Eric Nomura, a fourth-year M.D. student, didn’t anticipate that his sewing skills would come in handy in medical school beyond perfecting his suturing technique. As it turns out, his passion for hand-sewing elaborate Halloween costumes was directly applicable to the capstone project he selected: designing and crafting a model to depict the development of a fetal heart.

The idea for the fetal heart model emerged early on during an anatomy class, where Nomura and other M.D. students found it difficult to conceptualize the organ’s development from the 2-D drawings. Nomura was attracted to the challenge because it brought together basic science and medicine—a pairing he hopes to continue by pursuing a career in pathology.

His mentor Philip Copenhaver, Ph.D., a professor in of cell, developmental and cancer biology, OHSU School of Medicine, who joined him at the capstone poster presentation on March 6, explained: “Fetal anatomy is challenging to visualize because the fetal tissues grow and transform along three planes. However, it is critical that future physicians have a strong understanding of heart development, which is the basis for understanding physiology and pathology.”

Together Nomura and Dr. Copenhaver agreed that a larger and better 3D model of the four landmark stages of heart development could be more effective for teaching students and would make a good capstone project. “The developing heart doesn’t look like what you would expect, which is why a hands-on model is helpful,” said Nomura, who demonstrated how heart tubes fold and loop with his home-stitched model at the poster session.

Conceptualizing a new model was one thing, but to create it Nomura enlisted the help of his mother, who is an occupational therapist and talented seamstress. According to Nomura, she often brings the two together to design activities that help her patients with mobility challenges. Working side-by-side with her was special he says. “I’ve had my head down in med school for four years and spending time sewing my capstone project gave us a chance to reconnect. Explaining the model so we could stitch it also helped me create a model I know will be teachable.” In fact, Nomura is passing on his creation to OHSU faculty for use in the classroom, so future students can benefit from his work.

Preparing for Lifelong Learning

Nomura’s fetal heart project is one of 138 capstone projects that fourth-year M.D. students presented at the Scholarly Projects Capstone day, held March 6 this year. Now in its third year, the day of poster presentations and awards showcases what students have learned in a format similar to a professional meeting—a forum most will participate in as a part of continuing education throughout their careers. The scholarly projects are a key component of the sweeping curriculum changes the School of Medicine’s M.D. program.

For Scholarly Projects curriculum director Heidi D. Nelson, M.D., M.P.H., professor of medical informatics and clinical epidemiology and medicine, the value of student investigation embedded in the process itself—from conceptualizing a topic to working with a mentor to communicating their results in a presentation—which requires students to integrate research with clinical concepts.

“By researching complex clinical problems that resonate with their interests, students develop critical analysis skills that are essential to becoming a competent physician,” said Dr. Nelson.

Leveraging the scholarly project experience

For students, there is tangible value to the projects’ experience. Mentors can provide connections with a professional community and provide an avenue to explore a career path in a particular field.  Completing an original project also familiarizes students with interpreting new research, something they will need throughout their medical careers, whether in research or clinical practice.  For the projects, students must also communicate their conclusions as they would at a national meeting. So far 111 students have leveraged their work to present their posters at conferences and 46 have published research papers with another 41 papers submitted by students for publication.

Fourth-year student Fernando Salcido-Torres leveraged his capstone experience to help prepare for his intended career as a primary care physician. Salcido-Torres chose to study how medical students develop strong health literacy and patient communication skills.  His interest came from growing up bilingual, which he says gave him insight into the importance of reducing communication barriers between patients and providers. He saw first-hand that “patients’ language and health literacy limitations are only one part of the equation. The other part is how we (providers) engage with patients.”

This observation prompted Salcido-Torres to explore how medical students are taught doctor-patient communication. Because of his interest, Salcido-Torres was paired with mentor Cliff Coleman, M.D., M.P.H., a national leader in the field of doctor-patient communication, who teaches the subject to OHSU M.D. students and encouraged him to examine the effectiveness of new communication modules in the curriculum.

Utilizing taped simulated patient interviews that are a part of students’ clinical exams, Salcido-Torres determined that the new longitudinal communication curriculum was effective in helping students build patient-centered communication habits. The impact of building strong communication habits in medical students he says is “huge because the quality of communication with a provider can have an immense impact on a patient’s health outcomes.” As a future primary care physician with plans to serve bilingual or Spanish-speaking communities, he hopes his patients will benefit from the insight he gained through his capstone project.

Another fourth-year student, Rebecca Empey, designed a research study to understand how parents utilize the internet to make medical decisions about their children. Working closely with her mentor, Empey designed and administered a survey during her rotation in pediatrics, enabling her to complete the research portion of her project in about six weeks. She describes the work as an intense clinical experience, where she interviewed dozens of families seeking pediatric otolaryngology care for multiple hours a day over the course of her rotation. “It was a bit exhausting,” she admits, but “the experience of connecting with many parents was incredibly helpful to understand where they are coming from and what sources influence their decision making.”

Among the sample group, she found that parents’ decisions are greatly influenced by their initial internet research, even among those who have a high level of trust in their children’s medical providers.  Empey, who plans to go into general surgery, said understanding parents’ information biases can help physicians address misinformation and connect better with families.

Honoring mentors and scholars

Concluding the day of poster presentations involving formal assessments and informal discussions was a ceremony recognizing the contributions of both students and mentors. Faculty, mentors, students from across all four years and family members turned out to see the presenters showcase their hard work.

“Faculty mentors are absolutely critical to this work and to providing students with guidance and experiences that prepare them to be curious, critical thinkers and life-long learners,” said Dr. Nelson as she introduced the mentor awards. “Thank you to the more than 300 current and previous faculty mentors who provide an incredible range of opportunities for students.”

The winning Mentors nominated by their students for recognition were:

• Brian Frank, M.D., assistant professor of family medicine
• Teri Greiling, M.D., Ph.D., assistant professor of dermatology
• Carol MacArthur, M.D., professor of otolaryngology
• Alex Foster, M.D., M.P.H., assistant professor of pediatrics

Following the mentor acknowledgments, six students, one from each of the scholarly program areas, received awards in recognition of their scholarly contributions to medicine. Congratulations to the winning students and their School of Medicine faculty mentors!

• Group A, Law, Business and Health Policy: Zoe Frank, Timing of Delivery in Women with Prior Uterine Rupture: A Decision Analysis; mentor Aaron Caughey, M.D., Ph.D., professor and chair of obstetrics and gynecology
  
• Group B, Education, Quality Improvement and Ethics: Caroline Jolley, Impact of a culinary medicine class on medical students’ nutrition knowledge, attitudes, and behaviors; mentor: Brian Frank, M.D.; assistant professor of family medicine
• Group C, Combined degrees: James Goodman, Defining the role of the meningeal lymphatic system in Alzheimer’s dementia; mentor Jeffrey Iliff, M.D., associate professor of anesthesiology
• Group D, Basic Science and Biomedical Engineering: Douglas Preston, Ph.D., Improving Throughput and Sensitivity with ELISA Based Arrays for Pancreatic Cancer Exosome Detection; mentor Sadik Esener, Ph.D., director of the Center of Early Detection Advanced Research, Knight Cancer Institute
• Group E, Clinical Research: Marta Schenk, Public Perceptions of Abortion Complications: A National Survey; mentor Leo Han M.D., M.P.H., assistant professor of obstetrics and gynecology
  
• Group F, Epidemiology, Community and Global Health: Emma Felzien, Evaluation of written education efficacy regarding pneumonia among caregivers in Trujillo, Peru; mentor Rebecca Cantone M.D. Family Medicine