Andrew W. Borkowski (aborkowski@gmail.com)

Graduate Program:  Biomedical Sciences
Lab PI:  Rich Gallo
Undergraduate Institution:  Massachusetts Institute of Technology
Med-into-Grad Clinical training area:  Infectious Disease and Dermatology
Main clinical mentors:
Joe Vinetz (jvinetz@ucsd.edu)
Rich Gallo (rgallo@ucsd.edu)

Quote: “Med-into-Grad is a once in a lifetime experience that I am grateful I had the opportunity to participate.  I would recommend that anyone in medically relevant research take part in a clinical training program.  In addition to learning about diseases and treatments, you learn about the human aspect of disease.  Med-into-Grad gave me a sense of the urgency involved with treating disease and reemphasized the importance of biomedical research.”

Rational for Med-into-Grad training: 
My research in the lab focuses on identifying and characterizing immune stimuli that influence keratinocyte differentiation and regulate skin homeostasis.  The skin is the first line of defense against microorganisms and environmental assaults and I was interested in seeing what diseases or conditions of the skin would predispose individuals to certain infections or other pathologies of the skin.  I was hoping that by observing infectious disease and dermatology treatment I would gain a deeper understanding of the processes occurring at the interface of host pathogen interactions on the skin and the relevant problems that occur in the clinical setting. 

Medical training and identification of medically-relevant research issues: 
My training began in the fall quarter of 2009 and consisted of attending Infectious Disease (ID) grand rounds, microbiology rounds, taking a histology lab class with medical students and the class ‘Science meets the Medical Patient’.  During the following quarter, I began attending clinical activities full time.  During my time observing with the infectious disease team, I attended daily microbiology rounds, daily inpatient rounds, outpatient clinics, weekly medicine grand rounds, weekly ID grand rounds, and various research lectures.  All other time was spent speaking with attending physicians, fellows, and residents about the infectious diseases that were ailing the numerous patients. A good amount of time was also spent reading about the diseases that we observed.  During this time I learned how physicians approached, diagnosed, and treated the variety of infections that we saw. 
While observing with the dermatology team, I attended weekly grand rounds and research lectures.  I also observed surgeries, attended various outpatient clinics, and observed the clinical research team.  During this time I learned how physicians approached and treated various skin diseases.  This clinical training program gave me a greater insight into how the diseases that we research are treated and that although new discoveries are made every day, it takes some time before these findings can be translated into new treatments.  As most microbes evolve rapidly, new treatments, especially those with less harmful side effects need to be developed and implemented so that the morbidity and mortality of infectious diseases can be alleviated.

Potential Research collaborations:  Although I have not established any research collaborations as a result of the clinical training, I have made a number of contacts with physicians in my field of research.  I envision the possibility of using these contacts to find patients that I could use to take part in future experiments.  As patients with certain skin pathologies have differences in the makeup of their skin microbiota and immune responses, it may be possible to test hypotheses that I develop during my time as a graduate student. 

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:  During my rotation with the infectious disease team, I learned a lot about the diagnostics and therapeutics used to treat infectious disease.  During the microbiology rounds we learned how to identify different bacteria or fungi based on a number of characteristics.  By examining these microbes under the microscope, a lot can be determined about the type of bacteria.  Drug sensitivity and determination of specific enzymes present in the microbe also helped with the diagnosis and treatment.     While with the dermatology team, I also learned how to identify a number of common skin pathologies.  Most skin diseases can be identified simply by eye, though we also used histology to differentiate between types of cancer and microscopy to identify the presence of fungus.

Diagnostic & Therapeutic collaborations:  A number of virulence factor based antibiotics have been identified during recent years.  Some of these drugs are already approved for treatment though they have not gone through clinical trials to be used for treating infections and thus are not often used in the clinical setting.  As more and more antibiotic resistant microbes are being seen in hospitals, the need for these new antibiotics is more evident.  Clinical trials to determine of the efficacy of these drugs would greatly impact the state of public health.

Long term impact:  This program has given me a greater understanding of infectious and dermatological diseases.  The knowledge I gained studying the etiology and progression of these diseases has helped me to focus my research and ask clinically relevant questions.  Although my research is concerned with answering basic science questions about innate immune responses and skin homeostasis, this experience has helped me draw connections to the larger problems in these fields. 

Student-specific experiences:  My experience at the hospital made me appreciate being healthy and alive.  After seeing people afflicted with some of the most terrible diseases known to man, I value my health more and try to live a healthy and enjoyable life.  In particular, I am making a greater effort to protect my skin from the sun and to be more aware of the time I spend outdoors so that I can avoid skin cancer later in life. 

Advice for new trainees--Autumn preparatory quarter:  I would highly recommend taking the histology class with the medical students as opposed to the self study option.  Although what I learned was only mildly helpful in the clinical training quarter, the amount of knowledge that was gained during this course will help me for the rest of my career in research.  The class ‘Science meets the medical patient’ was also quite informative.  Attending grand rounds and microbiology rounds prior to the clinical training quarter was also quite helpful as the jargon used by doctors is hard to understand at first.

Advice for new trainees—Winter clinical training quarter:  My best advice would be to take part in as much as possible.  Sometimes, the doctors assume you wouldn’t want to take part in certain activities.  Make sure to ask if you are interested, as they will rarely turn you down.  Also ask lots of questions.  For the most part, doctors are happy to engage in scientific conversations. 

Take home perspective on Med-into-Grad at UCSD:
Med-into-Grad is a once in a lifetime experience that I am grateful I had the opportunity to participate.  I would recommend that anyone in medically relevant research take part in a clinical training program.  In addition to learning about diseases and treatments, you learn about the human aspect of disease.  Med-into-Grad gave me a sense of the urgency involved with treating disease and reemphasized the importance of biomedical research.  I also think this gives people who had thought about medical school a good snapshot of what life might have been like or could be like if that path is chosen.