On Thursday, April 25, Yale School of Medicine’s (YSM) Department of Internal Medicine held its 17th Annual Research in Residency Day.
“Research in Residency Day started as an idea to increase the exposure of our residents to our world-class department investigators that the house staff would not have exposure to during their clinical training,” said Vincent Quagliarello, MD, vice chair for education and academic affairs, Department of Internal Medicine. “Additionally, we strongly felt that exposing residents as trainees to research early on in their careers will make them better clinicians at the bedside, because the skill and refinement of thinking that is required to create new knowledge can be applied at the bedside.”
To give residents a larger audience to present their projects to and to better accommodate faculty schedules, a new format was adopted for this year. Three residents were chosen to showcase their work during the department’s Thursday morning Medical Grand Rounds.
PGY 3 Jesse O’ Shea, MD, MSc, resident, Internal Medicine Primary Care Residency Program, began the lecture with his project, “Population-Based Standing Orders: A Novel Approach to Hepatitis C Screening” with statistics regarding the Centers of Disease Control (CDC) guidelines for hepatitis C (HCV) screening. For his study, O’Shea chose the demographic of American patients born between 1945 and 1965, otherwise known as baby boomers. Of the three million people in the U.S. infected with HCV, most are baby boomers and three out of four baby boomers don’t know they have contracted the virus. O’Shea looked at previous methods of HCV testing strategies and asked if there was a way to increase screening for an entire population of people at risk for HCV without risking provider fatigue. He chose to use bulk standing orders to be drawn during lab work, regardless of a physician encounter. O’Shea found that testing rates significantly increased during his sample period.
O’Shea was mentored by Bradley Richards, MD, MBA, assistant professor of medicine (general internal medicine).
PGY3 Devika Kir, MD, resident, Internal Medicine Traditional Residency Program, chose to look at the “Association of Institutional Transcatheter Aortic Valve Replacement (TAVR) Volume and Patient Outcomes.” With aortic stenosis being the most common valvular heart disease in the developed world, Kir set out to learn if the volume / outcome relationship still exists with TAVR. She talked about the increase in centers that perform the TAVR procedure. She shared data that showed with the increase of TAVR procedures, surgical aortic valve replacement (SAVR) decreased. Kir performed meta-analysis on available data comparing low-volume, intermediate-volume and high-volume TAVR centers. She found that there was a reduction in mortality when comparing the low- to high-volume centers and intermediate- to high-volume centers. She asked whether quality and access to care could be compromised if volume thresholds for existing centers were increased.
Kir was mentored by Nihar Desai, MD, MPH, assistant professor of medicine (cardiovascular medicine).
The project by PGY-3 Nicolette Rodriguez, MD, MPH, resident, Internal Medicine Traditional Residency Program, is entitled, “Phenotypic Expression of CDH1 Germline Mutations Unselected for Hereditary Diffuse Gastric Cancer.” Rodriguez explained that hereditary diffuse gastric cancer (HDGC) is a genetic condition that is associated with both diffuse gastric cancer (DGC) and lobular breast cancer. With HDGC, patients present at a later stage and typically have a poorer prognosis. She reviewed the current guidelines for CDH1 genetic testing and noted that given the advent of multi-gene panel testing, more pathogenic CDH1 mutations are being identified that do not fulfill HDGC clinical criteria. Rodriguez sought to assess the cancer phenotype and cancer risk estimation among a group of CDH1 mutation carriers, independent of the indication for testing and thus not previously selected to meet HDGC clinical criteria. She performed a statistical analysis and found that the cumulative risk of gastric cancer was much lower than previously reported. Additionally, her research found that some families have a breast cancer only phenotype.
Rodriguez was mentored by Xavier Llor, MD, PhD, professor of medicine (digestive diseases); and Rosa Munoz Xicola, PhD, assistant professor of medicine (digestive diseases).
To learn more about each project, watch the April 25 Medical Grand Rounds.
At 11 a.m., poster presentations began at Harkness Lounge. The following residents displayed their research during this session:
- Queenie Abad, MD
- Veronica Azmy, MD
- Jason Bonomo, MD, PhD
- Catherine Gao-Howard, MD
- Leila Haghighat, MD, MPhil
- Kaoru Harada, MD
- Eileen Harder, MD
- Eric Jordan, MD
- Gillian V. Kupakuwana-Suk, MD, PhD
- Benjamin Lu, MD
- Nilofar Najafian, MD
- Phillip Nickerson, MD
- Corey O’Brien, MD
- Michael O’Donnell, MD, MBA
- Shawn Ong, MD
- Vivian Ortiz, MD
- Jesse O’Shea, MD, MSc
- Dipal Patel, MD, PhD
- Anahita Rabiee, MD
- Dushyanth Srinivasan, MD
- Natalie Uy, MD
- Jovian Yu, MD
Internal Medicine Traditional Residency Program resident, Gillian V. Kupakuwana-Suk, MD, PhD, is grateful for the research opportunity.
“This project was basic science and I was able to work with the residency program to be allowed to do this work, which can be difficult to do when you are so busy clinically,” Kupakuwana-Suk said. “If you really want to do something, this is an environment that allows you to explore it. I will be able to continue this research project because I am doing a hospitalist year and if our preliminary results are positive, we would like to obtain a R01 grant for it.”
Kir agrees. “I am glad that our leadership supports [this day] and gives us dedicated time to follow our research project and see it through.”
“The program has worked out beautifully,” said Quagliarello. “Before, there were a couple of residents who would do research and it was hit or miss. Now the program has grown to the point where we have 20 to 25 residents participating.”
John Moriarty, MD, FACP, program director, Primary Care Residency Program, echoed Quagliarello’s sentiment.
“Prior to this program, residents who were interested in doing research often did it on their own time, that may not have been as structured, and output and scholarship were often small. Through the Yale Research in Residency Program, we’ve organized the process of scheduling dedicated time for the residents for the research, as well as assured mentorship, and held residents and mentors accountable to a timeline to get the work done.”
To learn more about Yale Department of Medicine’s resident training, visit Residency Training Programs.