2604. 76. 35. Rosana Gonzalez-Colaso, PharmD, MPH, displayed these numbers on a screen at the end of the December 6, 2018, Outstanding PA Thesis event for the Yale School of Medicine’s (YSM) Physician Associate (PA) Program Class of 2018. Gonzalez-Colaso, director of the PA Research Program, explained that 2604 represents the number of citations that the 36 members of the class used in their required thesis projects, 76 is the number of thesis readers, and 35 is the number of faculty advisors for the theses. The advisors are drawn from YSM, including the Yale School of Public Health, and Yale School of Nursing.
Beyond the numbers, the effort that Yale faculty and staff, including Cushing/Whitney Medical Library (CWML) librarians, devote to PA theses is significant, reflecting strong institutional commitment toward the PA research requirement. The Outstanding PA Thesis event, which celebrated both student achievement and the student-faculty-staff collaboration, took place just days before the students’ graduation on December 10.
The Yale PA Program is known for its intensive research focus, which extends throughout the 28-month program. It begins in the first trimester of the first year with the first of three research courses in the curriculum. These courses focus on statistical and research methods, evidence-based medicine, ethical standards in research, and the interpretation and application of clinical articles to answer clinical questions.
PA students start identifying topics and faculty advisors for their theses by late spring of their first year, and typically work on the projects through the middle of their second year. Two experts review each thesis; the reviewers are not told the name of the student or the advisor, to ensure an objective review.
The range of topics covered in the theses demonstrates the breadth of academic interests in the class, from Telehealth-Based Gay Affirmative Cognitive Behavioral Therapy For Young Gay and Bisexual Men in The Rural South to Comparing Congenital Melanocytic Nevus Treatment Effect on Children's Health-Related Quality of Life. (A list of the 13 honors thesis authors, titles, and their faculty advisors is provided at the end of this article.)
Four of the honors thesis students presented on December 6 to an audience of PA students and members of their support system, including several thesis advisors, CWML librarians, faculty, and family. When PA program director Alexandria Garino, PhD, PA-C, welcomed the audience, she thanked Gonzalez-Colaso, a critical member of this support team who has played a significant role in expanding the research curriculum for the PA Program to its current status.
While each presenter focused on a very different topic, they all followed a similar outline: providing background on their topic, stating the problem, setting forth a hypothesis and their research methods, highlighting strengths and limitations of their study, and explaining the clinical significance of their proposed study. Due to time limitations, PA students are not required to carry out the research projects they propose, but occasionally proposed studies have been conducted at a later time.
The title of Emily Speck’s ’18 thesis was Neurodevelopmental Outcomes in Opioid-Induced Neonatal Abstinence Syndrome: An Evaluation of the First Year. She shared that there is very little research on neurodevelopment or long-term outcomes from opioid exposure, and she wanted to find out if in utero methadone exposure affects neurodevelopmental outcomes in the first year of life. She explained that if the study she designed did show a causal link between opioid exposure and delayed neurodevelopment, implications would include increasing awareness amongst medical providers, identifying opioid exposure, recognizing barriers to treatment in pregnant women, coordinating medical and social service follow-up, and early intervention programs.
Corinne Morrison ’18 presented next on her thesis: Effect of Vibration Therapy on Bone Density Among Children with Epilepsy on the Ketogenic Diet. She began by discussing the prevalence of epilepsy in children, explaining what a ketogenic diet is, and that this diet is gaining traction as an effective treatment for epilepsy, although it is linked to decreased bone health. She went on to propose the use of vibration therapy, which involves low magnitude mechanical stimulation that causes muscle spindle fiber contraction leading to strain on bone, which translates to biochemical signals for both resorption and formation of bone. She emphasized that the vibration is barely perceptible to the patient.
Morrison explained why this research is valuable: “Decrease in bone mineral density at a young age can have detrimental effects later on in life. This intervention is non-pharmacologic and without any major side effects, and could possibly make a meaningful impact on the children’s quality of life later on.” Additionally, the research could lead to further research on children with other bone-altering diseases.
Decrease in bone mineral density at a young age can have detrimental effects later on in life. This intervention is non-pharmacologic and without any major side effects, and could possibly make a meaningful impact on the children’s quality of life later on.
Corinne Morrison ’18
Shifting focus to the kidneys, Yukari Suzuki ’18 presented on Bioimpedance-Guided Management of Resistant Hypertension for Diabetic Kidney Disease. She explained that diabetic kidney disease (DKD) accounts for about 50% of kidney failures and about 25% of people with chronic kidney disease have resistant hypertension, a form of high blood pressure that requires at least three different medication classes to control. Her hypothesis was that non-dialysis DKD patients with resistant hypertension receiving bioimpedance-guided treatment and conventional clinical assessment-guided treatment will achieve a statistically significant difference in the change in average blood pressure over the 8-week study period. Suzuki explained this research of optimizing hypertension management with bioimpedance could positively impact the quality of life for DKD patients by delaying or preventing the need for dialysis or a kidney transplant. In reducing the demand for kidneys, the 83% of patients on the organ transplant list for a kidney - including 16.3% who have been waiting for five or more years - may receive their transplants earlier.
Tilly Philbrick, Class of 2018, gave the final presentation on Low-Dose Terbutaline to Decrease Post-Exercise Nocturnal Hypoglycemia in Adults with Type 1 Diabetes. Philbrick described how the optimal diabetes management is tight glycemic control, diet, and exercise, but that exercise is a strong trigger for hypoglycemia and hypoglycemia is the main limit to tight glucose control. So Philbrick was focused on decreasing the severity of hypoglycemia, especially at night, in order to encourage exercise and tight glycemic control in individuals with Type 1 diabetes, and her hypothesis focused on the role of low-dose terbutaline in this process.
A common element across presentations was that each student and faculty advisor pair expressed shared admiration and gratitude. For example, before Morrison presented, her faculty advisor, Vinita Knight, MD, assistant professor, MEDPED neurology, told the audience that Morrison worked incredibly hard and designed a great project. Morrison concluded her own remarks noting “Dr. Knight was incredibly supportive. I definitely could not have done it without this support.”
A comment from Speck’s faculty advisor, Matthew Grossman, MD, assistant professor, pediatrics, drew laughter from the audience. Because Grossman was unable to attend due to a travel conflict, Gonzalez-Colaso read a letter he had written to the audience, in which he described Specks’s thesis as “the best and most clear review of the topic I have read - and I have written some of them.”
Several speakers offered words of encouragement to the members of the PA Class of 2019, who are currently in the thick of the thesis process. Morrison shared that “this process is really hard, but it’s rewarding when you get to the end and feel like you’ve done something good.” Gonzalez-Colaso noted that the celebration of the outstanding theses of the Class of 2018 “comes at the right time, so that the Class of 2019 sees that there is light at the end of the tunnel.”
Below is the complete list of the members of the Yale PA Class of 2018 who received an honors on their thesis, along with the title of their thesis and their advisor’s name.
- Kara Becker, A Postpartum Hemorrhage Protocol For Reduction of Maternal Morbidity: A Cluster Randomized Trial (Advisor: Katherine Campbell, MD, MPH, assistant professor, maternal fetal medicine)
- Andrew Cook, Telehealth-Based Gay Affirmative Cognitive Behavioral Therapy For Young Gay and Bisexual Men in The Rural South (Advisor: John Pachankis, Ph.D., associate professor, social and behavioral sciences)
- Rachel Dayan, Modulation of the Gut Microbiome as Treatment for Childhood Obesity: A Randomized Controlled Trial (Advisor: Anthony Porto, MD, MPH, associate professor of pediatrics (gastroenterology))
- Julie Gedalecia, Does Use of a Molecular Rapid Pathogen Kit Improve Outcomes in the Bacteremic and Critically Ill? (Advisor: Matthew Grant, MD, assistant professor of medicine (infectious diseases))
- Claire Lai, Comparing Congenital Melanocytic Nevus Treatment Effect on Children's Health-Related Quality of Life (Advisor: Richard Joseph Antaya, MD, professor, dermatology)
- Danielle Lockwood, Palliative Care and Quality of Life In Huntington’s Disease: A Randomized Controlled Trial (Advisor: Diana Richardson, MD., assistant professor, neurology)
- Corinne Morrison, Effect of Vibration Therapy on Bone Density Among Children with Epilepsy on the Ketogenic Diet (Advisor: Vinita Knight, MD, assistant professor, MEDPED neurology)
- Lawrence Olala, Safety of Intensive Blood Pressure Goal in Type 2 Diabetes Mellitus Patients with Chronic Kidney Disease (Advisor: Jeffrey Turner, MD, assistant professor, nephrology)
- Elizabeth Philbrick, Low-Dose Terbutaline to Decrease Post-Exercise Nocturnal Hypoglycemia in Adults with Type 1 Diabetes (Advisor: Catherine Weikart Yeckel, PhD, assistant clinical professor of epidemiology)
- Emily Speck, Neurodevelopmental Outcomes in Opioid-Induced Neonatal Abstinence Syndrome: An Evaluation of the First Year (Advisor: Matthew Grossman, MD, assistant professor, pediatrics)
- Faye Steiner, Early Melodic Intonation Therapy for Post-Stroke Aphasia: A Randomized Controlled Trial (Advisor: Jason Sico, MD, assistant professor of neurology)
- Yukari Suzuki, Bioimpedance-Guided Management of Resistant Hypertension for Diabetic Kidney Disease (Advisor: Aldo Peixoto, MD, professor of medicine (nephrology))
- Connie Zuo, The Role of Obesity on Asthma-Related Health Outcomes In A Pediatric Population (Advisor: Alia Bazzy-Asaad, MD, associate professor of pediatrics)