Undergraduate research assistants Amy Atkinson and Paige Farley watch Emergency Department staff in one of the trauma bays care for patient who has just arrived by ambulance. Their black scrubs identify their research role.UAB undergraduate Paige Farley is one of the "rock people.”That’s the nickname from University Hospital doctors, nurses and staffers as Farley roams the teeming medical center — at any time, day or night — wearing black scrubs with the monogram “ROC, Alabama Resuscitation Center.”
Her 12-hour shift starts in the Emergency Department, the busy portal that serves 85,000 trauma and sick patients each year. But her work as the Emergency Department’s lead research assistant also takes her into hospital operating rooms, intensive-care units, step-down units, the kidney transplant floor, assorted medical laboratories and other buildings of the nation’s third-largest public hospital and vibrant medical research center.
“I love the people I work with, and the experience is unlike anything I have ever done,” said Farley, a biology major in the UAB College of Arts and Sciences planning to go to medical school. “For some protocols, we follow the patient to the operating room and observe. And then we follow them to the ICU. I get lab experience and operating room experience. How many undergrads get to go to a trauma operation?”
A research assistant job gives unusual responsibility to a handful of select undergraduate students. The Emergency Department’s need for trained research assistants who are available 24 hours a day, seven days a week, came from a trauma trial protocol of the Resuscitation Outcomes Consortium, or ROC, a 10-center clinical trial network for research on prehospital cardiopulmonary arrest and severe traumatic injury. Someone had to be there, ready when the ambulance arrived, any time of the day or night.
From that one protocol three years ago, the UAB Emergency Department now enrolls patients in 19 different protocols that serve biomedical researchers in the departments of Emergency Medicine, Surgery, Anesthesiology, Neurology, Nephrology, Pathology and Microbiology.
Farley takes a close look at the trauma patient's vital signs. If a blood transfusion is needed, the patient may be a candidate for one of the 19 research protocols run by the Emergency Department research assistants.Get knowledge and get paid for it. “It’s awesome.”
Research assistants have to be able to screen and enroll patients, get informed consent, do some lab processing, and sometimes (if they have been qualified for it) even draw blood.“They help collect data and work alongside doctors,” said Shannon Stephens, research program director for the Department of Emergency Medicine. Stephens at first just used foreign M.D.s (who have to earn a master’s degree before they can enter a U.S. residency program), nurses and paramedics as research assistants; but many of them were too transient.
“There’s a steep learning curve,” he said. “They have to know inclusion and exclusion criteria, what data need to be collected. It seemed we would spend two to three months training people, and then they would leave. So, we began looking at undergraduates. Paige was one of the first ones we hired.”
“A friend who knew I was interested in medical school and knew I was a hard worker told me about it,” Farley said. She has now done the work for more than three years, and she loves it.
“If I could be here all the time, I would shower here, I would sleep here,” Farley said. “I can tell when a trauma patient needs blood; I can read ABGs (arterial blood gases). Every time we start a new protocol, I get to learn about the conditions, such as strokes and traumatic brain injury. I get all this knowledge in return for my time here, and I get paid for it. It’s awesome.”
For some protocols, the research assistant just has to page the research coordinator or the principal investigator for a protocol. Other protocols involve hands-on work. A nephrology protocol on kidney transplants, for example, requires collecting urine from a catheter at 0 hours in the operating room, at 6 hours in the post-op ward, at 12 hours in the kidney transplant floor, and at 24, 48 and 72 hours. The research assistant has to put the urine on ice, carry it to a lab, centrifuge the sample and freeze the supernatant. With that schedule, the draws could be in the middle of the night or on a weekend.
The research assistants still include nurses, EMTs and foreign doctors; but they also include four or five undergraduates, Stephens says. All wear black scrubs to identify their unique role. The first published study that included undergraduate research assistants was published this month in The Journal of Trauma and Acute Care Surgery.
Inside the bay, Farley watches the 11-person team as they examine two wounds and look for other possible injury.Stop. Don’t cut those trousers.
A sign of how well the UAB system works, with its undergraduate research assistants, is a study of chronic pain development in African-Americans who have been in a car accident (CRASH), which is coordinated by the University of North Carolina-Chapel Hill. UAB has enrolled 15 of the 28 subjects so far this year, Stephens says. The other 11 medical centers across the United States that are also enrolling for the same study have enrolled a total of 13.Stephens says the UAB program is similar to those at other institutions. The key difference is that the UAB model uses a smaller core team.
“Our model seems to translate well for us, and we’ve shared it with others,” Stephens said. “These research assistants have provided a medium for facilitating research in the acute care setting and collecting research data around the clock. They get reasonable pay, but we have high expectations: We have to do the research we’ve contracted to do. But we also want to develop career paths for the students who work for us.”
Previous undergraduates in the program are now in medical school, nursing school or pharmacy school. Stephens has to prepare some research assistants for the shock of seeing trauma patients, but Farley quickly showed she was able to handle those stark clinical experiences.
As the lead research assistant, Farley has extra responsibility to train other research assistants and assist in coordinating certain protocols. Farley says she has seen touching moments and sorrowful moments in the Emergency Department, and one memorable scene showed her “what kind of doctor I want to be.”
A homeless man had come in, and the emergency team was about to cut off his pants, a typical step for emergency cases. But when the trauma surgeon, Sherry Melton, M.D., saw them, she said, “Stop what you’re doing. Are you going to give that man another pair of pants?” The pants came off without cutting, a moment of understanding the human needs of that particular patient.
“It really touched me,” Farley said. “That’s the kind of doctor I want to be.”