70 Years of Liver Fellowship at Yale with David Assis

Transcript

• 00:11Welcome back. Please note that
• 00:13due to time we will be skipping
• 00:16over the 5:15 Q&A session.
• 00:17If you have a question for any
• 00:19of the afternoon speakers,
• 00:20please feel free to send it directly
• 00:23to them through the attendee hub.
• 00:25Thank you, this is being recorded.
• 00:46So our final speaker this
• 00:47afternoon is from David Assis,
• 00:48who's an associate professor of medicine,
• 00:50and the fellowship director for the
• 00:52gastroenterology program, David.
• 00:55Thank you so much. Let me share screen.
• 00:58I hope everyone can see that.
• 00:59OK, thanks again for the opportunity
• 01:01to speak today and I think I'm going
• 01:04to start by taking a deep breath.
• 01:06I think it's been a long day and
• 01:07we've heard so many great things.
• 01:09I have a feeling that the discussion
• 01:11about training and hepatology at
• 01:13the liver center over the years is
• 01:16placed in this order for a reason.
• 01:18To kind of look backwards to some of
• 01:20the discussions throughout the day and
• 01:21also help us to look forward so it's
• 01:23a pleasure to speak on this topic.
• 01:25To me, I think if I summarized all
• 01:27of this and it's most basic format,
• 01:29I think that I would think of
• 01:30the liver center and trainees as
• 01:32really engendering a worldwide
• 01:34multi generational family tree,
• 01:35and the degree that we can know
• 01:37our roots know where we came from,
• 01:39help strengthen our existing
• 01:40structure and grow in the years ahead.
• 01:42I think we will guarantee the success of
• 01:45the liver center and future hepatologists
• 01:47and trainees for years to come.
• 01:50I'm not going to believe her.
• 01:51Some of the topics that were
• 01:52discussed earlier,
• 01:53but I think it's useful to think
• 01:55in terms of training purposes
• 01:56of the liver centers history in
• 01:58terms of several different eras.
• 02:00I think, as you can imagine,
• 02:02the 1st and foundational era was by
• 02:04Doctor Gerald Klatzkin who founded
• 02:06this study unit in the 1940s.
• 02:07Forty six I'm his fellows has been
• 02:10a great discussion with Doctor
• 02:11Boyer earlier today about the
• 02:13impact they have had at Yale and
• 02:15have broad throughout the world.
• 02:17And as we know,
• 02:18he was the first holder of a T.
• 02:2032 grand and liver disease,
• 02:21which I think is something that we should
• 02:24remember and celebrate and build upon.
• 02:26I'm certainly not going to belabor
• 02:27all the names and the law.
• 02:29The issue for some of the people
• 02:30who have gone through and trained
• 02:32under jailed klatskin,
• 02:33but I think it's worth just for a second
• 02:35to take a moment and recognize how many.
• 02:37Just a few are indicated here of the
• 02:39of the former fellows went on to be
• 02:41foundational figures in their own
• 02:43right at various different liver
• 02:45units and liver centers around the
• 02:47country and sometimes around the world.
• 02:48So I think there's a multiplier effect.
• 02:51Of us investing in training and passing
• 02:53on the enthusiasm that we have for
• 02:55our science and for our clinical research,
• 02:57I think this can really be transformational.
• 03:00Certainly the liver center legacy
• 03:02is one example of prior klatskin
• 03:04fellows lives on still to this day
• 03:06very strongly at the West Haven, VA.
• 03:08Here's a photo of Doctor Howard
• 03:10Kahn and a very nice dedication.
• 03:12He wrote out to Jerry Klatzkin when his
• 03:15Seminole work was put into into press
• 03:18and codifying Lactulose and hepatic coma.
• 03:21And we also know that the liver
• 03:22center has had a legacy that's been
• 03:24very strong and well beyond Yale.
• 03:25I mean, I give us a small example,
• 03:27this this cascade here.
• 03:28I think that it's very clear that
• 03:31faculty and fellows have a tremendous
• 03:34influence on undergraduates,
• 03:35medical students, residents,
• 03:37and multiple subsequent generations,
• 03:38as exemplified here,
• 03:39where Joseph Bloomer was a
• 03:41fellow of doctor Klatskin who
• 03:43went on to mentor David Brenner,
• 03:45who was a medical student resident
• 03:46who has mentored Bern.
• 03:48Schnabel, who is currently leading
• 03:49our field in many respects.
• 03:51And I think from that we have
• 03:53multiple future hepatology leaders,
• 03:54so we should always keep in mind
• 03:56that the gift that we have from
• 03:57our roots of of the liver center to
• 03:59strengthen our ability to pass on this
• 04:01enthusiasm for generations to come,
• 04:03and we have probably no idea in
• 04:05four or five generations some of
• 04:07the fruits that might come to bear.
• 04:09The second era very clearly is is
• 04:11a success story as well with Doctor
• 04:14Boyer as well as Doctor Grossman.
• 04:16I think we know very well Doctor
• 04:17Boyer as the founder of the NIH
• 04:20funded Liver Center and has
• 04:21been transformational as well as
• 04:23reestablishing the T32 training grant.
• 04:25And really,
• 04:26I would also emphasize increasing
• 04:28the the international footprint of
• 04:30research training through the liver center.
• 04:32I was able to dig,
• 04:33dig up a small blurb in the New
• 04:35York Times from 1984 when the
• 04:37Yale got the initial.
• 04:39Grant to establish the Liver Center,
• 04:41and I think it we need to cherish
• 04:42and to grow and to expand and build
• 04:44upon that a lot of that hard work
• 04:46that was put into the liver center,
• 04:48from which we all benefit to this day.
• 04:51Is some of you who were able to
• 04:53participate in the midday discussion
• 04:55with some of the former fellows from
• 04:56around the country and around the world?
• 04:58There's a really big gift also from this era,
• 05:01which we should not take for granted,
• 05:03and some of these figures who
• 05:04have gone on to lead not only our
• 05:07center currently but also have
• 05:09established lead centers around the
• 05:11world remain very important to us
• 05:14I think and help to cherish a lot
• 05:15of the memories that were in the
• 05:17gendered during their time here.
• 05:18And I think that's the kind of
• 05:20environment that we should strive to.
• 05:22To pass on to future trainees,
• 05:23this photo from the mid 1990s at the
• 05:26time of a transition for the liver
• 05:28Center is a great example of some
• 05:30of the multiplier effect that we
• 05:31can all hope for as we transmit our
• 05:33passion for science and research and
• 05:36clinical medicine to the next generations.
• 05:39Certainly that second era is also
• 05:41characterized by Roberta Grossman,
• 05:42who is, I think,
• 05:43was very appropriately recognized
• 05:45earlier today,
• 05:45but Doctor Garcia Sao.
• 05:47I think the international reach
• 05:48also through the liver center and
• 05:50the activities at Yale and the VA.
• 05:52We're even further multiplied as
• 05:55was described by Doctor Garcia
• 05:57with Fellows who came from and
• 05:59learned and went back to lead them.
• 06:01Their liver units and many
• 06:03places around the world.
• 06:04Doctor Garcia saw herself who has
• 06:06pioneered some of the clinical
• 06:08research and portal hypertension,
• 06:09as well as medical education
• 06:11and taking the name of the Liver
• 06:13Center and the research at Yale
• 06:15across the world is wonderful.
• 06:16I have a feeling that if Elon Musk
• 06:19ever establishes a colony on Mars,
• 06:21she will certainly be asked to give a.
• 06:23Medical education and portal.
• 06:24Hypertensive lecture on Mars as well,
• 06:26so it really, I think,
• 06:28brings home to me when thinking
• 06:30about this topic today that the
• 06:32interconnectedness with the greater
• 06:33hepatology conversation throughout the
• 06:35world is one of the strengths and the
• 06:37legacies of the Yale Liver Center,
• 06:39something that we should strengthen and
• 06:41further increase in the years to come.
• 06:43I think our current era then characterized
• 06:45by the leadership of Doctor Nathanson,
• 06:47I think is something that we
• 06:49should take a minute to consider
• 06:51from a trainee perspective.
• 06:52I think the strengthening of the
• 06:53liver center and the training.
• 06:55Grants is very important as well
• 06:57as the expansion of clinical
• 06:58footprint and clinical research.
• 07:00We know that the hosting and the
• 07:02home of the Hepatology Journal
• 07:03are key journal and the ASLD.
• 07:05For five years,
• 07:06Steve a lot of opportunities
• 07:08for fellows and trainees,
• 07:09and I think the last 20 years have seen
• 07:12expanded opportunities for students,
• 07:14residents, and fellows.
• 07:15Postdocs of all of all stripes.
• 07:17I think the diversity of liver faculty
• 07:19which was briefly alluded to earlier
• 07:21in the day is worth repeating here,
• 07:23and that's why I elected in this discussion.
• 07:26I've heard from multiple trainees
• 07:27in the past few years and even
• 07:29very recently over the past few
• 07:31months that significant positive
• 07:33impact of being at a facility in an
• 07:35academic center in which half of
• 07:38the 24 hepatologists are female.
• 07:39I think we should not underestimate
• 07:41the impact that that has,
• 07:43particularly in comparison
• 07:44to some of the institutions,
• 07:46perhaps where our trainees have been used to,
• 07:48in which there are less role
• 07:49models that do not fit the mold,
• 07:52and along with an increase in DE I
• 07:54representation among faculty and fellows.
• 07:56This is of course,
• 07:57strength.
• 07:57I think that we need to celebrate and
• 07:59to be proud of as a center because
• 08:01it does impact and makes a difference
• 08:03in the lives of our trainees.
• 08:05The Klatskin primary liver service,
• 08:07which started in 2008 as this very
• 08:09similarly had a tremendous impact
• 08:10on students and residents I know of
• 08:12at least one current faculty member
• 08:14who I had a chance to work with as
• 08:16as an intern who came through the
• 08:18ranks and has now joined us and
• 08:20Doctor Hawks is doing wonderful work
• 08:22in addiction medicine and liver night.
• 08:24I think we need to be very cognizant and.
• 08:26Celebrate the fact that this primary
• 08:28liver service has a tremendous impact
• 08:30on trainees and we all know and and
• 08:32appreciate our time on that service.
• 08:34And I think that something to take a
• 08:36look back at and and somehow quantify
• 08:39and celebrate the multiplier effect
• 08:41of us having this experience.
• 08:43Lastly, during the current era,
• 08:45I think it's very important to recognize
• 08:47the current efforts to break down
• 08:49silos within different disciplines,
• 08:50both at Yale and and beyond.
• 08:52Yale by thinking about the
• 08:54definition of a hepatologist as
• 08:55more than somebody who just treats.
• 08:57Liver disease from the
• 08:59strict traditional sense.
• 09:00I think Doctor Trezza Bosco has
• 09:02that as a big priority for the
• 09:05expansion for the liver center,
• 09:06and I think that is something
• 09:08that was exemplified through
• 09:09a lot of the discussions and
• 09:10the talks throughout this day.
• 09:12So when I think about training
• 09:13at the Yale Liver Center,
• 09:14then I really think about the liver
• 09:16center as being at the very heart
• 09:18and the core of so many different
• 09:20activities that so many people have
• 09:22and so many of our trainees experience,
• 09:24be they clinical and research
• 09:26fellows visiting postdocs.
• 09:27Working in their labs,
• 09:29students and residents rotating
• 09:30through the West Haven,
• 09:31VA,
• 09:32or Yale Inpatient Services or
• 09:34Yale over clinics.
• 09:35With the variety of specialty programs
• 09:37that were highlighted earlier today
• 09:39as well as long non liver trainees
• 09:40who come through and work with us.
• 09:42Being in Pediatrics and radiology,
• 09:44pathology and surgery,
• 09:45I think depending on how we look at this,
• 09:48it's important to recognize that
• 09:49the liver center has a significant
• 09:52footprint in medical education.
• 09:54Furthering science,
• 09:55furthering care for our patients that.
• 09:57Is increasingly important in
• 10:00this very fragmented world.
• 10:02So in the last two minutes I will just
• 10:04conclude with some brief thoughts on
• 10:06the future of liver training at Yale.
• 10:09I think one of the things that we can
• 10:11do at the Yale Liver Center from liver
• 10:14trainer training perspective is to
• 10:16continue to strengthen and bootstrap
• 10:18our research training for our fellows,
• 10:20including short track programs.
• 10:21I'd like to highlight and give
• 10:22a shout out to sad softball.
• 10:24One of our research fellows and to Marty,
• 10:26who wrote a very beautiful.
• 10:28Recent article on some of the
• 10:30structure that's necessary to promote
• 10:32success for research fellows.
• 10:33Something that is often the big
• 10:35nebulous in that we all can come
• 10:38together to help prioritize.
• 10:39I think this and other Rd maps will
• 10:41help that we get the one on one
• 10:43mentorship and scientific and clinical
• 10:45expertise to help our fellows to
• 10:47succeed for now and for decades to come.
• 10:50Second,
• 10:50I think it's important to recognize
• 10:52that our trainees should be
• 10:54increasingly to the degree they
• 10:56are even more integrated into our.
• 10:58Educational and research experiences
• 10:59to learn some innovations that
• 11:02currently exist in their selected
• 11:04worldwide from our year over center.
• 11:06As an example,
• 11:07Doctor Villarino has implemented
• 11:08genome rounds and adult hepatology,
• 11:10from which students at Yale and
• 11:12residents are able to participate.
• 11:14I think Fellows will increasingly
• 11:16become a part of this to the degree
• 11:18that genomic rounds and genome
• 11:19based care for patients with
• 11:21undifferentiated liver disease,
• 11:23it becomes part of the lexicon and our
• 11:25approach to standardize these patients.
• 11:27This is something that our trainees.
• 11:29Would be highly exposed to and this can
• 11:31really spark a passion and multiple
• 11:33trainees which for which we would like
• 11:35to promote their interest in our field.
• 11:38Some of our research and organoids,
• 11:40or at least the three dimensional models
• 11:42and stem cells has also benefited from
• 11:45involvement of trainees trying to.
• 11:48In part the benefits of having a
• 11:51translational approach to conditions
• 11:52that don't have any effective therapy.
• 11:55Also, I think it's important to recognize
• 11:57that there are a myriad of opportunities.
• 12:00Or high impact clinical research and
• 12:02our trainees are ready and waiting to
• 12:05to be roped into this steady stream.
• 12:07I will just highlight briefly a very nice
• 12:10article that came out in a Seminole time
• 12:12frame in Hepatology in 2020 from Yale,
• 12:15in which there was a one of the
• 12:17key descriptions of the effects
• 12:19of COVID-19 on liver.
• 12:21As as we all know,
• 12:22a very timely topic during the pandemic
• 12:23and one of our residents was able to work
• 12:26very productively with Doctor Lim and
• 12:28the rest of the team in getting this out.
• 12:30An example of something that we
• 12:32can increasingly leverage to not
• 12:34only spark passion for hepatology,
• 12:35but to increase our own imprint
• 12:38and impact on the field.
• 12:40Lastly,
• 12:41some of our work on even multidisciplinary
• 12:43studies such as effective mindfulness
• 12:45on cytokines and on stress in
• 12:47patients with autoimmune hepatitis.
• 12:49Was it a good example of cross
• 12:52pollination with our scale stress center
• 12:55as well as pediatric hepatologists
• 12:57who became part of our team,
• 12:59these and other efforts.
• 13:00I think we if we think about our
• 13:02research from a training perspective,
• 13:04it should hopefully give us a
• 13:05good sense of the Longview of what
• 13:08we're trying to accomplish.
• 13:09So last thoughts,
• 13:10I think we should focus on innovation
• 13:12and new technology for the sake
• 13:14of successive deliver center,
• 13:16but also for trainees,
• 13:17it got me thinking earlier this
• 13:18week preparing for this talk that
• 13:20if you think about the reasons why
• 13:22many people came to the liver center
• 13:23over the years,
• 13:24it really had to do with wanting
• 13:27to get access to innovation.
• 13:28May be it perfecting the liver biopsy.
• 13:311940s and 50s hepatic function tests.
• 13:33In the 60s and histological analysis,
• 13:35doctor Klatskin innovations and bile
• 13:38acid transporters, calcium signaling,
• 13:40and portal hypertension.
• 13:41I think that cutting edge approaches
• 13:43will certainly attract bright
• 13:45and forward looking trainees.
• 13:46That's always been the case,
• 13:47and that is something that the
• 13:49liver center has excelled them,
• 13:50and one of the reasons it has such
• 13:52a large footprint around the country
• 13:54and around the world.
• 13:55Second, I think we all know,
• 13:56in hepatology,
• 13:57certain moments that got us some
• 13:59infected with the liver bug.
• 14:01They made us want to devote our lives
• 14:03to academic hepatology and research.
• 14:05I think inviting trainees into the
• 14:07greater hepatology conversation is
• 14:09even more important now in this
• 14:11very fragmented world.
• 14:12Invitations to integrate into
• 14:14professional societies,
• 14:15special interest groups,
• 14:16single topic meetings,
• 14:17and patient and healthcare advocacy.
• 14:19I think in our own lives we benefited from
• 14:21being invited into this conversation and
• 14:23as much as we can be cognizant of that,
• 14:25it will benefit us interdisciplinary research
• 14:28and multicenter collaborations we had great.
• 14:31Examples earlier today of PI's who
• 14:33sent trainees here to Yale and I think
• 14:36we can have two way St collaborations
• 14:38with certain centers and sister centers
• 14:41from around the country and around the
• 14:44world that can benefit our trainees.
• 14:45And lastly prioritizing pilot funding
• 14:47for qualified trainees.
• 14:49It was very moving to hear from Doctor
• 14:51Scott Friedman's example that he still
• 14:53remembers of being able to obtain
• 14:56a research pilot fund as a starting
• 14:58out fellow the the glow effect of
• 15:00that can really help to jumpstart.
• 15:01Careers and lead to lasting benefits.
• 15:04So in conclusion,
• 15:05I think we really have to also think
• 15:07about the one on one human interaction,
• 15:09which remains essential.
• 15:10All of the people who came through the
• 15:12Oliver Center and went on to devote
• 15:14their lives to research into this
• 15:16field had one on one experiences,
• 15:17and I think COVID only reinforces
• 15:19this critical need.
• 15:20I don't know how many of the productive
• 15:22synapses and conversations that have
• 15:24occurred over the decades here at
• 15:25the liver center could have been
• 15:27very easily carried out on zoom,
• 15:29for example,
• 15:29and I think that we need to emphasize
• 15:31that because in the end.
• 15:32This is an apprenticeship model to
• 15:35provide lifelong inspiration for
• 15:36the future generations.
• 15:37I think it engenders loyalty and
• 15:40productivity for decades to come.
• 15:42It was asked earlier today what the
• 15:44most important achievement has been.
• 15:45Perhaps of the liver center,
• 15:47and I would posit that aside from the
• 15:49the science that in the summation of
• 15:51this it's been to inspire generations
• 15:53of hepatologists that then devote
• 15:55their professional lives to a variety
• 15:57of cutting edge fields to impact
• 15:59the disease and our patients,
• 16:01and so the path ahead from a
• 16:03trainee perspective of my view,
• 16:05is to expand the liver centrist
• 16:07family tree during the next 75 years,
• 16:08something that we can certainly
• 16:10build on as we know and celebrate.
• 16:12And with that I will conclude thank you.