The Medical Scientist Training Program's 19th Annual Retreat was held on August 9, 2019, at the Rochester Yacht Club. The retreat is an opportunity for the student body to gather to discuss science and welcome the incoming class. This year, the MSTP welcomed six new students: Maya Anand (Columbia University), Thomas Delgado (University of Florida), Svetlana Markova (Kharkiv National Medical University), Michael Meadow (UCLA), Gavin Piester (University of Rochester), and Victor Zhang (University of Rochester).

2019 Incoming Students

This year's Keynote address was given by Dr. Supriya Mohile, Professor of Medicine and Surgery at the University of Rochester, and was titled "Improving Care Delivery and Outcomes for Older Patients with Cancer and their Caregivers." Dr. Mohile highlighted the need for geriatric assessments in oncology to properly address concerns such as tolerability and toxicity of cancer treatments. She described the large clinical studies that are ongoing which demonstrate the feasibility of implementing geriatric assessments in oncology and stressed the need for all clinicians who treat elderly patients to use tools available to them to address concerns that are unique to this population.

The morning science session concluded with short talks by several current MSTP students. Second year medical student Emily Isenstein discussed her work on proprioceptive and visual integration in children with autism, Fara Tolibzoda Zakusilo (G2) discussed the role for the extracellular matrix in Alzheimer's disease, Jesse Wang (G3) spoke about the development of a digital medical scribe, Booyeon Han (G4) described her work to understand the tumor-draining lymph node in pancreas cancer, and Aimee Morris (M4) spoke about resting state functional connectivity in focal dystonia.

Following lunch, Kerry O'Banion, MSTP director, gave an update on curricular changes occurring in the medical school, which was followed by a presentation by students who attended the National MD/PhD Conference at Copper Mountain in July. New students were elected to the MSTP student council to end the afternoon. We look forward to another exciting year for the MSTP!

While a brain injury can be difficult to locate, new research identifies a single region of the brain that can be used to examine the impact of a concussion or repeated hits to the head.

The finding, published today in Science Advances, also supports the emerging idea that traumatic brain injury is not limited to people who sustain a concussion; it can result from repetitive head hits that are clinically silent--those that do not produce the visible signs or symptoms of a concussion. These subconcussive hits have been increasingly recognized as a potential threat to long-term brain health and as a possible cause of chronic traumatic encephalopathy (CTE).

Jeffrey Bazarian, M.D., M.P.H., professor of Emergency Medicine, Neurology, Neurosurgery and Public Health Sciences at the University of Rochester Medical Center and a co-author of the study says that the location of a brain injury varies widely from person to person. This is a major obstacle for physicians trying to diagnose brain injury using imaging techniques.

"This study is important because we found that no matter where the head gets hit, the force is translated into a single region of the brain known as the midbrain," noted Bazarian, who treats concussion patients and conducts research related to traumatic brain injury. "Midbrain imaging might be a way in the future to diagnose injury from a single concussive head hit, as well as from repetitive sub-concussive head hits."

University of Rochester fourth-year medical student Adnan Hirad, Ph.D., the first author of the research added, "Our findings do not dispute the fact that head-injury effects are distributed throughout the brain, but the midbrain may serve as a 'canary in a coal mine' in terms of identifying damage. From this study we know that the midbrain region, which is linked to brain functions often affected by a concussion, is the place to look to identify the impact of clinically defined concussions with visible symptoms and silent brain injuries that can't be observed simply by looking at or behaviorally testing a player, on or off the field."

Fear is a normal emotion in animals and humans alike, enabling us to stay safe and avoid harm. Human anxiety disorders, including conditions such as post-traumatic stress disorder and social anxiety disorder, are conceptualized as an 'over-reactivity' of normal fear responses, or inability to modulate fear once the response is no longer appropriate. In the last decade, studies have delineated fear circuitry in rodents, to build models of how normal fear responses are instantiated when threat is present, and how fear learning is 'neutralized' by new learning when threat is no longer present (a process known as extinction).

Up until now, these models had not yet been examined in brains similar to those in humans. In a new study, published in Cerebral Cortex, researchers at the University of Rochester Medical Center used very small, paired injections of neuronal tracers in the brains of nonhuman primates, and examined how the amygdala communicates with the primate analogues of the prelimbic (fear) and infralimbic (extinction) PFC. The study, co-led by Keshov Sharma, a third year MSTP graduate student, found that, as in rodent, projections from the basal nucleus of the amygdala exist in nonhuman primates. However, there is also a substantial input from a neighboring region known as accessory basal nucleus, a greatly expanded amygdala nucleus in nonhuman primates and humans.

Jesse Wang remembers exactly when his crusade began.

The doctor he had seen since childhood turned a computer screen towards him during an office visit, in obvious frustration.

He couldn't get the program started to make the required entries in Wang's electronic medical record.

"This is absurd," his doctor said. "I just want to be able to talk to you like I used to."

Wang, who is pursing both a medical degree and a PhD in translational biomedical science at the University of Rochester, understands the frustration. Especially when he reads studies showing it's not unusual for physicians to be online maintaining patient e-records from 5 in the morning until 9 at night.

"It's not what I signed up for; it's not what any doctor signed up for," Wang says.

Thanks to Rochester's Medical Scientist Training Program, which allows him to combine his interest in medicine with his passion for coding, Wang is well positioned to do something about the problem.

He'll explain how, as one of four finalists in the ACP Innovation Challenge — a "Shark Tank"-style competition hosted by the American College of Physicians on April 13 in Philadelphia.

During an eight-minute pitch in front of a panel of judges — and an audience of 100 or more physicians — Wang will describe the virtual assistant he is creating. The device will use speech recognition and natural language processing to take over the job of maintaining patient e-records, freeing up physicians to concentrate on their patients.

"It would be like Amazon Alexa," Wang says. "There would be a little speaker in the room that would be recording while your doctor talks to you and, based on that conversation, the device would know what to enter into the e-record."

"I think the key that will make this work is that doctors are already encouraged to use what's called a patient-centric communication style."

For example, physicians are encouraged at the end of a visit to sum up a patient's concerns and their plan to address them. Physicians would use a phrase like "to make sure I understand." The virtual assistant would recognize the phrase as a cue to transcribe everything from that point to the next cue, such as when the physician says, "Do I have that right?"

The device would be less expensive than hiring a transcriptionist, Wang says, and less obtrusive for patients who find it hard enough to divulge personal health information when there's just a physician in the room.

He already has a prototype for transcribing the summary portion of a patient's visit.

'Seamlessly see what the problem is — and fix it'

Wang, who is from Westford, Massachusetts, came to Rochester after majoring in physiology and neurobiology at the University of Connecticut.

He is now in his fourth year of Rochester's Medical Scientist Training (MD/PhD) Program, which currently enrolls 66 students. The program incorporates the MD and PhD degrees into a cohesive curriculum that endows the select group of students with the clinical and basic science skills needed to understand disease and to translate that understanding into new therapies.

Students spend the first two years on their medical degrees, then complete their PhDs in four years before returning for the last two years of medical school.

Wang is pursuing his PhD in translational biomedical science under the direction of Henry Kautz, professor and former chair of computer science and founding director of the Goergen Institute of Data Science.

Wang is now thinking about forming his own company after he graduates. He would use his medical and computing background to pursue his virtual e-record assistant and other medical-related projects full time.

"Physicians go to programmers for help with a lot of things besides e-records. It might be for applications for telemedicine," Wang says. "But it can be hard for them to convey what they need to a programmer who doesn't have a medical background.

"I'll have that background. I'll be able to very seamlessly see what the problem is — and fix it."

News Article by Scott Friedland, MD/PhD student

Many graduate students have varied overlapping academic goals and interests, or a hazy-at-best sense of their options when it comes to navigating from their current study into future projects or career choices. Some also need more help than others in finding the time or resources to explore opportunities in their fields that don't already dovetail neatly with their established career trajectories or fit within their considerable academic constraints. As an MD/PhD student, for example, my career path is, for the most part, laid out in front of me: when I finish my PhD, I will return to medical school for two years, and then apply for residency, not getting back into the lab for at least four years -- at this pace, an internship is never going to happen. But URBEST is dedicated to helping students explore all their options beyond their current coursework via regular workshops and seminars, and by helping students find and finance unique learning experiences they may not otherwise have considered pursuing. The following is my story that I offer to encourage the University of Rochester's graduate students to consider connecting with URBEST and to pursue additional academic interests and skill-sets, even when an internship is not a viable option.

Despite recognizing that my path was set in front of me, some mixture of curiosity and fear of missing out drove me to check out URBEST's offerings. My initial foray included a workshop on science communication; attending gave me a number of fresh perspectives on interacting with both lay and scientific audiences. That workshop helped give me skills that led to placing second in the Three-minute Thesis competition, and has encouraged me to participate in the UR Thinkers and Drinkers (a science outreach organization). At a different presentation given by URBEST, I learned that I could take a class at the Simon School of Business called Technical Entrepreneurship and Management. I learned about the creation and bringing to market of technologies from basic and translational endeavors. In doing so, I learned from and worked on a team with an MBA student, a data scientist, and post-doctoral fellow in statistics, all experiences that give me valuable perspectives as I move forward with my career.

Most recently, however, I wanted to enrich my skills in programming and bioinformatics, but couldn't see a clear path forward. In the Summer of 2018, I learned about the Programming for Biology course at Cold Spring Harbor Labs (PFB @ CSHL), but didn't think I would be able to afford to attend (even if I could talk my PI into giving me the time off). On a whim, I decided to talk to Tracey, the Executive Director of URBEST, whose office I'm lucky enough to have directly across the hall from my lab in the KMRB. She enthusiastically encouraged me to apply and told me that, if I were accepted, URBEST could help me make it happen.

The course was a two week intensive that focused on using Python, a user-friendly programming language, to tackle common problems in biology. We started with an introduction to Bash and the command line, a program for interacting with your computer and running programs that you've created. From there, we moved onto learning the actual language of Python. The second half of the course was more practical aspects of integrating programming and -omics data (e.g. whole genome sequencing and aligning or RNA-seq processing). When we weren't focused on learning or practicing Python, there was a fair amount of time for socializing, including group-wide trips into town, a Halloween costume party, and a banquet! For our final project, my programming group created an evolution simulator that was able to track the interactions of simulated people with different virtual genomes over time. Through this course, I went from very little training in programming to being able to solve many common problems in bioinformatics, leaving with tools and resources to further my studies after the course ended; and I had a great time connecting with a number of engaged, curious scientists in very disparate fields of biology who I may otherwise never have met.

These experiences have all shaped and transformed my life as a graduate student, and are all due in large part to the input and aid of URBEST. I want to encourage folks who don't feel that they have time or direction enough to complete a full internship (including my fellow MD/PhDs!) to nevertheless consider pursuing outside academic experiences that pique their interest. Tracey is an excellent sounding board, and immediately had several ideas that helped me to clarify my intentions and develop a coherent strategy for applying. If you think there's something that URBEST could help you achieve, don't hesitate to start in her office!