Pathways to Excellence | Spring 2020

Pathways to Excellence URMC DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE | WWW.PATHOLOGY.URMC.EDU | SPRING 2020 Jenna Dietz, MT, leads a hands-on microbiology teaching session with medical technology trainees at the Central Lab in Henrietta. At left, trainee, Nichole Whyland.

learning never stops Celebrating the People Who Drive Department-Wide Pathology Education Just who is the typical learner in Pathology & Laboratory Medicine? It’s the resident doing their first rotation, and the future med tech studying for their exam. It’s also the phlebotomist in training, the grad student preparing to defend their thesis, and the fellow on their way to becoming a certified dermatopathologist.

Each of these individuals has educational activities during their time at URMC. Their curriculum is designed by accrediting agencies, respective deans, and program directors. Our department faculty and medical technologists give the lectures. But the Path Education team, comprised of three program coordinators led

by Vicki Roberts, manager of Pathology Education, serves as “air traffic control” for all of these experiences.

“On any given day, we have open-door policies for our students and trainees because it’s very important that they know they have a person they can go to when they need something,”

said Roberts, who is also the director of the Medical Technology (CMT) Program. “They are our priority.”

Each year, her coordinators must navigate a demanding academic cycle. Most programs start onboarding and orientation for students and trainees in July, followed by recruitment and interview seasons that require careful planning and communication every step of the way. This year, the team collectively coordinated 100 interviews. And interview season is not over.

“Throughout the year we are constantly recruiting,” said Roberts. “Every interaction with a potential grad student or trainee is handled with exceptional customer service. We are ambassadors for the department.”

When you count up all the graduate students, residents and fellows that require regular support from this team, the number might surprise you.

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IN THIS ISSUE Education Team................................................................. 3

Alumni News.................................................................... 4

From the Chair.................................................................. 3

Research News.................................................................. 5

Giving Back, Abroad............................................................ 4

Focus on Faculty................................................................ 6

LEARNING NEVER STOPS

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“We really offer support from A to Z for 70 trainees,” student progress and is tasked with planning annual events Roberts said. This number does not reflect the 200 faculty lectures including formal graduation ceremonies for both the residency that must be scheduled for the med tech program alone. and med tech programs, as well as Pathology Research Day. Over time, these experiences have led many trainees to stay As an academic medical center in a rapidly growing health at URMC for fellowships, apply for faculty positions, or take system, the variety of clinical experiences within Pathology is vast jobs within UR Medicine Labs. Having some familiarity with and ever-evolving. In addition to the formal training programs, the people and processes learned at URMC helps streamlines there are also medical students from SMD who take part in their transition to more permanent roles. electives and dozens of students from affiliate institutions who Jennifer Findeis-Hosey, come onsite for certain clinical “Every interaction with a potential grad M.D. is the current director of rotations. Their interactions GI Pathology, and was a resident student or trainee is handled with exceptional customer might be part of training to service. We are ambassadors for the department.” here from 2007-11. become a med tech, cytology -Vicki Roberts, Manager of Pathology Education “My first interaction with tech, or phlebotomist. the department was really a phone call with Betsy McDonald, “Pathology education isn’t just distinctive to what us four are the previous residency program coordinator,” she recalls. “She doing. Education is happening all the time in this department,” set the welcoming tone of what has become my academic home Roberts said. “Every person is somehow engaging in education. more than 10 years later. The Education team is so critical to Whether it’s sitting on a committee to evaluate resident progress, the mission of the department. I know from my own experience teaching a lecture, working one on one in the clinical setting, that they are often the first point of contact for our trainees, so many folks in our department are a critical piece to the final communicating our commitment to high quality education and outcome. I think we should celebrate how education is woven clinical care.” through the fabric of everything that we’re doing.”

All of these day-to-day efforts support the educational mission by giving learners the richest and most beneficial PATHOLOGY EDUCATION BY THE NUMBERS: experience possible. The Ed team provides instructors and Residency Program faculty with the tools and support needed to assess and evaluate Faculty Directors – Linda Schiffhauer (Director), Majed Refaai (Associate Director) Residency Program Administrator – Leslie Antinarella Current Number of Trainees – 17 residents and 1 year-out student fellow Recruitment Window – September to December Recruitment 2019 Recap – 60 interviews for 7 open spots (all filled) Fellowships Program Coordinator – Melissa Sullivan 6 ACGME fellowships and 3 department fellowships, with multiple faculty for each Recruitment 2019 Recap - 60 applications, 17 candidates for 7 fellowship positions Cell Biology of Disease Ph.D. Program Faculty Director – Helene McMurray Program Coordinator – Donna Shannon Current Number of Trainees – 40 students Recruitment Window – July to February Defenses in 2019-‘20 – 11 Recruitment 2019 Recap – 70 applications, 17 invited to interview for 7 open spots

Kira Polvinen, a med tech in training. Ten students from URMC’s in-house training program are expected to come work for the department and 15 students are lined up for the 2020-21 cohort.

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Medical Technology (CMT) Program Faculty Director – Scott Kirkley Program Director – Vicki Roberts Program Coordinator – Melissa Sullivan Current Number of Trainees – 15 students in 2020-21 cohort, 10 expected to be hired from class of ‘20 Recruitment Window – October to May Candidate interviews in 2019 – 50 applied and 25 invited to interview for 15 open positions

FROM THE CHAIR

Bruce Smoller, M.D.

Grace Choung, M.D.

SYMPOSIUM POSTPONED The Annual Updates in Pathology Regional Symposium originally scheduled for May has been postponed until the fall due to safety concerns related to COVID-19. We appreciate your understanding and will be sure to share the new date and registration information in this newsletter when it becomes available.

I hope that this latest newsletter arrives to find all well in your world. Things here at the University continue to thrive, despite the myriad changes that surround us. We are rapidly managing the onslaught of Coronavirus testing.

Fortunately, our superb microbiology unit is on top of all of the late breaking developments and is testing several hundred patients each day.

Our hospital administration is to be commended for their willingness to act quickly and decisively regarding new equipment and reagents needed for this emergency development.

On a lighter note, the department is excited to have welcomed Dr. Grace Choung to our team in January. Grace comes to us following a year on faculty at Rutgers University and training in anatomic and clinical pathology at Yale and renal pathology at Columbia. She joins Drs. Jean-Gilles and Goldman as a member of what is now a solid team in renal pathology!

I am excited to share that we successfully matched 7 residency spots this year, all from the top half of our submitted list. Our campaign to increase the residency from 16 to 20 positions (the surgical accessions have increased from 25,000 per year to over 100,000 with no increase in positions in the last 20 years) was successful, which changed our annual number from 4 to 5. Further, we have one resident, Dr. Phoenix Bell, who is graduating with only AP training in order to take a position as a GI Pathology fellow at the Brigham and Women’s Hospital and another resident who transferred to a program in Cleveland in order to get married.

While thinking about training, we are really excited to have accepted Dr. Cynthia Reyes-Barron to be the first dermatopathology fellow at URMC. I personally ran such a training program for 25 years in my prior positions and am excited to have been able to bring this highly competitive fellowship program to our department. We already have many applications for the position starting in 2021 and even a few for 2022!

My office is sitting atop a major construction zone. Levels 1 and G of the 2100 wing are being re-built as the new Blood Bank and Automated Chemistry/ Hematology laboratories. The space they have occupied since the late 1970s is to be re-assigned to the new Emergency Department, necessitating a move down the hallway. Based upon the finished product at Bailey Road, I remain optimistic that the new labs will become a source of pride for our department. Meanwhile, the second floor of the 2100 wing is undergoing a cosmetic overhaul after 25 years. The breast pathology unit and the clinical pathology faculty who are not based at Bailey Road will be moving in to this area, as the department continues to evolve.

We are beginning to think, in earnest, about possible formats and structures for the final portion of the Bailey Road project, which includes parts of anatomic pathology. Clearly, certain aspects of our program such as frozen sections and fine needle aspiration cytology will need to remain on site, but other aspects are amenable to the hospital plan to create a smaller footprint at SMH for pathology in order to accommodate more site specific programs. Dr. Whitney-Miller will take the lead role in developing this phase of the re-location project. Ultimately, the department serves to gain space that it desperately needs given its unrelenting growth over the past two decades.

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GIVING BACK, ABROAD

FOCUS ON FACULTY

In November of last year, Hematopathology Director, Andrew Evans, MD, PhD, spent two weeks teaching pathology in Ethiopia with the Aslan Project, a nonprofit that developed the first Pediatric Oncology program to bring specialized cancer care to kids in that country.

Most of his time was spent teaching at Jimma University Hospital, in the southwestern part of the country, with an additional stay at Tikur Anbessa (Black Lion) Hospital in the capital city of Addis Ababa. Evans said pathology trainees receive limited subspecialized training, and are used to working in underfunded and understaffed conditions. To help develop local infrastructure and expertise, he hopes to facilitate the donation of digital microscope cameras that will enable a robust telepathology program, in addition to returning to teach in person, if possible. Visit www.aslanproject.org to learn more.

currently available medications affect the course of disease.

To make matters worse, PSC recurs within 5 years in about 20-30 percent of liver allografts. It is unknown if patients with PSC have a different inflammatory abnormality than patients who suffer from IBD, so Drage and his collaborators brainstormed possible disease pathways and developed a custom panel of genes to assess whether those pathways are important.

The primary readout of the work is to determine if the differential gene expression in the hepatobiliary system of PSC patients is unique to PSC, and also to study whether differential gene expression in the colon of IBD patients is distinct between patients with IBD alone and those with IBD and PSC. The goal of these efforts is to provide data for treatment selection, as numerous immunomodulatory drugs are coming onto the market, and the decision of what drugs to use, and in what order, will be a conundrum for management.

Drage admits that research often feels like an uphill climb, but says patient specimens he encounters in routine clinical practice provides constant inspiration to push to answer these questions. “Surg path is to some degree like detective work,” he said. “You have a lot of information that you must synthesize with the information that only you have and craft the most definitive report you can, to guide the clinicians. What you say has a huge effect on what the entire hospital system does. I find that very gratifying – to be able to say exactly what you want, knowing that it will have decisive impact on that patient’s care.” He says that he’s tremendously grateful to work in a department with such admirable colleagues, and with leadership supportive of research pursuits.

Drage and his family live in Brighton. He jokes that since having kids, there’s no time for hobbies, but they do enjoy gardening and playing tennis with their kids and spend most of their free time cooking together and reading at home.

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FORMER RESIDENT NOW DIRECTS ARMED FORCES MEDICAL EXAMINER SYSTEM Dr. Alice Briones, who was a Pathology resident at URMC from 2005-2009 has been named deputy director of the Armed Forces Medical Examiner System (AFMES).

According to a statement by the AFMES, Briones will now oversee approximately 300 military, civilian and contractor personnel who provide comprehensive services in forensic pathology, forensic toxicology, DNA technology and identification, and mortality surveillance for the Department of Defense.

Briones enlisted in the U.S. Army as a Combat Medic in 1990 and after completing basic training, she earned her bachelor’s degree at the University of Maine, later becoming a certified med tech in 1994. In 1995, she was commissioned in the U.S. Air Force as a biomedical sciences corps laboratory officer.

She has served in many roles throughout her career, as assistant chief of lab operations and squadron section commander at Luke AFB, Ariz., and chief of lab operations at Hanscom AFB, Mass.

“It has been an arduous road with numerous sacrifices and challenges from both my family and myself to get to where I am today,” said Briones. “I hope to be an inspiration to all the women in the military, science and medical fields as well as working mothers.”

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Briones received an Air Force scholarship and earned her D.O. from Lake Erie College of Osteopathic Medicine in 2005. After residency, completed a forensic pathology fellowship with the Albuquerque ME’s Office. She then became the deputy medical examiner in Rockville, MD, and Dover AFB, Delaware, and was appointed director of the DoD DNA Registry in 2014. In that role, she

coordinated services in both the Armed Forces Repository of Specimen Storage for Identification of Remains and the Armed Forces DNA Identification Laboratory.

“I look forward to leading this great organization into the future and exceeding the standard in forensic sciences for our greatest stakeholders – the families,” said Briones.

RESEARCH NEWS You may have heard the phrases “interesting times” or in Pathology, increasing the depth and breadth of our “strange days” quite a lot this spring. As I write this, we research disciplines. are living through the most disrupted period that I’ve On the education front, all of our faculty have experienced in my lifetime. The health and safety of temporarily moved to a distance education model to allow every member of society is endangered. For many, work coursework and training to continue across the spectrum and family life have been upended. And at a time when of learners in our department. Graduate student courses, our need for scientific discovery is at its highest, we are resident education sessions, medical technologist training experiencing a near-total shutdown of the scientific and even Grand Rounds have moved to the now-familiar research enterprise in the United States.

“Zoom” format. Although we old dogs have had to While acknowledging the seriousness of this time, learn some new tricks, we are happily discovering that I remain optimistic in the face of it all, hopeful in the technology is enabling a continuation of our educational beliefs that our excellence in clinical practice will protect work in a remarkably effective manner. the vulnerable and heal the sick; that our dedication to We are in the midst of recruiting new researchers-inthe people and things we care about will build resilience training, our incoming class of PhD candidates. To date, and yield support when we all need it most; and that our we have four students committed to join our program unceasing quest to better understand this fall and await response from several the natural world and its interaction more accepted students. Moreover, our with human health will yield discoveries current class of first year PhD students that will allow us to move past this are well on their way to future scientific challenging moment and into a brighter discovery with eight students out of nine future. I hope to share with you here already having identified mentors and some of what drives my optimism. laboratories in which to conduct their Our faculty and their research teams thesis work. continue to build and grow despite the We have also said goodbye to nine challenges they face. In fact, Dr. Lianping graduates this academic year, who Xing, a member of our department, have moved from their PhD training was recently awarded an R01 from the at URMC to post-doctoral training in National Institute on Aging for her work labs around the country, to positions in on synovial lymphatics and osteoarthritis scientific industry or have returned to Helene McMurray, Ph.D. in aging. Moreover, faculty members in the clinical portion of their medical school our PhD program have garnered half a dozen NIH awards training to complete both their MD and PhD degrees. We in the first three months of 2020, including Drs. Steve look forward to several more dissertations before the end Georas for his timely work on airway inflammation and of the academic year. antiviral immunity, Kirsi Jarvinan-Seppo for studies on Given all of our current successes and the exciting food allergens in human milk, Amy Kiernan for work on developments that the future holds, I hope that you share notch signaling during development of the organ of Corti my optimism for our research and educational efforts. in the ear, Minsoo Kim for multiple projects on viruses Reactivating our research laboratories and normalizing and the immune response and Terry Wright for studies our educational programs will not be without challenges, of innate immunity against fungal infections in the lung. but I believe that when the time comes, we will return We have also seen the addition of a number of junior and revitalized and with new perspective on the importance of senior faculty researchers as primary or secondary faculty these missions.

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Department of Pathology and Laboratory Medicine University of Rochester Medical Center 601 Elmwood Avenue, Box 626 Rochester, NY 14642

FOCUS ON FACULTY: MICHAEL DRAGE MD, PHD Dr. Michael Drage didn’t decide on pathology as a career until the last second. His interest in medicine began late, while he was a masters student in neuroscience at Boston College, trying to decide if he should stay for his PhD or apply to MD/PhD programs. “In retrospect, it should have been obvious,” he said. “On the wards, the clinical teams often found my questions of no interest at best, or alienating at worst.

Within hours of starting my rotation on anatomic pathology, I knew I had found my people. They loved my questions.”

He began volunteering at Brigham and Women’s Hospital when a chance encounter led to his observing a couple of cardiac bypass surgeries. “Quite suddenly, I found myself standing at the head of the patient undergoing cardiac bypass surgery,” Drage said.

“Maybe it was the rock music playing in the background, the team atmosphere, or seeing someone dump ice into the chest cavity, but I was immediately sold on medicine.”

After finishing his master’s at BC, he went on to join the medical scientist training program (MSTP) at Case Western Reserve University in his hometown of Cleveland, OH. It was during his years in the lab working in basic immunology that that he and Nicole Pecora (also in the MSTP) got married. After the birth of their first daughter, they couples-matched at Brigham and Women’s hospital where both completed pathology residency and fellowships – his in GI and cytopathology. They had two more children during training. Drage and Pecora joined the Pathology faculty at URMC in summer 2016.

Drage’s combined interest in GI pathology and immunology has led him headfirst into two long-term research projects with collaborators from BWH that seek to help patients suffering from colon cancer and inflammatory bowel disease.

The first project is partially funded by a grant from Strollin’ for the Colon (a Rochester-based community-funded philanthropic organization) and partly by our department, is a collaboration inspired by the lack of efficacy of immune checkpoint blockade in colon cancer (which, he adds, “should be the poster child of immune checkpoint therapy”). The study describes the expression and tissue distribution of several alternative pre-clinical immune checkpoint targets and correlates the findings with ex vivo functional assays and next generation sequencing (NGS) data.

Drage began these studies as a fellow and is now bringing them to completion.

One subproject is headed by resident, Phoenix Bell, who is comparing the prognostic capability of computer-assisted and manual scoring of tumor budding. “The computer’s not smart enough to know what’s a tumor bud versus debris, so we manually applied some geometric restrictions to the raw data, which work pretty well to discriminate the wheat from the chaff,” explained Drage. To illustrate this, he pulls up a digital slide on his computer screen and shows the discrimination between debris and tumor budding.

Another project, performed in collaboration with gastroenterologists and a pathologist at BWH, is funded by a patient. This study is an attempt to better phenotype patients with inflammatory bowel disease (IBD), a subset of whom also suffer from the idiosynchratic progressive fibrotic/stenotic disease of their biliary tree, primary sclerosing cholangitis (PSC). While symptoms for PSC patients can be managed, no

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