Posts from the ‘teaching & training’ category

Mummies Scanned at the Brigham Reveal Clues About Heart Disease

What secrets lie in the hearts of our ancestors? Signs of cardiovascular disease, for one, as a Brigham team of cardiovascular imaging experts recently helped discover.

Through a collaboration with an international team of researchers and anthropologists, Brigham faculty and staff performed CT scans on five mummies from 16th-century Greenland in the Shapiro Cardiovascular Center early last year. The team was looking for evidence of plaque in the arteries—also known as atherosclerosis—to see if the leading cause of death in the U.S. today was also prevalent centuries ago.

Sure enough, high-resolution scans of the mummified remains—belonging to four young adults and one child from an Inuit community—revealed telltale signs of the disease: hardened calcium deposits in various blood vessels in the chest.

“It’s always fascinating to look at humans who lived hundreds of years ago and see if learning about the past could teach us more about the present and future,” said Ron Blankstein, MD, associate director of the Brigham’s Cardiovascular Imaging Program, director of Cardiac Computed Tomography and a preventive cardiology specialist.

Blankstein was among the experts who scanned the mummies and interpreted the images last January, an event featured on National Geographic’s “Explorer” series this month. Other faculty and staff who helped conduct the scans included Kristen Burke, CT technologist; Marcelo Di Carli, MD, director of the Cardiovascular Imaging Program and chief of the Division of Nuclear Medicine; Abe Haboub, RT(R)(CT), cardiac CT manager; and Michael Steigner, MD, director of Vascular Imaging.

The effort was part of a broader project, led by a group of external researchers, to scan mummies from hunter-gatherer and preindustrial civilizations worldwide to search for signs of heart disease. The Brigham is one of several institutions to have participated and was approached based on the prestige of its cardiovascular imaging program, Blankstein said. 

Searching the Past

From Egypt to Mongolia and now Greenland, mummies throughout the ages have shown evidence of atherosclerosis. The Greenland mummies were particularly of interest due to their diet, which would have primarily consisted of fish and sea mammals.

While increased fish consumption is commonly touted as a heart-healthy diet—which may make the findings of atherosclerosis seem surprising—Blankstein emphasized that scientists still have much to learn about its exact relationship to cardiovascular health. For example, although it is known that consuming fish rich in omega-3 fats has benefits, some types of fish can also be high in cholesterol and, in the current era, contain toxins such as mercury or polycholrinated biphenyls (PCBs) that may pose some risk, he said.  

There could also have been lifestyle factors, such as exposure to cooking smoke in their dwellings, that contributed to the mummified individuals developing cardiovascular disease during their lifetimes, Blankstein explained.

With all that in mind—and the small sample sizes of these mummy scans—he noted that the team’s findings shouldn’t be taken too much to heart, so to speak.

“The question of whether fish is good or bad for you is still open-ended, and it would be unrealistic to think that we could provide a definitive answer by scanning a small number of mummies for plaque,” Blankstein said. “Our team found it fascinating that there was evidence of atherosclerosis despite the mummies’ estimated young ages, but this also doesn’t mean cardiovascular disease is inevitable. In fact, the majority of cardiovascular disease events that we see in patients is preventable with appropriate diet, weight control and lifestyle changes, such as regular exercise; at times, medication can also be used to treat various risk factors.”

A Different Kind of Patient

Although the mummies needed to travel only a few miles from a museum in Cambridge to Longwood, bringing them to the Brigham was no small feat logistically. Working closely with the hospital’s Police and Security team, Brigham faculty and staff members spent countless hours coordinating with museum officials and the researchers on how to safely transport these extraordinarily rare, delicate remains.

Once inside Shapiro, scanning the mummies wasn’t too different from work the cardiovascular imaging team normally does. In fact, they were a little easier to scan than a living patient; normally, the CT scanner must account for the movement of a beating heart.

Interpreting the images required a different perspective, however, Blankstein explained.

“This is not the same as scanning a [living] human. All of the organs are decomposed—in fact, you don’t see much of the heart at all,” he said. “The major plaque we saw was not necessarily in the arteries of the heart but in some other blood vessels in the chest, such as the aorta or some arteries of the neck.”

In addition to satisfying the team’s intellectual curiosity, Blankstein hopes their findings will inspire people to learn more about atherosclerosis and how to reduce their risk.

“It was certainly an exciting and interesting experience, and I hope we can use it to promote awareness of this mostly preventable disease,” he said.

Standing Room Only: Nursing Dreams Becoming a Reality

PCAs preparing to go to nursing schoolMany of you have already heard about the four amazing Brigham patient care assistants (PCAs) who received the inaugural Neskey Educational Opportunity Fund Scholarships, which provide full-tuition support to University of Massachusetts (UMass) Boston for PCAs who aspire to have a career in nursing. David and Sharon Neskey established the fund to honor the extraordinary care they received from a PCA here. As it turns out, the day we announced those four recipients was just one piece of what would become my One Shining Moment this year.

Weeks earlier, I had the pleasure of attending an information session about the scholarship. Considering that this was a new program, I set my expectations accordingly, thinking six to eight attendees would have been a good showing for our first year. Little did I know how incredible the response would really be. About 40 PCAs came to the session, brimming with enthusiasm about the next potential step in their careers. I was also amazed that attendees were at all stages of thinking about their future as nurses—some had completed all the academic prerequisites and were ready to start at UMass, while others who had never taken any formal steps for continued education viewed this potential scholarship as the push they needed.

Linda S. Thompson, DrPH, MPH, RN, FAAN, dean of UMass Boston’s College of Nursing and Health Sciences, was so inspired by the program that she attended the information session and spoke of how her own professional beginnings looked very similar to those in the room. The most moving part of the event, though, was that when I looked at that group of PCAs, I saw the future nurses of the Brigham, who will one day inspire the next generation that follows them. I can’t wait to see the amazing things they will do in the years to come.

Ron M. Walls, MD
Executive Vice President and Chief Operating Officer, Brigham Health

Q&A: Reflections on Interactive Teaching, Learning from Trainees

Raymond Mak

Raymond Mak, MD, of the Department of Radiation Oncology, was honored with the 2018 Bernard Lown Teaching Award, which celebrates physicians who are outstanding clinical teachers.

In this Q&A with BWH Bulletin, Mak shares his ideas on the field of radiation oncology, effective teaching and the Socratic method.

What drew you to the field of radiation oncology?

RM: I was always interested in cancer care and patients. One of my medical school mentors, Anthony D’Amico, MD, PhD, happened to be a radiation oncologist. He introduced me to the field of radiation oncology, serving as a mentor and teacher. The field combines procedural/interventional aspects of medicine, technology and imaging, with an academic, evidence-based and patient-centered focus, which was very appealing to me.

What is the key to being an effective instructor?

RM: From my perspective, it’s about trying to put yourself in trainees’ shoes. You need to understand where they are coming from, their level of knowledge and their experience. Using this information, you need to tailor your teaching style accordingly. I focus most of my efforts here when designing a lecture or lab for trainees.

Additionally, I try to make the material as interactive as possible. Using the Socratic method, I ask a lot of questions, both rhetorical and direct, to gauge the level of understanding in the classroom or clinic. As an instructor, this is the key to understanding the needs of the learner.

Whose teaching style has influenced your own?

RM: My dad was a college professor, so growing up, I often observed him teaching and tailoring material to the needs of different people, and much of my approach now comes from him.

In the past, I considered myself somewhat of an introvert and did not really think I would be a good teacher. It was in speaking to and learning from my mentors in medical school and throughout residency that I was able to hone my craft and come out of my shell.

At Harvard Medical School, the problem-based learning curriculum set the stage for my own teaching style. Going into residency, the teaching model was Socratic as well, with the emphasis on direct questioning and audience participation. This emphasis combined with the many great teaching role models in my department and at the Brigham greatly influenced my own teaching.

How has working with trainees influenced your work as a physician-scientist?

RM: Residents teach me a lot. They have great ideas, and they don’t follow the assumptions and orthodoxies that those who have been in the field for a long time do. Between the teacher and the trainee, it’s a two-way street. I ask them questions to help them learn, and in return, they ask me questions that challenge my own thinking and customs. I always tell my residents when they’re on service with me to make sure they continually ask why I’m doing a procedure or approaching a patient’s situation in a particular way. I encourage my trainees to challenge my conventions and methods as much as possible.

Our department is an environment with such an emphasis on teaching; everyone is pushed to improve, from residents to junior faculty. There was no doubt to me that one of the most important things that I could do as a physician was to be a great teacher for residents and medical students. This has always been a primary focus for me. When everyone you’re surrounded by is focused on effective teaching and trying to do their best, you have to bring your A-game.

Brigham Health’s Strategy in Action: Teaching and Training
Learn more about our strategic priorities at BWHPikeNotes.org.

Congrats, Grads! Celebrating Student Success Jobs Program Graduates

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As a shy and unsure high school sophomore beginning her BWH internship through the Student Success Jobs Program (SSJP) three years ago, Laureen Chalumeau froze when her supervisor instructed her to make her first phone call to a patient for an appointment reminder.

“I’m not ready for this,” she thought. But after a few months of working closely with her supervisor and mentor, Caroline Melia, BSN, RN, nurse care coordinator at Brigham and Women’s Advanced Primary Care Associates, South Huntington, something shifted for Chalumeau.

One day, a patient who only spoke Haitian Creole arrived for an appointment, but an interpreter was not immediately available. Chalumeau, who speaks Haitian Creole as well, jumped in to help translate without hesitation. Looking back now as one of this year’s 31 graduating SSJP seniors, she remembered how pivotal that moment felt and how surprised she was by her confidence.

“I don’t think I would ever speak Haitian Creole to anyone outside my family before that,” said Chalumeau, 18, who was recently awarded a six-year, full scholarship to attend Northeastern University, where she will study pharmacy. “SSJP just shook my world. I was so shy and introverted. Now I’m more outgoing and ready to challenge myself because SSJP supported me and put me in situations where I felt I could push myself.”

A program of the BWH Center for Community Health and Health Equity (CCHHE), SSJP matches Boston-area high school students with mentors across the Brigham for paid internships. The program is focused on fostering the next generation of talented, diverse health care workers. More than 40 departments host SSJP interns. All students who have completed the program enroll in college, and 75 percent study health or science.

Joined by their families, colleagues and SSJP underclassmen, this year’s seniors were honored during a graduation ceremony held at the Joseph B. Martin Conference Center on June 19. Attendees heard reflections from SSJP alumna Nakia Ellies, their peers in the program and keynote speaker Cheryl Clark, MD, ScD, director of Health Equity Research and Intervention at CCHHE and a hospitalist in the Division of General Medicine and Primary Care. Clark advised graduates to find strength in community, believe in themselves and “take the long view” on what they seek to achieve or change.

Donell Rankins Jr., a sophomore at the John D. O’Bryant School of Mathematics and Science in Roxbury, told the audience how valuable his first year interning with inpatient Radiology has been.

“I was able to truly see that teamwork really does make the dream work,” he said. “Not only have I had the pleasure of being on the Radiology team but also the SSJP team. I have made so many friends from a plethora of different backgrounds and experiences that all come together and form a diverse SSJP community.”

Mentorship Builds Bonds

Reflecting on her three years in the program, Chalumeau said the most important component for her has been her relationship with her mentor.

“Caroline has always been there for me. No matter what issue I have, I could easily come to her,” said Chalumeau, who graduated from the Urban Science Academy in West Roxbury this month. “I look up to Caroline and aspire to be as great as she is. She’s a one-woman army in my eyes.”

At South Huntington, SSJP interns are treated like any other team member, whose ideas and contributions are all valued, Melia said. Last year, Chalumeau led an effort to create a team newsletter to better communicate information from staff meetings.

“They’re not just students. They’re people with great ideas, and they add a lot to the patient experience,” Melia said. “This program is really important not only for the students as a learning opportunity but also for the community, the hospital and the future of health care.”

Melia said it has been rewarding to see Chalumeau grow as a person and professional over the past three years and take the next steps in her studies and career.

“I’m so proud of Laureen and so happy for her. She’s such a special person,” Melia said.

SSJP is actively seeking departments and enthusiastic staff members to support its efforts. To learn more about how to become a mentor and host an SSJP intern, contact Pamela Audeh at 617-264-8740 or paudeh@bwh.harvard.edu.

Brigham Health’s Strategy in Action: Teaching & Training
Learn more about our strategic priorities at BWHPikeNotes.org.