First annual Research Day highlights new scientist physicians

Alice Chen, a member of the Class of 2014, discusses her research project

The Virginia Tech Carilion School of Medicine has dedicated more than 1,200 hours of its four-year curriculum to research – and it shows.

Research Day 2014, the first annual celebration of student research at the medical school, recently highlighted the culmination of four years of research by members of the charter class.

The event consisted of oral presentations from eight students who received letters of distinction for their research and poster presentations by all 40 of the class members.

Students presented on a range of topics, including acute sleep deprivation, rotavirus assembly, new analytical tools for genotyping individual patients, contamination in pre-hospital care environments, effectiveness of the pneumonia vaccine in the elderly, and depression in patients with brain tumors.

The day included a keynote address by Dr. Bill Hazel, Virginia’s secretary of health and human resources.

“It’s a great time to be a physician,” Hazel told members of the Class of 2014. “There are plenty of frustrations in our health care delivery system today, but we are changing for the better. By dedicating part of your time in medical school to research, you have terrific opportunities to make a difference.”

An emphasis on research is one of the school’s four value domains and sets it apart from other medical schools.

Students begin focusing on research fundamentals during their first year. By the end of the first year, they are paired with a mentor from the Virginia Tech Carilion Research Institute, Carilion Clinic, or Virginia Tech’s Blacksburg campus – or, in a few are cases, with a mentor at an outside institution – and become immersed in a high-caliber research project.

“Our goal is to produce physician thought leaders who approach medicine scientifically, with the boldness to challenge dogma, to contribute to evidence-based medicine,” said Michael Friedlander, the school’s senior dean for research. “The fact that our students have already completed a comprehensive research project by the time they graduate distinguishes them from most of their peers at other schools across the country.”

The school’s other three value domains are basic science, clinical science, and interprofessionalism.

Rather than relying on potentially outdated standards of care or those without sound scientific foundations, these new doctors will keep abreast of the latest research findings and question the claims about new treatments with the eye and healthy skepticism of a scientist, enabling informed clinical practices.

The students’ research covered a breadth of topics, from rotavirus structure and function to antibiotic treatment in emergency rooms to genotyping and methods for tracking mental function in impaired brains.

Among those presenting research was Donald Vile, who, under the mentorship of Sarah McDonald, an assistant professor at the Virginia Tech Carilion Research Institute, studied the structure and function of rotavirus. Responsible for nearly half a million deaths in infants and children worldwide, rotavirus causes severe diarrheal illness­­.

Vile hypothesized that two of the rotavirus’s proteins, VP1 and VP2, interact similarly when replicating genetic material, RNA, and packaging the RNA to be released in a host. He found that the process was actually far more nuanced. The proteins are made of amino acids, each of which plays a role in viral assembly. The role can shift significantly depending on the current needs of the virus. It’s still not fully understood exactly how each protein fluctuates. Vile will be a resident in internal medicine at Wake Forest Baptist Medical Center.

Alice Chen conducted a safety analysis of a wait-and-see approach in emergency departments to reduce antibiotic use in the treatment of abscesses. The approach is designed to reduce the growth in the number of antibiotic-resistant infections. As part of this protocol, patients are treated and then given a prescription that can be filled if symptoms do not resolve in a given time.

With the guidance of her mentor, Dr. Melanie Prusakowsi, an assistant professor in the school’s Department of Emergency Medicine and a Carilion Clinic physician, Chen conducted a randomized, controlled trial of standard abscess care versus a wait-and-see approach during a 24-month period. She found that the wait-and-see approach did not pose added safety risks when compared with standard abscess care. In addition, when administered this protocol, subjects did not return for additional care more often, and they did not experience added pain. Chen will be doing her residency in emergency medicine at Akron General Medical Center.

Timothy Gall created a genetic mapping program that works much better than standard methods currently used. He was mentored by Dr. Emily Doherty, chief of medical genetics and dysmorphology at Carilion Clinic, and Dr. Thomas Markello, a geneticist at the National Institutes of Health.

Gall developed a powerful new program that uses diploid alignment, referring to the paired genetic set, rather than just one of the two DNA strands coded in cells. By matching diploids to a reference genome (the mother of a child with a previously unseen disease in that family, for instance), researchers can use a computer algorithm to find any discrepancies. This program should allow geneticists to interpret a genome more easily and quickly, bringing down the cost to a less prohibitive point, and further accelerating the race for real personalized genomic medicine. Gall won the only pediatric neurology residency position in the U.S. military; he will undertake his residency at the Walter Reed National Military Medical Center.

Katherine Dederer’s research centered on the electrical activity of inhibitory nerve cells and was carried out in the laboratory of Friedlander, who, in addition to overseeing the school’s research domain, is executive director of the Virginia Tech Carilion Research Institute. Dederer helped conduct some of the laboratory’s studies into how natural noisy patterns of electrical signals from the brain’s inhibitory nerve cells are transferred through the cerebral cortex, providing new information for the design of potentially more effective modalities of treatment of brain disorders with deep brain stimulation.

The study enabled Dederer to be among a small group of biomedical investigators who are trying to determine how realistic information that is often imprecise and noisy is relayed in the living brain, with the ultimate goal of helping researchers address brain disorders, such as seizures, Parkinson’s disease, and psychiatric disorders. This summer, Dederer begins her residency in orthopedic surgery at the University of North Carolina Hospitals.

Andrew Moore studied the use of computed tomography (CT) and admission rates among emergency department physicians. Although prior studies suggested that CT use by emergency physicians may decrease hospital admission rates, Moore, who will enter a residency in emergency medicine at McGaw Medical Center of Northwestern University this summer, wanted to take a closer look at the association between the two.

Under the mentorship of Dr. Damon Kuehl, an assistant professor in the school’s Department of Emergency Medicine and a Carilion Clinic physician, Moore’s research found a strong correlation between admission rates and CT use. Physicians who have high use of both suggest that a small cohort will consistently overuse resources. Moore postulated that a common factor such as risk aversion may account for this overuse. He concluded that future attempts to lower the usage rates of resources need to focus on the factors influencing the physicians who overuse them rather than targeting the resources themselves.

Lindsay Makara, whose mentor was Dr. James Sherman, a professor in the school’s pediatrics department and a Carilion Clinic physician, studied antibiotic administration in newborns at risk for early onset sepsis. She collaborated with the pediatric and obstetric departments at Carilion Roanoke Memorial Hospital to determine whether the time from birth to initial antibiotic administration for at-risk infants could be reduced. Makara’s research team was able to significantly shorten the time for antibiotic administration. Makara will be doing her residency training at Children’s National Medical Center in Washington, DC.

“We’re very pleased with our first class of scientist-physicians,” said Cynda Johnson, dean of the school of medicine. “A number of them have presented their research at conferences around the country and even internationally, and more than a dozen of them have already been published in scientific journals. This helps put the Virginia Tech Carilion School of Medicine’s research-intensive curriculum – as well as its unique partnership with the Virginia Tech Carilion Research Institute – on the map.”

Written by Catherine Doss, Susannah Netherland, and Ashley WennersHerron