Emily Kipper ’13, Ebersole Fellow in Children’s Health

This was not a full week due to the fact that I needed to leave on a weekend, and my work on my project was complete. It is crazy that my time here in Colorado is up, and I will be heading back to Iowa shortly. Friday was my last day, and all of the other interns and research assistants went out to Pho Duy for our last lunch together. It was great meeting all of the other employees of the MRC and Gait Lab over the course of the summer, and the people are definitely a big part of what I will miss about Colorado.

Research staff enjoying pho on my last day.

I learned so much through this fellowship and it not only made me excited for my future in medicine, but fueled my interest in research. I am excited to see where my project will go, and to see whether or not it will get published. If it gets accepted to POSNA, there is also the possibility that my project will be presented at the international conference that will be held in Toronto, Canada in May. This fellowship presented me with so many opportunities and I am very grateful to have had this experience.
Below are a couple pictures from my trip back to Iowa.

Saying goodbye to my summer home

Stopping for a bison burger, which I was told is a Colorado staple.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

After the presentation I gave last week, I was given feedback from the surgeons on how to improve my study and make it more likely to be published. This week I have been working on adding more patients to the study as well as adding variables to make the study more effective. I have also started to write the abstract for the manuscript that will be sent to POSNA (Pediatric Orthopedic Society of North America). I have also worked on finalizing the organization of the project. I had to organize all of the spreadsheets and finish working on a manual of how to navigate through the folder that contained all of the data that was collected for this project. My duties were winding down this week as my project had been taken as far as I could go with it. The work was light, but it was nice to have a week of just finalizing what I had worked so hard on over the course of the summer.

This week was also very fun because a fellow Cornellian, Kali Henson was able to come visit me. She was attending a swing dancing festival in Denver so she was able to stay with me for the weekend. We did a variety of fun things including a trip to 16th Street Mall downtown. I was also able to attend an awesome farmer’s market which was one of the biggest I have ever been to. It was great to be able to experience a little bit more of what Denver has to offer before I head back to Iowa.
Below is a picture from the farmer’s market.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

This week was the week of my big end of the summer presentation. I was presenting the study I’ve been working on, and some preliminary results of the data that I have collected for all of the orthopedic surgeons involved in research at Children’s. This was made slightly more stressful by the fact that up until the day before my presentation I hadn’t received any of the preliminary statistics that I was supposed to present. Throughout the week I had been working on getting what I could of the power point together without any results to add. Then, on the day before the presentation at 6:00 pm I met with the statistician. I received a packet of all of the preliminary findings as well as a text book in order to get more familiar with the statistical methods used to extrapolate data from my spreadsheet. I spent that entire night putting together my power point and learning some important points of the statistics. The next morning at 7:00 am I had to give the presentation. I was pretty happy with how everything turned out, given my brief education on the statistical methods used, and got good feedback from some of the surgeons.

For my observation hours this week, I was back in the emergency room. I got to observe during a night shift so it was a more high pressure environment than my other day observations. During this shift there was a head trauma case that arrived by helicopter. The patient was suffering from a horse kick to the head. I hadn’t yet experienced a trauma in the ER, so this was something new. It was great to see the physician, residents, nurses, and all others involved staying calm and working efficiently without alarming the patient or their family.

This weekend there was a party at one of the surgeon’s houses for a few of the research assistants that are leaving for either physician assistant or medical school. It was a lot of fun to be able to get together with everyone I work with outside of the hospital. It is a great group of research assistants here, and they have really added a lot to my experience at Children’s. It is crazy to think that I will be leaving Colorado in less than two weeks!

In my remaining time here, I will be organizing all of the data I’ve collected and documents I’ve made. I will be making a manual for the research assistant that picks up this project after I am gone. I will also be working on finishing up what I can of the manuscript that will be submitted for publication.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

My post for this week comes a bit late due to the many eventful happenings of this week. One of which being my car breaking down when I was camping this past weekend. The entire front right wheel of my car completely shot off when I was driving down the interstate on my way back to my apartment. Most of my free time this week has been consumed with trying to figure out how to get my car fixed, but it is finally fixed and I now have my car back in Aurora with me.

The week started with observing in the neonatal intensive care unit (NICU) at St. Joseph’s Hospital which is located in downtown Denver. It was great to be able to go visit a different medical campus and observe in a different setting. I was very excited for this day because I have always been interested in neonatology and was looking forward to finding out if it is something I could see myself doing for a career. I followed the doctor on his rounds and learned about an average day in the NICU. I expressed my interest in neonatology, so the doctor I was shadowing allowed me to stay longer than scheduled to follow one of his patients into surgery. I was only scheduled to observe for 5 hours this day, but ended up staying about 11 hours. The baby that was taken into surgery had necrotizing enterocolitis which is a condition seen among premature babies where parts of the bowel undergo necrosis, or tissue death. The surgery to fix this condition is a bowel resection, which is what I was able to observe. I was very thankful the doctor I shadowed could see my interest in neonatology and extended the duration of my visit to St. Josephs.

Then came Friday, which was a tragic day for all of the Aurora community. I got to work around 6:30 am that morning and was confused by the heightened security at the hospital. When I got to my cubicle I found out what had happened. The shooting at the Century 16 Theater occurred barely miles from where I live and work. Working on the Anschutz Medical Campus and living down the street from the gunman’s apartment really made the reality of this shooting hit me. Being in the midst of such devastation has been heartbreaking, but working at a great hospital such as Children’s has been very encouraging. The willingness of the staff to respond to this tragedy was enormous and I know the staff as well as the community will continue to come together to help everyone effected.
Below is a picture from the memorial:

The rest of the week I have been working on preparing my final presentation or my project. I will have to present my research and some preliminary findings to the orthopedic surgeons and other research assistants and interns next week.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

I have spent the majority of my week observing in the emergency department to fulfill the clinical and surgical observation portion of this fellowship. This has been extremely enjoyable for me, full of new learning experiences, and has been a great way to break up a normal week generally spent in my cubicle.

My first emergency department shadowing experience was one of the best observing experiences I have ever had the opportunity to partake in. Because the Children’s Hospital is a teaching hospital, there are always a large number of medical students doing rotations in the various departments of the hospital. The day I observed, I was able to follow a teaching attending who was already having third year med students follow him. His job was to explain the symptoms of each patient in the ER, then the med students had to tell him what the symptoms made them think the injury or illness was and what their plan of care would be. This was great for me because I got to see firsthand what it looks like to be a third year medical student on rotations. I also was able to learn a lot more about various illnesses and injuries that I otherwise would not have if all of the questions from the teaching attending were not being asked. After going from room to room and seeing each patient, the attending told the med students that they needed to go see a patient on their own and return to him with their diagnosis and plan of care. He allowed me to go with him and my job was to take notes on the physical state of the patients. I learned so much on this day because I was able to be more involved than the average shadowing experience. I appreciated the willingness of the attending to involve me and make sure I understood what was happening at all times.

The other shadowing experience was much different. I shadowed on a Friday afternoon when the ER was much busier than my previous experience. The attending physician in the ER carries a phone with them, in order to be accessible at all times. The phone of the physician I was following was constantly ringing and she was going from room to room at an extremely fast pace. It was interesting to be in the ER when the high pressure element was present. I was able to see what is expected from an emergency medicine physician and how they are often pulled in multiple directions at once.

The spreadsheet that I will be sending to the statistician to create the stats for my research has been finalized. I have also started writing the introduction and methods section for the manuscript that will be sent to journals for potential publication. The classes I have taken in the past year at Cornell have prepared me to write a scientific paper that I will be confident in. I am looking forward to applying the writing skills I gained in organic chemistry lab as well as cell and molecular biology to hopefully write an article fit for publication.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

The majority of this week has consisted of finalizing the data collection for my project. After many hours of chart reviews, all of the data has been collected and is ready to move into the next stages. All of the non-identifiable patient information I have organized in a spreadsheet and the patient identifiers have been saved in REDCap, a confidential online research database. The next step, which I have just begun, is to organize the spreadsheet in order for a statistician to analyze it. Because the statistician will not be familiar with the project, all of the information for the variables has to be recorded in binary. I will then make a data dictionary which holds the information for what variable each number stands for. This is in order for the statistician to most efficiently draw conclusions from the data.

This morning I was able to sit in on a data review for the Center for Gait and Movement Analysis (CGMA). The CGMA is a department within orthopedics that works with children who have abnormal walking function. The abnormal walking function in many of the patients seen in the gait lab is due to neuromuscular or musculoskeletal conditions such as cerebral palsy, spina bifida, brain or spinal cord injury, and muscular distrophies. During the week gait analyses are performed on these patients. Then the data review is when the physical therapists, kinesiologists, orthopedic surgeons, and engineers meet to watch the video and review the 3-D motion analysis and dynamic electromyography that was taken during the gait analysis, to determine what plan of care should be taken. It was very interesting to be able to watch the video of specific patients to get a visual of the gait of the patient. It was then interesting to learn about motion analysis and dynamic electromyography. The 3-D motion analysis creates a skeletal avatar of the patient and dynamic electromyography is a method to see what the muscle use during movement is. Both of these things allow for the CGMA staff to better analyze the gait pattern of the patient and determine what course of action would be best to improve their function.

Being able to observe meetings like this, where I learn so much about a new topic, has been one of the highlights of this experience. My shadowing hours begin this week, so I will have many more valuable learning experiences. I have a few days set up to shadow in the emergency department, one day in the neonatal intensive care unit, one in orthopedic surgery, and another in the gait lab. I am very much looking forward to the next few weeks as there will be a lot going on for me at the hospital. My project will be entering its final stages, and I get to observe excellent doctors in very interesting departments.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

At the start of this week, I had to give my first research presentation of the fellowship. There are bi-weekly meetings that include the Center for Gait and Movement Analysis staff as well as the Musculoskeletal Research Center (MRC) staff. Since I am interning for the MRC, I was required to go and give a presentation on what my research is about and an update on my progress. All five of the summer research interns had to give presentations, and it was very interesting to hear what everyone was working on. It is great to be able to contribute to such a large research organization.

The remainder of the week consisted of more data collection for the variables in my study. This process is getting more time consuming as the variables get more patient specific. I am spending each day at my desk searching through electronic medical records to find these specific variables. This is helpful as I continue to become more familiar with medical records as well as the electronic medical record database. The only difficulties arise in searching for the same information from patients who had different physicians. Different physicians tend to dictate their charts differently, so trying to decipher which way a physician will discuss a variable in their chart has been a challenge. Although it is a challenge, it is also causing me to become more familiar with all of the medical terms surrounding spine deformities and surgeries. I have enjoyed learning about one specific facet of orthopedics so in-depth.

My weekend was not spent here in Denver, but I was able to visit some family I haven’t seen in a very long time. I have family who have lived in Costa Rica for the past 8 years and have just moved to Santa Fe, New Mexico. Because Santa Fe is not too far of a drive from where I live in Colorado, I was able to go see them for the weekend. This was great because I don’t know when my next opportunity to visit them would be and I had a lot of fun exploring a new city.

Now I am back in Colorado and am working on finishing up my data collection. After all of the data is collected, my next step will be to complete a descriptive analysis of the data as well as meet with a statistician. It is exciting to see my project moving forward. I hope to be on to finishing up with data collection and moving on to the analysis by next week.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

This week has definitely been my favorite week here yet. I started off the week finishing up my patient log according to the inclusion criteria of the study. This was a very long process because each patient had to meet certain requirements in order to get in to the study. I was able to search for these requirements using the online medical chart database Epic, which made locating information a lot easier than if I were to have used paper charts. I have really gotten to know the database and have gotten much better at navigating the system. Because of my future professional goals, working this in depth with medical charts has been a great experience. There are a lot of different aspects to medical charts and getting to know how they organize information has been very valuable.

I have greatly enjoyed spending time with the other interns, and getting to know the other people I am working with. It seems like a very tight-knit team which makes my experience here so enjoyable. The other research interns, as well as the research assistants have similar future goals as I do, so it has been great to be able to get advice from them, as well as think about other possible professional avenues.

Friday was my 21st birthday, as well as a very exciting day at the hospital. Aside from working on my research project, this internship includes clinical and surgical observation hours. Friday was my first time in the operating room shadowing Sumeet Garg, the surgeon I am working for. Dr. Garg is an orthopedic surgeon who specializes in spine surgeries. My research is dealing with adolescent idiopathic scoliosis patients who have undergone spinal fusions so I was very excited that I was going to get to see one. Patients undergoing spine surgery are at a high risk of infection, so it was very important for me to be aware of where all of the sterile instruments were located as well as be fully dressed in scrubs, a surgical cap, mask, and gloves. I was able to follow the procedure fairly well because I have spent a lot of my time reading about spinal fusions. First, Dr. Garg made a very large incision from the top of the thoracic curve down to the bottom of the lumbar curve which made, what looked like, about a foot long incision, and opened the incision with metal clamps. Then the muscle had to be removed from the bone in order to expose the vertebrae. This was a very long process and somewhere in the middle, I began to get rather light-headed. This was very surprising to me because I have observed other surgeries before, and have never been affected. The monitor tech was very helpful, and reassured me it was just the altitude (I’m positive it was the fact that there was an exposed spinal column in front of me, but it made me feel better). After I sat down for about 5 minutes, I was back to observing. The joints between the vertebrae were then removed and the the screws and rods were placed to straighten out the spine. Because the vertebrae have been roughened up, the body responds by creating new bone. Bone graft is also added to between the rods to help the bone fuse together. The surgery took about 6 hours and I was amazed at how diligently the surgeon worked the entire time. His dedication and
excitement about the surgery was very inspiring.  After the surgery, I was able to see the radiograph of the spine before the fusion in which there was a very prominent curve.  After the surgery, it was almost completely straight.  This surgery is something that I am very lucky to have observed.  Dr. Garg made a comment about how he wished he would have an opportunity such as this during his undergrad, and it made me thankful for how this fellowship is placing me in settings that I would have never otherwise been. Overall, this made for quite the memorable birthday.

I am looking forward to the coming weeks because I was able to sign up for departments that I would be interested in observing for the clinical hours portion of the fellowship. I am extremely excited about the possibility of observing in the neonatal intensive care unit as well as the emergency department. These new experiences make me think more about what I might be interested in doing as a career, and this fellowship is making me consider many different avenues I haven’t previously thought about.

Over the weekend I was able to get out and explore Colorado a bit. I love all things outdoors, so I was very excited to be able to head out to the Mountains. I went hiking at Estes Park and enjoyed the beautiful scenery as well as some interesting wildlife. This was a perfect end to a very exciting week here in Colorado.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

This week has been very interesting because I have been able to attend many meetings and learn about many new topics. Last Wednesday morning I attended a meeting in which the biomechanical engineer who helped design the Gait Lab spoke. This meeting was for all of the new interns who are doing research here this summer. Because all of our research is connected to the Gait Lab in some way, this lecture was a very good overview of what types of things happen in the Gait Lab. He talked about all of the different Gait disorders and walked us through how they perform Gait analysis. This was very interesting for me because it was a subject I had very little previous knowledge on, and since it is such a big facility here, it was fun getting to learn about it at one of the best gait labs in the country.

Another lecture I was able to attend was given by a guest speaker who has done many postdoctoral studies. She gave a lecture on writing a systematic review. This was another topic that I have never learned about before so this lecture was also very valuable. She explained the differences between literature reviews, systematic reviews, and meta analyses. This was great to hear because when working in research, the distinction between the three is very important, as well as knowing how to run any one of them.

I was able to have another great learning experience on Friday when I was able to go to the biomechanics lab to see a research project in its very initial stages. The surgeon I am working for on my research project, is doing another project relating to spinal fusions. After a spinal fusion, it is fairly common for screws to come loose in the pelvis of active kids. The study that I got to observe was testing the utility of different screws. To do this, an initial feasibility test had to be run. Calf spines were used and different types of screws were placed in them as they would be in a human spine for a spinal fusion. The next step is to x-ray the spine and then see if the study will be able to gain funding. It was very neat to be able to see the very beginnings of a study such as this, that has the ability to better the way things are currently done.

My work for this week has consisited of transferring all of my data into an online database for research called REDCap. I have also started collecting data on the variables in our study. This week has been full of learning experiences and I am really enjoying the opportunity this is giving me to learn so much about not only the one project I am working on, but so much about the large field of medical research.

Emily Kipper ’13, Ebersole Fellow in Children’s Health

My first week here in Colorado has been a very good one, full of new experiences and a lot of learning. I moved in on Monday and got all of my things settled in to my new apartment. I started the fellowship on Wednesday morning. I was instructed to park in the visitor lot and then my site mentor came out to get me. When I drove up to the hospital, I realized why someone needed to escort me. The hospital is huge! It was really fun walking into such a large hospital with so much going on and getting to be a part of it.

I was lead up to the second floor into the administrative pavilion and shown to my own cubicle. The first thing I did when I got there was to meet with the surgeon in chief, Sumeet Garg, who is heading the research project I am working on. We discussed the project in length and his hopes for how it will turn out. I am researching the utility of radiographs in adolescent idiopathic scoliosis patients. Adolescent idiopathic scoliosis is a lateral curvature of the spine that appears at age 10 or after, commonly during adolescent growth spurts. Common practice is to correct this condition by performing a spinal fusion. After surgery, routine radiographs are taken for post-operative care. Radiographs expose children to radiation, which is dangerous because it has the potential to cause cancer. My research will be looking into whether or not these routine radiographs are necessary. If we find that they are not, Dr. Sumeet Garg is hoping that our findings would be able to change current practice, lowering the amount of radiation children are exposed to.

The first few days of this week consisted of me reading journal articles and looking up other literature on this topic. This was very important for me to become familiarized with all of the vocabulary and ideas surrounding my research. The third day of the fellowship, I was able to attend presentations of research by the doctors completing fellowships at the Children’s Hospital. There was one project that studied a different aspect of scoliosis which was very interesting to listen to because I had just spent the previous few days learning about the topic.

The rest of the week I spent putting together a patient log of all of the patients included in our study. I was trained to use the hospital database called Epic which holds all of the patient charts. This program is what I will be using to conduct my research this summer. It is very exciting to be a part of the initial stages of a project like this. I am looking forward to going deeper into the study. I am also having a great time getting to know the other interns and exploring Denver. I am looking forward to a fun summer filled with new experiences!