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Saturday September 22nd- AAST 2023 Recap
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Presidential Address: Interview of Dr. Eileen Bulger
Presidential Address, 'We Are in This Together': The Power of Social Connection'
Written by: Tanya Anand MD, MPH, MT(ASCP), FACS
The 82nd annual meeting of The AAST & Clinical Congress of Acute Care Surgery is upon us, and we could not be more excited! Dr. Eileen Bulger will be delivering the Presidential Address on Wednesday September 20th. Its title, “We Are in This Together: The Power of Social Connection” is meaningful and powerful and we are eagerly awaiting the lessons learned along the way.
I recently had the opportunity to sit down with Dr. Bulger, and better understand the inspiration for her talk. The importance of the human connection in her trek to becoming a leader in trauma was clear. She describes the lifetime of mentorship continuing to guide her career and allowing her to advance the care of trauma patients. From her early days as a paramedic to becoming the President of the AAST she attributes her success to the inspirational human element. An important example is the mentor-mentee relationship. She discussed the importance of early identification of mentors genuinely driven by their mentee’s success. The individuals in her life, whether it be her family, mentors, or colleagues, are vital sources of inspiration, support, and honest feedback during critical decision points in her life and career. These critical points, including her decision to train at the University of Washington and seeking institutional faculty to guide her research were just some of the areas that influenced her trajectory in trauma.
When discussing the importance of national meetings Dr. Bulger encourages everyone to get involved. There is early exposure to a wide breadth of trauma research, as well as numerous opportunities to develop a network of peers and collaborate. The bonds that form during these interactions contribute to scientific advancements and ultimately further the care of trauma patients. Navigation through these waters may be challenging for some, but very doable, and resulting in a high likelihood of success. Dr. Bulger wants to shorten the timeline from being the nervous trainee presenting at their first meeting, to being the person able to comfortably engage all members in the room. Creating that sense of community is of utmost importance.
She credits young trauma practitioners of pushing the envelope and thinking broadly to advance the profession. Though much work remains, the rise in young members and diversity has served to increase our awareness of topics concerning violence prevention, health equity, and social determinants of health. The younger AAST members have encouraged the profession to take a more holistic approach to trauma care and prioritize research on the post-discharge consequences of injury. Dr. Bulger foresees a more dominant role of ECMO in Trauma and Acute Care Surgery. Extending the breadth of ECMO training in fellowship will allow trainees to broaden their skillset and become comfortable in taking surgical rescue to the next level in trauma and ACS patients.
She cites that the pandemic was a great teacher as well. Social isolation combined with a stressed healthcare infrastructure contributed to a previously unseen level of burnout. The challenges experienced exposed unanticipated vulnerabilities in our system. Thus, how we manage the next surge and our ability to decrease preventable deaths depends on the improvements we make now. The creation of a National Trauma Emergency Preparedness System is amongst the many initiatives Dr. Bulger is developing in partnership with local, regional, and national entities to create a strong coordinated response that can withstand the next surge.
A key aspect of furthering initiatives in firearm injury prevention is shaping the national discussion as a vital matter for the public’s health. Dr. Bulger has played an instrumental role in defining and promoting the components of a public health approach towards firearm injury prevention. Investing in research to improve our understanding of the root causes of such violence is key in creating an informed and non-partisan approach to firearm safety. She stressed the importance of these programs and interventions at local, regional, and national levels. She has presided over several large multidisciplinary summits to identify knowledge gaps and improve collaboration amongst stakeholders.
Dr. Bulger understands that our awareness of our impact upon our patients, each other, and the community is an important driving force to improve the quality of life for others. She aims to continue building a diverse and inclusive environment that fosters meaningful engagement and collaboration at all levels of training and practice. Whether advancing our understanding of post-traumatic inflammation, increasing firearm safety awareness, facilitating the improvement of pre-hospital resources, or optimizing post-discharge recovery, Dr. Bulger has an uncanny ability to recognize multifaceted themes impacting the lives of trauma patients and bringing them to the forefront of the national psyche.
Fitts Lecture: Interview of Dr. J. Wayne Meredith
Fitts Lecture, "Endure, Adapt, Survive and Thrive"
Written by: Julia R. Coleman, MD, MPH
On Thursday, September 21st, the much-anticipated Fitts lecture will take place, this year delivered by Dr. Wayne Meredith. The Fitts lecture was named for Dr. William T. Fitts Jr, a historic surgeon who served as Professor of Surgery and Chairman of the Department of Surgery at the University of Pennsylvania School of Medicine. Born in Tennessee, he was a graduate of the Union University in Jackson, earning his medical degree from University of Pennsylvania and completing his surgical residency at the Hospital of the University of Pennsylvania. In World War II, Dr. Fitts served as a surgical ward officer for the 20th General Hospital in the Pacific Theater with the rank of captain. Internationally recognized for his contributions to trauma surgery, Dr. Fitts served as Editor-in-Chief of the Journal of Trauma, President of AAST, Vice Chairman of the American College of Surgeons Commission on Trauma, and President of American Trauma Society. Most importantly, he was known for his astute surgical judgement and close personal relationships with his colleagues, students, and patients. In 1974, the Fitts lecture was created.
Dr. Meredith’s Fitts lecture is named for a motto that has been prodigiously important in his recent life - “Endure, adapt, survive, and thrive”, spawned from his battle with leukemia cutis. At first, Dr. Meredith wasn’t sure if he wanted to share this personal part of his story for the Fitts lecture – in his words, “I thought about talking about the history of chest trauma in AAST…but I decided I’m going to give this a shot and risk it.”. In his Fitts lecture, Dr. Meredith will focus on 1) the lessons that trauma surgery taught him that got him through his illness and the lessons learned from his illness that helped him be a better surgeon and 2) advice to early career surgeons on how to get involved in and be successful in AAST.
In an interview preceding his Fitts lecture, Dr. Meredith reflects that he remembers when he was diagnosed with leukemia and his wife looked up the survival – it was “single digit twoyear survival.” With this dismal number in sight, Dr. Meredith adopted his motto – endure, adapt, survive, and thrive – and underwent chemotherapy, radiation, and a bone marrow transplant. As one might imagine, this experience was life-changing. In the words of Dr. Meredith, “I learned a lot about myself during that, a lot about being a patient, a lot about being a doctor”. Being a trauma surgeon helped him to get through his illness because it demanded the important qualities of trauma surgeon like resilience and tenacity. His fighting spirit didn’t go unnoticed. Soon, “endure, adapt, survive, and thrive” started to appear throughout Dr. Meredith’s hospital – from custom scrub caps to written signs by residents standing outside his windows to the name of the new hospital tower (“project EAST”). And Dr. Meredith did just what his motto called – he survived and walked away with wisdom and lessons. His Fitts lecture will be about those precise lessons.
Not all of Dr. Meredith’s lecture will talk about the past, but instead will also include a nod to the future, imparting advice to the early career surgeons. In speaking with him before his Fitts, he rattled off a list of seemingly easy yet high-impact things to do – come to the meeting, talk to people, send your best work to the AAST, volunteer for things, get engaged, show up to committee meetings on time, don’t let fear of imperfection paralyze you from submitting and sharing ideas and science, know the mission of committees and projects to adapt your mission. In the words of Dr. Meredith, his pearls are “true in AAST and all of academics: be energetic, be optimistic, be curious, be open to feedback, be solicitous to feedback, be generous with feedback, help people succeed.” These pearls will be ever-essential as the future of acute care surgery evolves. When envisioning the future of our specialty, Dr. Meredith believes adaptability, relevance, and the highest clinical excellence are all essential. “[Acute care surgeons need to]…make sure we continue to grow in our practices and training so that the body of work that is encompassed by acute care surgery is ours not because we are available at inconvenient hours but because we are the best people in the hospital to do this work.”
Ultimately, from talking with Dr. Meredith, it is clear his Fitts lecture will be one to remember. Being one of the highest honors of the society of AAST, Dr. Meredith is an obvious choice. This was apparent as I heard him reflect on what Fitts and other accolades mean to him. “I believe that you should not conduct your life to achieve honors. If you measure yourself by those milestones, you’ll have a hard time being happy. Happiness comes from doing the stuff that makes people consider you for those honors – doing the work, helping people.”
Expert Surgeon Lecture: Interview of Dr. Lillian Kao
Expert Surgeon Lecture, "Challenging Current Notions about Quality Improvement and Research"
Written by: Simin Golestani, MD
The topic of this year’s expert lecture, “Challenging current notions about quality improvement and research” is one that is pertinent and important for any practicing surgeon. For Dr. Lillian Kao, professor of surgery and chief of acute care surgery at McGovern Medical School at University of Texas Health Science Center at Houston, this talk is the result of many years of experience and research in quality improvement. Her inspiration for her research stems first and foremost from a desire to take the best care of her patients. As she describes it, well intentioned clinicians have in the past potentially harmed patients by following guidelines that were subsequently proven to be harmful, such as tight glycemic control in critically ill patients. Her support has come from mentors who were not afraid to question the reasoning for decision making in critically ill patients. For her, finding the balance between rigor and efficiency in aoplying promising but yet unproven treatments, especially in trauma patients, is necessary to provide the best care. Having previously been awarded a prestigious NIH K23 career development award for her research, Dr, Kao now co-directs the Center for Surgical Trials in Evidence Based Practice (C-STEP) in Houston.
Dr. Kao’s pathway towards trauma surgery was not linear, and her roles in this field continue to be vast and varied. After graduating surgical residency from University of Washington Medical Center, she went on to practice as an academic surgeon for five years before completing a fellowship in critical care. For her, it has been the people in the AAST who have become a source of influence, friendship, and support. She has been active in meetings for many years and is a member of the steering committee for the new leadership academy of AAST. Although she did not initially see herself taking on leadership positions, finding groups that resonated with her values and goals made her gravitate towards these leadership positions and she has left her mark on many different organizations. As a past- president of the Association for Academic Surgery, she promoted increased opportunities for trainees and young surgeons. She is one of the founding members of the Society of Asian Academic Surgeons, and is currently the vice chair and quality, research, and optimal patient care pillar lead of the Board of Governors of the American College of Surgeons.
In addition to her important roles as a leader and a clinical researcher, Dr. Kao also serves as a mentor and teacher. She is active in teaching the master’s degree course in clinical research and enjoys helping her trainees develop their own interests in research. She advises her students on setting achievable goals, being patient and remaining dedicated. With all these varied positions that she juggles, having a way to decompress is vital. For Dr. Kao it’s being active, especially in the form of kickboxing! Her two French bulldogs also keep her busy, and she enjoys the fellowship that comes with national conferences. A testament to her passion as a trauma surgeon, her favorite surgery is any open case where she can touch bowels.
Dr. Kao became a doctor to improve patient outcomes, and the way she discovered how to do that was to align her practice with high quality research. Her expert lecture will be an opportunity for all new and experienced trauma surgeons to understand the importance of patient focused quality research and to develop a practice in which we can do as she does, and “learn continuously as we provide care.”