Would decreasing the amount of sugary beverages adults drink lower asthma rates? Does Digital Breast Tomosynthesis mammography reduce the rate of false positive results? What is the best method for reducing Clostridium Difficile Infection in hospitals?
Three Yale Physician Associate (PA) Program students presented on these topics, which were the subjects of their theses, at a December 2017 event spotlighting the nine members of their graduating class who received Honors on their thesis projects. The Honors Thesis event was held just four days before the PA Program graduation ceremony.
Yale’s PA Program is known for its rigorous research component, which culminates in the thesis project. For many students, the PA Program’s research focus is cited as one of the reasons they chose to attend Yale. Patrick Ketchersid, MMSc’17, one of the presenters, stated that the Yale PA’s strong focus on research was a huge factor in his decision. He went on to explain that “evidence-based medicine is at the core of our training and understanding the research process and study design is an important part of that. Yale's thesis project and research curriculum taught us important skills and will help us stay up to date with new literature throughout our careers.” (Ketchersid’s thesis is entitled Strategies to Prevent Clostridium Difficile Infections: A Cluster Randomized Trial.)
The focus on research is woven throughout the students’ 28 months in the program. It begins during the first trimester of the first year, where students take Research I, the first of three research courses in which they learn statistical and research methods, the importance of evidence-based medicine, and discuss ethical standards in research. These courses also help them learn to interpret and apply various types of clinical articles when answering clinical questions.
By late spring of their first year, PA students are brainstorming about their thesis topics and reaching out to potential faculty thesis advisors, who can be affiliated with either the Yale School of Medicine, including the School of Public Health, or the Yale School of Nursing. Richard Belitsky, MD, Harold W. Jockers Associate Professor of Medical Education and associate professor of psychiatry and deputy dean for education, believes that “the selection of a faculty advisor is a critical element of the research process, because it often is the mentorship process that is the most educational and rewarding aspect of the thesis project.”
Rosana Gonzalez-Colaso, PharmD, assistant professor and director of PA research education, explains that when the relationship works, a student’s thesis advisor knows the student better than any other faculty member the student engages with during the PA Program.
Michelle Giwerc, MMSc ’17, another Honors Thesis presenter, describes the mentorship of her faculty advisor, Liane Philpotts, MD, professor of radiology and biomedical imaging, as follows: “she goes above and beyond to support her mentees -- I saw it time and time again as she went out of her way to advocate for both myself and her former fellow. She treated me with such kindness and respect, and her confidence in me has bolstered my own self-confidence. Getting to know and work with Dr. Philpotts was one of the highlights of my educational experience at Yale.” (Giwerc’s thesis is entitled Digital Breast Tomosynthesis: Outcomes and Tumor Characteristics in Women Recalled from Screening.)
Once the students finish their project, usually two years into the PA Program, it is subject to faculty review by two experts on the topic who do not know the name of the student or his or her advisor. This enables the review to be objective. It also requires a significant time investment by many faculty members. When Gonzalez-Colaso spoke at the Honors Thesis event, she noted that 109 faculty from Yale Schools of Medicine, Public Health, and Nursing served as advisors or readers, while several PA Program members and YSM librarians support the students during the development of their thesis project. This reflects the high value the PA program places on the thesis project and its centrality to the curriculum.
Beyond building research skills, the thesis process builds project management skills, which Gonzalez-Colaso noted are essential for anyone interested in a leadership role in health care. Perhaps not surprisingly, the Yale PA Program, the third oldest in United States, has a reputation for educating leaders in the PA profession.
While the students are not required to carry out the research projects proposed in their theses because of time limitations, some motivated students do. Giwerc’s project is an example of how the thesis projects can nurture interest in research. She and Philpotts’s team collected and analyzed the data from her project. Her findings were presented at a conference during the fall of 2017 and a junior attending working with Philpotts is furthering the work.
Another positive outcome of the rigorous thesis project experience is the satisfaction that comes from successfully completing a difficult task. Ketchersid expressed this well: “In the beginning, it seems like such a daunting task to combine a literature review and a novel study into a final product.” But “having the final draft in hand with the signature of my advisor, Dr. Louise-Marie Dembry, on it was a great feeling.” This sentiment was mirrored by Giwerc, who stated it “is an extremely daunting task to write a thesis during PA school, and I was definitely naive to that fact, but I can say in retrospect that I am so happy that I came here and completed a thesis – one that I'm really proud of. There are some incredible research opportunities at Yale, and I'm glad that I was able to take advantage of that during my time here.”
The other Class of 2017 PA Program Honors Thesis recipients are:
- Shreya Amin: Effect of Corticosteroid on Safety and Efficacy for Actinic Keratosis Therapy with Ingenol Mebutate (Thesis advisor: Suguru Imaeda, MD)
- Kristin Dalphon: Cancer Survivor Sexual Health Clinic in Breast Cancer Patients: A Randomized Trial (Thesis advisor: Tara Sanft, MD)
- Zachary Ewell: Lithium Trial in Mild Cognitive Impairment: A Randomized, Double-Blind, Placebo-Controlled, 18-Month Study (Thesis advisor: Cenk Tek, MD)
- Amy Zhao Li: Sugar-Sweetened Beverage Consumption and Asthma Control: A Randomized Controlled Trial (Thesis advisor: Amenuve Bekui, MD, MPH)
- Lauren Prince: Randomized Control Trial of The Effect of Cognitive Behavioral Therapy on Medication Adherence in Patients with Post-Acute Coronary Syndrome PTSD (Thesis advisor: Matthew M. Burg, PhD)
- Sarah Rocks: The Impact of Social Support on Diet Quality in Stroke Survivors (Thesis advisor: Jennifer Dearborn-Tomazos, MD)
- Ariel Skalka: Conventional Microdiscectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation (Thesis advisor: Peter Whang, MD)