On Rounds – Fall 2011

The fall issue of On Rounds is available now! You can view the online version here.

Enhancing Training Through Medical Simulation

Patient simulators are increasingly being used to teach medical procedures to health professionals, allowing them to practice procedures on manikins before they work with patients.

The Quest Center is a patient simulation training facility and a collaborative endeavor of DCH Health System and the College’s Institute for Rural Health Research.

Short for Quality Care Utilizing Education Simulation and Training, the Quest Center opened at DCH Regional Medical Center in Tuscaloosa this past spring. The Quest Center contains several patient simulation training rooms complete with medical equipment and monitors. The Institute provides adult, youth and infant simulators.

DCH currently uses the center to provide additional training for its nursing workforce. The Institute has access to the facility to conduct training sessions for emergency medical services personnel in West Alabama as part of its EMS Program.

The goal of the Quest Center is to enhance patient care, safety and outcomes from the pre-hospital setting through admission, treatment and discharge using simulation technology. “Our goal is to hard wire the simulation lab to everything we do,” says Angela Bridges, MSN, manager of Nursing Education and Development for DCH. “It is indispensible.”

The Quest Center provides a realistic environment for training, replicating a hospital setting and giving health professionals the chance to learn, practice and master techniques for patient care. Life-sized robotic patients mimic common ailments and symptoms and are used to teach the taking of vital signs, cardiopulmonary resuscitation and the use of defibrillators. There are video and audio recordings of the session to evaluate the training and its outcomes.

Future plans call for training in emergency situations, such as advanced cardiac life support and pediatric life support, as well as in intubations and chest tube insertions, Bridges says. “It is better to role play first,” adds Sandi Lee, RN, Nursing Education coordinator for DCH. “Some things you don’t see every day and you can do these first with simulation. Simulation gives a realistic flavor.”

Over the next year, training is also likely to include a nursing orientation for labor and delivery using the simulator mom, Noelle, and the simulator baby, Hal, Bridges says. She also envisions the Quest Center providing emergency and disaster response training.

“We are excited to work with the Institute,” Bridges says. “The result of this collaboration will be improved training and patient care for DCH and the community.”

College Selects Its First Endowed Chair Of Sports Medicine

Athletes are typically in peak physical condition, but even those at the top of their game get hurt sometime. And if they play for The University of Alabama or high schools throughout West Alabama, chances are they have been cared for by James Robinson, MD.

Robinson, a family and sports medicine physician, has served as head team physician for the University since 1989 and is the team physician for many area high schools. He has a private practice, West Alabama Family Practice and Sports Medicine in Tuscaloosa. He is also director of the College’s Dr. Bill deShazo Sports Medicine Center and oversees the College’s Sports Medicine Fellowship for Family Physicians.

In September, Robinson was named the College’s first Endowed Chair of Sports Medicine for Family Physicians.

As the endowed chair, Robinson will be responsible for administrative oversight of the Dr. Patrick Lee Trammell Sr. Excellence in Sports Medicine Program, which was developed in partnership with The University of Alabama Department of Intercollegiate Athletics. He will also teach and supervise sports medicine fellows, family medicine residents and medical students, provide patient care and community outreach and conduct research and other scholarly activities.

The sports medicine center, fellowship and newly endowed chair are all part of the College’s Dr. Patrick Lee Trammell Sr. Excellence in Sports Medicine Program. “The program is an incredible clinical experience,” Robinson says. “The fellows coming out of this program will be well trained and hopefully better trained than those in most other programs in the country.”

The program is named in honor of Trammell, a University of Alabama quarterback and Heisman Trophy candidate who led the Crimson Tide to a National Championship title in 1961. Trammell graduated from The University of Alabama School of Medicine but as he prepared to start his residency in 1968, he was diagnosed with cancer and died later that year at the age of 28.

Sports Medicine Elective

Despite his obvious love of sports medicine, Robinson, a New Orleans native, did not plan on a career in medicine when he started at Louisiana State University. He chose Zoology as a major, and while he found the curriculum interesting, he knew he wanted to do more. Several of his friends planned on medical school after graduation. Robinson knew his grades were better than many in his classes, and he says the opportunity to go to medical school “just fell into my lap.”

Prior to entering medical school, Robinson worked as a surgical scrub technician in the operating room of a Baton Rouge, La., hospital, where he also learned to operate EKG machines and perform several basic medical procedures, which further sparked an interest in medicine. With the encouragement of co-workers and classmates in medical school, Robinson decided to study family medicine. He says the specialty appealed to him because “I could work in all aspects of medicine.” 

Robinson’s first exposure to sports medicine came during a rotation in orthopedics, but he was able to see the specialty up close because the LSU School of Medicine offered a fourth- year elective that focused on sports medicine. During this rotation, he worked with the New Orleans Saints medical team and was sent to the NFL team’s training camp in Vero Beach, Fla., to help supervise players’ health. He cared for Saints players, including Hall of Fame running back Earl Campbell and former University of Alabama quarterbacks Kenny Stabler and Richard Todd.

After graduating from medical school, Robinson applied to the College’s Tuscaloosa Family Medicine Residency. “I came here for the diversity of residents who were in this program,” he says. “There were residents from most states in the Southeast, which provided an opportunity to learn a variety of skills taught in different parts of the country.”

The late William deShazo, MD, one of the College’s first faculty members, offered Robinson a rotation in sports medicine. 

deShazo was also the team physician for the University’s Athletic

Department and a personal physician to Coach Paul “Bear” Bryant. deShazo introduced the sports medicine rotation into the College’s curriculum.

During the rotation, Robinson spent time with the University’s athletic trainers, learning what they did on a day-to-day basis. He was particularly interested in how athletic trainers handled the University football team’s two-a-day practices. He enjoyed the work so much that he continued on even after his rotation was completed.

A Calling

By the final year of the three-year family medicine residency, Robinson knew sports medicine was his calling. He learned of a new field in medicine called primary care sports medicine and applied for and received a fellowship from the Cleveland Clinic in Cleveland, Ohio, and, at least temporarily, left The University of Alabama.

During Robinson’s fellowship year, deShazo retired, which left a void in the care coverage of University of Alabama athletes. Robinson says he received a telephone call from then Head Athletic Trainer Sang Lyda and was offered the position of sports medicine physician for the Athletic Department.

Several years later, Robinson was approached by former College Dean E. Eugene Marsh, MD, about developing a sports medicine fellowship. Robinson 

accepted the challenge and the result was the creation of a year-long Sports Medicine Fellowship for Family Physicians offered through the College’s family medicine residency. Under the guidelines of the fellowship program, fellows spend half their time in a clinical setting, of which four half days each week are spent seeing patients at the Dr. Bill deShazo Sports Medicine Center, located at University Medical Center, which the College operates. The fellows also spend time with a variety of faculty members involved in the field of sports medicine, including physical therapists, dieticians, exercise physiologists and orthopedic surgeons. In addition, fellows devote 10 to 15 hours per week to the University’s Athletic Department and provide weekly coverage at University sporting events and area high school sporting events.

Protecting Young Athletes

Robinson is also passionate about his work with high school athletes, and he was instrumental in helping pass legislation in Alabama to protect younger athletes from concussions.

“I got involved due to my work with The University of Alabama and all of the local high school athletes that I have taken care of for the past 23 years,” Robinson says. He says he was adamant about getting involved because he thought young athletes were returning to sports too quickly after sustaining concussions and placing themselves at risk for further injury or permanent damage.

Robinson says he was asked to be a founding member of a task force created several years ago by the Neuropsychology Department at Children’s Hospital in Birmingham to look at how to better manage concussions in young athletes in Alabama. “A friend of mine is the team physician for the Seattle Seahawks and was instrumental in passing a concussion law in the state of Washington. We talked about doing that here and eventually presented a proposal to several state senators and representatives. With their help, we were able to propose a bill.”

The bill was passed by the Alabama Legislature and signed into law in June. The legislation contains three important provisions: athletes and parents must receive educational materials each year about the signs and symptoms of a concussion; coaches must also be educated about the signs and symptoms of concussions; and athletes who show signs or symptoms of a concussion cannot return to their sport until they see a physician and the physician approves.

National Recognition

Robinson believes the Dr. Patrick Lee Trammell Sr. Excellence in Sports Medicine Program and its Sports Medicine Fellowship for Family Physicians and Endowed Chair of Sports Medicine for Family Physicians will bring national recognition to the College and show that it is a leader in sports medicine. Robinson’s goal is for the program “to attract the best fellows and produce the best sports medicine physicians in the country.”

He also wants the program to honor all of those who came before who worked so hard to make sports medicine an important part of the College and the University – people like Trammell and deShazo. “This program will exemplify their hard work ethic and dedication to sports medicine and athletics,” Robinson says.