Blog – Hanna Erickson, MD, PHD

Almost Docs: How I Found an Online Community

May 27, 2019July 12, 2019Leave a comment

This was originally shared on www.almostdocs.com (which no longer exists???) in May 2018. Twitter is a great place for connecting with other folks in the medical profession, so I thought I’d share it here!

I didn’t know much about MD/PhD programs as an undergraduate. I found some resources online and met with the program director at my school, but I didn’t really have easy access to any current MD/PhD students to go to for advice as I was preparing to apply to medical school. I also didn’t know many pre-meds or join any pre-med clubs. I hadn’t planned on going to medical school until late into undergrad, so I didn’t have a supportive group that would be going through the same grueling process that I was about to undertake. So I went to social media.

The summer I applied to medical school, I made a Twitter account specifically for connecting with the medical community. Twitter was an ideal platform for this purpose because of the short character limits for posts, the ability to make public posts and follow others who do not necessarily have to follow you back, the easy ability to retweet (or share) another account’s post on your own timeline, hashtags to connect posts to those of related content, and handles that allow you to establish your identity while also maintaining anonymity if desired (for example, I started being known as only pre-MD/PhD Life). While other social media sites have incorporated some of these aspects, Twitter remains the best site I’ve found for a robust discussion within a broad community.

I began by finding other pre-med accounts to follow. I did this by searching for those that had “pre-med” in their name or bio and then going through their following list to find others. Soon some started to follow me back. We would comment in response to each other’s posts and encourage each other when things didn’t go as planned. Some of these people I’ve even met in real life. Many of these people have since started med school, finished grad school, and are now in residency, and it’s been an absolute joy to see them progress through their training. I’m glad to learn from this community that has supported me since my early days of pursuing medicine.

Yet, here I am, 5 years in and still in the graduate phase on my MD/PhD program, which is one of the challenging things about this training pathway. As a MD/PhD student, the people who started med school the same time as me could nearly be practicing physicians by the time I step into the clinic as a 3^rd year medical student! Therefore, I needed to have a community of physician-scientist trainees who could understand the more unique aspects of our training that those in other tracks could not. There were a few of us who found each other on Twitter, but it was harder to find those who could provide insight from further along the training path in my early days on Twitter. I joined a local MD/PhD trainee community upon beginning my program, but that still didn’t give me a global perspective on what it’s like to be a physician-scientist in training.

There’s an added benefit when trainees from different institutions come together. They can learn about the different ways their programs ultimately train them for a career as a physician-scientist. For example, mine starts in the PhD portion, others start with med school and transition to the PhD two years in, and some have even moved part of the clinical rotations to before the PhD. There may be things that other programs do to help their students develop into physician-scientists that mine doesn’t and vice versa. Such a community can provide support and diverse insights, which can help identify ways by which our training and medicine in general can be improved.

To help facilitate this discussion, the hashtag #DoubleDocs was recently adopted by the physician-scientist trainee community to connect trainees from undergraduate to residency and beyond. It was designed to be inclusive to both MD and DO trainees as well as those who have chosen to pursue a PhD and those who pursue other paths for research training. It does not mean double doctorates, but docs who are doubly in the research and medical worlds. What is special about this hashtag is that it rose organically from the physician-scientist trainee community as a way to stay connected. Unlike other hashtags, it is intended to have a specific focus on the training aspect of physician-scientists.

Taking this a step further, I, along with my colleagues in the American Physician Scientists Association, utilized Twitter’s list feature to make it easier for physician-scientist trainees to find each other. On the APSA twitter account (@A_P_S_A), we now have public lists for students at different stages and pathways of training including pre-med, MD/DO students, MD/DO-PhD students, Residents and Fellows, and established physician-scientists who can be resources for trainees. People can subscribe to these lists to find the Twitter accounts of other #DoubleDocs.

In the span of a few days from the start of this hashtag, I made nearly 100 new connections to trainees across the globe that have a similar career goal and unique training path, which highlights the power of Twitter to bring people together. Social media can get a bad rep, but it can also be quite useful! #DoubleDocs is just one hashtag, but so many others exist that can help people find a community!

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Almost Docs: 10 Reasons Why Being a Medical Student is Awesome

May 13, 2019June 20, 2019Leave a comment

This was originally shared on www.almostdocs.com (which doesn’t exist anymore???) in April 2014. I’m sharing this again because it’s important to remind ourselves that what we’re doing is actually really great!

In a recent medical school class, one of my lecturers told us, “The best days of medical school are the day you get in and the day you graduate.”

We all laughed, but it was sort of a painful laugh as we hesitantly looked around the room to see how others reacted to the thought…

The underlying message of that statement that we all know too well is medical school is hard. It is way more work than you’d ever think you’d handle, which means a lot less sleep and a lot more stress. It separates you from your friends and family. The time you once had for things you enjoy seems to be sucked away. You may even find yourself in the wee hours of the night after weeks of sleep deprivation cramming for a few exams and questioning why you’re putting yourself through all of this.

And yet, it’s awesome.

It may not seem that way when you look around at your piles of books, notecards, lecture notes, empty energy drink cans, ramen packets, and building debt, but in comparison to other things, it’s pretty great.

Not convinced? Here’s 10 reasons to make you believe otherwise.

#1. You never have to worry about finding something to do.

Your to-do list is never ending, but it’s so much better than sitting around twiddling your thumbs. If you don’t believe me, set aside a free day to not work on anything for school and see how crazy it makes you.

#2. You get to do a variety of things.

Sick of studying for one M1 class? Study for another class or work on stuff for research if you’re a MD/PhD student like me. Research bringing you down? Go back to studying for your medical school classes. Don’t want to learn about the renal system any more? Good because the test is done and the class has moved on to endocrine system. You have so many things to do and study that you can always change up what you do to keep things exciting while continuing to be productive!

#3. You learn to get the most out of your time.

Do all the things.png — Do all the things.

Planning out your research so you have an incubation step during the time you have to go to class, a seminar, or TA? Of course. Studying notecards during centrifuge steps? Duh. Reading papers during breaks in classes? Always. Going through lecture notes on the bus? Yup. Add on normal people things like buying groceries, doing laundry, and paying bills and you’ve really got to multi-task. This way you’re forced to learn how to optimize your time and get as much done as you physically can.

#4. You may even get to defy the boundaries of time.

Whether you’re balancing medical school and graduate school classes, being a teaching assistant, and doing research like me, or simply dealing with the heavy load of medical school itself, there’s definitely more to do in the day than you have time for, but somehow, you can find a way to make it all work out.

Channeling my inner Hermione, I’ve had to do just that with the grad school and medical school allowing you to register for classes that sometimes meet at the same time. Luckily, I can get by without a time turner since the medical school podcasts the lectures instead and therefore maximize the number of classes that I can take at once. If your school podcasts your lectures, you can surely do the same!

#5. You don’t have to worry about finding a job for a very long time.

Where am I going to be for the next 4 years as an MD student or 8 years as an MD/PhD student? Right here. What am I going to be doing? Exactly what I’m doing now. You’ve made it through the competitive admissions process, so you don’t need to be job searching like your fellow college graduates.

#6. You learn to understand more about others than they seem to understand about themselves.

Patients may not always tell us everything that we need to know, and we’re taught early to figure out what they’re not telling us from their history and their tendencies during your interaction. You learn to see the subtleties in a person’s ways and learn how to interact with them to get the best outcome in their health. But this can carry on to your personal relationships and help you understand more about the people you deal with day in and day out as well.

#7. You don’t have to take any more lib eds.

Yeah that’s right. No more wasting time with classes that you have to sit through thinking, “When am I ever going to need to know this?” Now the answer is “When you’re a doctor.”

#8. You get to tell people that you’re a medical student.

Med Students.png — What medical students do.

This usually impresses people and only sometimes makes them think you’re crazy.

#9. You get to meet a lot of cool people.

Try talking to your parents or friends back home about signaling pathways that lead to T cell activation or the pharmacologic mechanism of any drug and they’ll probably just blankly stare back at you. But talk to your medical school friends about the same thing and they’ll not only understand but they’ll keep the conversation going. Medical school teaches us a sort of new language that most people don’t know but luckily your peers do. Seriously, look around the room and bask in the awe (and sometimes the terror) that you are surrounded by future doctors.

Taking it a step further, if you’re also in graduate school like me, you also get to know a lot of graduate students who are on their way to being doctors of a different type. These people share your love of discovery and become your support system through the struggle that is the PhD. Who knows, maybe one of them will even make a breakthrough discovery that changes the way we look at biology or treat disease. These are awesome people to know and you really can’t make it through without them.

#10. You get to learn a lot of cool things.

The human body is frustratingly – yet beautifully – complex and you get to spend your life learning about it. Lucky you. While the amount that you’re expected to know about it can be overwhelming at times (and by times I mean always), you are incredibly fortunate to be living in a time when we know as much as we do. Can you believe that there was a time that we didn’t know how the heart, lungs, or kidneys worked? A time when we didn’t realize that something as simple as washing hands would decrease spread of infectious disease particularly in hospital settings? Sure, we have a long way to go, but we’ve already come such a far way, and you get to benefit from the hard work of others who once struggled to discover what you’re now learning.

AMCAS Research Personal Statement

March 28, 2013June 27, 20191 Comment

For those applying to MD/PhD programs, you will have to complement your MD personal statement with a MD/PhD statement and a research statement. The research statement has a 10,000 character limit and serves to strengthen your argument why you want to do research and why you would be a good researcher. As an example, here is my research personal statement:

I initially became interested in research as an alternative to becoming a pharmacist because I wanted to actively search for new information rather than simply apply what is known. My experience volunteering at the University of Minnesota Medical Center (UMMC) helped me gain an interest in contributing to health care, which led me to wanting to do research that would have an impact on human wellness and understanding of the human body. As a freshman in college, I had wanted to work on synthetically designing novel drugs so that I could use chemistry to help improve human health. Although I was planning to do strictly chemistry research, a guest speaker for my genetics freshman seminar said he had availability for undergraduates in his lab so I jumped on the opportunity. This was an important decision that caused my vision for my future research to involve a broader spectrum of science.

My first research lab experience was in Scott Fahrenkrug’s lab in the animal science department at the University of Minnesota, which incorporated quantitative genetics, functional genomics, and genetic engineering to design methods for specifically inducing homologous recombination to create mutations in DNA. This research was applied to the design of transgenic animals such as a pig model for cystic fibrosis and cows lacking the growth hormone inhibitor gene so that they would produce more muscle per animal to potentially produce more meat to supply the growing world population.

I was involved in the research by performing much of the manual lab work for the assistant professor and lab supervisor, Dan Carlson. I cloned plasmids and verified their identity by gel electrophoresis, isolated RNA from tissue samples, and grew cells, lysed them and analyzed their DNA by PCR. I was able to learn vast amounts about the process of research and how my work contributed despite my limited knowledge of genetics and biochemistry that made it difficult to completely understand the mechanism by which we were pursuing our goal. I eventually understood how everything was connected in the lab: I made plasmids that were designed by Dan who would then put them into pig or cow cells to express the sequence-specific homologous recombination-inducing restriction enzymes that were either zinc-finger nucleases or transcription activator-like endonucleases (TALENs). The cells modified by these restriction enzymes had the potential to be cloned into animals to determine the effectiveness of the mutations.

I volunteered in the lab for the summer after my freshman year of college and was hired as a lab technician for the remainder of my time in the lab. Working in this lab helped me appreciate biology from a chemist’s perspective almost to the point that I felt like more of a biologist than a chemist. This experience made me excited about my future biochemistry and genetics classes where I was finally able to understand the general mechanisms of the protocols performed in the lab. By having applied a wide range of protocols, I found it easier to learn the biochemical mechanisms behind the research. This also made me more interested in topics related to our work in genetic engineering such as the possibility of using siRNA or miRNA to selectively turn off or reduce translation of certain proteins that could be potential methods for selectively targeting cancer cells based on their mutations. I learned to value the biological techniques involved in the lab’s research even though I do not want to focus my research on genetic engineering of transgenic animals.

Because I want to more directly contribute my work to medical research and utilize my chemistry background, I sought another lab position that would give me an opportunity to begin preparing myself for such a career. Therefore, I joined Natalia Treyakova’s medicinal chemistry research group in the cancer research center at the University of Minnesota in my junior year of college. The primary goal of the lab is to understand the role of DNA adducts in carcinogenesis by using the tools of mass spectrometry, organic synthesis, biochemistry, molecular biology, and computational chemistry.

My experience in this lab has helped me grow as an independent researcher because I was able to quickly comprehend concepts due to my strong chemistry background and previous experience in a genetic engineering lab. This experience helped me quickly become more independent in the lab. It has also improved my ability to communicate my results to others and practice creativity by designing my own project, going to lab meetings, presenting my research, participating in journal club, writing reports for Professor Tretyakova, troubleshooting, and receiving feedback from the other lab members.

When I started in the lab, I was placed to work with Teshome Gherezghiher, a post-doctoral student, to help him with his work on cyclophosphamide, a prodrug of a DNA alkylating agent, nornitrogen mustard. I learned how to perform the fundamental techniques used in the lab such as high-performance liquid chromatography and mass spectrometry while I was beginning to optimize the synthesis of standards for biological analyses. These standards had already been described in the literature, but I worked for four months to alter the reaction conditions to increase the yield of the reaction. I also synthesized an additional standard from one of the products of the reaction that had not been synthesized in the lab before and was not well characterized.

Over time, I have begun to understand how my work has contributed to more advanced analytical techniques. These standards are used to not only quantify the adduct formation and repair in cell lines in vivo, but they are also being used to quantify adduct formation in leukocytes isolated from donated blood that are treated with the drug. This can potentially be used in an ex vivo test in the clinic. Developing such a test to quantify adduct formation will hopefully contribute to personalized dosing of the drug, which is important because it has been shown that the sensitivity of the drug varies; this is the case in Fanconi Anemia patients who require a much smaller dose than other cancer patients without the disease to have the same amount of adduct formation because there are more defects in their DNA repair mechanisms. Without proper dosing of the drug, higher sensitivity patients may experience more severe side effects.

In addition to contributing to Teshome’s work on cyclophosphamide, I took on a project from a previous graduate student in the lab, Xun Ming, to study the occurrence of protein-DNA cross-links induced by cisplatin and their potential to facilitate mutagenicity and cytotoxicity. To our knowledge, cisplatin has not been previously shown to form mutagenic DNA-protein adducts. In his thesis, Xun showed how he had studied a cisplatin cross-link between lysine and guanine; he was successful at synthesizing a standard and was able to observe the cross-link in cells treated with the drug. He also wanted to search for guanine-cysteine cross-links that he determined to exist. Although he tried to synthesize a novel standard for the guanine-cysteine adduct, he struggled with its stability. Since December 2011, I have been trying to optimize a multi-step synthesis and purification method for this molecule.

When I synthesize and purify the standard without degradation, I will be continuing my research to search for the cross-link in cancer cell lines. Xun had hypothesized the cysteine-guanine cross-links migrate to guanine-guanine cross-links though the rate is unknown. The migration is believed to only occur with cross-links involving cysteine, but the formation of the specific adduct has not been confirmed. Observing the stability of the conjugate in cells will help determine whether the DNA-protein conjugates could potentially have a mutagenic effect. Also, verifying the formation of such cross-links in cells could help explain the effectiveness of the drug in certain kinds of tumors such as sarcomas, lymphomas, and some carcinomas based on protein interactions.

My research experiences have motivated me to learn more about cancer and become passionate about understanding its mechanisms and improving its treatment. Cancer is an incredibly complex disease; every cancer involves different genetic mutations resulting in alterations in the expression and structure of proteins – these mutations even vary within individual tumors. I am optimistic about the possibility to take advantage of these modifications to create personalized medicines that selectively target cancer cells to more efficiently and effectively treat cancer.

I plan on utilizing my undergraduate research experiences to propel myself into more advanced cancer research emphasizing in pharmacology and medicinal chemistry to contribute to the development of more specific anticancer medicines. I am inspired by the development of medicines such as the breast cancer drug Herceptin that targets cells containing a large abundance of the Her2 receptor that is characteristic of some breast cancers. Herceptin uses an antibody and has improved the survival rate of patients with Her2+ breast cancer. There have been some great advancement recently in more personalized cancer treatment such as with the design of Herceptin and I want to be a part of the discovery of new drug targets and the design of novel anticancer drugs. Researching novel ways to personalize medicines will combine my interests in the biology fostered in the genetic engineering lab and the chemical aspects of my research in the medicinal chemistry lab to contribute to improving the treatment of cancer.

Featured image: Instagram | Hanna Erickson (@MDPhDToBe)