New emphasis on large data sets at Student Research Day

During his 30 years as director of the Yale School of Medicine’s Office of Student Research, John Forrest Jr., M.D., HS ’70, FW ’71, has seen research trends come and go. He’s seen projects that have been lab based, clinically based, humanities-in-medicine based, and epidemiologically based. At this year’s Student Research Day, held May 7 in The Anlyan Center, he spotted the latest trend: the use of large database sets for research and theses. “With EMR (electronic medical records), lots of data are being collected, and it’s more accessible. Many of these databases contain more than ten thousand cases of an illness,” Forrest said.

Among the 95 research posters presented this year, projects ranged from studies of patients with acute myocardial infarction having enormous pre-hospital delays not associated with insurance status to an examination of whether administrative databases are valid for use in academic research when studying obesity.

Alexander Luryi’s examination of positive margins (the tumor remaining at the edge of where the surgeon cuts) in early-stage oral cavity cancer made good use of a dataset—he reviewed 20,602 oral cavity cases. Sometimes doctors leave margins because the tumor is next to a vital structure like a vein or bone. Other times it’s the result of carelessness. Luryi concluded that leaving positive margins is associated with decreased survival. “Margins are a good measure, and they’re well reported,” Luryi said. “They can be used to measure the quality of care at a facility.” Luryi, a fourth-year student, plans to specialize in ear, nose, and throat care.

Not all research projects relied on volumes of electronic data. Chung-Sang Tse, a third-year student who plans to pursue internal medicine, created a 35-minute online module to teach second-year medical students about end-of-life care. Assessing data collected from more than 100 students over two years, Tse found that students who used the module did better on a knowledge assessment of terminal care, but found no substantial effect on the attitudes or comfort level in the care of dying patients. “The module helped with knowledge,” Tse said. “Improvements in comfort level likely require more direct supervised experience with actual patients, which students get in the later years of medical school.”

Elizabeth Rawson investigated parental and health care provider attitudes toward discussing psychosocial stressors in pediatric primary care. Such traumatic events as the incarceration of a family member, witnessing community or intimate partner violence, psychiatric illness or substance abuse among family members, homelessness, and food insecurity are associated with a wide range of negative health and social outcomes, including obesity and depression. Early intervention is key, but as Rawson notes, that requires early identification, and providers don’t identify stressors consistently.

As a result, Rawson said, there is a lot of interest in developing new initiatives to introduce more psychosocial screening and surveillance into pediatric primary care. Better understanding of the attitudes among parents and providers that affect their behaviors around discussing stressors, she said, would inform the development of more successful screening programs. When it comes to pediatric primary care, said Rawson, a fourth-year student who plans to specialize in psychiatry, “it’s an opportunity to change lives.”

James Rothman, Ph.D., the Fergus F. Wallace Professor of Biomedical Sciences and professor and chair of cell biology, who delivered this year’s Farr Lecture began by praising the quality of student research. “The level and range of research here is really extraordinary,” he said.

Noting that when he began the research that led to his Nobel Prize for Medicine or Physiology in 2013, other scientists tried to dissuade him from what they saw as a risky project, he offered some advice to students. “Don’t listen to older scientists,” he said. “Had I listened to older scientists I probably wouldn’t ever have been invited to give the Farr Lecture.”