Dana Lin, MD

All Publications

• MDM4 is a key therapeutic target in cutaneous melanoma NATURE MEDICINE Gembarska, A., Luciani, F., Fedele, C., Russell, E. A., Dewaele, M., Villar, S., Zwolinska, A., Haupt, S., de Lange, J., Yip, D., Goydos, J., Haigh, J. J., Haupt, Y., Larue, L., Jochemsen, A., Shi, H., Moriceau, G., Lo, R. S., Ghanem, G., Shackleton, M., Bernal, F., Marine, J. 2012; 18 (8): 1239-?

  Abstract

  The inactivation of the p53 tumor suppressor pathway, which often occurs through mutations in TP53 (encoding tumor protein 53) is a common step in human cancer. However, in melanoma-a highly chemotherapy-resistant disease-TP53 mutations are rare, raising the possibility that this cancer uses alternative ways to overcome p53-mediated tumor suppression. Here we show that Mdm4 p53 binding protein homolog (MDM4), a negative regulator of p53, is upregulated in a substantial proportion (∼65%) of stage I-IV human melanomas and that melanocyte-specific Mdm4 overexpression enhanced tumorigenesis in a mouse model of melanoma induced by the oncogene Nras. MDM4 promotes the survival of human metastatic melanoma by antagonizing p53 proapoptotic function. Notably, inhibition of the MDM4-p53 interaction restored p53 function in melanoma cells, resulting in increased sensitivity to cytotoxic chemotherapy and to inhibitors of the BRAF (V600E) oncogene. Our results identify MDM4 as a key determinant of impaired p53 function in human melanoma and designate MDM4 as a promising target for antimelanoma combination therapy.

  View details for DOI 10.1038/nm.2863

  View details for Web of Science ID 000307469300030

  View details for PubMedID 22820643

  View details for PubMedCentralID PMC3744207

• Preoperative basal calcitonin and tumor stage correlate with postoperative calcitonin normalization in patients undergoing initial surgical management of medullary thyroid carcinoma SURGERY Yip, D. T., Hassan, M., Pazaitou-Panayiotou, K., Ruan, D. T., Gawande, A. A., Gaz, R. D., Moore, F. D., Hodin, R. A., Stephen, A. E., Sadow, P. M., Daniels, G. H., Randolph, G. W., Parangi, S., Lubitz, C. C. 2011; 150 (6): 1168-1176

  Abstract

  The optimal initial operative management of medullary thyroid cancer (MTC) and the use of biomarkers to guide the extent of operation remain controversial. We hypothesized that preoperative serum levels of calcitonin and carcinoembryonic antigen (CEA) correlate with extent of disease and postoperative levels reflect the extent of operation performed.We assessed retrospectively clinical and pathologic factors among patients with MTC undergoing at least total thyroidectomy; these factors were correlated with biomarkers using regression analyses.Data were obtained from 104 patients, 28% with hereditary MTC. Preoperative calcitonin correlated with tumor size (P < .001) and postoperative serum calcitonin levels (P = .01) after multivariable adjustment for lymph node positivity, extent of operation, and hereditary MTC. No patient with a preoperative calcitonin level of <53 pg/mL (n = 20) had lymph node metastases. TNM stage (P = .001) and preoperative calcitonin levels (P = .04), but not extent of operation, independently correlated with the failure to normalize postoperative calcitonin. Postoperative CEA correlated with positive margins (adjusted P = 04). Neither preoperative nor postoperative CEA was correlated with lymph node positivity or extent of surgery.Preoperative serum calcitonin and TMN stage, but not extent of operation, were independent predictors of postoperative normalization of serum calcitonin levels. Future studies should evaluate preoperative serum calcitonin levels as a determinate of the extent of initial operation.

  View details for DOI 10.1016/j.surg.2011.09.043

  View details for Web of Science ID 000298337500039

  View details for PubMedID 22136837

  View details for PubMedCentralID PMC3880195

• Routine second-opinion cytopathology review of thyroid fine needle aspiration biopsies reduces diagnostic thyroidectomy SURGERY Davidov, T., Trooskin, S. Z., Shanker, B., Yip, D., Eng, O., Crystal, J., Hu, J., Chernyavsky, V. S., Deen, M. F., May, M., Artymyshyn, R. L. 2010; 148 (6): 1294-1299

  Abstract

  Follicular thyroid carcinoma cannot be distinguished reliably from benign follicular neoplasia by fine needle aspiration (FNA) biopsy. Given an estimated 20% risk of malignancy, many patients with indeterminate FNA biopsies require thyroidectomy for diagnosis. Some centers have shown significant discordance when a second pathologist evaluates the same FNA biopsy. We sought to determine whether routine second-opinion cytopathology reduces the need for diagnostic thyroidectomy, especially in patients with indeterminate FNA biopsies.In all, 331 thyroid FNA biopsy specimens obtained from outside centers from 2004 to 2009 were reviewed at our institution. The FNA biopsy results were categorized into nondiagnostic (Bethesda I), benign (Bethesda II), indeterminate (follicular/Hurthle cell neoplasm, follicular/Hurthle cell lesion; Bethesda III & IV), and malignant (papillary or suspicious for papillary or other malignancy; Bethesda V and VI). Second-opinion cytology was compared with the initial opinion in 331 cases and with final operative pathology in the 250 patients who progressed to thyroidectomy.The average patient age was 51 with a predominant number of female (79%) participants. The overall cytology concordance for all 331 FNA biopsies was 66% (218/331). Concordance was highest at 86% (74/86) with malignant FNA biopsies. Concordance in the 129 patients with indeterminate FNA biopsies was only 37% (48/129). Indeterminate FNA biopsies were reread as nondiagnostic in 21% (27/129) of patients and as benign in 42% (54/129) of patients. Twenty-two patients with an indeterminate FNA biopsy reread as benign progressed to operative therapy for reasons other than cytology (eg, symptomatic nodule and radiation exposure/high risk) and were found to be benign in 95% (21/22) of patients on operative pathology for a 95% negative predictive value. An additional 11 patients with an indeterminate FNA reread as benign had follow-up FNA biopsies, each of which was benign. Indeterminate FNA biopsies on initial cytology had a malignancy rate of 13% (17/129) on operative pathology compared with 29% (14/48) for indeterminate FNA biopsies from second opinion. A second opinion improved FNA biopsy accuracy from 60% to 74%. Overall, second-opinion cytology of indeterminate FNA biopsies avoided diagnostic operation in 25% (32/129).Routine second opinion review of indeterminate thyroid FNA biopsies can potentially obviate the need for diagnostic thyroidectomy in 25% of patients without increases in false negatives.

  View details for DOI 10.1016/j.surg.2010.09.029

  View details for Web of Science ID 000286088900058

  View details for PubMedID 21134564

• A Phase 0 Trial of Riluzole in Patients with Resectable Stage III and IV Melanoma CLINICAL CANCER RESEARCH Yip, D., Le, M. N., Chan, J. L., Lee, J. H., Mehnert, J. A., Yudd, A., Kempf, J., Shih, W. J., Chen, S., Goydos, J. S. 2009; 15 (11): 3896-3902

  Abstract

  Ectopic expression of GRM1 in murine melanocytes results in transformation into a form of melanoma, and more than 60% of human melanoma samples tested ectopically express GRM1. Stimulation of this receptor in vitro results in up-regulation of activated extracellular signal-regulated kinase (ERK). Furthermore, a xenograft model of melanoma treated with riluzole, an oral GRM1 blocking agent, showed decreased tumor growth compared with the untreated controls. We have now completed a phase 0 trial of riluzole in patients with melanoma.Patients enrolled on this trial underwent a pretreatment biopsy, took 200 mg of oral riluzole per day for 14 days, and then underwent resection of their remaining tumor. We compared the levels of pERK and pAKT in the pretreatment and post-treatment samples and assessed the metabolic activity of pretreatment and post-treatment tumors using fluorodeoxyglucose positron emission tomography (FDG-PET) scanning.We accrued 12 patients and all expressed GRM1. We found a significant decrease in pAKT and/or pERK in post-treatment tumor samples as compared with pretreatment samples in 4 (34%) patients. These four patients had a significant decrease in FDG-PET intensity post-treatment as well. Two other patients had a clinical response with no corresponding metabolic response; five patients had similar pretreatment and post-treatment FDG-PET scan findings; and one patient had progressive disease.Our data show that glutamate blockade with riluzole can inhibit signaling through the mitogen-activated protein kinase and phosphatidylinositol 3-kinase/AKT pathways and suppress the metabolic activity of melanoma. The ectopic expression of metabotropic glutamate receptors may be important in the pathogenesis of human melanoma, and targeting this pathway may be an effective therapy.

  View details for DOI 10.1158/1078-0432.CCR-08-3303

  View details for Web of Science ID 000266659000031

  View details for PubMedID 19458050

  View details for PubMedCentralID PMC2812866

• Rewired ERK-JNK signaling pathways in melanoma CANCER CELL Lopez-Bergami, P., Huang, C., Goydos, J. S., Yip, D., Bar-Eli, M., Herlyn, M., Smalley, K. S., Mahale, A., Eroshkin, A., Aaronson, S., Ronai, Z. 2007; 11 (5): 447-460

  Abstract

  Constitutive activation of MEK-ERK signaling is often found in melanomas. Here, we identify a mechanism that links ERK with JNK signaling in human melanoma. Constitutively active ERK increases c-Jun transcription and stability, which are mediated by CREB and GSK3, respectively. Subsequently, c-Jun increases transcription of target genes, including RACK1, an adaptor protein that enables PKC to phosphorylate and enhance JNK activity, enforcing a feed-forward mechanism of the JNK-Jun pathway. Activated c-Jun is also responsible for elevated cyclin D1 expression, which is frequently overexpressed in human melanoma. Our data reveal that, in human melanoma, the rewired ERK signaling pathway upregulates JNK and activates the c-Jun oncogene and its downstream targets, including RACK1 and cyclin D1.

  View details for DOI 10.1016/j.ccr.2007.03.009

  View details for Web of Science ID 000246439100007

  View details for PubMedID 17482134

  View details for PubMedCentralID PMC1978100

• Pediatric vs Adult Adrenocortical Carcinoma: Different Rate of Surgical Treatment and Patient Outcome Sedaghati, M., Lin, D. T., Cisco, R. M., Kebebew, E. ELSEVIER SCIENCE INC. 2019: S81–S82

  View details for Web of Science ID 000492740900139

• Resection of the Primary Tumor in Patients with Distant Thyroid Cancer Metastasis Is Associated with Longer Survival Sedaghati, M., Lin, D. T., Cisco, R. M., Kebebew, E. ELSEVIER SCIENCE INC. 2019: S82

  View details for Web of Science ID 000492740900141

• Flipping the Boot Camp: A Multidisciplinary Curriculum for Incoming Interns Lee, E. W., Sapp, R. W., Mazer, L. M., Merrell, S., Lau, J. N., Lin, D. T. ELSEVIER SCIENCE INC. 2019: E184

  View details for Web of Science ID 000492749600437

• Aggressive resection of neuroendocrine tumor (NET) liver metastases: NET neutral or gain? SURGERY Cisco, R., Lin, D., Kebebew, E. 2019; 165 (1): 176–77

  View details for DOI 10.1016/j.surg.2018.08.019

  View details for Web of Science ID 000454471900028

• Introductory Surgical Skills Course: Technical Training and Preparation for the Surgical Environment. MedEdPORTAL : the journal of teaching and learning resources Miller, S., Shipper, E., Hasty, B., Bereknyei Merrell, S., Lee, E. W., Lin, D., Lau, J. N. 2018; 14: 10775

  Abstract

  Introduction: Early exposure to surgery in a positive learning environment can contribute to increased student interest. The primary objectives of this study included developing increased comfort in the operating room (OR) environment, confidence in surgical skills, and mentorship for students interested in surgery.Methods: The course comprised seven 2-hour sessions covering both nontechnical and technical skills facilitated by attending and resident surgeons. Sessions included nontechnical skills training, basic knot tying and suturing, laparoscopic surgical skills, and high-fidelity operative simulations on animal and cadaver models. The curriculum also matched students with faculty mentors in order to scrub into operative cases. Surveys assessing self-reported comfort in the OR, confidence levels in surgical skills, and whether students had mentors in surgery were distributed before and after the course.Results: Thirty preclinical medical students were enrolled in the course in 2016 and an additional 41 students in 2017. Results showed increased confidence in all skills and in comfort in the OR, as well as increased surgeon mentorship. Thirty-two students who completed the course entered clinical rotations in 2018 and, when surveyed, reported increased confidence in the aforementioned domains and in their preparedness for their surgery clerkship, compared to 49 peers who had not completed the course.Discussion: The course successfully increased comfort in the OR, increased confidence in performing surgical skills, and provided students with mentors in surgery, all of which will hopefully foster positive experiences during their surgery clerkship and ultimately increase their consideration of surgery as a career.

  View details for PubMedID 30800975

• Psychologist-Facilitated Group Sessions for Residents: A Worthwhile Investment? Lin, D. T., Qiu, W., Lai, C., Post, L. I., Merrell, S., Lau, J. N., Salles, A., Mueller, C. M. ELSEVIER SCIENCE INC. 2018: E53–E54

  View details for DOI 10.1016/j.jamcollsurg.2018.08.138

  View details for Web of Science ID 000447772500120

• Emotional Intelligence as a Possible Safeguard to Surgeon Wellness Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S145

  View details for DOI 10.1016/j.jamcollsurg.2018.07.307

  View details for Web of Science ID 000447760600278

• Surgeon Emotional Intelligence Is Strongly Correlated with Patient Satisfaction Lee, E. W., Hasty, B. N., Lau, J. N., Merrell, S., Hawn, M. T., Shanafelt, T., Salles, A., Lin, D. T. ELSEVIER SCIENCE INC. 2018: S164–S165

  View details for DOI 10.1016/j.jamcollsurg.2018.07.350

  View details for Web of Science ID 000447760600321

• Aggressive resection of neuroendocrine tumor (NET) liver metastases: NET neutral or gain? Surgery Cisco, R., Lin, D., Kebebew, E. 2018

  View details for PubMedID 30266442

• Social Belonging as a Predictor of Surgical Resident Well-being and Attrition. Journal of surgical education Salles, A., Wright, R. C., Milam, L., Panni, R. Z., Liebert, C. A., Lau, J. N., Lin, D. T., Mueller, C. M. 2018

  Abstract

  OBJECTIVE: In light of the predicted shortage of surgeons, attrition from surgical residency is a significant problem. Prior data have shown that those who are happier are more productive, and those who are less well have higher rates of absenteeism. This study sought to identify the role of social belonging and its relationship to well-being and risk of attrition.DESIGN: Surgical residents were invited to participate in an online survey containing measures of social belonging (a 10-item scale adapted from previous studies), well-being (the Dupuy Psychological General Well-Being Scale, Beck Depression Inventory Short Form, and Maslach Burnout Inventory), and risk of attrition (indicated by frequency of thoughts of leaving the program).SETTING: We surveyed residents at 2 tertiary care centers, Stanford Health Care (2010, 2011, and 2015) and Washington University in St. Louis (2017).PARTICIPANTS: Categorical general surgery residents, designated preliminary residents going into 7 surgical subspecialties, and nondesignated preliminary residents were included.RESULTS: One hundred sixty-nine residents responded to the survey for a response rate of 66%. Belonging was positively correlated with general psychological well-being (r = 0.56, p < 0.0001) and negatively correlated with depression (r = -0.57, p < 0.0001), emotional exhaustion (r = -0.58, p < 0.0001), and depersonalization (r = -0.36, p < 0.0001). Further, belonging was negatively correlated with frequency of thoughts of leaving residency (r = -0.45, p < 0.0001). In regression analysis controlling for demographic variables, belonging was a significant positive predictor of psychological well-being (B = 0.95, t = 8.18, p < 0.0001) and a significant negative predictor of thoughts of leaving (B = -1.04, t = -5.44, p < 0.0001).CONCLUSIONS: Social belonging has a significant positive correlation with well-being and negative correlation with thoughts of leaving surgical training. Lack of social belonging appears to be a significant predictor of risk of attrition in surgical residency. Efforts to enhance social belonging may protect against resident attrition.ACGME COMPETENCY: Interpersonal and Communication Skills.

  View details for DOI 10.1016/j.jsurg.2018.08.022

  View details for PubMedID 30243929

• Determining the educational value of a technical and nontechnical skills medical student curriculum. The Journal of surgical research Shipper, E. S., Miller, S. E., Hasty, B. N., De La Cruz, M. M., Merrell, S. B., Lin, D. T., Lau, J. N. 2018; 225: 157–65

  Abstract

  Residency application rates to general surgery remain low. The purpose of this study is to describe the educational value of a curriculum designed to increase preclinical medical student interest in surgical careers to better understand the process by which medical students decide to pursue a career in surgery.We used qualitative methodology to describe the educational value of a technical and nontechnical skills curriculum offered to preclinical medical students at our institution. We conducted semistructured interviews of students and instructors who completed the curriculum in 2016. The interviews were recorded, transcribed, and inductively coded. The data were analyzed for emergent themes.A total of eight students and five instructors were interviewed. After analysis of 13 transcripts, four themes emerged: (1) The course provides a safe environment for learning, (2) acquisition and synthesis of basic technical skills increases preclinical student comfort in the operating room, (3) developing relationships with surgeons creates opportunities for extracurricular learning and scholarship, and (4) operative experiences can inspire students to explore a future career in surgery.These factors can help inform the design of future interventions to increase student interest, with the ultimate goal of increasing the number of students who apply to surgical residency programs.

  View details for PubMedID 29605027

• Medical student perceptions of a mistreatment program during the surgery clerkship. American journal of surgery Hasty, B. N., Miller, S. E., Bereknyei Merrell, S., Lin, D. T., Shipper, E. S., Lau, J. N. 2018

  Abstract

  Medical student mistreatment remains a concern, particularly in the surgery clerkship. This is a single academic institution's report of medical student perceptions of a mistreatment program embedded in the surgery clerkship.Students who completed the surgery clerkship and the mistreatment program volunteered to be interviewed individually or in focus groups. The interviews were transcribed and qualitatively analyzed.Twenty-four medical students were interviewed and nine transcripts were obtained. Codes were identified independently then nested into four codes: Student Growth, Faculty Champion and Team, Student Perspectives on Surgical Culture, and Program Methods. Rank orders were then calculated for each major code.Our mistreatment program has shown that providing students with an opportunity to define mistreatment, a safe environment for them to debrief, and staff to support and advocate for them empowers them with the knowledge and skillset to confront what is too often considered part of the hidden curriculum.

  View details for PubMedID 29395030

• A Multi-Institutional, Qualitative Interview Study Investigating Attrition and Retention Resident Experiences Affecting the Decision to Complete General Surgery Training Shipper, E. S., Braverman, G., Brandford, E. C., Hasty, B., Mazer, L. M., Lin, D. T., Choi, J. N., Kissane-Lee, N. A., Baynosa, J., Lau, J. N. ELSEVIER SCIENCE INC. 2017: S170

  View details for DOI 10.1016/j.jamcollsurg.2017.07.384

  View details for Web of Science ID 000413315300362

• Prevalence and predictors of depression among general surgery residents. American journal of surgery Lin, D. T., Liebert, C. A., Esquivel, M. M., Tran, J., Lau, J. N., Greco, R. S., Mueller, C. M., Salles, A. 2017; 213 (2): 313-317

  Abstract

  Recent resident suicides have highlighted the need to address depression among medical trainees. This study sought to identify the prevalence and predictors of depression among surgical residents.Surgical residents at a single institution were surveyed. Depression and personal traits were assessed using validated measures; participant demographics were also obtained.73 residents completed the survey (response rate 63%). 36% met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. In multivariate linear regression analyses controlling for demographic factors, trait emotional intelligence alone was a significant inverse predictor of depression (β = -0.60, p < 0.001).Depression is prevalent among general surgery residents. Identifying protective factors and at-risk populations may allow for effective initiatives to be developed to address depression, and optimize the mental health of trainees.The aim of this study is to identify the prevalence and predictors of depression among surgical trainees. Over one third of respondents met criteria for at least mild depression, of which 20% met criteria for moderate to severe depression. Among demographic and personal trait variables, emotional intelligence emerged as a significant inverse predictor of depression.

  View details for DOI 10.1016/j.amjsurg.2016.10.017

  View details for PubMedID 28017297

• Grit as a predictor of risk of attrition in surgical residency. American journal of surgery Salles, A., Lin, D., Liebert, C., Esquivel, M., Lau, J. N., Greco, R. S., Mueller, C. 2017; 213 (2): 288-291

  Abstract

  Grit, a measure of perseverance, has been shown to predict resident well-being. In this study we assess the relationship between grit and attrition.We collected survey data from residents in a single institution over two consecutive years. All residents in general surgery were invited to participate (N = 115). Grit and psychological well-being were assessed using validated measures. Risk of attrition was measured using survey items.73 residents participated (63% response rate). Grit was positively correlated with general psychological well-being (r = 0.30, p < 0.05) and inversely correlated with depression (r = -0.25, p < 0.05) and risk of attrition (r = -0.37, p < 0.01). In regression analyses, grit was positively predictive of well-being (B = 0.77, t = 2.96, p < 0.01) and negatively predictive of depression (B = -0.28 t = -2.74, p < 0.01) and attrition (B = -0.99, t = -2.53, p < 0.05).Attrition is a costly and disruptive problem in residency. Grit is a quick, reliable measure which appears to be predictive of attrition risk in this single-institution study.

  View details for DOI 10.1016/j.amjsurg.2016.10.012

  View details for PubMedID 27932088

• A Mixed-Methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship. Academic medicine Lau, J. N., Mazer, L. M., Liebert, C. A., Merrell, S. B., Lin, D. T., Harris, I. 2017

  Abstract

  To review mistreatment reports from before and after implementation of a mistreatment program, and student ratings of and qualitative responses to the program to evaluate the short-term impact on students.In January 2014, a video- and discussion-based mistreatment program was implemented for the surgery clerkship at the Stanford University School of Medicine. The program aims to help students establish expectations for the learning environment; create a shared and personal definition of mistreatment; and promote advocacy and empowerment to address mistreatment. Counts and types of mistreatment were compared from a year before (January-December 2013) and two years after (January 2014-December 2015) implementation. Students' end-of-clerkship ratings and responses to open-ended questions were analyzed.From March 2014-December 2015, 141/164 (86%) students completed ratings, and all 47 (100%) students enrolled from January-August 2014 provided qualitative program evaluations. Most students rated the initial (108/141 [77%]) and final (120/141 [85%]) sessions as excellent or outstanding. In the qualitative analysis, students valued that the program helped establish expectations; allowed for sharing experiences; provided formal resources; and provided a supportive environment. Students felt the learning environment and culture were improved and reported increased interest in surgery. There were 14 mistreatment reports the year before the program, 9 in the program's first year, and 4 in the second year.The authors found a rotation-specific mistreatment program, focused on creating shared understanding about mistreatment, was well received among surgery clerkship students, and the number of mistreatment reports decreased each year following implementation.

  View details for DOI 10.1097/ACM.0000000000001575

  View details for PubMedID 28121657

• Evaluation of a technical and nontechnical skills curriculum for students entering surgery. The Journal of surgical research Shipper, E. S., Miller, S. E., Hasty, B. N., Merrell, S. B., Lin, D. T., Lau, J. N. 2017; 219: 92–97

  Abstract

  Prior interventions to address declining interest in surgical careers have focused on creating early exposure and fostering mentorship at the preclinical medical student level. Navigating the surgical environment can be challenging, however, and preclinical students may be more likely to pursue a surgical career if they are given the tools to function optimally.We designed a 10-wk technical and nontechnical skills curriculum to provide preclinical students with knowledge and skills necessary to successfully navigate the surgical learning environment, followed by placement in high-fidelity surgical simulations and scrubbing in on operative cases with attending surgeons. We administered pre-post surveys to assess student confidence levels in operative skills, self-perceptions of having a mentor, overall course efficacy, and interest in a career in surgery.The overall response rates presurvey and postsurvey were 100% (30 of 30) and 93.3% (28 of 30), respectively. Confidence levels across all operative skills increased significantly after completing the course. Faculty mentorship increased significantly from 30.0% before to 61.5% after the course. Overall effectiveness of the course was 4.00 of 5 (4 = "very effective"), and although insignificant, overall interest in a career in surgery increased at the completion of the course from 3.77 (standard deviation = 1.01) to 4.17 (standard deviation = 0.94).Our curriculum was effective in teaching the skills necessary to enjoy positive experiences in planned early exposure and mentorship activities. Further study is warranted to determine if this intervention leads to an increase in students who formally commit to a career in surgery.

  View details for PubMedID 29078916

• Pilot evaluation of the Computer-Based Assessment for Sampling Personal Characteristics test. The Journal of surgical research Shipper, E. S., Mazer, L. M., Merrell, S. B., Lin, D. T., Lau, J. N., Melcher, M. L. 2017; 215: 211–18

  Abstract

  High attrition rates hint at deficiencies in the resident selection process. The evaluation of personal characteristics representative of success is difficult. Here, we evaluate a novel tool for assessing personal characteristics.To evaluate feasibility, we used an anonymous voluntary survey questionnaire offered to study participants before and after contact with the CASPer test. To evaluate the CASPer test as a predictor of success, we compared CASPer test assessments of personal characteristics versus traditional faculty assessment of personal characteristics with applicant rank list position.All applicants (n = 77) attending an in-person interview for general surgery residency, and all faculty interviewers (n = 34) who reviewed these applications were invited to participate. Among applicants, 84.4% of respondents (65 of 77) reported that a requirement to complete the CASPer test would have no bearing or would make them more likely to apply to the program (mean = 3.30, standard deviation = 0.96). Among the faculty, 62.5% respondents (10 of 16) reported that the same condition would have no bearing or would make applicants more likely to apply to the program (mean = 3.19, standard deviation = 1.33). The Spearman's rank-order correlation coefficients for the relationships between traditional faculty assessment of personal characteristics and applicant rank list position, and novel CASPer assessment of personal characteristics and applicant rank list position, were -0.45 (P = 0.033) and -0.41 (P = 0.055), respectively.The CASPer test may be feasibly implemented as component of the resident selection process, with the potential to predict applicant rank list position and improve the general surgery resident selection process.

  View details for PubMedID 28688650

• Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions. American journal of surgery Brandford, E., Hasty, B., Bruce, J. S., Bereknyei Merrell, S., Shipper, E. S., Lin, D. T., Lau, J. N. 2017

  Abstract

  Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students.Students completed anonymous surveys during the first and last didactic session of their surgery clerkship in which they defined and gave examples of mistreatment. Team-based thematic analysis was performed on responses.Between January 2014 and June 2016, 240 students participated in the surgery clerkship. Eighty-nine percent of students completed a survey. Themes observed included (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, and (4) Contextual Amplifiers of Mistreatment Severity.The themes observed in this study improve our understanding of the students' perspective on mistreatment as it relates to their role in the clinical learning context, which can serve as a starting point for interventions that ultimately improve students' experiences in the clinical setting.

  View details for PubMedID 29167023

• Belonging, Well-being, and Attrition in General Surgery Salles, A., Lin, D. T., Liebert, C. A., Esquivel, M., Mueller, C. ELSEVIER SCIENCE INC. 2016: E40–E41

  View details for DOI 10.1016/j.jamcollsurg.2016.08.106

  View details for Web of Science ID 000395825100087

• Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study. Surgery Liebert, C. A., Mazer, L., Bereknyei Merrell, S., Lin, D. T., Lau, J. N. 2016; 160 (3): 591-598

  Abstract

  The flipped classroom, a blended learning paradigm that uses pre-session online videos reinforced with interactive sessions, has been proposed as an alternative to traditional lectures. This article investigates medical students' perceptions of a simulation-based, flipped classroom for the surgery clerkship and suggests best practices for implementation in this setting.A prospective cohort of students (n = 89), who were enrolled in the surgery clerkship during a 1-year period, was taught via a simulation-based, flipped classroom approach. Students completed an anonymous, end-of-clerkship survey regarding their perceptions of the curriculum. Quantitative analysis of Likert responses and qualitative analysis of narrative responses were performed.Students' perceptions of the curriculum were positive, with 90% rating it excellent or outstanding. The majority reported the curriculum should be continued (95%) and applied to other clerkships (84%). The component received most favorably by the students was the simulation-based skill sessions. Students rated the effectiveness of the Khan Academy-style videos the highest compared with other video formats (P < .001). Qualitative analysis identified 21 subthemes in 4 domains: general positive feedback, educational content, learning environment, and specific benefits to medical students. The students reported that the learning environment fostered accountability and self-directed learning. Specific perceived benefits included preparation for the clinical rotation and the National Board of Medical Examiners shelf exam, decreased class time, socialization with peers, and faculty interaction.Medical students' perceptions of a simulation-based, flipped classroom in the surgery clerkship were overwhelmingly positive. The flipped classroom approach can be applied successfully in a surgery clerkship setting and may offer additional benefits compared with traditional lecture-based curricula.

  View details for DOI 10.1016/j.surg.2016.03.034

  View details for PubMedID 27262534

• Emotional Intelligence as a Predictor of Resident Well-Being. Journal of the American College of Surgeons Lin, D. T., Liebert, C. A., Tran, J., Lau, J. N., Salles, A. 2016; 223 (2): 352-358

  Abstract

  There is increasing recognition that physician wellness is critical; it not only benefits the provider, but also influences quality and patient care outcomes. Despite this, resident physicians suffer from a high rate of burnout and personal distress. Individuals with higher emotional intelligence (EI) are thought to perceive, process, and regulate emotions more effectively, which can lead to enhanced well-being and less emotional disturbance. This study sought to understand the relationship between EI and wellness among surgical residents.Residents in a single general surgery residency program were surveyed on a voluntary basis. Emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-Short Form. Emotional intelligence and wellness parameters were correlated using Pearson coefficients. Multivariate analysis was performed to identify factors predictive of well-being.Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence scores correlated positively with psychological well-being (r = 0.74; p < 0.001) and inversely with depression (r = -0.69, p < 0.001) and 2 burnout parameters, emotional exhaustion (r = -0.69; p < 0.001) and depersonalization (r = -0.59; p < 0.001). In regression analyses controlling for demographic factors such as sex, age, and relationship status, EI was strongly predictive of well-being (β = 0.76; p < 0.001), emotional exhaustion (β = -0.63; p < 0.001), depersonalization (β = -0.48; p = 0.002), and depression (β = -0.60; p < 0.001).Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI can identify those who are most likely to thrive in surgical residency. Interventions to increase EI can be effective at optimizing the wellness of residents.

  View details for DOI 10.1016/j.jamcollsurg.2016.04.044

  View details for PubMedID 27182037

• Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial AMERICAN JOURNAL OF SURGERY Liebert, C. A., Lin, D. T., Mazer, L. M., Bereknyei, S., Lau, J. N. 2016; 211 (2): 451-U214

  Abstract

  The flipped classroom has been proposed as an alternative curricular approach to traditional didactic lectures but has not been previously applied to a surgery clerkship.A 1-year prospective cohort of students (n = 89) enrolled in the surgery clerkship was taught using a flipped classroom approach. A historical cohort of students (n = 92) taught with a traditional lecture curriculum was used for comparison. Pretest and post-test performance, end-of-clerkship surveys, and National Board of Medical Examiners (NBME) scores were analyzed to assess effectiveness.Mean pretest and post-test scores increased across all modules (P < .001). There was no difference between mean NBME examination score in the prospective and historical cohorts (74.75 vs 75.74, P = .28). Mean ratings of career interest in surgery increased after curriculum completion (4.75 to 6.50, P < .001), with 90% reporting that the flipped classroom contributed to this increase.Implementation of a flipped classroom in the surgery clerkship is feasible and results in high learner satisfaction, effective knowledge acquisition, and increased career interest in surgery with noninferior NBME performance.

  View details for DOI 10.1016/j.amjsurg.2015.10.004

  View details for Web of Science ID 000368344800023

• Belonging as a Measure of Risk of Attrition Salles, A., Liebert, C. A., Lin, D. T. ELSEVIER SCIENCE INC. 2015: S49

  View details for DOI 10.1016/j.jamcollsurg.2015.07.103

  View details for Web of Science ID 000361119700084

• Emotional Intelligence as a Predictor of Resident Wellness Lin, D. T., Liebert, C. A., Lau, J. N., Salles, A. ELSEVIER SCIENCE INC. 2015: S52

  View details for DOI 10.1016/j.jamcollsurg.2015.07.110

  View details for Web of Science ID 000361119700091

• Validity evidence for Surgical Improvement of Clinical Knowledge Ops: a novel gaming platform to assess surgical decision making AMERICAN JOURNAL OF SURGERY Lin, D. T., Park, J., Liebert, C. A., Lau, J. N. 2015; 209 (1): 79-85

  Abstract

  Current surgical education curricula focus mainly on the acquisition of technical skill rather than clinical and operative judgment. SICKO (Surgical Improvement of Clinical Knowledge Ops) is a novel gaming platform developed to address this critical need. A pilot study was performed to collect validity evidence for SICKO as an assessment for surgical decision making.Forty-nine subjects stratified into 4 levels of expertise were recruited to play SICKO. Later, players were surveyed regarding the realism of the gaming platform as well as the clinical competencies required of them while playing SICKO.Each group of increasing expertise outperformed the less experienced groups. Mean total game scores for the novice, junior resident, senior resident, and expert groups were 5,461, 8,519, 11,404, and 13,913, respectively (P = .001). Survey results revealed high scores for realism and content.SICKO holds the potential to be not only an engaging and immersive educational tool, but also a valid assessment in the armamentarium of surgical educators.

  View details for DOI 10.1016/j.amjsurg.2014.08.033

  View details for PubMedID 25454955

• The assessment of emotional intelligence among candidates interviewing for general surgery residency. Journal of surgical education Lin, D. T., Kannappan, A., Lau, J. N. 2013; 70 (4): 514-521

  View details for DOI 10.1016/j.jsurg.2013.03.010

  View details for PubMedID 23725940

• The Effect of Positive and Negative Verbal Feedback on Surgical Skills Performance and Motivation Annual Spring Meeting of the Association-for-Program-Directors-in-Surgery (APDS) Kannappan, A., Yip, D. T., Lodhia, N. A., Morton, J., Lau, J. N. ELSEVIER SCIENCE INC. 2012: 798–801

  Abstract

  There is considerable effort and time invested in providing feedback to medical students and residents during their time in training. However, little effort has been made to measure the effects of positive and negative verbal feedback on skills performance and motivation to learn and practice. To probe these questions, first-year medical students (n = 25) were recruited to perform a peg transfer task on Fundamentals of Laparoscopic Surgery box trainers. Time to completion and number of errors were recorded. The students were then randomized to receive either positive or negative verbal feedback from an expert in the field of laparoscopic surgery. After this delivery of feedback, the students repeated the peg transfer task. Differences in performance pre- and post-feedback and also between the groups who received positive feedback (PF) vs negative feedback (NF) were analyzed. A survey was then completed by all the participants. Baseline task times were similar between groups (PF 209.3 seconds; NF 203 seconds, p = 0.58). The PF group averaged 1.83 first-time errors while the NF group 1 (p = 0.84). Post-feedback task times were significantly decreased for both groups (PF 159.75 seconds, p = 0.05; NF 132.08 seconds, p = 0.002). While the NF group demonstrated a greater improvement in mean time than the PF group, this was not statistically significant. Both groups also made fewer errors (PF 0.33 errors, p = 0.04; NF 0.38 errors, p = 0.23). When surveyed about their responses to standardized feedback scenarios, the students stated that both positive and negative verbal feedback could be potent stimulants for improved performance and motivation. Further research is required to better understand the effects of feedback on learner motivation and the interpersonal dynamic between mentors and their trainees.

  View details for DOI 10.1016/j.jsurg.2012.05.012

  View details for PubMedID 23111049

• The EphB4 receptor promotes the growth of melanoma cells expressing the ephrin-B2 ligand PIGMENT CELL & MELANOMA RESEARCH Yang, N., Lopez-Bergami, P., Goydos, J. S., Yip, D., Walker, A. M., Pasquale, E. B., Ethell, I. M. 2010; 23 (5): 684-687

  View details for DOI 10.1111/j.1755-148X.2010.00745.x

  View details for Web of Science ID 000281552100016

  View details for PubMedID 20649938

• Papillary Thyroid Cancer Presenting As Horner Syndrome PEDIATRIC BLOOD & CANCER Yip, D., Drachtman, R., Amorosa, L., Trooskin, S. 2010; 55 (4): 739-741

  Abstract

  Thyroid carcinomas are an uncommon entity in childhood. We report a case of papillary thyroid cancer presenting as Horner syndrome in a 14 year-old child, which is the only reported such case in the pediatric population.

  View details for DOI 10.1002/pbc.22599

  View details for Web of Science ID 000281542900029

  View details for PubMedID 20535818