Doris Tong, M.D., MBBS, MSc-HRM, FRCPC (Anesthesiology)
Director of Clinical Research, Michigan Spine and Brain Surgeons
Director of Operations, Michigan Spine and Brain Surgeons
Medical Education: University of Hong Kong
Residency: Obstetrics and Gynecology – University of Hong Kong
Anesthesia: University of Hong Kong
Anesthesia and Critical Care: University of Toronto
Fellowship: Anesthesiology – The Toronto Hospital, Toronto, Ontario
Research: Masters degree – Clinical Epidemiology, Health Research Methodology Program, McMaster University, Hamilton, Ontario
Neurosurgery research is a required component of the residency program at Ascension Providence Hospital. All residents are required to engage in clinical and/or bench neurosurgical research starting in their intern (PGY-1) year and throughout the duration of their residency.
Our research program is structured as follows:
Research is resident-driven with the assistance and guidance of a faculty sponsor and the Director of Neurosurgical Research
Residents utilize a long-term prospective outcome database (a cloud-based integrated infrastructure) for resident projects and continuing outcome improvement
Pharmaceutical and non-pharmaceutical sponsored clinical trials
Monthly research meeting with the Director of Neurosurgical Research at Ascension Providence Hospital to discuss progress, review anticipated research needs for future project, offer guidance with brainstorming and decisions, and assist in peer review of manuscripts during preparation for publication
Affiliated with the Michigan State University College of Osteopathic Medicine
Optional dedicated fifth or sixth year (PGY-5 or 6) of training for research at the discretion and approval of the Program Director
Research and Scholarly Activity
Scholarly activity is an integral part of each rotation. In addition, elective clinical research rotation is available at PGY-4 for a 6-month rotation.
The program has a Neurosurgical research faculty member who supervises the research activity. Dr. Doris Tong is a board-certified anesthesiologist who was trained in the University of Toronto, Anesthesiology program. Additionally, Dr. Tong completed the Health Research Methodology/Clinical Epidemiology Master’s program from the renowned program in McMaster University in Canada. Dr. Tong was active in resident teaching in University of Toronto, being the faculty member of Anesthesiology department, Chair of the University Anesthesiology journal rounds and member of the publication committee and scientific papers review committee of the Society of Ambulatory Anesthesia. Dr. Tong will dedicate about 15 hours per week to research supervision. Selected attending surgeon who is the senior author of the resident projects will also fulfill a supervisory role.
The residents are encouraged to attend regional, national or international professional and research conferences. The resident will be reimbursed for one approved conference annually, for up to five days, Additional support is available via the hospital when the residents' work are accepted for presentation.
The hospital has a research department which oversees all research activities within Ascension Providence Hospital. The research office offers regulatory support such as IRB and trial monitoring for FDA trials. In sponsored clinical trials, the research department will assign clinical research nurses to specific trials. The research department offers statistical and logistical support for resident research. Annually, there is a hospital research day in which all Providence residents compete in oral and poster presentations.
Regarding IT support, in addition to the use of electronic medical record which offers ready access to patient clinical outcome information and the wide availability of hospital computers, the hospital offers research and statistics applications such as SPSS, IRBnet and Midas database.
There is a monthly clinical research methodology didactic lecture and an accompanying Journal Club related to the same topic. Resident attendance is mandatory. Residents are expected to read, review, and be able to discuss the journal articles and complete a worksheet. A typical annual assignment of topics include meta-analysis/systematic review, prognosis, causation, guideline, randomized controlled trial, developing an instrument, observation (case control/cohort studies), economic analysis, decision analysis and diagnostic studies.
The journal club is overseen by the neurosurgical research faculty and coordinated by a senior resident. The monthly topic for journal club is determined annually and each month’s selection will correspond to a clinical methodologic topic. Once a month, an assigned resident will select an article corresponding to the topic. The attendance sheet will be kept by the program director and program coordinator. The attendance will be discussed at the quarterly evaluation meeting. Failure to attend or participate will lead to remedial action at the discretion of the program director.
This collaborative will be attended by all the residents, neurosurgical clinical and research faculty in the Ascension Providence Hospital and other internal stakeholders including the Director of Institutional research, and the Designated Institutional Official. Clinical and research faculty from the participating sites will also be invited. The goal of the collaborative is to better coordinate, monitor scholarly activities within the institution, and to foster collaborative research efforts.
Basic science laboratory
Ascension Providence Hospital Research departments comprise 12,500 sq. ft. located on the Southfield Campus. The basic science area occupies 3,500 sq. ft. and a PhD scientist and associate medical researchers staff this research laboratory. The basic science area consists of separate laboratories for cell culture, microbiology, protein chemistry, x-ray film development, nucleic acid extraction, and molecular biology. The laboratories are available for use 24 hours with electronic badge entry and identification.
Cell Culture: Biosafety cabinets, 6 ft., COR2R incubators, light microscopes, phase contrast microscope with epifluorescence and analysis software, refrigerator, -20° C freezer, -70° C freezers, liquid nitrogen dewars, centrifuges, BioTek EL-312 micro-plate reader and micro-plate washer.
Microbiology: Biosafety cabinet, 4 ft., refrigerator, environmental shaker, bacteriological incubator.
Protein Chemistry: Refrigerator, -20° C freezer, -70° C freezer, centrifuge, Hoefer scientific instruments, Model SE600 electrophoresis units with power supply (13 x 15 mm format), Bio-Rad Trans-Blot cell and power supply, Bio-Rad Trans-Blot SD cell, Labline Dual Action Shaker, Labline Shaker Water Bath, and AGFA model CP1000 X-ray film processor.
Molecular Biology: Biosafety cabinet, 4 ft., centrifuge, microcentrifuge, Milton Roy Spectronic Genesys 5 spectrophotometer, PRO Scientific, inc., model PRO200 homogenizer, refrigerator, -20° C freezer, PE Biosystems, Gene Amp PCR System 9700, Owl Scientific Gel Electrophoresis Chambers, Alpha Innotech AlphaImager 2200 Gel Documentation System.
The animal department is a 3,500 sq. ft., USDA-registered class-R facility. It includes large and small area housing, a fully equipped surgical suite as well as procedure and recovery rooms. It is staffed with (1) full-time and (1) part-time Licensed Veterinary Technicians. Microsurgery and Gross Anatomy Laboratories offer microsurgical training, gross anatomy instruction and review by a Certified Microsurgery Instructor.
Clinical Research Facilities
Ascension Providence Hospital main campus is located in Southfield, MI with nineteen residency and fellowship programs. It is a 365-bed in-patient care facility with physician offices and outpatient services on campus. Our secondary site is in the Novi campus which is a 200-bed in-patient care facility with physician offices and outpatient services. In addition, Ascension Providence Hospital has multiple ambulatory office sites throughout the metropolitan Detroit area. These areas offer a variety of settings for clinical research.
The hospital supports the design, maintenance and population of clinical research database via the Midas system. It is a secured, encrypted, cloud-based application accessible throughout all the computer hospitals in the Ascension Southeast Michigan Health System and remotely via the Citrix secure portals. Currently, the active neuroscience-related clinical outcome database includes a skull-base database supported by the Michigan Ear Institute and the Spine Surgery Clinical Outcome Database supported by Michigan Spine and Brain surgeons.
Helen L. DeRoy Medical Library
The Health Sciences Library is located on ground floor of Ascension Providence Hospital-Southfield campus. The Health Sciences Library supports teaching, research and patient care in a multitude of programs. The library maintains a current print collection of over 265,000 serial and monograph volumes, more than 93,000 books, more than 1,000 electronic books, over 200 print professional healthcare and biomedical journals, and nearly 6,000 electronic journals. Additionally, the library supports access to over 120 primarily web-based electronic research databases including but not limited to ACCESSMedicine, MDConsult, Ovid MEDLINE, Medline via PubMed, ClinicalKey, Cochrane Library, National Guideline Clearinghouse, TRIP database, Books @OVID, eBook clinical collection, R2 digital library, ScienceDirect, UpToDate and Web of Science.
On the library portal, the main access points are “ClinicalKey”, “Journals @ Providence”, and “eneurosurgery". Through these access points, the residents can access books such as “Principles of Neurological Surgery” by Ellenbogen, “Neurological Surgery’ by Youmans, “Core Techniques in Operative Neurosurgery” by Jandial, “Operative Neurosurgical Techniques” by Schmidek and Sweet, “Surgical Anatomy and Techniques to the Spine” by Kim, “Microneurosurgery” by Yasargil, “Meningiomas” by Al-Mefty, ‘Handbook of Neurosurgery’ by Greenberg, and any book published by Elsevier or Thieme. There are more than 66,100 pages of Thieme e-book content, more than 69,100 images and videos, a collection of 418 step-by-step illustrated procedures and 225 in-depth cases. Numerous classes on how to access and improve the effectiveness of managing information resources are offered throughout the year. A complete list of the library resources and the contact information of the Medical librarian, Alexia Estrabrook, M.S.L.S., can be found in the Appendix section of this manual.
Information technology and administrative support
There are (6) computer workstations in the Ascension Providence Hospital research laboratories. These computers are linked into the hospital intranet providing password-protected access to clinical information, links to the library with access to electronic research databases as well as high-speed internet. All the hospital computers in clinical areas and private research computers in outpatient physician facilities also offer the same access. The Southfield research administration office has a poster printer. There is a small library and an adjoining conference room with full AV and teleconferencing capabilities.
Michigan State University Health Sciences Digital Library
Our affiliation with the College of Human Medicine, Michigan State University, allows us access to various basic, clinical research facilities and the extensive electronic resources in the0T0T42TMichigan State University Health Sciences digital library42T. The MSU Libraries provides College of Human Medicine faculty, residents, and students at clinical sites access to extensive print and electronic holdings appropriate for advanced research and clinical care. The focus of the MSU medical library collection is on electronic resources, all of which can be accessed from anywhere using MSU netID. Printed resources such as books are also available to residents and faculty at clinical sites through electronic document delivery of individual chapters or interlibrary loan delivery of books through the hospital library. For the 2015-2016 fiscal year, the MSU Libraries allocated over $1.5 million for the purchase of materials in the clinical medical sciences and an additional $1.1 million for materials in the basic biomedical sciences. With this, the MSU Libraries provides access to over 9000 electronic journals in the clinical and biomedical sciences, thousands of current electronic medical textbooks, research databases, procedures, and point-of-care resources. This includes all of the major journals and hundreds of advanced specialty titles in neuroscience, neurosurgery, and neuroanatomy. Some key resources included are Access Medicine, Access Surgery, Clinical Key, Lippincott’s Clinical Choice electronic books, Cochrane Library, Thieme Anatomy Atlases, Science Direct journals, DynaMed, Embase, Medline, Web of Science, and Scopus.
Michigan State University Neurosciences research facility
The Department of Translational Science and Molecular Medicine (TSMM) within the MSU College of Human Medicine conducts translational research with the goal of developing or improving therapeutics for neurodegenerative disorders. The faculty and resources of this CHM research unit are located on the CHM Grand Rapids Campus and are potentially available to all CHM affiliated residents and faculty. The 15,000 square feet neuroscience based laboratories are located on the 4th floor of the state-of-the-art research building adjacent to the College of Human Medicine’s Secchia Center in Grand Rapids, MI.
The TSMM CHM laboratory is equipped with the following:
Areas for Reagent Preparation: Mettler Analytical Balances, pH meters, glassware, stir plates, centrifuges, pipettors and fume hoods.
Specimen and sample preparation areas: Sliding microtomes, vibratomes, a cryostat, and immunocytochemistry preparation areas and materials.
Microscopy facilities: One Nikon Eclipse 90i microscope system and camera, Nikon inverted light microscope and camera, Olympus BX60 light/fluorescence microscope and camera, two Olympus BX51 microscopes equipped with Microbrightfield stereology system hardware and software as well as state of the art confocal and electron microscopy systems (Nikon A1+ confocal microscope with live cell imaging , Transmission electron microscope JEOL 1400).
Analytical Biochemistry and Gene Expression services : High performance liquid chromatography with electrochemical and photodiode array detection (ESA Coulometric Array detector and a Waters 2996 photodiode array detector), spectrophotometers, western and northern blot equipment, a Kodak 2000R chemiluminescent Imaging System, a Licor Odyssey Near-Infrared Imaging System, two real time quantitative PCR systems with (ABI 7500 and a Life Technologies Viia 7 mutliplatform PCR Machine that can analyze 96, 384 and Taqman Low Density Array based formats), a high throughput sample handling robot (Eppendorf EpMotion 5070), a Life Technologies Veriti Thermocycler and a Nanodrop spectrophotometer.
Sample and reagent storage: Refrigerators, -80 C and -20 C freezers, liquid nitrogen storage tanks and a dedicated cold room.
Tissue culture facilities: 18 incubators, 9 laminar flow hoods, autoclave and inverted microscopes.
Tissue microdissection and necropsy area: dissection microscopes, Teca specialized dissecting cold plates, perfusion pumps, microdissection tools.
Additionally, vector production for gene therapy based interventions is also available through TSMM faculty consultation as are proteomics services.
Beyond the lab facilities, there are numerous touchdown spaces for visiting faculty or residents, a dedicated high-resolution videoconference room, and other meeting rooms, lecture halls and common areas can be scheduled for use as needed.
Van Elslander Surgical Innovation Center
Opened in January 2015, the Van Elslander Surgical innovation center at Ascension Providence Hospital, Novi is a high-tech training and communication base for physicians, residents and clinical staff. The Surgical Innovation Center is the first and only facility of its kind in the Midwest. Almost 10,000 square feet in size, the Center features a state-of-the-art amphitheater with video conferencing technology and seating for 50. Fifteen lab training stations are equipped with high-tech microscopes and video conferencing technology. A small conference room also has video conferencing capability. A dining room serving lunch and dinner, men’s and women’s locker rooms, and a cadaver storage area, complete the facility. The video conferencing capabilities are extensive. The amphitheater is outfitted with video conferencing technology and is an ideal venue for medical education programs. Video conferences can be held between the Center’s lab and conference room, and from the conference room to Ascension Providence Hospital in Southfield. Video conferencing capabilities are also in place between the operating rooms at Ascension Providence Hospital, Novi and the conference room at the Surgical Innovation Center in Southfield. Use of the Center spans the breadth of all surgical specialties and is ideal for a variety of training and education scenarios. Cadavers are available for attending physician practice and demonstration, and resident and fellow training. Ascension Southeast Michigan Hospital has partnered with Platinum Training, a national organization that runs six similar facilities in the United States, to operate the Center. Platinum interacts with medical device manufacturers to bring new technology and courses to Ascension Southeast Michigan Hospital.
Microvascular Teaching laboratory
Located in Ascension Providence Hospital-Southfield campus, the microvascular teaching laboratory is a 350 square foot facility. The microvascular teaching laboratory offers individualized training year round in microsurgical techniques (arterial, venous, nerve anastomoses) taught by certified microsurgical instructors who are members of the Society of Microsurgical Specialists. The laboratory also offers gross anatomy instruction and review courses, experimental surgical training and testing in the areas of: Microvascular, Plastic and Reconstructive Surgery.
Simulation and education center
The new Simulation and Education Center opened September 2017, and is located in the Southfield main hospital with a 6,827 sq. foot area. The new center consists of a procedural skills training room equipped with task trainers, high-fidelity simulation models, and ROSS, the robotic simulator; a virtual reality surgical skills training room; a simulated operating room and two team training rooms that can be used as delivery rooms, emergency exam rooms or other clinical settings; 2 exam rooms for viewing and assessing clinical skill performance with simulated patients, conference rooms to debrief training sessions; and a large classroom to host workshops and conferences. All the above are equipped with video-conferencing and presentation capabilities.
Residents have access to hospital computers in all locations of the campus. Residents also have remote access from home via ez.stjohn.org. These mechanisms allow the access to system subscriptions of online electronic research databases. The GME offers computer-based learning modules maintained by American Medical Association. It is a comprehensive library of learning modules currently with more than 30 modules. The topics include Patient Safety, Quality Improvement, Sleep Deprivation, Physician Employment Contracts, with more modules to come! Each module includes a formal lecture or interactive lesson, post-assessment, evaluation and course certificate of completion. There is 24 hour access and extensive reporting features to track and document progress.