First YOUR M.D. cohort presents their scholarly projects

March 13, 2018

Fourth-year – and some third-year – M.D. students gathered March 9 for the first Scholarly Project Capstone Event, a culminating moment in the maturation of the first cohort of students to complete the YOUR M.D. curriculum. Students presented 118 projects, including eight projects presented by third-year students, in the M.D. class of 2019.

Undergraduate medical education staff transformed the Collaborative Life Sciences Building third-floor classrooms into an exhibit hall for the day, with aisles of posters grouped by concentration area.

The event design is key to understanding the goals of the curriculum, explained Heidi Nelson, M.D., M.P.H., M.A.C.P., research professor and vice chair of medical informatics and clinical epidemiology and medicine, and director of scholarly projects, OHSU School of Medicine.

"We're trying to replicate what students might see at a national meeting, such as the American College of Physicians, which will be a part of their continuing medical education across their entire careers," Dr. Nelson said. "They may not all become researchers, but they're all going to be physicians who need to understand the implications of new research."

Scholarly Projects is a three-course curriculum within YOUR M.D. – a competency-based, time-variable approach to medical education. These competencies include skills that haven't traditionally been evaluated for a medical degree, such as communication, presentation and critical analysis of information. Designing and performing a research project, and then presenting the findings at a meeting, demonstrates all of these skills.

Dr. Nelson emphasized that while the scholarly element of the program is narrowly defined, the interpretation of "project" is broader. This flexibility is meant to mirror the scientific process overall, where even a well-designed inquiry may not result in the expected outcome. It also encourages the development of new ideas and products, as demonstrated by scholarly projects resulting in a children's book about dealing with serious health problems and a method for developing personalized aortic valves.

"Research is always messy," she said. "It's a learning experience similar to students rotating through a clinical ward. In this case, all the patients don't miraculously recover and go home … but that doesn't mean they failed the course. The process may not be linear and the outcomes may be unexpected."

Planning the curriculum: concentration areas

The Scholarly Project curriculum is organized into concentration areas that students helped to choose, allowing administrators to then identify faculty leads and mentors who can guide and support student interests.

Mark Baskerville, M.D., J.D., MBA, assistant professor of anesthesiology and perioperative medicine, OHSU School of Medicine, is the concentration lead for Law, Business and Health Policy. It's a broad category that includes projects beyond direct legal and policy inquiries.

"We all have lives beyond whatever our concentration is. Yes, I'm a lawyer but I also work in an ICU, so if there's anyone that's doing critical care or anything else in my background, I'll get those students as well," said Dr. Baskerville.

Dr. Baskerville described his role as "the matchmaker and wedding coordinator," meaning he helps connect students with mentors in their specific areas of interest, track their progress and troubleshoot problems. He's also a backup to support students directly if someone's mentor leaves OHSU.

Hands-on experience with global health

Kaitlyn "Katie" Main and Shira Einstein, both M.D. class of 2018, collaborated on an 11-week trip to Lima, Peru, to work with Health Bridges International. Main is pursuing emergency medicine and Einstein plans to go into pediatrics, but they share a passion for global health.

"We both knew that we wanted to have a global health experience, and this project sounded like a really sustainable, ethical way to learn and give back," said Einstein.

They created a standardized manual as a resource for health ambassadors advocating for children and families who live in extreme poverty, to help navigate a complex health care system and overcome barriers to access.

"With the scholarly project, when we heard we were all expected to do some kind of research project, we all thought bench or lab research," Einstein said. "It didn't speak to me in the same way that doing some kind of advocacy, patient-centered work did. I think it's really cool that we could make evidence-based, scholarly contributions to the field of global health."

Main credited the scholarly project requirement for helping her learn what's needed when presenting at a major conference. She said the larger YOUR M.D. curriculum schedule – and supportive M.D. program leaders – provided the flexibility and time to pursue the project, including their international travel.

Peter Engdall, M.D. class of 2018, examined social determinants and global health closer to home. Partnering with Winding Waters clinic in Enterprise, Ore., Engdall identified circumstances that impact health that are not traditionally part of a doctor-patient discussion –such as housing, food insecurity, access to transportation or a phone.

"The more that your care team knows about these [circumstances], and can help tailor specific treatments, the better the outcomes. My project simply asks, 'why aren't we asking everybody?'," said Engdall. "We can give you all the medicine for whatever ails you, but if you don't have a home, you're not going to be healthy."

Analysis with clinical impact

Joel McLouth, M.D. class of 2018, plans to pursue radiology, so his research focused on how image analysis can benefit patient care – specifically "the association of sarcopenia as it related to adverse outcomes following liver-directed treatment in patients with unresectable hepatocellular carcinoma."

"From obtaining IRB approval to statistical analysis, there is a lot more that goes into a successful project than I initially anticipated," said McLouth. "This was an eye-opening experience and I certainly feel that I am more prepared to present research findings than I was at the start."

Dacey Brooke, M.D. class of 2018, already has a master's degree and some experience with conducting and presenting research. However, the clinical focus she pursued with her scholarly project was a new direction for her. She explored the efficacy of imaging options to detect shunt failure in children with hydrocephalus, primarily comparing shunt series (X-rays) and shuntograms, which require exposing children to radiation.

She said she hopes the research will illuminate the limits of these tests and better support emergency department physicians and neurosurgeons needing to decide which tests to use on children with concern for shunt failure.

"The fewer tests that we can do on these patients, while still keeping them safe and providing them medical care, the better," she said.

Brooke presented this research at a regional meeting of the Society for Academic Emergency Medicine, and has been accepted for the national meeting. She will also share her findings at the Pediatric Academic Society in Toronto.

Recognizing student work and contributions to medical knowledge

The capstone event closed with a gathering to celebrate all of the work and the award winners.

"It's a proud moment for the curriculum and the program with your work coming to light, and this event brings it all home – back at CLSB where you all started," said Tracy Bumsted, M.D., M.P.H., associate dean for undergraduate medical education, OHSU School of Medicine. "You've created a lot of new knowledge with your projects. I can't thank you enough for your perseverance, your creativity, your passion for the projects that you have created to change and improve human health."

2018 capstone event award winners

• Group A, Clinical Research I: Derrick L. Tao, Mutational Testing in Advanced Prostate Cancer and its Impact on Clinical Decision-Making
• Group B, Clinical Research II: Harrison M. Mooers, CRC Screening in Women age 50-59 years: A Risk-based, Tiered Approach with Fecal Occult Blood Test
• Group C, Basic Science and Biomedical Engineering: Qiuying "Selena" Liu, Midostaurin Improves AML Patient Survival by Targeting the Microenvironment
• Group D, Law, Business and Health Policy: Peter A. Engdall, Social Determinants of Health Survey Prior to Clinical Visit: An Intervention to Improve Healthcare Delivery
• Group E, Education, Quality Improvement and Ethics: Joel D. McLouth, Association of Sarcopenia with Adverse Outcomes after Liver-directed Treatment for Unresectable Hepatocellular Carcinoma
• Group F, Epidemiology, Community and Global Health: Kaitlyn "Katie" Main and Shira Einstein, Health Advocacy Curriculum Development for Health Care Ambassadors and Families of Medically Fragile Children in Lima's Urban Slums

Photos by Aaron Bieleck.

Top photo: Students and faculty gathered March 9 for the first Scholarly Projects capstone event.
Second photo: Dr. Heidi Nelson addressed students and faculty at the conclusion of the capstone event.
Third photo: Katie Main (left) and Shira Einstein both created posters to present their research.
Fourth photo: Peter Engdall gave an overview of his project to attendees.
Fifth photo: Dr. Tracy Bumsted (right) thanked students for their work before award-winners were announced.
Sixth photo: From left, Derrick L. Tao, Katie Main, Joel McLouth, Peter Engdall, Shira Einstein, Harrison Mooers, Quiying Liu