Authors: Associate Director Ben Chen, MD PhD; Associate Director Talia Swartz, MD PhD; and Director Margaret H. Baron, MD PhD

It is an exciting time for the Icahn School of Medicine MSTP. Many thanks to the new editors and the writing team for rejuvenating the MSTP Newsletter. We have numerous updates since our last issue.

Director of the ISMMS MSTP, Margaret H. Baron, MD PhD

In October, 2015, we proudly welcomed Gayle Schneiderman as administrator of the MD/PhD program. She has been strongly committed to our students, multitasking very effectively, and making sure that everything runs smoothly.

Warm congratulations to our graduating class of 2016! We celebrated their achievements over champagne and cheese, shortly before Commencement. Our MD4 students did phenomenally well, matching in top programs all around the country. We are delighted to welcome them to our alumni network and hope that they will continue to serve as informal mentors to our students as they move on in their training. We also congratulate the large cadre of 13 newly defended PhD recipients this year and celebrate their impressive accomplishments in the laboratory.

A new MSTP-tailored core curriculum that was redesigned to integrate with the MD1 curriculum version 1.0 was successfully launched in fall 2015 and spring 2016 (BMS for MD/PhDs). We were able to offer a dedicated section of Responsible Conduct of Research (RCR) for MD/PhD students as well. All MD1 students took this course last fall, thereby freeing up some time when they begin to work in the lab in the PhD phase of the program. Our students also took the biostatistics course MPH0800 last fall. This course was considered more rigorous and relevant to the needs of MD/PhD students.

All graduate students, including MD/PhD students, can begin their thesis research much more rapidly as a result of the elimination of the General Knowledge Exam and the earlier timing of the Thesis Proposal Exam. The format of the Thesis Proposal is the same as that for an NIH F30/31 proposal and we strongly encourage all students to submit a proposal to the NIH as early as possible.

From Left: Associate Director Ben Chen, MD PhD; Associate Director Talia Swartz, MD PhD; and Director Margaret H. Baron, MD PhD.

We are excited to welcome our MD1 students, who arrived in July and have been engaged in summer rotations and an outstanding interactive course called Problem Solving in Biomedical Sciences. Just days after their arrival at Sinai, they were interacting on a professional level, teaching each other, analyzing and distilling information, and proposing novel and thoughtful new approaches to current scientific problems. They have made us very proud!

The 2016 Annual MSTP Retreat took place September 9-11 at the Bushkill Inn in the Pocono Mountains. It was a great opportunity for all of our students to bond. Our keynote speaker was Dr. Vincent Racaniello, Higgins Professor of Microbiology and Immunology at Columbia University, author of Principles of Virology, and celebrity host of the podcast TWIV (This Week in Virology). The breakout sessions were informative, the alumni participants inspiring, the student presentations fantastic, and the scientific discourse stimulating. Unique and grandiose awards were presented for the best posters, to Mark Bailey, Matt Chambers, Fiona Desland, Efrain Ribeiro, Ranjan Upadhyay, and Lum Zony. Many thanks to the Retreat Planning Committee for their hard work, new ideas, and enthusiasm and for organizing such a successful event.

Our MD/PhD Program Admissions season is about to begin, and we always appreciate the great efforts that the current students make to help us to continue to recruit the best students to our program. We appreciate the input of student representatives on the MSTP Admissions Committee and are pleased to announce that student interviewers will now be full voting members of the committee! The interview season always helps to showcase the accomplishments of our students and the unique qualities that make this MSTP great.

We warmly thank everyone who put in many hours of work for preparation and submission of our competitive renewal of the MSTP T32 Training Grant. The collection of data from our 94 students, ~180 participating faculty, MTA directors, alumni, and ISMMS leadership was no easy feat, but it allowed us to take stock of what a special program we have and how productive our students are. We learned, for instance, that our students publish an impressive average 5.6 papers before they graduate and that these are mostly in translational or clinically relevant areas of biomedical research. Over 80% of our graduates are in academic medicine, pharma, or biotechnology. The program is now approaching its 40th anniversary of NIH funding! We are so proud of the accomplishments of this MSTP and of our current and past students. This fall, we look forward to showcasing for the NIH site visitors the unique strengths of our program.

It’s a great time for our MSTP and we continue to marvel at the wonderful achievements of our students. Advances in science are coming faster than ever and there has never been a greater need for scientists who understand the major challenges of clinical medicine. We are proud to be involved in the training of future physician scientists who will transform the face of translational medicine.

Authors: Michael Daniel (MP3) and Andrew McKenzie (MP3)

Every year the members of the ISMMS MSTP put down their books, pipettes, and stethoscopes for a weekend and head to a relaxing location outside of the city, in a tradition that is known as the MD/PhD Retreat. This year our retreat was at the Bushkill Inn & Conference Center in Bushkill, Pennsylvania, a bucolic setting for a brilliant event. Vincent Racaniello kicked off the festivities with a wonderful keynote talk. In this talk, he first entertained us with his fascinating data on his work on neurotropic viruses, and then he spoke to the importance of communicating our science to the public. After dinner and student poster presentations, many of the students joined together for a Trivia Night. The questions at this event spanned the gamut from Olympic athletes to contemporary pop music to 1950’s science fiction movies, and, as your humble narrators can attest, required the full activation of one’s dorsolateral prefrontal cortex.

The Annual MSTP Retreat was held the weekend of September 9-11th, 2016. Per tradition, the entire MSTP student body, invited alumni, faculty, administration, and keynote speakers in attendance took a group photo on Saturday morning

Following a lively alumni panel with Dr Rita Shaknovich, Dr Steven Seigel, and Dr Jeffrey Parvin, students chose which breakout sessions to attend. These are designed to appeal to students at different stages of the program and allow some of the faculty members that attend the retreat to impart wisdom in lively, interactive meetings. This year the breakout sessions included a session on how to choose the right lab, how to develop a good research project, how to write an NIH F30 grant, and how to plan for a residency application. After this, everyone had a break, during which some people went on a hike to the beautiful Bushkill Falls, some played a spirited game of ultimate frisbee, and some just relaxed. Finally, one of the highlights of the retreat every year is the student presentations — and this year was no exception — where senior members of the MSTP have forty minutes to present their research. All in all, the retreat was once again a smashing success, with 95.9% of respondents saying that retreat was at least “Good,” and 10.2% percent saying that it was the “Best Ever.” Until next year!

Author: Andrew McKenzie (MP3)

This July, I was fortunate to attend the Alzheimer’s Association International Conference (AAIC) in Toronto along with thousands of other attendees. The topics covered at this annual conference range from clinical practice guidelines to neuroimaging, postmortem neuropathology, animal and cellular models of disease, and results of clinical trials. Historically, the conference has focused on the clinical side of Alzheimer’s disease, including the first reports of results from several large clinical trials, and the clinical area retained the lion’s share of presentations this year; however, I was told by veteran attendees that the quantity and proportion of basic science lectures, especially genetics, have dramatically increased over the past several years. Another extremely hot topic at this year’s conference was tau imaging, the signal for which, as predicted from neuropathology data, was generally found to correlate better with memory loss than the imaging signal for amyloid.

A View of Toronto’s Lake Ontario near the 2016 Alzheimer’s Association International Conference (AAIC)

In addition to attending a multitude of informational presentations, I was also given the opportunity to discuss my own work on the functional genetics of oligodendrocytes in Alzheimer’s disease at one of the AAIC symposiums. This was my first oral presentation at an international conference and I was quite nervous about it. I asked a mentor for advice and he assured me that I’d be fine — as long as I practiced my 20-minute talk at least ten times. The night before the presentation, I sat in my hotel room and timed myself as I read the slides over and over again until I fell asleep. The meat of the presentation aside, a key takeaway for me from this experience was how much effort it takes to make an oral scientific presentation look effortless.

I was also able to attend a number of career development events aimed at scientists and clinician-scientists in training. At one of these, we walked through a mock peer review process of an accepted manuscript originally submitted to a journal focusing on Alzheimer’s disease, and we were given pointers on how to make the manuscript submission process more efficient. At another training session, we learned from some of the leaders at the NIH about career development awards and pathways available to aspiring scientists interested in Alzheimer’s disease. One of the other trainees at this event asked whether the many such training programs that have recently been established would be cut due to lack of funding over the coming years. The speaker assured us that the two hardest things to do in government are to get something new started and to get something old stopped, so the training grants were highly likely to continue to be available.

In my anecdotal experience, the vast majority of MD/PhD students at the Icahn School of Medicine at Mt Sinai attend at least one national or international science conference a year. Doing so is obviously a great way to learn about new topics, make scientific contacts and rekindle old ones, and have fun traveling to a new location. What I didn’t expect to learn from attending AAIC is that going to a conference is also a tremendous motivator to work hard on my own lab work. Seeing so many bright clinicians and scientists interested in Alzheimer’s disease helped remind me that although my research can sometimes feel overly detail-oriented and esoteric, it makes a lot more sense contextualized within a broader research community that is exploring a wide variety of possibilities to develop better therapies to treat Alzheimer’s disease.

Author: Sandhya Chandrasekaran (MP2)

The East Harlem Health Outreach Partnership (EHHOP), Mount Sinai’s student-run free clinic, has been serving uninsured patients in the East Harlem area for 12 years. Since its inception in 2004, EHHOP has steadily evolved from an urgent care model into the primary care home for over 200 patients. This growth has largely been due to the indispensable synergy of preceptor mentorship and student involvement. And as MD/PhDs committed to a dual-degree program, we are in the unique position to both contribute to and benefit from EHHOP in several fundamental ways over the duration of our training.

The number of total senior clinicians (SCs, black) at EHHOP must remain close to 7 to comfortably accommodate the number of patients scheduled for Saturday clinic. While third- and fourth-year MD students generally volunteer very regularly (red), MSTPs in their PhD+ phase (blue) volunteer regularly as well, roughly compensating for major dips in the senior clinician pool due to medical student scheduling conflicts. In recent months, MSTPs have been increasing their volunteering commitments — hopefully, a trend that persists in the coming years!

On Saturday clinic days at EHHOP, a junior clinician (first or second year medical student) assists a senior clinician (third or fourth year medical student, or an MD PhD student in the PhD+ phase) who serves as the predominant medical interviewer. The history and physical examination information jointly gathered from the encounter by these students is then discussed with an attending preceptor to finalize an assessment and plan. For MD/PhDs in their PhD phase, this system not only offers a venue for regular note writing and oral presentation practice, but also provides ample opportunities for teaching students and developing mentorship qualities.

Clearly, EHHOP’s inherent structure relies heavily on senior clinician involvement to address patients’ medical concerns. However, given that many of these senior clinicians are third- and fourth- year medical students balancing demanding clerkships, shelf exams and residency interviews, certain weekends conceivably suffer from lower volunteer commitment. As the PhD years offer more flexibility with respect to specific work hours, MD/PhD students are prime substitutes. Indeed, MD/PhD involvement has reliably compensated for fluctuations in medical student involvement over the course of the last year to keep overall senior clinician numbers relatively stable year round, especially considering the size of our program in relation to the third- and fourth- year medical school classes.

Our additional years as practicing senior clinicians also afford us the opportunity to follow select patients longitudinally, consequently forging deep bonds and meaningful connections with some of the clinic’s sickest and medically complex patients. Jennifer Diaz, a sixth year in the program, has been following one of her patients for three years now, having honed her skills in hemodialysis and blood pressure management as a result. She attests, “I think patients have a lot to teach, and following them longitudinally gives us space to really learn from them. Each patient is unique. Given time, you learn to utilize clinical reasoning that incorporates your previous experience with the patient and the latest clinical research, rather than blindly applying textbook knowledge.” This chronic care dynamic builds upon the concept of ‘longitudinal clinical exposure’ or LCE introduced in the preclinical medical curriculum by granting MD/PhD students the responsibilities of overseeing patient care firsthand.

Understandably, years removed from regular clinical exposure renders MD/PhD students in their PhD phase both unconfident about their medical competence and anxious about their integration into third year rotations. To this end, Dr. Yasmin Meah and Robert Rifkin, a current seventh year in the program, meticulously designed and launched the EHHOP Clinical Service Enrichment Program (CSEP) for MD/PhDs in 2014, with the goal of providing concrete medical milestones and a structured platform for critical clinical practice discussions. Under the guidance of Benjamin Laitman and Noa Simchoni, the program has since morphed into tailored didactic sessions from physician experts; CSEP has received overwhelmingly positive reviews from students since it began.

Arguably, fueling EHHOP’s continued progress is its investment in research. MD/ PhDs have been instrumental in this effort by organizing and heading the EHHOP Quality Improvement Council (QIC). Now in its sixth year, the QIC caters to the budding research interests of preclinical students by equipping them with the tools to critically analyze and address key issues within EHHOP’s infrastructure in several successive ‘plan-dostudy-act’ (PDSA) cycles. Naturally, the QIC appeals to the research-oriented minds of MD/ PhD students, and has indeed benefitted from strong MD/PhD participation and leadership in coordinating QIC projects and initiatives.

With so many opportunities for involvement, it comes as no surprise that MD/PhDs have percolated several roles on the steering and executive leadership committees of EHHOP – overseeing research, finance, technology, education, and pharmacy. As such, it is clear that our steady presence in these capacities affords the clinic the necessary glue to hold together multiple isolated medical encounters in the context of a free clinic striving to better suit the needs of the patient population it strives to serve.

Author: Jennifer Long Diaz (MP4)

Across the country, women make up only 38% of MD/PhD students, and ISMMS comes in just below that national average. This disparity presents unique challenges and opportunities to advocate for women’s careers as physician-scientists. To address this need in our program, Women in MSTP formally launched in the spring of 2016. We aim to advocate for and support the success of women in the Medical Scientist Training Program at ISMMS through mentorship and educational efforts.

The Women in the MSTP (WiMSTP) held a recent picnic for students and faculty on a beautiful summer day in East Meadow at Central Park. In the upper right corner of the skyline, you can catch a glimpse of Annenberg, one of our flagship buildings.

Our inaugural event was a Medical Centerwide workshop on negotiating skills in February 2016, featuring successful physician-scientists from ISMMS and a keynote speaker from Albert Einstein. About 75 men and women at all career stages attended. Of those who gave feedback, 95% learned something new, and the majority hoped to attend a similar event again. We are currently collaborating with other student groups on a bigger, better negotiating skills event for 2017.

This fall semester, look for social and educational events where we will discuss issues important to women, students, physicians, and scientists. We’ll continue to work with other student groups as we leverage our unique position as mudphuds to bring together students from both the graduate and medical schools. As we reach out to students, we hope to increase awareness and get more women and men participating in our efforts. (Yes, you read that right: men’s participation is a critical part of advocating for gender equality!) Finally, our investigation into the roots of the MD/PhD gender disparity is ongoing in collaboration with a similar group at the University of North Carolina.

We hope to see you at a Women in MSTP event sometime this year. If you’re interested in becoming more involved, ask one of us about open positions, or tell us your idea for a new one!

2016-2017 WiMSTP Executive Board

President and Co-Founder: Jennifer Long Diaz, MP4

Co-Founder: Rebecca Hamlin, MS3

Vice President: Jessica Tan, MS2

Mentorship & Research Chair: Grace Mosley, MP1

Social & Communications Chair: Helya Ghaffari, MP3

Senior Student Advisors: Rebecca Hamlin, MS3 Mitra Heshmati, MS4

Faculty Advisors: Margaret H. Baron, MD PhD Miriam Merad, MD PhD