Andrew Taylor Bright (atbright@gmail.com)
Graduate Program:  Biomedical Sciences
Lab PI:  Elizabeth Winzeler, PhD
Undergraduate Institution:  Princeton University
Med-into-Grad clinical training area:  Infectious Disease
Main clinical mentors: Joe Vinetz (jvinetz@ucsd.edu)

Quote:  “Going into the Med-into-Grad program, I did not expect to find a direct collaborative project between my research lab and the clinical setting as I work on malaria and did not expect to see any cases of malaria in the San Diego area.  I was pleasantly surprised, though, to see a presentation by a medical fellow from the US Navy detailing 3 cases of malaria that he had recently seen in San Diego.  After further discussions with the Navy medical fellows I realized that they currently see a number of cases because of the current deployment of US Military Forces.  I have since written a short proposal attempting to answer current questions in Plasmodium biology using our microarray technology and samples obtained from patients seen by the US Navy medical fellows.”

Rational for Med-into-Grad training: My long-term goal is to work at the intersection of basic science research and clinical medicine.  This interest in translational research is what drew me to the Med-into-Grad program.  My training up to this point has been on the research side of biomedical sciences and in order to help me achieve my goal, I decided that I needed to get experience in the clinical setting as well.  The opportunity to get clinical experience during my research training is why I participated in the Med-into-Grad program and why I ultimately chose to complete my PhD at UCSD.
My thesis research involves malaria genomics.  I am interested in working directly with infectious pathogens and helping develop new vaccine and drug candidates.  Because of my thesis research topic I chose the Infectious Disease track of the Med-into-Grad program as it most closely fit with my thesis research and long-term interests.

Medical training and identification of medically-relevant research issues:  My clinical training began in the Fall quarter when I attended microbiology rounds at the VA.  This initial experience introduced me to the basic pathogens I would see later in my clinical rotation and the diagnostic methods used in the clinical microbiology lab.  Beginning in the Winter quarter, I began working with the Infectious Disease consult team at Hillcrest.  We would see patients, attend microbiology rounds and then meet with the attending physician each day.  Additionally, I attended Infectious Disease City Grand Rounds each week.  My role as part of the ID consult team was to identify basic science concepts that would arise during our cases and then report back to the team on the most recent data.  One of the most important issues identified during my clinical rotation was the idea of antibiotic stewardship.  A great deal of emphasis was placed on quickly and correctly identifying a pathogen and getting the patient on the appropriate therapeutic so as to limit the spread of resistant bacteria and maintain the effectiveness of the current generations of antibiotics.

Potential Research collaborations:   Going into the Med-into-Grad program, I did not expect to find a direct collaborative project between my research lab and the clinical setting as I work on malaria and did not expect to see any cases of malaria in the San Diego area.  I was pleasantly surprised, though, to see a presentation by a medical fellow from the US Navy detailing 3 cases of malaria that he had recently seen in San Diego.  After further discussions with the Navy medical fellows I realized that they currently see a number of cases because of the current deployment of US Military Forces.  I have since written a short proposal attempting to answer current questions in Plasmodium biology using our microarray technology and samples obtained from patients seen by the US Navy medical fellows.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: I achieved a solid understanding of diagnostic methods used currently in infectious disease through the daily microbiology rounds.  Also, we discussed on a daily bases the different therapeutics that were and were not appropriate for each case we were consulted on.  Currently the needs for new therapeutics revolve around the emergence of resistant stains of common bacteria.  These strains are becoming increasing prevalent in hospitals as well as the community as a whole, and new basic research needs to be done to identify novel pathways for new therapeutics to target.  Some of this work is being done at UCSD so it was interesting to see both sides, the research and clinical aspects, of the same question.  Additionally, new methods of surveillance to monitor emerging resistant strains need to be developed and new hospital practices need to be instituted to help prevent the misuse of antibiotics and the spread of resistant bacteria.

Diagnostic & Therapeutic collaborations:  Part of my lab works on developing new anti-malarials using our mircroarray technology to elucidate novel methods of inhibition.  As many of these compounds are still in very early phases I have not talked to any physicians.  There is also work being done to develop a microarray based technology that would allow the monitoring of emerging resistant malaria species but again this is work that is still in development and also might not be of germane interest to most UCSD clinicians.  I am collaborating with one UCSD clinician who has a field office in Peru and works with tropical diseases on my thesis project as well as some of the ideas from the Med-into-Grad program.

Long term impact:  My Med-into-Grad training has impacted my long term planning by confirming my desire to work on basic research questions that are directly applicable to clinicians.  I hope to direct my thesis project to the discovery of new therapeutics that target novel Plasmodium biological pathways as well as develop new tools for investigating malaria parasites in the laboratory setting.  Longer term I envision working in a capacity to help ensure that current methods for treating disease are available in a gold standard to all those afflicted.

Student-specific experiences:  Med-into-Grad was a fantastic experience and lived up to my expectations.  I was able to gain a level of clinical experience that opened my mind to new questions and new problems that I would have otherwise not been exposed to.

Advice for new trainees--Autumn preparatory quarter:  The Med-into-Grad Autumn activities are essential in preparing the student to integrate into the clinical setting as quickly as possible.  For the infectious disease track, the microbiology rounds hosted at the VA by Dr. Josh Fierer provide a good introduction to what the students will see in the clinical setting.  These small group sessions introduce the students to some of the common diagnostic methods as well as some of the common pathogens that the students will encounter in their clinical training.  Micro rounds also slowly introduce the complex vocabulary of clinical infectious disease and Dr. Fierer is a wonderful teacher who takes the time to explain everything thoroughly.  In addition to microbiology rounds, I highly recommend that the student obtain a copy of Lange’s Infectious Diseases: A Clinical Short Course and begin to study it during the Autumn quarter.  This book is very accessible to students lacking a medical school background and presents many of the key concepts the student will need in the clinic.  Most importantly, the text presents an in depth explanation of current anti-microbial therapy.  After a diagnosis has been made, deciding what therapeutic course to administer is the most important decision in treating patients with infectious disease and students will spend a lot of time with their teams discussing which drugs to use.  After the student has a good understanding of the current classes of antibiotics, they should obtain a copy of the current antibiogram for Hillcrest from Dr. Sharon Reed.  This document will show which strains of bacteria are most prevalent in the hospital and also what forms of resistance are the biggest threat.  By gaining a preliminary understanding of diagnostic methods, common pathogens, and current anti-microbial treatment in the Autumn quarter, the students will be well placed to assimilate quickly into the clinical setting and get the most out of the Med-into-Grad program.

Advice for new trainees—Winter clinical training quarter:  There is no one set way to interact with your team and it will depend greatly on your current fellow, who, to make things complicated, will change every month.  Because of the nature of the infectious disease team the main role of the Med-into-Grad student will be to observe the fellow and residents interact with the patients and then contribute where appropriate during daily rounds.  There is some opportunity to interview patients (usually limited to a question or two) and to examine patients but unlike other Med-into-Grad tracks the students will most likely not interview and examine patients on their own.  This stems from the fact that by the time the ID team is consulted, the patients are usually deteriorating or have a major issue and the team attempts to move to a diagnosis and treatment as quickly as possible.  The main area where the Med-into-Grad student can contribute is explaining relevant biological mechanisms of disease or drug interactions during daily rounds.  Again, this is dependant on your particular fellow and also how busy the team is.  The students should focus on learning as much as possible through observation at first, and after they feel comfortable with their team, they can begin to participate in those areas where they feel they can make the biggest contribution.

Take home perspective on Med-into-Grad at UCSD: I recommend Med-into-Grad to PhD students that are interested in working at the intersection between clinical research and clinical practice.  The program helps you understand the issues faced by clinicians today and what questions still exist upon which PhD students can apply basic research methods.  The program has helped me in my training by exposing me to new experiences and focusing the direction of my future work.