Shannon Weiman (sweiman@ucsd.edu)

Graduate Program:  Biomedical Sciences
Lab PI:  Victor Nizet
Undergraduate Education:  Cornell University
Med-into-Grad Clinical training Area: Infectious Disease
Clinical mentors:
Doug Richman drichman@ucsd.edu
Josh Fierer jfierer@ucsd.edu

Quote:  “Through Med-into-Grad, I was introduced to the world of microbiology, of which I had little prior knowledge, but became completely fascinated with.  In the year since I have participated in the Med-into-Grad program I have switched thesis laboratories and am now working on Group B Strep for my thesis project.  I find the study of bacterial pathogenicity very exciting and fulfilling.  Med-into-Grad was a wonderful opportunity that opened my eyes to a whole new world of medical science.  I entered with a sense of excitement and inspiration and found a fascinating and challenging experience that ultimately changed my perspective and gave me and invaluable education to pursue a career bridging research and medicine/pharmaceutics.”

Rationale for Med-inito-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: While participating in this program, I was studying HIV latency in resting CD4 T cells, which are unaffected by antiretroviral therapy and therefore present the greatest challenge to eradication of HIV.   My thesis project involved investigating the use of histone deacetylase inhibitors as a potential means to induce viral replication from these cells in order to target them for destruction. 
            I was very excited about participating in the Med-into-Grad program because my interest in biomedical science has always stemmed from a fascination with the connection between molecular mechanisms to systemic manifestation of disease and treatment.  I have had a solid education thus far in basic biology and molecular biology involved in pathogenesis, but have had less opportunity to become acquainted with pathology on a systemic level.  This level of understanding is essential to my career development in bridging the gap between research and pharmaceutical science.  I chose the Biomedical Sciences program at UCSD because I felt it was geared towards this bridge, and the initiation of this new program perfectly fit my needs.

Medical training and identification of medically-relevant research issues:    I attended various medical rounds in which case histories were presented.   This introduced me to clinical jargon, as well as the methods which clinicians use to diagnose and treat patients, an eye opening experience.  I became acquainted with a wide variety of microbial pathogens and their clinical manifestations as well as treatment regimens.
            Monthly journal clubs involving both PhDs and MDs were also implemental.  The discussions of scientific literature with experts from both of these backgrounds was an excellent venue for intellectual stimulation, as researchers and clinicians added very different but equally important aspects to discussion.  PhDs were able to critically evaluate the methods used in the papers while MDs were able to bring in their amazing breadth of clinical knowledge to make connections between the scientific research and clinical findings, which leads to breakthroughs in the science of medicine.
            The most valuable activity I was involved in was microbiology rounds with Dr. Fierer.  In the microbiology lab, I met with a small group of medical and pharmaceutical fellows and discussed patient lab reports.  The case history of the patient was presented, followed by analysis of bacterial growth under the microscope, and description of various aspects of microbial pathogenesis by Dr. Fierer.  Dr. Fierer’s extensive knowledge on all levels from molecular mechanisms of drug resistance to epidemiology made this discussion invaluable.

Research collaborations:  I did not develop any research collaborations based on an idea that I identified, but meeting and working with MDs in the hospital setting introduced me to a wonderful resource of people to which I will always be welcome to discuss ideas with.  I was also introduced to the world of microbiology, of which I had little prior knowledge, but became completely fascinated with.  In the year since I have participated in the Med-into-Grad program I have switched thesis laboratories and am now working on Group B Strep for my thesis project.  I find the study of bacterial pathogenicity very exciting and fulfilling.

Long term impact:     This training taught me to think about the applicability, necessity and feasibility of research while planning my own work and while critiquing the work of others.  For example, diagnostics and therapeutics should be developed in areas that are lacking effective options, and be developed in minimally invasive, easy to administer ways.  These are examples of limitations that do not occur to researchers who have no experience with clinical medicine.  A diagnostic or therapy is of no use, wasting effort and resources, if it does not improve upon already available therapies or if it is very difficult to administer to a patient. 
            I also identified a void in the area of diagnostic research.  It is widely overlooked because everyone is focused on developing a cure for something.  But something cannot be cured if it cannot be accurately detected and defined.  Development of new, quicker and easier diagnostic techniques would allow appropriate treatments to be administered in a more timely manner and remove much of the extensive guesswork involved in medicine.  This would eliminate many of the dangers associated with administration of inappropriate treatments.
            The Med-into-Grad program also taught me to think on a more global scale with respect to these restrictions.  If considering a treatment that will work on the molecular level, you have to consider its effects on tissues, different organs, the organism as a whole, as well as entire populations (i.e. Antibiotic resistance).  This will minimize wasted time and effort on things that might be effective in vitro but will be doomed to fail as a clinical treatment due to systemic side effects or prohibitive population effects.  Also, if a treatment is prohibitively difficult to administer or overly costly, for an ailment that is not particularly debilitating, it is not worth developing or should be altered or improved to be appropriate.  Similar restrictions should be involved in decisions about developing treatments for use in 3rd world and developing nations.
            All in all I believe I am now much better informed to make good decisions about research development in biomedical science.

Training in diagnostics & therapeutics, and identification of unmet diagnostic & therapeutic needs:       I learned a great deal about diagnostics in microbial infectious disease.  These methods have long been established.  Identification of bacterial infection is determined by culturing various bodily fluids on different types of agar plates to identify nutritional needs of the organism, such as aerobic vs. anaerobic, lactic acid fermenting or not, lytic on blood agar, etc.  Gram stains, observation of bacterial shape and aggregation under the microscope, and colony morphology also contribute to identification.  These methods also allow for quantification of bacteremia, and antibiotic resistance, which are used to determine treatment method and dose.
            These diagnostics are well established, but are not precise and require days for results to appear.  Because they are fairly effective, new diagnostics are not a high priority in research development.  Bacterial resistance to antibiotics continues to be a concerning issue.  The search for new and modified antibiotics that circumvent resistance mechanisms is ongoing. However, due to the rapid replication of bacteria, and their ability to transfer genetic information horizontally, the development and expansion of resistant strains inevitably evolves quickly, creating an endless race in which therapeutics sometimes struggle to retain the upper hand.

Diagnostic & therapeutic collaborations:  PCR of bacterial DNA sequences could be used to determine which organism is causing a bacterial infection.  This would be a very rapid means for identification.  However, the amount of DNA available as template could limit the feasibility of this method.  If one had to grow enough bacteria to establish a positive result this would delay turnaround time, and might not improve upon the rate of current methods.  Development would not be difficult but would require a great deal of optimization.  Ideally bacteria would only have to be grown for a few hours to generate enough genomic DNA to serve as the template in a PCR reaction.  Identification of genes specific to a particular genus and species would not be difficult, as all of this information is available through the publicly available online databases.  I have not spoken with any clinicians about my ideas because it is not an urgent need of the medical world and is also not directly related to my thesis research.

Student-specific experiences:  This training was fascinating and very motivating.  It rejuvenated my interest in biomedical science and confirmed my desire to work between the worlds of research and medicine/pharmaceutics.  The opportunity to be involved in clinical medicine on such an intimate level was an amazing experience that gave me a fresh outlook on biomedicine.  I have a more realistic and informed view of the practice of medicine and clinical research, which will enable me to traverse these fields with more confidence and competence in my future endeavors.  This program has given me the experience to become a leader and to make an impact in translational research as I progress with my career. 

Advice for new trainees--autumn preparatory quarter:  Infectious Disease Grand Rounds are an excellent introduction to the clinical world.  You will be introduced to medical jargon, as well as the detective process clinicians use to make a diagnosis and determine treatments.  You will also become acquainted with MDs and their relationships to each other.  This is a great way to be introduced to the medical family.
            Find someone during this time that can act as a mentor- perhaps one of the fellows, or even an older medical student- someone with whom you feel comfortable discussing questions and cases, and who is equally willing to impart their knowledge to you.   This will be implemental as you will be frequently overwhelmed and confused when immersed in this foreign world.  You will learn much more and much more quickly if you have someone who is willing to help you along the way.  Once you have become comfortable with the basics, your ability to interpret and contribute to more complicated and engaging cases will make this experience much more valuable.
            Make it known that you are excited to learn, and are willing to take part in any activity that might be educational.  Often clinicians don’t realize that what has become mundane and boring over the years to them is still new and exciting to you.  Take every opportunity that you can to experience new things.  If it is not worth your while, don’t continue to attend, but you never know when you might come across an invaluable experience.
            Definitely speak to your advisor and make sure that he or she is on board with the program.  Let him or her know what you would like to experience and take out of the program so that they can tailor it appropriately to your needs.

Advice for new trainees—Wwter clinical training quarter:  Be outgoing and let people know who you are and about the Med-into-Grad program.  After an introduction most clinicians are very accepting and enthusiastic about helping and teaching you.  Be eager to learn and grateful for the opportunity to participate with them.
           
Take home perspective on Med-into-Grad at UCSD:  Med-into-Grad was a wonderful opportunity that opened my eyes to a whole new world of medical science.  I entered with a sense of excitement and inspiration and found a fascinating and challenging experience that ultimately changed my perspective and gave me and invaluable education to pursue a career bridging research and medicine/pharmaceutics.
            I would highly recommend this program to anyone who is interested in the translation of scientific research to medicinal practice, as the understanding of both sides of the equation is essential to building an effective bridge between the two.