Medical school’s mentors ‘pay it forward’

Though few of the hundreds of busy people who pass through the doors of Sterling Hall of Medicine each day notice the Greek inscription on a plaque overhead, the language there says much about life at the School of Medicine. In translation it reads, “Those having torches will pass them on to one another.”

Some torches are passed straightforwardly. During their training, medical students, doctoral students, and even postdoctoral associates learn facts, many thousands of them. But as in all fields, from the law to violin-making, to ultimately succeed in medicine or science there is no substitute for learning the ropes from a seasoned mentor. Throughout its 200-year history, mentorship has been integral to the mission of Yale School of Medicine, where it plays a part today in nearly every sphere.

A hand up in medicine
Until recently, Associate Dean for Student Affairs Nancy R. Angoff, M.P.H., M.D., served as advisor to every member of every medical class at Yale, providing counseling in every realm from the academic to the personal. In 2009 the advising duties were split among four faculty, each of whom guides one quarter of each class. While they are not mentors in the strictest sense of the word, the new advisors—John S. Francis, M.D., Ph.D., assistant professor of medicine; Karen J. Jubanyik-Barber, M.D., assistant professor of emergency medicine; Michael K. O’Brien, M.D., Ph.D., assistant professor of surgery; and Patrick G. O’Connor, M.D., M.P.H., professor of medicine—meet with students individually during students’ first year, and in groups thereafter. Angoff still stands by to lend a hand with personal or social challenges, but the new advisors concentrate on “any kind of academic problems, struggles, issues,” Angoff says.

The School of Medicine requires that medical students complete a thesis based on original research. Students are encouraged to independently seek out and contact researchers they’d like to work with, but many begin their research after their first year, before they are familiar with the many research options available to them. One role of the advising team is to help pair up students with mentors who can best guide medical students through the projects that will ultimately form the basis for their theses.

Medical student Daniel “Pete” Duncan, who is spending an extra year at Yale devoted to research, chose to work with Christopher K. Breuer, M.D., assistant professor of surgery and pediatrics, who uses tissue engineering techniques to build new blood vessels for children with congenital heart disease. With colleague Toshiharu Shinoka, M.D., Ph.D., associate professor of surgery, Breuer has pioneered the use of tissue-engineered vascular grafts (TEVGs). Created by seeding a biodegradable scaffold with a patient’s bone marrow cells, TEVGs are living vessels that live and grow with the patient and are not prone to the immunological problems that affect transplanted tissue.

Despite Breuer’s busy schedule, which also includes clinical work as a pediatric surgeon, “somehow he is always keeping track of what we’re doing,” Duncan says. “When he’s in his office, he is always available. I’m interested in pediatrics, and he is very excited about that, very supportive, and willing to help in any way. He’s a very easy person to talk to.”

For his part, Breuer stresses that mentoring students is a two-way street, with great benefits for his lab. “It’s a wonderful give-and-take relationship,” he says. “I’ve got incredibly enthusiastic and accomplished people that come and help me with my project. I’m a huge beneficiary of working with these bright, hard-working people.”

Faculty and graduate students
In addition to future doctors, future scientists also train in many departments at the School of Medicine, ultimately earning the Ph.D. Graduate students study at the medical school via the Medical Scientist Training Program (MSTP; known more commonly on campus as the M.D./Ph.D. Program), which is devoted to educating physician–scientists, and the Combined Program in Biomedical and Biological Sciences (BBS), which gives Ph.D. students experience in several labs at both the university and the medical school before they settle into a BBS-affiliated department, many of which are at the School of Medicine.

Daniel Okin, a member of the medical school’s Class of 2014 in the M.D./Ph.D. Program, and Noah Palm, a doctoral candidate in the BBS program, both work in the laboratory of Ruslan Medzhitov, Ph.D., the David W. Wallace Professor of Immunobiology and a Howard Hughes Medical Institute investigator. Medzhitov is world-renowned for his work on the innate immune system, the body’s first line of defense against infection.

“When I heard about him and read some of his papers, I was immediately drawn to working with him,” Okin says of Medzhitov. “Ruslan is probably one of the most creative thinkers that I’ve ever encountered.”

After doing a rotation in Medzhitov’s lab, Okin decided to join the research team during his second year of medical school. Okin, who is conducting research the innate immune system’s response to nonpathogenic stressors such as obesity, describes Medzhitov’s approach to mentorship as “very collaborative. It’s very much that you work with him, together, to define an area that you’re both interested in, and to define a project that would be interesting both intellectually and scientifically.” Having spent more than six years in Medzhitov’s lab, Palm has learned and grown, he says, and has himself become a sort of mentor to new lab members. “There is a real feeling of responsibility in the lab of helping out the new students and postdoctoral fellows to become used to the lab, to feel welcomed, but also to get up to speed,” Palm, who plans to begin a postdoctoral fellowship at Yale next year, says. “When I came in, the people who are now long gone helped me, so it’s kind of a ‘pay-it-forward’ scheme,” he says.

Last April, Medzhitov became one of the youngest members ever to join the elite National Academy of Sciences. But despite his accomplishments, Medzhitov is extraordinarily dedicated to those under his wing. “He has an amazing track record of producing really top-notch scientists,” says Palm. “As far as I know, there’s no better lab in the world to have been in during the past five to 10 years, in terms of going on to really great positions at great universities and continuing to publish really great papers.”

Medzhitov sees developing a student’s individual interest as vital to the role of an advisor. “The challenge is to nurture that interest and to develop a certain set of skills that are necessary to do research, which are beyond just technical skills.” Among these skills, he says, are “the ability to see the big picture, to see why the problem is important and interesting, to be able to define important and interesting questions, and to see where that line of investigation will go and how it fits into the broader picture,” Medzhitov explains.

A continuing cycle
Mentorship continues to play an important role even after a person finishes medical or graduate school. Scientists holding a doctorate still need the guidance of mentors before they strike out on their own.

Michael J. Caplan, M.D., Ph.D., knows this well. As a graduate student at Yale School of Medicine, Caplan, now chair and C.N.H. Long Professor of Cellular and Molecular Physiology and professor of cell biology, gained vital experience working jointly with Professor of Cell Biology James D. Jamieson, M.D., Ph.D. (now director of the M.D./Ph.D. Program) and George E. Palade, M.D., the late Romanian-American cell biologist and Nobel laureate.

Last April, Caplan received the first annual Yale University Postdoctoral Fellows Mentoring Award. The fellows who nominated Caplan described three ways in which he is an exceptional mentor: he checks in with his lab members daily to talk about experimental data and to challenge them to think creatively about interpreting their results; he helps postdoctoral scholars advance their own careers by helping them to think strategically about their futures, providing extensive feedback on their grant proposals and participating in mock job interviews as they prepare for real interviews; and, not least, he strives to maintain a “family-friendly” climate in his lab that acknowledges and accommodates the challenges of balancing a scientific career with family life.

Mentorship is cyclical: mentees become mentors, and knowledge is continually passed on. As with parents and children, one generation of scientists raises the next, “just like we hear our parents’ voices in our heads when we’re talking to our children,” Caplan says. In the laboratory, as in parenting, maturity and confidence come with time—and when they do, the rewards are unparalleled, he says.

Caplan likens scientific training to an apprenticeship in carpentry: “There are people who come in knowing how to use all the tools and having a tremendous intuition for the wood, and there are people who don’t.” And with the latter, “the great pleasure comes from watching as, either suddenly or gradually, they acquire that intuition.”