GA was Peachy

The best thing to come out of Georgia for me was a chance encounter with a kindred soul. I was interviewing for the MD/PhD program at Emory & Georgia Tech and met Lee; there for the same reason. We just clicked. Since then, we have probably spent a total of 8 days together. My top three schools were the UW, Emory and UCSD. He preferred UCSD, Emory and the UW. So we ended up on the left coast but in different corners. I saw him when I was in La Jolla for a conference and happened to be at another conference in Michigan the weekend he got married there. Well anyway, it looks like Obama won.

Advice To Those Who Follow

So let's say you are one of the 400 or so MD/PhD students out there planning on restarting medical school next year. Please give yourself more than 10 days between your defense and your first day on the wards. Trust me on this. No matter how little sleep you need, every day will drain your energy to the extent that the only science you could even consider doing after you get home is the variety served on CSI. And even then, it's a safe wager that you'd be asleep before the killer confessed in light of the evidence.

These days, I've been spending too much time on figures and edits and not enough reading about fever in the newborn or asthma.

I guess that is how it always will be.

Married Classmates

Today, an interesting discussion ensued while I rode in a shuttle with some of my medical school classmates between clinic and our teaching didactics. There are a couple of things that medical students who do not know each other very well can talk about easily. At the top of the list is the location of your next rotation. (UW folks have five states where they can be assigned.) My pediatrics clerkship is coming to an end, and soon I will be off to Anacortes, WA to learn about family medicine. When my colleague learned I would be heading up to Anacortes, he inquired if my wife would be able to join me up there. I almost turned to her and asked, "What do you think, honey?"

You see, currently, my wife is one of my classmates and was sitting right in front of me. None of my other classmates are aware of this. My outpatient clinic attending physicians know it (we bring the same food in for lunch); the folks in administration know it (we did put each other as emergency contacts); even my supervising intern knew (sometimes you have good conversations that can only go so far while concealing such a big component). But none of the 9 other students know about us. I bet that they just think we know each other well because we are both MD/PhD students... I think keeping this secret is a fun, harmless game that keeps things interesting for us. Anyway, that fact would just get in the way of the already isolating effect of being an MD/PhD kid.

Anyway, I am pretty sure I pulled off the answer to my classmate's question in a straight face with a simple, "No, she's going to stay in Seattle. Hopefully, we will see each other on the weekends." Susan pitched in with, "How long a drive is it? Two hours?"

Actually it's one and a half.

Stealing Home...

The game is tied in the bottom of the 10th. I'm in graduate school's extra innings - that's the time between defending the PhD and moving on to whatever's next. If you've been there, you know that this period involves putting the finishing touches on the manuscripts, making sure the margins are all spaced correctly on the dissertation, cleaning up hard drive filing systems and making sure the lab notebooks are legible.

In baseball, if you don't score in the bottom of the inning, there's always the next inning. My situation is different. If I don't score right now, that's it. There's no second chance. Soon, a two-headed beast will emerge from the depths of the sea, barge through the bleachers and destroy the very field I am playing on. Lucky for me, I know the beast's schedule. It is due to arrive in 17 hours. Perhaps by the time you read this, the game will be over. I'll be a medical student at Children's Hospital

I'd made it to third base on Friday. My adviser and I had settled on the text for one of my papers and only had one figure to finish up for it. A second paper was in worse shape. I had modified one of my dissertation chapters for half of the paper, and was in the process of filling in the other half with the needed background and appropriate referencing. After fiddling with some of the figures (for too long!), I tied myself to the computer. I knew my adviser (former adviser?) was leaving early Sunday morning and he needed a copy before he left. Last week in a similar situation, I left a document on his doorstep. Hard copies are easier to travel with... This morning, I made sure the document was on his stoop by 5 AM. When I tied myself to my desk, I committed to stealing home. It was do or die. That sea monster was looming.

By midnight, I was in a full sprint. The southpaw pitcher had a deliberate windup, and I was two thirds of the way home by the time the ball left the mound. I just hope the pitch is in the dirt. I've already found weaknesses in the document I finished this morning, and one of my co-authors has already sent back some helpful comments. At least something is written. Today, I've been touching up my figures and combining them into those big panels that folks use so much these days. I'm ready for the imminent maelstrom of dust, dirt, and colliding bodies.

Let's hope that my trip home is as fortunate as this one by the Cubs' Derrick Lee. By the way, I've been tapped a couple of times in the past few days; Kate and Mike have passed on some good memes. You can expect my responses to show up in a few days. Those are two tags I don't plan to slip in under...

A Doctor For Two Weeks

Well, I passed my final examination yesterday. I tried to approach the presentation like it was any other talk, but that didn't work for me. I was nervous for 40 minutes - up until the Q&A. I came into my own then, and had actually a lot of fun; this extended into the hour long closed meeting with my committee. Perhaps I'm so used to the Seattle tradition of asking questions throughout the talk, I got intimidated by the audience not interrupting me! Reliable sources indicate that I carried on a couple of conversations with myself (three actually) during the presentation, which evidently elicited laughs from the audience. And then there's the complement that goes something like, "I actually understood (insert fraction greater than 1/2) of your talk!" I suppose that bodes well for my interests in communicating science to the public.

I can't say that I feel much different this morning than 24 hours ago. I'll try to put the PhD to good use in the next two weeks before I start the third year of medical school, as I finalize two papers and one resubmission. Then I will have to put the PhD in my back pocket for a couple of years while I assume the mantle of humble & helpful medical student.

When I Grow Up...

...I want to be a medical student.

Since the hell that I hear is third year medical school looks to me right now more like Elysian Fields (Odyssey 4.563), I decided to share with you the specifics of my clinical training schedule. Assuming my committee releases me from my current servitude on September 13, I will conduct the next academic year learning medicine in the following places.

• Oct 1-Nov 9: Pediatrics; Children's, Seattle, WA
  
• Nov 12-Dec 21: Family Medicine; Anacortes, WA
• Jan 7-Feb 29: Internal Medicine; Sacred Heart, Spokane, WA
• Mar 3-Mar 28: Internal Medicine; Harborview, Seattle, WA
  
• Mar 31-May 9: Surgery; Spokane, WA
• May 12-Jun 20: Ob/Gyn; Fairbanks, AK
• Jun 30-Aug 8: Psychiatry; Seattle, WA

I'll be applying for a carbon footprint waiver for all of that traveling... Fortunately, my wife and I will be in the same city (but not the same hospital) for all but 6 weeks of this adventure.

Combined Degree Programs

I am part of an NIH-funded program that has been around for more than 30 years. The combined degree MD/PhD training program, called the Medical Scientist Training Program (MSTP, pronounced "messed up" by some of us) serves a need to better bridge basic science with clinical implementation. The idea is to train impressionable young scientists and clinicians in the ways of science AND medicine so that when they grow up, they can speak the same language and navigate the varied cultures of science, medicine and engineering. The result is a long, sometimes grueling path leading to a career in academic medicine. Every year, another 300 or so students sign up for this gig. One benefit of these programs is that we trainees don't have to pay for school, and get a livable stipend. The other side of the coin is that upon graduation we each enter a lifelong fundraising campaign to support our research. The big donors here could be private industry, but usually the benefactor is the Federal Government, via the National Institutes of Health.

Well, the NIH is seeking advice about how to reform the granting process so that the money (your taxes) they spend is most effective. For instructions on how to give advice, switch to this post. To hear one of my 'creative' ideas, keep reading.

I recently entered Seed Magazine's science writing contest. (The topic was science literacy.) Having only this blog as my science writing experience, I do not expect to win anything. For me, the contest helped me form an idea about what is missing in the public science communication complex. At the core of science literacy today is the need for effective translators; between religious folk and scientists; between doctors and newspapermen; between researchers and housewives; between professors and policymakers.

The MSTP has filled a critical need to connect the bench with the bedside. Sure, it takes too long for us to finish, and there is an attrition rate, but MD/PhDs tend to get grants because they understand what is needed on either the medical or the basic science side. Furthermore, several competitive programs exist to fund slightly higher risk efforts in translational medicine. Following these leads, the NIH would do well to support a small and competitive initiative to better train civic scientists. These would be professionals who garner some of their salary support solely to communicate with the public or with policymakers. A small number of students could earn dual degrees in hard science and communications or engineering and political science. These people will be the go-to resource for the public's questions and concerns about controversial topics like stem cell research, nanotechnology, designer genomes and drug safety. They also will be trained to develop innovative mechanisms to instill in Joe Public a scientific sense - that science does more than generate trivia.

This is my charge to the NIH (and other Federal funding agencies, for that matter):

Support Translational Science

Translators to the public and for the public. That will be money that can only feed back into the system.

MD/PhD Interest?

I've noticed a surge of referrals from an online forum about folks interested in MD/PhD programs. I am a student in the University of Washington's MSTP, and am happy to answer specific questions about our program or about my take on training the physician scientist. You can find one of my email addresses with only a little digging, OR you can comment on this entry. I am scheduled to defend September 13, and am very happy to be getting back on the wards.

You will probably notice that only a portion of my posts deal explicitly with medical research and graduate school. That's because I believe some physicians and scientists should assume more of a citizen's role - able to communicate about science and medicine in the context of public policy, general understanding and pop culture. This blog is meant to improve my communication skills in those areas.

Thanks for visiting!

Clouds Are Breaking

It's a Saturday night - June's final day. The last streaks of sunset are receding across the Northwest sky, rainclouds have been banished until October, and Seattle is in its prime.

Some of you will recall the 40 day flood of experiments I inundated myself with back on May 22. If your calender is handy, that means the time is almost up. Tomorrow, we can expect a reprieve. As I write this, I am preparing the last batch of cells for my last surgical experiment of my graduate career. The clouds are breaking for me, too. The sky is lightening. I can almost feel the sun cooking my pale Northwest skin.

This feels good.

I sure hope it takes me less time to find land then it took Noah et al. I am ready for it to finish.

40 Days

Let's see. It rained on Noah for 40 days and 40 nights. Moses was on the mountain for 40 days. Jesus fasted in the wilderness for 40 days.

I am also on a 40 day journey.

First, some context: As I type this, I am eating my ninth consecutive meal at the lab. You know work is busy when the porcelain is replaced with tupperware in the dishwasher at home. I now know the relative distances, operating hours and selection-economy axis of the three grocery stores closest to my lab. I am friends with Abdikadir, the late shift custodian in our building. I also know when to move from my lab bench to tissue culture to avoid being "mopped in." (10:30 pm)

The motivation for these recent developments can be traced to two dates: May 22 and September 13. On May 22, my advisory committee agreed that I could defend my dissertation on September 13. Of course, I do not have quite enough data to complete the scientific stories I am trying to tell. I presented an ambitious plan to finish all of my wet experiments (which for me includes those involving cells and animals) by July 1.

That puts me today at number 19 of a 40 day flood of experiments. Just like the one described in Genesis, this rain falls day and night. And while it may sometimes feel like I am in the wilderness, I am not fasting, nor do I expect at the end of it all to be tempted with world domination or anything like that. No, I will be tempted to embark on a second flood. One of words. That's right: I hope to have a draft of my dissertation, (and two accompanying articles for submission) by August 9.

Now that this information is out there for all 25 of you readers, I will have to commit to it. For you locals, here are the specs.

"Reducing Fibrosis and Cell Death in Transplanted Cardiomyocytes"
Thomas E. Robey
September 13, 2007
3:00 PM
Hitchcock Hall 132

By the way, you could select another "40" for me here or here.

Bioengineering ELSI

This report is a summary of one I presented to the committee tasked with identifying the future of bioengineering and by extension the UW BioE department. It has been revised for consideration by the Bioengineering Department's chair search committee. My opinions are based in large part on my experiences leading a group on campus called the Forum on Science Ethics and Policy.

I think it is important for the bioengineering department – and by extension the chair – to seek innovative ways to bridge science and engineering with medicine, ethics and social impact. From my perspective, the extent that this is even considered as an important task by the bioengineering department is small. In the current environment of ultra-competitive funding (Science, Vol 316, 20 April 2007, p. 356-361), increased occurrences of scientific misconduct (Nature, Vol 435, 9 June 2005, p.737-8), and ever-prevalent social concerns about science, I believe it important for the chair to have ideas about how to prepare students for the complexities of biomedical research and enable faculty to engage each other in meaningful conversations.

Several research strengths at the UW exist in the midst of important public discussions about science and society. Three of these are global health, stem cell research, and nanotechnology. Not only are there prominent researchers in each of these fields within or affiliated with the bioengineering department, but there are centers here focused on each of these topics. As the bridge between basic biomedical research and practical implementation, bioengineers are uniquely positioned to think critically about the needs and expenses of the technology they are building. I believe that the best bioengineers will be able to integrate needs and opinions from society into the healthcare setting. They should be, at the minimum, competent communicators about issues in science, engineering and society.

I believe strongly that a deliberate effort to incorporate issues of social responsibility and public policy into science and technology would provide the foundations to develop individuals that will lead their fields in academia, the corporate sector and the public sphere. How would this be accomplished? I have some ideas, but there are several more out there. Candidates for chair should provide innovative insights into how meaningful conversations about ethical, legal and social implications of research could be facilitated in the UW Bioengineering department. It will not be easy to incorporate concepts often relegated to liberal arts departments into a technical education, but creativity and dedication could result in significant gain. Bioengineers familiar with the global, social and political context of their work will be better prepared to tackle the current challenges in health care and lead us through the next century.

bioMEDICALengineering

This entry is modified from text I prepared for submission to the search committee for the new bioengineering department chair. For the record, I also submitted a revised form of a previously prepared recommendation concerning the role of ethical, legal and social impacts on engineering education. I am interested in hearing what anybody out there thinks of this perspective.

My comments today focus on the need for the new chair of bioengineering to lead efforts in interdisciplinary collaboration, interdepartmental partnerships and translational clinical research.

The new chair must have a vision for more and better collaborations with clinicians. Such a perspective (and the skill to form and implement a plan) will ensure that translational research is not merely entrepreneurial, or “bench to bedside,” but is “bedside to bench to bedside.” Too often, it seems that clinicians, scientists and engineers are not on the same page. This is a problem in the increasingly competitive environment for funding, where there will be good science that does not make the cut. In the context of bioengineering, the proposals that will succeed will contain good science that is problem driven. It is easy to label this as lofty talk, but I believe it is possible to fulfill these ideals if the department chair possesses some particular skills and is willing to facilitate certain kinds of interactions. Some of my ideas are listed here:

1. The chair should hold regular meetings with leaders from other departments and centers, and should make an effort to foster relationships all over campus. A familiarity with other centers’ research programs is important.
2. The chair should freely offer statements to departmental faculty that start with the phrase, “Have you spoken with...?” The chair should be in the best position to synthesize new collaborations because she or he has relationships with other campus administrators.
3. The chair could hold periodic department-wide meetings (with food) to offer a “State of the Department” address or to host feedback sessions.
4. The chair could sponsor quarterly seminars that appeal (either in one talk or in rotating talks) to clinicians, applied and basic scientists. It might be necessary to hold such seminars at a location that enables clinicians to attend. Any event that mixes clinicians and faculty would improve our current state.
5. The department should reiterate support for extending teaching and exam privileges to clinicians. Such clinicians could teach classes, serve on committees or co-advise students. More deliberate infusions of clinical experience would benefit students and faculty alike.

The bioengineering department at the UW is excellent. It is ranked highly in reputation and in revenue. This status is well-earned. I am surprised that there is not more interaction with the clinicians just down the street, particularly at the student level. Third-world diagnostics design might be more pertinent if trainees had some experience in the laboratory medicine department. Bone, heart or esophageal tissue engineers could learn a lot by interacting with orthopedic, heart or gut surgeons. I believe that a chair who has experience working in translational medicine and can communicate with engineers, basic scientists and clinicians will enable the UW to develop into the best bioengineering department in the nation.