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Volume
2, Issue 3 Sponsored by: The National Institute on Aging, The John A. Hartford Foundation, The Community Health Foundation of Western and Central New York, the Cardinal Health Foundation, and the Lillian R. Gleitsman Foundation
Administered by: The American Federation for Aging Research (AFAR) and the National Institute on Aging (NIA) ____________________________________ This online newsletter provides news and information about the Medical Student Research Training in Aging (MSTAR) Program to current and former student scholars, program directors, mentors, and others involved in the program. PLEASE HELP US DISSEMINATE THIS NEWSLETTER to medical students and others in your institution. It is one of the best ways to promote this valuable program to potential applicants. Thank You!
____________________________________ 1. Next MSTAR Program Application Deadline: February
7, 2008 ____________________________________________ Next MSTAR Program Application Deadline: February 7,
2008 _____________________________________________ It has a logo on the front and
it says "Summer Tour 2007" on the back. A Bon Jovi concert t-shirt?
No-just a clever promotional tool dreamed up by Dr. Alison Moore, Training
Director of the MSTAR program at the University of California Los Angeles
(UCLA), and her team. "We think it'll be fun for the students to have as
well as a great recruiting tool," Dr. Moore explains.
The program uses videoconferencing to hold weekly lectures for all
three sites. "That's been our way of connecting with the students and
having the students connect with each other," she explains. Students from
the two distal sites also visit UCLA for two days during the summer to
interact with their peers and the faculty there and to present their
summer research together with the UCLA students.
The UCLA MSTAR program has three training components: research,
clinical, and didactic. For the research component, mentors meet with
students at least once a week to help them complete a research project and
prepare an oral presentation and paper of their research at the end of the
summer. With their mentors' assistance, many students also prepare an
abstract to be presented at a scientific meeting. For the clinical
experience, students spend half a day a week in a geriatrics clinic or
attending hospital, nursing home, or palliative care rounds. Dr. Moore
also tries to ensure that students get experience in their specific
interests-a student interested in cardiology can shadow a cardiologist,
for example. Finally, the program provides lectures on general topics that
any researcher needs to know: how to write a paper, prepare a poster, give
an oral presentation, and more. "The students really like the various
components of the program," Dr. Moore acknowledges.
She and her colleagues have worked hard to make that happen, tweaking
the program regularly to ensure that students get the most out of it. "We
evaluate all aspects of the program every year and make adjustments based
on the students input," she says. "We're interested in continuous quality
improvement here." Some recent changes involve the topics that students
learn about. In addition to geriatrics topics, such as dementia and
assessment of the older patient, the program has recently added career
topics, such as "What is it like to be a clinician/scientist?" and
optional training courses on statistics and statistical programs.
According to Dr. Moore, the program's administrator, Robin Catino, is
another one of its strengths. "She's the point person for the program-the
one students go to first with questions. She's terrific," says Dr. Moore.
"She really runs the program-I just help her tweak it!"
As for her own career, Dr. Moore says she enjoys program development
and mentoring students. Her research focuses on alcohol and aging-the idea
that older adults can drink in ways that are safe or unsafe depending on
how much they drink, what co-morbidities they may have, and what
medications they take. She also sees patients regularly, and says she
loves geriatrics because of the heterogeneity of older patients. "You can
have an 80-year-old who's in better shape than you are, and an 80-year-old
who's in a nursing home near death," she says. "Some patients are simple
and some are complex-it makes it highly interesting."
Dr. Moore looks forward to continuing to run the MSTAR program. "It's
been great interacting with the students all these years. I learn a lot
from them," she says. "I've really enjoyed myself!"
_____________________________________________ Julie Bynum, M.D., M.P.H.,
has been involved with AFAR for so long, she says, "It's like being in a
family!" Dr. Bynum's relationship with AFAR began in 1994, when she
participated in the MSTAR program as a second-year medical student at
Johns Hopkins University. Since then, she has gone on to receive two more
AFAR grants. Dr. Bynum, now an Assistant Professor at Dartmouth Medical
School, credits all these AFAR grants with helping to foster her
successful geriatrics career.
When she was in high
school, Dr. Bynum wanted to study physical therapy. Her plans took a twist
when she began volunteering in the field. "I got turned on by the fact
that when people get good rehabilitative care, their function can
improve-in particular, stroke patients," she recalls. "I got motivated to
work with the elderly population." That was when she decided to pursue a
career in medicine rather than physical therapy.
Dr. Bynum completed her
MSTAR research project at her home school of Johns Hopkins. She worked
with Dr. Bruce Leff on his Home Hospital Project, and says she had a great
experience. She then completed her M.P.H. at Johns Hopkins before
graduating from the medical school. She went on to do a residency and
chief residency in internal medicine at Dartmouth-Hitchcock Medical
Center, where she was able to adapt her curriculum enough to continue to
learn and practice geriatrics. "I think geriatrics is fantastically
complex and rewarding," she says. "What I really love about it is that no
decision, clinically or in research, is straightforward. You have to be
very thoughtful and often clever to solve difficult problems."
The following year, Dr.
Bynum received the Hartford/AFAR Academic Geriatrics Fellowship and
returned to Johns Hopkins do to her research. Continuing her MSTAR
research, she studied health care utilization in Alzheimer's disease and
the influence of co-morbid illnesses. She showed that people with the
disease have very expensive care and a lot of potentially preventable
hospitalizations. She examined what is being done in health systems for
this vulnerable population that increases their risk so greatly, and what
changes can be made to ambulatory care to prevent such high
hospitalization rates. The study was published in the Journal of the
American Geriatrics Society.
Currently, as an Assistant
Professor at Dartmouth, Dr. Bynum does clinical work and clinical teaching
and research. She also does a lot of lecturing in the community and for
residents training at Dartmouth's hospital, and she serves on the
committee for Ph.D. students. This past spring, she won the prestigious
Beeson Award. She is studying the quality of local health care systems for
people 80 and older, and how to ensure that these systems provide the
highest quality care possible for this vulnerable population.
If there's a lesson to be
learned from Dr. Bynum's career, it's that every small project can lead to
great things. "What may seem like a brief summer project through the MSTAR
program, is an important building block where you can gain significant
skills-and these pieces build over time," she says. "If you can do a
project and present it as a poster-and maybe even get published-wow! It's
a tremendous opportunity to do that as a medical student, and it means a
lot later in your career."
As for her own career, Dr.
Bynum says she has considerable research and grant work to do. "I'm
pushing on the issues of how we organize care and continuity, and what
that means for the oldest old and their health care," she says. "I ask
questions with my research that can influence health policy decisions, so
it can have a real impact."
_____________________________________________ 2007
Scholar Tony Rosen Discusses His Research Project Ask
anyone in charge of the MSTAR program what they hope for in a grantee and
they'll likely mention energy and enthusiasm. They need look no further
than 2007 MSTAR scholar Anthony (Tony) Rosen. Rosen, a second-year medical
student at Weill Cornell Medical College, cannot stop talking about his
summer research project-one that he hopes to be working on for years to
come. "It's a really exciting project to be a part of," he says.
Rosen fell into geriatrics by accident. He'd been working in business
when he decided to switch careers and enrolled in UCLA's School of Public
Health. Though he didn't have any particular interest in the subject, he
decided to take a geriatric epidemiology course simply because it fit into
his schedule. His professor, Dr. Roberta Malmgren, quickly piqued his
interest in the field. "Frankly, it's not very hard to get enthusiastic
about the subject from a public health perspective because it's such a
significant and growing issue," Rosen says.
To that end, they conducted 16 focus groups with both day and night
staff-including nurses, nurses' assistants, housekeepers, social workers,
dining staff, and occupational therapists- and cognitively intact
residents at a Manhattan nursing home. They asked participants to reflect
on their experiences with resident-to-resident aggression. Rosen learned
about various aggressive incidents, such as residents throwing water on
each other and wheeling their wheelchairs into each other. "It was
interesting to hear different observations from different types of staff
members," he says. What he found especially gratifying was that all
staffers-not just nurses and nurses' assistants-considered themselves part
of the care team and really wanted to help the residents.
Rosen says he greatly enjoyed working with Dr. Lachs. "On the one hand,
he provided a lot of help and guidance, but he also gave me autonomy and
the opportunity to do my own thing." Rosen also notes that he and Dr.
Lachs share similar interests in elder abuse and public health. "I was
very excited to be learning from him about public health and measurement
methodology," Rosen says.
Rosen forged relationships with two other doctors who also became
project mentors: Dr. Karl Pillemer, a professor in the Department of Human
Development at Cornell University, Ithaca campus, and Dr. Ash Bharucha, a
professor and geriatric psychiatrist at the University of Pittsburgh. Dr.
Pillemer had previously collaborated with Dr. Lachs on some well-known
work in the elder abuse field, and worked closely with Rosen and Dr. Lachs
on their project. Dr. Bharucha was working with a group from Carnegie
Mellon to analyze the use of Risperidone-an atypical anti-psychotic that's
often used to treat agitated behavior among cognitively impaired
people-and had filmed 13,000 hours of video inside a nursing home. Rosen
and Dr. Lachs thought that analyzing those films to find episodes of
aggressive behaviors would be a great way to potentially measure this
behavior, so they flew to Pittsburgh to meet with Dr. Bharucha and his
team. "They collaborated on our work, and now we're collaborating on
theirs," Rosen explains.
Rosen says his experience as an MSTAR scholar was very positive.
"Cornell has an active, organized, and comprehensive program that's highly
regarded," he says. "Drs. Carol Capello and Veronica LoFaso, who run our
program, pull out all the stops." Rosen says the MSTAR program was "just
structured enough," and that he enjoyed getting both clinical and research
exposure. "A lot of my classmates who didn't do MSTAR didn't get nearly as
much out of their summers," he explains.
A review paper Rosen and his mentors produced on his MSTAR project has
just been accepted for publication in Aggression and Violent Behavior, and
the group is also preparing a paper on their focus group work. But the
project did not end with the summer. His mentors recently filed a large
grant proposal to continue the research, and Rosen plans to stick with it.
"I consider myself lucky to be able to assist with this project," he says.
"This is valuable research that needs to move forward."
_____________________________________________ Letter from
a Former AFAR Summer Fellow The
following letter was written in response to the April 2007 MSTAR
newsletter. We thank Dr. Hamblin for sharing his story with us!
I just received the MSTAR newsletter and saw the article on Camille
Pedigo Vaughan, M.D. It made me think of my path to geriatrics and how
AFAR and the mentorship of Frank Williams, M.D., were such positive
influences on my life choices.
I attended medical school at the University of Rochester from 1996 to
2000 and worked with Dr. Williams after he offered to develop the
Geriatric Interest Group at the school. He recommended the AFAR summer
fellowship, and after being accepted I worked at Harvard during the summer
of 1997. I continued to shadow and work with Dr. Williams while at U of R.
When I attended UCLA/Northridge for a family practice residency I
continued to connect the dots through rotations at the Veterans
Administration and the Motion Picture Association Retirement Center. I
followed residency with a geriatrics fellowship at UCLA. Today I am at a
federally funded clinic north of San Francisco. I practice family medicine
four days a week and also follow roughly 60 to 70 patients in Skilled
Nursing Facilities (SNFs) and dementia units. I was asked to be medical
director of a local SNF last year and I am also beginning a term on the
board of the West Marin Senior Services.
I account all of this to you in an effort to explain the deep
appreciation I have for the AFAR scholarship experience I had, and to show
how fully it affected my personal and professional choices.
Sincerely, _____________________________________________ Boston University Summer Institute in Geriatric Medicine: AGS Local Geriatrics Mentoring Program: Geriatrics career information, including profiles of
geriatricians: AGS Resident Recruitment Initiative: www.americangeriatrics.org/education/residents/
AGS student chapters and other information for medical students: www.americangeriatrics.org/education/geristudents/
American Medical Student Association (AMSA) Geriatrics Interest
Group: American Association of Medical Colleges (AAMC) Organization of Student
Representatives: AAMC Careers in Medicine program helps students select a specialty and
apply to residency: MSTAR information and online application: www.afar.org/medstu.html
_____________________________________________ If you have news or
announcements you would like mentioned in our next newsletter, please
forward them to grants@afar.org. |
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Indeed, Dr. Moore and her team work hard to ensure that
participation in the MSTAR program is both fun and a learning experience
for the students who take part. She became involved with the program when
she joined UCLA's faculty in 1994, and took over as Director a couple of
years later. Along with Co-Director Dr. Catherine Sarkisian, Dr. Moore
runs the UCLA training site and partners with two satellite sites-the
University of Colorado at Denver Health Sciences Center (UCDHSC), directed
by Dr. Eric Coleman, and the University of California San Francisco (UCSF)
directed by Drs. Kenneth Covinsky and Michael Harper. Typically there are
a total of 18 MSTAR students at the three sites: three at UCDHSC, three at
UCSF, and the rest at UCLA. Next year, thanks to some private foundation
support, up to 20 students can be accommodated.
Dr. Bynum's passion was further stoked when she spent a term
studying socialized medicine in England, the Netherlands, and Hungary as
an undergraduate. She says she was floored by these countries different
attitudes toward aging. "The U.S. tends to shun age, and we're fearful of
it. We want to put it away in an institution-and many of our institutions
look like institutions," she says. "But in the nursing facilities in the
U.K., people bring their own furniture, and there's a more home-like
environment. Geriatrics as a field has existed for 60 or 70 years in the
U.K., yet it's a fairly new field here in the U.S." Realizing that there
were different ways to care for older people assured Dr. Bynum that she
was on the right track.
He went on to study at Weill Cornell, which is also where he
worked on his MSTAR project. Rosen examined resident-to-resident
aggressive behaviors in nursing homes. While prior research had been done
on staff being abusive to residents or vice versa, little had been done on
residents being aggressive towards other residents, and the research that
did exist focused only on very serious incidents. Rosen and his mentor,
Dr. Mark Lachs-a member of AFAR's Board of Directors-sought to understand
the entire spectrum of the phenomenon: verbal abuse, sexual innuendo or
abuse, physical aggression, etc. They wanted to determine the incidence
and prevalence of such aggressive behaviors. To do so, they aimed to
develop an instrument they could use to measure the phenomenon.