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Duke Surgery Spring 2019 Newsletter

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Duke Surgery Spring 2019 Newsletter SPRING 2019 CURATING CARE [Machine Learning's Deep Dive into Big Data] Duke Surgery Chair Chief of Staff Allan D. Kirk, MD, PhD Cynthia K. Shortell, MD Vice Chairs Gregory S. Georgiade, MD Clinical Practice Ranjan Sudan, MD Education E. Shelley Hwang, MD, MPH Research 4 Chief of the Clinic Chief Administrator 4 Michael E. Lipkin, MD Katherine Stanley, MBA Division Chiefs Abdominal Transplant Surgery Plastic, Maxillofacial, Debra L. Sudan, MD and Oral Surgery Jeffrey R. Marcus, MD AT A GLANCE Cardiovascular and Thoracic Surgery Surgical Oncology Peter K. Smith, MD Peter J. Allen, MD Emergency Medicine Surgical Sciences Curating Care Charles J. Gerardo, MD Kent J. Weinhold, PhD 4 Machine Learning's Head and Neck Surgery & Trauma and Critical Communication Sciences Care Surgery Deep Dive into Big Data Howard W. Francis, MD, MBA Suresh K. Agarwal, Jr, MD Metabolic and Weight Urology Loss Surgery Glenn M. Preminger, MD Resilience in Surgery Dana D. Portenier, MD Vascular and 8 Pediatric General Surgery Endovascular Surgery Improving Provider Henry E. Rice, MD Cynthia K. Shortell, MD Well-Being EDITORIAL STAFF Transplant Firsts in NC Editor in Chief Honorary Director 10 Looking to the Future, Brooke Walker Jill White Together Writers Designer Scott Behm Scott Behm Renee Dubois Brooke Walker Medical Illustrators Duke Surgery Pilots Lauren Halligan Editor Megan Llewellyn, CMI 14 National Curriculum Ashley Morgan for Medical Students Administrative Assistant Wendy Dixon 16 Training Surgeons Follow us on Social Media in Immunobiology @DukeSurgery On the cover: In the operating room and emergency room, Copyright © 2019 Duke Surgery data can serve to make sense of the chaos. Illustration by Lauren Halligan and Megan Llewellyn, CMI. 2 Duke Surgery 10 16 MESSAGE FROM THE CHAIR urgeons have a direct, personal improving the experience of our care students in the surgery clerkship. This new relationship with their patients, providers. By focusing on the well-being curriculum bolsters our surgical program combined with a truly tactile of our faculty and trainees, we aspire for medical students to foster their success Sexperience with their patients’ illnesses. to cultivate an atmosphere of trust and in medical school while establishing a This unique access to both the patient support. The department now offers peer clear pathway for their future careers as experience and associated biological support groups for faculty and trainees to surgeons. processes puts our department in a promote resilience. Prioritizing the health position to define the entire spectrum of our faculty and staff is vital to providing By working to improve the experience of of health, disease/injury, and recovery— high-quality care to our patients. our patients, providers, and trainees, the access so compelling, it demands that we Department of Surgery strives to blend do so, “for all patients.” In this issue of Duke Surgery has been at the vanguard excellence into all aspects of our mission. the Duke Surgery newsletter, we examine of scientific discovery as demonstrated the means by which we are curating the by this year’s number 1 ranking in NIH experiences of our patients, providers, funding among departments of surgery. Sincerely, and trainees to build a foundation for Two recent advances in transplantation clinical excellence, innovative research, highlight our translational discovery work. Allan D. Kirk, MD, PhD, FACS In fall 2018, Duke surgeons were the first and formative education for the future of David C. Sabiston, Jr. Distinguished in the state of North Carolina to perform surgery. Professor and Chair an abdominal wall transplant (done with Department of Surgery Duke surgeons are actively engaged in a a simultaneous small bowel transplant!), Duke University School of Medicine university-wide “+DS” drive to harness the and our hand transplant team performed Surgeon-in-Chief power of data science, wielding big data the first bilateral hand transplant in the Duke University Health System to augment provider decision-making and state: remarkable technical achievements enhance the quality and value of clinical made all the more impactful by their care. In collaboration with the Duke School association with cutting-edge immune of Engineering, our faculty are gathering investigational protocols. These novel clinical and mechanistic data for use surgical procedures offer new options to as ground truth in artificial intelligence patients while providing insight into the and machine learning algorithms. These safe and efficacious application of these new approaches to data analysis aim to transplants in future patients. optimize the delivery of care and reduce surgical complications, length of hospital Finally, a significant part of our mission is stay, and wait times in the Emergency to develop the next generation of leaders Department. in surgery. We are working with the American College of Surgeons to enhance Importantly, improving our patient the trainee experience by implementing experience goes hand in hand with a standard curriculum for medical Contents 3 1 1 1 0 0 1 1 0 0 1 1 1 1 0 1 1 0 1 0 0 0 1 1 1 1 1 0 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 0 1 1 1 0 0 1 1 10 0 1 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 11 1 1 1 1 0 0 1 1 1 0 0 0 1 1 1 0 1 0 1 0 1 01 1 1 1 1 1 1 1 1 11 1 11 0 1 1 10 1 1 0 1 1 1 0 1 1 1 0 1 0 1 0 0 0 1 1 1 10 1 1 1 1 1 0 0 1 0 0 1 0 0 1 0 1 0 10 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0 0 1 0 0 0 1 0 1 1 0 1 0 0 1 0 1 0 1 1 0 1 1 0 0 1 01 1 1 1 00 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 0 1 10 11 1 0 1 0 1 0 0 0 0 1 1 1 0 1 0 10 1 1 0 0 1 0 0 1 1 0 1 11 0 1 0 1 1 0 1 0 1 1 0 1 0 1 1 0 1 0 0 0 1 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 0 1 1 1 0 0 CURATING1 1 0 1 1 0 00 0 CARE0 1 0 0 1 0 1 1 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 00 1 0 1 1 0 0 0 1 [Machine0 0 Learning's1 1 1 0Deep10 Dive0 into0 Big Data]1 0 0 1 1 1 1 1 0 0 1 0 0 1 0 0 0 1 0 0 0 10 1 1 0 0 0 1 1 0 1 0 1 0 0 1 1 1 0 0 0 1 1 0 0 1 1 1 1 0 1 1 11 0By1 Scott 1Behm 1 1 1 0 1 0 1 1 1 1 1 0 0 0 1 0 1 0 1 0 0 0 0 0 00 0 0 1 0 0 Dr. Jason Theiling, right, discusses recent Emergency Medicine data output with Strategic Services Associate Elizabeth Stacks, Division Chief Dr. Charles Gerardo, and Associate Professor Dr. Lauren Siewny (left to right). Photo by Colin Huth/Photo C4. 4 Duke Surgery onsider the sheer volume of data sources has the potential to inform your brain processes in making one decisions in monumental ways—creating a decision. Something as simple as detailed roadmap to improve quality and Cyour choice of breakfast is the culmination efficiency of care and to minimize potential of data analysis—decades of zeroing in on complications. personal taste, allergic reactions, nutrition, health considerations, and other factors. Curating Existing Data The use of data to make decisions, then, For a system as large as Duke Health, is not profound—it is an innate aspect of curating EHR datasets to creating the human condition. In the surgical field, meaningful, useful data can take years. historically this data processing took place Kristin Corey, a medical student at Duke through the lens of personal experience. and scholar at the Duke Institute for Consider why a senior surgeon is typically Health Innovation (DIHI), has spent 2 years more trusted than an intern. More time working as part of the DIHI team to build in practice constructs a robust dataset to PYTHIA, a data pipeline that has wide make sound surgical decisions. application potential across Duke Health and beyond. For today’s surgeons, however, the dataset has expanded exponentially. To As part of the Perioperative Risk start, electronic health records (EHRs) Optimization with Machine Learning for an create massive datasets—a resource often Improved Surgical Experience (PROMISE) untapped due to the lack of processing program, Corey’s original focus was power needed to leverage terabytes of predicting outcomes for geriatric patients. data in a way that human brains can comprehend and make practical. “Because DIHI IS is an innovations group, As the capabilities of machine learning is really creat ive,” Corey says. “They gave expand, big data from EHR and other us the free range and flexibility to think Patient Contents Care 5 big. When we got into the data, we started procedures and spanning 4 years,” trained with Duke University Hospital data asking questions.
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