For my STEP signature project, I assisted Dr. Michelle Humeidan and the Clinical Anesthesia Research Lab in conducting the Neurobics Trial. This clinical trial’s aim was to assess the efficacy of preoperative cognitive exercise on the onset of postoperative delirium in a subset of elderly patients – delineated by specific exclusion criteria.
As a result of my STEP signature project, I was able to work in the middle of an ongoing, multi-year clinical trial, which allowed me to test my previous assumptions of clinical research. My assumptions that were tested include the difference between direct patient care and clinical trial proceedings, the level of separation between a research team and the medical staff taking care of patients involved in the clinical trial, as well as what treatments may be tested in a clinical trial. Before my experience in the Neurobics trial, I believed that patients in a clinical trial were taken care of by members of the clinical trial’s research team. Instead, I now understand that a research team works alongside attending physicians in the hospital, and they are another addition upon the existing medical team tasked to take care of each patient. Additionally, my preconceived idea of the separation between a research team and other medical staff was challenged. I previously believed that research teams would operate separately from existing medical staff; however, I now understand that research teams act alongside existing medical staff in order to provide patients with excellent care and keep them involved in the trial. Finally, I used to believe that the only treatments included in clinical trials were prescription drugs. However, I can see that a treatment option can be more than just a prescription drug, but even cognitive exercise.
The experience that challenged my previous assumptions was shadowing cognitive tests. When shadowing cognitive tests, I was able to see that, as a member of the research team, our job was not to take care of patients, but to supplement their care with the proceedings of the clinical trial. Not only did I see that they were under the full care of their normal medical team, but I also saw that I did not extensively monitor their health – as a physician or nurse would – as a member of the research team. Before this experience, I had no idea that clinical trial members were not under the full care of the research team.
In addition to shedding light on the difference between direct patient care and the care given from a research team, shadowing allowed me to reevaluate the separation between the two medical teams. When shadowing, it was crucial to coordinate with the nurses and physicians on staff when beginning a cognitive test or drawing blood for other sections of the trial. This showed that I was wrong to believe how separate the two teams were because we were all acting as one team. Instead of acting separate, it was obvious to me that everyone was part of one team because all of the staff on the floor was prepped and equipped to assist with the clinical trial as well as watch over each patient.
Finally, as a result of shadowing the clinical trial’s cognitive tests, I was able to see that a treatment method was not always a prescription medication. Instead, I saw that cognitive stimulation via an iPad was a treatment method being tested. Because of being a part of this experience, I now believe that I have a fuller understanding of the scope of clinical research as being far more than a drug testing site. Instead, it is an intellectual playground where novel ideas can come in all forms.
My new understanding of clinical research is not only currently valuable to me, but crucial in my future career. I now understand that as a physician, I can be given the option to both care for patients and help enhance current medical knowledge without having to devote myself as only a physician or a clinical researcher. As a result, I further understand how crucial physicians are to not only conducting but also maintaining long clinical trials, which further increases my understanding of the power of a team of motivated individuals in making a difference in the world. Additionally, I understand how incredible, yet simple, medicine can end up being. If, upon completion, the Neurobics trial shows that cognitive exercise is a viable preventative measure to combating postoperative delirium, something as simple as cognitive stimulation before surgery will have been able to stop the onset of something that even drugs have failed to remedy. This once again has helped inspire an awe of the human body, which has helped bolster my desire to become a physician.