Research

COMET Fellow Publication

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

Top left to right: Jyotsna Natarajan, Elwyn Moir, Melissa Chase

Bottom left to right: Jimmy Yao, Jamie Yang

Many applicants interested in the Stanford Medical Scribe Fellowship are drawn to our program for the immersive and developmental research experience. Some of our fellows go on to develop research abstracts, present at national and international conferences, and may even be published in various medical/research journals. Below are three research journals that were recently published this year by Jyotsna Natarajan (Class of 2019-20), Elywyn Moir (Class of 2019-20) , Jamie Yang (Class of 2017-2018), Jimmy Yao (Class of 2016-17), and Melissa Chase (Class of 2019-20).

Intracranial Grade II Meningioma Oligometastatic to the Cervical Spine

Authors: Jyotsna M. Natarajan, Donald E. Born, Griffith Harsh, Lawrence M. Shuer, Scott G. Soltys

Abstract: 

For intracranial meningiomas that metastasize extracranially, an oligometastatic state exists that is intermediate between incurable, widely metastatic disease and non-metastatic curable disease. Similar to oligometastatic cancer, aggressive local treatment of meningioma oligometastases is warranted, as it may be curable. We present a patient with multiply recurrent intracranial meningiomas over 19 years, with a transformation from grade I to grade II histology, with oligometastatic disease to the C5 vertebral body. Three years following definitive spinal stereotactic radiosurgery, she remains without evidence of other metastatic diseases. Our case highlights the oncologic concept that metastatic meningioma need not be widely disseminated and provides the clinical rationale for aggressive local treatment of an oligometastatic meningioma.

Do as I Do: Physician- and Learner-Led Mind-Body Medicine Group Visits

Authors: Elwyn Moir, Jamie O. Yang, Jimmy Yao, Eva Weinlander

Abstract: 

Introduction: Care of patients with chronic medical and mental health conditions can be a source of frustration for primary care clinicians and may present a challenge in modeling effective interventions for medical learners. Mind-body medicine (MBM) interventions have shown success for a variety of conditions, and training in MBM has been associated with decreased burnout and improved professional satisfaction.8 We piloted MBM collaborative visits led by faculty physicians and facilitated by medical learners. We then assessed their efficacy treating patients with complex needs.

Methods: We conducted a series of eight weekly 2.5-hour MBM interventions for groups of five to eight participants (52 in total) with chronic health conditions. Matched-pair hypothesis t tests analyzed nine health indicators measured pre- and post intervention: the Patient Health Questionnaire-9 (PHQ-9) as well as participants’ perceived mental and physical health, stress and stress coping, agency, and capacity to connect with others. We made conservative calculations of effect size using Hedges’ g.

Results: Participants showed significant, large improvements in their PHQ-9 scores (P<.005, g=0.807), and moderate improvements in ability to cope with stress (P<.005, g=0.502), sense of control over their diagnoses (P<.05, g=0.413), and perceived overall mental health (P<.05, g=0.424). Other outcomes were nonsignificant, including a small improvement in participants’ perceived overall health (P=.071, g=0.286).

Conclusions: Patients completing the intervention enjoyed largely improved outcomes despite unchanged stress at work and home. Physician-led MBM collaborative visits comprise a feasible, reproducible, and reimbursable treatment option for improving patient care. They also immerse medical learners in an evidence-based practice model supportive of professional satisfaction.

Differentiation syndrome during ivosidenib treatment with immunohistochemistry showing isocitrate dehydrogenase R132H mutation

Authors: Mika M. Tabata  Melissa Chase , Bernice Y. Kwong,  Roberto A. Novoa, Sebastian Fernandez‐Pol

Abstract: 

We report a case of differentiation syndrome in a patient receiving the IDH1 inhibitor ivosidenib, with skin biopsy showing isocitrate dehydrogenase (IDH) R132H‐mutated leukemia cutis. A 72‐year‐old man with IDH1‐mutated acute myeloid leukemia (AML), status‐post allogeneic cell transplantation, on ivosidenib for 6 months, was admitted for culture‐negative neutropenic fever, pink and purpuric plaques and patches on the legs, abdomen and back, edema, hypotension, and shortness of breath. Skin biopsy revealed an infiltrate of atypical, immature, myeloperoxidase‐positive mononuclear cells compatible with leukemia cutis or Sweet syndrome. Although dermal edema and interstitial neutrophilic infiltrate with karyorrhexis characteristic of Sweet syndrome were not seen, the atypical cells lacked expression of CD117 and CD34, which were expressed in the original leukemia. Additional immunohistochemical staining of suspected blasts was strongly positive for IDH1 R132H, suggesting a diagnosis of leukemia cutis. As the immunophenotype of blasts in skin infiltrates can significantly differ from the immunophenotype seen in blood and bone marrow, this case shows that mutation‐specific antibodies such as anti‐IDH1 R132H may be useful to help distinguish malignant from non‐malignant infiltrates in the skin. Furthermore, differentiation syndrome may show histopathologic features of leukemia cutis on skin biopsy.

Posted on 4/5/21


Virtual Conferences: The Future of Sharing Research

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

At this point in the fellowship year, many of our fellows are hearing back from various national and international conferences. In the past this might have included booking flights, hotels, and other travel related items to prepare to attend conferences in person. But whether in person, or virtual, research in the Stanford Medical Scribe Fellowship continues, and with continued success.

So far, the following COMET Fellows and their providers have had research abstracts accepted to three national conferences! Many more of our fellows are continuing to work on research/quality improvement projects and are in the various stages of data collection, data analysis, and manuscript drafting.


https://www.stfm.org/

In Their Own Words: Patients Contributing to Their Own Health Histories May Increase Total Electronic Health Record Engagement

 Dr. Erika Schillinger, Elyse Gonzales, Catalina Sun, and Trevor Larson

The Impact of Outdoor Diabetes Group Visits on Health Management in a Homeless Population during COVID-19

Dr. Angela Jiang, Aline Thiengmany, and Carolina Chong, 

Empowering Medical Students in Telemedicine: A Workshop for Best Practices in Communication and Physical Exam in Video Visits

Dr. Rika Bajra and Bella Anderson Enni

Putting PEP in Your Depressed Elderly Patient’s Life During a Pandemic: The Positive Experience Project

Dr. Nancy Morioka-Douglas, Dr. Amelia Sattler, and Mei Keck

The Rise of Team Documentation: Impact on the Quadruple Aim and the Future of Medical Education

Dr. Steven Lin, Dr. Stephen Earls, Dr. Sandra Hong, Claire Godenzi, and Jacob Less

Five years’ experience with a medical scribe fellowship: shaping future healthcare students while addressing provider burnout

Dr. Steven Lin, Dr. Valerie Teng, Anthony Duong, Al Gourrier Jr., and Marcia Mata

Evaluation of a scribe training curriculum and scribes’ perspectives on tele-scribing

Dr. Lin, Dr. Teng, Anthony Duong, Priyanka Suresh, Damini Patel, and Hyun Jin Lim


https://www.endocrine.org/

Covid Lockdown Impact on Type 1 Diabetes Health and Wellbeing

Dr. Marina Basina, Jamie Calma, and Sabrina Sangha

A Retrospective Analysis of Progestogen Use in Transgender Women

Dr. Danit Ariel, Dr. Julia Chang, and Phoebe Zhang

Psychological Impact of Diabetes Technology on Type 1 Diabetes Pregnancy

Dr. Marina Basina and Jacob Less

 


https://www.additionalventures.org/svim

Reduced T- cell Diversity and Recent Thymic Emigrants in Fontan Patients with Protein Losing Enteropathy

Dr. Anitra Romfh and Akaansha Varma

Posted on 2/19/21


Interview with Cathina Nguyen, NP, a Former COMET Alumna

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

Many of our COMET Fellows aspire to attend various Health Professions Programs. It is the hopes of these fellows to graduate and become practicing healthcare providers. Proudly, one such COMET Alumna, Cathina Nguyen, is a practicing Nurse Practitioner with Stanford Family Medicine who graduated from the fellowship in 2019. Cathina has a strong research background, including her time with COMET.

Interview

Jacob: “What was your first experience with research?”

Cathina: “During my undergraduate education, I was a Psychology Major, and my first experience had to be my senior thesis. Prior to writing my thesis, I worked on a research project for two years that sought to help children with autism, and their families, implement tools to improve every day stress and quality of life. In this first formal experience, I worked under an amazing principal investigator (PI), who walked me through the whole process. This thesis would take another year after I graduated to publish, but was the most rewarding paper that I have published.

Jacob: “As a psychology major, were you always interested in a career in healthcare, or becoming a Nurse Practitioner (NP) specifically?

Cathina: “I was always interested in a career within healthcare, and that includes so many different parts. I know that I always liked research and population health. I saw population health as healthcare to the ‘masses.’ After undergrad, I completed a Master’s in Public Health (MPH) at UC Davis, where I did 1-2 years of research in epidemiology. Throughout this work, I did realize I missed working with patients/individuals one-on-one. I happened to meet someone who is an MD that ended up changing careers to go into public health. He framed his transition that he was, ‘working with trees, but wanted to take a step and look back at the whole forest.’ From this, I actually took away that I’ve looked at the forest, seen the beautiful landscape, but missed taking care of each ‘clinical’ tree. I would end up looking into NP schools after finishing my MPH.”

Jacob: “How has your perspective on, or relationship with, research changed over the years of your experience?”

Cathina: “Previously, I thought of research as a linear process. You go from point A to point B. A variable changes, you measure it, and you report on it. Through my various projects and involvements, I’ve learned that research requires patience, and not just to get it done with and look to publish a paper. I’ve also learned that not all research ends. There is a different continuum to each project, and you will have to be patient with the entire process.”

Jacob: “Are you currently involved in research?”

Cathina: “My last project ended, maybe, 2 years ago. It was actually a QI project with Stanford Family Medicine (SFM) I was conducting as a COMET Fellow. This project looked to increase the completion rate of patients getting Gardasil vaccinations to prevent infection with Human Papillomavirus (HPV). For full immunity, 2-3 separate shots are necessary, and patients are often lost to follow up. In my clinic as an NP, I am working to better my interactions with patients, but I would love to rejoin a project in some supportive role.”

Jacob: “As a scribe with my providers, I have sometimes seen how they cited research or quoted treatment guidelines. How often do you find yourself citing research with patients, and do you have any thoughts on it now that you are the practicing provider?”

Cathina: “I definitely find myself citing research a lot. We can see how in today’s time, outcomes with patients are important in knowing what happens when someone gets a new vaccine. We’ve heard a lot of news about safety, efficacy, statistics over the past few months, and how these numbers are being used in actual application. I am trying to stay up to date on research being published, as patients always have questions - asking the “Why should I do this?”. When patient’s have these questions, it’s important to have prepared answers based on evidence-based practices. Oftentimes this is much more reassuring. It makes sense that not everyone would be able to understand the pathophysiology of a disease or disorder or the mechanism of a vaccine. But when we tell a patient that eight out of ten patients who don’t get a vaccine will likely become infected with a virus, everyone can understand that better. And it is a much more convincing argument.”

Jacob: “Do you have any final recommendations to prospective and current fellows interested in research?”

Cathina: “Find your passion. Research is hard, even when it’s “easy” and seemingly straightforward. Most research is even harder because it is more ‘windy’ and can take longer. I recommend you find groups of individuals and mentors that have that same passion. You’ll have to work together to gather resources and shape questions. Finally, research without a well formulated hypothesis can be difficult. You want to have a clear idea of what you are studying and what questions you are trying to answer. A clear goal and the passion to explore what you are trying to answer is one of your best tools that will make research worthwhile.”

Posted on 1/25/21


Specialty Research Mentor Highlight

Dr. Marina Basina

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

In the Stanford Medical Scribe Program, physician mentors generally have a strong interest and wealth of experience in clinical research. Our COMET Fellows have the unique opportunity to work alongside their mentors on various projects across many different Stanford clinics.

Dr. Marina Basina is a clinical endocrinologist and clinical researcher with a focus on diabetes management, thyroid, and adrenal conditions. This year marks her third year with COMET, and every year she mentors several fellows in her clinic, and with various research projects. 

 

Jamie Calma
2020-21 COMET Fellow

“I have learned so much navigating through the whole clinical research process, which has included skills in survey development, data collection, and result analysis. I have Dr. Basina to thank for this learning opportunity and for her amazing support since I started with COMET. Working on research projects with her has been truly enjoyable and rewarding. Research has also helped me reinforce the knowledge I have gained through scribing and enhance my overall experience in the program. Working alongside dr. Basina on research, I feel even more fulfilled and am able to connect the conditions of patients seen in the clinic with research studies, including quality improvement and chart review.”
 

Phoebe Zhang
2020-21 COMET Fellow

“Working on research with Dr. Basina added another facet to my scribing experience; it gave me the opportunity to participate in medicine in two very different ways. Not only was I able to help patients directly via clinic visits, but I was also able to help patients behind the scenes through our project. This experience gave me more insight into the many aspects that make up the medical field.

“Dr. Basina is a wonderful mentor. She allows you to come up with your own research idea and provides valuable insight and guidance for a meaningful project. She takes the time to teach you the many components that are involved in the research process. Additionally, she identifies potential obstacles that you may not have thought of and gives suggestions for potential solutions. Moreover, she explains how these projects are fundamental to healthcare as a whole and how it will help you in a future career in medicine.”

 

Sabrina Sangha
2020-21 COMET Fellow

“As a Stanford COMET fellow, I have had the privilege of working alongside Dr. Basina in the Endocrinology clinic and on research. Dr. Basina has been an amazing mentor to work with and learn from, always going above and beyond to ensure that I am able to understand the process and course of a medical issue a patient presents with.

I have had the opportunity to work with her on a project concerning patients living with Diabetes. Dr. Basina’s knowledge and guidance has helped me to develop a better understanding of Diabetes, and provide insight on what goes into addressing and treating the complex nature of this disorder. I have enjoyed the chance to apply the things that I have learned into a research project, with the hope and goal that anything we discover might make a difference to enhance a patient’s healthcare experience.”

Posted on 1/05/21


Claire Godenzi, former Chief Scribe and current Fellowship Coordinator, facilitating a research workshop in 2019. All research workshops for 2020 have been conducted virtually.

Monthly Research Workshop Update

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

The COMET Leadership team has now successfully facilitated three of our monthly research workshops. These workshops, that will continue each month until the end of the fellowship year, are designed to educate fellows on the components of a research project (including developing an abstract or poster), provide a space to receive feedback on their current progress/drafts, and support collaboration within, and between, research groups. 

Our most recent workshop broke down the components of a research abstract, including some examples from past fellows that were accepted to previous national conferences. 

The current COMET fellowship class is finalizing approval on projects, generating protocols/surveys for data collection, and starting to outline their research abstracts. Many conferences that they will be applying to present at will be open for submissions in the first several months of the new year. Our next research workshop, scheduled for December 7th, is designed to provide direct feedback on abstract drafts from current fellows and their groups.

Posted on 12/1/20


Day in the Research Life of a COMET Fellow

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

We interviewed one of current COMET Fellows, Bryson Gomez, on his motivation for, experience in, and takeaways from Research in COMET! Read below to learn more about Dr. Ian Nelligan, Sandra Aguilar, and Bryson Gomez’s QI Project on Improving Adherence to Quarterly Bacterial STI Testing in MSM on PrEP through Self Swabbing. 

“I just wanted to actually experience clinical research for myself. It’s a unique process to come up with solutions to problems you see on your own. And it is even more impactful to see the possibility of having those protocols implemented and take some sort of effect.” 

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Jacob Less, one of our Chief Scribes overseeing the Stanford Specialty Clinics, had the chance to interview Bryson, a current Stanford COMET Fellow, working with Physician Mentors in Family Medicine and Internal Medicine. 

Jacob:

“As research is an optional component, why did you decide to get involved with a project?“

Bryson: 

“Research offered by the COMET program was actually one of the main reasons I was attracted to, and applied to COMET. I didn’t have much experience or time to work on research at my undergraduate school.” 

Jacob:

“How did you get connected with this particular project?”

Bryson:

“My physician mentor, Dr. Nelligan, asked me if I had any projects in mind. When I told him I didn’t have a set interest yet he pitched a project that he felt advocated on a particular need in one of the patient populations he sees. What was unexpected is how he told me that I would be lead investigator, almost like it was my project. In undergrad, I worked as a health educator on campus and had some background knowledge on PrEP and STI testing, so it seemed like a good fit.”

Jacob:

“Wow, that is awesome! And you’ve only been working with Dr. Nelligan for about 4-5 months now? How has the relationship worked between you and your physician mentor?”

Bryson:

“Dr. Nelligan has been amazing in providing mentorship, guidance, and experience to myself and the project. We’ve done a lot of literature review, devising a workflow to be implemented, and now working on training those that would be implementing this protocol. Dr. Nelligan even had me present this project to the Stanford Family Medicine (SFM) all staff meeting.”

Jacob:

“So what has been your main goal in finding a research project in COMET? Do you feel like you are on your way to meeting this expectation?”

Bryson:

“Honestly, I just wanted to actually experience clinical research for myself. It’s a unique process to come up with solutions to problems you see on your own. And it is even more impactful to see the possibility of having those protocols implemented and take some sort of effect. If found to be useful, this could be utilized by patients on PrEP at SFM for many years. I feel like even in times of COVID, I have been finding everything I expected out of COMET. The leadership team has made me feel supported and the physician mentors do a great job of mentoring.” 

Jacob: 

“Any last words that you’d like to say?”

Bryson:

“I think the 1-1 mentorship from Stanford physician mentors is what sets this program apart. In 4-5 months, I have had the opportunity to not only perform, but lead a research/QI project and be treated on the same level as my provider. I have no prior experience and, while I am getting a lot of guidance and support, this has allowed me to develop my own abilities, as well as grow personally, and professionally.”

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Thank you all for taking the time to read this brief interview on one of our current COMET Fellow’s process finding and engaging in research. We hope to continue to highlight our current class of fellows and share the amazing work they are doing!

Posted on 11/2/20

Research in COMET: Class of 2020 Successes and Class 0f 2021 Endeavors

Written by: Jacob Less, 2020-2021 Chief Scribe of Specialty Clinics

Research is another pillar of the Stanford COMET Fellowship that distinguishes it from other traditional medical scribe opportunities. Our fellows are encouraged to pursue research/quality improvement projects with their physician mentors and supported to develop their own original research project if they are interested. While research is an optional component of our program, many of our fellows have gone on to present at national conferences, publish in medical journals, or learn how to create an abstract and research poster. In 2020, 16 COMET Fellows were accepted to present at the Society of Teachers of Family Medicine's annual national conference (August 2020). Below is a list of fellow's and their accepted projects. Click here to read our fellows' research abstracts.

Excitingly, our current COMET Class of 2021 is kicking off their research endeavors with more than 25 fellows engaged with a project. Working closely with their faculty mentors, many of our fellows take the lead on developing surveys, collecting data, and analyzing results. They have also attended two research workshops (so far!) as part of a monthly series put on by the leadership team.  

With projects under both research and quality improvement lenses, some topics that are being investigated this year include “Cohort Study on the Impact of an Outdoor Diabetes Group Course on Chronic Condition Management and Preventative Care in a Homeless Population during COVID-19,” “Use of Artificial Intelligence in Diagnosing Skin Cancer,” and “Improving Adherence to Quarterly Bacterial STI Testing in MSM on PREP Through Self-Swabbing.” 

At least once a month we will be providing updates and highlights of our amazing fellows engaged in research. Be on the lookout for our next research post where we will interview a current COMET Fellow on their motivation for engaging in research and experience taking the lead on their project!

Posted on 10/23/20