Heidi Schmidt (heidi.j.Schmidt@gmail.com)

Graduate Program:  Bioengineering
Lab PI:  Sanjay Nigam
Undergraduate Education: Oregon State University
Clinical training area in Med-into-Grad:  Medical Genetics
Clinical mentors:
Kenneth Lyons Jones (klyons@ucsd.edu),
Marilyn Jones (mjones@rchsd.org)

Quote: “My experiences in this program literally changed my life.  I always suspected that academic medicine would be a great career for me, but getting the opportunity to experience the life of an academic clinician for three months was the push I needed to change directions and go to medical school.  My research training will always be a huge part of my life, and med into grad taught me how closely connected these two fields can be.  Clinically minded researchers and research minded clinicians are uniquely qualified to implement translational research for the benefit of patients, and I am now in a position to train to be one of these professionals.”

Rationale for Med-into-Grad training:
Medical training and identification of medically-relevant research issues:
Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:
Diagnostic, therapeutic, and research collaborations:
Student-specific experiences:
Long term impact.:
Advice for new trainees--autumn preparatory quarter:
Advice for new trainees--winter clinical training quarter:
Take home perspective on Med-into-Grad at UCSD:

Rationale for Med-into-Grad training:  My interests in Dr. Nigam’s lab focus on merging the techniques of developmental biology and tissue engineering to create a protocol for growing a kidney in vitro that can ultimately be implanted into humans as a treatment for congenital kidney disease and end stage renal failure.  Specifically, I am working on inducing neovascularization in the tissue engineered kidney.
I was interested in the Med-into-Grad program because tissue engineering is inherently translational and focused on patient outcomes.  I felt that there was a lot that I needed to know about how to make in vitro created organs a realistic solution in the clinic; I wanted to know what challenges and limitations doctors deal with when trying to implement novel technology.  

Medical training and identification of medically-relevant research issues:  The clinical knowledge I gained in the HHMI program enables me to communicate more efficiently with physicians.  Because the application of our tissue engineering work is ultimately to replace kidney transplantation, our technology will have to move into the clinical realm.  I am also more aware of the need for a solution to kidney transplantation to be practical, accessible, and reliable in order for it to be implemented by physicians.

Research collaborations: Based on my interactions with Kenneth Jones, I’ve become interested in the study of teratogen transport across the placental membrane.  A group in my research lab works on organic anion transporters in the kidney, and I’m beginning to collaborate with them to study one transporter, OAT4, that is present in both the kidney and the placenta.  We hope to do some transport assays to see if this protein is involved in transporting antivirals to the fetus.  This is an area I wouldn’t have thought to pursue before my MSP experience, and I hope to collaborate with physicians in the future while pursuing this work.

Long term impact: I am more able to contextualize the research I do into broad clinical imperatives and to understand the bigger picture of a disease.  In particular, I realize that genetic mutations have a broad range of phenotypes that vary much more than what we observe in the controlled manipulations of a lab.  In addition, instead of seeing the kidney as an isolated system, I became aware of the effect of a variety of diseases and pathologies on kidney function.
In addition, I realized how much I love seeing biomedical science play out in the context of a patient’s life and story.  Consequently, I decided to apply to medical school with the hope that I can eventually incorporate my research background with clinical care as an academic physician.  I will start medical school in the fall, either at UCSF or Harvard.  I’m lucky to have research connections at both schools through my med into grad experience, which will allow me to continue to spend time in lab while I go to school.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs: One of the things I found most interesting was how, though technology was obviously important, the doctors I shadowed were more concerned with the art of medicine.  Diagnostics were used, but history and examination provided the subtlety necessary to make a diagnosis and develop a treatment.  In research, we think quantitative data is the end all, but this is not the mindset of the clinical medicine I experienced.
Before this experience, I was not aware of what was used clinically to diagnose genetic diseases besides a basic karyotype.  I learned about the prenatal diagnosis options (amnio, CVS, etc) and about how genetic counselors take risk factors into consideration when recommending these tests.  I also learned about the molecular tests done including FISH, PCR using bisulfide treatment to specify methylation, comparative DNA hybridization, and basic nucleic acid sequencing.  Finally, I saw that the way most clinicians are able to make the diagnosis is based on mental and physical characteristics, and the molecular tests are most often used as confirmation. 
I was also surprised by the impact that economics and the healthcare system’s structure can have on what tools are employed.  In basic research, we do not often think about whether the technology we are developing will be too expensive, or require too many resources to utilize.  In reality, even if a great test or treatment is available, it may not be successfully implemented if it is too impractical.  This is an important consideration even in the beginning stages of research.

Student-specific experiences:  I had a wonderful experience and made some extremely valuable contacts.  I was particularly pleased with the time my mentors took to teach me about clinical medicine and how it relates to my research.  I also came to appreciate how different the languages and attitudes of clinicians and researchers are, and how much effort it takes to overcome this barrier. 

Advice for new trainees--autumn preparatory quarter:  Go to ground rounds and as many lecture series as possible-- especially ones aimed at the medical students-- so you have some idea of how research and clinical aims are different.  This also helps orient you to the language differences and gives you an idea of what you need to be studying so you’re not lost when you get into the clinic.  
For medical genetics, histology was irrelevant, and I wish I had spent a lot more time on physiology.  The best training I had was taking the medical genetics class in the school of medicine.  It was also a good idea to commit to taking and passing the final, as this kept me focused during the relatively short class.

Advice for new trainees—winter clinical training quarter:-in in a new:  The absolute best thing I did during my training quarter was to keep a notebook and pen with me at all times.  I kept a running list of terminology I didn’t know and looked words up every night when I went home.  I also wrote down ideas that came to my head during exams and procedures about topics I wanted to look into more.  I also found talking to the residents and medical students when I had questions to be very helpful, because they were more likely to acknowledge how little medicine I knew and take the explanations down to my level. 
Make sure to wear comfortable shoes (lots of standing) and to look professional—you do not want the patients to question whether or not you should be there.  Try not to be too shy and intimated; when I had the opportunity to talk to patients, I was always so surprised about how much I learned from hearing about their experiences with their illnesses.

Lastly, even if you don’t normally drive, this is a time to suck it up and buy a parking permit; coming and going between the hospitals and campus can be a real time drain, especially if you try and take the bus.

Take home perspective on Med-into-Grad at UCSD: My experiences in this program literally changed my life.  I always suspected that academic medicine would be a great career for me, but getting the opportunity to experience the life of an academic clinician for three months was the push I needed to change directions and go to medical school.  My research training will always be a huge part of my life, and med into grad taught me how closely connected these two fields can be.  Clinically minded researchers and research minded clinicians are uniquely qualified to implement translational research for the benefit of patients, and I am now in a position to train to be one of these professionals.

Unsolicited communication:

Hi Dr. Kamps,

I just wanted to thank you again for your support in my decision to go to medical school after my med into grad experience.  I have been accepted into my first choice, UCSF, and I am planning to head to the bay area this fall.   Please let me know if I can ever to anything to help out with the HHMI program or any of its future students who may choose to follow the same path as me.

Cheers,

Heidi Schmidt