Richard W. Dow Student Research Scholarship in Surgery
The Department of Surgery is pleased to announce the availability of scholarship support for Geisel students who chose to do surgical research during the summer between their first and second year. An education fund supported by faculty and former residents in surgery had been created in memory of Dr. Richard Dow, former Chair of the Department of Surgery. Dr. Dow was a committed educator who was recognized with the Parker J. Palmer “Courage to Teach” Award from the ACGME in 2005. The fund established in his name is designed to promote student and resident education in surgery.
The Dow Student Scholar program will offer $3000 to up to 4 Geisel students to support their time doing research mentored by a surgery faculty member during their break between Year 1 and 2. A number of research opportunities are available in different surgical sub-specialties, such as those outlined below. In addition, other surgical faculty may be available as research mentors. Students who are interested in pursuing this opportunity should contact a surgery faculty member to discuss the research opportunity. After this discussion, the student should submit the following information as an application to Sara Chartier in the Department of Surgery by February 26, 2024 (Sara.L.Chartier@hitchcock.org):
- A one-page statement explaining their interest in the specific research project, their overall career plans and background, and a description of how the funds will be used (which can be for personal support).
- A copy of their Curriculum Vitae.
Applications will be evaluated by the Dow Education Fund Advisory Committee. Up to 4 students will be selected to receive a scholarship.
Interested students should meet with potential mentors this fall to determine interest. Applications (above) are due February 26, 2024. Notification of scholarship recipients will occur by February 29, 2024.
Please address any specific questions about this program to Jennifer Hong, MD, Department of Surgery (Jennifer.Hong@dartmouth.edu). A list of faculty members who have mentored students, with a description of their research interests, is below. If you desire to participate, but don’t know which faculty mentor might be most appropriate, please email Dr. Hong outlining your research interests and she will provide advice about a potential mentor.
2024 Dow Student Summer Research Opportunities
Dartmouth Cancer Center
Andrew Loehrer, MD, MPH
Andrew.P.Loehrer@hitchcock.org
Research Overview and Student Participation
Dr. Loehrer is a surgical oncologist and health services researcher whose work focuses on health equity, specifically evaluating the intersection of public policy, political determinants of health, and exploited and oppressed populations. Medical students will have an opportunity to participate in one or multiple studies including 1) evaluation of the influence of federal and state health policy on the equity of cancer care delivery, 2) assessment of the impact of social spending by hospitals and governments on equity of cancer care and 3) determine the influence of cancer center location as mechanism of structural racism in the United States. Students with various degrees of prior research experience are welcome. For students with minimal prior exposure to research, there are opportunities to participate in study design, conducting literature reviews, participation in interpretation of data, and composition of abstracts and manuscripts. For those students with more experience in research methodology and data analysis, we will work to start developing their own portfolio and/or expand expertise in advanced methodologies. All students will complete research ethics and confidentiality training. Additional educational materials will be utilized to strengthen students’ foundational knowledge of surgical health services and policy research.
Section of Ophthalmology, Department of Surgery
Nikhil Batra, MD
Michael Zegans, MD
Michael.E.Zegans@hitchcock.org
The section of ophthalmology is looking for a motivated M1 medical student who is interested in a career in ophthalmology to join us during the 2024 summer for a hands-on experience in conducting clinical research. This will include mentored outcomes research in secondary intraocular lens Implants (anterior chamber vs. scleral fixated), retinal detachment surgery, and macular surgery. Additional research involves the ophthalmic manifestations of Vitamin A deficiency, as well as an evaluation of our recently initiated ophthalmology residency. The research is expected to result in a quality and outcomes report that will be published and accessible with open access., as well as abstract submission to a regional or national conference, and manuscript submissions to a peer reviewed ophthalmology journals. The opportunity to submit ophthalmology case reports for publication also exists. The student will have the chance to hone their ophthalmology knowledge and skills by fully participating in occasional clinic sessions and OR cases with faculty mentors, as well as formal didactics. The EyeSi cataract surgery simulator could be available for interested students to use under the supervision of our ophthalmology residents.
Thank you for your consideration.
Section of Urology, Department of Surgery
Rachel Moses, MD, MPH
Projects:
- Title: Genitourinary Outcomes Following Interventions for Pelvic Malignancy (GOFI MIPO)
Background: Genitourinary radiation injury unpredictably occurs in up to 10%-20% of patients undergoing radiation for pelvic cancer and may lead to repeated admissions and surgery for bleeding complications and genitourinary obstruction. In contrast to alternative pelvic cancer survivorship adverse outcomes, such as stress urinary incontinence or erectile dysfunction following radical prostatectomy that can be managed definitively with evidence based pharmacologic and surgical interventions, there are a lack of definitive, organ sparing radiation injury treatments.
Purpose: To better understand the genitourinary outcomes and adverse urinary events following radiation versus alternative intervention for pelvic malignancy including prostate, and cervical cancer.
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- Facilitate data collection for the GOFI MIPO database.
- Explore changes in urine biomarkers and patient reported outcomes following hyperbaric oxygen therapy for radiation cystitis.
- Evaluate long term outcomes of radiation for pelvic malignancy.
- Evaluate variation in treatment for pelvic radiation injury management.
- Exploring Decision Making and Outcomes in Metoidioplasty and Phalloplasty Gender Affirming Surgery
Background:
Metoidioplasty and phalloplasty gender affirming surgeries (MaPGAS) are increasingly performed and are important for many to achieve gender congruence but remain high risk procedures that require patients to make complex decisions affecting future gender congruence, fertility, urinary, and sexual function. However, there is a lack of validated MaPGAS decision support due to a historical lack of understanding of patients’ decisional needs and dearth of high quality published outcomes or guidelines. Taken together, this limits the extent of MaPGAS counseling and shared decision making, potentially leading to poor quality decisions and unexpected outcomes.
Purpose: To better understand outcomes and improve decision making in MaPGAS.
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- Facilitate data collection for MaPGAS via the Dartmouth Health Gender Affirming Surgery Health, Decision Making and Quality of Life longitudinal Registry (GASH DM QOL).
- Evaluate changes in clinical and patient reported outcomes pre and post gender affirming surgery.
- Application of decision-making support in patient decision readiness and decisional conflict.
Duncan Morhardt, MD, PhD
Duncan.R.Morhardt@hitchcock.org
Our lab works with zebrafish to understand the development of the urinary system. Our knowledge of the zebrafish urinary system can be extrapolated to and harnessed as interventions in human disease. As part of these investigations, we are characterizing the physiology of the zebrafish bladder. This involves injecting a fluorescent tracer into anesthetized fish, imaging them, and analyzing their bladder behavior after exposure to several clinically relevant medications. During this summer rotation, the selected medical student will engage in basic science studies about zebrafish and vertebrate bladder physiology. The project be tailored to the medical student’s previous research experience (which may be none), skills, interests, and abilities. Some possible activities could include python programming, image analysis, microscopy, animal husbandry, RNA-seq analysis, spatial transcriptomic analysis, bladder physiology measurements and analysis. The technique and scope of the project will be customized to be completed in 4-5 weeks with time reflect and report their findings.
Section of Pediatric Surgery, Department of Surgery
Reto Baertschiger, MD
Reto.M.Baertschiger@hitchcock.org
The division of pediatric general surgery would like to welcome a summer student to be part of our division and participate in one or several research projects.
We will have opportunities to work on three different projects including pediatric general surgery, pediatric surgical oncology and pediatric trauma care.
- Pediatric General Surgery:
Appendicitis is one of the most frequently diagnosed surgical problems in children. We have identified that certain bacteria cause more complication in children with perforated appendicitis in children in an unpublished performed in 2018. Briefly, Streptococcus anginosus (SA) is contained in a subgroup of normal gut flora with pathogenic propensity toward abscess formation. The aim of this study is to expand the previously gathered data on children with perforated appendicitis from 2012-2017 to 2018-2024 and to evaluate the clinical significance of SA in the setting of appendicitis at our center.
Methods: This is a retrospective cohort study at DHMC. Patients will be identified by ICD 9/10 code diagnosis of acute perforated appendicitis from 2018-2023. Medical charts will be reviewed to confirm clinical evidence of appendicitis and patients needed to have a corresponding intra-abdominal or pelvic fluid culture. Patients with positive culture for SA (SA(+)) will be compared to those with negative culture (SA(-)), and followed for a minimum of 6 months. Primary outcomes of interest will be disease severity, including complications, readmission, length of stay (LOS), and duration of antibiotics.
We anticipate 150-180 additional patients to be included in the study.
- Pediatric Surgical Oncology:
Trisomy 18 is a severe chromosomal abnormality in children. These children survive and are at risk of developing renal and liver tumors. We plan to participate in a mutli-institutional study analyzing the outcomes for Patients with Trisomy 18 and Nephroblastoma or Hepatoblastoma: a Retrospective Review project. We will include at least two of our patients, after IRB approval. We will collect the data, including demographics, surveillance data, diagnosis and treatment information as well as long term follow-up.
- Pediatric Trauma:
Children, particularly during adolescence, are among the most frequent victims of traumatic injury in North America. In the United States, 7,444 children aged 0-19 died due to unintentional injury in 2019 for an average of 20 preventable deaths per day. Unintentional injury is also among the leading causes of pediatric presentation to the emergency department with more than nine million initial emergency room visits annually. Beyond the harm of the initial injury itself, traumatic injury in children also carries significant risks of long-term physical disability and chronic pain, as well as the development of psychologic illness such as post-traumatic stress disorder. Furthermore, trauma is not always an isolated event and can put adolescents at risk for future injuries. Indeed, teenagers over the age of 14 who experienced a significant traumatic event have been found to be as much as ten times more likely than others to have a subsequent trauma.
We propose to study and better understand the causal attributions which adolescents hold from their traumatic injuries and to establish how these attributions might relate to injury prevention strategies for these children. We plan to use a mixed method model of surveys and structured one-on-one interviews to interact with participants. Our ultimate goal is to use our findings to construct injury prevention messages and strategies that will appeal to adolescents more directly than those created by adults only.
The student duties and involvement:
The selected student will participate in data collection, data analysis and manuscript drafting on one or multiple projects. The goal is also to submit an abstract to a local and hopefully national conference. The student will be required to take the CITI Good Clinical Practice in research course, as requested by our IRB. The student will also be able to participate in our tumor board, regular learning opportunities such as grand rounds and divisional education opportunities – case discussions, journal club etc.
Section of Urology, Department of Surgery
Florian Schroeck, MD, MS
Florian.R.Schroeck@hitchcock.org
The student will be involved in research activities related to improving care for non-muscle invasive bladder cancer. This might involve working with existing quantitative or qualitative data or being involved with an ongoing clinical trial.
Further information on the projects can be found here: https://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141707037 [hsrd.research.va.gov]
And here:
https://prevention.cancer.gov/funding-and-grants/funded-grants/R37CA275916 [prevention.cancer.gov]
Depending on interest and timing, the student will get experience in participant recruitment, data abstraction/collection, qualitative or quantitative data analyses, literature search related to the project, or drafting of presentations, abstracts, or manuscripts related to the research. It is important to note that a commitment is needed at least 3 months prior to the start of the summer break, so that we can assure all necessary training and privileges are in place for the student to get access to VA data and participate in VA research activities.
Section of General Surgery, Department of Surgery
Meredith Sorensen, MD, MS
Meredith.J.Sorensen@hitchcock.org
Perioperative Patient Portal Use and Anxiety: A Study of Thyroid Surgery Patients
The purpose of this study is to understand perioperative portal use among patients who undergo thyroid surgery and explore its relationship to perioperative anxiety. We hypothesize that patients who access the portal more frequently, or who use internet sources or seek advice from non-medical personnel to address their questions or concerns, will report increased perioperative anxiety compared to their counterparts. Studies to date have examined the evolution of patient use of patient portals both in the inpatient and outpatient settings and the rendering of patient care by surgeons via these portals. There is a dearth of information, however, related to portal use and its relationship to perioperative anxiety.
The study will involve a single, in-person survey filled out by the patient at the time of their post-operative follow up after thyroid surgery. The objectives are: To understand the relationship between portal use and patient anxiety in the perioperative period, to understand how patients resolve questions and concerns that arise during the perioperative period, and to uncover differences in portal use and perioperative stress between patients who undergo thyroid surgery for benign vs. malignant pathology.
The student’s role in this project will be to help with IRB modifications (this is written as a paper study, but we may investigate the feasibility of transferring it to a portal-based survey). Data collection can start before the summer, but in order to accrue enough patients, the project may need to extend beyond the summer. The student will be involved in data analysis. For first authorship, the student would need to take charge of the project, to include authoring an abstract for submission, creating a poster/presentation if accepted, and drafting the manuscript.
Patient Perceptions of Surgical Residency Training (this is a collaboration with Vanderbilt)
There are innumerable complexities that patients face when navigating the medical setting. One of these complexities is the integration of resident training and patient care at academic medical centers. Patients overwhelmingly do not understand the education, roles, and responsibilities of the members of their medical team. Unfortunately, while most patients feel it is important to help train the next generation of physicians, many do not want trainees participating in their procedural and/or surgical care. Previous work has demonstrated that patients may be more open to trainee participation in surgical care after learning about trainee education, roles, and responsibilities. We hypothesize that patients will be more willing to allow trainee participation in their surgical care after reflecting on their own experiences with a procedural learning task (i.e. learning how to drive). We will recruit approximately 40 patients who are scheduled to undergo elective surgery to undergo semi-structured interviews. Patients will be randomized into control and intervention arms. Participant in the control group will be subjected to a semi-structured interview about their experiences with and expectations for trainee participation in surgical care. Participants in the intervention group will be subjected to the same semi-structured interview but will also be engaged in a discussion about the similarities between learning how to drive and learning how to perform operations. Transcripts from all interviews will be transcribed and then subjected to both thematic and statistical analysis.
The student’s role in this project would likely be with conducting the interviews and then participating in the coding process and thematic analysis. For first authorship, the student would be expected to author the abstract, create the poster/presentation if accepted, and draft the manuscript. This project is likely to extend beyond the summer, though it may be possible to at least complete the interviews in the summer timeframe. Some of the Dow funds would need to be used for transcription.
Section of Minimally Invasive Surgery, Department of Surgery
Ted Trus, MD
We have seen a lot of variability in paraesophageal hernia repairs recently given the number of surgeons now doing these and the different approaches used including robotic and laparoscopic approaches. We propose to review our institutional data to evaluate the relative benefits, risks, costs and outcomes of each surgical strategy. This is a straightforward project with a quick path to publication.
Review of this data has 3 primary benefits; QI work is necessary to identify areas for improvement as an institution, comparisons or robotic vs laparoscopic approaches are underreported, and costs for each approach are not well documented.
I will work directly with the medical student to collect, analyze and review the data and to write abstracts, posters or papers resulting from this work.
Section of Vascular Surgery, Department of Surgery
Jesse Columbo, MD
Jesse.a.Columbo@hitchcock.org
Dr. Columbo is an early career vascular surgeon at Dartmouth-Hitchcock, where he also completed his residency in vascular surgery. He holds appointments at both the Geisel School of Medicine at Dartmouth, and at The Dartmouth Institute. He works with students in a variety of ways. He is an active preceptor for the On Doctoring program, is the clerkship director for the third-year rotation in vascular surgery, and serves as co-mentor to PhD students. Students working with Dr. Columbo will participate in one of his active ongoing research projects (see below), where the student would have the opportunity to work on existing projects, including data collection, data analysis, and abstract and manuscript preparation, depending on the interests of the student. In addition, students will have the opportunity to be embedded in an ongoing research effort that includes weekly meetings with research fellows, PhD candidates, biostatisticians, and economists.
- Studying stroke after carotid revascularization
Carotid revascularization surgery, including carotid stenting and carotid endarterectomy, are some of the most common procedures performed by vascular surgeons in the United States. There is ongoing debate regarding a variety of aspects in the management of these patients, including what type of surgery patients should undergo, whether they should undergo surgery at all, and how they should undergo surveillance. Addressing these questions is a primary focus of Dr. Columbo’s research efforts. Example publications: PubMed IDs: 36172943; 31941366; 29914828; 28190714; 33616666
- Patterns of stress test utilization before vascular surgery
The use of preoperative stress testing for cardiac risk-assessment before vascular surgery is highly variable. Despite recommendations from the American Heart Association and American College of Cardiology, testing demonstrates wide variation across centers, with little differences in the baseline characteristics of patients. Dr. Columbo is investigating the impact of this variation, and ways to reduce it. Example publications: PubMed IDs: 36036487; 33684471; 32247699
- Reintervention and aneurysm related mortality after endovascular abdominal aortic aneurysm repair
Abdominal aortic aneurysms are a common diagnosis among vascular surgery patients, and endovascular abdominal aortic aneurysm repair is one of the most common procedures performed by vascular surgeons across the world. Patients who undergo endovascular surgery (minimally invasive repair with stent-grafts) as opposed to traditional open replacement of the aorta, are subject to a variety of important considerations. These include the risk for reinterventions to shore up the aneurysm, and the feared complication of late aneurysm rupture related to failure of the implanted graft. Measuring these complications and defining their risk factors is an important component of quality assurance for patients with abdominal aortic aneurysms. Example publications: PubMed IDs: 36283705; 36036487; 35090989; 35090992; 31290764; 32150470; 31471231
- Development and use of advanced biostatistical methods to study outcomes in surgical care
Sometimes existing biostatical methodology is limited in its ability to address certain research questions. These include but are not limited to, situations with time-variant exposures (such as repeated measurements of carotid ultrasound prior to surgery), or situations where a randomized controlled trial is not possible or unlikely to happen in the near future (such as with transcarotid artery revascularization versus transfemoral carotid artery stenting). In these situations, advanced methods can improve upon traditional strategies for risk adjustment, allowing enhanced inference and stronger validity of study findings. Dr. Columbo works closely with a group of biostatisticians and economists who investigate novel applications and methods to address these challenges. Example publications: PubMed IDs: 36172943; 33616666; 31165658; 30354571; 30646140
Section of Vascular Surgery, Department of Surgery
Rebecca Scully, MD
Rebecca.E.Scully@hitchcock.org
- The impact of patient sex/gender on endovascular aneurysm repair outcomes and postoperative surveillance
Sex-based differences in outcomes after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) have been noted with women experiencing increased mortality and increased re-intervention rates over time. The goal of the project is to evaluate differences in adherence to recommended post-operative surveillance protocols between male and female patients and to determine if such disparities impact EVAR outcomes. The project is an opportunity to work with data from the Vascular Quality Initiative (VQI) dataset and to work with health services researchers in the Department of Surgery and within the Heart and Vascular Center.
- Gender-based differences in compensation model preferences among surgeons
Differences in compensation between male and female physicians is a well-established issue however physician preferences around compensation models based on gender are less well understood. Data surrounding best practices to address and close the gender pay gap are also lacking. Using a mixed methods approach, the goal of the current work will be to design and distribute a survey and to also perform structured interviews with early, mid, and late career surgeons employed under a variety of compensation models.
Section of Vascular Surgery, Department of Surgery
Philip Goodney, MD, MPH
David Stone, MD
philip.p.goodney@hitchcock.org; david.h.stone@hitchcock.org
Drs. Goodney and Stone have collaboratively mentored Geisel students in health services research in topics related to surgical care, especially vascular care, but other topics have been investigated as well. These projects range from case series, to large observational analytic projects, to literature review/meta analyses, as well as methodologic and developmental projects. Students interested in this work can read more at www.dartmouthcesc.org, www.mdepinet.org/vision-crn/, and www.vaoutcomes.org. Partnership with Drs. Sandra Wong, Andrew Loehrer, Joga Ivatury, Florian Schroeck, Alex Iribarne, and other surgical health services researchers in the Department of Surgery and Heart and Vascular Center are included in these summer research experiences. Students will be assigned a role in an existing project of their choosing, report their findings at the end of the summer experience, and share their work in regional and national meetings and publications.
Section of Neurosurgery, Department of Surgery
Jennifer Hong, MD
Project 1: Understanding the relationship between interhospital transfer and surgical outcomes.
This is a clinical research project that builds on earlier work which discovered that patient outcomes for acute surgical diagnoses are worse for patients who are transferred from outside hospitals compared to those who present primarily to the emergency department, even after adjusting for other predictors of poor outcome such as disease severity. I am interested in analyzing data from national and institutional databases to better understand why inter-hospital transfers are associated with poor outcome and to identify ways to improve the mechanisms for transfer in healthcare delivery. This is particularly important in rural academic healthcare systems which have a high rate of transfers. A student who is involved in this project would be working closely with me to review patient charts, plan analyses and write and present findings.
Project 2: Pten deletion to accelerate peripheral nerve regeneration
This is a translational research project, using an animal model for nerve regeneration (the mouse sciatic nerve), to assess the effects of Pten deletion to accelerate nerve growth after injury. I use viral-mediated gene therapy approaches to conditionally inactive Pten in peripheral nerves. The goals of this student project are to 1) assess viral (AAV) infection rates in mice, 2) analyze live-imaged primary neuron cultures, and 3) perform detailed behavioral analyses in mice to assess sciatic nerve function. A background in basic science research is preferred, but I will directly supervise and train any student.