Participants are guaranteed a salary at the full Accreditation Council for Graduate Medical Education level even during their American Board of Internal Medicine–mandated research years, along with additional supplements for housing and education. They’re also guaranteed a fellowship position at Stanford after successfully meeting residency requirements. Weldy, for example, will be joining the cardiovascular medicine fellowship after he completes two years in the internal medicine fast track program.

Additionally, TIP provides myriad mentorship opportunities—from quarterly dinners hosted by faculty to involvement in the Pathways of Distinction program, a mentorship initiative that allows residents to select one of several individual pathways that best aligns with their academic interests. These initiatives help build a sense of community, says Weldy.

Chad Weldy, MD, PhD, found his calling deep in the toxicology laboratory at the University of Washington (UW), while he was working alongside physician-scientists to investigate the effects of air pollution on cardiovascular and pulmonary health. Weldy always knew that he loved scientific research, and it was this interest that propelled him through college at Western Washington University and a subsequent PhD program. But he had never considered a career in medicine. His work at UW—along with his exposure to a blend of cardiology and basic science—was “my first introduction to the possibility of doing both,” he recalls. “I decided that was my goal.”

After earning his doctorate, Weldy pursued that goal in earnest—completing a postdoctoral fellowship at UW in the lab of a prominent cardiologist, and receiving his MD from Duke University. He landed at Stanford in 2017 as one of nine residents in the Department of Medicine’s Translational Investigator Program (TIP).

Additionally, TIP provides myriad mentorship opportunities—from quarterly dinners hosted by faculty to involvement in the Pathways of Distinction program, a mentorship initiative that allows residents to select one of several individual pathways that best aligns with their academic interests. These initiatives help build a sense of community, says Weldy.

“We’ve had several lunches where we have had amazing investigators present some of their research, as well as their path to how they ended up as faculty at Stanford. I love being able to get away from the wards for an hour to sit with other physician-scientists and talk science.”

Training is another key component. Wu elaborates: “We have sessions on everything related to career development, including grant writing, how to seek a mentor, how to apply for faculty positions, and more.”

Participants also benefit from Stanford’s collaborative and innovative spirit. “At many medical centers the university is separate from the medical school and the hospital,” Wu explains. “At Stanford everything is in close proximity. I think that leads to a rich array of opportunities for research and collaboration.”

Weldy agrees, adding: “The TIP program stood out to me because of the unique culture of innovation and discovery that is infused across campus. There’s not only a history of discovery—there’s a palpable sense that Stanford is on the tip of changing the practice of medicine.”

“We’ve had several lunches where we have had amazing investigators present some of their research, as well as their path to how they ended up as faculty at Stanford. I love being able to get away from the wards for an hour to sit with other physician-scientists and talk science.”

Training is another key component. Wu elaborates: “We have sessions on everything related to career development, including grant writing, how to seek a mentor, how to apply for faculty positions, and more.”

Participants also benefit from Stanford’s collaborative and innovative spirit. “At many medical centers the university is separate from the medical school and the hospital,” Wu explains. “At Stanford everything is in close proximity. I think that leads to a rich array of opportunities for research and collaboration.”

Weldy agrees, adding: “The TIP program stood out to me because of the unique culture of innovation and discovery that is infused across campus. There’s not only a history of discovery—there’s a palpable sense that Stanford is on the tip of changing the practice of medicine.”

On any given day, he can be found in the emergency department, helping faculty evaluate the efficacy of a new critical care program; in the lab, acting as principal investigator on a multi-site clinical trial of an FDA-approved device designed to test subepidermal moisture and writing up the results; in the office, creating curriculum for an RN postdoctoral fellowship in palliative care; or in the classroom, leading the advanced practice provider fellowship program and training interdisciplinary staff as the director of the Center for Professional Development.

Garrett Chan, PhD, a clinical associate professor of primary care and population health and emergency medicine, spent his 20s pursuing a career as an art curator, taking classes like art history and humanities, with the eventual goal of working at a museum.

But then he met with a counselor, who prompted him to scrap the curatorial track and explore a career in nursing. Chan was surprisingly receptive. “I said sure!” he explains, “so she handed me a paper with a list of courses like chemistry, anatomy, and biology.” Clutching his new curriculum, he set off to embark on an entirely new path.

Chan spent the next several years acquiring degrees (an RN and BSN from San José State and a MS and PhD from UC-San Francisco), and clinical experience (in the emergency department and palliative care services of the San Jose Medical Center and at Stanford) at breakneck speed.

He joined Stanford Health Care as a nurse-scientist in 2006, and the Department of Medicine as a faculty member in 2014. Chan is not exclusively a nurse. His interests—and identities—vary widely. “My daily work as a faculty member includes administration in Stanford Health Care, direct care of patients, and work as a research scientist and an educator.” On any given day, he can be found in the emergency department, helping faculty evaluate the efficacy of a new critical care program; in the lab, acting as principal investigator on a multi-site clinical trial of an FDA-approved device designed to test subepidermal moisture and writing up the results; in the office, creating curriculum for an RN postdoctoral fellowship in palliative care; or in the classroom, leading the advanced practice provider fellowship program and training interdisciplinary staff as the director of the Center for Professional Development.

Chan is also part of a growing community of advanced-practice providers—including registered nurses, nurse practitioners, and physician assistants—working alongside medical doctors on campus. There are several nurse scientists employed by the department. And in August Stanford welcomed the inaugural class of 27 students in the master of science in physician assistant studies program. It’s an exciting and beneficial shift, Chan explains. “A significant part of physician education and practice is focused on disease management,” he says. “And while nurses always have disease management in mind, they bring a very holistic perspective to health care. We’re paying attention to how patients and families are coping, patient education, and other psycho-social aspects of care.” Chan predicts that the inclusion of different care perspectives will both complement—and enhance—the practice of medicine and delivery of health care at Stanford.

Chan is also part of a growing community of advanced-practice providers—including registered nurses, nurse practitioners, and physician assistants—working alongside medical doctors on campus. There are several nurse scientists employed by the department. And in August Stanford welcomed the inaugural class of 27 students in the master of science in physician assistant studies program. It’s an exciting and beneficial shift, Chan explains. “A significant part of physician education and practice is focused on disease management,” he says. “And while nurses always have disease management in mind, they bring a very holistic perspective to health care. We’re paying attention to how patients and families are coping, patient education, and other psycho-social aspects of care.” Chan predicts that the inclusion of different care perspectives will both complement—and enhance—the practice of medicine and delivery of health care at Stanford.

Growing old can be a pain in the neck—or a pain in the stomach. As you age, you’re more prone to constipation, acid reflux, and bowel control problems. Some of that’s due to medications older people are more likely to take, chronic diseases, or inactivity, but it may also be due to changes in the gut, according to Laren Becker, MD, PhD. A physician-scientist in the Division of Gastroenterology & Hepatology and an instructor of medicine, Becker has advised undergraduate and graduate students during their research rotations during the past several years.

Recently, Becker studied the guts of mice, which led him to discover another factor driving gut problems: immune cells change with age and drive inflammation, which in turn, change the function of the GI tract.

“If this is also true in humans, and we could find a way to prevent these changes, we wouldn’t have this overwhelming burden of GI problems in older people,” says Becker, whose research was published in Gut in February 2017.

Immune System to Blame
Like every other system in the body, the digestive system is chock full of immune cells that patrol for invading pathogens that we might have swallowed with our food. In the muscle layer of the gut, the most plentiful of these cells are muscularis macrophages, immune cells that surround the nerve cells of the intestines. Becker wanted to study how these macrophages—which, aside from their defensive role, are known to help coordinate the cross-talk between the nervous system and GI tract—change during aging. In initial studies, he turned to young and old mice to make the comparisons. Here’s what he found:

To sum up, the entire population of muscularis macrophages in the gut changed as the mice aged, promoting inflammation and killing off lots of neurons in the gut. This could lead to all sorts of gastrointestinal conditions, Becker says, since those neurons are critical to keeping the gut moving.

Next, Becker wants to see whether the findings made in mice hold true in humans. He’s also curious which factors are initially responsible for the shift in FoxO3 levels and macrophage function. The microbiome—the collection of bacteria that live in your gut—may play a role, for instance. And more work is needed to reveal whether macrophages in other organs of the body make similar shifts toward inflammation during aging.

“If we have a better understanding of how macrophages change with age, targeting these cells could be a way to restore many parts of the body to a more youthful state,” Becker says.

To sum up, the entire population of muscularis macrophages in the gut changed as the mice aged, promoting inflammation and killing off lots of neurons in the gut. This could lead to all sorts of gastrointestinal conditions, Becker says, since those neurons are critical to keeping the gut moving.

Next, Becker wants to see whether the findings made in mice hold true in humans. He’s also curious which factors are initially responsible for the shift in FoxO3 levels and macrophage function. The microbiome—the collection of bacteria that live in your gut—may play a role, for instance. And more work is needed to reveal whether macrophages in other organs of the body make similar shifts toward inflammation during aging.

“If we have a better understanding of how macrophages change with age, targeting these cells could be a way to restore many parts of the body to a more youthful state,” Becker says.

But he also knew that many scribes are interested in a health career, perhaps as physician assistants, doctors, or nurse practitioners. He thought that having a longitudinal relationship with one or more providers would be valuable in the eyes of admissions committees, as would “opportunities to stand out and get experience.”

Scribing, he thought, “was an obvious place to go to, but I wanted to do it in a way that was a win-win-win scenario. Could we provide an experience that would benefit the scribes so they could go on to achieve their dreams of working in the health profession?” 

Like many of her recent college graduate peers, Cat Carragee was unsure how to get from here to there. There was a job in the health professions, perhaps as a doctor, but here wasn’t where she needed to be.

Here was work she was doing as a scribe in the emergency department at O’Connor Hospital in San Jose, California, for minimum wage. While she was getting some exposure to clinical medicine, she wasn’t really learning clinical medicine. “As a scribe I was there to help the doctors,” she says. “Any clinical learning was just a sideline.” She also knew that she needed research experience to strengthen an application to medical school, but to get such a job would require years of experience including work in the field.

Then a friend told her about COMET, and her life changed.

COMET (Clinical Observation and Medical Transcription Fellowship) is the brainchild of Steven Lin, MD, a clinical assistant professor of primary care and population health, who proposed a scribe service model with a twist.

Lin was interested in scribing after seeing his colleagues burn out from what he describes as “an explosion of administrative work being put on the shoulders of primary care physicians, plus frustration with the inefficiencies of electronic health record [EHR] systems like EPIC.”

But he also knew that many scribes are interested in a health career, perhaps as physician assistants, doctors, or nurse practitioners. He thought that having a longitudinal relationship with one or more providers would be valuable in the eyes of admissions committees, as would “opportunities to stand out and get experience.”

Scribing, he thought, “was an obvious place to go to, but I wanted to do it in a way that was a win-win-win scenario. Could we provide an experience that would benefit the scribes so they could go on to achieve their dreams of working in the health profession?” At the same time, could this model “be of tangible help to our primary care physicians, be meaningful, and decrease their work responsibilities in terms of charting and the EHR so they could spend more time with their families?”

Lin further describes COMET: “That’s how the post-baccalaureate scribe fellowship came about. In our unique model a mentoring relationship is central. We’re committed to the scribes and their education. They work with one to three physicians for an entire year. These are faculty members who mentor them, teach them at the bedside, do scholarly research projects with them that scribes then present at national conferences. We write recommendation letters for them and mentor them on their applications and their career development. It’s been a really good experience for both our scribes and our providers.”

Carragee could not agree more. After being one of the two pilot COMET fellows in 2015, she spent an additional year as chief scribe, orienting and supporting the incoming class of six fellows and finding ways to expand COMET to more clinics. She’s finished with that now, though; in September 2017 she started medical school at University College Dublin. She has reached her there.

As for the providers, Lin reports that “the scribes relieve the documentation burden. They increase our physicians’ ability to complete their charts on schedule. They can go home on time and have weekends free with family. It’s really been a great benefit to them.”

At the same time, could this model “be of tangible help to our primary care physicians, be meaningful, and decrease their work responsibilities in terms of charting and the EHR so they could spend more time with their families?”

Lin further describes COMET: “That’s how the post-baccalaureate scribe fellowship came about. In our unique model a mentoring relationship is central. We’re committed to the scribes and their education. They work with one to three physicians for an entire year. These are faculty members who mentor them, teach them at the bedside, do scholarly research projects with them that scribes then present at national conferences. We write recommendation letters for them and mentor them on their applications and their career development. It’s been a really good experience for both our scribes and our providers.”

Carragee could not agree more. After being one of the two pilot COMET fellows in 2015, she spent an additional year as chief scribe, orienting and supporting the incoming class of six fellows and finding ways to expand COMET to more clinics. She’s finished with that now, though; in September 2017 she started medical school at University College Dublin. She has reached her there.

As for the providers, Lin reports that “the scribes relieve the documentation burden. They increase our physicians’ ability to complete their charts on schedule. They can go home on time and have weekends free with family. It’s really been a great benefit to them.”