MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – The Col. Pat C. Kelly Madigan Research Day is a day for big words and big ideas. One of the lessons a fledgling doctor must learn is how to communicate the complex medical information they understand into laymen’s terms for their patients. Each May as the academic year comes to a close, MRD suspends that expectation fully and doctors in training at Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., get the chance to delve deep into a communal exploration of the leading edge of the field of medicine.
Medical professionals, to include doctors in over 35 resident, intern and fellowship programs as well as staff, presented a wide array of research findings in the form of podium presentations and posters.
“A day like today takes a lot to pull together,” said Madigan Commander Col. Jonathan Craig Taylor, acknowledging the effort and hours of planning that go into just the presentation of these research protocols.
With over a dozen podium presentations and four and a half dozen posters, the involvement of Madigan staff is extensive. This day is the culmination of months, sometimes years, of research.
Research posters offered a visual description of study findings. They constituted a significant part of Madigan Research Day, which has become a misnomer as DCI now makes these posters available digitally to staff on the organization’s intranet as well as supporting a display in the Medical Mall for the week preceding MRD itself and just outside the auditorium throughout the day of presentations.
The 50-plus posters fell into the categories of case reports, pre-clinical, clinical and quality improvement research studies.
Some posters contained QR codes to direct viewers to additional information and references for the research displayed. Each used every millimeter of space to convey some important aspect of the protocol or the study’s findings.
Similar to the poster categories, podium presentations by the lead researcher fell into the last three categories.
Gamble Lecture
While each of the presentations is a tight summation of a researcher’s study, the featured address comes from an invited speaker who is prominent in military medicine. Dr. Kevin K. Chung, who is a retired Army colonel and current professor of Medicine and Surgery and the chair of the Department of Medicine at Uniformed Services University School of Medicine in Bethesda, Md., fits that bill perfectly.
A graduate of the U.S. Military Academy at West Point and Georgetown University School of Medicine, Chung wanted to go to Walter Reed, then Army Medical Center, as his first rotation site. The Army had other ideas and sent him to Eisenhower AMC at Fort Gordon, Ga., where he grew to love the field of critical care in the company of some real standouts and pioneers in the field.
His ensuing stops at Walter Reed, with work in the Washington, D.C. medical community that includes Bethesda, then Naval Hospital, the National Institutes of Health, Johns Hopkins University and others, gave him a wider perspective on how medicine can be practiced with varying approaches.
His time at the Institute of Surgical Research, which is synonymous with the Army Burn Center, opened his eyes further and, in the wake of 9/11, provided ample opportunities to conduct research and innovate.
Chung worked pretty much every day, weekends included, for the first three years he was there; he felt such an obligation to these service members who were suffering so badly.
He figures that commitment allowed him to pack a decade’s worth of experience into those first three years.
“I basically had the ability to and had the experience of following patients from day of admission all the way through discharge; and some patients were there for over a year in the ICU. These are burn patients. When you’re there every day you notice patterns, you notice very subtle things that occurs from a day-to-day and I think that helped shape me as a clinician and it really, really made me a better doctor by being at the bedside every day,” said Chung on the Hills and Valleys podcast in 2019.
For his lecture at MRD, Chung employed a simple yet powerful framework for his lecture that cut to the heart of the dual-minded instinct of the doctor - a scientist who is always searching for a way to help heal and sustain their fellow humans.
Chung prefaced each new chapter in his career of searching for solutions with a service member who prompted that quest with a problem that claimed their life.
Again and again he showed a photo of a young service member who found themselves in Chung’s care, almost all of whom died of their injuries.
Working in the Institute for Surgical Research, Chung quickly identified that some of his patients died because of poor communication.
As an injured service member was transported from the site of injury through levels of care, across continents, and finally to the ISR, the providers along the way followed the established standard of care, but it was lacking an adequate accounting of some of the care rendered, specifically, how much fluid was given to these patients. Many were given too much as documentation was lacking for this metric at each handoff.
Chung worked with his team, walking the biomedical engineer through the creation of a flowchart that was then put into an algorithm.
“This is now on an app. It’s been licensed to a company and 20 percent of all burn resuscitations around the country are now done with the burn navigator. And, in fact, just recently, we briefed the Ukraine physicians, war physicians there, and they're adopting this as well,” said Chung.
This solution was prompted by the loss of Sgt. 1st Class Alwyn Cashe who escaped a Bradley fighting vehicle that hit an improvised explosive device only to be severely burned when he returned, doused in fuel, to the vehicle to save his fellow Soldiers.
Through multiple handoffs across continents, Cashe was given too much fluid and Chung and the ISR team were not able to save him.
“Although standard of care was not enough for Alwyn Cashe, I guarantee there have been lives saved as a result of his death inspiring this type of innovation,” stated Chung.
Chung displayed a photo of Spc. Darren Howe and spoke of how the kidney injury he developed spurred the ISR team, particularly the nurses, to start a renal replacement therapy program that provides treatment over a longer period of time to put less pressure on a patient’s organs, especially the heart, allowing greater stability.
Again, where the standard of care was not enough for the warfighter, the team innovated to raise the standard of care to meet the increased need presented by current conflicts.
Chung has published a considerable amount of research findings, many within his work in critical care and burn treatment. His latest research has been in treatments for COVID-19. In addition to the aforementioned podcast, like many leaders in medicine today, Chung uses numerous forms of communication to reach audiences interested in medicine, especially military medicine.
Chung has posted on his experiences as a doctor covering the ICU during the omicron surge and has offered inspirational messages with kudos to the medical staff around him.
History of research support
This was the second time Chung provided the keynote speech for MRD that is named for Maj. Gen. Jack Gamble who served at McChord, then Air Force Base, in the 1960’s and ‘70’s, and was a founding member of the Madigan Foundation, a volunteer organization formed by champions of Madigan to support military families and their quality of life as patients of Madigan.
Madigan’s base has long been a center for teaching the next generation of medical professionals. During World War II, for example, Madigan trained hundreds of nurses to care for wounded Soldiers returning from battlefields in the Pacific theater. It is now one of the premier training facilities in the Department of Defense.
Within five years of opening its doors, Madigan AMC, then known as Madigan General Hospital, had a residency program to train new doctors.
Madigan developed research elements of its training programs that have now become the standard across the DoD.
The day concluded with an award ceremony for the various categories as well as honorary awards and words from the commander.
“It’s been a very inspiring day for me. It reminds us that we can see a complex problem, again, particularly in military medicine, I appreciate that we have a talented and energetic group that wants to solve those problems. I think about the problems, that I think Dr. Chung highlighted so well, that we have seen in the last two decades or more and we have said, ‘You know what, we can solve that problem.’ What I appreciate so much is the team here at Madigan is an extraordinary group of problem solvers. I think you look across what was presented today and across a research portfolio that has 240 or so active protocols, we are trying to solve the problems that actually make a difference and help bring all those people home. Thank you for that and thank you for this day,” said Taylor.
Awards
All award photos by Ryan Graham
Madigan Foundation Research Award (with $2,500 grant)
Lt. Col. (Dr.) Joseph Galvin for project titled: “Gene and protein discovery in the synovial microenvironment." Award accepted by MAJ Joseph Dannenbaum from Dr. Dave Soma from the Foundation
Honorary awards:
Charles A. Andersen Award for Simulation Research: Maj. (Dr.) Kyle Couperus
Brig. Gen. Mack C. Hill Facilitator’s Award: Mr. Troy Patience
Nancy Whitten Research Regulatory Staff Award: Dr. Nicholas Ieronimakis
Brig. Gen. George J. Brown Mentor’s Cube: Lt. Col. (Dr.) Bruce Pier
Research Manuscript Awards:
Maj. Gen. Byron L. Steger Resident Research Manuscript Award: Capt. (Dr.) Kendal Rosalik, OB/GYN; “Surgical menopause and impact of cardiovascular events: A cross-sectional study on timing of bilateral oophorectomy”
Madigan Foundation Fellow Research Manuscript Award: Capt. (Dr.) Sarah Ligon, maternal fetal medicine, OB/GYN; “The influence of fetal sex on neuroinflammation and antepartum treatments in a murine model of preterm birth”
Maj. Gen. Kenyon Joyce Staff Research Manuscript: Dr. Shashikumar Salgar, DCI; “Stem cell, granulocyte-colony stimulating factor and/or dihexa to promote limb function recovery in a rat sciatic nerve damage-repair model: experimental animal studies”
Outstanding Research Posters:
Most Outstanding Case Report Poster: Capt. (Dr.) Maxwell Jensen, DoM/Internal Medicine; “Wet beriberi in a patient with chronic malabsorption and restrictive diet”
Original Research and Quality Improvement Poster: Dr. Tyler Snow, Rehabilitation Medicine; “Use of a treadmill, lift, and carry battery as a composite functional neurodynamic test”
Outstanding Research Podium Presentations:
Most Outstanding Podium Presentation Award in the Preclinical Category: Capt. (Dr.) Danny Lammers; “Recombinant coagulation factor synthesis via CRISPR/CAS9 targeted gene overexpression”
Most Outstanding Podium Presentation in the Clinical Category: Maj. (Ret.) Sherrill Schaaf, PA-C; “The impact of pain catastrophizing on military readiness”
Most Outstanding Podium Presentation Award in the Quality Improvement Category: Maj. (Dr.) Joseph Dannenbaum; “Total joint replacement outpatient pathway: multi-disciplinary team transition to outpatient joint replacement”
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