Opportunities allow future doctors to enhance their knowledge

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Trainees who are studying to become doctors at Upstate's Norton College of Medicine have the opportunity to do medical research as students.

Here to tell about the Office of Research for Medical Students is Dr. Dimitra Bourboulia. She's an associate professor in the department of urology and the assistant dean for undergraduate and graduate medical education. She's also the director of the Office of Research for Medical Students.

Welcome to "The Informed Patient," Dr. Bourboulia.

Dimitra Bourboulia, PhD: Thank you very much, Amber, for inviting me, and I look forward to having this discussion with you today.

Host Amber Smith: Are medical students required to do research as part of their education?

Dimitra Bourboulia, PhD: The quick answer is: It depends. At Upstate Medical University, we have four colleges. So, we have the College of Graduate Studies, the College of Health Professions, of Nursing and the Norton College of Medicine. We have multiple degrees that are offered from our educational programs, ranging from undergraduate bachelor's degrees to graduate, for example, master's or PhDs or doctoral degrees, of which we require students to spend significant time in research activities, so this is a requirement for graduation.

At the Norton College of Medicine, medical students can graduate with a single degree, which is an MD degree, or they might choose to graduate with a double degree, which means, for example, having an MD and a Doctor of Philosophy or doctorate or PhD, or Doctor of Medicine, an MD, with a Master's of Public Health, which is an MPH. So in some programs like these, the student is required to do research to graduate.

However, if you ask me about the MD students, students that are enrolled just to do medicine and train for a medical degree, for those, we have optional programs that the students can participate in to do research. And that's because the LCME (Liaison Committee on Medical Education), which is an authority that accredits medical schools in the U.S. and Canada, has specific standards that require medical schools to incorporate, somehow, programs that students can choose to do research if they want to. And this is a mandatory element for that reason. And so medical schools, like ours, spend a lot of time establishing programs like that and improving programs for research.

So students, therefore, that are enrolled just for the MD program are not required, but spend significant time doing research throughout the training.

Host Amber Smith: So some of them, it's an elective for them, it sounds like.

Dimitra Bourboulia, PhD: So, yes. So, there are different, I suppose, choices. There are electives, there are unique electives, and there are programs that our office offers to the students, especially during the first year, when they start medical school.

In fact, actually, I have students who contact our office even before they start medical school, while they know they will join, of course, our program. And so, they contact me directly and say, "Dr. Bourboulia, can you help us out, connect with faculty that do research?" before even they start the first year of medical school.

And so we have a great interest from students to start as soon as possible, hands-on research.

So what we have created throughout the years and what we have actually improved throughout the years is our summer program, is a fellowship (training program) that we offer to medical students between the first year and the second year.

And during that first year, students actually team up with faculty experts in research who have spent really the whole career learning about research, doing research and teaching and mentoring students, medical students, in the lab environment.

So, this summer program that we have developed, students spend almost eight weeks of full-time research with a faculty member. This is a very competitive program, attracts over 15% of the first-year medical students to apply for that.

And we have, as you know, over 30 different basic and clinical departments at Upstate. Some of the departments dedicate full-time on research, so students can just do full-time research, bench work (laboratory research), or they can just join a clinical department, and they can do more like a translational project -- I can explain that a little bit later.

So, there are different options for students to do any type of research they want.

Host Amber Smith: So, the summer program, does that take place in Syracuse?

Dimitra Bourboulia, PhD:

Yes. So, the summer program we offer is for medical students to stay in Syracuse and do research in Syracuse at the Upstate campus. Nevertheless, because of the COVID years, we had to try to change somehow this possibility, and so, we now offer remote projects. Students can go back home during the summertime, and they can connect through doing a remote research with faculty. And so that's also optional. And students, some students, prefer to do that because they don't need to stay, they don't need to pay rent, although the summer program offers a stipend to the students to stay and cover all the expenses they have. So, many students decide to stay, especially students that come from our area, but some students that are trainees here from a different state, they might want to go back home, and so that's also a possibility, and it can happen.

Host Amber Smith: Do the students potentially publish medical journal papers related to their work from the summer program?

Dimitra Bourboulia, PhD: The majority of the students that I know in this program publish. There are different types of research they can do. As I said, they can be physically in Syracuse, and they can do research here. They can go back home and do research remotely. Ultimately, the projects could be from lab work to translational to being in a clinic, and even do remotely. For example, doing epidemiological studies, computational studies, artificial intelligence studies that you don't need to be here physically to do, as long as you connect with a mentor.

And we find, they find, we help them find, the best mentors they can to actually complete this project during the summer. It's interesting though, allow me to say that many students decide to continue doing research even if they finish during the eight weeks, because they enjoy so much doing that, and they can actually decide how much time to spend. And even if it's a part-time, they can produce several types of publications, from reviews to a research paper. They can collaborate with other peers. They can collaborate with graduate students who are just doing a PhD, so they can learn more than just doing their own little research.

Host Amber Smith: And what is translational research?

Dimitra Bourboulia, PhD: Let me explain a little bit about just the basic biochemical research, which is more like dedicating time in the lab, doing a research specifically with, let's say, molecules and try to understand a mechanism behind a disease, I would say.

But there are projects, for example, where you want to test a drug to see if it has any side effects, or you want to test an antibiotic, or you want to test a system where you need more than just a test tube. So you might want to have cells to work with, you might want to have animal models.

You want to have models that you can test, and it's more like physiologically relevant to a disease that happens in a patient. Or you want to, let's say, test an instrument that you have designed, with, of course, the help of the mentor, and you want to test it to see whether it fits in a patient.

So these types of projects are more translational projects.

Host Amber Smith: You're listening to Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Dr. Dimitra Bourboulia. She's the director of the Office of Research for Medical Students at Upstate.

Why do you think it's important for students to have the opportunity to do real medical research during their training?

Dimitra Bourboulia, PhD: Thank you so much for this question. This is very important question. Studies have shown it's widely accepted, that promoting research education through programs and initiatives that we have at Upstate and, of course, other medical schools do, early exposure on research experiences, those boost long-term student career profiles. That's one part: Students benefit long term.

And it also increases the idea and the culture of evidence-based research. We base our research on facts, and we try to take our data, our results, for clinical practice.

There is no better way to describe the importance, but just to give some examples of how research by a medical student has benefited humankind, for example, I'll give you heparin, which is an anticoagulant and used very much in medicine and in surgical procedures, was discovered by a medical student, a second-year medical student at Johns Hopkins, back in 1916, and, of course, we still use it.

The anesthesia process: again, a medical student. It was William Clarke, who used it in surgery, and that helped, for example, remove a tooth without pain.

So, ultimately, you want to know that the student has the ability and wants to and is motivated enough to go and do research and discover something new, because if it's not new, there is no point of doing the research.

Some discoveries are small, but some discoveries big, and some discoveries can last forever. But the interesting part that I can say is our students want to do research, and they're very enthusiastic, and they look forward to discover, even if it's small or big.

Host Amber Smith: Does having solid research experience help make students more competitive for residencies and fellowships (training programs) after medical school?

Dimitra Bourboulia, PhD: Yes. Many residency programs actually require research experience from the candidates they interview. So, students, as you mentioned earlier, publish while they're at medical school. They need to publish the research activities to show this is a productivity process. You need to produce something to show that you have done research.

Mentioning that you are doing research is not enough. So we always, in our office, and me personally, I always encourage students to talk to the mentors and discuss publication, and how they can contribute, how can they create in, maybe, a new field, or how they can improve the field they're working on, by writing the results and publishing it before leaving medical school.

So, this is very important, and a lot of residencies actually look for those publications. The research experience, also, students acquire mostly career profile, and also they can be employed later on. Publication as an undergraduate or while you are trained as a medical student has long-term implications for doctors as well.

There are many surveys out there, there are many studies on that. Academic physicians found that the career research success is associated with how much research they have done during the medical school. Physicians who undertook extracurricular research produce many times more publications than the peers that haven't done this.

And publication is very important for a student, even now, while they're training, or even later on, when they're doing residencies and fellowships, especially if you want to become a physician scientist. It also contributes to students' CV (curriculum vitae, or résumé), and also, I would say that it boosts the confidence of the student later on to come out and discuss the research they have done in a more specializing way.

They know what they're talking about, and other people listen to them.

Host Amber Smith: Let's talk about some of the research that students at Upstate have done. Can you share some examples from the area of cancer?

Dimitra Bourboulia, PhD: Yes, absolutely. Upstate has, as I said, over 30 different departments, many basic departments, dedicated research, clinical departments, so students have the opportunity to connect with multiple different fields and multiple focuses on research.

So, with regards to cancer, for instance, we have students that participate in brain, breast, bladder, kidney, prostate: There is quite a variety there. But the interesting part is our students have a different kind of focus. They want to do different things while they are in medical school, and so some of them do lab-based research, but some of them may do more like the translational research I mentioned earlier.

So you can see students doing, for example, research on immune disorders or cancer in children. You can see students who are doing artificial intelligence projects. And then we're going to the other side, neurological projects, for example, students work on blindness or stroke or the effect of blood pressure on stroke or neurodegenerative disorders.

I don't want to leave anything out. I can talk about viral infections, COVID: During the COVID years, many students actually participated in research on COVID. We can even move to zoonotic diseases, like Lyme disease, which is very prominent in our state throughout the year.

Dimitra Bourboulia, PhD: You can have students participate in our projects in the psychiatry department, for example, attention-deficit disorder, depression, metabolic diseases.

So all these options, our students can see projects that are available, areas of research that they are jumping on immediately, as soon as they start medical school.

Host Amber Smith: Many of the medical students at Upstate graduate and become physicians taking care of patients. Do you think having research experience makes a physician a better physician?

Dimitra Bourboulia, PhD: Yeah, that's a great question. Many studies have shown that this is the truth, this is real. I would just say: Research -- what is research?

Well, research is needed to understand the world we live in, if it is a microcosm or if it is looking at the stars in the sky. You need to understand the world we live in, and you cannot do this without research.

Every treatment, every drug, every knowledge we have, on a disease, on diagnosing a disease, or even prognosis or even the treatment, is because of research. And so being involved, no matter the time spent, contributes to the advancement of medicine.

Any medical doctor needs to help the community they live in, if it is one person or it is the whole group of people, here in our city or in the state will live in or nationwide. And so it also provides the opportunity to learn why a disease has specific symptoms, for instance. That's, again, because of research.

Reporting a new case a doctor might see in the clinic requires them to understand what has been done already, what's the background of this disease, if it existed before, or if it's something new. And you need to know how to address this problem.

And also, the more knowledgeable you are on a specific problem that the patient has, they listen to you. The patient listens to you. You have a voice that brings responsibility. You have a duty to describe, to be able to describe, what is happening with that person you try to treat. All the policy makers are listening to the doctor who has this extensive knowledge of detail of a disease that happens in the community.

And so, that brings me to the answer to the question. Yes, of course, research. The more you spend on research, the more time a student spends on research, the better clinician they will be, a physician will be, in the end because they will know more, and they will know how to treat a patient.

Host Amber Smith: Thank you so much for making time for this interview, Dr. Bourboulia.

Dimitra Bourboulia, PhD: Thank you for the invitation. It was a pleasure to be here.

Host Amber Smith: My guest has been Dr. Dimitra Bourboulia. She's an associate professor in the department of urology at Upstate, and the assistant dean for undergraduate and graduate medical education and the director of the Office of Research for Medical Students.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.