The Last Official Day Interning..

After a hectic day the day before, I was hoping this day would be better. I woke up to find out that over 100 people died now :( It was very very sad news. I got dressed and went to class. Diana was really sweet and asked if I needed to cancel because of everything that happened. But I was feeling good enough to finish the last day interning on a good note, not just doing more and more blogging. haha. So we met after my class at 11:30a. Diana printed up all the Data from Stata that we needed to look at for our research. Then we went through each 2x2 table of interest to see if any had a P value<0.05/0.10.>

But there was still more graphs to be looked at. The next tables are a lot more difficult to explain and understand. We looked at conintuous variables like age, cancer patient monthly volume, breast cancer patient monthly volume, percent of patients who have breast cancer, percent of patients under managed care arrangements, and the time allocated to be with a patient. The numbers/values were determined on a logistic regresssion-which was hard to understand but basically its a way of fitting all the data to a logistics curve, it helps find the probability of occurance. So for our particular study our question would be: what is the probability of satisfied physicians based on age, patient volume, etc etc--all the continuous variables listed earlier in this paragraph. We could still look at the P value for these data tables but another thing Diana said to look at was the Odds Ratio. If the number was less than 1 then the physician had a lower likelihood of being dissatisfied and if the value was greater than 1 then they'll be more likely to be dissatisfied. So we wanted to highlight any table that had a Pvalue less than 0.05 or 0.1 or an Odds Ratio greater than 1. None of our Odds Ratios were greater than 1, but we did have one category that had a P value less than 0.1. It was the time spent with patients it had a Pvalue of 0.076. Diana also showed me the mean and median of the responses the 348 physicians filled out for this question, but I cant remember the exact values for these. I believe the median was 20 or 30 minutes which means over half of the physicians who participated said they spent 20 0r 30 minutes to consult their patients. It ranged from 10-120 minutes-which shows why they were dissatisfied with this part of their job.

Diana and I moved on and looked at more 2x2 tables of the barriers that physicians face when giving referrals in relation to their satisfaction. And we found two variables with P values less than 0.05! One variable was the gatekeeper barrier and the other barrier was the patient inability to pay, with respective P values of 0.013 and 0.028.

And the last data sets were tables similar to the 2x2 tables but it was 4x2 chi^2 table. The question from the survey asked for the availability of various clinicians/services and whether they were 1. within the practice, 2. outside the practice with arrangement, 3. outside with no arrangemnt, or 4. not available at all. We wanted to know if the availability of other services made the physicians more or less satisfied-services such as: primary care doctor, mental health, oncology nurse, physical therapy, nutritionist, care coordinator, patient support group, and home health. None had values that were particularly significant. But there were trends in the tables that as you moved away 1 through 4 the percentage of dissatisfied physicians increased.

And lastly we looked at another 2x2 table that crossed overall physician satisfaction with their satisfaction of the time they were able to spend with their patients. This gave a P value of 0.000!! So they were very much associated without any chance.

Diana and I gathered the significant data and made a brief outline of it all. She said there was still more to do with this information and that we would probably have to talk to the statistician that is apart of this research because we had to make sure that our predictors to our outcome of physician satifaction were exogenous--which means they cannot be predicted by another predictor variable because then other researchers would throw it out as faulty. She said the statistician would have to figure out a programming for our barrier and available services variables and to see if we can look at emergency medical record variables.

Diana asked if I would like to continue on this project with her even though I wouldnt be getting paid anymore since the internship finished today. And of course I was interested, I was even going to ask her if she would mind if I continued to do work with her! I want to get the experience!!

After meeting with Diana I had to go home to complete my blogging, since it was the last official day of the internship.

Overall, I had a really good experience with the PI Pipeline Health Internship. I am so very blessed and pleased to have been apart of the first cohort! :) It was fun and interesting. I met a lot of people. I learned a lot!! And I hope I can continue to grow.

Thank you for EVERYTHING!!

:( The earthquake and tsunamis in American Samoa and Samoa...

The day started like any other, I woke up early for class, got ready, drove to school and went to class. I was planning to meet with Diana today when I was finished with class to go over the research and do more work on Stata. She texted me and said she could only meet for an hour because her daughter was sick. But I didnt want her to have to drive here only for an hour to meet and then have to go back home, plus I had a lot of blogging and admin work I had to do. So we scheduled to meet on Wednesday after class. And instead I would just blog the entire day and try to still do the readings she gave to me in the beginning.
I finished class at 12:15p. Right after class I get a call from my older sister and she is upset. I had no idea what was going on. She tells me there was an earthquake in American Samoa and Samoa and there were tsunami warnings and that its flooded and that no one can get ahold of my grandma or any other family on the island. :( I was going crazy. I was crying in the computer lab as I was looking it up. The first reports said it was a 7.9 than I see it was 8.3 and that tsunami waves, WAVES not one single wave but plural, hit the islands. I was so very worried and scared for my family-especially my grandma. I was just thinking about all the fales in Samoa and what theyre made of and then reading all the reports I was just going crazy this day. I called my mom to ask her if she talked to my grandma but I couldnt even utter a word because I was choked up and crying. She said she'd call me back. I started praying, praying really hard for my family and just everyone on the islands. I was so scared. and I knew my grandma had to be too and then my cousins and aunties and uncles too. I was going crazy!! My roommate calmed me down and told me to not worry or jump to conclusions and that everything would be ok. I waited for my mom's call or text for an update. I kept trying to call my grandma myself but it wouldnt connect me-which scared me more even though I knew that after an earthquake, especially to that magnitude, phonelines would be down and contact would be hard. My mom finally texted me that my family was ok and she'd call me later. I was relieved. But I was still so very sad. American Samoa and Samoa are such tiny tiny islands-I felt like the islands were going to be washed away or something. I just knew there was going to be a lot of damages and I was so sad to think of the possible deaths. :( It's so heartbreaking and devastating. I was happy my family were alive but I was still so heartbroken that this disaster happened to the islands that I love so much. And I've only been there once!! And then I was sad to hear from my roommate that some of her family were missing still and that one of the PIER students at Carson high lost a family member as well.
I later read reports that 14, then 20, then 28, then more and more people died. My heart was breaking more and more with all the pictures and reports that were coming out. I couldnt help but think about all the families that lost a member of their families or even whole families that could have been lost. I was mourning for all those who passed and I didnt even know them! But I prayed more and more through out the day-asking God to please be with the people and give them courage, strength, love, safety to keep fighting and helping each other.
I didnt get started on my actual blogging til about 3p. I couldnt get my mind off what happened. I blogged for the rest of the day until I went to sleep at midnight again. Blogging was a good distraction for my mind not to go completely crazy. Writing about my experiences with this internship made me even more thankful for all the blessings I have in my life. I completed about 3-4 more blogs, prayed one last time then fell asleep.

And the Blogging continues...

The next day was pretty busy for me. I woke up at 6:30a left for school at 8a class started at 9a. It was an hour long and I had an hour break between classes. So I went to the computer to blog even more! I finished my very first one. I tried to start another one, but since I'm a beginner blogger I didnt know how to navigate my way around (I still dont actually, still learning! haha), plus, my next class was going to start soon so I wouldnt be able to finish the second one if I tried!
I went to my next class and then I went to work, again. uugh. 2-930p. I got home and I knew I had to get the blogging done before the 30th so I stayed up late again blogging blogging blogging! It was fun because it reminded me of how far I've come in just a few short weeks and how much I've learned and all the people I met.
I had class early again the next morning and was planning to put in a full day of work with Diana and also continuing to try to finish blogging about everyday. So I went to sleep..
ZZZzzzZzZzzzzZZzzzzz......

Blogging Blogging Blogging

So because I was not able to make it to the orientation on August 28 I missed out on all the requirements for the internship! Sina emailed me and told me that we were supposed to be blogging about our experience. So I actually started all of this blogging late!
I read through Sina's blogs and started writing my first one. But I rambled waaay too much and did not finish I knew I could finish in the morning it was getting late and I had class at 9a the next morning so I went to sleep!
Who knew blogging could be so tiring??

Lookin at the Data on Stata..

On Friday, after my microbiology class I walked to Westwood to Diana's office. We discussed the next steps of our proposed research--looking at the data. If we could find associations in our data through the topics that we chose then we would have something to write about. Remember, the possible topics we chose that affect physician satisfaction: gender, ethnicity, income, patient/work load, time spent with the patients, the type of practice they work in, and how insurance plas a role in this.
Diana showed me the statistics program they used for the input of all their data on this research. It is called Stata. It looks like an old program because the screen is black and the letters are green and yellow, but of course its not old and it's actually a very advanced/complex program that takes the numbers inputed from the research and can find percentages, p values, associations, etc (all those statistics terms!). It can cross two variables of research and see how they relate to each other. I think it can do more than two also, but we only looked at crossing two this day.
Another thing about Stata is that it uses codes for every category of data. Some of the codes were obvious, like the one for the race of the physician the code is "race". Their answers were also codes. Actually, all the answers to every question were numbers codes. For example, a yes or no question would have the codes 0 and 1. Or the race question ranged from 1-5 (White, Latina, African American, Asian-Pacific Islander, Other). Some other category codes weren't so easy to distinguish like mvar9 or svar9, I do not know what it means off the top of my head. I think the 9 refers to what question it was?
So what we need to look at is the variable of the physicians who were satisfied and the physicians who were the least (or not) satisfied at all and cross it with each topic we chose to look at. This will then give us a 2x2 table to show how many answered yes to each question or no to each question or yes then no or no then yes. For example, taking into account the physicians gender the boxes of the table would be: satisfied male physicians, unsatisfied male physicians, satisfied female physicians, and unsatisfied female physicians. Make sense? Crossing these variables will then give us a P value. This value tells how associated these variables are or if chance had any thing to do with the relation. If the P value is less than 0.05, than we would consider the variable for further research because less than 0.05 means that it wasnt due to chance. Sometimes researchers accept P value less than 0.10 also.
Diana and I didn't do a lot of crossing of variables, we decided we would do it on the next time we would meet. She had to go to a meeting, but I stayed in the office to read and fill out the paperwork that Khushbindar gave me at the REACH conference. I left it in Diana's box then had to go to work til 9:30p. uugh!

Oh another day of reading.....

So reading isnt my favorite thing to do.. I'm still reading the stack of articles Diana gave me. I should take a picture of it so I can post it up on here to show its not an exaggeration. haha. It could be a lot worse, I'm sure. And its not THAT bad so I dont mean to sound like I'm complaining but reading the articles is probably my least favorite part of the internship, haha. But, I know it must be done, so I'm trying to get through them. They are interesting though.
One of the research studies was about how recent medical school graduates-so new doctors- are so excited to start their job as a doctor. It wrote a scenario story about how this new doctor promised himself he would always love being a doctor despite his older colleagues who have been in the profession much longer and were unsatisfied or hated their job or didn't have personal relationships with their patients etc etc. But then it goes talking about the hardships of being a doctor choosing your job over your family, the sometimes ridiculous hours, etc. This article was one in the Physician Satisfaction pile (kind of obvious though, I'm sure).
I'm pre-med and I've always been pre med and I still plan on going to med school and striving to be the best OB/GYN or pediatrician or general physician that I can be. After reading this article, I'll admit it makes me worry about the future and what it will be like for me when I am a doctor. I hope and pray that I will always love my job, but on top of that be the best wife and mother as well! I know I really shouldnt be worrying about any of this now because I'm still young and an undergrad so none of this will happen for quite sometime. But this article definitely got me thinking and planning! haha..
Well I didnt meet with Diana today. She was at the REACH Conference presenting her research she is doing with GCN. I wish I could have been there!! Dr. Heckert (the woman from University of Hawaii Med School) was presenting this day as well. It would have been nice if I could have went to support my preceptor and then to also show face at Dr. Heckert's presentation. But school started today and it's not a very good idea to miss class--especially when you're taking only upper division science courses, missing one day can totally mess you up.
I meet again with Diana tomorrow though... so goodbye for now!

The REACH US Conference in Long Beach, CA

Alisi and Khushbindar of OCAPICA and Diana, my preceptor, invited me (and the rest of the interns) to attend the Racial and Ethnic Approaches to Community Health across the U.S. Conference (REACH US) in Long Beach, CA at the Hyatt Hotel. I knew it was going to be a good experience for me and a chance for me to network and meet a lot of people working in the community.

The conference began at 8:30a so I left my house in "Ingle-chester" (Inglewood-Westchester) at about 7:30a. The drive is only 23 miles-according to Google maps, so I thought I gave myself enough time... But I never expected to get lost. haha... Well I eventually found it, thank goodness. I went to the sign in table to my designated letter group, but they didnt have my name. I was worried I wouldnt be able to attend anymore. But they knew who Alisi and Khushbindar (because they helped with the whole conference) and they gave me a name tag. Then I finally met Alisi and was able to put a face to the name of the woman I had talked to in August and had been emailing for so long. haha. She was very nice and welcoming. She gave me my conference bag and materials then told me to go upstairs and find the islanders, she said it wouldnt be hard.
And it wasnt. haha. As soon as I got off the escalator I saw Vanessa Tui'one from the Tongan Community Service Center and another Pipeline intern, Sina Fifita. Sina and I were both assigned to Diana as our preceptor, but since she is still in high school and wanted to do research on health issues of teens, they chose a location that was better for her schedule and research which was at the Tongan Community Service Center. I was glad we were able to hang out with each other that day because I was afraid I'd be a loner or something! But I think we 'clicked' and will be keeping in touch much longer after this internship... SHOUT OUTS BACK TO YOU SINA!! ;) haha
First, we got some breakfast. We were kind of shy about going around the exhibitor tables so we went to sit down with Vanessa. We sat at a table with members from the Samoan National Nurses Society- Ofeira Lutu and Genesis Lutu. Also, I met Brian Hui from the TGSC I actually re-met him that day because we had met at PIFA last year. And I also re-met Tana Lepule from the Union of Pan Asian Communities, I had met him earlier this year at a Pacific Islander Symposium at UCLA.
The MC for the morning may have been short in height but she wasnt short in laughs, thats for sure. She was so funny and was trying to set people up on dates. Poor guy at lunch time was probably embarrassed, but it was so funny.. The first people to come on stage was the Chamorro group, Kutturan Chamoru. I've seen them perform before at UCLA PISA's IMUA in 2007, as well as at PIFA in 2008. They're one of my favorites, so very talented and so in touch with their culture. It's really great.
We were welcomed by Don Knabe, the LA County Supervisor. And then Dr. Wayne Giles spoke to us. He is the "Director of the Division of Adult and Community Health, National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention"-such a long title! His presentation was interesting. The correlations he found in his study were shocking, but an unfortunate reality. That when someone who is Black or Latino are perceived as White they received better care than those people who are perceived as Black or Latino. It's very sad that this is the reality we live it, thats why conferences and studies like these are important so we can see the disparities and inequalities and promote change!!
One thing that he did which I dont like when people do is that he lumped Asian Americans with Pacific Islanders. I've always had a problem with this since I was in elementary school when you have to fill in the bubbles on the state tests. I would always cross off "Asian American/Pacific Islander" and fill in the "Other" bubble and write in Samoan. haha. UCLA's PISA along with the Asian Pacific Coalition came up with a campaign called "Count Me In". We were arguing for the separation and dissemination of the Asian American and Pacific Islander categories. We wanted to know our enrollment numbers for our specific communities not be bunched together and then given a list to try to distinguish from (which passed and should be on the UC applications now). So when question time came I was happy that one of the elder ladies of the Native Hawaiian community told him how much lumping together Asian Americans with Native Hawaiian/Pacific Islanders hurts our communities and when will the CDC fix this problem. Kudos to her!
After Dr. Giles presentation we had a "Lift Off" break. It was a lot of fun. Everyone was gettin down and really getting into it! It was fun and funny. Sina and I somewhat got into it too, not as much as our neighbors though, but it was a nice little energy break. haha..
The next speaker was Dr. Camara Jones. Her position is Research Director on Social Determinants of Health and Equity in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention--another long title! I found her presentation even more interesting. She told a lot of stories and gave analogies. Lessons learned: for the pink flowers to realize that they are just as beautiful or more beautiful than the red flowers despite all the bad soil (hardships) and that we must turn around on the conveyor belt and walk away from racism and get everyone headed for it to turn around with you and then find a way to break the racism conveyor belt. Alisi wasn't kidding when she said Dr. Jones was "the real deal".
After Dr. Jones we were sort of kicked out of the ballroom so they could set up for lunch. haha. Kicked out nicely though. :) Sina and I visited exhibitor booths and collected material and cards. We met a guy from the US Census and Guam Communications Network, Keith Castro. He was a very nice guy and asked us about school. While talking to him, he introduced me to a lady named Karen Heckert. She is a Program Director for the Pacific Center of Excellence in the Elimination of Disparities and works in the Departmen of Family Medicine and Community Health, John A Burns School of Medicine, at the University of Hawaii. So like I said in my "About me", I was Pre Med and the University of Hawaii is actually my number one pick for Medical School. So I was very excited to have met her. I told her about this and she told me to give her my contact information. So I did. :) I was excited. So I plan to send her an email soon. :)
On this break before lunch, I finally met Khushbindar and two other interns, Ono Vaifale and Lena Yandall-who are both intering with Dr. Sora Park-Tanjasiri at CSUF. Khushbindar gave us packets of information to be filled out and returned to our preceptors the following Friday (9.25.09). I also met Anna Tapu, one of the recipients for the PATH scholarhip. And then I met another intern, Jocelyn Delfino she is interning with GCN. They allowed us to come back into the ballroom for lunch. All the interns I met, Anna, and another intern, Elna Simpson, and Alisi, Brian and Keith sat together at the front table. The food was different for us. I've never had a green salad that had pears in it! lol. But it as pretty good. And the main lunch good too, I liked the rice thing (I'm not even sure if it was rice, haha) a lot. I talked to Sina and Anna most of lunch.
Unfortunately, :( I had to leave the conference early, too early. I had to commute to UCLA because I had work at 2p. No one wanted to switch shifts with me!! And school started the next day so I had to miss the second day of the conference as well! I was bummed. I'm happy I was able to make it for what I could be there for. I networked. I learned. I met a lot of people. It was a really great experience and I'm so very thankful and fortunate to be apart of this internship to have such opportunities!! Thank you, thank you, THANK YOU! :)