Curēus stopped by to talk to Olga Afanasiev, a pathology graduate student at the University of Washington. Olga has begun her thesis in the laboratory of Dr. Paul Nghiem. The focus of her research is on studying a rare, and often lethal, neuroendocrine skin cancer, Merkel Cell Carcinoma (MCC) She entered her poster into the Curēus Fall 2012 Poster Competition on the same topic.
Q) As one of the younger members of the Curēus Editorial Board (early 40s) and being right in the middle of the professional world that pushes “publish or perish” what attracted you to Curēus?
A) I love the idea of having public free access to medical content…I like the idea of making information more readily available. One of the issues of other public access journals is the fact that authors are charged steep fees. Something should be published because its quality not because I am willing to pay a fee.
A) I trained at Harvard and then went to Chicago for a Fellowship, but I had signed an agreement to return to CRC before I left. The more complex answer as to why cartilage repair… is that I had done research in this area, but in orthopedics at large most of the work is in hip replacements and it can become boring. With sports medicine, there are far more procedures and the spectrum is very interesting. What arthroscopy gives you is a real relationship with patients for years. Sports medicine is of course financial, which is necessary, but I wanted more. You see patients [in sports medicine] for a few months and within a few years they will never remember your name. Cartilage repair is a nice mix of these two…you get long term relationships but also the variety in surgical procedures.
Q) How do you deal with burn-out and repetition?
A) We all feel stressed. Our environment is such that we have a private practice model inside an academic environment. We have to see patients to make money, and we do our academic research at nights and on the weekends. I try to take every other Friday off …. but it rarely turns into an actual day off (like today, I have taught two courses, done administrative work, and now I’m talking to you)… but a day off from seeing patients and the OR gives me a little break.
Q) What are you most proud of on your CV?
A) I am probably most proud of my residency….it was the hardest thing. I came from abroad (Germany) and it is very competitive to get into a top orthopedics residency program. I was lucky in many ways…I certainly benefitted from people I met along the way, but I have always been told luck favors the prepared mind.
Q) What are you most proud of that is not on your CV?
A) I am most proud of my kids. I have two kids…one from Taiwan and one from Korea. Infertility is the best thing that ever happened to me and my wife because it led to two terrific kids.
Q) What percentage of time do you dedicate to clinical and research?
A) 100% clinical and 50% research [laughing]? There is so much I want to do…things on my list, but I don’t have even have time to sit down and start. I really work 4.5 days a week clinically and incorporate the day off every other week. I go home and put the kids to bed and then spend 8 to midnight working on my academic work.
Q) Outside of work and your kids what are your other passions?
A) That’s a tough question…I have no time for anything. I would love to use my treadmill for something other than drying laundry [laughing]. I can’t complain though because I could change my work mix, but right now, I choose not to. If I had the chance I would live in different countries. I did that as a child because my dad was a pilot. If I could I would live in a new country for 6 months to a year at a time so I could get to know the area as a local.
Q) Finally, what would you want to share with our readers related to your experience living and working internationally?
A) As someone who has lived and worked in South Africa, England, Germany and briefly in China, it is worth noting that every country in the world is struggling with the same health care issues as we are. There is no perfect system. The grass is not always greener… I know, because I have been there.
I had the chance to chat with Mark Yarchoan, MD one of the key people behind launching the Curēus International Poster Competition.
Mark is a first year resident at the University of Pennsylvania and is the Director of the soon-to-be-launched Curēus Ambassador Program (medical students and residents).
Q) For a little background, tell us where you grew up and where you went for undergrad and medical school.
A) I grew up in Bethesda, MD, a suburb of Washington, DC. I completed my undergraduate degree at Amherst College and then went on to study medicine at the University of Pennsylvania.
Q) What attracted you to pursue a career in medicine?
A) My parents are both physician-scientists, and I think that attracted me to medicine from a young age. While growing up I also loved science class in school. However, choosing medicine was still a challenging decision for me because I was bothered by the idea of following in my parent’s footsteps, and I resisted by searching for alternative careers. I spent a summer living in a tent and catching bats for the National Park Service, thinking that I might want to be a field biologist. I also spent a year after undergrad as a medical reporter. It took me a while to settle on medicine as a career.
Q) As a first year resident, what has been the biggest surprise or most interesting experience so far?
A) I think one of the surprises I’ve come to recognize about medicine mostly since becoming a resident is that in the end, so much of patient care falls into a grey zone. Most of medical education is focused on learning facts; there is a right answer to every test question. However, in practice, there rarely is just one right answer because there simply isn’t specific data for the majority of medical decisions we make. This is partly what makes medicine so interesting, and why I think it’s a bit of an art.
Q) If you were to go back to medical school, is there anything you would have done differently in terms of preparing for/applying for Residency?
A) Medical school has become a multitude of important steps: basic science classes, clinically-oriented classes, tests, clinical evaluations, and then there are the national Step exams; and at each juncture I really had the sense that if I didn’t shine I might fall all the way down the staircase. In retrospect I wish I had spent more time just enjoying the privilege of becoming a doctor. Let me give you an example: I actually went through most of medical school never drawing blood from patients. Blood draws were not something we were expected to do on the wards, and blood drawing skills were never tested on any kind of exam. Instead, I spent time memorizing that Krabbe disease (1 in 100,000 births) is caused by a deficiency in the enzyme galactocerebrosidase because that occasionally showed up on tests. I wish I had just given up my one point on the test for not knowing about Krabbe’s disease and become the best in my class at drawing blood from patients with challenging veins. It’s something that in the end is much more important.
Q) Thinking back to creating your first poster, what is the biggest misconception you had about authoring a poster or what is something you now know that you wished you knew then?
A) Like a lot of other people, I greatly overestimated the time I had to sell my story to viewers. I thought that viewers would spend several minutes reading my poster. Instead, most people simply read the title, or perhaps look through the figures. That experience taught me to make as much information available as quickly as possible to the viewer: clear, concise titles; clean figures; a readable 30-second abstract.
Q) Did you have any good or interesting experiences creating or presenting posters that immediately come to mind?
A) The highlight of presenting a poster, at least for me, has always been meeting people who are in your field who came to learn about your research. This is part of the reason that I’m enthusiastic about Curēus. I think having posters archived online will prolong this period of discussion and increase peer interaction among researchers who might never have otherwise met.
Q) You have parents who are physicians, what is a lesson or two you have drawn from them regarding your medical training or career?
A) One thing my parents have valued throughout their career which I find very inspiring is constant learning. My parents are always reading journals and updated medical textbooks to keep up with innovation and change in medicine. Right now I’m in an environment where I’m constantly being taught by different senior residents, fellows, and attending doctors. However, at some point I’ll be at the top of the education chain and if I want to improve I’ll be forced to mostly teach myself.
Q) You have been doing some very interesting and specific work related to diabetes…can you elaborate a bit? What drew you to this area of research? Where do you want to see this go?
A) After college I worked as an associate for a diabetes information company, and I came to appreciate the extent that diabetes and obesity have become epidemics of our time. When insulin was first purified in the early 1920s, the NY Times and other newspapers of the time famously proclaimed that diabetes had been “cured.” I think people back then would have been shocked to find out just how many people a full 90 years later are living with diabetes, and more disturbingly, with life-altering complications of this disease. I also find the science of insulin signaling and glucose metabolism to be fascinating. I still don’t know what I want to do with my background in this area, but I do find it to be intellectually engaging and incredibly important.
Q) What has been the response from peers and medical students you have heard from with respect to the Curēus poster competition?
A) I think the whole Curēus model is quite different from the current state of publishing, and understandably it may take some time to catch on. However, my peers – young physicians and medical students – are the least entrenched in the current state of medical publishing and the most open to something truly new and different. And I think the overall response has been very positive.
Dara Torres, mother of 6-year old, Tessa, and author of Age is Just A Number, took time from her busy schedule to talk with Cureus about her experiences as a 5-time Olympic swimmer and her perspectives as a vast consumer of medical services.
Many people have asked Dara questions about her swimming career, but Cureus wanted to better understand her experiences with the healthcare system resulting from the stress and strain of training and competing intensely for over 3 decades.
Torres laughed, “this will take a year to answer…I’m serious, I’ve had about 25 surgeries!”
Medicine evolves quickly, and just as an Olympic athlete must stay at the “top of his/her game,” Torres is a quintessential example of how important it is for doctors and surgeons to stay at the “top of their games.”
How? By training! The same way an Olympian trains. And Olympians don’t train on rusty outdated equipment.
• An Olympian trains (and competes) with state of the art tools and methods and equipment. Remember when Olympic swimmers wore just plain bathing suits? Now, no racer hits the water without super-slick highly absorptive, muscle compression/supportive skin suits! These suits are designed to give swimmers the best position in the water and added speed above all.
• Physicians train by learning and practicing, and learning and practicing some more. But for this type of skill mastery, a system needs to be in place that gives doctors that “competitive edge”…by giving them quick access to knowledge that allows them to employ the most up-to-date procedures and innovative techniques. This gives doctors the best position!
That’s where Cureus comes into play. Cureus is that system supporting the physicians racing to touch the wall for a medal finish. Doctors no longer have to read papers that were written 5 years ago from data that were collected 5 years before that. Doctors now have Cureus’ super-slick way of publishing information and getting it out there effectively and efficiently and to everyone!
Torres has dealt with the following surgeries:
• Tommy John surgery
• 2 repairs to a deviated septum – which Torres attributes to diving into the water so frequently and with such force. She joked: “Obviously I haven’t done anything to change the shape of my nose.”
• 4 laparoscopies
• a torn ligament repair of the thumb (for hitting the timer on the pool wall so hard to ensure proper recording)
• 3 hand surgeries (nerve repair)
• 5 shoulder surgeries
• 8 bilateral knee surgeries
“As far as my knees go, the most recent surgery was the biggie. It was 2009, about a year after Beijing; I had just finished swimming at World Championships; I couldn’t even walk up and down the stairs. Torres describes her experience HERE.
According to Dara’s surgeon, at the Cartilage Repair Center (CRC) at Harvard Medical School, “Torres had patellar maltracking with cartilage loss on the patella and trochlea groove. Her patella was realigned with a tibial tubercle osteotomy (TTO) and resurfaced on both surfaces with her own laboratory grown cells” via autologous chondrocyte implantation (ACI).” This was a complex reconstructive surgery that required extremely careful post-operative rehabilitation.
Without the cutting edge knee reconstruction detailed above, Torres would not have been able to consider a 6th Olympics, nonetheless come within 9/100ths of a second in the final heat of the US Olympic Trials.
The physical demands on the body for such a long duration of competitive athletics, and at that intensity, are truly incredible. But because of the quick up-to-date access to the latest and greatest medical tools, demanded by an Olympic Athlete, Torres is NOT limping up any more stairs and she IS running and working out as she so desires.
Few of us will compete in athletics at the level Dara has enjoyed, but when it comes to medical care, wants and needs, Torres is just like the rest of us, searching for a highly skilled physician who cares about his/her patients! And since medicine is changing constantly, Cureus is going to make sure the spread of medical knowledge is disseminated at Torres-like speed!
This week, members of the Cureus team had a chance to chat with Richard Baxter, MD of the Cureus Editorial Board and a leading plastic surgeon based in Seattle, Washington.
Why plastic surgery? It’s the ultimate “integration of the left and right brain,” Baxter says. Initially an art major in college, he combined art, his aptitude for medicine and science, and his belief that “there’s gotta be a better way to do these things!” With this mindset, Baxter sees each patient as a living breathing work of art; leveraging creativity with medicine has “allowed me to be innovative in my practice,” he says.
As a medical journal, we asked Dr. Baxter how he digests the published information out there. “Interesting dilemma,” he replied. “I read the abstracts…” He’s noticed the trend that medicine has become increasingly cross-disciplinary over the years, and says “journal politics and inter-specialty rivalry” has made publishing more difficult. While he had an academic appointment years ago, he has actually been more prolific in private practice than in the past. Why? “Quitting my academic appointment has enabled me to have more unfettered relationships with innovative companies, but as you can imagine there is always more to it.”
Why did Dr. Baxter join the Cureus Editorial Board? 1) He is a self-proclaimed “curious” individual, and 2) because of the major opportunities for Cureus to provide a missing link between the too often disparate worlds of the academics and private practitioners. “The boundaries of specialties are changing,” Baxter says, and Cureus can be that platform to both encourage and reinforce cooperation and collaboration.
Baxter believes information and knowledge need to be more readily available both within specialty, and across specialties, connecting the gap between “hot topics” and “innovation” throughout the medical community as a whole.
With his personal drive for innovation, Baxter became tired of waiting two years or even more for published information to be revealed in a traditional journal, saying, “by this time, the information is stale.” He attends The Emerging Trends Committee of the American Society of Plastic Surgeons which organizes a symposium called “hot topics” in conjunction with the annual meeting. Dr. Baxter is a regular speaker at these 6-hour sessions “for curious minds,” which provide an opportunity to hear something new while it is still in fact new. Publishing is not just for academics anymore; “We should be entrepreneurs and innovators!”
Always looking for ways to innovate, Dr. Baxter has combined his vast knowledge of wine with his medical training to author a book entitled: Age Gets Better With Wine, now in its second edition. Dr. Baxter explores the health benefits of wine, and for all of us who love wine, he presents several more reasons to open up another bottle this evening.
“One of the reasons why I got involved in Cureus and why I’m on the editorial board is pretty simple – I want to have open access to journals, be able to publish journals and review journals in a timely fashion so it doesn’t take two years to get a paper out.” – Dr. Rod Oskouian, told Cureus.
“I think the younger generation we’re all using mobile applications, going online a lot – the traditional journals where you have to subscribe to some obscure article that costs the institution thousands of dollars in some corner of the library that you have to go look up is not happening.” – Dr. Oskouian added.
A. About 180 peer-reviewed papers, 25-30 book chapters and 10-20 patents.
Q. When did you know you wanted to be a physician?
A. As an undergrad in chemistry and physical chemistry I enjoyed investigating molecular structure and during this time I decided to apply to medical school. Professors suggested I could always come back to chemistry if the doctor thing didn’t work out. During my summer breaks I returned to the lab for work.
I was particularly influenced to become a neurosurgeon by eminent figures such as Dwight Parkinson, MD, Theodore Rasmussan, MD and Bill Feindel, MD. I was drawn to Ontario by Charles Drake, MD – one of the grandmasters of neurosurgery. He performed thousands of challenging cases but he always took great care examining x-rays when things didn’t go well…not just when procedures were a success. When I began my practice, I continued his tradition. This inspired me to bring imaging into the operating room.
Q. Your paper describing the potential and current usage of robots in surgery and involving brain tumors in particular is fascinating. Give us a little background as to how project neuroArm came about.
A. While having intraoperative images obtained during surgery is wonderful, the process of acquiring the images disrupts surgical rhythm. So I thought it would be great to have a machine that could acquire images during surgery without such a disruption. Essentially, I wanted a machine that could operate within the image as it is acquired. NeuroArm is a step towards this goal.
Q. You mention the system has been used on over 30 cases to date. What have been the primary learnings from these instances?
A. One of the early requirements was to create a workstation that recreates the sight, sound and touch of surgery. The learning curve of using such technology is relatively steep, taking 20 cases to become confident using the unfamiliar tools of the workstation. It became clear that the workstation would be an ideal platform to bring the various technologies of the operating room to a single console.
However, the workstation is not yet perfect. While technology is quickly advancing, it cannot yet perfectly replicate complex human senses like touch. There is still some ways to go in order to understand and replicate touch. As this technology improves, so will the workstation’s ability to transmit the sensations of surgery back to the surgeon.
Q. If you were telling a patient why a robotic procedure is optimal for their particular circumstance, what would be the typical drivers for that recommendation? How should a patient weigh their decision?
A. We had to go through normal ethics and regulatory approval processes which includes informed patient consent. The primary indicators for the use of the robot were brain tumor, cavernous angioma, and infection. Patients with these conditions were approached about robotic surgery. Patients were informed that the robot would be integrated in a safe and graded manner. If the situation would not be ideal for robot use, we would revert to conventional procedure. Effective treatment always takes precedence over the experimental use of the robot.
Q. What are some of the bigger challenges associated with getting published?
A. Getting a paper into the review process is not simple. Each journal has different style and formatting requirements, and look for different content. Top journals have a rapid initial review which will determine if the paper is appropriate for their publication. My major critique is that once you submit for peer review and it goes through the process of revisions and resubmissions and so forth it is not uncommon to take a year. This can result in publications that are not timely, and do not accurately reflect current advances.
As a case in point, I have a paper in the queue based on the first 35 robot cases, and by the time it’s published, we will have likely performed 80 robot surgeries. The paper may be out of date before it’s even published. Unfortunately, in the academic world there is a lot of emphasis on publication volume, which might interfere with the research process. This creates a conflict between the length of time it takes for publication and the required output of a career academic.