Alumni Research Spotlight: Dr. Rachel Ranson ('21)

Dr. Rachel Ranson (‘21) was the first Campbell Medicine student to receive Honorable Mention from the AACOM Student Researcher of the Year Award. Dr. Ranson took a gap year as an MS-III to participate in a research year at New York University’s Orthopedic Surgery Department and is now in residency for orthopedic surgery at George Washington University in Washington, DC. She recently shared the details of her experiences with medical research before and during medical school that she believes were instrumental in her receiving Honorable Mention as well as her continued work while in residency.

“I would like to thank Dr. Craig Fowler for telling me about the AACOM Research Award and for mentoring me regarding the required letters of recommendation, personal essay and CV of my research. Dr. Fowler also advised me through the process of seeking a research gap year, and I was very fortunate to get accepted to NYU for a 2019-2020 research year where I gained significant research experience.

“There were hundreds of applications, a winner, the runner up, and a handful of honorable mentions. To be among those who received Honorable Mention was amazing because a huge component of the award criteria is osteopathic – ‘how is your research helping osteopathic students?’ Unfortunately, I hadn’t published anything of that nature yet, even though I’m working on it now, I was really honored that they respected my drive and what I’m doing.”

WHAT PROMPTED YOU TO APPLY FOR THE RESEARCH YEAR AT NYU?

I went to medical school to be an orthopedic surgeon. I really knew what I wanted to do. I was obviously open to other things, but in my heart, I knew that’s what I wanted. So, I tried to get involved in some research, but it was difficult to get ortho specific research without a home [Campbell affiliated] ortho program. Doctor Fowler showed me an article about gap years - research years. A lot of allopathic students have been doing this, and he suggested I pursue one.

It was really hard to grapple with taking a year off - knowing you are putting another year between you and graduating - losing a year of pay. But, I decided if it can solidify a spot in something I know I want to do, I’ll do it, and then I got the most amazing opportunity.

When I got into the fellowship at NYU, I had no idea how impactful it was going to be. The Primary Investigator I did research with, Dr. Kenneth Egol, is quite significant in the ortho world, and he’s a great guy. He wrote The Handbook of Fractures and was the program director for NYU for quite some time -one of the top orthopedic programs in the country - and he is now the vice chair. Later, when I was doing residency interviews, folks asked me “You got to work with Ken? Wow, that’s pretty cool”.

WHAT WERE THE SPECIFICS OF YOUR PROJECTS AT NYU?

NYU has had this research program for almost 20 years, so it’s a well-oiled machine as far as what fellows do; you are assigned certain internal databases. I was in charge of a large geriatric database and one about proximal humerus fractures. Additionally, I created a hip fracture database with NYU’s data, which they have continued using since I left, resulting in several publications already.

Also, they had just created a tibial shaft database which was an international, multi-center study with the AO Foundation - a huge trauma conglomerate in Switzerland who come up with a lot of the treatment principles. They chose NYU to be one of the sites for this multinational study, and I was the sole person setting it up for the whole institution. A guy came from Switzerland to train me. He also brought me chocolates which was super nice.

In addition to the databases, I was going to IRB meetings myself and presenting, coming up with protocols, talking to the legal department, et cetera. I got to see the inner workings of research from an administrative standpoint as well - that was really unique.

Unfortunately, SARS COV-2 hit while I was in the program in New York, but it provided an opportunity for some really interesting research on the orthopedic impacts of the virus that we were able to publish. Using our hip fracture database and many man hours, we got all of our data for the COVID papers in about 2 weeks.

"SARS-COV-2 and Hip Fractures - you have a hip fracture, and you have COVID-19, what’s your mortality risk?"

If you have COVID, it can be terrible. If you have a hip fracture, that’s terrible because within a year of hip fracture, there’s a 30% mortality risk in and of itself. For geriatric patients, either one is a pretty rough thing to happen, so we were interested to see how COVID-19 + hip fractures impacted mortality rates.

Turns out it’s really bad.

We looked at data from 2019 and compared to 2020 and the mortality risk was significantly more.

Using the database, we factored in patients’ age, their comorbidity index, the injuries they sustained, and plug that information into an algorithm to calculate the percentage risk of patient death within their hip fracture hospitalization and even 30 days out.

Our paper shared how we can use this tool for patients to risk stratify them in quartiles and every single person who had COVID was in the highest quartile. It was predictive of their death rate, which was really upsetting, but it also gave us a better treatment algorithm for patients who have both conditions. Typically, if you have hip fracture, you get surgery right away, but if you have COVID symptoms, it’s actually in your best interest to hold off until you’re asymptomatic.

It was a really interesting project because it affected patients in the moment of the evolving pandemic. I’m still working with NYU, and we are about to do a one-year follow-up. Unfortunately, the data is looking bleak in regards to patient morbidity. It quite sad, yet it is such important information.

We published to the "Journal of Orthopedic Trauma." The papers can be found on PUB Med as well as a few international journals. Later, when I was interviewing for residency, interviewers said “Oh, I read your paper! We’re teaching it and updating our hip fracture policy because of it” - that was a bit surreal and definitely exciting. It was in that moment when I realized how truly impactful the project was; I knew research could be impactful, but it got me even more excited to continue doing research.

Articles published: “Increased Mortality and Major Complications in Hip Fracture Care During the COVID-19 Pandemic: A New York Perspective”

“Modifications of Validated Risk Stratification Tool in Characterize Geriatric Hip Fracture Outcomes and Optimize Care in a Post-COVID-19 World”

OUTSIDE OF THE NEW DIRECTION IN YOUR RESEARCH, HOW WERE YOU IMPACTED PERSONALLY BY THE COVID PANDEMIC?

I got COVID pretty early in 2020. Thankfully, it wasn’t terrible for me. It was like a week-long flu.

I only lost my taste for a day, so really, I had best case scenario with it. My cat got sick too though, so that was really sad. I was really worried. She had horrible breathing, and the vets weren’t even open, but she recovered, too.

New York City is usually so lively and vibrant with something always going on, but when everything was fully shut down, no one was out. It was like a ghost town. It was terrifying. It made you realize how serious the situation was.

I was in research, but we had a huge clinical component to this year as well, so I was going to clinic and the hospitals after I recovered. Then, I got pulled out like all nonessential hospital staff from the end of March or early April until June.

That’s when things were getting really bad; I went to the hospital and patients were packed along the hallways like sardines because there weren’t enough beds. It was exactly like what the media said happened. I saw the Red Cross come...It was pretty scary.

Luckily, I didn’t have a lot of first-hand experience compared to all of the physicians who have, unfortunately, gone through a lot of trauma. I was only peripherally there seeing it all.

In April and May, we weren’t allowed to be in the lab, so we did our research remotely. June 1st, we went back. To be by yourself in a tiny apartment for two months…it was rough for a while, but we made it through.

WHAT ARE YOUR PLANS FOR FUTURE RESEARCH WHILE IN RESIDENCY AT GW?

I’ve continued the research with NYU, and I’ve started some new projects.

"NYU Hip Fracture Anesthesia" - One of my main projects with NYU was looking at a new anesthesia technique for hip fracture care. Instead of doing general anesthesia or a spinal, it was like when you are under for a dental procedure - it’s called MAC sedation, along with injections of lidocaine in your hip, so it’s the most minimal.

We did this for patients who were really sick, when it was not recommended to do general anesthesia, and spinal’s can be hit or miss, so we were seeing if this was a more safe and effective option. It turned out great especially in light of COVID and other patients who are really, really sick.

We want to do a multi-center clinical trial, and I’m hoping to do it with George Washington, Cedars Sinai, and NYU.

Publication: “Monitored Anesthesia Care and Soft-Tissue Infiltration With Local Anesthesia: An Anesthetic Option for HighRisk Patients With Hip Fractures”

"The Tulane Project: Osteopathic Presence in Orthopedics"

I’ve started working with Dr. Mary Mulcahey at Tulane who’s also an allopathic (MD) physician. My research year was at NYU, which is allopathic, and I was the first and only DO ever to enter into the NYU research program. This inspired me to look at osteopathic students, residents, and physicians in orthopedics, especially academic medicine.

An important component of the AACOM Research Award is how it’s helping raise the profile of osteopathic medicine and, through my experience at NYU, I saw how underrepresented DO’s are in orthopedic research. Given DOs’ additional musculoskeletal training, I thought it was pretty crazy how osteopathic medicine is not well represented in orthopedic surgery, so I pursued doing a study to document how many DOs, both faculty and residents, are in academic medicine by reviewing all of the residency program websites.

Eventually, I want to compare DO’s versus MD’s board scores because you would think intuitively DO scores would be higher since we have more MSK training, at least initially. Some board data that’s out there has shown DOs outperform MDs in the early years of residency. Unfortunately, we cannot gain access to the in-training examination raw data, so we cannot tell if this is statistically significant, yet.

Currently, we’ve decided to make a broader study to see where osteopathic students are going in general; we are looking at The Match data. Also, we will look at DO residents in orthopedics and then DO faculty in ortho - compare and contrast. For example, if there are more DO faculty, does that correlate to more DO residents in these academic centers?

Historically, DOs are more “community based”, so more rural or suburban, but I think we need to realize that even big cities are a community, right? So, it’s translatable. I don’t want there to be a bias at community programs towards researchers thinking “they are too big league for us” and that researchers will only want an academic, ivory-tower environment.

Community research should be done as well so we can reveal how to treat all patient populations. We need a more accepting environment both ways - more from the osteopaths to support those who want to get more involved in academic medicine as well those who want to be community medicine focused and more major academic institutions to be accepting towards osteopathic practitioners. No matter what, don’t discourage.

Dr. Mulcahey and I are also interested in females in positions of power. If there are more female faculty members, do those programs have more female residents?

She is the vice president of the Ruth Jackson Orthopedic Society, and she is passionate about getting women and POC involved in orthopedics as well as the cause of equality for osteopathic residents and physicians. Being able to work alongside her has been phenomenal. Our research is specific to orthopedics, but it also affects all women going into surgery, because women are underrepresented in surgery in general, but especially orthopedic surgery. I idolize her cause and want my career path to emulate hers – by helping marginalized populations achieve their goals.

Personally, I want to represent us - women and DOs - in these specialized fields where we don’t currently see as many, and I hope these studies will help increase our numbers, too.