Annie's Summer Research at the Exercise and Health Lab

I am an incoming senior at Northwestern University studying the biological sciences and psychology. Since last fall I have been interning at Feinberg School of Medicine's Exercise and Health Lab, where I have worked on the development and implementation of an app-based exercise program for breast cancer survivors. I will be living in Chicago this summer and continuing my work in the Lab with a project that interviews survivors about what they would have liked in an exercise program while they were undergoing breast cancer treatment.

Week Six!

My survey and interview project is fully underway! At the start of this week, I worked with Dr. Phillips to further finalize all of my survey forms in Redcap, and at the end of the week I sent my first recruitment email to participants. I got so excited when the lab’s phone rang on Friday and it was a question for me! The recruitment response was great- after just a few days, I have almost half of the women I need for my study. Redcap allows us to schedule emails to be sent out based on whether or not they respond to surveys linked in prior emails, so the women who did not respond to my initial email will be contacted again next week.

 

One of the biggest frustrations these last few weeks has been securing access to the study’s email address. In order to use Outlook, we found out that I also need to have a Northwestern staff email address. After exchanging many emails with Feinberg IT, talking with them on the phone, and screen sharing on a few occasions, we came to the conclusion that we need to ask someone higher up in the department to give me permission to make a staff account. In the meantime, I am working with a team member to send emails through her account so that the study isn’t halted!

 

At the beginning of this week, I also worked on writing a “Manual of Procedures” for my study. Dr. Phillips is very organized, and her goal is that everything we do in her lab is clearly recorded so that our team can easily reference the manual. It was difficult to write at the beginning of the study since I am still working out many of the procedures for myself, but fortunately I had the manuals for the IMPACT and Fit2Thrive studies to reference for ideas.
I was also fortunate to have some time in the evenings to meet up with friends! On Tuesday, I went with a sorority sister to see the Beguiled, which I admired for its emphasis on the women’s perspective of the events, a result of the influence of director Sofia Coppola, but ultimately was not as much of a thriller as it was marketed to be. Later in the week, I went shopping and bought my first suit for upcoming medical school interviews. I was also able to meet with friends for dinner a few times (Koco Table in Evanston is a new fave) and have plans to go to the beach with some of my friends from high school over the weekend!

-Annie

Week Five!

My first full week back after the fourth of July felt like a long one! Fortunately, this was just what I needed to get everything with my project finalized to launch next week. I will be collecting data over these next few weeks and then analyzing the results of my interviews and surveys at the end of August.

 

This is the familiar logo of my old friend, Redcap, with whom I spent most of this week.

I spent much of my time this week programming the screening, consent, and survey into Redcap, Northwestern’s online research database. It was a big learning curve for me over these past few months to not only learn how to use the database, but how to write simple code for the surveys and forms I needed to create. I was so proud when at the end of the week my twenty page form was complete and functional with its layers of branching logic. With final approval from Dr. Phillips, it should be participant-ready and we can use it to start recruiting at the beginning of next week!

 

This was also the first week of the Fit2Thrive intervention, so our study participants were all making progress towards their goal of 30 minutes a week of moderate to vigorous intensity aerobic physical activity.  One of the highlights of the week was serving as an exercise coach to the breast cancer survivors. Half of our participants are scheduled to receive biweekly coaching calls from the study team (that’s me! And my coworkers) where we review their progress and offer suggestions and words of motivation for the coming weeks. I wrote the scripts for these calls back in the spring, and so it is fulfilling to see my work come to fruition. It is heartwarming to take these few brief minutes in the day to check in on our participants individually. I am learning so much about how to motivate others and form long-term relationships with them, and these are skills that will translate well into my practice of medicine one day.

 

I can’t wait to share more updates with you next week about my first interviews!

Week Four!

Happy belated fourth of July! The lab was closed on Monday and Tuesday for the holiday, so I had a nice long weekend. The highlight was going to see fireworks- twice! On Monday night, I sat in my backyard in Deerfield with my family and some friends from high school to watch the fireworks go off in a local park. It was great to relax and catch up with everyone. On Tuesday night, I walked over to the Northwestern Lakefill with my friend Caroline to see Evanston’s fireworks. The show was shorter than Deerfield’s but much more intense.

    

I also spent the week settling into my new apartment! On Saturday, I moved my clothes and the other few items I had with me from Rogers Park to my new studio. Without furniture, the place was still pretty empty! On Tuesday I enlisted the help of my parents and boyfriend to move all my furniture in, and over the weekend I went shopping for necessities and some decorations. I will post a picture once I have finished settling in 🙂

 

We are one week to the start of the Fit2Thrive Intervention, and that means it has been very busy I spent a lot of time on orientation calls explaining to our participants what they should expect from the study. We also had loads of tech calls- everybody seemed to have some type of problem with our apps! I did not anticipate how many questions we would have about app functionality, but fortunately we had scheduled in extra time for troubleshooting.

 

Monica Hsu, the other summer URG recipient in my lab, and I before heading to a meeting with our PI, Dr. Siobhan Phillips. Photo Credit: Austin Gardner, another intern in our lab.

Another struggle was getting in everyone’s paperwork on time for the Intervention to start on Monday, July 10. If our participants fail a physical activity readiness questionnaire, we need to receive physician consent in order for them to participate. Their buddies had to pass the

same questionnaire or get consent as well, and unfortunately, some of the buddies’ doctors’ offices did not fax us back the necessary forms on time. I had to call our participants and explain that we would need to push back their start dates two weeks. They were understandably frustrated. I would be disappointed too if I had to push back the start of an exercise program because of something out of my control. Most of the women were understanding of the circumstances, and we are working on a plan to get them started as soon as possible!

 

There has also been good news on the IRB for my project. Dr. Phillips submitted it early in the week and we got pre-review comments back! We made some wording clarification adjustments to a few of our documents which should help it go through the review process even faster. My project is just an interview, so things should go smoothly for consenting and scheduling participants as long as there is enough interest! I will be spending lots of time these next few weeks working on just that, and can’t wait to talk with breast cancer survivors about their desires for an exercise program during chemotherapy! This is very meaningful work.

 

Until next time,

Annie

Week Three!

Hi everyone,

My third week was off to a busy start! Dr. Phillips, Dr. Welch, and Monica Hsu are working on the study that my project is a part of, and they were all back in the office at the start of this week. One of our biggest successes was that we decided on a study name- StepUp! We also decided that my interview project will be completely separated from the sedentary behavior reduction intervention that Monica is running for her URG project. Our recruitment parameters are slightly different, so we will likely be pulling from different groups of women. In our team meeting next week, we are going to discuss exactly how we will recruit participants to our studies.

This week, I continued to develop materials for my interview project so that we can get going quickly after obtaining IRB approval. I wrote recruitment call and email scripts as well as finalized a script for my interviews. It is very important that these materials are standardized so that participants have an informed and consistent experience. Speaking from a script on a phone call can feel a little awkward at first, but I learned from Fit2Thrive that once you get used to the script you can adjust the words a little bit to make it comfortable and your own.

Gillian Lloyd, one of the research assistants at the Exercise and Health Lab, also took some time to teach me how to do qualitative analysis of interview data. She is analyzing interview data from Fit2Thrive to prepare it for a paper, so she walked me through her steps. First, I will label sections of the interview to correspond to a codebook of various types of responses to the questions I ask. Then, I will group the coded sections of responses by type and write summary paragraphs of them so that I can accurately determine the participants’ opinions. Gillian’s instruction was good preparation for later this summer when I will be analyzing interviews as part of my study.

We also did a lot of work this week putting final touches on Fit2Thrive. Part of the intervention includes a study website with “Fit Studies”, easy-to-read reviews of physical activity research, and “Survivor Spotlights”, where participants can read about other breast cancer survivors who have successfully increased their physical activity levels. I spent a lot of time uploading these to WordPress, editing them, and finding appropriate photos to include. Reading the recent research and the success stories of these women is very inspiring, and I hope our participants will think so too.

As some of you may know, I am currently in the process of applying to medical school. My primary applications were turned in June 1, and the second wave of applications began on Friday. I have already received a few emails from medical schools asking me to fill out secondary applications, and will start sending them in over the weekend. After I turn in my secondary applications, the colleges will review them and determine if they will offer me an interview. I am excited to get going with these next steps!

I have a four day weekend coming up with the fourth of July, so I will update you soon on what I have been up to! I am planning on seeing fireworks in Deerfield and in Evanston this weekend as well as moving into my new apartment in Evanston.

-Annie

Week Two!

The highlight of my second week of summer was a Wednesday night dinner out at Ema with my family, but more about that later on in this post 🙂 First, a little update on my research progress!

On Monday I met with Dr. Welch to go over some content ideas and study names for our sedentary behavior reduction intervention and my interview project. Dr. Welch was out for the rest of the week and Dr. Phillips was at a conference, so it was just me at the office getting started on developing our intervention content! Most of our materials were adapted from the Fit2Thrive study, another project I have worked on at the EHL. For our sedentary behavior reduction program, I wrote a number of weekly feedback emails so the women can stay up to date on their progress, motivational “coaching” emails, and compiled videos of different workouts and individual exercises that we can push to the women as part of the study. I also developed an educational ebook that participants will be able to refer to for more information about exercise, sedentary behavior, and their safety. I sent those materials as well as a few ideas for study names to Dr. Welch and Dr. Phillips and am still waiting to hear back!

The rest of my time in the office was spent on the Fit2Thrive study. I made a few orientation calls to the women to explain to them the different components of the study that they will receive and tried to troubleshoot some of their tech questions. I knew we would run into lots of problems with the app, but I didn’t expect how many hours we would spend trouble-shooting with our tech team!

These types of situations can be very frustrating for our participants. One of my coworkers was talking to a study participant on the phone last week and she was very abrupt about how she was frustrated with the length of the instruction packets and how the apps weren’t working for her. Usually our participants are very grateful and patient, so this was unexpected. This conversation really affected my coworker and we had to take a little break to calm down from some of the participant’s harsh words. We are looking at it as a positive experience, however, because criticism allows you to adjust your work  and better handle tough situations in the future.

On Wednesday night I enjoyed meeting up with my parents and my sister at Mediterranean small plates restaurant Ema. The restaurant’s large windows were open to the outdoors, so even though we were sitting on plush leather chairs inside it felt like we were dining al fresco. Trendy music played in the background while we nibbled on an avocado and sweet pea spread, shaved romaine and farro salad, crispy potatoes, asparagus, and chicken, lamb, and beef kefta among other dishes. We ended the night with a trip to Sprinkles Cupcakes and brought them back to my apartment in Rogers Park.  Spending time with family is the best mid-week pick me up 🙂

Overall, a pretty smooth week! I expect that things will get crazier next week when Dr. Phillips, Dr. Welch, and Monica are all back to work on our summer project. Will update you soon!

-Annie

Shadowing an Obgyn!

Last week I had the privilege of shadowing an obgyn at Northwestern Memorial! Dr. Howard Arof is a family friend from my church and attended Northwestern for undergrad and medical school as part of the Honors Program in Medical Education. He has been there ever since for his residency and practice. With such purple pride and over 30 years of experience, Dr. Arof was the perfect person for me to shadow!

I spent the first two hours of the day at my research office before walking over to Dr. Arof’s office at Northwestern Memorial. Dr. Arof was planning to see a few patients for general exams before doing three procedures in the afternoon. Some of those morning exam patients allowed me to observe, and what really stuck out to me was how close Dr. Arof was to these women. He had delivered many of their children and was well trusted by his patients. Even though he only saw some of them once or twice a year, he knew and remembered them. I really admired that special connection and know that it is something I will want to form with my future patients!

After seeing patients for their checkups, Dr. Arof and I had lunch in his office with a pharmaceutical sales rep. She brought in delicious Mediterranean food that I was more than happy to eat! I was a little embarrassed when I tried to cut a piece of chicken off a kabob and sent it flying across the table, but otherwise we had really great discussion about contraception. The sales rep was promoting Nuva ring and the arm implant with a target market of college-aged and early career women. My two years living in a sorority house meant that I had a fair amount of knowledge on these topics, so I was able to discuss with the rep and the physicians some of the concerns young women had about these devices.

Here is an awkward bathroom mirror selfie I took for my mom! Enjoy

 

After lunch, I scrubbed up to attend Dr. Arof’s procedures. The first was a very unusual labiaplasty where he was going to modify a woman’s labia minora that was causing her a significant amount of discomfort when biking. I had never heard or seen anything like her condition, so it was amazing to observe how Dr. Arof clamped and severed the tissue, cauterizing and stitching the wound. He said he had never seen anything like it in his 30 years, but that he was happy to give this woman some relief and help her do what she loves.

At one point in the afternoon I asked Dr. Arof how he had become interested in obstetrics and gynecology. Many people are curious how young men in medical school choose to go into this field, but Dr. Arof reported how in his third year obgyn rotation he was mesmerized when attending a birth. For him, this experience is so amazing that he considers it spiritual. It is a testament to his dedication that after 30 years he has only recently retired from delivering babies. I was amazed that he had delivered over 4,000 children in his career and how he said he greatly missed it now that he was retired from that part of his practice. Talking to him and then later shadowing one of his colleagues who was seeing a 34 week pregnant woman helped me be able to see myself performing this type of medicine. There is perhaps nothing greater or more rewarding than being a part of the process of the miracle of life.

Dr. Arof and I also had a discussion later on about the ethics and empathetic pieces of being a doctor. Obviously, the job is not only taxing but emotionally difficult. Losing patients is difficult not just for the family, but for the medical team. He even noted that obstetrics has some of the highest highs- bringing a new baby into a family’s life- and some of the lowest lows- losing a child to miscarriage or stillbirth. He talked me through his journey with some of these lows and it helped me understand better the challenges I will be facing in medical school and how to overcome them.

Later in the afternoon, Dr. Arof performed two hysteroscopies. The most time consuming part of this process was dilating the cervix, which usually requires multiple steps and can be uncomfortable for the woman even if she is under anesthesia. Once that was accomplished, Dr. Arof used a scope to show me the inside of a healthy uterus, which was pink smooth muscle. I even saw the holes in the uterus that lead to the opening of the fallopian tubes! On the first woman, Dr. Arof then performed an ablation, a procedure that is done to destroy endometrial tissue that leads to heavy and painful periods, and then showed me how the uterus looked completely different, like whispy cotton. He was content that the woman would now likely not have (heavy) periods and be able to live a much higher quality of life. The second hysteroscopy was to look for cells in the uterus that might be causing the woman excessive watery discharge, but the cervical dilation was unexpectedly difficult and he was not able to insert the scope or take tissue samples from the uterus. While her results are less predictable, there is still hope that the cervical tissue samples might reveal the nature of some of her complaints!

This was one of my most eye-opening shadowing experiences to date, and my first time observing a surgery. It confirmed my interest in pursuing obstetrics and gynecology as a career since it is such an interesting blend of personal clinical medicine and surgical procedures. I also feel more aware now of the difficulties of this career field, from frequent night calls to some of the ethical concerns. I am so grateful to Dr. Arof, a physician and friend whom I trust and look to for guidance, for allowing me to observe his work in the office!

Week One!

The Sunday after finals week, I moved into my friend’s apartment in Rogers Park to get the summer started! I am subletting from her until the start of July, when my own lease in Evanston begins. While it is a much quicker commute to work downtown from Rogers Park, I hadn’t anticipated all of the problems that would arise in her new place. Half of the light bulbs were out, mold covered the walls and tiles and in the bathroom, orange slime coated the shelves of the refrigerator, and there was no air conditioning or wifi! I spent all of my free time the first two days cleaning the place up to an acceptable level. Luckily, with the help of my friend and the landlord, most of the cleaning is done.

Things at the EHL were also hectic this first week because some of the research assistants were on vacation and we had four new interns! It was fun getting to meet everyone and helping show them around the lab. I also ended up spending a lot of time working on the existing Fit2Thrive study making phone calls and preparing packets to send to breast cancer survivors who are getting ready to start their exercise interventions in a few weeks. This was tedious but important work!

My first day back in the lab, I met with Dr. Phillips and Dr. Whitney Welch, a post-doc in the lab who is also guiding me in designing and implementing my summer project of interviewing and surveying breast cancer survivors about what they would have wanted out of an exercise JITAI program during chemotherapy. Dr. Welch presented an overview of the broader exercise program of which my interview project is just a piece. Together with Monica Hsu, another summer URG recipient, we will be designing a sedentary behavior reduction intervention for breast cancer survivors who were recently involved with the EHL’s IMPACT study.

The sedentary behavior reduction intervention will have four components: reminders to move delivered to a Fitbit Alta, a prescription for steps per day, email coaching, and a short videos with workouts sent to participants. Using a multiphase optimization strategy (MOST) design, participants will have a 50% chance of being assigned to any of these components and they may receive any combination of them. We will have 16 different combinations of components to which participants may be assigned!

At this point, we are still waiting for the study to be approved by Northwestern’s Institutional Review Board (IRB), which ensures that studies like ours, which involve human participants, abide by certain ethical standards to protect the participants from physical and emotional harm and to ensure that their personal information is being protected. Until we receive IRB approval, we can’t start recruiting participants! In the meantime, I will be working on preparing the intervention materials so they are all ready to go once we do have participants. As of week one I am still waiting on some information from Dr. Phillips and Dr. Welch in order to do that, but should have updates in my Week Two Post!

This week I also spent the day shadowing an obgyn at Northwestern Memorial Hospital and will be writing a post about that experience as well 🙂

-Annie

A little background about my work this summer…

Hi everyone!

I am so excited to share more of my experience at the Exercise and Health Lab (EHL) with you. I joined Dr. Phillip’s lab at Northwestern University’s Feinberg School of Medicine last fall to help with the Fit2Thrive study, an app-based exercise intervention designed to help breast cancer survivors become more physically active. Everyone knows that exercise is good for your overall health, but it is particularly beneficial for women in recovery from cancer treatment because it can help fight fatigue and prevent cancer recurrence. It is also a good way for women receiving chemotherapy to keep up their strength.

Looking to do an independent project with Dr. Phillips, I applied this spring for a Summer Undergraduate Research Grant from Northwestern and was fortunate to receive the grant! One of the advantages of being a student at Northwestern is the many resources the university makes available to us. You can keep reading to hear more about the special project for which I received the grant.

Most exercise interventions are considered to be “pull” programs because they require participants to actively seek out the intervention materials for support. Obviously this requires some motivation! Instead of a pull intervention, we are interested in what a “push” intervention would look like in breast cancer patients and survivors. Push interventions send materials and motivating messages directly to individuals through texts or emails, taking out the need for them to be motivated to go look for it.

One model for push programs is the “Just in Time Adaptive Intervention,” or JITAI, which involves using sensors and inputs from a smartphone to send targeted messages to an individual. This type of intervention would use a wide array of inputs on current context (i.e. location, weather, days since treatment dose), intrapersonal states (i.e. motivation, symptoms) and responses to prior intervention output (i.e. snoozed message, increased steps)  to “push” the right intervention strategies (i.e. text messages, telephone support calls, etc.) to individuals at the right time (i.e. text message encouraging activity promotion when fatigue is low). Currently, no JITAI studies have been done in any cancer population, so we are looking to figure out the best types of information we can gather from a smartphone to use to push messages to breast cancer patients and survivors to motivate them to get active.

My special project this summer is to follow up with breast cancer survivors from the EHL’s recent IMPACT study to learn from them through surveys and interviews what they would most want in an exercise JITAI program during chemotherapy. The survey will go out to survey participants online, but the interviews are more complicated. I will call about 32 breast cancer survivors and talk to them for an hour on the phone, recording our conversation so it can be sent out for transcription. Then I will write a code book so that I can perform qualitative analysis on the transcripts and determine what it is that breast cancer survivors would have wanted in a chemotherapy exercise JITAI! Getting here will take many steps and lots of work, but I am excited to figure out what a lab like the EHL can do to be most helpful to these women who have been through so much.

My interview and survey project is only one small part of a larger study that I am helping to design for this summer. In my week one update post I will share a little bit more about the broader study and other happenings during my first week of summer!

-Annie

Hi!

This summer I will be continuing my work at Northwestern University’s Feinberg School of Medicine in the Exercise and Health Lab with an independent project interviewing breast cancer survivors to determine what they would like to see out of a technologically based exercise program for women receiving breast cancer treatment. I was fortunate to receive an Undergraduate Research Grant from Northwestern to fund my work this summer, and look forward to sharing more about my research process and how I spend my time over the course of the summer!