All aboard the research train

Does cooling a resuscitated patient who’s still comatose after a cardiac arrest increase rates of good neurological outcome? Which patients with traumatic brain injury need hospitalization, and which can be safely discharged? Can we guarantee the efficacy of home care for certain people with pneumonia? And do we really have to write such extensive notes?

In a chaotic emergency department (ED), asking these questions is the easy part. Answering them is altogether different.

As emergency medicine physician Eric Melnychuk, DO, explains, “When you have a question, you naturally start to investigate to find the answer. You can start by reviewing current and past literature. But if there’s no answer to your question or no literature directly related to your idea, you can choose to try to further the world’s knowledge by undertaking a systematic research process. This includes organizing information on what is already known, obtaining ethical approval through an application to an Institutional Review Board, further refining your question and making sure the appropriate methodology is being used to answer the question. All of this takes a significant amount of time and effort. And doing the work alone is not as rewarding as having others involved.”

Nurturing curiosity and discovery to enhance patient care

Processes, infrastructure, teams — everything Dr. Melnychuk says is vital to nurturing the curiosity and discovery needed to enhance patient care is found in a high-performing academic medical environment. And activity in a bustling ED, for example, is amped up by quality improvement projects, clinical trials, grant-funded research — and plenty of medical students to complement the residents and fellows.

Chadd Kraus, DO, system director of emergency medicine research and professor of emergency medicine at the Geisinger Commonwealth School of Medicine, has built this electric environment of research and scholarly activity in Emergency Medicine at Geisinger using the “two biggest keys to leading change”: having a vision and engaging others to buy in.

“One of the first things we did when I arrived five years ago was establish a research committee and set recurring meetings,” he said. “They’re open to everyone. We engage nursing and our PAs and NPs. Essentially, we have a Shark Tank where you can bring ideas, vet those ideas and discuss them. It provides a way for us — a clinical department with finite resources — to unite everyone and say, ‘These are the projects we're going to prioritize.’” Success is a team effort — from generating innovative ideas through to publication.

Dr. Kraus also set a framework of inclusivity for defining scholarly activity in emergency medicine at Geisinger, using Boyer’s Model of Scholarship. This model advocates for every team member to be simultaneously a learner, a teacher and a scientist. “That's been our guiding principle, and we've been successful at building the infrastructure in a sustainable way across years, across faculty, across our learners and with an interdisciplinary team. We’ve built what I think of as a research train. The train is our scholarship as a department, and learners, like students and residents, get on and off at different stations, but we're all still heading somewhere together.”

All aboard the research train

Five Geisinger Commonwealth students are currently on board, mentored by Drs. Kraus, Melnychuk and Emergency Medicine Residency Program Director Chris Wilson, MD. “Ask any of them. They’ll tell you they now realize how challenging it is to implement improvement processes or even get data from public databases,” Dr. Kraus said. “They truly see what the process of research discovery and dissemination is, from soup to nuts.”

Conner Johnson from the class of 2024 said using that process in his own study has been transformative. “I gained an appreciation of what it takes,” he said. “Research keeps you intrigued and at the top of your game. You need to keep asking questions and staying up to date.”

For Niraj Vyas, a member of class of 2024, his project provided an opportunity to flex his skills in implementation science, which he described as “one step beyond quality improvement.” He researched ways to apply Geisinger’s much-celebrated surgical ProvenCare® program to patients with pneumonia. The experience has been invaluable to his future plans in pathology. “People think of microscopes when they hear pathology,” he said. “But it’s actually running the labs — ensuring quality. That involves a lot of elements — including the constant assessment I learned by doing this research.”

Adam Klaus, also a member of the class of 2024, discovered that research is a good path to advocacy. “In my study, I’m looking at the macro view and trends of patients’ ED use based on their insurance status and their citizenship status. The research has challenged some common misconceptions,” he said, adding that he hoped to have the power one day to influence public policy. “I’ve seen that Dr. Kraus has impact with the local government, and he has meetings and presents data to the state legislature. I hope to go with him to one of those meetings. His example made me want research to be a big part of my career.”

Impacting the future of emergency medicine

Dr. Wilson said that’s what academic medicine is all about. “It’s the trickle-down effect. The idea is if you train them really well, show them what evidence-based medicine is and engage them in research and leadership, they take that experience and knowledge and enhance the quality of patient care and the practice of medicine. They educate others, so it’s not just one physician you're affecting, it’s the future of emergency medicine.”