Travis Stiles (tstiles@meded-mail.ucsd.edu)

Graduate Program:  Biomedical Sciences
Lab PI: Steve Gonias
Undergraduate Institution: Willamette University
Med-into-Grad clinical training area : Neurology
Main clinical mentors:
Stephanie Lessig: slessig@ucsd.edu                  David Song: dsong@ucsd.edu
Jody Corey-Bloom: jcoreybloom@ucsd.edu        Doug Galasko: dgalasko@ucsd.edu

Quote:  “For me, my research is motivated by the potential impact it can have on people.  I enjoy science, but my passion comes from a desire to contribute to the science that has the potential to directly impact human disease.  I chose graduate school over medical school because I was more interested in the research aspect of medicine than in the actual clinic.  However, what I’ve discovered as a graduate student is that the science is often so far removed from being clinically relevant that it is difficult for me to get excited about it.  What the med-into-grad program has allowed me to do is gain valuable clinical experience concerning my field of research that allows me to perceive the potential impacts of my work from a larger perspective.  I believe that as a result of this experience I will have a much greater capacity for identifying projects and results that may play a role in certain diseases, thereby making me better able to see potential applications in diagnostics and therapy”.

Rational for Med-into-Grad training: My thesis research deals with interactions between components of the myelin sheath and the low-density lipoprotein receptor related protein (LRP-1).  Preliminary studies have demonstrated that this receptor plays an important role in maintaining myelin homeostasis post-injury or insult and also plays a role in the regenerative capacity of CNS neurons.  As a result, I felt it was important to understand the disease pathology that may be influenced in this system to better direct my research to clinical relevance.

Medical training and identification of medically-relevant research issues: My clinical training consisted primarily of rotating with the 3rd year med-students in various neurology clinics.  Specifically I had the opportunity to work in the Huntington’s Disease, Multiple Sclerosis, Movement Disorders (Parkinson’s Disease, Spinocerebellar ataxia, etc), and dementia clinics.  What was emphasized most in this clinics, other than a detailed understanding of distinct disease pathology, was the diagnostic criteria and examination techniques in these conditions.  I gained a great deal of respect for the skill and knowledge it takes to utilize neurological examination techniques to make distinctions between different neurological conditions.  However, the fact that many neurologic conditions rely solely on clinical diagnostic criteria is troubling and there is a tremendous need for biological markers of disease in these patients

Potential Research collaborations:  In multiple sclerosis (MS) patients in particular, I was struck by the incredible variability in disease presentation from patient to patient who often carried identical diagnoses.  MS is a complex condition that is closely related in both presentation and pathology to numerous similar CNS demyelinating conditions that are distinct by response to treatment, symptom progression, and disease aggression.  However, the basic biological principles as we understand them for these conditions remain the same.  As a result I feel there is a great deal to understand about the subtle distinctions between all patients with CNS demyelinating conditions to better understand the body’s response to demyelination and potential initiators of myelin loss.  Because of advancements in the understanding of some of the more detailed cellular pathology of neurological diseases, I believe that large-scale, detailed molecular cell biological analysis of CNS tissue from patients with demyelinating disease could provide valuable insight into factors surrounding such conditions.  Such analysis is easily conducted in our laboratories, however this information is far more valuable when correlations between lab findings and clinical records can be analyzed.  As a result, a collaboration that would facilitate clinical records with cell biological analysis could be a powerful tool in understanding these conditions.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: In my time in this program, I feel that I gained a strong perspective on the diagnoses and therapies of most of the conditions I encountered.  I feel especially confident in my understanding of the pharmaceutical interventions used in various neurological conditions.  I gained a great deal of appreciation for the amount of knowledge physicians possess about the pharmaceuticals, especially the numerous names used for identical substances.  Although there was a great deal to learn, the repeated exposure to the testing utilized and therapies prescribed really solidifies the information in your head.  However, neurology is quite a bit different from some of the other MIG specialties in the sense that neurologists rely more on clinical diagnostic techniques for many conditions than, for example, cardiologists or infectious disease specialists.  As a result a great deal of neurologic conditions could benefit a great deal from improved diagnostic techniques that identify specific biological markers of disease.  However, neurology is advancing quickly, especially in the imaging techniques involved

Long term impact:  For me, my research is motivated by the potential impact it can have on people.  I enjoy science, but my passion comes from a desire to contribute to the science that has the potential to directly impact human disease.  I chose graduate school over medical school because I was more interested in the research aspect of medicine than in the actual clinic.  However, what I’ve discovered as a graduate student is that the science is often so far removed from being clinically relevant that it is difficult for me to get excited about it.  What the med-into-grad program has allowed me to do is gain valuable clinical experience concerning my field of research that allows me to perceive the potential impacts of my work from a larger perspective.  I believe that as a result of this experience I will have a much greater capacity for identifying projects and results that may play a role in certain diseases, thereby making me better able to see potential applications in diagnostics and therapy. 

Student-specific experiences: My experience has given me a great deal of respect for the medical profession.  I was consistently impressed with how much these people care for their patients, and genuinely desire to improve the quality of care they can provide.  Unfortunately, these doctors are extremely dedicated, and therefore very busy.  As basic scientists we must reach out to the clinicians and utilize them as the all-to-often untapped resource that they are.  With the current state of medicine being what it is, we cannot expect the converse situation to take place and I believe our research will only benefit from such efforts.

Advice for new trainees--Autumn preparatory quarter:  The best piece of advice I can offer is to learn the area as best you can BEFORE going into the clinic.  I was underprepared.  I spent a good amount of time learning about multiple sclerosis, but really only from a basic science perspective.  Try to get a general understanding of diagnostic criteria, examination techniques, and basic biological tests used in diagnosis and treatment.  This will GREATLY enhance your learning as you will be able to expand much faster upon this basic knowledge once you get into the clinic as opposed to cramming the first couple of weeks so you don’t look stupid next to the other med students.  Don’t stress out, it won’t take a ton of effort, but make a real attempt at it.  Another idea is to brush up on basic neuroanatomy.  That will help you a LOT!  Also, you’re going to find out real quick that what you lack the most is the drug knowledge.  So it will probably be a good idea to research the common pharmaceuticals used to treat the conditions you’re going to be seeing and learn a bit about them.  Otherwise you’re going to be spending a lot of time trying to keep drug names straight in your head.

Advice for new trainees—Winter clinical training quarter:  First of all, the 4 main people you will likely be potentially working with are listed above.  The first thing you should do is have someone like Dr. Kamps or Dr. Koo give them an email to let them know what you are doing and make sure they are ok with having you.  Next, you need to find out there schedules.  This is very important.  Don’t commit to anything right off the bat, just contact them, let them know what you are planning to do, and ask them for their clinic schedule and which clinics they would be ok with having a student in.  Keep in mind these doctors have some clinics that are once or twice a month, so try and get a comprehensive idea of what clinics they have (ie: Huntington’s Disease, Movement Disorders, Dimentia, Alzheimer’s Disease Research Center, etc) and when and where they are located.  Then, prioritize your interests and make out a schedule.  Initially go to everything.  You won’t, I repeat WILL NOT, be able to keep up that pace, but you want to get a feel for what is going to interest and benefit you before you start slimming your schedule to a more manageable level.  Also, be sure to throw some non-clinic activities in there like the brain-cutting seminars.  Otherwise you’ll get burnt out on clinic.  Get a feel for the different clinicians.  Some love questions and love to discuss patients and the different conditions, but some are in a hurry and just want to stay on schedule.  Recognizing this early will be useful. 

Take home perspective on Med-into-Grad at UCSD:  In the current scientific environment, funding opportunities are highly competitive and the pressure to publish and produce results is as high as ever.  As a result, many researchers have adapted by becoming experts on very specific and narrow topics thereby creating for themselves a “niche” and making it easier to establish a reputation in a given field.  While there is tremendous value to this approach, the drawback to this approach is that the greater perspective is often lost.  This is problematic due to the fact that many researchers rely on clinical relevance of their research to gain and maintain funding.  What this situation results in is a widening of the gap from the clinic to the bench, which I feel impedes the progress of biomedical discovery.  The Med-Into-Grad program is designed to counter these problems and it does an excellent job of providing a clinical perspective and framework from which to develop your research.  It allows those who are truly interested in clinical research, but not in being a clinician, the opportunity to learn about areas of interest as well as identify gaps in the current understanding of conditions and relevant diagnostic complications.  As a result, I highly recommend this program to anyone who is motivated by the medical relevance of their work.