Scholarly Concentration in Translational Research in Medicine

Concentration in Translational Research in Medicine

Translational Research in Medicine Concentration Directors:

Tracy Madsen, MD, ScM
Email: [email protected]
Work Address: Dept of Emergency Medicine
55 Claverick Street, 2nd floor
Providence, RI 02903 

Other participating faculty:
 

Susan D’Andrea, PhD, Assistant Professor of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Director, The Gait and Motion Analysis Laboratory, Providence VA Medical Center

J.J. Trey Crisco, PhD, Henry F. Lippitt Professor of Orthopaedics, Warren Alpert Medical School of Brown University, Professor of Engineering, Brown University

Leo Kobayashi, MD, Associate Professor of Emergency Medicine, Warren Alpert Medical School of Brown University, Director, Research and Innovation, Lifespan Medical Simulation Center, Rhode Island Hospital

Francois I. Luks, MD, PhD, Professor of Surgery, Professor Obstetrics and Gynecology, Professor of Pediatrics, Warren Alpert Medical School of Brown University

Brian Silver, MD, Associate Professor of Neurology, Warren Alpert Medical School of Brown University, Director, Comprehensive Stroke Center, Rhode Island Hospital, Vascular Neurology Fellowship Director

Overview

The primary objective of the Scholarly Concentration (SC) in Translational Research in Medicine (TRM) is to mentor medical scientists throughout their study at Alpert Medical School by providing opportunities for early engagement in applied clinical research across the university and hospital populations. Our collaborative team of researchers has successful programs in biomedical engineering, computer science, medical simulation, and the clinical subspecialties of: emergency medicine, orthopaedics, surgery, neurological emergencies, diagnostic imaging, radiation oncology, pediatrics, surgery, obstetrics and gynecology.

Students will be exposed to a broad array of translational research projects within this active group. They will have the opportunity to partner with a single faculty member, who will mentor them through their initial summer research assistantship and throughout the students’ II-IV years.  Dr. Lisa Merck will oversee conference didactics in parallel with research activities; these didactics will focus on clinical research design. Students will participate early in laboratory and hospital activities pertaining to their research focus. Upon completion of a specific project, scholars will receive mentoring in the preparation of manuscripts for peer-reviewed publication and delivering presentations of their work at local and national conferences.

Curriculum

Students selecting the SC in TRM will be expected to:

  1. Undertake self-directed learning to acquire knowledge in chosen area of translational focus. 
  2. Choose and work closely with a faculty mentor in one of many collaborative settings: Neurological Emergencies, Orthopaedics, Engineering, Diagnostic Imaging, Surgery, and Emergency Medicine. Listed below are a sample of ongoing projects within our team.
  3. Complete didactic work within the context of chosen translational focus.  This will occur weekly in small group sessions in the summer period, and monthly throughout Year II.  The objective of the small group didactic sessions is to facilitate learning in the basics of clinical research design, good clinical practice standards, regulatory requirements, statistical analysis, and data interpretation.  Scholars will be invited to attend additional didactics to compliment their area of research focus in Years II-IV.
  4. Meet with the Directors of SC in TRM monthly to discuss individual progress, goals and trajectory of the project.

Timeline of Activities

Year I

  • August-December: Attend information session, learn about the SC program, meet with concentration leaders and identify an area of interest in applied clinical research.
  • December-February: After consulting with SC-TRM directors, identify a research mentor and area of focus (see list below); together with mentor, outline and develop a SC project for the summer and over the ensuing 3 years; prepare application to the SC program; consider application for external funding (University Emergency Medicine Foundation; Division of Emergency Neurosciences, Department of Emergency Medicine; NIH/NINDS; Foundation and Industry funding).
  • Summer period (8-10 weeks): Begin summer project to lay the foundation of research project; attend and participate in weekly small group didactic sessions. Didactic curricula will be designed to compliment each student’s translational focus.

Year II

  • Allocate time on the day protected for self-directed learning each week to continue to work on research project.
  • As study personnel, students will also be engaged in enrollment of research subjects (as their schedule permits).  Responsibilities will include subject screening, recruitment, informed consent, data review, data analysis, and preparation/presentation of results.
  • Attend and participate in specific monthly didactic sessions; attend meetings of the Division of Emergency Neurosciences, emergency medicine resident lecture series, neuroradiology conference, as well as courses in entrepreneurship (EN 2910), and medical ethics, when possible.
  • Meet with the Directors of SC in TRM to discuss individual progress, goals and trajectory of the project; submit a brief summary report of progress.
  • Attend/present research results at a related regional or national conference venue.
  • Submit poster on summer work to the Summer Showcase event.

Years III & IV

  • Continue to work and develop research project as clerkship demands permit, with goal to prepare SC project report or manuscript for submission to a peer-reviewed journal in Year IV.
  • Students who are study personnel will have the opportunity to remain active on projects and complete work/clinical shifts as their schedule permits.
  • Attend and participate in specific monthly didactic sessions as determined by the research mentor.
  • In Year IV, complete at least one clinical elective based on concentration focus. For example, a student working on a project in Stroke would have the opportunity to enroll in a Neurology or Emergency Medicine elective, with a focus on Clinical/Translational Research during the fourth year.
  • Meet with the Directors of SC in TRM to discuss individual progress, goals and trajectory of the project; submit a brief summary report of progress.
  • Attend/present research results at a related regional or national conference venue.
  • Present final scholarly project to TRM directors and faculty in spring of Year IV.

Learning Objectives and Evaluation

By graduation, Translational Research in Medicine (TRM) scholars will:

  •  Acquire and utilize skills in clinical research design and good clinical practice
  • Develop and utilize ethical principals of conducting clinical and translational research
  • Formulate, design, and implement a clinical research investigation that is feasible to complete, publish, and present at a subspecialty meeting

For the above learning objectives, students will be evaluated by 1) their mentor; 2) co-mentors; and 3) SC in TRM leadership.  Students will also submit a summary report of their educational and research accomplishments to the scholarly concentration leadership in March of Year IV. Approval of this summary indicates that the student has successfully completed all requirements for the Scholarly Concentration in Translational Research in Medicine.

Project Examples

Students may choose to work in one of many collaborative settings: Neurological Emergencies, Orthopaedics, Engineering, Diagnostic Imaging, Surgery, and Emergency Medicine.  Listed below are a sample of ongoing projects within our team.  

Neurological Emergency Research

There are a number of active national clinical trials conducted via the Division of Emergency Neurosciences, as well as independent research studies. 

Throughout the 4 years, students who are interested in clinical trial implementation/design will have the opportunity to participate in Division meetings, to observe patient enrollment and monitoring, and to become study staff, assist in enrollment and monitoring of patients for individual study of interest.   

Ongoing projects include:

  • ProTECT3D – 3D computer visualization in the assessment and monitoring of traumatic brain injury. This is a locally led investigation in collaboration with the national team of researchers from the ProTECTIII clinical trial. The student would have the opportunity to assist in 3D segmentation of brain injury, as well as to correlate radiographic evidence of brain injury and evolution of injury with outcomes.  
    Primary investigators (PIs): D. Merck and L. Merck
  • Automated Ventricular Analysis – 3D visualization of change in cerebral ventricles during states of increased intracranial pressure related to hydrocephalus. This is a locally based study designed in collaboration with the University of Chicago. Students will have the opportunity to perform 3D image analysis and to correlate imaging with clinical data, such as need for surgery.
    PIs: D. Merck and L. Merck
  • Established Status Epilepticus Treatment Trial (ESETT). This is a national randomized clinical trial to assess the efficacy of Keppra, Dilantin, and Valproic Acid in the cessation of benzodiazepine refractory status epilepticus.
    PI: L. Merck
  • Platelet-Oriented Inhibition in new TIA and minor ischemic stroke (POINT).  National randomized clinical trial to assess the efficacy of aspirin and Plavix in preventing neurovascular complications after TIA or minor stroke.
    PI: B. Silver
  • A Study to Evaluate the Efficacy and Safety of Two Dose Strengths of Dalfampridine Extended Release Tablets for Treatment of Stable Walking Deficits in Post-Ischemic Stroke  (MILESTONE℠)
    PI: B. Silver
  • An Extension Study to Evaluate the Long-Term Safety, Tolerability and Efficacy of Dalfampridine Extended-Release Tablets for the Treatment of Chronic Post-Ischemic Stroke Walking Deficits in Subjects Who Participated in the DALF-PS-1016 Study (MILESTONE℠)
    PI: B. Silver
  • HT-3951 vs. Placebo in Stroke Rehabilitation (RESTORE)
    PI: B. Silver

Orthopaedics / Biomedical Engineering
Studies are conducted with Dr. Susan D’Andrea at the VAMC.

Ongoing projects include:

  • Virtual Reality Rehabilitation for Individuals with Lower Limb Amputation
    The objective of this project is to compare the effectiveness of virtual reality gait training system with that of conventional treadmill training for people with transtibial (TT) amputation.  We will conduct a randomized clinical trial comparing 6 weeks of training in both conditions and evaluate improvements in gait, balance and mobility.
  • Effect of Prosthetic Suspension on Residual Limb Motion Using Biplane X-Ray Video
    The purpose of this investigation is to compare the fit, comfort and dynamic in-vivo interactions between the residual limb and a transfemoral prosthetic socket suspension system using compression/release suspension.
  • Dynamic Corrective Force Device: A Balance Measure for Amputees
    Given the incidence of loss of balance in the military and veteran amputee population, it is important to select the most appropriate components for each prosthetic device to optimize balance. The proposed system provides a means to obtain quantitative outcome measures which allow an individual to obtain the most appropriate components to optimize balance and ultimately reduce the number of falls. 
  • Foot Motion During Running Shod and Barefoot
    The objective of this investigation is to use biplanar videoradiography to provide an accurate description of foot bone kinematics during running and compare the standard shod condition to barefoot running.

Diagnostic Imaging / Engineering

Studies are conducted with Dr. Derek Merck at RIH.

Ongoing projects include:

  • Tumor Ablation Procedure Planning and Optimization – translational project that encompasses multiple sub-projects, including thermal simulation, medical image segmentation and fusion, and clinical tool development.  Related projects are in progress to develop other image-guided treatment procedures such as in radiation oncology.
  • Medical Image Biomarkers for Pathology – research crossing imaging modalities and domains of image and shape feature analysis, statistics and classification, and machine learning.  Current projects are focused on ultrasonography for automatically assessing hepatic steatosis and for prenatal detection of craniosynostosis, MR for cancer phenotyping, and CT for in assessment of neurological emergencies. 

Emergency Department Clinical Environment Engineering
Studies are conducted with Dr. Leo Kobayashi at RIH.

Ongoing projects include:

  • 5S-based projects:
  1. Emergency Department informatics infrastructure assessment - a just-in-time 5S project to 1inventory and assess the functionality of critical ED informatics devices and systems in order to identify problems, deficiencies, inefficiencies and potential solutions for improved bedside delivery of patient care.
  2. Aeroso Environmental Toxicity in Healthcare-related Exposure and Risk (AETHER) study- multi-phasic program examining particulate matter levels and potential sources in ED settings as a potential contributor to patient illness and provider occupational hazard.  Phase I (pilot) and Phase II (assessment) complete, Phase III (intervention) TBA.
  3. eco ED initiative - concept for examination of improving operational efficiency (energy, waste streams, etc.) to mitigate environmental impact of clinical facilities.
  • Alarm fatigue mitigation.  AHRQ-funded PERSEUS study - 3-year (2014-2017) program to create and deploy an experimental multi-parametric smart alert system to improve the specificity and positive predictive value of patient monitoring systems and reduce false alarms.
    PIs: L. Kobayashi and D. Merck
  • Application of bedside patient monitor datastream interface (hardware + software) for clinical informatics and research.
    PIs: L. Kobayashi and D. Merck
  • Bedside procedural surface development - ongoing R+D and use-testing of an experimental procedural surface for ED clinical use.

Pediatric Surgery / Biomedical Engineering

Studies are conducted with Dr. Francois Luks and Dr. Derek Merck at RIH.

Ongoing projects include:

  • Interactive Laparoscopic Image Display - translational project, from inanimate trainer to clinical pilot study. Engineering tool to increase visibility and communication during multi user laproscopic procedures.
  • Haptic training model of ultrasound-guided procedures - an engineering project to create training tools for students/residents/fellows in ultrasound guided invasive surgical procedures. The training model is now in a developmental phase (with an undergraduate research assistant); if/when mature, the haptic training model will be used to teach one-person percutaneous procedures. One future research project would involve testing the hypothesis that this is a useful training tool in medical education.

Maximum number of students
 

The Concentration can currently accommodate up to 4 students.  The program will assess enrollment goals annually.

Funding Opportunities as alternatives to Summer Assistantships
 TRM Scholars are encouraged to apply to the following for additional funding:

  • University Emergency Medicine Foundation
  • Division of Emergency Neurosciences, Department of Emergency Medicine
  • NIH/NINDS
  • Foundation and Industry funding