• Education

    The Role of Research in Medical Training

Sean Cantwell arrived at Mayo Clinic School of Medicine with little background in research. That changed in human anatomy class.

“There was something magical about dissection of the human hand,” says Cantwell, who grew up in Newport Beach, California, and studied physiological science at the University of California, Los Angeles. “The biomechanics were just so beautiful. The pathology was so interesting.”

Sean Cantwell, M.D.

Compelled to track down authors he was reading, he found the world’s leading experts right down the hall – and willing to talk.

“Mayo is just so accommodating when it comes to education,” Cantwell says. “It doesn’t matter if you’re new on campus and contacting the most senior physician in the department.”

Cantwell volunteered to help with research projects and found two mentors in Brian Carlsen, M.D., and Steven Moran, M.D. ─ both of whom are hand and plastic surgeons.

“They helped me look critically at clinical problems. Their ingenuity, passion and dedication are characteristics required to advance the field,” Cantwell says.

Most medical trainees have a similar tale to tell. With more than 750 physicians and 330 full-time scientific faculty actively involved in research, Mayo is rich in opportunities.

That experience tends to inspire medical students to perpetuate Mayo’s tradition of physician-scientists.

Research is part of the core curriculum for Mayo Clinic School of Medicine, which accepts 50 medical students a year in Rochester, Minnesota, and 50 at its new campus in Scottsdale, Arizona.

“We believe it’s essential that medical students, residents and fellows actively participate in some type of research,” says Fredric Meyer, M.D., executive dean of education, Mayo Clinic. “Research advances one’s own knowledge base. It enhances care. It leads to discovery of new and better ways to treat patients.” Dr. Meyer is the Juanita Kious Waugh Executive Dean for Education.

About 80 percent of Mayo medical students — more than twice the national average — publish research articles in peer-reviewed journals while in school.

Much of Cantwell’s research focused on outcomes following upper extremity surgery. He graduated in May 2017 as co-author of 10 journal articles and three book chapters. He began a residency in plastic surgery with Mayo Clinic School of Graduate Medical Education, where more research is likely, along with his clinical training.

“Because of the size and scope of Mayo’s practice, research spans a wide spectrum of basic science, translational, and clinical subjects. That’s a big advantage over many other schools,” says Steven Rose, M.D., dean of Mayo Clinic School of Graduate Medical Education. “Much of research is best learned in a mentorship model, where an experienced investigator shows you the ropes and engages you in projects.”

Finding Your Niche

Soyun Hwang earned a degree in biochemistry from the University of California, Davis. She worked for two years as a junior specialist in the university’s Muscle Physiology and Proteomics Laboratory, which focused on the role of proteins in diseases of the heart muscle.

Soyun Hwang

She came to Mayo to get her doctor of medicine degree, hoping to help with research projects as opportunities arose. “With our connections with the faculty, we’re easily able to identify a project that we’re interested in. And we are given time to follow up on that,” Hwang says. Publishing case studies with the oncology department and assisting on plastic surgery research convinced her of one thing.

“I was still very interested in basic science research,” says Hwang. “I wanted to get more proper training in basic science research.”

In 2015, after her second year, Hwang put medical school on hold when Howard Hughes Medical Institute awarded her its Medical Research Fellowship, designed to develop America’s next generation of physician-scientists. For the yearlong fellowship, including a grant from the Orthopedic Research Educational Foundation, she conducted mentored biomedical research in orthopedic surgery at Mayo Clinic with Jennifer Jane Westendorf, Ph.D., a researcher who focuses on mechanisms that regulate skeletal development and regeneration.

“The whole purpose of the fellowship was to gain the skills to come up with good questions and to design good experiments,” says Hwang, who wanted to find a way to regenerate cartilage for osteoarthritis, which affects over 20 million people but still lacks a disease-modifying treatment.

During the year, she spent time in the lab with Dr. Westendorf and attended seven national conferences, where she met physicians “who are doing the type of research that I want to do and have built the kind of career that I wish to achieve.”

Hwang is drawn to the collaborative and relentlessly inquisitive nature of research. At Mayo — a leader in collaborative, team-based research — researchers and physician-scientists from multiple disciplines work side by side to transform scientific discoveries into therapies and critical advances in patient care.

Hwang says the research year gave her a combination of skills, motivation and confidence to integrate research more heavily into her career path.

“It was instrumental in solidifying my passion to be a physician-scientist,” says Hwang, who graduates in May 2018 and hopes to land a residency in general surgery or anesthesiology.

Customized Training

Mayo’s Medical Scientist Training Program produces the ultimate physician-scientist — a medical doctor who also has a doctorate in biomedical sciences with an emphasis on research training. This program, offered by Mayo Clinic School of Medicine and Mayo Clinic Graduate School of Biomedical Sciences, has been turning out physician-scientists since 1986.

The typical route for a M.D.-Ph.D. degree is two years of medical school, four years for a Ph.D., two more years of medical school, then on to residency.

Elizabeth Vogel, M.D., Ph.D., pioneered a different route. A Rochester native, Dr. Vogel began her residency in anesthesiology at Mayo after graduating from the University of Minnesota Medical School. At the end of a brief research project, her mentors asked if she had ever considered a Ph.D. and offered her a research training grant position through the National Institutes of Health.

Elizabeth Vogel, M.D., Ph.D.

So Dr. Vogel took the unusual step of pausing her residency as she pursued a Ph.D. She expected the interruption to cause problems for her residency but encountered only encouragement.

“They didn't bat an eye,” she says. “They just figured out how to do it. Overall, Mayo is so open and excited about having students at any level involved in research.”

Dr. Rose says tailoring education to fit the trainee is standard procedure. “We offer greater flexibility in terms of designing a curriculum that is specific to each resident and fellow’s interests but still in compliance with our accrediting and certifying bodies.”

Most residencies and fellowships sponsored by Mayo Clinic School of Graduate Medical Education, the nation’s oldest and largest graduate medical training program, provide opportunities for clinical, basic science and translational research. The school’s more than 1,600 trainees on Mayo’s Arizona, Florida and Rochester campuses also can conduct clinical research in conjunction with their clinical rotations.

In graduate school, Dr. Vogel’s research revealed that the use of supplemental oxygen and respiratory support in preterm infants can cause thickening of the airway wall and increased reactivity of the airway smooth muscle, similar to the changes that occur in asthma. This may help explain why preterm infants are at increased risk of developing airway disease.

“Physician-scientists have a unique role in that our clinical work provides grounding for our research endeavors,” Dr. Vogel says. “It allows our focus to be translational and deeply connected to direct improvement of patient care. My research time helps me find ways to improve my clinical practice, while my clinical practice provides motivation for further research. It is a fantastic partnership of disciplines.”

Dr. Vogel received her Ph.D. from Mayo’s Graduate School of Biomedical Sciences. She plans to complete her residency in anesthesiology in July 2018. Then, she says she will pursue training in pediatric cardiothoracic anesthesiology.

Just like the Mayo physician-scientists before her, who pursued discoveries that deliver hope and better health to their patients, she continues to work on finding ways to prevent airway disease later in life for preterm infants.

─ Greg Breining and Jon Holten, September 2017