Capstone Project Opens Door to Collaboration Between Researchers, Clinicians at USU

By Vivian Mason

Second-year medical student Navy Ensign Bryson Hewins had the unique opportunity to showcase his research to an audience from around the globe as part of his Uniformed Services University of the Health Sciences (USU) Capstone project recently. Hewins presented his work at the Special Operations Medical Association’s (SOMA’s) Scientific Assembly (SOMSA). 

SOMA is a medical association that brings together prehospital, tactical, wilderness, austere, disaster, and deployed medicine providers and its annual scientific assembly is the largest gathering of special operations forces medical personnel in the world.  The meeting offers an opportunity for military and civilian medical providers, academia, and industry to meet and exchange ideas. 

The National Intrepid Center of Excellence (NICoE) Traumatic
Brain Injury (TBI) team (left to right): LCDR Kent Werner, Dr.
Kimbra Kenney, and ENS Bryson Hewins. (Photo credit:
Courtesy of ENS Bryson Hewins)

“Overall, it was a really good conference,” says Hewins. “It was valuable to have the opportunity to engage with other researchers from such diverse and experienced fields. There was a mix of active duty and civilian personnel, as well as international attendees. It was my first time there, and I’m glad that I was able to attend.”

The Capstone Program at USU is a unique, optional opportunity for medical students to carry out independent research to devise an innovative solution for a real-world problem and learn the process of research within the Department of Defense. This Capstone experience allows students to focus on a personal area of interest. Students are encouraged to dedicate up to three months (or more) working on their project under the guidance of a faculty mentor. Dr. Martin Ottolini, assistant dean of the Capstone Program, was enlisted as one of Hewins’ mentors to guide Hewins through the program’s required proposal submission, project completion, and final presentation of data.

As part of his Capstone experience, Hewins worked with research teams consisting of both established USU faculty and fellow students. He believes that the Capstone Project opens the door to collaboration between researchers and senior clinicians at USU.

“[USU staff are] more than willing to share their expertise,” Hewins adds. 

To Hewins, however, the Capstone experience is just one avenue that connects people. 

“You develop the project. You’re the subject authority. You’re engaging with people and sharing your data. It’s an important step on the road to academic ownership that is taught as a major focus of USU when developing its military medical officers. I doubt I would have had the same experience elsewhere and appreciate how well the institutional culture matches with its stated mission.”

Hewins’ Capstone experience consisted of submitting two projects for presentation at SOMSA. The first project was a surgical simulator championed by upperclassmen 2nd Lt. Joshua Hansen and 2nd Lt. Austin MacDonald, extending to 2nd Lt. Austin Rasmussen, a third-year medical student, and second-year student 2nd Lt. Corbin Lee. They developed a low-cost, 3D printer model of a shoulder and obtained preliminary performance data from orthopedic surgeons to establish a proof of concept for the novel device. 

The aim of this project was to overcome an ongoing barrier in surgical simulation by reducing platform costs while retaining a very life-like model. Hewins was accompanied by Lee, who played a key role in obtaining project data from orthopedic staff members at Walter Reed National Military Medical Center. Lee presented the group's work to conference attendees. 

The second project was a retrospective study of neuroendocrine dysfunction in Traumatic Brain Injury (TBI) patients at the National Intrepid Center of Excellence (NICoE) Outpatient Treatment Program. TBI is a devastating injury and the major cause of death and disability in the United States, even more so for the U.S. military population. Hewins was mentored by a broad team, including Dr. Kimbra Kenney of NICoE and Navy Lt. Cmdr. (Dr.) Kent Werner, assistant professor in the Department of Neurology at USU. Hewins also collaborated with USU alumna Navy Lt. (Dr.) Rachael Campbell, who helped initiate the project idea. 

"I doubt I would have had the same experience elsewhere and appreciate how well the institutional culture matches with its stated mission.” - ENS Bryson Hewins, second-year USU medical student

TBI is also associated with acquired pituitary dysfunction. The pituitary is a small gland responsible for influencing endocrine signaling to nearly every system in the body. Despite this, a well-characterized prevalence of pituitary dysfunction in the military population had not been established. Many of the nonspecific symptoms of hypopituitarism can mimic TBI without pituitary damage. Thus, the project sought to better characterize the more common neurobehavioral and neurocognitive symptoms associated with this unique patient population in the hopes of reducing the time to treatment for patients who may suffer from an illness easily treated by standard hormonal replacement therapy. 

Hewins and his team used SOMSA as part of their Capstone project by following a framework of synthesizing, analyzing, and reporting data, all while collaborating with others. They shared results and were open to criticism and feedback from the scientific community. The poster presentation also allowed them to share this new experience and their data with people from all over the world. 

“Our research turned into a big idea-sharing project, and I can’t say enough about it,” notes Hewins. “2nd Lt. Lee and I gained a tremendous amount of knowledge from the experience of  making our preparations, organizing speeches, and finalizing our presentations. Everyone was very welcoming to the ideas we put forward.” 

ENS Bryson Hewins at Special Operations Medical Association Scientific Assembly (SOMSA) presenting National Intrepid Center of Excellence (NICoE)

traumatic brain injury (TBI) research. (Photo Credit: ENS Bryson Hewins)

In the first phase of the surgical trainer project, senior attending surgeons were recruited to perform three timed trials of a foundational arthroscopic skill to establish a baseline. The second phase of the project involved getting students to use the simulator. These students were given the same procedural instruction as the senior attending surgeons and were timed three times while performing the same task. The results of the two groups were then compared to show the significant difference between the mastery standard and novice performance. 

Adds Lee, “Once we have shown that our mastery standard is indeed superior, we will use our developed curriculum to train novice learners to that standard. Once the novice learner has been through the curriculum, we will conduct timed trials to determine the effectiveness of our model. The combination of a low-cost surgical simulator with a validated curriculum is exactly what orthopedic education needs right now.”

“I became involved with this project because I had an interest in neuroscience,” Lee continues. “After attending a lecture given by Lt. Cmdr. Kent Werner, I had the opportunity to discuss ideas and talk about what his lab is currently working on. I found that faculty members are very open to students, and the spirit of mentorship is palpable throughout our campus.” 

Hewins and Lee believe that what USU does really well is to realize untapped potential. 

Hewins explains, “There’s a vast pool of talented researchers and faculty members at USU. Making connections between them and students while young in our career can have a massive impact on our ability to contribute to the medical mission downstream.”