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Diastole: Residents at rest

The Department of Internal Medicine’s Diastole blog encourages residents like Sarah Lee, M.D., to use writing as a chance to reflect and build resiliency.

The Department of Internal Medicine’s Diastole blog encourages residents like Sarah Lee, M.D., to use writing as a chance to reflect and build resiliency.

The patient lay in her hospital bed and stared into space, unable to make eye contact with the doctors who had come to help her.

Battling end-stage HIV/AIDS, the woman seemed unable to come to terms with her condition.

“I’m not sure if she could hear us, or if she was in denial and chose not to respond,” says Sarah Lee, M.D., a second-year resident in the Department of Internal Medicine. “It was frustrating and sad. That was my first year, and it was tough to deal with something like that so early on.”

Lucky for Lee, she had help. For the past two years, first-year residents have written reflective blog posts with the hopes of normalizing reflection and increasing resilience.

“That first year can be pretty jarring,” says Megan S. Lemay, M’11, assistant professor of medicine in the Division of Internal Medicine. “It is overwhelming for the best of us. As they face extremely difficult tasks, we are teaching the residents skills in resilience so that they can keep themselves well.”

Diastole, the relaxation phase of the heartbeat, is the perfect name for the blogs, Lemay says.

“If the heart does not take time to relax and then fill up, blood won’t be pumped out,” she says. “In the same way, if you don’t take time to relax and reflect, you have nothing to give.”

Interns have reflected on a variety of assigned topics, including the role model whose traits they want to emulate and the challenges they face in treating patients with mental illness. When Lee and her classmates were asked to reflect on their lowest and highest day in haiku form, she shared her experience with the non-verbal patient by writing,
She won’t look at me.
Only nods and sighs out loud.
Wonder what she feels.

Her haiku along with others from her fellow residents are featured in the latest issue of the Medical Literary Messenger, a web-based journal that strives to promote humanism and the healing arts through prose, poetry and photography.

“Sometimes it’s easier to try to forget a difficult experience,” Lee says. “But to share them, as well as your good ones, is healthy.”

Interns have also written about the embarrassment they feel when they make a mistake, the stresses of long hours and the sadness of losing a patient.

“They are identifying with each other and building empathy,” says Lemay, who is also an associate editor of the Messenger. “When they share their emotions the feedback they are getting is, ‘I didn’t realize anyone else felt that way.’”

The blogs are part of a larger resiliency program that includes monthly meetings and workshops that help interns cope with the demands of residency. Lemay oversees the blogs and meetings that are part of the overall resiliency curriculum created and run by Stephanie Call, M.D. M.S.P.H., program director, and Rebecca Miller, M.D., assistant professor.

“I don’t think people realize that taking the time to reflect on the challenges they face is normal,” Lemay says.

Lemay has been writing and publishing prose since she was a resident. When a patient she had been visiting throughout her first year passed away, she doubted her career choice.

“I wrote about it four months later as part of a workshop, and it lifted this burden from me,” she says. “It was extremely powerful.”

She hopes interns today experience similar benefits.

“I think 20 years ago the attitude was to suck it up,” Lee says. “But today, it’s OK to talk about what you are feeling. It’s great we can focus on our wellness too.”

By Janet Showalter


Surgeon and inventor: Class of 2012’s Max Sirkin brings military medicine closer to home

Max Sirkin, M’12, and Col. Jason Hiles have invented the SHRAIL, a new system that helps improve care for soldiers injured in the field.

Max Sirkin, M’12, and Col. Jason Hiles have invented the SHRAIL, a new system that helps improve care for soldiers injured in the field.

There are many qualities that make a good surgeon. According to surgeons themselves, one of those qualities is an innate desire to understand how something works and find ways to make it work better.

Surgeons, of course, apply that talent to the human body. But there are a few who seek additional outlets for that inner drive. That was the case for Max Sirkin, M’12, who has found a second calling as an inventor.

“Doing surgery is a dream job, but I had always wanted to do more,” Sirkin says. “I wanted to be an inventor, but all my ideas had been taken and research wasn’t for me.”

As he worked his way up to the rank of major in the U.S. Army, Sirkin began to speak with physicians and surgeons who had served overseas, sometimes in far-flung parts of the world. In those areas, taking care of soldiers can present challenges, they said. Sometimes, those challenges can be life-threatening.

Sirkin, who is also now an attending general surgeon at Fort Bragg in North Carolina, learned that the mobile medical equipment doctors rely on in more austere areas of operation can be very difficult to assemble and move. Sometimes, certain pieces of equipment are not compatible with other equipment or materials. When minutes and seconds count, equipment that is easy to use can make all the difference.

Therein lay Sirkin’s big idea.

Max Sirkin, M’12 (left) and Col. Jason Hiles demonstrate the SHRAIL.

Max Sirkin, M’12 (left) and Col. Jason Hiles demonstrate the SHRAIL.

“I had never deployed, but doctors who had saw a real problem,” Sirkin says. “There was a problem when surgeons were setting up in remote geographies, and it was a problem I thought I could fix.”

Sirkin and his inventing partner, Col. Jason Hiles, developed the SHRAIL (short for the Sirkin-Hiles Rail System), a system that affixes to a standard stretcher – or litter in Army parlance. A variety of devices, monitors and products can be easily attached to and removed from the rails, so that they are accessible even while the patient is on the move.

“We thought why don’t we start with the rails on the side of every OR table, which are all created with set dimensions?” Sirkin recalls. “We found a way to make a rail that attached to the litter and can snap into place. We designed it so an 18-year-old in a stressful situation could put it together.”

The design, which Sirkin and Hiles first conceived in 2014, allows for far more freedom and mobility than previous options.

“Other options are big and expensive and you have to use specific devices that match a specific system,” Sirkin says. “It can take people who really know what they are doing to set it up, and even then the patient often still needs to get from the point of injury to the mobile medical station.”

One of Sirkin’s mentors, who saw the SHRAIL when it was still its “back of the napkin” stage, says Sirkin has long had a drive to invent.

A soldier tests the SHRAIL in near Fort Bliss, Texas.

A soldier tests the SHRAIL in near Fort Bliss, Texas.

“He has always struck me as someone dedicated to surgery,” says Col. David Cox, M.D., a cardiothoracic surgeon and deputy corps chief for the Army Medical Corps. “This was the result of his curiosity. One thing surgeons like to do is fix problems. With the SHRAIL, Max saw a problem that needed solving, and he solved it.”

The SHRAIL was featured in May at the Smithsonian Institution’s Military Invention Day. More importantly, it has been deployed to an undisclosed location, where it was successfully used.

Sirkin said the SHRAIL could serve other purposes that are not necessarily military in nature, such as search-and-rescue or disaster relief operations.

“Everyone who has been in an austere environment and had to do a medical intervention understands,” Sirkin says. “You can set up an operating room with what you can carry in your backpack. That puts the doctor and the soldier one step closer to being back at home, where doctors have everything they need to help a patient, and that means more lives saved. The goal is to get people closer to home.”

By Scott Harris


The incredible Class of 2022

The Class of 2022’s John Nestler paddled solo for 27 days through the Grand Canyon.

The Class of 2022’s John Nestler paddled solo for 27 days through the Grand Canyon. Scroll below for more pictures from the incoming class.

A tropical disease researcher who can diagnose Chagas disease and remove parasites from cows. And her classmate who has first-hand experience with typhoid fever and malaria – but as a patient.

EMTs and emergency department scribes. A ballerina who bakes wedding cakes, and an R&D engineer who has patents pending on the next generation of razors.

Volunteers who have staffed an HIV food bank in Barbados, free clinics in Ghana, a traveling Peruvian medical mission and the Domestic Policy Council in the White House.

A student who’s the first in his family to graduate college, and a classmate who’s the third generation to come to our medical school.

Thrill seekers and wilderness explorers who’ve skydived from a plane and scuba dived to a shipwreck. A kayaker who paddled solo for 27 days through the Grand Canyon, and a marathoner who ran his race without training first.

A first-generation American who was born in Sweden. A wanderer who spent their childhood living in 25 different towns all over the U.S., and another who calls Virginia’s smallest town home.

A traveler who crossed the Saharan Dessert on camelback. Another who walked 465 miles with pilgrims from around the world to visit a shrine in Spain.

One rescues cats, another names his house plants.

Wakeboarding, horseback riding and the sport of fencing – they’ve competed in all three. A pair of avid sock collectors might turn it into a competition.

One student can say the alphabet backwards – really fast.

Another applied, not only to medical school, but also to the Food Network’s Chopped TV show. Instead of waiting for her casting call – she is here on the MCV Campus now!

Story by Erin Lucero

Click the images below for expanded views.


M.D.-Ph.D. student Audra Iness named president of American Physician Scientists Association

M.D.-Ph.D. student Audra Iness is the 2018-19 president of the American Physician Scientists Association.

M.D.-Ph.D. student Audra Iness is the 2018-19 president of the American Physician Scientists Association.

“When did you know you wanted to be a doctor?”

It’s a question that begins in medical school admissions interviews and lasts throughout a physician’s career. Many can point to an influential moment — whether it’s a family member’s illness, an encouraging mentor or a desire to give back.

Audra Iness is no exception. At 15, she sat by her older brother’s bedside as he battled chronic pancreatitis, a diagnosis that kept him in and out of the hospital for the better part of a year. It wasn’t until his surgeons collaborated with researchers on a special surgery that he found relief.

And his sister found her calling — not only as a physician, but as a physician-scientist.

“I saw the interaction between the physicians and surgeons and the research lab,” Iness says. “Seeing it all come together was amazing. It transformed his life and our family’s life. That’s why I’m not only interested in the clinical side but also the research. I want to transform medicine as a whole.”

The VCU School of Medicine M.D.-Ph.D. student has already started, serving as a national leader among the next generation of physician-scientists. In July 2018, Iness began a one-year term as president of the American Physician Scientists Association, an organization led by trainees, for trainees. APSA strives to be the student physician-scientists’ leading voice for improving educational opportunities, advancing patient-oriented research and advocating for the future of translational medicine.

“Audra is a remarkable individual who deeply cares about the future of clinical research in the U.S. and does everything she can to advance the pipeline of physician-scientists,” says Michael Donnenberg, M.D., senior associate dean for research and research training.

As APSA president, Iness promotes key initiatives including mentorship and establishing an international consortium of physician-scientist trainee organizations. She recently returned from a conference in Canada and regularly speaks with M.D.-Ph.D. students across the globe about the challenges they face and ways to learn from one another.

Strong peer relationships are especially critical for M.D.-Ph.D. students who spend an average of eight years earning their dual-degree. At VCU, their medical education begins with two years of preclinical, followed by three to five years of graduate studies, and then back to the M.D. program for two clinical years.

“The training path is long and challenging so it’s helpful to have the peer support as students and later as peers in our professional lives,” says Iness, who is in the final semester of the graduate phase of the program. “Starting to establish those relationships now is extremely valuable.”

In December 2018, Audra Iness will earn her Ph.D. in cancer and molecular medicine. Then she'll begin clinical rotations and complete her remaining two years of medical school.

In December 2018, Audra Iness will earn her Ph.D. in cancer and molecular medicine. Then she’ll begin clinical rotations and complete her remaining two years of medical school.

Iness joined the national APSA chapter when she entered medical school in 2013 and later resurrected VCU’s APSA chapter. She also founded Advocates for M.D.-Ph.D. Women at VCU to address the underrepresentation of women in the field.

“While the gap has closed for women in medical school — more females enrolled in medical schools in 2017 than males — that’s not the case for physician-scientists, where only about 30 to 40 percent of trainees are female,” Iness says. “We want to find out why and support the women who are here.”

Support throughout the VCU community is what brought Iness to the MCV Campus from her home state of California. “Accessibility to my advisor is huge,” Iness says. “I know who to go to and they’re happy to talk to me. The faculty here has made such a difference and encouraged me to be in national leadership positions.”

She’s also grateful for the M.D.-Ph.D. program’s financial support that covers her tuition costs and provides a stipend. In 2015, a $16 million gift from longtime benefactor C. Kenneth Wright named the C. Kenneth and Dianne Wright Center for Clinical and Translational Research at VCU and provided $4 million to fund the physician-scientist scholars program.

“We fully fund all our M.D.-Ph.D. students — many schools can’t claim that,” Donnenberg says. “It’s important to make that commitment to our students. This wonderful gift from Ken Wright allows us to attract even more students who share an equal passion for patient care and for science and research.”

In December, Iness will earn her Ph.D. in cancer and molecular medicine. She’s spent the last four years working in the lab of Larisa Litovchick, M.D., Ph.D. Her thesis project is focused on B-Myb, a recognized oncoprotein known for its role in cell cycle gene regulation.

High B-Myb levels are associated with a poor prognosis in many cancers, yet its role in ovarian cancer is not well understood. Iness’ research, funded by a National Institutes of Health grant, could help identify predictive markers and therapeutic targets for treatment of ovarian cancer.

Now she’s eager to apply what she’s learned in the lab when she returns to the medical school and begins clinical rotations in January.

“That’s what excites me the most — to see everything fall into place,” Iness says. “I’ve had a vision of working at the border between science and medicine, and seeing through patients what needs to be addressed in the research lab. Now I can take what I’ve learned in the lab and apply it in the clinic and see what happens. That back-and-forth is really the power of dual-degree training.”

By Polly Roberts


M2 Justin Chang returns to NIH to conclude eye research

The Class of 2021’s Justin Chang participated in the NIH Summer Internship Program studying a common cause of blindness.

The Class of 2021’s Justin Chang participated in the NIH Summer Internship Program studying a common cause of blindness.

Three years ago, the Class of 2021’s Justin Chang began working in the National Institutes of Health laboratory of Kapil Bharti, Ph.D., a Stadtman investigator at the National Eye Institute. They were trying to solve a tricky problem: proliferative vitreoretinopathy, or PVR, a growth of scar tissue that causes the detachment of the retina — and, for many, blindness.

It happens to between 5 percent and 10 percent of every person who undergoes retinal reattachment surgery. The only way now to treat PVR is another surgery, but that can be unsuccessful if it leads to more scar tissue growth behind the eye, a return of the original problem that causes the retina to detach again weeks or months later.

With a bachelor’s degree in biology from the University of Maryland, Baltimore County, and a master’s degree in biotechnology from Johns Hopkins University, Chang wanted to learn more about medical research and applied for the job in Bharti’s lab in 2015, before starting medical school last fall.

This summer, Chang returned as a member of the NIH Summer Internship Program to complete his research in PVR.

“This disease happens when there’s a puncture to the eye, or a retinal detachment,” Chang explains. A considerable number of current PVR patients are members of the military who have experienced battlefield injuries. Shrapnel or other debris can cause an eye injury, or even the shock of a blast may detach the retina, Bharti says.

Bharti’s lab focuses on pharmaceutical treatments that could prevent the destructive growth of diseased retinal pigment epithelium, or RPE, cells. While healthy RPE cells protect the retina’s photoreceptors, their unchecked growth can lead to PVR. “We’re interested in how these cells divide, proliferate,” Bharti says, “and how to prevent it.”

Chang spent two years as a post-baccalaureate research fellow at the Bethesda, Maryland, lab, conducting tests to see which medications repress or encourage growth of RPE cells.

Because PVR occurs so often among veterans, the Department of Defense has placed a high priority on its research, Bharti says. A medication that already has been approved by the FDA to treat metastatic cancers appears promising in the RPE study, he adds, and may be able to treat PVR and age-related macular degeneration.

Chang moved from Taiwan to Montgomery County, Maryland, when he was 14, and his father is an internal medicine physician who practices in Taiwan. Still, eye research wasn’t on his radar until he began working in Bharti’s lab.

“I was surprised by how complicated the eye is and how many diseases I didn’t know about,” Chang says. “Initially, I didn’t look at eye research when I got my master’s.” In addition to his lab work, he had the opportunity to shadow ophthalmologists in the NIH’s pediatric eye clinic and see firsthand some unusual conditions, including a type of juvenile macular degeneration and coloboma, in which a part of the eye is missing at birth.

As he returns to the MCV Campus to begin his second year, Chang says he especially appreciates his classmates. “They’re always willing to help you. We study together, have fun together.” He is still deciding on what specialty he’d like to pursue, although ophthalmology is now definitely in the running.

Bharti calls Chang a “very capable person. Not everyone is at the same level as Justin. If he wants to come back next summer, we’d love to have him.”

By Kate Andrews


VCU sends pair of students to prestigious Lindau Nobel Laureate Meeting

M.D.-Ph.D student Chelsea Cockburn (left) and Ph.D. candidate Katie Schwienteck (right) with Nobel Laureate Walter Gilbert, Ph.D., at the 68th Lindau Nobel Laureate Meeting in Lindau, Germany.

M.D.-Ph.D student Chelsea Cockburn (left) and Ph.D. candidate Katie Schwienteck (right) with Nobel Laureate Walter Gilbert, Ph.D., at the 68th Lindau Nobel Laureate Meeting in Lindau, Germany.

Katie Schwienteck set a goal several years ago to one day attend the Lindau Nobel Laureate Meeting in Lindau, Germany.

“I had heard how wonderful it was,” she says. “I thought it would be an awesome experience. As it turns out, it most definitely was.”

A Ph.D. candidate in the medical school’s Pharmacology and Toxicology Department who’s already earned an advanced degree from the School of Pharmacy, Schwienteck, Pharm.D., was one of two students from the School of Medicine to be selected to attend this year’s event. Dedicated to physiology and medicine, the 68th Lindau Nobel Laureate Meeting was held in June.

“It was a once-in-a-lifetime opportunity,” says M.D.-Ph.D. student Chelsea Cockburn, who also was selected to attend. “Just to meet all the laureates and hear their stories was incredible.”

Schwienteck and Cockburn were among 600 international students from 84 countries. Only 30 were from the U.S.

“I think that speaks highly of our graduate trainees,” says Mike Grotewiel, Ph.D., associate dean for graduate education in the School of Medicine. “There is no other gathering that comes close to this one, so this is extremely special for these students. We are very proud of them.”

The annual summer meeting gathered an all-time record 43 Nobel Laureates. They presented lectures on their scientific research, broke into smaller groups to discuss topics such as science diplomacy and careers in biomedical research and took students on “science walks” for more casual conversations.

“These Laureates are considered celebrities,” Cockburn says. “What was wonderful is how normal they really are and how willing they are to sit down with young scientists.”

Cockburn took a science walk with Nobel Laureate Randy Schekman, Ph.D., and the two discussed publishing scientific research. He stressed the importance of the quality of the research, not the size and prestige of a particular journal.

“It was really cool to get his perspective,” Cockburn says. “It should all be about the quality of your work, about good science.”

Cockburn, who earned a bachelor’s degree in biology from James Madison University, is on track to complete her Ph.D. in microbiology and immunology along with her M.D. in 2021. She plans to focus her career on infectious diseases and global health.

“Going to Germany really rejuvenated me,” she says. “As great as it was meeting the Laureates, getting to meet other young scientists from around the world was also invaluable. These people will be my future colleagues. They already are becoming my friends.”

Students exchanged ideas and discussed how medicine is practiced in their home country. They brainstormed solutions to roadblocks they face in their own research.

“You need diverse backgrounds, ideas and thought processes to produce the best science,” Cockburn says. “I think we sometimes forget that because we get caught up in our own bubble. But collaboration is so important.”

Schwienteck, who holds a bachelor’s degree in neuroscience from the University of Pittsburgh, also bonded with other young scientists while in Germany.

“There are so many dedicated people out there doing remarkable work,” she says. “It’s not just about what I’m doing.”

Schwienteck’s research is focused on studying potential treatments for opioid substance use disorder in the lab of Matthew Banks, Ph.D. Her science walk with Nobel Laureate Robert Lefkowitz, M.D., was perfect timing.

“I’m studying drugs that he helped develop,” she says. “That was pretty cool. He offered me very good advice related to career planning.”

Because of that advice, Schwienteck now plans to pursue a post-doctorate after completing her Ph.D. next year.

“Never be afraid to take risks because it is OK to fail,” she says. “It was so reassuring to hear how even Nobel Prize winners faced their own failures along the way.”

The key is to never stop trying.

“One common theme at the meeting was to never make winning a Nobel Prize the goal of your career,” Cockburn says. “Do what you love that will benefit humanity. That is more important than any award.”

By Janet Showalter

Virginia Commonwealth University
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Updated: 04/29/2016