Discouragement is a Bear

I have been reading a lot of dissertations recently, at least the introduction sections, because they give me a good idea about what is expected and how to properly structure a good dissertation. I have come to recognize two main themes in these dissertation papers. The first is that without the help of God, a good faculty committee, a loving a supportive spouse (if applicable) and family hardly anyone would have what it takes to climb this mountain and graduate with a PhD.

It is very important to surround yourself with people who support you and encourage you! In fact, the number one reasons I chose to go to the University of Utah was because of the encouragement and excitement of the faculty that I spoke with before I even applied. Other schools said things like "You are welcome to apply but you need to know that we only accept students with well thought out research goals and motives" or "you should come to campus and visit the faculty and school to see if it is a good fit before you consider applying". These are both valid points but they are not very enthusiastic and encouraging at the same time.

The faculty at the U of U were excited and encouraged me to apply and pointed me to the resources I would need to find success and made the decision so easy! I am very grateful to them for that!

The second thing that I have learned is that discouragement is a BEAR! When you are climbing a mountain, there are not many obstacles as ominous or frightful as a large bear standing on the trail staring you down.

This image has caused me to ponder quite a bit lately because not a single week has gone by in which I don't have one day of a good old dosage of discouragement! Discouragement comes in many forms. Sometimes it is physical discouragement due to sleepless nights and tired itchy eyes! Sometime it is mental and emotional discouragement that beats you down because you are not smart enough and don't have the quantitative skills that it takes. Sometimes it is what I will call social discouragement, or being discouraged because of your own perception of the other successful students and faculty around you and not being able to measure up.

So what do you do when there is a bear in your path???

You have a couple of options..

1. Wait and see if it leaves and then continue on your journey.

2. Use bear spray or a gun to harm the bear and hope it will run away and not kill you instead.

3. You can try to go around the bear and climb up some other way.

4. You can do nothing and let the bear kill you...which is the most ironic option of all because of how many students take this course of action. I suppose this is another good reason why it is so important to have supportive faculty and family members to knock some sense into you.

I have found that options 1 and 3 are what I choose to do most often. When I am discouraged I might just need to take a little break and sit down and have a snack in some shade off the trail and wait for the BEAR of discouragement to get bored and leave. This works well for the day to day discouragement of working so hard and feeling not up to the task. If the problem is larger than this then waiting is not going to do any good at all! You have to take one of the other three options!

Finding another way up the mountain and going around the BEAR is a good option because it involves less risk and you might find a better way up the mountain that others can learn from and follow. If you run into problems with a dissertation idea that you just can't move or solve in the time frame that you have, and that are not going to get bored and wander off, you just might have to go around the problem and keep moving forward. You are a PhD student and it is expected that you know how to blaze new paths and be innovative! Don't let the BEAR of discouragement eat you up and ruin everything that you are working to accomplish!!!

Is getting a PhD hard?

This is an interesting question. Having almost finished up my first year I have to admit that getting a PhD is not as hard as I thought it would be, in some cases, and much harder than I thought it would be in others.

The coursework is not any more difficult than any upper division undergrad course or graduate course in my opinion. This is especially true since most PhD students are already well versed in the subjects their coursework exposes them to. Some courses present advanced topics and methods but nothing that any student who has now been in higher education for at least six years shouldn't be able to learn and accomplish in a semester.

The difficult part of a PhD, and this is what separates it from any other degree, is the fact that the student is not being asked to show how well they can learn and regurgitate information any longer, but rather they are being asked to come up with their own research topics and prove to their committee members and other faculty that they have what it takes to do independent research. This is a new and daunting experience and gives every PhD student some heartburn and added stress.

I have also seen two types of PhD students and the two types have very different experiences. The first type is the funded student who is basically handed a research topic from a faculty member who is already performing research in a specific field and needs a PhD student to assist them. In return for doing a lot of analysis in the lab and writing a bunch of papers, the student has a very well defined and canned dissertation in the bag. I shouldn't make it sound that easy because they still work very hard and earn the degree, just with a lot less mental and emotional stress that the second group of students face.

The second group of PhD students are either unfunded or are funded but their advisor does not have a research project to hand over to them from the first day of class. These students have to really work hard to figure out what research topic they are most interested in and come up with a unique and independent study that will fulfill the requirements of a dissertation. This causes a lot of added stress and sleepless nights but in the end I think that it is beneficial to the student because they learn a lot about themselves, their own interests (as opposed to those of their advisor) and what they want to research. Passion matters! When you are climbing a mountain you have to be passionate about what you are doing or else you will not have the stamina to finish the climb.

I am in somewhat of a hybrid situation, which I think is the BEST place to be. I am funded in another department as a Research Assistant but I am not doing my dissertation on the work that my PI is engaged in. I am finding my own way and making myself responsible for my final dissertation and research topic. I have only been in the program for one year and I am on my fifth dissertation topic!!! The reason for this is because I have no problem coming up with great ideas...but when I start to dig deeper into the literature and learn more about the topic I realize that 1. this has already been done or 2. that there are so many road blocks to the data and resources and funding that it is just not possible in the time I have to finish this degree.

One of my professors made the analogy to digging a well. The good research questions are the water at the bottom of the well. You have to dig through the literature and available body of knowledge on a topic until you get to the water. This takes time and you have to read and look for holes and gaps in the literature and you will start to develop your own ideas and research questions. The key here is to ASK QUESTIONS!!! Question everything. Question the methods used, the data source, the analysis, the audience and everything else because that is where you will find water. That is where you will find the holes and gaps in the current knowledge of a topic and new ideas and direction will spawn.

Husband, Father, Provider & Student

Like many PhD students, I have multiple roles and responsibilities in my life including being a husband, father of five, provider and student. OK, maybe not all PhD students have five kids but I love being a dad more than anything and I will never complain about having a big family and being in school. I chose to climb this mountain and I am going to take my family along with me just like I take them snow skiing with me and hiking and camping with me. I think the hardest thing I have ever done is teach three little kids to ski, AT THE SAME TIME, by myself! The rewards are worth it all though when I go skiing now and they all tear it up down the mountain in front of me.
I listed my responsibilities in the title of this blog in order of importance to me. First comes my wife! I love my wife and I do everything that I can to support her and show her my appreciation for all that she does for me and my family. Last night when I got home I made my priority to help her in any way that I could, which included cleaning up ALL the laundry detergent that our three year old dumped on the floor of the laundry room, doing the dishes, and staying up through the night with the same three year old as she threw up all over her bed, clothes, carpet and bathroom! Yes, I had homework to finish and yes I was tired and NO I don't like cleaning up throw up but I try to maintain my priorities of husband, father, provider and student.
I also try to live by the rule that when Dad is home he is Dad and not student. When I get home I play outside with the kids and help with homework and dinner and dishes and holding the baby and LISTENING to all that they kids have to say about school and teachers and friends and funny things they saw or heard or did throughout the day. I strongly believe that when priorities are right, all other things fall into place or they simply drop out of our lives...which means that they are not necessary to begin with. Unfortunately, exercise has been one of those things that has no place or time in my life right now! I just hope that the time I spend walking to and from class will do the job for now!
The hardest of my responsibilities right now is being a provider. Going to school is great and being a husband and father are great but working while going to school full time is rough to say the least. If there is a will, and a loving and understanding wife, then it is possible to work and provide for a family and go to school full time. It requires long days and late nights and early mornings and a lot of patience but it is possible. We have a family motto this year, thanks to my great wife, that is keeping me alive and healthy through all of this. The motto comes from the Bible, Hebrews chapter 12:1-2, which says "Let us run with patience the race that is set before us, looking unto Jesus the author and finisher of our faith". Every single day I tell myself that I need to run with patience today and not be rushed but be calm and enjoy the world around me and I will get through the day.
For me, being a student is the easy part. I love what I am studying. I have many many ideas for research topics and papers to write and impacts to make in my field. I love learning new things and gaining new skills in geography, statistics, public health and research. I like to find and read new research papers and I like to work on problems that affect peoples lives and health.
I guess what I am trying to say is that no matter how much you have on your plate, if you have priorities and do your best to keep them, you can accomplish more than you thought possible. Some students are stunned when I tell them I have five kids...and then I tell them that I work as well and they say that it is not possible. I say that it is possible as long as you run with patience and take each day one at a time...and realize that the grace of God makes all things possible.

Beware of False Summits

So far this has been one of the most challenging mental and emotional climbs I have ever attempted. When I was 14 I climbed Gannett Peak in Wyoming with my Dad. At almost 14,000 ft. this is a technical and challenging climb for anyone. It required the use of crampons, ice axes, ropes, protection from the elements and a good deal of grit and determination. Being the youngest one in our group, I had no choice but to follow the footsteps of others and assume that I would either make it or die trying. Just before the summit there is a narrow snow covered ridge that must be traversed and I was not convinced that I would make it across that ridge alive.
Since starting my PhD in January of 2016 I have had daily thoughts of self doubt. Some days it is "I am not smart enough to do this" and other days it is "I should just go get a good paying job like everyone else and move on with life". I have to constantly remind myself that I chose to climb this mountain and there is great reward and satisfaction in setting a goal and seeing it through to the end. I even made a reminder for myself that I keep on my desk. It is a picture of Hayden Peak in the Uintah Mountains in Utah with the words "Give me this mountain".... printed in the top right corner. This phrase comes from chapter 14 of Joshua in the Bible where Caleb, who is now 85 years old, says "As yet I am as strong this day as I was in the day that Moses sent me...Give me this mountain".
So, while I could be sitting in an office making more money and thinking that I am moving on with my life I step back for a moment and hold on tight to these thoughts that keep me moving forward. I encourage everyone who has a mountain to climb to find your own quotes or stories or examples to cling to when everything says that you are not strong enough, or not smart enough or not old enough, big enough, fast enough or whatever. If you are willing to work at it and hang in there you will be made capable to the task!
One year before I even applied for a PhD program I was on a small hike in the Wasatch Mountains just east of Salt Lake City and I learned a profound lesson about not giving up. Do you know what a false summit is? Well, it is exactly what it sounds like...a false or fake summit that looks like the real thing but when you get there you realize that you still have a long ways to go. Well, I was climbing up a ridge towards a summit and there was not one false summit but three! As you climb you cannot tell that there is more mountain to climb because of your vantage point. The false summits block your view of the real summit and make you think you are closer to the end than you really are. In some ways it keeps you going because you think you just have to go a little more, only to realize that you were wrong. In another sense, it can be discouraging and frustrating feeling like you were deceived and have to go further than you thought you could. When I finally reached the REAL summit I sat down and pondered on what I had just experienced and how it applied to my life. I was making good money at a stable job and was somewhat happy...just like I might feel if I stopped at one of the false summits and thought that I had climbed enough and that I could be happy with result if I talked myself into it. My life was a false summit. I needed to keep on climbing and get to the real summit! For me that summit meant getting my PhD and learning to do independent research in medical geography. For others it will mean something entirely different but I encourage you to keep climbing until you reach the REAL summit and can look back at all the false summits you passed along the way and see how much you have grown.

The Dissertation

To begin with, the word dissertation comes from the Latin word "dissertatio", meaning "path".

I like this definition because it has to do with climbing a mountain. Getting on the correct path is the key, both at the beginning of the journey and staying on the path all the way to the end.

So how is a dissertation a path?

To begin with, most paths are not perfectly straight! A path winds around obstacles and up and down hills as it makes it's way to a destination.

When I began my PhD program I knew exactly what I wanted to study and write for my dissertation. I wanted to study Type 1 Diabetes and the environmental factors that are known to contribute to the development of the disease. In my first semester I found over 60 research articles on the subject and I began to read them and learn all that I could on the subject. My reasons for choosing Type 1 Diabetes were two fold. First, I have two nieces with Type 1 Diabetes and I have seen how difficult a disease it is to manage and how hard it can be on a young person and their family. I knew I wasn't in a position to find a cure but perhaps I could learn something about the onset of the disease and how to prevent it in the future. My project quickly expanded and I ran into the road block that all PhD students will face...GOOD DATA!

If you don't have good data to base your research off of then you are stuck in the mud. The problem with Type 1 Diabetes is that most of the data available combines both Type 1 and Type 2 Diabetes together. I was told many times that a good estimate for the number of Type 1 cases is 10% of the total. The two diseases are completely different and I couldn't believe that the data was still being combined. That left me with the option of collecting my own data and working with the local children's hospital to conduct a survey for all the newly diagnosed children with the disease. I would also need to find a control group and it would likely take about a year of data collection to really start to get some good data. The other obstacle I ran into was the fact that the strongest environmental factor, according to the literature, that was contributing to the onset of T1D were viral infections. In medical geography we attempt to map the explanatory variable and then spatially analyze the impact it might have on the at risk population near it. I cannot for the life of me figure out how to map viral infections, or viruses in general, and even particular viruses at that.

So...I was in Rockville, MD for a work conference and I was reading a Primary Care Needs Assessment from the State of Montana and a light bulb went off in my mind about a new dissertation topic that appeared to have much less data issues.

I was don't some work on Health Professional Shortage Aras (HPSAs) and Medically Underserved Areas and Populations (MUA/Ps) and I found a common theme that HPSA scores, which are a complicated system that I won't go into here, are not consistent with poor health outcomes in almost every area around the country. I immediately stated to map out the HPSA areas and get data from the County Health Rankings website so that I could do some preliminary analysis to see if this was in fact true. Come to find out that HPSA scores do not have a statistically significant correlation to poor health outcomes! This would be a great dissertation! The data is all public, it is relevant to my field of study, it has policy implications and I am already familiar with the subject.

So I went full steam down this path...until...again I talked to enough people and read enough federal regulations and manuals that I came to the conclusion that there is no point in correlating HPSA scores to health outcomes because HPSA scores were never meant to find the areas with poor health, they were meant to find areas with a shortage of providers and where NHSC providers might be placed. There goes that idea.....

Through all of this I have been reading many papers and learning more about my field of study and the topics of interest at this time. I am confident that I will figure out the next direction this "path" will lead me because I am not a quitter and I set my sights high and I know what it will take to get where I want to be.

One day I was walking across campus and I noticed a small tree near the path I was walking on and there was a plaque in front of the tree with the picture of a professor and a quote. It had a profound impact on me and has become almost the motto of my PhD journey.

"All things excellent, are as difficult as they are rare." - Spinoza

Medical Geography

I am a PhD student in Medical Geography...wait for it...

What is that?

I get this question almost 100% of the time I tell people what I am studying. I even get this question from doctors, nurses and other medical professionals.

One formal definition of medical geography or geomedicine is...

"The branch of medicine dealing with the effect of geography on disease." (source)

Another more complex description is...

"Medical geography studies the effects of locale and climate upon health. It aims to improve the understanding of the various factors which affect the health of populations and hence individuals. It is also called health geographics. The idea that place and location may influence health is not exactly new." (source)

So, let me ask you this question. Do you think that were you live has an impact on your health?

I can guarantee you that it does!!! It has been said that where you live (your zip code) has a greater impact on your health than your genetic code.

It has also been said that "Geography is destiny in medicine". - Jack Lord, MD

So why has nobody ever heard of Medical Geography or Geomedicine? Although it has been known for years that where you live has an impact on your health, it is a fairly new discipline in academia. It is not purely public health or epidemiology and it is not purely geography and spatial analysis. Geomedicine is a hybrid of the two disciplines. It requires an understanding of public health as well as the spatial analysis tools and skills of a geographer. Fascinating isn't it!

So, after saying all of that in response to the question "What is that?" I find that people are suddenly very curious and want to know more and talk for hours about their health and their family member who lived in North Salt Lake and was exposed to all the oil refineries and had numerous medical conditions, etc.

So what do I want to accomplish with a PhD in Medical Geography?

I want to improve public health by locating the environmental factors that are causing health problems in the areas around us. I want to improve access to primary care in rural areas and do research and write papers that influence policy and legislation with the end goal in mind of improving health. I want to find the areas with the most poor health and figure out what is happening and how the trends can be reversed.

Basically, I want to do research that makes a difference and changes lives, not sits in a library and collects dust.

Give Me This Mountain

This is a blog about my journey and climb through a PhD program in Geography at the University of Utah. I chose this title because it means a great deal to me, and perhaps to anyone who has, by their own choice or not, been given a mountain to climb and must dig deep into their soul for the strength to make the climb one day at a time. 

My journey began in the summer of 2015 and already (today is September 7, 2016) I have learned so much and climbed just enough to sit down and look back at where my journey began and what I have overcome so far. As with any climb, it is also a moment to look up and see how much more of the mountain there is to climb, which can be quite intimidating to be honest, but I have to remind myself every day that I chose to climb this mountain. There are many people who did not get to choose the mountains they have to climb and for them I feel deeply sorry and for them I continue my climb.

My purpose in writing this blog is to record my own development and to document my climb up this mountain we call a PhD. I also hope that this blog will serve to encourage and uplift others who are hard at work climbing whatever mountain they face. 

I have to admit that a PhD is a mental, physical and emotional challenge far greater than I ever realized. I may not be able to explain what I mean in a sentence or two, but over time I hope that it will become apparent through my writing why it is such a challenging and rewarding climb. 

If you feel inclined to comment about my posts please do so! I am happy to receive feedback, criticism, encouragement and what I call "gear" or "words of wisdom" to help make the climb and to help others make their climb!

Matt