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Dr. Ian Francis is 2020 graduate of our program who is now a resident at Baylor College of Medicine’s Pediatrician-Scientist Program, located in Houston, Texas. He met with Dr. Borkan to discuss his experiences both in and out of our training program, and what he has learned along the way.
"What are the most valuable aspects of your dual degree, training?"
I considered this a broad question, looking back from at my time at BU, through what i'm doing now at Baylor College of Medicine and Texas Childrens Hospital. To me, both degrees share a perfect core element, an integration of two worlds: clinical science and the scientific understanding and I was drawn to both-from the first moment that I began Introduction Problems (IP) at BU. In class, we would go completely off road to and turn these basic, first year med student case presentations into questions we might ask in the lab. I really loved this learning approach of medicine and science just mashed together. At Texas Childrens, we spend half of half of our rounds talking about “What questions does the patient in Room 3 make you consider?” I enjoy a path that is more than just trying to get through each 10-hour shift. I enjoy thinking with both sides of my brain every day: the clinician side and the research side of your brain. It's so valuable that I'm trying to explicitly build it in our curriculum for residents, probably the first such program in the country, but certainly our institution’s first pediatric scientist training curriculum.
"What problems need to be solved in your chosen field of expertise?"
“Clinically, I'm pursuing pediatric intensive care, which is part of the reason I'm drawn to the space where so many clinical problems need to be solved. Surprisingly, even to this day, clinical inquiry into the clinical care of kids has not exactly been taboo, but is taken with an extreme level of caution. Children are a very sensitive population; they are at risk and are “delicate”. Partly as a result, there is a frustrating lack of data and science to guide the decisions that we make with our patients, especially in our intensive care unit. We often extrapolate from adult data and basic physiology to make clinical decisions even in the era of evidence-based medicine. There are so many scientific questions to be asked, especially in my worlds of microbiology and immunology acquired during my PhD training at BU. A question that firmly lives firmly in my brain, at intersection of these two scientific worlds, is why, why does the same infection have different outcomes in the NICU? Currently, we do not have accurate predictors (without rhyme or reason) for why clinical courses are so different for our septic kids. I'm really interested in the interplay between the immune system and the micro-invaders that tip some kids over the edge into immune dysregulation and septic organ failure. I hope that inquiry can define some of the pre-sepsis immune programs and microbial virulence factors needed to improve our targeted therapies. I would start with pseudomonas infections, which have a huge burden of disease that could truly impact the lives and health of the children I see.
“What advice would you share with our current md PhD students?”
For all levels MD/PhD training is such a remarkably unique path to walk because day by day, your “hat” is changing. What served me the best was walking into even the most unlikely of circumstances with an open mind, a willingness to be surprised, and also excited by anything and everything in front of me. Looking back at my time at BUSM, I was so sure that I would do vaccine development… these early experiences helped me to become the scientist I am. But afterwards, as I encountered new researchers, new labs, and new people, I was shocked at what else there was around me that opened my mind. Opening up my mind to other clinical problems to be solved in the ICU setting has excited me, and I’m running with it.
“What important lessons, did you learn during the transition between your dual degree, training and career path?”
Continuing to challenge both sides of the MD/PhD mind during your clinical time during residency that is so all encompassing and demanding. Even if we're lucky enough to be in a physician scientist training program, it is difficult to take productive steps during the final admission of the day. It is challenging to ask: “What does this patient offer me from a scientific standpoint? What question can I ask for it, even if it’s not profound: “Why am I using this medication for this patient?” or “Why is this the “standard?”. “For this presentation, what does this lab actually tell me about what's going on in my neutropenic patient?”. Even stopping to think “Why am I rechecking a CBC again, only hours later” will make me a better clinician. It helps to practice asking “why”, in order to keep my curiosity strong. We never know which one of our questions will balloon into a bigger question and a larger pursuit. Everyone's dream as a physician scientist is to find that question, then go back to the lab to chase it down.
“What attracted you to the research track during your residency training?”
Ian Francis: The research tracked placed both respect and emphasis placed on both science and medicine. This track included monthly meetings for just our pediatric scientists program residents to attend a journal club, career talk or network research progress to explore a dual path, which is hard and is not pre-paved. This is a rocky hike up the side of a mountain and there's no shame in and finding those things that help inspire this journey. When this track fits, others are here to throw me a rope to find my way…particularly to shield me when I need protected research time…this is a luxury and I see it as invaluable for my continued research training.
Final words: “If it speaks to your heart, we truly need pediatric research scientists. You will find welcoming arms, unlike any other specialty."
- What is your favorite BUSM experience or memory?
My MD/PhD training was definitely quite a journey. One of the happiest days of my life was the day when everything finally came together with my project…the day of my thesis defense. I was able to share with all the people who have helped me along the way...from the medical school to graduate school staff to the MD/PhD program directors, family and friends…even the Facility Cores. I had gotten so much help from so many people and the defense was the single day that I could personally thank everyone. It was a culmination of everything I have done…and a result of collaboration with all those I met. Even though some days were negative, I left my training with many positive memories.
- What are the most valuable aspects of your dual degree training?
There are several benefits of doing a PhD and then going back into medicine. One is the becoming curious about the issues that we’re facing in caring for patients…and many are missing answers. PhD training helped me to ask questions that generate conversation, making my residency training a lot more interesting and fun. The second is that our PhD trains us to give oral presentations...and tell a story. Story telling occurs every time I present a patient in front of others, pulling it together in allotted time, while sustaining listener’s interest. The third PhD benefit was the opportunity to interact with senior faculty, breaking down the usual hierarchy to share interesting ideas. Instead of being afraid to ask questions during my residency, I took an active role in my learning, just like during my PhD training.
- What attracted you to the research track during your residency training?
I wasn’t like super sure that I wanted to join pulmonary critical care when I entered pulmonary research as a doctoral student at BUSM. But I found pulmonary questions engaging, I fit in with pulmonary folks, and also realized that there’s interesting questions still to be answered. At the end of the day, I like helping people who are having trouble breathing. I now realize that there are several “research tracts”. Many residencies offer a “research pathway” but without a promised fellowship position thereafter. While this would have exposed me to like-minded researchers, it is challenging to actually do research during residency training and I do not suggest it. In my research tract training, I could have chosen to train in another specialty [other than pulmonary critical care], since physician-scientists are valued in many subspecialty fields. When I interviewed for residency, I also interviewed for my fellowship and was offered both...a big relief! In exchange for doing 2 years of residency training, I promised to do an additional year of research during my fellowship…a fair trade off since I want to be physician-scientist as my career and loved the pulmonary fellowship at UCSF. I would remind trainees that it is also possible to ask about fellowships during residency interviews and make contacts for the future…even if you choose residency and ultimately fellowship training at two different institutions. Admission into competitive fellowship programs can be harder and more complex due to their smaller size, so a guaranteed fellowship position is more valuable than I initially realized. While “short tracking” at one institution is not for everyone, I am so very, very grateful for this opportunity.
- What problem(s) need to be solved in your chosen field of expertise?
Although ARDS was unusual, it has become common in the SARS CoV2 era. During my PhD, I had been thinking about the lung injury, repair, and fibrosis. Other than mechanical ventilation and oxygen, we have little to offer for treating ARDS and many patients die. Some survivors appear in my pulmonary clinic with post-COVID lung diseases that is not yet understood. Now we have an explosion of questions to be answered in pulmonary critical care. I think about these questions because I see outcomes affecting human beings…it is definitely tragic to see patients dying and also feels inspiring. This crisis will happen again at some point in our lifetime...but maybe we will have a better idea of how help our ARDS patients.
- What additional training would have been valuable before you left BUSM?
I actually think our medical and research training was excellent. I do wish for training in stress management techniques. Residency was really hard (granted there was a global pandemic) but I did not previously consider mental health and activities outside of work that I enjoyed… as result, I found it really hard to attain a sense of life balance during residency. Residency support, including a therapist, made a huge difference in my happiness. I do think that it is one of the most important things I learned after leaving BUSM!
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We are so proud of our students who are beginning their transition back into their clinical training. Below are our students and the titles of their thesis.
- Shen Ning (GPN, PI: Shelley Russek)- “Developing Targeted Magnetic Nanoparticles for Therapeutic Antibody Delivery in Alzheimer’s Disease”
- Margaret Minnig (GPN, PI: Valentina Sabino)- “The Role of Corticostriatal Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) in Excessive Alcohol Drinking”
- Anthony Yeung (MTM, PI: George Murphy)- “Hematopoiesis in the Lung: From Development to Adulthood”
Join us in congratulating Geoffrey Ginsburg, MD/PhD ‘84 for being selected by the NIH All of Us Research Program to serve as next chief medical and scientific officer! We're excited to follow all of your exciting new work