgery alongside Dr. Hammond in high school as well as my experience learning about health disparities among pediatric patients from my mentor Dr. R. Alexander Blackwood, MD, PhD. To incorporate my interest in plastic surgery with my passion for pediatric health equality, I met with yet another physician, Dr. Kavitha Ranganathan, to develop a meaningful research question. Dr. Ranganathan and I quickly realized that very few studies had examined differences in care among cleft lip and palate patients. Thus, in an effort to fill this identified gap in medical knowledge, I set out on a research project aimed at determining the effect of sociodemographic variables on the quality of health care received by cleft patients. The potential for this project to improve pediatric plastic surgery by proactively identifying individuals at-risk for receiving lower health care quality, motivated me to begin immediately.
The first step in performing any research project is gaining approval from the Institutional Review Board (IRB), which is a committee that ensures health and social science research is conducted ethically. The IRB application is fairly extensive, so I met with the several health professional involved in the care of cleft patients to improve my study design. After speaking with a plastic surgeon (Dr. Buchman), speech and language pathologist, social worker, and IRB member (Dr. Blackwood), I wrote what I believed to be an all-inclusive study plan. Though the project gained approval within days, the study design process was far from complete.
I began the data collection process around the mid-way point of my junior year. Though I initially envisioned this step as simply reading through patient files and recording information, the process soon became much more involved. Before patient information could be gathered, each specific data point of interest needed to be carefully defined. I was collecting over 50 specific data points, so defining each variable based on previously published literature and conversations with medical professionals took a considerable amount of time. Then, while attempting to collect information on the first several patients, I realized much of the material I hoped to collect was not present in the electronic health records. So, I re-defined almost all of the variables. This was a painstakingly slow venture, and challenged my desire to proceed with the project.
Nonetheless, I finalized all variable definitions, and soon confirmed the patient study sample, which included a total of 178 individuals. It took approximately an hour and a half to complete each patient’s study file. My time to work on this project was limited by my full class schedule and additional extracurricular involvements, making the data collection process sluggish. After realizing the sheer amount of work involved in the project, as well as my unique opportunity to mentor a younger student interested in medicine, I decided to recruit additional help. I quickly asked Matthew Bageris, a freshman in the University of Michigan Honors College who I played hockey with in high school, if he was interested in getting involved. He accepted the offer without hesitation. The ensuing experience mentoring a younger student gave me a newfound sense of responsibility, which pushed me to continue working hard.
Matthew and I had successfully collected information on the first 100 patients by the summer between my junior and senior year, and we decided to perform an initial statistical analysis to determine if the study design was producing meaningful results. We found that ten of our twenty-five variables were significant predictors of patient attendance rate at appointments, which is highly related to the quality of care received by patients. I distinctly recall the excitement I felt upon hearing the study I had invested so much time and energy into was giving positive results. Furthermore, I submitted an abstract based on the attendance rate findings to the University of Michigan Department of Pediatrics and Infectious Diseases Annual Research Symposium, and was selected to give an oral presentation. The award I received in recognition of this talk gave me added confidence in our study and in my ability to contribute to health science research as an undergraduate student.
Motivated by the significant results and external interest in our work, Matthew and I finished collecting data on all 178 patients around the time I began brainstorming ideas for the Minor in Writing Capstone Project. I believed the data constituted a publishable body of work, and became motivated to make a permanent contribution to the growing body of scientific knowledge. This made my decision to write a research paper for my Capstone Project easy.
I began the writing process by identifying several model papers from the Cleft Palate-Craniofacial Journal, the publication to which I planned to submit my work. Though I initially thought about trying to publish my work in other places such as the Plastic and Reconstructive Surgery Journal or Annals of Plastic Surgery, I decided to submit my work to the Cleft Palate-Craniofacial Journal because I felt the findings of my study would be most meaningful and important to the readers of this publication. Moreover, based on the form of and content contained in my models, I set out to draft the research paper. The introduction, methods, and results sections were relatively easy to compile. This was due to the highly relevant model papers I found, which were written on the topic of missed appointments among cleft patients as well. However, I met significant challenges writing the discussion and conclusion of the piece because I lacked the clinical knowledge of a plastic surgeon. I met with Dr. Ranganathan to overcome this hurdle. After implementing the four-paragraph discussion structure typically seen in health disparities research publications, and confirming my work properly aligned with my model papers, the draft was complete.
Dr. Buchman (left), Dr. Blackwood (middle), and Dr. Ranganathan (right).
Myself (middle) and Matthew (right) following our final hockey game together. The team was coached by Dr. Hammond.
Preparing the draft for submission to the Cleft Palate-Craniofacial Journal was the final step of the writing process. I met with a statistician from the Office for Health Equity and Inclusion here at Michigan to ensure all data analysis was performed correctly. Then, I met individually with Dr. Blackwood and Dr. Buchman to review the content of the paper. Completing these final review meetings filled me with excitement, for they marked the conclusion of a yearlong project.
My experience asking a scientific question and subsequently expending the time and energy necessary to pursue an answer, has been extremely rewarding. Aside from actively participating in the creation of new knowledge, the most significant part of this project was the confidence I gained in my decision to pursue medicine. From a professional standpoint, it is my hope that readers of my article, “Sociodemographic Predictors of Missed Appointments Among Cleft Lip and Palate Patients,” will gain a better understanding of the health disparities that currently exist in the field of plastic and reconstructive surgery, and take action to better distribute the resources necessary to improve care for at-risk individuals. However, by presenting this piece online via my Capstone Project site, I hope to also inspire my classmates to pursue personally enriching projects of their own.