Chapter 11: Taking on the Chair Position and Building Veterinary Medicine and Surgery
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In this chapter, Dr. Tinkey talks about several changes she brought to the department once she took over as chair.
She begins by explaining that from 2006 – 2006 she was serving as chief of the Section of Experimental Surgery and Imaging Support. She loved the job, she explains, and took on the chairmanship out of a sense of loyalty and duty to Dr. Gray.
She then provides an overview of the vision she brought to the role: having a centralized veterinary surgical service. She explains that research benefits when veterinarians are involved, bringing “surgical judgement” to animal research methods. She gives examples, discussing aseptic technique and leg amputations, noting that the latter creates chronic pain which, left untreated, can alter research results.
Next, she talks about changing departmental culture so that faculty and staff are all interested in “electronicizing” whenever possible (her term), i.e. always exploring how technology can help them perform better. She gives several examples: capturing information for datamining to evaluate workflow; using an iPhone to trouble shoot after-hours problems with animals; using a 3D printer to create a device to anaesthetize baby rats; creating an electronic medical records system for rodents.
She explains the importance of the EMR for rodents –an in-house written program (later replaced with a commercial version). This allowed for individual health care for valuable rodents. (Mice can cost $150 each.)
Identifier
TinkeyPT_02_20160607_C11
Publication Date
6-7-2016
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionOverview; Definitions, Explanations, Translations; The Clinician; The Administrator; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Professional Path; Care; On Care; Offering Care, Compassion, Help; Patients; Patients, Treatment, Survivors; Discovery and Success; Professional Practice; The Professional at Work; Collaborations; Understanding Cancer, the History of Science, Cancer Research; Technology and R&D; Discovery and Success; Working Environment
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Now let me just interrupt you for a sec here to get dates. So 2003 to 2006 you were deputy department chair.
Peggy Tinkey, DVM:
Correct.
T. A. Rosolowski, PhD:
OK, so that was the interim period after Dr. Gray had retired?
Peggy Tinkey, DVM:
No, he retired in 2006. That was part of the run-up, yeah.
T. A. Rosolowski, PhD:
OK, so that was a training period. So then 2006 to the present you’ve been department chair.
Peggy Tinkey, DVM:
Yes, that’s correct, right. And I think a few minutes ago you asked how I felt about stuff. And from 2002 to 2006 yes, I held a couple of administrative roles in the department. I was the attending veterinarian and also the deputy department chair. But my section role at that time, I was serving as section chief of Experimental Surgery and Imaging Support. And in Experimental Surgery we dealt primarily with the nonrodent animals. So rabbits, dogs, pigs, and primates. And it’s as it’s titled, Experimental Surgery. So MD Anderson, if anybody wants to do a surgical procedure on a nonrodent, it has to be done in the veterinary facility in our surgical suite. And the reality is I loved that job. I loved everything about that job. I like what I’m doing now, but when I look at my whole career, I don’t know if I’m that gifted of a surgeon, but a hands-on person is what I am. I’m a clinician and I’m a surgeon. So it was with a little bit of poignancy in 2005 when Dr. Gray said, “I’ve decided I’m stepping down, I really want you to be a candidate for my position.” It was what I knew he wanted, and it was what I believed I owed him. And it’s been great, don’t get me wrong. But I was leaving my dream job. And so there were some days I thought, Do I really want to do this.
T. A. Rosolowski, PhD:
You’re not the only person who’s talked about being -- to use a phrase -- reluctant administrator.
Peggy Tinkey, DVM:
Exactly. Because administration doesn’t leave you a lot of time to be a veterinarian really. And so that’s probably the thing that I miss the most right now in my current job, being with the animals on a daily basis. Because there are some days I don’t see an animal, I’m in meetings all day long.
T. A. Rosolowski, PhD:
Well, you’re looking at animals, but of another kind.
Peggy Tinkey, DVM:
Exactly. Right. But like I said, on the whole, I believe that’s what Dr. Gray had mentored me for. This is what he really wanted to see me try and do. And I guess this sounds a little arrogant. But the other thing that crossed my mind is well, Peg, if not you, who? Can you think of somebody who would do a better job? And there were probably lots of people. But to myself I thought do I really want to take the chance of having somebody come in and maybe they’re not Dr. Gray and golly, what if they make changes that I really don’t want to see in the department. Because I felt some ownership of the department. Am I going to be able to deal with that? So at the end of the day, I guess that’s part of developing the department. I did have things I really liked about the department, I really liked about Anderson, that I wanted to see continue. And I didn’t want to take the chance that somebody else with a different vision might come in and take us in a different direction, or maybe even a direction I thought was backwards for the animals.
T. A. Rosolowski, PhD:
So tell me about those. What were those things that you wanted to see continue that you wanted to develop?
Peggy Tinkey, DVM:
I had a couple of years where I went over to Baylor College of Medicine. Baylor has a great animal care program too but the culture is much different. One of the simplest ways I can illustrate that is they did not have a centralized veterinary surgical program. So a lot of the surgery including on large animals like dogs and primates and rabbits was done in surgical facilities that were out in research labs. Perfectly acceptable, perfectly within standards. The standards still have to be met, but there’s no requirement for animal surgery to be done in a centralized veterinary controlled facility as long as the standards are met. And so there are actually a lot of animal care programs that are like that. And it just depends on culture, how the institution developed and culture. But what I experienced at Baylor was it was very disconcerting to me to not know when animals were undergoing surgery as the veterinarian. I might be the veterinarian in charge of an area and walk in on a Monday morning to discover oh, they did surgery on Saturday and I didn’t know about that. So that’s a simple way to illustrate. While that’s perfectly acceptable and it worked for Baylor, it didn’t work for me. That’s not an indictment of the people doing the surgery. They were well trained. But I came away with a deep belief that the program I worked in needed to have more veterinary involvement than that.
T. A. Rosolowski, PhD:
So what value does that bring to the institution, to research? What value does that centralization have?
Peggy Tinkey, DVM:
Well, we talked a little bit last time that while there are many people who learn to do animal manipulations, whether it’s surgery or a particular technique, well, it’s different when you’re not a veterinarian. You haven’t been formally trained and educated in animals, their biology, their physiology, the appropriate way to anesthetize or give pain relief, or even to observe them and look for signs of pain. Veterinarians are formally trained to do that. When you’re not formally trained to do that and you learn that after the fact, you can certainly become competent at that, but that’s not who you are. And I don’t know a better way to articulate it. A good way I heard someone articulate it, we were talking about surgery. Actually the guy was giving a seminar about experimental surgery. And the statement he made was nonveterinarians -- and now we’re excluding human surgeons because human surgeons are formally trained to do surgery like veterinarians are trained to do surgery, so excluding those, we’re talking about someone who maybe has a PhD or something like that -- he said folks performing research can certainly be trained to do surgery, and they can be extremely well trained to do a particular procedure over and over again. And that makes them a great surgical technician. But what veterinarians and other people who have formal medical training have is surgical judgment. Meaning they can take skills they learned on procedure A and now they can do procedure B. And because they’ve been formally trained to assess the way tissues look and to handle tissues with their instruments and to have a feel for where you need to put suture and how tightly you need to ligate something. That’s surgical judgment. And so it’s translatable. You can have a veterinarian walk in and do a surgery they’ve never performed before in their life. And while they might not be expert at it, they’re going to be way better than someone who’s only been trained to do this one procedure and now all of a sudden they’re in a totally different area of the body and they don’t know what they’re doing. And so that’s just one small example I’ll give you in surgery. And I think you can expand that though. Like I said, when veterinarians who have spent four years and probably umpteen other years practicing their craft on animals and been formally trained to know the biology, behavior, and responses of animals come into a situation, they bring so much to the table that you can’t even articulate. It’s just a way of observing the animal. It’s judgment. It’s a feel for what the normal behavior ought to be.
T. A. Rosolowski, PhD:
So how does that surgical judgment, that biological judgment if you will, about the whole creature, how does that enhance or shore up the research integrity of a trial for example? Instead of having a PhD or someone who’s not trained performing the surgery and acting like the vet, what does the veterinarian bring to a research program along with that judgment?
Peggy Tinkey, DVM:
I’m trying to think of a good example. And one eludes me right now. But even something like pain relief, like we were talking about last time. For many years folks would do what we know, let’s say a leg amputation, we know this is a painful procedure. And because a mouse that’s been anesthetized and had a leg amputation within two hours of recovering from anesthesia will be moving around the cage and eating, the assessment I think for years and years by people was well, animal is perfectly fine. What we know now is chronic pain has huge impacts on research results and the immune responses of the animals and that the animals who have a leg amputation and who are given good pain relief have much more normal immunologic responses than animals who don’t. And that’s the kind of thing I think veterinarians bring. I might stand beside a cage along with someone else and look at an animal and this person is saying, “The animal looks perfectly fine to me.” And I say, “That animal is not perfectly fine. There’s four mice in the cage and your guy is over here in this corner by himself, that’s not normal mouse behavior. All these other guys in the cage just got changed, and all these other guys are sniffing and exploring and moving up and down, and your guy is walking very calmly, sitting down. Yeah, he’s not writhing in pain, but that doesn’t mean the animal is normal.” So it’s a lot of those kind of judgments because we’re looking at animals day in and day out every single day. And like I said, it’s not an indictment of our research community. But they’re many times so focused on their research results they forget to look at the animal. They don’t look at the animal. And we look at the animal.
T. A. Rosolowski, PhD:
Well, obviously the example that you gave about chronic pain and how pain can affect the immune system, all kinds of things, having that sort of awareness enables a research team to control factors that may be affecting outcomes.
Peggy Tinkey, DVM:
Absolutely.
T. A. Rosolowski, PhD:
It’s absolutely critical knowledge areas that you bring to the table.
Peggy Tinkey, DVM:
Right. And just things like aseptic technique. So aseptic technique is the basic standards that veterinarians use that say if you’re going to perform surgery you would shave the hair off the surgical site, apply a surgical scrub, put on a sterile drape, use sterile instruments, and wear sterile gloves. And honestly 20 years ago a lot of people didn’t perform sterile surgery in rodents because you would even hear people say, “Well, rodents don’t get infections.” And because we didn’t have lots and lots of mice dying of postsurgical infections doesn’t mean that they weren’t having some subclinical infections and skewing research results. So that’s the kind of value. Sometimes it’s an uncomfortable situation because veterinarians constantly challenge these techniques and standards that developed over the years before veterinarians were involved in the process. And now we’re having to come in and say just because an animal lives through something doesn’t mean that’s the right way to do it. There’s a better way to do it, and this better way will be better for your research. But there’s always that tension like I’ve been doing it this way for 15 years and everything’s been fine, why are you coming in telling me to change it now. So even though sometimes people find it uncomfortable, that’s the real value that veterinarians bring to the process. Because again their focus is the animal. We want to get the research done, but our focus is still the animal. The researcher’s focus is the research. And together we’re way better off than separately. But that doesn’t always mean it’s a comfortable fit right at first.
T. A. Rosolowski, PhD:
So tell me more about some of the areas that you began to -- you talked about being section chief and how that was a job you really loved. And first wanting to make sure that there was a centralized surgical service. What are some of the other practices that you were really really adamant needed to persist and things that needed to grow?
Peggy Tinkey, DVM:
Well, I could talk about a few things. They’re boring to tell you the truth, but you’ll hear people around the department laugh. We made up a word electronicize. One of my passions was how can we use technology to do our jobs better. That was a passion of mine just because I think my natural personality is, well, a couple things. One, I’m geeky, and I like technology and gadgets and things like that, especially if they make something easier for you. But the other thing is just hate to waste valuable time. And the example that I’ll laugh at. So one of the things I really have pushed always over the years is we’ve got a ton of electronic tools, programs, and applications, mostly computer-based stuff, at our fingertips. How should we be using these to make either our observation of the animals better, or communication faster, or response time faster? How can we use these things? It’s been several years ago now, but I was doing a review of something. I was just talking to somebody. And I said, “Well, tell me how you do that. And then what’s the next step? And so what then happens after that?” Come to find out one of my supervisors, we were trying to capture more information electronically so that we could actually mine it better, so we could see trends and things happening in an animal room. Let’s say maybe we were trying to report animal deaths, let’s say, mice found dead. Trying to see if there was a trend early that might tip us off there’s something going on here. And I had a supervisor who was getting information. I can’t remember now exactly but it was kind of like this. Getting information handed in in a hard copy format, a bunch of slips. And she was then typing all that information into an Excel spreadsheet. Good so far. Then she was printing the Excel spreadsheet and giving it to someone else who was typing it somewhere else. Bad, right? And we’ve encountered so many things like that in our department over the years where we just don’t look, we just do things robotically. It’s the way we’ve always done it. And I remember having that experience and I’m sitting here thinking you what, you type it into Excel and then you print it, that kind of thing. So that’s been one of my passions. And actually I guess it’s serendipitous because one of the national emphases now is reducing administrative burden in research. And while trying to do something more efficiently, taking it from 10 steps down to 5 steps, doesn’t sound like it’s a sweeping step in the right direction, all those things add up. All those things matter. So we’ve just really worked hard on upgrading our business applications. The circumstance I had the other day was I was on call on the weekend and I got a call from one of the vet techs. He said, “Got a cage of mice. And we’ve been watching the condition. And I’m not 100% sure. And I think the mice need to be looked at.” And I said, “OK, no problem. I’ll be there but it’s going to take me about 30 minutes to get there. I got to just jump in the shower real quick and then drive down there.” And he hesitated, I could tell. And I said, “What’s the problem?” He said, “Well, I’m in a hazardous containment suite right now, that’s where the animals are, and I can’t really go anywhere else. So I can’t continue my job. So I’ll have to sit here and wait for 30 or 40 minutes until you get here.” And I feel bad because the guy is working on the weekend. And he’s actually the one who said -- he said, “Dr. Tinkey, am I talking to you on your iPhone?” I said, “Yeah.” He said, “Well, I have my iPhone with me. Why don’t I put you on FaceTime and I’ll show you the mice? And if you can see what you need to see maybe it’ll work.” And I said, “Oh, Jack, that’s a good idea. Why don’t we do that?” So the bottom line is Jack let me examine the cage of mice for about 20 minutes over a FaceTime connection using our iPhones. I could see exactly what I needed. Like OK, see that one right there with the two stripes on his tail, could you pick him up, then set him there, let him walk around, uh-huh, uh-huh, OK, now can you show me that right rear leg, uh-huh, and turn him, aha. That kind of thing. So the bottom line is I was able to examine the mice, make a decision. I said, “Jack, this is what I want you to do. Go ahead and get that all set up. I’m still going to come down and look at the mice. But now you can continue on your way. Write up these veterinary orders. Now you can continue.” So he was able to do his work faster and continue. I was able to come in in a more reasonable fashion without breaking speed limits and take a look. And so it’s just things like that. All of my technologists now have iPads so they can do cageside, they can call us with FaceTime, they can call the researcher with FaceTime, communicate instantaneously.
T. A. Rosolowski, PhD:
That’s a great example. So I’m getting the feeling that this sort of attention to workflow and being creative in these situations is really a part of the culture of the department.
Peggy Tinkey, DVM:
I think it is now. And I’m not sure I can take 100% credit for it. I have to ask, but I think most people would say, “Oh yeah. Tinkey is much more geeky than Dr. Gray ever was.” So when I retire, if I feel like I started the culture that’s always willing to challenge a process, can we do this better, can we do this faster, can we do this using some sort of technology that allows us to utilize our worktime more efficiently, I think I can take credit for that, and that would make me happy. That would make me happy if I could do that.
T. A. Rosolowski, PhD:
Yeah, I don’t think that was boring at all.
Peggy Tinkey, DVM:
Well, the tech stuff is boring, I think. It’s not like oh, I created a new surgical heart valve.
T. A. Rosolowski, PhD:
Well, sure, but this is really the bread and butter level of how work gets done. Does a person need to spend an extra -- waste 40 minutes or an hour on something really silly as opposed to feeling they have the freedom to speak up and suggest and say, “Wait a minute, here right now on the spot is a better way to do this,” and make that happen?
Peggy Tinkey, DVM:
I heard something yesterday I really want to try. I was at journal club. And we were talking about something. And we were doing a journal article where newborn rats were being anesthetized with an inhalant anesthesia for a procedure. Now newborn rats are small. And their little faces are this big around. And their little noses. And I asked a question because that would be very hard to intubate an animal that size. I said, “Well, what were they doing, using a nose cone?” And we looked and the girl said, “Oh yeah, they must have been using some tiny little nose cone, I don’t know how they made it.” Anyway in talking about that somebody said, “Oh, I wonder if we could use a 3-D printer for something like that.” I’d never have thought of that. So I think we ought to be looking into can we make some of these. Because some of this stuff is not commercially available. One of the other girls said that she did some baby mice, not neonates but maybe 14-day-old mice, and she used the tip of a 1 cc syringe case. So we’re always trying to find something in our environment that we can use for something else. Ooh, a 3-D printer might be cool. I don’t know how those work. I’m going to check it out though.
T. A. Rosolowski, PhD:
Yeah. What kind of research would you use baby rats for?
Peggy Tinkey, DVM:
Well, so this was journal club.
T. A. Rosolowski, PhD:
An article.
Peggy Tinkey, DVM:
Yeah, so it wasn’t research being done here. I believe what they were doing on these neonatal rats is they were doing a stem cell injection into the liver and so they had to anesthetize the little guys and do that. We do have an investigator here though who’s doing a modified cell injection into the brains of one-day-old mice.
T. A. Rosolowski, PhD:
Oh wow. Those are tiny little creatures too.
Peggy Tinkey, DVM:
Yes, very tiny little creatures.
T. A. Rosolowski, PhD:
Super tiny, bumblebee size.
Peggy Tinkey, DVM:
Tiny little creatures.
T. A. Rosolowski, PhD:
Microsurgery.
Peggy Tinkey, DVM:
Definitely, yeah, he’s definitely working under a scope.
T. A. Rosolowski, PhD:
So tell me about some other -- you started on the discussion of the -- what was it?
Peggy Tinkey, DVM:
Electronicize. That’s what one of the people in the department, Stacy or somebody, says. She’s like, “Oh, Dr. Tinkey wants to electronicize everything.”
T. A. Rosolowski, PhD:
Sounds like you need department shirts.
Peggy Tinkey, DVM:
Electronicize.
T. A. Rosolowski, PhD:
Exclamation point.
Peggy Tinkey, DVM:
Exactly.
T. A. Rosolowski, PhD:
What are some other things like that that you feel you’ve created in the department?
Peggy Tinkey, DVM:
Well, we have a rodent health record database, an electronic medical record for rodents, that we created because we could not find a commercial application that worked. So that’s in-house-written. And we’re actually right on the brink of deploying a brand-new commercial application that we just purchased. In fact I got an e-mail today that said that the software vendor just uploaded it to our server and we’re beginning to play. We’re going to try and go live. It’s supposed to replace the in-house-written system that we’ve been using, gosh, for five or six years. So I’m very nervous because people get used to the in-house-written system because we could tweak it exactly like we wanted it. But I think we need to go to the new system because it’s almost like going from ClinicStation to Epic. We’ve outgrown our in-house system and we really need to go to something that’s more powerful that’s beyond our capability to write. But I’m su
T. A. Rosolowski, PhD:
So what did this EMR for rodents do? What did it enable you to do?
Peggy Tinkey, DVM:
So before we implemented the EMR for rodents, as I told you, in 2006 really we didn’t do a whole lot of individual health care on rodents, it was more herd health care. If an animal looked sick or had a lesion or had a research-induced illness, our default decision was well, we better euthanize the animal. But as we got more and more transgenic animals, as the value of the individual mouse got higher and higher because either it took them three years to develop the mouse or this is some -- I mean some of the mice we purchase right now are coming to us at $150 a mouse. So the stakes are -- you don’t want to like oh, well, it looks like it has a little boo-boo on its foot, better euthanize it. So we began to do more individual animal health care. But when we were doing mainly herd health, preventative maintenance, we kept a spreadsheet, but our individual animal records were on little slips of paper on the cage that when we were done with the case went into a filing cabinet. So there was absolutely no way to mine the data. There was no way to see trends in the room. It was really very difficult. We were using our brains saying, “Isn’t this the tenth mouse that Dr. Smith has had with the same condition? I think something’s going on with her research protocol.” But we were doing it from memory because it was hard to go back and see. So I just decided we have got to get these animal medical records in electronic format. So that’s what we did. One of the positions that I asked for when I became chair was for a programmer. So we hired a computer programmer and one of the early things she did, maybe not the very first thing she did, but I’m going to say golly, probably in 2007 or ’08 maybe, we said, “We need an electronic records database. And it needs to pull data.” We had a commercial application that allowed us to barcode the cages. So that system already had a lot of information in it. It had the investigator’s name, the protocol number, it had a unique cage card identifier. And I told you I really hate wasted redundant effort. So I’m like, “We’ve already got this information. I need you to write an interface to pull that information out and have it autopopulate if there’s a sick mouse in the cage.” Anyway she did it, she did a great job. So that probably went through two or three years of constant tweaking and we deployed --
T. A. Rosolowski, PhD:
What was the name of this person?
Peggy Tinkey, DVM:
Ambika Baburaj. So she worked with our group of veterinary technologists and our clinical veterinarians. And they met routinely over the course of a couple of years. It’d be like how’s that working for you. Well, this works but that doesn’t. Now they have iPads, but at the same time, we purchased tiny little laptop computers, like the ultra. We purchased notebook computers for all the technologists so they could take them with them. If they entered the cage card number, the data popped up, and then they could say, “One of five mice in the cage has a tail lesion. We’re putting it on topical antibiotic ointment and an antibiotic in the water.” And that was cool because then the vets could go back and say, “Dr. Smith has had 10 mice with tail lesions in the last two weeks. Somebody in Dr. Smith’s lab doesn’t know how to do tail vein injections.” And we would contact Dr. Smith’s lab and train them to do tail vein injections. So it’s been really really good. But any time you electronicize, one of the things I thought was so frustrating is so they wrote this integration, they began to write the database. We went out and bought notebook computers for everybody. At the same time because of a different IT project they were putting wireless coverage throughout the whole animal facility. I’m like, “Cool, we can leverage this.” So I was all happy and we got these notebook computers with everybody. And instantaneously all the technologists are like, “The wireless coverage is spotty. I can get it in two rooms. I can’t get it in the third room. I’m halfway through the data entry and the connection dropped. It’s horrible, it’s terrible, it’s taking me so long.” So we had to walk through a yearlong process. And that wasn’t in my control. So I was constantly calling IT saying, “Hey, the wireless down here isn’t working. I’ve got to have it. My people can’t connect.” It’s better now but I remember it being so frustrating for a while because we had this great product and it’s frustrating when you have a great product and something like the third room in the suite the wireless connection drops and you can’t get your work done. And the IT Department goes, “Well, it looks good to us.” “Come down here.”
Recommended Citation
Tinkey, Peggy T. DVM and Rosolowski, Tacey A. PhD, "Chapter 11: Taking on the Chair Position and Building Veterinary Medicine and Surgery" (2016). Interview Chapters. 1231.
https://openworks.mdanderson.org/mchv_interviewchapters/1231
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