Title: RESEARCH AN ESSENTIAL PART OF THE TRAINING OF A WELL ROUNDED SURGEON Prof Franklin Rosenfeldt
1RESEARCHAN ESSENTIAL PART OF THE TRAINING OF A
WELL ROUNDED SURGEONProf Franklin Rosenfeldt
2CARDIAC SURGICAL RESEARCH UNIT
ALFRED HOSPITAL
BAKER HEART RESEARCH INSTITUTE
MONASH UNIVERSITY DEPARTMENT OF SURGERY
MELBOURNE
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4NORMAN SHUMWAY
- Shumway commenced at Stanford University in 1958
- where, in collaboration with Dr Richard Lower, he
undertook ground-breaking work in cardiac
transplantation. - He discovered a simplified donor to recipient
atrial anastomoses and the method of preserving
the donor heart in ice-cold saline - In 1967, Dr Christian Barnard, who had observed
Shumways experimental techniques first hand at
Stanford performed the first human cardiac
transplant. - In January 1968, Shumway performed the first
cardiac - transplant in the United States.
- Norman Shumway will always be remembered as the
- true father of cardiac transplantation and for
training a - generation of cardiac surgeons.
5NORMAN SHUMWAY
Shumway, his team and his trainees had a major
commitment to research
6Green Lane Hospital Auckland New Zealand
7Major achievements
- Performed the worlds first human tissue aortic
valve replacement performed in 1962 (independent
of and almost simultaneous with Sir Donald Ross
in London). - Contributed actively to tissue valve research
almost until his death. - His passion was paediatric cardiac surgery and
his work, - starting in 1969 with the use of deep hypothermic
circulatory arrest in young infants, led to
techniques which were quickly adopted worldwide.
8BARRATT BOYES
Barrat- Boyes , his team and his trainees had a
major commitment to research
9Benefits of Research
- Learn Problem Solving Using the Scientific Method
- Learn to Critically Evaluate the literature
- Cultivate an enquiring mind
- Develop an adventurous Spirit eg Shumway and
Barratt-Boyes - Understand Language of Science
- Learn Scientific writing
- Learn statistics
- Enhance career opportunities
10Benefits of Research
- Learn Problem Solving Using the
- Scientific Method
11Scientific Method
12Scientific Method
- Hypothesis
- Perform an experiment
13Scientific Method
- Hypothesis
- Perform an experiment
- Collect results
14Scientific Method
- Hypothesis
- Perform an experiment
- Collect results
- Accept hypothesis
15Scientific Method
- Hypothesis
- Perform an experiment
- Collect results
- Reject hypothesis
16Scientific Method
- Hypothesis
- Perform an experiment
- Collect results
- reject the hypothesis
- Make another hypothesis
17State the problem to be solved or idea to be
tested The rate of wound infection in the
Alfred has increased
- Hypothesis Staff wearing their theatre clothes
in the wards or the street bring bugs into the
theatre - Perform an experiment Fine everyone who wears
their theatre clothes outside the theatre 100
per offence - Collect results Measure wound infection over the
next 6 months - RESULT 1 wound infection rate falls by 50
- Accept the hypothesis
18State the problem to be solved or idea to be
tested The rate of wound infection in the
Alfred has increased
- Hypothesis Staff wearing their theatre clothes
in the wards or the street bring bugs into the
theatre - Perform an experiment Fine everyone who wears
their theatre clothes outside the theatre 100
per offence - Collect results Measure wound infection over the
next 6 months - Result 2 wound infection unchanged
- Reject the hypothesis
- Make another hypothesis
19COMPLEXITY IN BIOLOGICAL SYSTEMS AND ITS
IMPLICATIONS FOR CARDIOVASCULAR MEDICINE
- Joseph Loscalzo
- Harvard, Bigham, Editor of Circulation
20RESEARCH
- How ?
- When ?
- Where ?
- What ?
21 HOW ?
- Full Time
-
- Batchelor of medical science
- Examples Stephen Repse, B med Sci
- PhD
- Higher Degree
- . 1 2 years MS or MD
- . 3 years PhD
- Part Time
- . Follow project for several years
22WHEN ?
- During your medical course a good time
- Before Specialist or GP Training Possible
- During Training a good time
- After Training Difficult
23WHERE ?
- University Department
- Research Institute
- Hospital
- At Home or overseas
24What?
- Case Report
- - Unique
- - Has a teaching point
- Series of Cases
- - Needs a comparison group
- Clinical Trial
- - How many cases necessary
- for statistical significance?
- Laboratory Project
25Select a Topic
- Select a topic for an investigative project early
on. This is preferably done by yourself. - Alternatively a topic may be suggested by your
supervisor
26- Where Ideas Come From Examples
- A chance observation Harvesting the IMA with
diathermy is OK - Why not the radial too?
- Patients Patient suffering with Claggett
treatment for Pheumonectomy space infection
with pinhole leak at bronchial stump -
- An original idea Cooling the A-V node should
be protective not damaging -
- Something you have read Orotic acid protects the
heart - Or heard at a meeting
27- Your boss
- An experienced clinical researcher
- An original thinker
- A basic scientist
28FORMULATE AN AIM AND AN HYPOTHESIS
- Work out a specific aim
- To develop a technique for sterilising a
pneumonectomy space - To simplify the technique of radial artery
harvest - Formulate an hypothesis preferably positive
- It is possible to sterilise a closed
pneumonectomy space - Diathermy does not necessarily cause radial
artery spasm
29 BADLY DESIGNED EXPERIMENTS
- ..whereas for a properly designed experiment we
can perform a valid analysis, for an experiment
which is not properly designed we can often only
carry out a post-mortem to decide what the
experiment died of. - R A Fisher, Master
statistician
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31APPLICATIONS
- Ethics
- Helps you clarify your ideas
- May cause delays so start early
- Research Grant
- Preferably do this the year before you start the
project difficult! - Commercial Company
- Drug firm
- Equipment company
32Give talks at any early stage
- . Where ?
- - Departmental meeting
- - Hospital meetings
- - National meeting
- - International meeting
- . Take note of the questions
- . Giving talks helps you prepare for writing
your paper
33CARRY OUT THE PROJECT
- Pursue this special interest during your whole
period of training - You could include a period of full-time research
work as part of your training period
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36CONCLUSIONS
- Research is very rewarding
- I will get bored sewing coronary on grafts or
repairing hernias for the rest of my life! - Research experience makes a better doctor
37ALFRED HOSPITAL
BAKER HEART RESEARCH INSTITUTE
MONASH UNIVERSITY DEPARTMENT OF SURGERY
MELBOURNE
38THE SEVEN STAGES OF AN IDEA
- Norman Shumway, recalling the pioneering days of
heart transplantation described the seven stages
the idea went through before it eventually
entered the field of routine clinical practice - 1. Initial stage Wont work been tried
before. - 2. After successful experiments in animals
Wont translate to man. - 3. After 1 successful clinical patient Very
lucky doubt if patient really needed
transplant. - 4. After 4 or 5 clinical successes Highly
experimental, too risky, immoral unethical I
understand they have had a number of deaths they
are not reporting.
39THE SEVEN STAGES OF AN IDEA
- 5. After 10 to 15 patients May succeed
occasionally in carefully selected cases but very
few patients really need an operation anyway. - 6. After a large series of successes So and so
has been unable to duplicate their results. I
hear that a number of their patients are now
dying late death. - 7. Final stage This is a very fine
contribution. A straightforward solution to a
difficult problem. I predicted this. In fact, in
1939 I had the same idea. Of - course, we didnt publish anything. We had no
cyclosporin. - The time frame of this evolution took more than
20 years, between 1960 and 1982.