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Residency Research Opportunities


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Clinician Scientist Track


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.

Robert Schonberger - It is a great honor to serve as the Director of our NIH-funded T32, Research Scholars Program (RSP), and Clinical Scientist Track (CST) which together endeavor to support the educational and research missions of the Department of Anesthesiology by offering a strong research pipeline for diverse trainees with a variety of research backgrounds.
While the CST program is an ACGME-approved part of many anesthesiology residencies, the RSP/T32 pathway is relatively unique to Yale and provides a flexible pathway available for selected resident applicants who have demonstrated a strong interest in pursuing research as part of their future career. The RSP program integrates into the clinical residency years and ideally serves as a feeder program into the T32 research training grant following the conclusion of residency (see figure above at right).
Both the RSP and T32 date back to 2009 when Drs. Niklason and Hines, recognizing the transformational power of an internal pathway to support early-career physician-scientists, developed these programs for the long-term growth of the Department’s research footprint. With the help of T32 Associate Director Helene Benveniste and a diverse group of T32 PIs across the university, these programs have supported multiple investigators who have since transitioned into K-level and R01 funded programs of research.
While the RSP/T32 pathway is well-established, the mission of the RSP is in fact broader than just as a T32 feeder program. In recognition of the many phenotypes of resident applicants who are interested in academic careers, one of the guiding principles for RSP is flexibility. Recent RSP participants include several MD/PhDs with extensive research resumes, but we also deliberately encourage residents with other research backgrounds to apply. We realize that many resident applicants come to their clinical training with diverse life experiences but without a classic “MSTP research pedigree” (e.g. Yale students who have taken a “fifth year” of research during medical school). We have a history of accepting applicants ranging from bench researchers to clinical researchers to outcomes researchers.


Whatever their background, our message to clinical residency applicants is that they need not put their academic interests aside simply because they are entering an intense clinical training period. On the contrary, we believe that clinical exposure will enhance young researchers’ ability to pose questions of strong impact for the specialty. With this approach, we have been able to attract both residents who already know they are entering academic careers as well as those who are “at the border” but who may be drawn into the academic pipeline with the support of RSP.
The RSP program is centered around 1) Early efforts to identify mentors appropriate to the resident’s area of interest (including outside of the anesthesiology department), 2) Dedicated time for research rotations during the course of the 4-year residency curriculum (for a total of 6-months during their final residency year), and 3) The formation of a social network of other RSPs, T32s, and early-career investigators, who meet together with more senior research faculty at structured social events several times per year.
Areas for Improvement: While our program has been notably successful in attracting a diverse group of trainees, Dr. Benveniste and I see a need for improved gender balance and early-career retention as two priorities for future program growth. Regarding gender balance, even as we recognize that each of our trainees is diverse in their own way, we want to see our future classes of research fellows more closely reflect the gender balance of our clinical trainees. Regarding improved retention, we recently saw two promising investigators move elsewhere after many years of internal support. We need to do a better job recognizing what our internal “stars” need to thrive and make sure we provide it. This involves proactive engagement to identify unmet needs and a concerted effort to address those needs early.

Recent RSPs presently with funded career development awards:

2021 Research Scholars Program Future Residents:
RSP applications are accepted on a rolling basis in parallel with residency applications. Accepted medical students can then consider their RSP status as they make ranking decisions within the standard residency matching process. This year’s residency matching class has 3 highly promising RSP scholars who elected to come for clinical training to Yale. They are: Burhan Ozturk, MD (Yale); Christopher Dextras, MD (Michigan State); and Jimmy Hom, MD, PhD (Hofstra, Harvard)

The other RSPs presently in our residency program are listed below by year.

Intern:Wendy Wang: MD/PhD: from Rockefeller University and Weill/Cornell: Interested in anesthetic exposures and pediatric neuro-cognitive development.

CA-1:Saul Siller: MD/PhD from Stony Brook: Interests include cellular developmental biology, regenerative medicine, hypoxia and cell signaling.
Bartlomiej Bartkowiak: PhD from Duke followed by MD from Chicago. Interested in the work of the Waxman lab to study molecular biology of pain syndromes.
Jae Woong Lee: MD in Seoul followed by post-doctoral work at U Colorado. Interested in further training with computational biology, genetics, and computer science.
CA-2:Jose Duarte: MD from Venezuela 2013 with subsequent industry work in AI. Interested in pursuing clinical informatics fellowship through YCMI.
Nitish Aggarwal: MD from Ohio State. Interested in outcomes research. Pursuing analysis of predictors of delayed graft function in kidney transplant recipients.
CA-3:Clark Fisher: MD/ PhD from Cornell in neurobiology. Will start his cardiothoracic anesthesiology fellowship this year with transition to clinical trials and outcomes research.
Eric Strand: MD UNC Chapel Hill. Interested in pursuing ICU fellowship after a T32 research fellowship studying the biology of transitions from ICU into long-term PTSD.
Clinical Scientist Track:
In parallel with the T32/RSP program, the Clinical Scientist Track program is a vehicle for residents to undertake from 1 to 6 blocks of research during the CA3 year. Projects range from bench research to clinical trials to history of medicine. We were very happy to attract a strong crop of applicants this year.
Please also join me in thanking the generous faculty mentors who have volunteered to work with the respective residents. These faculty are absolutely essential to make the CST program successful. Finally, thanks to the concerted advocacy of Drs. Gaiser and Hines, we were able to assure the necessary non-clinical time to support the following rising CA-3 residents for next academic year:
2021-2022 CST Residents and Mentors:
Khushboo Baldev (with mentors Jehan Elliot, Jodi-Ann Oliver, and Donna-Ann Thomas): Comparison of Erector Spinae Block with High Dose Steroids to Intrathecal (IT) Morphine in Perioperative Pain Management of Pediatric Patients with Scoliosis Undergoing Spinal Fusion Surgery – A Retrospective Pilot Study
Hesham Ezz (with mentor Paul Heerdt): Continuous non-invasive measurement of left ventricular preload: Accuracy and precision of a novel method during hemorrhage and resuscitation.
Adrienne Mejia (with mentors Cheryl Gooden, Rob Schonberger, and Robert Chow): Assessing Racial and Ethnic Disparities in Access to Pain Management and Utilization of Interventional Pain Treatments

Shireen Sarah Nouri (with mentor David Waisel): An Examination of the Impact of the COVID-19 Pandemic on the Empathy of Anesthesiology Residents

Melanie Wood (with mentor Robert Chow): Use of Intranasal Ketamine as Prophylaxis for the Treatment of Chronic Refractory Migraine (pending regulatory review).

KATZ RESIDENT RESEARCH FELLOWSHIP:
Thanks to the generosity and vision of Dr. Jonathan Katz, Clinical Professor of Anesthesiology at Yale and Professor of Anesthesiology at the Frank H. Netter School of Medicine, the Katz Research Fund has been established to support resident research that focuses on themes of wellness and provider health.
The inaugural winner of the Katz Fellowship is Dr. Shireen Nouri. Please congratulate her on this accomplishment! The fellowship provides funds to support her research and/or a travel stipend to defray costs of presentation at a national meeting.
We hope that the Katz Fellowship will help to promote investigations into the critical topic of caring for the caregiver, an area of research that is as important as it is often overlooked. In the context of the residents’ heroic responses to the COVID-19 pandemic, the importance of Dr. Katz’ generous gift has only grown.

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

More Projects:

Vascular Cardiovascular Neuroscience Regional/Pain Environmental Obstetrics Education

Vascular

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

Cardiovascular

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.

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.

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 rodent experiments of above.

Neuroscience

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.

Characterizing the hemodynamic effects of Yoda1 in rodents: Resident or Fellow Role: Participate in analysis of existing datasets, as well as data collection in human and animal models of these areas. 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.


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.

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.

Regional/Pain

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.

Environmental

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.

Obstetrics

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.

Education

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.

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.

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