How MSc in EBHC alumnus Dr Lance Sese’s dissertation research could significantly aid decision-making in tailoring care before, during, and after paediatric neurosurgery.

About the author

Dr Lance Sese is an MSc in Evidence-Based Health Care (EBHC) alumnus and Internal Medicine Trainee based in Newcastle. A budding researcher, he has strong academic and clinical interests in both neurosciences and cardiovascular medicine, and intends to pursue higher specialty training and doctoral studies in one of these fields in the future. Prior to taking his MSc at Oxford he finished a Bachelor’s degree in Health Sciences and pursued a dual degree of Doctor of Medicine and Master in Business Administration all at the Ateneo de Manila University in the Philippines. Following his registration in the UK to practice medicine, he worked as a resident in stroke medicine at the National Hospital for Neurology and Neurosurgery (NHNN), Queen Square, London for a year where he was actively involved in several clinical trials, and worked as a clinical fellow in neuromuscular diseases in the same hospital.

WHY DID YOU CHOOSE THE OXFORD FOR YOU MASTER'S PROGRAMME AND WHAT HELPED YOU MAKE THAT DECISION? 
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When I began exploring options for my post-graduate study, I was fortunate to have received offers from leading universities, such as Harvard University, Johns Hopkins University, and Columbia University. However, the University of Oxford stood out to me, not only because pursuing further studies at Oxford has always been my dream, but I found that its MSc in Evidence-Based Health Care offered more than world-class academic training. It also offered the flexibility of a hybrid (online and in-person) format, which allowed me to continue working as a doctor while pursuing my master’s. I found modules I had done in study design and research methods, medical statistics, systematic reviews, and meta-analysis particularly helpful in doing and participating in research in Queen Square.

WHAT HAS YOUR EXPERIENCE OF THE PROGRAMME BEEN? 
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As an alumnus, I have nothing but words of affirmation and praise towards the entire Centre for Evidence-Based Medicine team who made my experience in Oxford very memorable. I have always been passionate about using evidence to inform and improve patient care, and this programme aligned perfectly with that ethos. The hybrid structure also allowed me to balance my studies alongside full-time clinical work in the Philippines during the first half of the programme, and then in London, which was something that I never thought would be feasible. Despite the physical distance at times, I always felt intellectually connected and well-supported by the faculty and my peers.

Lance with fellow students and tutors on the Medical Statistics module

One of the programme’s strengths is the approachability of its faculty. Dr Annette Plüddemann and the entire team consistently created a welcoming environment where curiosity was encouraged, and no question was too small. I vividly remember instances when discussions about evidence-based medicine principles would continue over a cup of tea after class. Prof Carl Heneghan, who was my supervisor, was also very supportive and he answered all my questions when I was doing my dissertation. I believe this intellectual camaraderie fostered by mentors and peers has greatly contributed to my being able to finish the degree with a distinction – that is, one just needs to ask a lot of questions.

WHAT WAS YOUR RESEARCH FOCUSED ON? HAVE YOU SUCCEEDED IN PUBLICATION?____________________________________________________________________________________________________________________________________________________

My research focused on analysing available literature on hospital readmissions of children who had undergone neurosurgical procedure. Paediatric neurosurgery often involves complex, high-risk cases, making readmission rates a valuable indicator of both complications and potential gaps in perioperative care.

As part of my MSc dissertation, I chose to do a systematic review. Over 2,500 studies were screened, and in the end, 52 studies were included. The majority of these 52 studies were retrospective cohort studies from the United States focusing on cranial procedures, such as shunt placements for hydrocephalus and cranial tumour resections. A meta-analysis, though initially planned, was not performed due to heterogeneity in study designs, outcome definitions, and overlapping patient cohorts, especially from large US national databases.

With the help of a colleague during the data extraction process, we identified 34 different significant risk factors affecting readmission. Some examples included:

• Patient age: younger children showed higher odds of readmission as compared to older children.
• Procedure-specific risks: early shunt revisions and anterior approaches in spinal fusion surgeries being associated with higher readmission.
• Aetiology-related factors: infectious causes for early shunt revisions showed higher readmission likelihood.
• Sociodemographic factors: race and insurance type, with minorities and publicly insured patients being more vulnerable.
• Hospital characteristics: larger paediatric hospitals generally had lower readmission rates, though the relationship between hospital volume and outcomes was complex, with some high-volume centres showing worse outcomes for specific procedures like shunt surgeries.

Understanding these risk factors can significantly aid decision-making in tailoring care before, during, and after surgery. We envisioned to share the findings of the study to highlight what clinicians, and the entire multi-disciplinary team should be aware of, especially when discharging paediatric neurosurgical patients. This was made possible when the study was accepted for publication. I am extremely grateful that this work was published in the prestigious British Medical Journal Open in July 2025. The study can be found here: https://bmjopen.bmj.com/content/15/7/e093459

SO, WHAT ARE YOU PLANS NOW FOR THE FUTURE?_________________________________________________________________________________________________________________________________________________

I plan to pursue a DPhil/PhD someday – probably, when I have finished my internal medicine training, prior to higher specialty training. I am strongly considering pursuing the DPhil in Evidence-Based Health Care at the University of Oxford.

WHAT WOULD YOUR ADVICE BE TO STUDENTS CONSIDERING STUDYING YOUR PROGRAMME AT OXFORD?________________________________________________________________________________________________________________________________________________

If you are passionate about improving healthcare through critical thinking, this programme is worth pursuing. The MSc in Evidence-Based Health Care at the University of Oxford offers more than just academic excellence in training. It equips you with the tools to ask meaningful questions, critically appraise evidence, and effectively contribute to improving patient care.

My advice is to come with an open mind and a sense of curiosity. Do not be afraid to ask questions whether this be in the lecture rooms, over lunch, or even over a casual cup of tea with faculty during breaks. For me, the community in Oxford is top-notch as you will be surrounded by passionate like-minded individuals from all around the world. You do not need to have everything figured out prior to coming as the programme will support you along the way.

Learn more about the MSc in Evidence-Based Health Care and watch videos of our students talking about their experiences on the programme.