February 21, 2003

Medical Scholars Program enhances lives of students, provides direction

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Dr. Jason Morrow, left, and Dr. David Haas talk with student Brian Lishawa. Lishawa is one of nine VUSM students in the Medical Scholars program. (photo by Dana Johnson)

Medical Scholars Program enhances lives of students, provides direction

Vanderbilt University School of Medicine is recruiting medical students for its 2003-2004 class of the Medical Scholars Program, a one-year, in-depth research experience.

The program is geared toward trying to interest medical students in academic research careers and has attracted 32 research-oriented students since its inception in 1998. It is recognized as one of the best programs of its type in the United States and has served as a model for similar programs across the country.

At Vanderbilt, nine students, normally between their third and fourth year, but sometimes after graduation or in other years, take a year off from medical school to participate in research — basic, epidemiological, or clinical. They are paired with a faculty mentor, do not pay tuition for the medical school year, and receive a $20,000 stipend.

“The physician-scientist is a vanishing breed, and we’re trying to turn that around,” said Dr. Jason D. Morrow, F. Tremaine Billings Professor of Medicine and Pharmacology and director of the program. “We feel at Vanderbilt that we have a highly talented group of students, a number of whom have an interest in research but don’t know how to express that. Many feel they do not want to get a Ph.D. in addition to their M.D. because that’s a very long commitment. But they want to undertake research.

“We view it as an important opportunity to give them a year to do that, to extend their medical school curriculum from four to five years, and as a result provide them in an early stage of their training with the opportunity to see what research is like. They don’t have to do basic laboratory research. The only criterion is that they have to ask a scientific question of some type. We’re flexible.”

Student research projects have ranged from studying PEP carboxykinase (PEPCK) gene regulation by fourth-year student Gopa Iyer, which won a Howard Hughes Medical Institute award, to the effect of divorce on diabetic control in children by current Medical Scholar Anu Subramony. More than 200 faculty members serve as potential advisors for the program.

Before the Medical Scholars Program, the students’ only exposure to research was the Introduction to Biomedical Research class, two half days a week during the first year of medical school, or working in research labs during the summer break.

Students have earned dual medical/Masters of Business Administration and medical /Masters of Public Health degrees while participating in the Medical Scholars Program. More than 30 published papers have resulted from research undertaken by students in the program.

The Medical Scholars Program is supported by funds from VUSM and the National Institutes of Health. It began with five slots, then NIH funded an additional three, and the National Institute for Diabetes and Digestive and Kidney Diseases has funded one.

The NIH initially funded the Vanderbilt Medical Scholars Program as a pilot project. Following the demonstration at Vanderbilt that such a program could be effective in introducing medical students to research, the decision was made to launch a medical scholars program nationwide on a competitively funded basis.

The NIH provides up to 100 slots at medical schools across the country, and the National Center for Research Resources provides up to 50 positions at various medical schools. The Doris Duke Foundation also provides an additional 50 slots across the country.

Dr. John Oates, Thomas F. Frist Professor of Medicine and Professor of Pharmacology, was the first principal investigator of an earlier scholars program at Vanderbilt, funded by the American Heart Association. After some time, the AHA put its money elsewhere, and Vanderbilt, in a strategic planning process headed by Dr. Harry R. Jacobson, vice chancellor for Health Affairs, decided to start its own program.

“I’m very enthusiastic about the Medical Scholars Program,” said Oates, who chairs the program’s steering committee. “It provides an alternative entry point for medical students to do research training. Many develop an interest after entering medical school and the program provides them the opportunity for the interest to be nurtured.

“The program at Vanderbilt is as successful as any in the United States. It’s become a part of the Vanderbilt medical student culture. Students who have enjoyed their experience pass it down to the classmates who follow them.”

Dr. Steven G. Gabbe, dean of VUSM, agrees.

“For many students it’s the opportunity that launches them into a career in research in the future,” Gabbe said. “It’s an excellent chance to take a full year and devote it to research.”

Morrow said the experience gained by those in the program has also helped Vanderbilt medical students obtain the highest quality resident slots at Vanderbilt and other institutions.

The projects are as varied as the backgrounds of the students who participate. One student traveled to Japan to study rheumatological diseases common in the area. Another spent time in Colombia to observe tuberculosis infections and bring back clinical samples to study the molecular biology of TB. Other projects include the role of COX-2 in prostate cancer, gene expression in glioblastomas and reovirus adhesion and pathogenesis.

Brian Lishawa, a current Medical Scholar in between his third and fourth year of medical school, spent the first four months of the program in Ecuador. An important component of the Medical Scholars Program is to try to offer a clinical experience for interested students in addition to exploring a scientific problem. He concentrated on learning how to speak Spanish more fluently the first six weeks, then worked for another six weeks in a mission hospital, where, among many things, he saw patients with HIV and TB. For the last portion of his four months, he worked in Hospital Vos Andes Shell, a hospital in the Amazon jungle where he did everything from delivering babies to treating poisonous snake bites. “It was the greatest medical exposure I have had,” he said.

Lishawa is currently working with Dr. David W. Haas, associate professor of Medicine at the Comprehensive Care Center, studying the role of P-glycoprotein in HIV infection and believes that his earlier clinical experience has greatly enhanced his interest in HIV infection and treatment.

“This program has most definitely altered my career,” Lishawa said. “It’s given me a real-life experience of seeing doctors working in a mission hospital in the jungle, almost exactly what I want to do with my career. My spiritual calling to this sort of mission work has been amplified throughout this year.”

Lishawa said he wasn’t ready to make a career decision at the end of his third year. “The program came at a good time for me. It gave me more time to explore.”

Students don’t have to be in the lab. Last year, third-year students Jeff Smithers and Joshua Denny worked with Dr. W. Anderson Spickard III, assistant professor of Medicine, designing online educational curricula for students.

“Our project began with the desire of Dr. Spickard to have better ways of finding curriculum content and answering questions such as ‘where is genetics taught’ or finding out what a student in the third year knows about congestive heart failure,” Denny said. “The idea was that he, as a teacher, could tailor his lectures to what his students already knew.”

Dr. Randolph A. Miller, professor and chair of Biomedical Informatics, mentored the informatics portion of the research, which is intended to improve the integration of the curriculum, to identify overlaps, and to improve access for all students.

“Our goals were to create a state-of-the-art search engine that would ‘understand’ documents such as lecture handouts and PowerPoint slides,” Denny said. “When it encounters the acronym ‘CHF’ in a document, it tries to determine whether you are talking about congestive heart failure, Crimean hemorrhagic fever or congenital hepatic fibrosis. It also sees synonyms such as ‘Wilson’s Disease’ and ‘hepatolenticular degeneration’ as the same thing. We compared this to a concept identifier produced by the National Library of Medicine and showed it performed better on our documents.”

The students then created a Web site to access and search the curriculum based on this search engine. It was tested with the Anatomy and Histology courses and Denny and Smithers are currently studying user interactions and opinions of the Web site.

“I gained a new career focus from the project,” Denny said. “Long interested in research, I’ve now decided to focus my research energies in medical informatics after completing an internal medicine residency. I love teaching, mentoring and developing students.

“It’s been fulfilling to not only be involved in a project that not only allows me to improve education, but also allows me to work directly with students.”

Morrow said he hopes the program will grow. “We would like to have 15 students in the program next year. Depending on the funding we can obtain, the sky can be the limit.”