JOINT BASE LEWIS-MCCHORD, Wash. — Medical knowledge and practice advance through significant, long-term investment in research. Madigan Army Medical Center on Joint Base Lewis-McChord makes that investment and celebrates it every spring. On Friday, May 5, the Col. Pat C. Kelly Madigan Research Day offered up 13 podium presentations and 64 posters detailing research done at Madigan over the past year.
The morning started with brief introductions by Lt. Col. Jacob Hogue, the chief of the Department of Clinical Investigation, and Madigan Commander Col. Jonathan “Craig” Taylor, and quickly moved into the podium presentations.
Consisting of preclinical, clinical and quality improvement and program evaluation categories, the podium session gave presenters the opportunity to highlight their research in subjects including the duration of breastfeeding, developing training on sexual assault for healthcare professionals, pain therapies and mindfulness and stress mitigation, to name just a few.
Sandwiched between the preclinical and clinical sessions was the Maj. Gen. Jack K. Gamble Memorial Medical Lecture by U.S. Navy Capt. Sherri Rudinsky, a physician and the chair of the Department of Military and Emergency Medicine at Uniformed Service University of the Health Sciences School of Medicine in Bethesda, Md.
Rudinsky’s lecture was titled, “Preparing the next Generation of Military Medical Officers: Innovative Research Opportunities in Simulation-Based Education.”
She noted that the unique requirements of operational medicine — the need to adapt and provide medical care in deployed environments that are, by definition, dangerous — means the contemporary military medical officer needs a nuanced skill set beyond what the education they traditionally received would produce.
Conducting studies to get a handle on how military medical officers feel their education prepared them to render care in the wide variety of circumstances they may find themselves, the need for more military-specific elements in the curriculum is clear.
While most felt well-prepared to comfortably practice medicine in a clinical environment, fewer than half deemed themselves ready to perform with confidence as deployed physicians.
These studies revealed that the number one barrier to building more operational elements into medical education was time. While the ability to conduct field training exercises is limited due to their need for extensive planning and resources, simulation is part of the answer.
“Simulation, we know, is a broad spectrum of modalities, from the simple to the task trainers to our role players all the way to immersive, large-scale, high-fidelity simulations. And certainly, all modalities have their strengths and weaknesses and really need to be utilized in a way that makes sense,” said Rudinsky.
Task trainers — mannequins that are usually just a part of the body for medical professionals to train on — are in common use for doctors, nurses and technicians to practice skills like drawing blood, putting in an IV or intubating — putting a tube down a patient’s throat.
Top-of-the-line simulators have become surprisingly life-like. Some have simulated breathing, heartbeats, pulses and come complete with layers of skin, fat and muscle.
Madigan’s Charles A. Andersen Simulation Center has a variety of simulators for all types of training opportunities.
Rudinsky argued that just as a physician would not be expected to perform a procedure for the first time on a patient in an emergency room, neither should a military physician experience some of the aspects of providing military medicine on their first deployment.
At USUHS, they take a gradual approach to incorporating operational medicine into the curriculum.
First year medical students play the roles of patients in the large-scale battle-type exercise. They see first-hand how a team of medical professionals works together in a stressful, dangerous situation to provide care to their teammates.
From there, they enter their own teams that grow with each passing year, as does the level of care they provide in the exercises — from initial assessment of the injuries of a patient to prolonged care in a combat environment with limited resources, equipment and personnel to treat that patient.
Their last year brings all of the lessons together and they are the student leaders in the large-scale exercise. The communication, teamwork, leadership, stress management and other skills they have developed in these exercises is intended to better prepare them for deployed situations later in their careers than training in a classroom or clinic could.
Rudinsky said of the years of these simulation exercises, “They really grow and progress over time, and it really solidifies the learning.”
While Madigan does a single exercise with its graduating residents each year in May, they repeatedly voice that it has the same impact on their learning of giving them a deeper understanding of what to expect in terms of operational medicine.
In answering questions from the audience about making the most of simulators and simulation, especially when some of the equipment is very expensive and difficult to maintain over time, Rudinsky advised to develop a very solid set of objectives for training and work backwards. This way, the design of the training, and what equipment is needed, is focused on what the students will learn. She noted that the high-end mannequins may be great, but they aren’t always what meets the training need the best, which is what should always be the focus.
Following a morning of podium presentations, the DCI opened its doors and hallways for a luncheon and the poster judging session. Each of those 60-plus posters were displayed on the long hallways of the ground floor research area of Madigan.
Standing beside their work, the residents and interns engaged instructors, staff, researchers from partner organizations like the University of Washington and Geneva Foundation, as well as their own classmates in their research. They answer questions about their posters and the research findings they displayed.
While there was some nervousness, the electricity in the air seemed mostly excitement at sharing a year’s worth, or sometimes more, of research.
Maj. Joshua Monson, a resident in the obstetrics/gynecology program, smiled broadly as he stood next to his poster with original research.
Monson appreciated, “Being able to go back to the primary sources.” He enjoyed taking a deeper dive into research than he had before, learning how to better apply what he found to his own field of medicine.
For Capt. Timothy Wright, a urology resident who had two posters on view, collaboration made the experience especially valuable.
“It’s a cool opportunity to work beside other people in the hospital, from different specialties and from the other departments of the hospital,” he said. “I was able to work with the statisticians, the folks in DCI and the radiologists, and get involved more.”
It was exactly this interaction with other staff that made Capt. Johanna McGrath’s research highly meaningful to her when her OB/GYN patient ran into difficulties with her pregnancy.
“We actually involved so many other services like general surgery, anesthesia, the nursing supervisor, our nursing staff, and the ICU was aware of her, and that's not normal for most of our patients, because they're generally very healthy and they go home after one or two days. So, this experience really showed me about being very aware of when a patient needs multidisciplinary care and being open and communicating with those services. Going forward, I think that's something for me to actually really think about when I see a patient that may not be our typical, healthy mom,” said McGrath.
The day closed out back in Letterman Auditorium with an award ceremony that included honorary awards for a year’s worth of service to research at Madigan as well as the winning presentations and posters. Visit Madigan's Facebook page to see all the award winners.
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