Medical Knowledge and Skills CEO 2.2: Understand the clinical relevance of scientific inquiry and demonstrate the ability to evaluate emerging knowledge and research as it applies to diagnosis, treatment and the prevention of disease.
Research is integral to the advancement of medicine. It is the means by which we learn more about the diseases that plague our patients and search for treatments that may improve the lives of our patients. Personally, I am motivated towards research by the loss of my mother. She unexpectedly passed away when I was thirteen, and the coroner was unable to provide a definitive cause of death, only that her heart had stopped. Although I was unsatisfied with that explanation, I also realized that I would likely never know why my mother died. That lack of information, however, sparked my interest in medicine. The available scientific knowledge was insufficient to diagnose my mother’s condition, but perhaps one day, we will be able to identify the disease in someone else.
This desire to contribute to medicine led to a number of research opportunities throughout my undergraduate career. Most notably, I completed: 1) two summer research fellowships at Stanford University in the lab of Dr. Marlene Rabinovitch, MD, studying the genetics and cellular biology of pulmonary arterial hypertension, which culminated in a middle-author paper in the American Journal of Respiratory and Critical Care Medicine, and 2) two years as an undergraduate research student at the California Institute of Technology (my alma mater) in the lab of Dr. Paul Sternberg, PhD, looking at the functional significance of the AWC neuron in olfaction for the nematode Caenorhabditis elegans, which became the subject of my biology senior thesis.
Upon matriculating into medical school at The Ohio State University College of Medicine, I was determined to continue conducting research. My search for a mentor ultimately led me to Dr. Debra Zynger, MD, from the OSU Department of Pathology, whom I began working with at the beginning of my third year in medical school. My project analyzed the frequency and clinical relevance of repeat biomarker testing in breast cancer patients who receive neoadjuvant chemotherapy prior to surgery. Specifically, we wanted to know if there were any biomarker changes upon repeat testing that led to modifications of the adjuvant regimen, as this question has never previously been studied. There are presently no guidelines regarding repeat biomarker testing, which is currently performed at the discretion of the attending pathologist, but novel research like mine that demonstrates the clinical value of repeat biomarker testing could help to create guidelines that focus repeat testing to be most impactful.
This project is special to me. Although I had worked on many others in the past, this was the first time that I would serve as leading author on a paper destined for publication in a scientific journal. I was responsible for conducting the background research, collecting and analyzing data, and compiling the final manuscript. Balancing this project on top of my already rigorous third-year clerkship schedule required much diligence and perseverance, but I was motivated by the fact that I was fulfilling my dream of conducting significant medical research that could positively affect so many lives. Approximately 1 in 8 women in the U.S. develop invasive breast cancer over the course of their lifetime. Statistically speaking, I can expect at least 1 person in my group of close female friends to eventually develop breast cancer. My hope is that the work I do will make a difference in their medical treatment and outcome.
By the fall of my third year, my manuscript was complete, and come winter, it was accepted for publication in Human Pathology.
In addition, I also had 2 abstracts from my project that were accepted for poster presentation at national meetings: 1) the United States and Canadian Academy of Pathology (USCAP) Annual Meeting in the spring of 2017, and 2) the American Society for Clinical Pathology (ASCP) Annual Meeting in the fall of 2017.
1) Do Tumor Characteristics Predict Changes in Breast Cancer Biomarkers Following Neoadjuvant Chemotherapy?: Abstract and Poster
2) Pathologist’s Practice Patterns in Breast Cancer Biomarker Testing After Neoadjuvant Chemotherapy: Abstract and Poster
Although it is known that changes do occur upon repeat testing of breast cancer biomarkers after neoadjuvant chemotherapy, there has been little analysis into the tumor characteristics that may predict those changes, and even less investigation into what tumor characteristics may influence a pathologist’s decision to repeat biomarker testing (as mentioned above, with no published guidelines, repeat testing occurs per pathologist preference). To create our guidelines, we must first develop a clearer understanding of what drives the changes that we observe.
The opportunity to attend these national conferences is truly a remarkable experience. Investigators and clinicians from around the world gather to present their research, and I am incredibly humbled to have been selected as one of them. We are all working towards the same goal, of improving medicine such that we can better human lives. My poster for ASCP was also selected as a finalist for the ASCP Best Lab Practice Poster Award Competition, thus exemplifying the accomplishments that medical students at The Ohio State University College of Medicine are able to achieve, and it is an honor to represent The Ohio State University College of Medicine at the national level.
As I come to the last year of my medical school, words cannot express my excitement for what lies ahead. I plan to apply for a residency in radiology, and I am currently working on my Advanced Competency in Research with Dr. Zynger on a pathology/radiology project that looks at the prevalence and histopathologic characteristics of entrapped fat in renal cell carcinoma, whether this fat was noted on preoperative radiographic imaging, and if the fat raised the differential diagnosis of angiomyolipoma. Our goal is to have abstract accepted for presentation at the USCAP Annual Meeting in the spring of 2018 and a manuscript accepted for publication in a peer-reviewed scientific journal.
I am so grateful for the all the opportunities that I have received here at The Ohio State University College of Medicine. Each day, I am achieving my goal of contributing to medicine. My successes in research have only fueled my passion.