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Summary

The WOW! experience was very unexpected. Instead of being given one main project to work on, I was given 4 separate projects to work on. The four projects were a group research project on risk communication, a newsletter on Heath Technology Assessment (HTA), the transcription of 2 interviews and data entries into an Excel for collation of results. The transcription of the second interview was split between me and Eunice.

About the organisation

Changi General Hospital (CGH) is one of the few public hospitals in Singapore. The Health Services Research (HSR) department was established to be the core of research in CGH and helps CGH make better and more informed decisions. The HSR supports CGH on four fronts: programme evaluation, management analytics, health technology assessment and investigator-initiated research. These help to fulfill the goals of HSR which is to identify the most effective ways to provide high quality care, reduce medical errors and improve patient safety.

Background information of the projects

1. Research project on risk communication

The project was to aid in taking the first step in research into patient-doctor communication. Risk communication is a very important concept for research as proper risk communication is essential in aiding informed decision making on the part of the patient. Currently, many patients lack enough health literacy and numeracy to understand the risk that the doctor is trying to communicate to them. This means that they may not fully comprehend the extent of the severity of their illnesses, and thus may adversely influence their decision-making. Studies have shown that even educated adults have difficulties with percentages and numeracy. The problem is even worse with less educated adults and seniors who may not even have the enough health literacy to know what their condition is. It is also shown that patients usually prefer to receive more information about their illnesses than is given to them.

Proper risk communication is essential to help patients to fully comprehend the severity of their condition and how likely an even worse symptom of the condition may arise. This helps as firstly, they will be able to make necessary behaviour changes to prevent further complications from happening. Secondly patients will also make more informed decisions on the medical procedures that they would like to have to improve their medical conditions. Lastly, they would be more mentally prepared for any possible uncertainties during the treatment process itself.

Hence, in order to let patients make more informed decisions, and can understand and relate to the information that the doctor has given to them, it is necessary to find more efficient methods of risk communication.

As full research projects would usually take a few years to complete, the mentor decided that we would carry out this mini research project to have some experience into coming up with research proposals, doing literature reviews and planning a research within the span of one month. This would just be a small step to kick off research efforts into improving patient-doctor communication.

2. Newsletter for the HSR: HTA

The newsletter that we had to do is a quarterly newsletter to be sent to the staff of CGH who have little to no knowledge of the subject topics. Hence, as a student who does not really know about the topic, I was tasked to, from this perspective, come up with a newsletter which included relevant information that I thought would be useful to people like me who also had little to no knowledge of the topic. The boss required the newsletter to be both visually eye-catching and informative. This newsletter would act as a publicity for the HSR towards clinicians who would like to carry out research, so that they would know which area would be most applicable to them. The older newsletter was rather wordy, hence the boss also wanted us to make the information more succinct, so the clinicians would be more attracted to read and find out more about the subject. At the point when I joined, there was no work yet on the newsletter. Hence, I had to create the layout and content for the newsletter.

HTA is a very important aspect in the hospital as it would help with decision-making on the management level. It assesses both the direct and indirect impacts of the health technology or the health service and program. By promoting this, it would help clinicians who would need some form of evidence-based recommendations for their decision-making

3. Data Entries

On the first few days that I went to Tampines plaza, I was assigned some data entries to put into a collated Excel sheet for analysis. The data entries is for the Steady Feet program which is a pilot fall-prevention program that CGH liaises with ActiveSG to carry out. Some portions of the data entries for the baseline test and the 3-month evaluation for the Tampines participants had been filled in, so I had to fill in the rest. Also, I did the full data entries for the 6-month and 12-month evaluation for the Bedok participants. These results are from the assessments that were held to check on the progress of the participants was conducted at the 3 month, 6 month and 12 month benchmarks. The collated results would be then used for analysis of the pilot results for the Steady Feet program.

4. Transcription

On the 15^th of January, I followed my mentor to an interview session, the interview was to find out more information from a Fitness Instructor in a program called Steady Feet. Steady Feet program is a fall prevention program for the elderly that CGH is involved in. The program is still at its pilot stages and has not been rolled out to the general public, and the interview gave first-hand feedback on how the program is run. During the interview, I was tasked to take down notes, and afterward, transcribe the whole interview. The interview is a key stage in the whole research and program evaluation of Steady Feet program, where the objective of carrying out all these interviews would be to obtain saturated opinions on the program. This is a point where there would no longer be any other varying opinions on the program. The transcript of the interview would be used for analysis to deduce what can be improved and what should be continued in the Steady Feet program. This is an important part of the program evaluation that the HSR would be carrying out. Also, the interview cannot be saved for a long period of time to keep it confidential. Hence, it would need to be transcribed.

Elaboration of the activities

1. Research project on risk communication

For the first two weeks, we were not given much guidance on what we had to do for this project, and what was the scope of our research. We were only given a mini lesson by one of the doctors on how to most efficiently search for results online. He introduced us to a search engine called Pubmed where we would be finding most of our results and taught us some strategies such as inputting keywords “AND”, “OR”, “NOT” into our search to tailor the results to be most effective to us. After the lesson, the doctor came to explain to us some problems that doctors had faced with patients. For the project at this stage, this was the only guidance given to us. Hence, we were left to decide which was our focus topic. At first, we started with a proposal on patient adherence. However, it was rejected for the fact that since this was going to be a research project, it needed feasible solutions, and the doctor had felt that patient adherence may not have feasible solutions. Next, we did a proposal on patient distrust. However, since it was hard to measure trust from the patient, we decided that ultimately, since it would be hard to measure the success of the intervention methods, we would not carry this proposal out. Then, we came up with a proposal about patient dissatisfaction and its relationship with the doctor’s non-verbal communication. This was approved, but in the end, after the mentor at Tampines Plaza helped us by discussing with the doctor on what topic we should do, it was decided that we should focus on risk communication between doctor and patient. With the topic decided after two weeks, we did not have much time to complete the full research. Also, with the Wuhan Virus outbreak, we were unable to go to CGH to carry out our survey. Hence, we only did a literature review and a proposal on the research, which included the background information, study objectives and study plan (survey questions). Since this was more of an opinion related topic, we decided on collecting data using survey questions. Overall, with the tight timeline, we were not able to complete the full research. Through this, I realised that a challenge that researchers faced was to come up with and narrow down the research topic. When I asked my mentor, she confirmed that indeed, coming up with a research proposal would take up to a month since research topics would have to be very specific in order to allow the research carried on later to flow more smoothly. Hence, narrowing down on the topic was the biggest challenge for me.

2. Newsletter for HSR: HTA

The newsletter was also unguided at first, and my groupmates had thought that after the very brief session where we met with our mentors and they told us about the project, we were supposed to do the project by ourselves with the aid of the previous newsletter which was published 10 years ago. However, after clarifying with my mentor, she then came up with the timeline, and told me that I should first come up with the layout of the newsletter first, before her boss would come and review the layout on the following week. One main takeaway was that we should take more initiative, as due to the different styles of work, our mentor may not be upfront in briefing us on what to do, and it was up to us to ask and clarify when in doubt of what we should do. At first, following the template given of the previous newsletter, we had come up with two pages of layout of the newsletter. However, the boss then asked us to change it to one page, as it would then be more succinct for the viewers. Hence, a challenge was taking all of the designs and choosing which one would be the most eye-catching for the viewer.

The information was rather difficult to come up with, especially finding the impacts of how HTA had influenced the decision-making of managements. In many sources, it was indicated that finding out how HTA has directly influenced the decision-making processes in healthcare institutes is extremely difficult due to the fact that decision-making can also be influenced by many other factors. However, using the search strategy that had been taught to me, I was able to find a resource locally on how HTA has helped in giving evidence-based recommendations to the Ministry of Health (MOH) in Singapore. By consulting with my mentor, I received a source on CGH’s incorporation of HTA in the decision-making.

Another big problem was the space restriction, and how to make it seem less wordy while being aesthetically pleasing at the same time. After making many changes, and making some pictures smaller, I was able to fit all the information into one page while making it aesthetically pleasing as well.

Generally, I am very proud of the newsletter because I had put in a lot of effort, and received positive feedback on both the design and the content of the newsletter.

3. Data Entries

The date entry process was a big learning curve for me. At first, I had done it very slowly as I was trying to be very careful to input the information. However, the more I did it, the easier it was and the faster it got. The biggest challenge was how tedious it was. Since the entries were about the scores that the elderly participants had gotten while doing the exercises, it was quite interesting to see how well they did and whether they improved through the various months’ evaluation. I had to transfer the data from the hard copy version into an Excel sheet so that it could be collated and analysed to see whether the program was helpful in improving the elderly’s stability. It was difficult as I had to be both fast and accurate at the same time, as any mistake could cause the results to change. Another difficulty was the number of results and the position of the results in the Excel sheet. Sometimes, I mistakenly put the results in other columns, hence being very careful to check was needed. However, I was thankful that my mentor gave me guidance, and through the process, by asking questions, I was able to learn more about the different types of exercises that the elderly could do to test their ability to be steady on their feet.

4. Transcription

I was tasked to transcribe one 47 minutes and 41 seconds interview and a half interview that was about 40 minutes long. Transcription was a very long and tedious process. Since I had to transcribe in verbatim, I had to replay each sentence a few times in order to capture the whole speech. It was also a big learning curve as I had to figure out which was the most efficient method to transcribe. After completion of the first interview, when I submitted the first draft to my mentor, my mentor gave me feedback such as how I had to put the proper punctuation signs in my transcript. While editing the first transcript, I was given a part of the second transcript to do. There was a document on the guidelines of transcription. However, I made the mistake of only reading the first page of the document and not the second page. I only realised this after I almost completed the second transcript, hence I had to quickly go back and rectify the errors in the transcript and add what was needed based on the second page of the guidelines of transcription. Apart from transcribing the words spoken in the interview, I also had to transcribe the non-verbal cues such as laughter, etc, and had to highlight times when the speech overlapped, etc. Some words were hard to understand without context, so I also went online to find out more about some programs that the interviewee had mentioned, so that I could figure out the context of what they were saying. This helped me in my transcription as I was then able to figure out what they were actually trying to say. This was my first experience transcribing, so it was a challenge for me.

3 content knowledge/skills I learnt

1. How to search the internet effectively.

This was very important and helpful as previously, I would always have a hard time trying to find relevant information from the web. Through this, I was taught how to search up research papers and more credible sources of information through Google Scholar and Pubmed. I think the knowledge gained from this can be used in JC during project work, when I am trying to research, especially on things related to science and healthcare. The keywords “AND”, “OR”, “NOT” are ways to help to streamline the results, “AND” being the intersection of the two subjects being researched, “OR” being one subject or the other, and “NOT” being used to exclude one subject form the search. Though simple, these strategies are very effective.

2. Research methods and process.

A research process consists of the proposal phase, implementation of study and the analysis of the research, each having their own sets of challenges. Through the WOW experience, I was exposed to mainly the proposal and the implementation of study phase.

For the proposal, I learnt that first, we had to come up with a research topic. That topic had to have a feasible solution or it would, as my mentor mentioned, just be gaining knowledge and not solving problems. Usually, research would start with a literature review to prove the problem exists, and to also ensure that the topic being researched has not already had a solution. After going through the process of the literature review, the next step would be to craft a proposal, which had to have a background of the study, study objectives and study methods included. This phase could take up to a month to do, and researchers normally would have to have meetings on how to narrow down the research topic. According to my mentor, the more specific the research topic is, the easier it will be for the planning of the implementation of the study. From our experience, coming up with the proposal was a process that had a lot of trial and error.

Next, the implementation of the study can either be through surveys, or, as interviews, which I had a chance to take part in. This would allow the researchers to garner data from the ground for analysis. When I asked how they knew when to stop collecting data, they mentioned that there was a point of saturation in which any more interviews or survey questions would not generate new insights and perspectives into the research topic. Saturation of opinions is a goal that researchers usually try to achieve.

Finally, analysis involved collation of all the data. The transcript and data entries that I did would help with the analysis portion of the research.

Research is a long process, usually taking up to a few years to complete. This is because of the extensive measures and logistics having to be placed and the point of saturation which is difficult to achieve. Also, researchers can work on very versatile cases, ranging from programme evaluations to dietary research. Researchers work on contract basis and thus have more flexible jobs. They do not specialise in certain topics, instead they take the skills that they have learnt and adapt it to various situations.

3. Taking initiative to ask and clarify

As mentioned previously, there was little guidance at first for the first few days. Hence, a lot of time was spent doing nothing. This was very unproductive and I learnt that we could have made better use of the time by taking initiative to ask the mentors what to do. Even when we moved to Tampines Plaza and started on the newsletter, we were at first only told that we had to do the project, and not how to start or where to begin. Hence, I had to go and ask the mentor on details on where to begin. This was where I learnt that bosses have different styles. My sister’s mentor had everything planned for her and gave her a timeline on what she had to complete every day. However, for me it was more own time own target. It was only after I asked the mentor where to begin that she explained more about the goals of the newsletter and what were her plans for us. At first, my friends had thought that we were just supposed to come up with something ourselves. Since our mentor was less strict in terms of what we had to do every day, we had to plan our own timeline and clarify with them whenever we faced challenges or did not know what to do.

2 interesting aspects of my learning

1. Research is actually an office job but includes interviews and ground efforts which requires the researchers to travel to many places. The job can be a rather unstable job as it is contract based, but that is what makes it flexible.

2. Health Technology Assessment is a much-needed area in healthcare. Health technology can be both medicine and devices used for healthcare and since new technology is always invented, it is necessary to perform a HTA to assess it and measure whether it is cost-effective, and how well it works. It helps with decision-making processes regarding the health technology, which is important as this influences healthcare policies and guidelines regarding the health technology and impacts what technology would be used for patients.

1 takeaway for life

I think the whole experience of research is something I can take away. Even though the during the group projects in school, we do carry out research, it was fascinating to see the large scale of it in play in the work condition. Also, the meals that I ate and the experience of staying back until 6.30pm were unforgettable.