Research summer student trains eye on medical assistance in dying

Thinking, Fast and Slow is a book Kelvin Ng calls “iconic.” Written by Nobel Prize winner Daniel Kahneman, the New York Times bestseller unpacks humans’ two systematic modes of thought: the first relies on instinct and emotion; the second takes a slower and more logical approach. Ng read the non-fiction book during his undergraduate degree in economics at McMaster University in Hamilton, Ont., and it left a lasting impression. Little did he know, though, that the themes would surface in his work three years later at Sunnybrook Research Institute (SRI).

Ng is spending the summer under the guidance of Dr. Don Redelmeier, director of Evaluative Clinical Sciences at SRI. He is one of about 40 students to have earned a placement through the SRI Summer Student Research Program.

“We’re looking at health care workers’ opinions on medical assistance in dying and how they help patients throughout the process,” says Ng, who recently completed his first year of medical school at the University of Toronto. “We think a large driver of how they help patients is based on empathy.”

The project involves distributing surveys to health care workers at Sunnybrook—Ng is aiming to reach about 500—that explore perceptions around end-of-life care. The questions on the survey are scenario-based. Ng offers an example: “There’s a man who’s considering medical assistance in dying. We’re asking people about things that could happen to him during this process. Say he notices that nurses never remember his name, even though he’s been in the hospital for days; how much worse does this make him feel?” Respondents provide a rating from zero to 10 to reflect their stance.

To contrast opinions with behaviour, Ng’s project will also entail assessing large health care databases that include information on patients who have received medical assistance in dying. “This database analysis will help show us the actions of health care workers and complement the survey, which shows the opinions of workers,” Ng says.

The purpose of the project, Ng says, is to uncover whether health care workers’ opinions on medical assistance in dying accord with their behaviour. If there is a discrepancy, then Ng says health care workers should be informed, as this could affect their interactions with patients. “We’re really trying to improve the process of medical assistance in dying,” says the aspiring clinician-scientist.

Circling back to Thinking, Fast and Slow, Ng says it’s the emphasis on thought processing that shines through in his work at SRI. “While system 1 is adequate for decision-making the majority of the time, it can result in people making irrational decisions, but in a predictable and understandable way. We’re currently studying a case where we believe people may be using system 1 when coming to conclusions about medical assistance in dying. If they were using system 2 instead, [then] we believe they may make different decisions,” he says.

This isn’t Ng’s first research experience; he has about a handful of projects listed on his CV, one of which was carried out at SRI. In 2016, he was a summer student working with the late Dr. Jack Tu, who was a cardiologist and scientist in the Schulich Heart Research Program. Ng assisted Tu, a world leader in cardiovascular outcomes research, on a project that tracked recent trends in cardiovascular disease in Ontario. He says the months he spent with Tu taught him to read literature more critically, a skill he’s polished as a student editor of a journal.

STEM Fellowship Journal is a Canada-wide peer-reviewed publication that features the work of high school and university students. It’s meant to be a launch pad for aspiring scholars in the STEM (science, technology, engineering and math) fields. Ng reviews submissions to ensure they meet a standard of quality. If they do, then he passes them on to a team member with a PhD or another reviewer with more expertise to determine their suitability. A fellow student editor of the journal is Megan Lam, a 2017 SRI summer student.

Ng says the position has improved his own projects. “If I look at a paper that has been submitted, and I see some really good ideas and ways of tackling problems, then that can be useful and transferable to my own research,” he says.

Around the same time Ng became involved with STEM Fellowship Journal, he dipped his toe into the world of dragon boating. Fast forward a few years, and it’s a full-fledged passion. Dragon boating is a team sport whereby 20 people, 10 on each side, paddle a huge canoe-like boat in a race against 10 to 20 other crews. The events they compete in are called regattas. “It’s had a huge impact on my life. Since joining, it’s created a routine in my life where I’m regularly physically active. Plus, there’s a really good community,” Ng says.

During the fall-to-spring off-season, the focus is on training; come summer, it’s on competing. As a U of T student, Ng paddles with the men’s boat on the Rotman Commerce Liquid Assets team. He says their goal is to go to nationals in Regina, Sask. later this summer and qualify for next year’s international regatta in France.

As Ng puts down his editor’s pen and dragon boat paddle, it’s back to surveys and collaborating with Redelmeier. “Of all the research I’ve done, this project has been the one I’ve been most interested and invested in,” he says. It’s clear that a factor in his enjoyment this summer is his supervisor. “Dr. Redelmeier’s been one of the most helpful supervisors I’ve had.”

He appreciates the time Redelmeier carefully spends mapping out projects, and thrives on the energy he brings to the research environment. “He has a pure level of excitement, which you don’t see in some other people,” Ng says. “Even printing off these surveys, he was excited to see them for the first time!”

Kelvin Ng received an SRI Summer Studentship Award.