USA Health surgery resident wins regional paper competition

Richard Rieske, M.D., a surgery resident and postdoctoral research fellow in the University of South Alabama department of surgery, recently won the American College of Surgeons Regional Resident Paper Competition for Region 4. USA has won the regional competition four times in the past six years.

Rieske’s research highlighted the work conducted in a year spent in the lab with Jon Simmons, M.D., associate professor of surgery and pharmacology at the University of South Alabama College of Medicine.

Rieske’s research examined the blood of trauma patients and discovered that those patients with elevated DAMPs (molecules that trigger inflammatory responses via pattern recognition receptors) in their blood were more likely to die or have serious injuries. From this, they tried to understand where DAMPs come from and how they impact the survival of trauma patients. The work found that blood products contain unrecognized cellular contamination, and this could be a source of harmful DAMPs in trauma patients who receive multiple blood products.

“We learned that plasma, which physicians typically regard as a blood product that doesn't contain blood cells, contains significant numbers of white blood cells,” Rieske said. “This is a problem because these cells can interact with the immune system in the patient or may lead to inflammatory reactions.”

Since blood transfusions are an essential part of trauma care, Rieske says that they don’t yet fully understand all the implications of what they have discovered about giving large amounts of white blood cells to trauma patients.

“This research helps us ask important questions about how we produce blood products and how we ensure the safest use of blood products in trauma patients,” Rieske said.

Rieske was one of two USA Health residents to win at the state level and then compete at the regional competition in South Carolina. He was scheduled to present at the national competition in March, but this has been rescheduled due to concerns about COVID-19.

“This is the most prestigious resident research award for trauma from the American College of Surgeons,” said Michael Chang, M.D., chief medical officer for USA Health. “Participating in the national competition will be a wonderful opportunity for him to get exposure for the great work he’s doing, and sends the message that the research that Simmons’ group is doing is cutting-edge in the resuscitation of injured trauma patients internationally.”

YouTube channel goes behind the scenes of emergency medicine

Larry Mellick, M.D., professor and vice chair of emergency medicine at the USA College of Medicine, is the creator of a YouTube channel for medical education. 

A ring stuck on a swollen finger, a dislocated shoulder, a foreign body in the nose – these are a few reasons people might seek emergency treatment. They are also video topics of a popular YouTube channel that goes behind the scenes of emergency medicine to support medical education.

Larry Mellick, M.D., professor and vice chair of emergency medicine at the University of South Alabama College of Medicine, created the channel in 2010. At the time, he worked at the Medical College of Georgia in Augusta. The videos served as an additional resource to teach medical students and residents about scenarios they might encounter in the emergency department.

“It became a much better way to teach procedures,” said Mellick, who also serves as division chief of pediatric emergency medicine at USA Health. “Having a real patient involved – not just a simulation or a PowerPoint presentation – is so much more powerful from an educational perspective.”

Screenshot of Dr. Larry Mellick's YouTube channel

When he joined USA Health in February 2018, Mellick started a new YouTube channel. However, he couldn’t replicate the success of his existing channel, which already had a loyal following. Mellick worked with USA Health’s legal team, compliance officers, and marketing and communications to rebrand his original channel to USA Health.

Before being uploaded to YouTube, each video is vetted through a peer and compliance review process, Mellick said. In addition, all patients and family members featured in the videos have given signed consent to be filmed and have their stories shared.

“We greatly respect and care about our patients’ rights and privacy,” Mellick said. “People are making personal sacrifices to allow these videos to be made for education purposes. I feel sincere gratitude to patients who have made that sacrifice because of the impact it has had on learners all over the world.”

The videos are popular with a spectrum of learners including medicine, paramedicine, nursing, respiratory therapy, coding and billing, as well as practicing clinicians, Mellick said.

“The importance is to be real. This is real medicine,” he said.

Mellick said the videos also attract viewers who are searching for information about a recent diagnosis or who are awaiting a procedure in the emergency department.

“Patients will go to YouTube and look up what their doctor is talking about following initial conversations,” he said. “They also search for answers about a specific diagnosis and related treatment.”

Mellick said the videos have even saved some lives. “I personally have had several patients reach out to me in the comments and I advised them that they needed to go to the ER immediately. A week or two later I found out through the patient that they had undergone emergency surgery,” he said. “I have also had occasional testimonials from physicians about how the information in the videos helped them save a life.”

The channel has 333,000 subscribers, and 26 videos uploaded to the channel have more than 1 million views each. The channel’s most popular video to date demonstrates the management of a nail gun injury. Appropriately titled “Finger Nail,” the video has more than 22 million views.

Mellick said the videos have a broad appeal because of the lay public’s fascination with medicine and the videos’ human interest component. He has seen an increase in views over the past two months, which he attributes to people being at home and watching more videos during the coronavirus quarantine.

The channel is monetized, and Mellick donates all proceeds to the USA Health Emergency Medicine Residency Program to support training and education in emergency medicine.

Mellick edits the videos on his own time, usually late at night. “Sometimes I need a break from my academic endeavors to explore my artistic side,” he said.

Visit Dr. Larry Mellick's YouTube channel to watch or subscribe to USA Health emergency medicine training videos.

Third-year students to return to clinical rotations

Medical students round with attending and resident physicians at University Hospital in 2019.

After 10 weeks on virtual clerkship rotations because of COVID-19, third-year medical students at the University of South Alabama College of Medicine will return to USA Health hospitals and clinics starting June 1.

T.J. Hundley, M.D., associate dean for medical education, said that the students will follow all screening and PPE requirements set forth for USA Health employees to reduce the spread of infection, and will not be allowed to treat COVID-19 patients.

“The faculty and residents are excited about getting our students back into the clinical environment where they can see patients, interact with them and learn those critical skills that complement the medical knowledge they’ve been gaining while they’ve been outside the clinical environment,” Hundley said.

Classes at the USA College of Medicine transitioned to an online learning format in March in response to the COVID-19 pandemic. Faculty members used Zoom video conferencing to post team-based learning exercises, including lectures and interactive case studies, allowing students to interact with faculty and ask questions.

The shift was significant for third-year clerkships, which form the foundation of the third year of medical school. Rotating through clerkships in family medicine, internal medicine, neurology, OB-GYN, pediatrics, psychiatry and surgery, students begin to apply the knowledge they gained during their preclinical years to real patients under the direction of resident and attending physicians.

Third-year medical student Jordan Smith said she is relieved and grateful to be returning for the final two weeks of her internal medicine rotation. “Internal medicine is known for being the clerkship in which you see the same patient every day for up to four weeks,” Smith said. “You can really develop a deeper relationship with your patients and their families.”

Third-year medical student Ravi Rajendra was preparing to begin his orthopaedics elective when the college transitioned to virtual learning. “My dream is to become a pediatric orthopaedic surgeon, so initially I was sad that my orthopaedics elective would not proceed due to COVID-19,” he said.

Rajendra was still able to round virtually with faculty and residents in his pediatric rotation. “Although I am not physically at the hospital, I have been able to learn about newborn care and, to my delight, about certain pediatric orthopaedic conditions that can affect the newborn,” he said.

Lynn Batten, M.D., associate professor of pediatrics, said that some – but not all – lessons can be taught virtually. Faculty can present cases and ask students to develop their clinical reasoning skills by formulating a differential diagnosis and considering what tests to order and why.

“The things they’re missing in the virtual environment are the patient interactions – actually putting a stethoscope on someone and deciding if there’s a murmur and what it is,” she said. “They’re missing the humanistic side of medicine – touching a mom’s shoulder and reassuring her that her child is going to be fine, or calming down a scared toddler by juggling his shoes to make him laugh. We hope to provide those experiences for them when they come back.”

Hundley said that students will return to the clerkship rotations they left, ensuring that they don’t miss out on important skills.

Also, returning in June will keep the class from having to make up hours in July, thus keeping the fourth year mostly on schedule, said Smith, who will apply to urology programs in the fall. “Not having to make up clinical time will allow us to study diligently and ace board exams, complete and excel in acting internships for letters of recommendation, and also ensure that the Medical Student Performance Evaluation will be completed by the time we begin to apply for residency. It cannot be understated how important this is.”

Lee receives AAST research scholarship

Larry Lee, M.D., assistant professor of surgery at the University of South Alabama College of Medicine, was recently awarded an American Association for the Surgery of Trauma (AAST) Research and Education Fund Trauma Critical Care Scholarship for the 2020-2021 academic year.

The $50,000 award supports Lee’s research project “Immunomodulatory effects of cellular contamination in plasma products for transfusion.”

“Our project seeks to better understand how the white blood cells in plasma routinely given to  patients affects their immune system,” said Lee, who is also a trauma surgeon at USA Health. “Through our research we hope to get a deeper appreciation of the spectrum of effects - both immediate and delayed - of blood product transfusion, and use this information to improve transfusion practices.”

Lee is one of three physicians across the United States to receive the scholarship for 2020-2021. Awardees are selected through a completive process by a committee of well-respected trauma surgeons from within the AAST.

“I’m incredibly honored to be selected for this award, not just for the financial support that will help me further my research efforts, but also the recognition of the work we’re doing here at the USA College of Medicine and USA Health,” Lee said. “I’d like to thank my mentors and colleagues for their ongoing support, and the AAST for their commitment to advancing the science of surgery and mentorship of young physician-scientists.”