Med student: Education lab helps people to ‘understand why’

Lessons from Sanford Health PROMISE lab and other research successes

An American medical student bends down to pose with three Guatemalan children.

When Jessica Boerner was preparing for a mission trip to Guatemala earlier this year, she borrowed a fetal ultrasound monitor from Sanford Health’s PROMISE lab in hopes of helping pregnant women in Central America hear their baby’s heartbeat.

PROMISE, which stands for the Program for the Midwest Initiative in Science Exploration, connects what is happening in the Sanford Health research labs with the rest of the community. Students and adults of all ages come to PROMISE in Sioux Falls, South Dakota, to engage in scientific activities to better understand complex information and high-level lab experiments. Information is then broken down so those of any education level can learn to appreciate what happens in the biomedical research world.

The lab also has a lending library that provides laboratory equipment to science teachers and educators across the region, which Boerner used for her trip.

Boerner grew up in New Prague, Minnesota, and studied biology and psychology at Augustana University in Sioux Falls. During that time, she was a research assistant in the PROMISE lab for two years and also worked at the Sanford USD Medical Center to pick up clinical experience. She is now a fourth-year student at the University of South Dakota Sanford School of Medicine.

In this Q&A, Boerner discusses how her job in the lab helped on the mission trip to care for patients and prepare her for medical school. 

Why did you take the fetal doppler?

While most women in Guatemala do receive regular prenatal care, it is very different than the care women receive in the United States. Usually, they are not meeting with a doctor. They meet with a midwife who puts their hands on the woman’s stomach and feels for the baby, which we also do in the United States.

But with this scenario, there is no real laboratory or objective assessment of how the baby is doing and whether there may be an issue with the baby’s delivery. It is also just a very cool, emotional experience for the mother to hear her baby’s heartbeat for the first time, so we wanted to be able to provide that if we saw pregnant women in our clinics.

What was their reaction?

While some of the mothers struggled to make out the sound of their babies’ heartbeat, we were able to do more than what happens in a regular midwife visit in Guatemala. To be able to tell them that we think your baby is healthy based on all of these things is very reassuring to them.

Why did you want to go on this mission trip?

This is my third time doing this. Another former Sanford Research employee went down to Guatemala before he was accepted to medical school. They allowed medical groups to come in and work within the hospital system, but they will also set up opportunities for them to go to rural communities and see patients who don’t have access or transportation to the main hospital.

He had seen the positive outcome of this mission, and when I was accepted into medical school, I was able to learn from him how to organize everything. I was able to join in on his second and third trips. When he graduated, I took over the organization of the trip.

What was the main objective of the mission trip?

To provide care to patients in underserved communities. Every day we would go to a different rural community. We would bring all of our supplies and medications, everything we needed, and create a pop-up clinic.

There are volunteer health promoters in each community that work closely with their friends and neighbors. They spread the word when medical groups come from the United States to provide treatment. What’s really great about our partnership with the Friends of San Lucas is that we’re working through their already-established program. We are not creating our own. Their model is what actually makes our mission work sustainable long-term.

I was there for two weeks. We took a group of students who had completed their first year of medical school and those starting their fourth year of medical school. The first week, both groups were there and the second week was just the fourth-year students. We had supervising physicians and PAs (physician assistants) there for the duration of the trip.

What did you learn in Guatemala?

It really puts in perspective how lucky we are to have access to things like Tylenol and ibuprofen. Most of these people can’t afford things that we just take for granted. Also, realizing that as different as it can be, we still see a lot of the same complaints, even in a Third World country.

We saw a lot of colds, allergies and infectious diarrhea. There are parasites and amoebas that are pretty common in Guatemala. There were also a lot of rashes. That is very common down there. Of course, there are really strange things that happen there as well. It’s a big combination of “I’ve never seen that before” and things we see every day.

Do you think your background adequately prepared you for what you did?

I had done other mission trips before traveling to Guatemala. I had spent time in other Spanish-speaking countries, so I was able to see most patients on my own without the help of an interpreter.

In addition, all students that participate in this trip are encouraged to take a medical Spanish class before we leave. That way, even if some students don’t have strong Spanish skills, they are able to connect with patients on a cultural level, as well. Each student had learned to say basic things like “I’m going to take your blood pressure” and “what problems do you have today?”

I think my background with PROMISE specifically has helped me throughout my medical education. My time in the lab taught me how to explain complex biomedical concepts to people of every age. I think my ability to talk to patients in terms they understand is really strong, and I credit PROMISE with a majority of that.

What role do educational programs like PROMISE have in health care?

People need to understand why we are doing the things that we do. Since I’ve begun spending more time evaluating and treating patients as part of a medical team, I’m realizing that the general population could use a stronger foundation in health literacy. Patients tell us they have high blood pressure, heart disease or diabetes without really understanding what their diagnosis means or why it’s so important to treat.

People often get so frustrated with the cost of medical care, but I think something that could help solve that frustration is education. That is part of PROMISE’s goal. We want to help people understand the research and financial investment that goes into creating medical treatments for people and their families. PROMISE is trying to bridge the gap between what people often don’t know or don’t understand in health and biomedical sciences. I think that is what a lot of physicians want, too.

PROMISE gives kids and adults an idea of what we mean when we are talking about this explosion in genetics and everything that happens not only when you go to the doctor, but even how your medications are developed. I think it’s a great opportunity for kids to get interested in science careers at all levels at an early age.

Research notes

Boerner’s use of the PROMISE lending library was one of the numerous recent developments involving research, one of the key areas of innovation at Sanford Health. Some other research highlights include:

Behavioral sciences

A community assessment identified the need to reduce the risk for alcohol-exposed pregnancy among American Indian and Alaska Native adolescent girls. Jessica Hanson co-authored a study identifying community priorities for a culturally relevant and age-appropriate alcohol-exposed pregnancy intervention program. The data was published in the International Journal of Environmental Research and Public Health.

There are a number of momentary situational factors that precipitate eating disorder (ED) behaviors and cognitions. A recent study authored by Stephen Wonderlich, Ross Crosby, Kathryn Smith and Scott Engel investigated momentary situational triggers in relation to ED symptoms, finding that self-criticism predicted ED behaviors with thoughts of food and urges to eat. This data was published in the journal Eating Disorders.

Susan Hoover was selected to serve on the Standards and Practice Guidelines Committee of the Infectious Diseases Society of America (IDSA). IDSA is a community of over 11,000 physicians, scientists and public health experts with a mission to improve health and promote excellence in patient care, education, research, public health and prevention relating to infectious diseases.

Arielle Selya recently gave spoke at the Academy Health conference in Washington about predicting medical visits with diabetes patients. Her presentation was about a predictive model using data from the Sanford Data Collaborative. She also participated in a discussion panel about machine learning for health services and policy research.

Different assessments are used to determine the eating disorder type, frequency, and symptom progression. Kathryn Smith recently published a comprehensive review in Current Psychiatry Reports that discusses how ambulatory assessment methods have influenced our understanding of the nature of eating disorder psychopathology and informed on effective intervention approaches.

A need exists for teen pregnancy prevention programs that are responsive to the specific needs and cultural contexts of Native American communities. To address this disparity, DenYelle Kenyon conducted formative research with Northern Plains Native American community members, resulting in My Journey, a culturally attuned curriculum for 6th to 8th graders. A pilot study revealed My Journey made a meaningful practice-based evidence contribution as a community-defined, culturally integrated curriculum that is effective. This data was published in the International Journal of Environmental Research and Public Health.

Cancer biology and immunotherapies

Pilar de la Puente presented research updates at the annual meeting of the Midwest Tumor Microenvironment (TME) at the University of Notre Dame in South Bend, Indiana. De la Puente was invited to give a talk about her work on the development of plasma-derived 3D engineered tumor microenvironment (3DeTME) cultures to recreate breast cancer drug resistance, intra-tumoral hypoxia and immune evasion.

Sam Milanovich received a grant titled, “Characterizing ARID5B transcriptional regulation in hematopoiesis and acute leukemia” from the Northwestern Mutual Foundation. Funds will add non-capital equipment to carry out future experiments investigating ARID5B-dependent transcriptional regulation during normal hematopoiesis (the process where blood cells are formed) and development of acute leukemia.

Michael Kareta received an award to perform single-cell gene expression analysis using services at the University of Nebraska Medical Center Genomics Core. This will advance his laboratory’s investigations into tumor heterogeneity at the single-cell level, a topic that is at the cutting edge of the cancer field. This award is funded by the Great Plains IDeA-CTR Network supported by the National Institute of General Medical Sciences.

Paola Vermeer received a grant from the Dakota Cancer Collaborative on Translational Activity (DaCCoTA) for a grant titled, “Tumor innervation in ovarian cancer.” This project will define ovarian cancer innervation in a subtype-specific manner and determine if innervation changes during disease progression. Also, an experimental model of ovarian cancer will test therapeutic efficacy of targeting tumor innervation.

Pediatrics and rare diseases

Kamesh Surendran gave an invited talk at the recent NIH-NIGMS IDeA Central Region Conference in Oklahoma City. The talk highlighted recent findings in the Surendran lab of the unexpected plasticity of adult mature kidney collecting duct cells, which is of relevance to understanding the cellular and molecular basis of certain kidney disorders, as well as the adaptive capacity of the kidneys.

Enabling technologies

Proximity-based labeling methods such as BioID can detect candidate protein-protein interactions or map the protein constituency of a subcellular domain. Due to the popularity of BioID, Kyle Roux published a paper describing the protocol by which a BioID fusion protein can be validated and utilized for BioID pull-downs. This technical paper was published in Methods in Molecular Biology.

Cell nuclei rupture following exposure to mechanical force and repair of such ruptures is facilitated in-part by BAF, a small DNA-binding protein, but its precise role in this process is not known. A recent publication by Kyle Roux found that BAF is important in triggering nuclear rupture repair by binding DNA at the rupture site and recruiting transmembrane LEM-domain proteins. This data was published in the Journal of Cell Biology.

Environmental influences on health and disease

Peter Vitiello gave an invited presentation on his research program investigating molecular mechanisms of oxidative injury in the pre-term lung at the meeting of the PanAmerican Congress on Physiological Sciences (PANAM) in Havana, Cuba. The mission of PANAM is to stimulate a creative exchange of ideas and collaborative work across physiological societies across the western hemisphere.

Clinical research

The Sanford Cancer Oncotherapeutics team, including Steven Powell, Chad Spanos, Jenna Hove, Linda Reisdorfer and Staci Vogel, activated a new clinical trial with a first-in-human agent, 9-ING-41, a novel GSK3β inhibitor aimed at making resistant cancers sensitive to chemotherapy again. Sanford Health has treated the first patients in the country on this study, and it is currently only available at Sanford, the University of California San Francisco and the Mayo Clinic.

Clinical investigators and orthopedic surgeons David Potter (site PI) and Robert VanDemark opened and enrolled people on the PREPARE study. PREPARE, a Pragmatic Randomized trial evaluating Pre-operative Alcohol skin solutions in FRactured Extremities, tests the choice of antiseptic skin preparation solution for extremity fracture surgery. This PCORI-grant-funded study is coordinated by McMaster University in Ontario, Canada, and the University of Maryland in Baltimore.

Clinical investigator and cardiologist Orvar Jonsson co-authored a study in JAMA Cardiology finding that patients with heart failure who were implanted with a pulmonary artery pressure sensor had lower rates of heart failure hospitalization. This supports that ambulatory hemodynamic monitoring may improve outcomes in patients with chronic heart failure.

Jecinta Scott, Preston Steen and Kiara Pochardt met with leadership staff from the Minnesota Cancer Clinical Trials Network (MNCCTN) to discuss the impact, questions and concerns of having clinical trials at the Sanford hospital in Thief River Falls, Minnesota. MNCCTN is an initiative from the state of Minnesota aimed to improve cancer outcomes through greater access to clinical trials.

The Vyriad clinical trial, using an experimental oncolytic virus aimed at infecting and destroying cancers, has expanded to an IV formulation. Sanford Health is leading the enrollment on this trial and has treated patients in the past month. The oncotherapeutics group anticipates continued growth with more oncolytic virus and experimental immunotherapy trials coming over the summer.

Education and outreach

Students participating in the various summer student intern programs through Sanford Research and other local programs have started their 10-week internship. This year we welcome the following 44 students: four PROMISE Scholars, three SURE, 25 SPUR, one BRIN, one RISE-UP, seven USD medical students and three SHIP. All students work under the mentorship and direction of Sanford Research faculty and have the opportunity to present their summer research at a poster symposium in August.

Sanford PROMISE welcomed collaborators from Harvard Medical School’s Personal Genetics Education Project for a two-day workshop at Sanford Research in Sioux Falls. Dr. Marnie Gelbart and Robin Bowman presented, “Talking with students about personal genetics” to regional science teachers to explore topics involving genome editing and increase awareness and conversation about the benefits and ethical, legal and social implications of personal genetics.

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Posted In Faces of Sanford Health, Research

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