Residency Research Opportunities


Clinician Scientist Track

Anesthesiologists Treat a Patient During a Surgical Procedure

Clinician Scientist Track: Any resident interested in engaging in research is encouraged to apply to the Department’s Clinical Scientist Track (CST). Each year, between one and five CA2 residents are selected for a 1-6-month block of research during their CA3 year, under the guidance of a mentor within or outside the Department. CST residents typically perform their research in clinical areas of the medical center (including the Operating Rooms, Intensive Care Units, or the Clinical Research Center) and/or a research laboratory. Creativity is encouraged. The goal of the CST is to support resident research projects that have great potential to generate impactful data, to provide a meaningful research experience, and to help launch and enhance careers in academic anesthesiology. CST committee members, who are clinical and research faculty in the Department, are always available to assist in study design, implementation, and analysis.

Projects:

1) Glutamate is an amino acid and excitatory neurotransmitter, and plays an important role in neuronal communication. Abnormally elevated glutamate in the brain’s fluids leads to excessive stimulation of neurons, seizures, neuron cell death, and is a possible causative factor for many neurological conditions such as epilepsy, head trauma, stoke, brain tumors, and epilepsy. The underlying mechanisms of this elevation are poorly understood, however, and there are no effective treatments that reduce the elevation or limit glutamate’s toxic effects in the brain. Our laboratory studies fundamental and novel pathways of glutamate metabolism in the brain, and how manipulations in these pathways impact brain chemistry, seizures, and neuron viability. Our work is expected to profoundly advance our understanding of how neurotransmitters in the brain are made, and will aid in the development of more effective and targeted treatments for glutamate neurotoxicity. Faculty Contact: Shaun Gruenbaum 

Resident or Fellow Role: Learn associated laboratory techniques and/or be involved in translational work in neuroanesthesia.

2) My major research areas are roles of local anesthetic adjuvants/additives in peripheral nerve blocks. Specifically, I am working on optimization of current clinical protocols and use adjuvants to improve acute pain management perioperatively and to potentially minimize persistent postsurgical pain (PPP)/chronic pain. The major peripheral nerve blocks involved in my studies are adductor canal nerve blocks for total knee arthroplasty, thoracic paravertebral blocks and fascia layer blocks such as TAP/PEC/QL for rib fractures, chest and abdomen procedures, and femoral nerve blocks for elderly hip fracture patients. Faculty Contact: Jinlei Li

Resident or Fellow Role: Participate in observational and interventional clinical studies in regional anesthesia.

3) My research work involves clinical, laboratory, and computer modeling projects within the broad areas of integrative cardiopulmonary monitoring, systemic consequences of perioperative lung “metabolotrauma” (how small molecules are added or extracted from the blood during lung transit), and development of novel neuromuscular blocking drugs and reversal agents. Faculty Contact: Paul Heerdt

Resident or Fellow Role: Participate in analysis of existing datasets, as well as data collection in human and animal models of these areas.

4) Characterizing the hemodynamic effects of Yoda1 in rodents:

Piezo1 ion channels are mechanotransduction proteins that exists in several cell types including endothelial cells, renal tubular cells, primary (immotile) cilia and red blood cells. Impaired function of the Piezo1 gene (biallelic mutations) in humans is associated with lymphedema. Recent studies have shown that the Piezo1 ion channel controls blood pressure; and mice deficient for Piezo1 in the endothelium develop mild hypertension (systolic blood pressure increases from 120 mmHg to 135mmHg). Yoda1 is a synthetic Piezo1 channel activator which when applied to vessels can induce vasorelaxation in a dose-dependent manner in vitro.  The role of Piezo1 ion channels on blood pressure and hemodynamic parameters in general has never before been investigated in a live animal. We are conducting a series new pilot experiments to explore and characterize the role of Piezo1 on hemodynamic parameters in vivo. Faculty Contact: Helene Beneviste

Resident or Fellow Role: Participate in rodent experiments of above.

5) The effects of dexmedetomidine and inhalational anesthetics on cerebrospinal fluid transport and water diffusivity in the rodent brain: The glymphatic pathway transports cerebrospinal fluid (CSF) through the brain thereby facilitating waste removal. A unique aspect of this pathway is that its function depends on the brain’s state of consciousness and is associated with norepinephrine (NE) activity.  A current view is that all anesthetics will increase glymphatic transport by inducing unconsciousness. This implies that the effect of anesthetics on glymphatic transport should be independent of their mechanism of action, as long as they induce unconsciousness. We are testing this hypothesis by comparing the effects of dexmedetomidine (DEXM), which lowers NE, and inhalational agents such as ISO and SEVO, which does not.  Faculty Contact: Helene Beneviste

Resident or Fellow Role: Participate in rodent experiments of above.

6) An evaluation of the Prevalence and the Neuro-cognitive Effects of Chronic and Acute Sleep Deprivation among Anesthesia Residents at YNHH. The aim of the study is to evaluate the extent and the depth of fatigue on anesthesia residents according to their different type of calls and tasks.  Faculty Contact: Jean Charchaflieh

Resident or Fellow Role: Participate as co-investigator in the above.

7) The perioperative period is increasingly recognized as an opportunity to identify undertreated cardiovascular risk factors. Anesthesiologists may have an opportunity to impact population health by intervening with surgical patients so that such risk factors receive appropriate follow-up and treatment.   Faculty  Contact: Robert Schonberger

Resident or Fellow Role: Participate as co-investigator in the above.

8) The choices that we make in the OR carry important environmental effects. This program of research looks at the environmental consequences of different anesthetic choices and ways to modify behavior to lessen these impacts. Faculty Contact : Jodi Sherman

Resident or Fellow Role: Participate as co-investigator in the above.

9) Non-invasive monitoring has the potential to guide intraoperative therapies by identifying early signs of hypovolemia, and changes in cardiac output, vascular resistance, and venous capacitance. Using both clinical and laboratory models, this group seeks to understand how best to apply such monitoring to improve patient care. Faculty Contact: Aymen Alian

Resident or Fellow Role: Participate as co-investigator in the above.

10) Studies in vascular tissue mechanics showed several decades ago that the bulk of the mechanical properties of arteries derived not from the cellular components, but from the collagen- and elastin-based extracellular matrix. Using this principle, we have utilized banked human vascular smooth muscle cells to engineer implantable arteries. Our approach to vascular engineering involves seeding allogeneic vascular cells onto a degradable substrate to culture vascular tissues in a biomimetic bioreactor. After a period of 8-10 weeks, engineered tissues are then decellularized to produce an engineered extracellular matrix-based graft. The advantage of using allogeneic cells for graft production is that no biopsy need be harvested from the patient, and no patient-specific culture time is required. The acellular grafts can be stored for 6 months and are available at time of patient need. These grafts are being tested in 3, Phase I clinical trials in Europe and in the US. These tissue engineered vascular grafts have been tested most extensively as hemodialysis access in patients who are not candidates for autogenous arteriovenous fistula creation, with the first patient being implanted in December 2012 in Poland. Since that time, a total of 60 patients have been implanted with engineered, acellular grafts for dialysis access, 40 patients in Europe and 20 in the US. Patients utilize the grafts for dialysis access as soon as 4-8 weeks after graft implantation. This early experience supports the potential utility of this novel tissue engineered vascular graft to provide vascular access for hemodialysis.

The decellularization approach has also allowed us to generate scaffolds to support whole lung regeneration. Using rat, porcine and human sources of organs, lungs have been subjected to a range of decellularization procedures, with the goal of removing a maximal amount of cellular material while retaining matrix constituents. Next-generation proteomics approaches have shown that gentle decellularization protocols result in near-native retention of key matrix molecules involved in cell adhesion, including proteoglycans and glycoproteins. Repopulation of the acellular lung matrix with mixed populations of neonatal lung epithelial cells results in regio-specific epithelial seeding in correct anatomic locations. Survival and differentiation of lung epithelium is enhanced by culture in a biomimetic bioreactor that is designed to mimic some aspects of the fetal lung environment, including vascular perfusion and liquid ventilation. Current challenges involve the production of a uniformly recellularized scaffold within the vasculature, in order to shield blood elements from the collagenous matrix which can stimulate clot formation. In addition, we have developed methods to quantify barrier function of acellular and repopulated matrix, in order to predict functional gas exchange in vivo. Faculty Contact: Laura Niklason

Resident or Fellow Role: Participate in laboratory studies in biomedical engineering.

11) My investigations focus broadly on areas of vascular aging, outcomes in cardiovascular anesthesia, the role of platelets in acute kidney injury following cardiac surgery, and in intensive care management of patients following cardiac surgery.  As the Director of Clinical Research in the department, I also oversee several industry sponsored clinical trials.  Faculty Contact: Manuel Fontes

Resident or Fellow Role: Participate as co-investigator in the above.

12) As the population ages, anesthesiologists are increasingly asked to care for the elderly and extreme elderly with little guidance as to the changes in pharmacokinetics and pharmacodynamics that may accompany extremes of age.  Our group seeks to identify best practices for care of the elderly patients across the spectrum of anesthetic care. Faculty Contact: Shamsuddin Akhtar

Resident or Fellow Role: Participate as co-investigator in the above.

13) My research covers the integration of technology into teaching and patient care, as well as looking at educational outcomes using these tools.  I am also active in Global Health issues and am the Chair Designee for the SEA Global Health Outreach Committee. I have led the integration of the Flipped Classroom model for Anesthesia Resident Training at Yale. Faculty Contact: Viji Kurup

Resident or Fellow Role: Participate as co-investigator in educational interventions in the department.

14) Currently, we are engaged in an industry sponsored clinical trial that seeks to determine whether reversal of residual neuromuscular blockade following isolated CABG will contribute to shorter times to extubation in the CTICU. Faculty Contact: Amit Bardia or Robert Schonberger

Resident or Fellow Role: Participate as co-investigator in the above.

15) At present, our group is looking at a variety of monitors including cerebral oximetry, tissue oximetry, and processed EEG to understand the association between regional blood flow, depth of anesthesia, and outcomes.  Faculty Contact: LingZhong Meng

Resident or Fellow Role: Participate as co-investigator in the above.

For more information, contact:
Robert Schonberger   at : robert.schonberger@yale.edu

NationalClinicianScholarsProgram

YMS3414_0008_Residents shrunk

National Clinician Scholars Program: Yale University is proud to be one of only four sites nationally to participate in this prestigious program. The National Clinician Scholars Program offers unique clinical and community-based research training through intensive mentorship for clinicians as change agents driving policy-relevant research and partnerships to improve health and healthcare, and has grown out of the Robert Wood Johnson Foundation Program sites.

This program involves two years of training, where trainees complete graduate-level programs in their areas of interest. The National Clinician Scholars Program has a commitment to teaching rigorous research design, ensuring Scholars develop a nuanced understanding of how the health system and social determinants affect health, engagement of those who can help apply research results, and emphasizing the outcomes and impact of research. Yet the new NCSP is building upon this core strength, moving in a new direction by partnering directly with institutions and agencies sponsoring individual slots, with a strong focus on commitment to partnering agencies and creating generalizable lessons for improving health of patients and communities. All Yale anesthesia residents who are interested in health care outcomes, disparities, ethics, and financing are invited to apply to this exciting program. Applications are accepted in the CA-1 through CA-3 years..

For more information, contact:
Roberta Hines, at Roberta.hines@yale.edu.

QualitySafetyFellowship

doctors

Yale Anesthesiology Quality & Safety Fellowship: Significant changes in delivery and financing of health care present both a challenge and also an opportunity to improve patient care. The Yale Department of Anesthesiology Quality and Safety Fellowship provides opportunities for fellows to rapidly acquire a comprehensive understanding of quality and safety and to apply this knowledge by creating practical solutions to real-world problems. Because teams of providers must work within a health care system, the core curriculum includes a systems-based approach to healthcare delivery and patient safety. Fellows train for either 1 or 2 years during this fellowship, and also have the opportunity to obtain a Masters Degree in Health Sciences should they choose to do so. Applications are accepted in the CA-1 through CA-3 years.

For more information, contact:
Robert LaGasse, at Roberta.lagasse@yale.edu.

ResearchScholarsProgram

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The Research Scholars Program (RSP) was founded in 2006, in order to further the careers of residents who have a keen interest in academic medicine and research. Residents who are accepted into the Research Scholars Program will receive hands-on mentoring with respect to choosing a research path in either clinical research or in basic science. In the first two years of residency, Research Scholars will become acquainted with research that matches their interests, both inside and outside of the department. In the third year of residency, Research Scholars will spend 6 months of full-time effort in the research group or laboratory that best suits their interests and that can provide outstanding scientific training and mentoring. Thereafter, RSP trainees can go onto an assured Clinical Fellowship of their choice at Yale, where they can combine their research interests with ongoing clinical training. Applications are accepted during medical school as part of the residency application, and also during the PGY-1 and CA-1 years of residency.

For more information, contact:
Laura E. Niklason, at laura.niklason@yale.edu.

T32-RSPPathway

mind with gears

The Research Scholars Program also has a more “research-intensive” pathway, dubbed the “T32-RSP Pathway.” In this pathway, trainees work with mentors during the CA-1 and CA-2 years, and complete 6 months of research during the CA-3 year. Thereafter, T32-Research Scholars will go onto (typically) two years of research with their chosen mentors, often paired with a clinical fellowship of their choosing. At the completion of this intensive two-year research experience, T32-Research Scholars will be extremely well positioned to obtain independent funding of their own and go onto highly productive and independent careers in academic medicine. The training opportunities for this program draw on the outstanding research faculty in Yale’s School of Medicine and Yale University. 

The T32-Research Scholars Program will provide exceptional training and support for those select residents who have strong aptitude and desire for a career in academic medicine. The goal of this program is to nurture the next generation of medical scholars who will lead Anesthesia for generations to come. The T32-Research Scholars Program provides financial support for the outstanding residents that are chosen: during the three years of residency, the supplement to Research Scholars will be $12,000 per year. During the subsequent two years of full-time research training, Scholars will be supported by NIH-funded training grants in Anesthesia and elsewhere. Applications are accepted during medical school as part of the residency application, and also during the PGY-1 and CA-1 years of residency. .

For more information, contact:
Laura E. Niklason, at laura.niklason@yale.edu.