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School of Medicine discoveries

21
2016

Kelley Dodson named first female president of the Virginia Society of Otolaryngology

I think my presidency definitely reflects the change in traditionally male dominated surgical specialties to now being more representative and inclusive of women as a whole.

“I think my presidency definitely reflects the change in traditionally male dominated surgical specialties to now being more representative and inclusive of women as a whole.”

Housestaff alumna and School of Medicine faculty member Kelley M. Dodson, M.D., was installed as president of the Virginia Society of Otolaryngology on June 4. She is the first female president in the society’s nearly 100-year history.

It’s a milestone that Dodson says has special meaning for her.

“I think my presidency definitely reflects the change in traditionally male dominated surgical specialties to now being more representative and inclusive of women as a whole.”

Dodson has been involved with the society for a half dozen years. She served as president-elect last year and before that as vice president.

Through her service, she says, “I have gained significant insight especially into legislative issues facing the commonwealth of Virginia, as we have been very active in the legislative process on issues affecting our specialty.”

Kelley M. Dodson, M.D.

Kelley Dodson, M.D.

The Virginia Society of Otolaryngology was chartered in 1920. It provides continuing medical education for its members and addresses political and regulatory challenges affecting practice issues. Each spring, the society holds an annual meeting, which was held this year in McLean, Va.

Dodson has a clinical interest in pediatric otolaryngology as well as in congenital and genetic hearing loss. On the research front, she is interested in language and speech outcomes in children with hearing loss and has been involved with genetic studies of tinnitus and different forms of hearing loss. She also studies pediatric chronic rhinosinusitis and the mask microbiome in cystic fibrosis.

After completing her residency in the Department of Otolaryngology on VCU’s MCV Campus, Dodson joined the medical school’s faculty in 2005. She is now director of the department’s residency program.

By Erin Lucero
Event photography by Susan McConnell, Virginia Society of Otolaryngology

08
2016

Medical student hurdling toward Olympic Games

Many athletes have gone to medical school before or after the Olympic Games. Very few, however, try to pursue the two simultaneously.

The Class of 2017’s Mallory Abney, a 400-meter hurdler, has kept up world-class training during his time in VCU’s School of Medicine. He’ll begin his fourth year of study later this summer – right around the time he hopes to be competing at the Olympic Games in Brazil.

The Class of 17’s Mallory Abney

The Class of 17’s Mallory Abney has kept up world-class training during his three years in medical school. Now the 400-meter hurdler is aiming to turn in a qualifying time to make it to the Olympic Trials.

But first he’s got to get to the Olympic Trials. A few months ago, he would have automatically qualified as one of the top hurdlers in the country. But several athletes have since beat his qualifying time, pushing him down a notch and necessitating a faster finish before the end of June. He hopes to accomplish that this weekend in Maryland; otherwise, he’s got another chance later in the month.

While most of his competitors are training full time, Abney is tackling an acting internship in emergency medicine at VCU Health. “It’s been challenging,” he admits. “It’s hard to get the rest you need. But it’s helped keep me focused and organized.”

“Mallory is tough,” said his coach, Leslie Young. “As hard as he works towards his medical degree, that’s how hard he works at his hurdling.”

On a typical day, Abney gets up around 4:45 a.m. and is out the door for an endurance run by 5:15. He spends the day on VCU’s MCV Campus in school or the hospital, then heads to Virginia State University in Petersburg for a track workout followed by a weight-lifting session. He goes home to his (“very patient”) wife around 7 p.m., eats dinner, studies until almost midnight, and catches a few hours of sleep before starting it all over again.

It’s a grueling schedule, but Abney says he appreciates the support he’s gotten from medical faculty, staff and other students. Some classmates have gone to watch him run or accompanied him to training sessions. They’ll be rooting for him to qualify for the games, even though Abney admits he’s an underdog.

“People call 400-meter hurdles the toughest race in track,” he says. “It requires you to train in a few different disciplines. It’s a sprint race, so you need speed. But it’s the longest sprint race — a full lap around the track, so you need stamina. And then there are these 10 hurdles in the middle of it all, so you need flexibility.”

The Olympic Games weren’t part of his plans a decade ago.

After a solid – but not spectacular – track career at the College of William and Mary, Abney thought he’d just be a casual runner. He worked as a medical scribe at Memorial Regional Medical Center in Mechanicsville, Va., planning to take the MCATs and apply to medical schools.

But a chance encounter with a former rival reignited the desire to compete and he eventually re-entered serious training. After a coach told him his hurdling form was ineffective, Abney refined his technique and found his times dropping significantly, propelling him to national and international levels.

The MCATs were put aside, as he continued working as a scribe and competing. But in 2011 – just after he’d qualified for the 2012 Olympic Trials – he was sidelined by injury. Rather than sitting around during recuperation, he enrolled in the Premedical Graduate Certificate Program on the MCV Campus as a refresher and finally took the MCATs.

He was accepted to VCU’s School of Medicine and began in 2013.

Now 30, he realizes 2016 may be his last shot at the Olympics. If he makes the team, he plans to postpone applying for residencies for a year, since the September application deadline would be too tight. If he doesn’t make it – “the easiest road, but the saddest” – he’ll continue his medical training.

Both are really good options, he admits. “I’d be ecstatic to make the team. But whatever happens, I’m just happy I stuck with it.”

By Lisa Crutchfield

01
2016

The humble art of great teaching

Clint Thurber, PGY2, an internal medicine resident, was trying to give a brief presentation on different types of IV fluids to an audience of two interns and a medical student.

Things were not going well.

One of the interns was clearly interested, but the other appeared distracted, and impatiently interrupted Thurber. Could he cut to the chase? Could he just tell them the key points they needed to know? Meanwhile, however, the medical student seemed lost and unable to follow Thurber’s presentation. What was that term you used? Could you repeat that? Can you explain that?

Finally, Reena Hemrajani, H’10, stepped in. Associate program director for the internal medicine residency, on this day she was taking the role of facilitator in a two-day workshop on the art of effective teaching. The workshop participants were all second-year internal medicine residents, and the scenario that had just unfolded was a scripted role-play. The interaction was specifically designed to present the kinds of challenges and frustrations residents are likely to encounter in an actual teaching situation.

“How did it feel to be in the role of teacher?” asked Hemrajani.

“I think,” reflected Thurber, “that we often overshoot the knowledge base of our students.”

Hemrajani, who is an assistant professor in internal medicine, confirmed his idea. “The hardest part of teaching is remembering what they don’t know.”

During the workshop, roleplaying scenarios are videotaped so residents can analyze the challenges and frustrations that occur in actual teaching situation. They also get a chance to try simple behaviors for creating a more effective learning climate, giving feedback and organizing their teaching.

LEARNER AS TEACHER
By the time you graduate from medical school, you’ve spent years – almost your entire life – as a learner. Then you start your residency, and even though you’re called “doctor” now, you’re still fully aware of how much you have yet to learn. Suddenly you find yourself stepping into another new role you hadn’t really anticipated, a truly unfamiliar one that you might never even have thought about until the first day you’re expected to take it on.

Suddenly, you’re a teacher.

You’re a teacher, and that medical student who only a year ago was you is now looking at you for guidance. And you’re expected to know what to do.

“It is a huge mental shift, and when you think about being a physician, you really don’t think about the teaching part of it,” says Morgan Vargo, PGY2, who was taking part in the workshop. “Not only are you teaching in residency or if you become an academic practitioner, but you are always going to be teaching your patients too.”

In the Graduate Medical Education program on the MCV Campus, helping accomplished learners begin the journey to becoming effective teachers is the focus of the workshop in teaching skills. For a decade, it’s been offered annually to all second-year residents in internal medicine and, more recently, has been expanded to reach residents across the specialties.

The seminar is based on a framework developed by a Stanford internist. It focuses on seven categories — like feedback, communicating goals and promoting understanding and retention — that, though not necessarily intuitive, are essential for effective teaching.

“Most of student and intern education is from the senior residents when the attendings are not in the room, so teaching residents how to teach effectively is critical,” says Stephanie Call, M.D., who is the residency program director and associate chair for education in VCU’s Department of Internal Medicine.

Call has been facilitating the Stanford framework for more than a decade. The workshop offers an introduction to “really simple behaviors residents can use,” says Call, “particularly for creating a more effective learning climate, giving feedback and organizing their teaching.”

Beyond the skills it cultivates, the workshop also serves to reinforce to busy residents the School of Medicine’s commitment to creating not just great physicians, but also great teachers.

Gregory Trimble, M’03, another facilitator, is assistant dean for faculty at the VCU School of Medicine’s INOVA Campus in Fairfax. He notes that his own passion for teaching was discovered during residency and says that he emphasizes the important role residents play in medical education. “I remember coming out of medical school I felt well prepared entering residency,” he says, “and the people who were most influential as teachers were the house staff.”

John Greer, MD-PhD’13, is a third-year neurosurgery resident who completed the workshop earlier in the year. He says, “It was a good reminder that we are really positioned as residents to be teachers. Even when we are really busy and tired and there are lots of things we are still learning, we have to take the time and make the priority to teach the medical students and junior residents.”

Gregory Trimble, M’03 (center), is assistant dean for faculty at the VCU School of Medicine’s Inova Campus in Fairfax. He says he discovered a passion for teaching during residency. “I remember coming out of medical school I felt well prepared entering residency,” he says, “and the people who were most influential as teachers were the house staff.”

FACILITATING LEARNING
Central to the resident-teaching workshop are the roleplaying scenarios. They’re video-taped and analyzed in small-group sessions, giving the residents opportunities to try on different teaching situations, to see themselves in action, to think about what they might or might not do differently. As second-year resident Thurber contended with his restive audience of residents and medical student in one room, in another, Derek Leiner, PGY2, played the role of the impatient intern, checking his pager, taking a call on his phone.

Improvising, the resident taking the part of the teacher commandeered Leiner’s attention by engaging him and asking a question related to one of Leiner’s own patients. In the discussion that followed, Leiner acknowledged it was an effective tactic. “It was hard to pretend I had more important things to do when we were talking about my own patient,” he said.

Throughout the role-play, session facilitator Call was quick with warm praise: “Great job.” She posed thoughtprovoking questions: “How do you feel about giving reading assignments?” She offered helpful suggestions: “Develop little canned talks on something you are comfortable with, that you’re likely to have on your service.” She acknowledged challenges and limitations she’d faced in her own efforts to become a better teacher, like having to learn not to talk in a monotone when she was nervous.

Third-year neurosurgery resident John Greer, MD-PhD’13, makes a point of tailoring his teaching
to medical students’ career interests. That’s what he did with the Class of 2017’s Emily Kershner who’s considering emergency medicine as a career, but spent two weeks with Greer as part of her surgery rotation.

Animated, lively, enthusiastic, engaging, genuine — Call’s manner seemed anything but forced or scripted. Yet after the session, she pointed out that a great deal of thought and planning, refining and improving goes into every detail of how she and the other facilitators lead the workshop, that everything they do actively models and reinforces the very teaching strategies being learned. The residents, she says, “could label every behavior I used.”

Admitting her own limitations? The residents would call that creating a comfortable “learning environment.” Asking questions that lead to self-reflection? “Promotion of understanding and retention.” Even keeping the sessions on time — the role-play breakouts wrapped up right at 10:30 a.m., as the printed workshop schedule indicated — is part of the framework, under “control of session.”

“We think about everything, every aspect,” says Call, noting that every time she facilitates a workshop, she learns more herself.

“If we feel like the teaching is not going well, we adjust and ask ourselves, what are the behaviors I could use to make this go better?” adds Hemrajani — which is exactly what they want residents to learn to do as well.

SETTING THE STAGE
A few weeks later, second-year resident Leiner, looking back on the seminar, says he found the experience eyeopening. He’d gone into the workshop thinking he knew about teaching: his mother-in-law is a teacher, he has friends who are teachers, and of course, “I had been in school and seen plenty of teaching,” he says.

“But all the behind-the-scenes aspects of teaching I had never considered before, how there is so much more to teaching beyond the passage of knowledge. The learning climate, how you present yourself, how these factors relate to what you are trying to teach — I had not realized all these things are in play.”

Leiner says he took away strategies that he believes will be “very, very effective” in changing the way he will approach learners. “It showed me different techniques to use but also showed me that just the way I ask a question could change the way I pass on knowledge.”

Neurosurgery resident Greer says that he also found the experience immediately valuable. He notes, for example, that he now has medical students set goals at the beginning of a rotation and then provides them feedback on those goals at the end.

“Before this class I would never have walked in and said, ‘Hey, you have two weeks, what do you want to learn in that time?’” says Greer. “It was a good reminder about how we approach medical students and how we can give them the best education even though we only have them for a short time.”

Story by Caroline Kettlewell

Photography by VCU University Marketing

01
2016

Networking 101

Melissa Powell’s last job interview was in 2009 during her undergrad years — for a restaurant gig. But when she graduates next year with a Ph.D. in neuroscience, she feels empowered to land a great job in research or academics, thanks to a thorough education and a chance to hone her networking skills.

Powell and several dozen other graduate students from VCU’s School of Medicine attended Networking 101 last fall. The event offered tips to meet and mingle with potential employers — and then a chance to practice what they’d learned with members of the Virginia Biotechnology Association, a statewide non-profit trade organization representing the life sciences industry.

Katybeth Lee, associate director with Career Services at VCU, coordinated the event with the Graduate Student Programming Board on the MCV Campus.

“Last year, it became clear that students and post-docs are seeking opportunities to connect with professionals working in the bioscience field. Those professionals are looking to connect with the talent we have here at VCU, strengthening the bioscience workforce pipeline in Virginia,” she said. “This event was intended to meet both these objectives, capitalizing on VCU’s strong partnership with VABIO, our state bioscience association conveniently located on the MCV Campus.”

Many graduate students feel better equipped for the lab than getting to know potential employers in social situations. Sri Lakshmi Chalasani, a Ph.D. candidate in pharmacology and toxicology, noted, “We’re spending up to 14 hours a day on our work. Sometimes we don’t know what’s happening outside.”

At the networking session, Lee encouraged attendees to use those skills they’ve developed through years of study and labwork. “You are scientists,” she told the group. “Consider networking as an alternate form of data collection.”

“You are scientists. Consider networking as an alternate form of data collection.”

She encouraged students to be prepared with engaging conversation starters (“What’s the most interesting thing that’s happened today?”), a knowledge of reception etiquette (“If you’re drinking, hold the drink in your left hand so your right hand isn’t cold and clammy when you shake hands”) and a plan to break into conversations with others (“make eye contact with someone already in the group”).

And when it comes to conversation, “The key to networking is finding common ground,” Lee told students.

Pharmacology and toxicology’s Allen Owens, who earned his doctorate this spring, was active in programs for career development. “Being a part of these programs has helped me solidify career goals,” said Owens, who gained experience in an internship at the VCU Innovation Gateway.

Master’s and doctorate level graduates will not all end up in academia.

“It’s simply a matter of numbers,” said Jan Chlebowski, Ph.D., the medical school’s associate dean for graduate education. “However, the skill sets that these people are developing are very marketable in a wide variety of areas. Our students have a thirst for any kind of information about any alternatives that are out there.”

After the 30-minute Networking 101 crash course, students were released into a reception attended by dozens of VABIO industry representatives. They shook hands. They chatted. They collected contact info and made plans to stay in touch. VABIO organizations were pleased, said Chlebowski, and hope to keep communications channels open.

“Tonight is not a one-and-done,” Lee reminded students. “You’re here for the long haul.”

By Lisa Crutchfield

Photography by VCU University Marketing

01
2016

Basic science back up plan

In a recent School of Medicine postdoctoral scholar survey, nearly 43 percent of respondents said their main career goal was to be a tenure-track faculty member; an additional 12 percent want another type of academic position. According to the National Science Foundation, only about 20 percent will secure a position in academia within five years of receiving their degrees.

You don’t have to be a genius to know it doesn’t add up. Some have claimed the country’s graduate education system is broken or even that it’s a Ponzi scheme of sorts, preparing students for jobs that may never exist.

But where many see problems, VCU sees opportunities for students to find meaningful careers — perhaps better fits than academia.

When she began her doctorate, Arlene Buller-Burckle, PhD’97 (HGEN), charted her own course to a career in private industry. Today’s students, too, are more and more often planning for careers outside academia.

“The university community has known for a long time that we’ve been producing more Ph.D.s in biomedical sciences than we have academic positions for,” said Jan Chlebowski, Ph.D., the medical school’s associate dean for graduate education. He champions an NIH and NSF-supported initiative encouraging each student to have a development plan that addresses the question: What happens when I’m done?

Chlebowski points to chemistry as a field where graduates have always transitioned successfully into private industry, and suggests other disciplines can build on that model.

Arlene Buller-Burckle, PhD’97 (HGEN), chief director of the Molecular Genetics Laboratory/Quest Diagnostics in San Juan Capistrano, Calif., supports that.

When she began her doctorate in human genetics, she assumed she’d end up working in a large research university. She soon realized that academic research wasn’t for her, and was discouraged by a lack of support from many faculty members. Despite that, a handful recognized her clinical skills and helped guide her toward private industry. After completing a post-doc and fellowship, she joined Quest and rose through its ranks.

Joyce Lloyd, Ph.D., professor of human and molecular genetics, believes that’s the role faculty should take: look at a student’s strengths and offer guidance. “What you don’t want to see is someone who wants to be in academia but is stagnating as a post-doc for years without preparing for anything else.”

All students are developing marketable skills, she says. “To me, a Ph.D. is someone who runs the projects, is a person who is in charge, a problem solver, a troubleshooter who can make things happen.”

Honing those skills is an imperative for faculty members. It’s a focus for students, too, with 80 percent saying non-academic career information was important or critical to them.

The School of Medicine offers resources to ensure success in or outside academia. Lloyd leads the Careers in Biomedical Sciences Seminar, a course offered in the fall that aims to broaden students’ knowledge and prepare them for professional endeavors.

In addition to events such as Networking 101, VCU’s Career Center has beefed up resources for graduate students. Its Ram’s Roadtrip program, Chlebowski notes, recently introduced students to public and private organizations in the Washington, D.C., area, giving them a chance to interact and glean insight into other job options. Two stops last fall were the NIH and MedImmune, the global biologics research and development arm of AstraZeneca, where Nancy Ulbrandt, PhD’88 (BIOC), hosted the group.

VCU’s Women in Science program facilitates communication and networking among its members with a
variety of professional events designed to help members land jobs.

Quest’s Burckle says those in the private sector appreciate those efforts. “When we hire people from academia, we often have to re-train them and hope they can adapt to the industry. It’s such a different world.”

Lloyd hopes every student will end up in a dream career, academia or otherwise. “You certainly don’t want to squash anybody who’s got big ideas. After all, if you don’t aspire to it, you’re not going to get it.”

By Lisa Crutchfield

01
2016

On call: When Lew Stringer, M’66, responds, he brings a hospital with him

When a disaster strikes, the medical community leaps into action. Hospitals brace for an influx of patients, emergency medical teams seek out those who may be injured and doctors provide care to their community. But what happens when a tornado, earthquake or hurricane destroys a community’s hospital and prevents people from getting the care they need?

In steps Llewellyn Stringer, M’66.

Stringer is the project manager for the National Mobile Disaster Hospital, designed to deploy anywhere in the country when disaster strikes. The mobile hospital contains all the familiar elements of a normal hospital, such as an X-ray unit, blood banks and pharmacy. This one, however, can be loaded on tractor-trailers, sent to a disaster area and begin receiving patients within days.

Since the 1990s, Llewellyn Stringer, M’66, has held leadership roles in countless emergency preparedness
and response situations. Today he is project manager for the National Mobile Disaster Hospital, designed to deploy anywhere in the country when disaster strikes.

The mobile hospital project was conceived in 2005 after Hurricane Katrina hit New Orleans and left many without access to medical services. FEMA decided it needed to find a way to respond to such disasters, when local hospitals are either damaged or overwhelmed by the number of patients.

Stringer was an obvious choice to lead the project. Since the 1990s he’s held leadership roles in countless emergency preparedness and response situations. For 10 years he served as commander of the National Medical Response Team and was the senior medical advisor to FEMA under the Department of Homeland Security.

He helped develop medical response training after 9/11, testified before Congress about preparing for attacks with weapons of mass destruction and managed response teams for U.N. General Assembly meetings and several State of the Union addresses. All while responding to nearly every natural disaster in the country.

Coupled with these experiences is a reputation for getting a job done regardless of the circumstances. “Lew is a no-nonsense, get-the-job-done type of guy.

There’s no place Lew wouldn’t go if needed,” says Gary Sirmons, a regional coordinator for the Department of Health and Human Services who worked frequently with Stringer throughout his career. He helped Stringer research and develop the mobile hospital idea.

“I’ve seen him sleeping on a concrete floor in a tornado bunker in Missouri, working endless hours during hurricanes in Florida. He never asks his team to do something he wouldn’t do himself. He is a strong force and is considered one of the best responders out there. The national responsibilities he has held through his career are evidence of the reputation he has in our field.”

Also well-known is Stringer’s big personality and a sometimes colorful vocabulary. Stringer owned a cattle farm for many years near Winston-Salem, North Carolina, a fact that, according to another longtime colleague Joe Brennan, reflects both his rural charm and straight-shooting style. “I remember asking Lew to tone it down before one meeting and afterwards I had people wondering if he was feeling OK because he wasn’t speaking with his usual candor. He has calmed down since those days though.”

Stringer retired from FEMA in 2006, but soon was back to work at the North Carolina Office of Emergency Medical Services. In 2008, FEMA moved the mobile hospital from Fort Detrick in Maryland to North Carolina, and Stringer took charge again.

The hospital is made up of large tents and mobile hard structures. It features a 21-bed emergency department, 10-bed critical care unit, two operating rooms, full digital X-rays, a small lab, blood bank, a pharmacy and a central medical supply with enough stores for 72 hours of operation, a morgue and an administrative and command control unit. Stringer also recently added two five-bed emergency departments that he can deploy to small rural hospitals that don’t require all of the resources of the 21-bed set up.

“We can perform just about anything other than open heart surgery,” says Stringer.

Flexibility is key for Stringer and his team. Their home base in central North Carolina allows them to quickly respond to tornadoes in the Midwest and hurricanes on the East Coast or in the Gulf.

With a goal of deploying within 24 hours of receiving an assignment, the mobile hospital brings a 21-bed
emergency department, 10-bed critical care unit, two operating rooms, full digital X-rays, a small lab, blood bank, a pharmacy and a central medical supply.

“The goal is to deploy within 24 hours of receiving an assignment, bring all units, except the ICU, online within 48 hours after arrival on site and have the ICU operational within 72 hours.”

Collaboration is another central part of the project. Created by FEMA, it is owned and maintained by North Carolina’s EMS with grant funding from the U.S. Department of Health and Human Services. Much of the grunt work of unloading and setting up the hospital is done by volunteers from the N.C. Baptist Men’s Disaster Relief organization, who travel with the hospital when it’s deployed.

The volunteers include plumbers, electricians, carpenters and other tradesmen ready to solve any problem that might slow down the hospital’s deployment. Stringer has even partnered with a local North Carolina hospital to make sure he can maintain a stockpile of medical materials that are ready at a moment’s notice.

Stringer and his team got their first taste of action in 2014 when the hospital deployed to Louisville, Mississippi. The town and its local hospital were badly damaged by tornadoes and in need of help. Within days of being deployed the hospital was able to offer basic services and soon after was able to accept a wide range of patients.

Officials plan to have a temporary hospital open in some capacity until 2018 when construction of a new hospital in Louisville is complete. “Quick response time is obviously an important part of our mission, but maintaining a presence in the affected communities can be equally important. One of the major obstacles to New Orleans’ recovery after Katrina was that many of the health care workers had left town. There weren’t hospitals for them to work in.

“In Louisville we’ve managed to keep 100 of the 140 hospital employees. These people have relationships with their patients and it’s important that they stay in this community to continue providing care.”

The deployment in Louisville also provided an important opportunity to see what worked and what needed to be improved. Nurses told him that showers need to be wheelchair accessible and that they prefer simpler, single-channel IV pumps. Patients requested more private rooms. Doctors asked for improved access to electronic medical records.

Perhaps the biggest problem is one you wouldn’t expect. “Truckers. We have all the equipment loaded and ready to go, but it’s hard to find drivers and rigs to haul 23 trailers across the country at the drop of a hat. That hurt our response time.”

Despite the problems he encountered, says Stringer, the first deployment was a success. “I was the senior medical officer for many natural disasters in the country for 10 years, and I can honestly say that the collaboration and sense of community I witnessed on this project was the best I’ve ever seen.”

By Jack Carmichael