Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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Thu, Sep 10 6:00am · Health disparities curricula an "opportunity to be seized upon" in resident training

A study recently published in the Journal of the American Medical Association points to a significant opportunity to improve health disparities training provided to medical residents in U.S. internal medicine programs.

Researchers from Mayo Clinic and other academic medical centers examined a data set that merged two national survey samples from 2015: internal medicine program director and internal medicine residents. They found that, despite mandates from governing bodies in medical education, only 40% of residencies provide health disparities curricula. In addition, they found that resident perceptions of training and its quality were not associated with the existence of an actual curriculum.

Why such a big disconnect?

Denise Dupras, M.D., Ph.D.

Denise Dupras, M.D., Ph.D., first author, says competing curricular priorities are a major barrier, as is the expertise to teach this topic.  In addition, she says, “most program directors did not have the data about the diversity of the patients they serve, so customizing the education to best meet the needs of their local population is not possible for most of them.”

Mark Wieland, M.D.

Mark Wieland, M.D., a co-author and a health disparities researcher at Mayo Clinic, adds that limited time to devote to teaching about health disparities “may prevent the implementation of authentic community-engaged curricula,” which leaves “efficient but insufficient” didactic teaching as the only practical option.

According to the study, more than 70% of residents say they’ve received health disparities training and most would rate their training as either very good or excellent. The authors suggest that residents may receive much of that training on the job.

Residents tend to care for a larger proportion of underserved patients, observe the authors, providing an opportunity for meaningful learning at the point of care. However, without a formal curriculum in place, there is concern that residents “may overestimate acquisition of needed skills.”

The authors say it’s vital to offer robust health disparities curricula in medical education. “It’s an opportunity to be seized upon,” says Dr. Dupras.

“As physicians, we are interested in the health of our patients, not just their health care,” says Dr. Wieland. “Since social determinants of health and structural racism shape the health of our patients, it is important for physicians in training to understand these mechanisms so that we may help to systematically address them.”

Dr. Dupras says, “We need to move beyond a checkbox mentality of learning about generalities to teach cultural humility and instill a genuine curiosity about the patient in front of us and the factors that impact his or her health. We don’t treat white people, or Black people or gay people.  We treat the entire person and need to consider all the things that make them unique.”

How should outcomes of this teaching be measured?

Dr. Dupras says, “While we can measure a resident’s knowledge, attitudes, and a patient’s satisfaction with their care, in the in the end the most important outcome remains quality of care and patient outcomes.”

Asked about Mayo Clinic’s current health disparities curricula, Dr. Dupras says, “This is a work in progress. We continue to introduce curricular elements and experiences outside of a formal curriculum to enhance residents’ exposure to our diverse patient populations.”

Dr. Wieland notes that Mayo Clinic is involved in a variety of initiatives designed to promote health equity and to enhance the diversity of Mayo’s student body and workforce.

“Mayo Clinic is leading a coalition that recently released a statement with an action plan on how to eliminate racism and promote health equity in workforce training,” says Dr. Wieland. “Medical education is an important platform for combating health disparities. Equity is achievable, in part, if we make it a core part of our mission as educators.”

Mon, Jul 20 6:00am · Minority communities attend virtual town halls in Arizona to receive COVID-19 information that dispels myths, equips them to lessen impact

The Mayo Clinic Center for Health Equity and Community Engagement Research recently addressed community health needs related to COVID-19 for hundreds of attendees at virtual town hall meetings in held in Arizona:

  1. Arizona African American Virtual Town Hall Meeting – April 28
  2. Arizona Hispanic/LatinX Virtual Town Hall Meeting – May 19

Both meetings featured speakers from Mayo Clinic and local organizations such as the Arizona Commission of African American Affairs, the Arizona Hispanic Chamber of Commerce, Arizona State University, and the University of Arizona. These meetings launched an ongoing series of virtual town halls planned in the coming months.

 “The purpose of these town hall meetings is to build and reinforce connections with community leaders in order to provide information and answer questions about COVID-19 and to dispel harmful myths,” says Chyke Doubeni, M.B.B.S., director, Center for Health Equity and Community Engagement Research. The meetings also aim to spark discussions about finding ways to lessen the impact of COVID-19 on minority communities and the ways in which research can help.

What puts minority communities at greater risk?

Graphic illustrating interrelated reasons why African Americans are dying from COVID-19
Image from Dr. Doubeni’s presentation at the Arizona African American Virtual Town Hall Meeting, April 28, 2020

Presenters cited statistics showing that minority communities are being disproportionately impacted by COVID-19.

Of those patients with race and ethnicity reported, “about 30% of the cases are in African Americans,” observed Dr. Doubeni, speaking at the African American town hall. He predicted that these numbers would change over time as race and ethnicity reporting improves, but he said, “I guarantee you that the proportion will remain higher than the proportion of the population that is African American, which is about 13% as of the last census.”

“And this is not a surprise,” he said. “For all of us, this has been part of the lived experience of African Americans.”

At the Hispanic/LatinX town hall, Judith Flores, M.D., chair of the National Hispanic Medical Association noted that in geographic locations with large populations of Latinos, the Latino COVID-19 death rate is much higher on average than for the general population.

What puts these communities at greater risk? Dr. Doubeni pointed to social injustice.

People in the African American community, noted Dr. Doubeni, are more likely to have high risk jobs without the opportunity to take time off work, more likely to use public transportation, more likely to live in overcrowded housing, and have less access to high quality health care. In addition, he said, “they don’t have a lot of trusted information sources, which may lead to delays and lack of trust in information people receive. It may lead to a delay in taking up protective advice”—such as masking and social distancing.

He also pointed to social injustices related to risks of dying from COVID-19. “If you look at the statistics around cancer, asthma, heart disease, diabetes, kidney disease, and many other preventable conditions, you will find that African Americans have the highest mortality rate.”

It has nothing to do with DNA, he says. It has to do with socioeconomic circumstances. “It’s just a reflection of this environment.”

Graphic illustrating reasons why Latino communities are disproportionately impacted by COVID-19
Image from Dr. Flores’ presentation at the Arizona Hispanic/LatinX Virtual Town Hall Meeting, May 19, 2020

The presenters at the Hispanic/LatinX town hall said that these communities face similar problems. In her presentation, Dr. Flores cited four main reasons why these Hispanic and LatinX communities are disproportionately impacted by COVID-19: employment, socioeconomic inequalities, health vulnerabilities, and immigration status.

“We are mostly essential workers. We have high risk of exposure,” said Dr. Flores. “I have seen multiple home health aides, all of which were Hispanic, who contracted the disease and some of whom brought it home, had other people be infected, and also had some deaths in the family.” This is just one example.

“We have so many vulnerabilities and all of these things showed up with this pandemic,” said Dr. Flores. “We’re going to be dealing with the consequences and the approach to the situation for years to come.”

Finding ways to lessen impact and come together as a community

“COVID has unveiled the effects of systemic policies and conditions that have existed for decades,” writes Dr. Doubeni. “If nothing is done, the massive social, economic and health fallout from COVID-19 will worsen social inequalities.”

At the African American town hall, he posed an important question: “Can this crisis serve as a turning point for effective policies and actions to improve the health of minority communities?”

The answer is yes. And there is important work to be done on every level: for individuals and communities, and for society and government.

“Despite centuries of adversity, communities of color have demonstrated resilience,” says Dr. Doubeni. “The current experiences call for the communities to unite, create greater awareness of disparities within our communities, and organize to drive the changes needs to achieve equity in physical, social and mental health.”

In partnership with institutions like Mayo Clinic, he said, minority communities should “use our knowledge of prior injustices with research to become drivers of the types of studies needed to improve health and promote wellbeing in the community.  This will ensure that we are prepared when the next ‘COVID’ arrives and can write a better narrative than the current one.”

Learn more:


Mon, Jul 13 6:00am · A pioneering Hispanic health conference, two years in the making

It’s less than two weeks before the Jax Saludable (Healthy Jacksonville) Hispanic health conference is scheduled to begin and Elizabeth Pantoja, a clinical research coordinator at Mayo Clinic and one of the event organizers, is putting the finishing touches on the event program.

“There’s always so much to do at the last minute, the last few hurdles,” she says with a tired grin.

The two-day virtual conference, to be held July 25-26, will bring together more than 300 Hispanic leaders from across Jacksonville, Florida, including faith leaders, health care professionals, health care payers, business leaders, educators, and patients and caregivers.  

Dr. White poses in a hallway
Richard White, M.D.

We have been told multiple times by our community partners that this effort is the first of its kind to address in a comprehensive fashion the health challenges many in our Hispanic community are facing.

Richard White, M.D.

“Our vision is to educate, inspire and organize leaders and the broader community to collaborate to improve health care access, processes, and outcomes for Hispanics in Northeast Florida,” says Richard White, M.D., a Mayo Clinic health disparities researcher and community internal medicine physician, who is leading the development of the Jax Saludable conference.

Included in this vision is a focus on the role of patient-centered outcomes research in achieving more equitable health care, particularly for conditions where the Hispanic community faces the greatest disparities compared to the general population: breast cancer, diabetes, dementia, mental health, and nutrition and exercise.

“We have been told multiple times by our community partners that this effort is the first of its kind to address in a comprehensive fashion the health challenges many in our Hispanic community are facing,” says Dr. White.

A community-academic alliance focused on Hispanic health

Several dozen people pose for a photo..
Jax Summit 2019 workshop attendees

The health conference is the culmination of a two-year research project led by Dr. White, funded by a contract from the Patient Centered Outcomes Research Institute (PCORI). Its goal is to support “capacity building” for future research. Capacity building involves gaining the interest, trust and buy-in of the community. It also involves learning about the community: its needs and its desires; its trials and challenges as well as its unique strengths and sources of resilience.

Dr. White and his team started their engagement effort in 2018 with the creation of an advisory panel composed of Hispanic community stakeholders tasked to identify the primary drivers of health inequities as opportunities to apply patient centered outcomes research to address these disparities. Next, the advisory panel used what they had learned to develop a training workshop for other community stakeholders.

“Our goal was to empower attendees to develop the skills necessary to recognize health disparities, identify patient-centered outcomes research results relevant to those issues, and apply them to improve the health of the Hispanic patients and caregivers,” says Pantoja.

Workshop attendees gave glowing feedback about their experience. “When we departed, there was one voice, one message and 100% commitment among this group of Hispanic leaders,” said Ed Perez, a community leader and President and CEO of 3 Grains of Rice Missions. “The commitment to improve the health and wellbeing of our Hispanic community is paramount.  I found it to be a highly impactful meeting. ”

The Jax Saludable Hispanic health conference is the third step in the engagement program—an event where advisory panel members and workshop-trained stakeholders will have the opportunity to share what they’ve learned with the larger Jacksonville Hispanic community.

“Jax Saludable will feature a dedicated group of leaders and experts in the fields of breast cancer, diabetes, dementia, mental health, and nutrition and exercise who will lead discussions with members of the Hispanic community around these issues,” says Dr. White.  “And just as importantly, they’ll lead discussions on how we can collaborate to improve the spectrum of health outcomes in these areas.”

“This sort of knowledge and collaboration to address health equity in our community is like a preferred type of viral spread,” jokes Dr. White. “We started out with a simple idea among just a few people, but we spread it to the larger advisory group, and bunch of people have ‘caught’ it at our workshops, and now, at Jax Saludable, we’re hoping to inspire towards action for better health among our whole community.”

Learn more:


Tue, Jun 9 6:00am · Fishing for solutions to COVID-19 challenges

Local innovators and members of the Minnesota entrepreneurial community gathered May 15, 2020, for a virtual Walleye Tank: COVID-19 Showcase. The event showcased how Minnesota innovators and community leaders are stepping up to conquer COVID-19 challenges. It was hosted by Mayo Clinic Office of Entrepreneurship and University of Minnesota.

The event is typically held as an in-person pitch competition. But this time, due to the pandemic, the event’s organizers decided to pivot to an online format. Fifteen teams presented; five in each of three categories:

  1. Diagnosing the virus and understanding spread
  2. Personal protective equipment and public safety
  3. Resiliency in the community

There were no winners at this showcase event. Instead, participants cast their lines for support from the local entrepreneurial community. Audience members were invited to donate directly to teams with projects of interest. In addition, teams were invited to kick off crowdfunding campaigns at the event.

“This is all about feeding forward the entrepreneur ecosystem and the innovations space because we know that getting out of COVID is not a short-term solution,” said Stephen Ekker, Ph.D., director of the Mayo Clinic Office of Entrepreneurship, in an interview with ABC 6 News. “It’s going to take all of us working together but we can innovate out of it  and we can make a better future out of this, not just going back to normal but making a new normal that’s better.”

The next Walleye Tank event is scheduled for December 11, 2020.


Thu, May 28 6:00am · Mayo researchers, minority communities team up to combat COVID-19 health disparities

Diverse family

As the COVID-19 pandemic takes more lives each day across the U.S., public health officials report that racial and ethnic minorities are disproportionately impacted. In a paper published as an accepted pre-proof article May 15, 2020, in the Journal of Clinical and Translational Science, researchers at Mayo Clinic detail how a community-engaged intervention tackled critical health communication problems within vulnerable minority communities. Community leaders collaborated with medical experts to serve as trusted conduits of information to their communities. The shared goal was to help people of diverse backgrounds understand what they need to know about COVID-19 prevention and testing, how to seek care, and how to access community resources. 

Mark Wieland, M.D., a community internal medicine physician at Mayo Clinic and the first author on the study says that the pandemic has amplified existing health inequities. 

“We know that racial and ethnic minorities are disproportionality impacted with chronic diseases and that these same communities tend to have higher COVID-19 infection and death rates,” says Dr. Wieland.

These disparities are driven by social determinants of health, such as socioeconomic position, immigration status, and limited English language proficiency as well as other factors, he says. 

To find solutions to these complex problems, it’s crucial for academic researchers and community stakeholders to work together as equal partners and to leverage existing partnerships, says Irene Sia, M.D., an infectious disease physician at Mayo Clinic, and the study’s senior author.

“Rich relationships have been formed over years and over many joint projects that have benefited the community,” says Dr. Sia. In a pandemic situation, these relationships are critical because they provide a strong foundation for outreach to vulnerable populations.”

Drs. Sia and Wieland are part of a long-standing community-academic research partnership, Rochester Healthy Community Partnership (RHCP), in Rochester, Minn., formed in 2004. Through the community partnership, they are working with community leaders to rapidly identify community needs and to co-create and deliver the right messages. 

Community members say that the work of the partnership has allowed them to communicate more effectively, enabling communities to take actions to prevent the spread of the virus. 

“We are very grateful of the guidance, support, and the strategies put forward by RHCP, and the difference it has made in the fight against COVID-19,” says Ahmed Osman, Somali community member and program manager, Employment Services, Intercultural Mutual Assistance Association, and a co-author on the study. “Without RHCP commitment, I really believe that we would not have been able to reach out and educate our communities, and be prepared as we are today. RHCP work is far from over, but the community knows that they have a reliable and trusted partner.”   

The work is ongoing. Researchers and community members plan to continue their collaboration throughout the pandemic to discuss needs and to coordinate communication. 

The researchers say that they hope the methods laid out in their paper can serve as a model for other community-academic partnerships during the COVID-19 pandemic. 

“These sorts of partnerships are common throughout the country,” says Dr. Wieland. “Each partnership is unique, but we think our framework can be a guide for others to borrow from to help them communicate with vulnerable populations.” Mayo Clinic currently has two other research groups who have begun successfully using this framework. 

In the near future, Drs. Wieland and Sia say they plan to study the impact this health communication strategy has on self-efficacy and perceived capacity, as well as on health behaviors within vulnerable communities.

Watch this Mayo Clinic Q&A interview with Drs. Sia and Wieland:


This story was originally published on Mayo Clinic News Network.

This research was funded by Grant No. UL1 TR000135 from the National Center for Advancing Translational Science (NCATS).

Thu, Mar 19 6:00am · Mentorship program a 'guiding star' for astrobiologist-turned-microbiome-researcher

Dr. Walther-Antonio poses in her lab
Marina Walther-Antonio, Ph.D.

Marina Walther-Antonio, Ph.D., came to Mayo Clinic to help start the Center for Individualized Medicine’s microbiome research program. In her previous job at NASA, she had worked with mathematicians, engineers, geologists, psychologists, and even political scientists to try to detect life in outer space. Mayo recruited her to look for “aliens”—bacteria and other organisms—living in the “extreme environments” inside human bodies.

Dr. Walther Antonio began a research fellowship at Mayo in 2012 and it wasn’t long before her advisers began encouraging her to apply to the KL2 Mentored Career Development Program.

The KL2 program, offered through the Mayo Clinic Center for Clinical and Translational Science (CCaTS), provides protected research time and intensive, mentored training under the guidance of a senior investigator.

“I didn’t realize how important the program was until after
I applied and got it,” says Dr. Walther-Antonio. “I didn’t expect or anticipate
the impact it would have on me and my career. Now, through the program, I see the
whole system lifting me up. I really feel that I have institutional support
behind me and a kind of family invested in me and the success of my research.”

Mayo Clinic Public Affairs recently sat down with Dr.
Walther Antonio to ask her about her experience in the KL2 program and her
future goals in research.

To really shake the ground you need diversity of thought and you need to be willing to take calculated risks. That’s where the big transformative power of science comes from.

– Marina Walther-Antonio, Ph.D.

Why did you apply to the KL2 program?

My fellowship advisers, particularly Dr. Virginia Miller, encouraged me to apply. KL2 is a great opportunity because it really protects a lot of time—75% protected time for three years—letting me take a breath and do more of the research I’m passionate about and not just write grants all day long.

What is your research project?

Blue gloved hand holds a microfluidic flatfrom

I’m working on figuring out the role of the microbiome in endometrial cancer. We’ve found a signature, kind of like a biomarker of the microbiome, associated with patients with the disease. We want to find out if this is just a biomarker or if there is a role the bacteria play in the causation or progression of the disease.  Our hypothesis is that a particular bacterium that is highly associated with the disease is infecting the cells and disrupting the cellular machinery, causing the cell to develop carcinogenic properties. If we’re right and the bacteria has a role in this process that gives us a target to help treat the disease. It would be easier to target the bacteria than to target the cancer, which is a part of the patient. And it would be less of a burden on the patient too.

There are other types of cancer that are closely associated with a bacteria or a virus: stomach cancer and helicobacter pylori; cervical cancer and human papillomavirus (HPV). We’re wondering if endometrial cancer works that way too.

The KL2 program recruits a diverse team of research scholars and emphasizes the importance of multidisciplinary team science. Why do you think that’s important?

My training is in astrobiology. It’s a world where, I often
say, it’s not just that people think outside the box, is that they have no
boxes. Because of that, it’s rare for there to be a question that nobody in the
room can answer. Or maybe they know somebody who knows the answer. That breadth
of contact and experience is a huge advantage.

I try to bring this kind of “no box” thinking to my medical
research.  I always try to hire people
who are not like me so I get that diversity of thought and experience at the
table. For a simple problem, you can probably be more efficient with a
specialized team. But for complex problems that involve, say, a paradigm shift,
that’s difficult to do with a specialized team. If you all have the same kind
of background and training, you have tunnel vision. To really shake the ground
you need diversity of thought and you need to be willing to take calculated
risks. That’s where the big transformative power of science comes from.

Has the KL2 program taught you anything unexpected?

I never anticipated I would enjoy, or gain so much from the
classwork that is required. I looked at the list of courses and got excited.
I’ve learned a lot and explored topics I would never have had time to learn
about otherwise.

In particular, I’ve gotten really into bioethics and health equity. I took a class from Dr. Joyce Balls-Berry on diversity and I got a publication out of that, which was very well received. It asked the question: “are early screening biomarkers for endometrial cancer needed to reduce health disparities?”

In endometrial cancer, which is the focus of my KL2
research, there are disparities related to screening. Some people think there’s
no need to develop a screening test because most cases tend to be found early
when it’s relatively easy to treat. But that’s really only true of white women.
Black women don’t tend to have the same symptoms as white women and, due to a
variety of other systemic inequities, endometrial cancer tends not to be
detected early, which leads to higher rates of advanced disease and higher
rates of morbidity and mortality.

I’ve come to realize that a lot of the difficulties of
implementing new medical approaches are not necessarily related to the science.
It’s the system that’s not prepared for it. This knowledge is so powerful and
it gives me a framework to think about how research should be designed to
address systemic as well as scientific issues.

How have your mentors helped guide you in your development as a researcher?

I can’t even count the ways they’ve helped me. Heidi Nelson, Nicholas Chia, Scott Kauffmann, Bill Cliby, Virginia Miller, Robin Patel, Jim Maher, Andrea Mariani; the list goes on. They are always one phone call away, or one short walk away. I appreciate every minute of the time they dedicate to me, because I know how valuable and limited their time is. These are such important, accomplished scientists and they’re people I can reach out to any time; I know they’re there and they’ll do anything to help me.

It feels really good to have people on your side like that. My mentors have been absolutely critical to my development as a person as well as a scientist. They push me forward beyond the science and into leadership and career development opportunities as well. I would not even have applied for a KL2 scholarship if it wasn’t for them.

Would you like to become a research mentor to someone else?

Mentoring is something I truly enjoy. I always tell people
that if you discover the cure to cancer and it dies with you in a coffin it
doesn’t do anybody any good. It’s really important to share knowledge and to
bring others along on for the journey. The more different those people are from
you the better because that’s what leads to big transformations. The only way
to move science along is to share it.

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Wed, Feb 26 6:00am · Training that increases research knowledge and confidence also boosts academic productivity

Pharmacy residency class photo
Mayo Clinic Midwest pharmacy residents, 2019-2020

Engaging in research can be challenging and intimidating for those who have never done it before. Mayo Clinic’s pharmacy residency program ensures all its trainees are set up for success by offering research and scholarship education as a standard part of their curriculum.  A recent paper published in Currents in Pharmacy Teaching and Learning demonstrates the impact of this training program, showing significant improvements in residents’ knowledge and confidence toward research and biostatistics as well as higher levels of academic productivity at one year after graduation.

Leveling the playing
field

Jason Barreto poses for a photo wearing a suit
Jason Barreto, Pharm.D.

“Residents come to Mayo Clinic with varying degrees of formal
training in research,” observes Jason Barreto, Pharm.D., lead author. “The
pharmacy department’s structured research education is intended to bridge existing
gaps in training.  We want to provide
knowledge about research methods and promote involvement with meaningful, impactful,
scientific investigation.  Completion of
this curriculum enables residents to critically interpret the medical
literature and to pursue research opportunities both during and after their
residency with confidence.”

The training program includes:

  • Essentials
    of Clinical and Translational Science
    online modules providing an overview
    of research terminology, epidemiology, and biomedical statistics.
  • A two-day, interactive workshop delivered by
    pharmacy department researchers.
  • Completion of a pharmacist-mentored research
    project involving a multidisciplinary investigative team.

The study found that, before training began, although baseline
knowledge of biostatistics and clinical research skills was relatively high
based on a knowledge assessment, only 27% of residents reported feeling at
least somewhat confident their knowledge and skills, and only 19% reported a
positive attitude toward their understanding of statistical terminology.

After training was complete, knowledge assessment scores
improved and reported feelings of confidence and positive attitude skyrocketed.
91% of participants reported feeling at least somewhat confident in their
knowledge and skills, and 82% reported a positive attitude toward their
comprehension of statistical terminology. One year after graduation, 53% of
participants had successfully published at least one peer-reviewed manuscript
(the general publication rate is 4-20%).

Garrett Schramm, R.Ph.
Garrett Schramm, R.Ph.

Garrett Schramm, R.Ph., director of Pharmacy Education and Academic Affairs at Mayo Clinic, is a firm believer in his department’s research training program.  “Our research curriculum began in 2007 when three pharmacists came together with a goal to formally incorporate research into our training programs. The success of the curriculum, coupled with Mayo Clinic’s longstanding collaborative relationships between pharmacists, providers, and biostatisticians, has resulted in a resident research publication rate of 53% at the end of the first year and 75% overall,” he says. “The pharmacy department hires approximately half of its residents, and all of those individuals are equipped to go on to become productive research team members or independent researchers. It’s an investment in the future,” he says. “Get these people trained and they could be making research a part of their daily activity for the next 30 years.”

What’s next?

In subsequent studies, Dr. Barreto wants to dig deeper to
find out which aspects of the research training program have the greatest
impact on knowledge and confidence. He also wants to study the impact of the
training program over a longer period of time with a larger sample group.

One last point of intrigue for a future endeavor: study participants
reported an increase in knowledge immediately after an intense, structured
curriculum; however, whether that knowledge is retained or improved after
several years into clinical practice remains unclear and requires investigation.

Ultimately, he says the biggest takeaway from this study is
the ability to increase research and statistical knowledge as well as the high
levels of scholarly productivity.

 “Vince Lombardi [former coach of the Green Bay Packers], used to say ‘confidence is contagious,’” says Dr. Barreto. “I like to think our program is helping more residents to couple an increased level of confidence with the knowledge to properly conduct research. The more people we have on the research journey the better, because that leads to more medical advances that can help more and more patients.”

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Thu, Feb 13 6:00am · Embracing clinical research with 'both feet and hands'

Dr Vella, seated in his lab, faces the camera
Adrian Vella, M.D.

Adrian Vella, M.D., says medical careers run like a hereditary condition in his family. “My father is a physician, my brother is a surgeon, and there are lots of medical people on my mother’s side as well.” So it was almost inevitable that, from an early age, he thought about becoming a physician as well.

Or an astronaut. His ten-year-old self would have been ok with that too.

Dr. Vella’s medical career trajectory began to diverge from the patient care path followed by the rest of his family when he moved halfway around the world to join Mayo Clinic’s residency program. He wasn’t here long before the research bug bit. It bit hard.

Now, 25 years later, Dr. Vella is a clinician-researcher at Mayo Clinic, specializing in endocrinology and diabetes research. In addition, he was recently appointed director of Mayo’s Clinical Research and Trials Unit, which provides infrastructure and support for medical researchers at Mayo Clinic and in industry.

Back home in Malta, when he began his training, he never
would have predicted that his career would take this turn. But he’s glad it
did. “The opportunity came along and I decided to embrace it — with both feet
and hands,” he says with a grin.

Coming to Mayo ‘almost by accident’

Dr. Vella and his parents pose together on a plaid couch.
Adrian Vella, M.D., and his parents, July 1995, a few weeks after he began his residency at Mayo Clinic.

A friend in medical school had applied to Mayo’s residency
program the year before so, on a whim, Dr. Vella decided to apply to Mayo too. Traditionally,
he says, Maltese medical students apply to schools in England to complete post-graduate
training. But on impulse, he decided to throw Mayo Clinic into the mix.

Dr. Vella forgot all about his application until a few
months later, when the phone rang at his parents’ house.

When his mother told him Henry Schultz, M.D., the residency program director from Mayo Clinic, was on the line, he didn’t believe her at first. “’How would you expect me to know who the residency program director at Mayo Clinic is?’ she asked me, so exasperated,” he recounts. “’I didn’t just make that name up out of a cloud.’”

“Anyway, I talked to Dr. Schultz. And a few days later he called me back to offer me a place in the program,” he says. Dr. Vella remembers putting the phone down and asking his mother what he should do about the offer. His mother, true matriarch of a medical family, knew all about Mayo Clinic. She turned to him and said, “It’s pretty obvious what you’re going to do. You’re going to go.” And that was that.

Getting hooked on research

Drs. Rizza, Vella and Conover pose  at a holiday party. Dr. Conover precariously holds three full beverages.
Endocrinology holiday gathering, 2001. Left to right: Robert Rizza, M.D., Adrian Vella, M.D., Cheryl Conover, Ph.D.

Research training is a standard component of the curriculum for Mayo Clinic residents and fellows, so it wasn’t long before Dr. Vella got his first taste of the lab.

One of his first and most important research mentors was Robert Rizza, M.D., an endocrinologist whose research has been responsible for major advances in diabetes care. Dr. Rizza helped kindle a desire in Dr. Vella to understand the underlying physiological reasons that determine whether a person will develop type 2 diabetes.

“I remember our first publication together,” says Dr. Vella. “I learned how good it feels to put in years of work and all the deferred gratification, and at the end to have the physical representation of what we had done. The fact that that paper still stands on its own, all these years later, is a real source of pride.”

Dr. Rizza recently retired and now Dr. Vella leads this
research.

“Contrary to popular belief, type 2 diabetes is not
something caused by the patients themselves,” says Dr. Vella. While diet and
lifestyle play an important role, other physiological factors have a great deal
of influence. “If you went into a bariatric surgery practice, you’d find that
only about one-third of the patients there have type 2 diabetes — two-thirds
don’t. Even when someone is significantly overweight, diabetes is not
inevitable.”

Dr. Vella’s current research focuses on understanding the physiological reasons why some people are more resilient to developing type 2 diabetes than others. He also seeks to identify disease pathways that can be manipulated to prevent diabetes from developing.

Promoting the tools of the clinical trials trade

As a diabetes investigator, much of Dr. Vella’s research has
relied on the resources of Mayo’s Clinical Research and Trials Unit. “Clinical
diabetes research requires careful control of diet and activity level of
research volunteers, as well as meticulous monitoring of blood sugar, and
inpatient stays,” says Dr. Vella. “This sort of work would be difficult or even
impossible without the support of the Clinical Research and Trials Unit.”

The Clinical Research and Trials Unit offers Mayo Clinic and
industry investigators access to inpatient and outpatient research facilities
staffed by specially trained nurses, registered dieticians, and technical and
support staff; supported by a large selection of procedural and laboratory
services.

The Clinical Trials and Research Unit is a resource Dr.
Vella is determined to promote and protect in his new role as director.

“Many investigators, particularly young investigators, don’t
have sufficient funding to access resources like these without the help of the
Clinical Research and Trials Unit,” says Dr. Vella. The Clinical Research and
Trials Unit enables researchers to accelerate their work, finding answers and
new treatments more quickly.

“I feel very lucky,” says Dr. Vella. “Mayo probably has the best clinical research center in the country, which by definition probably means the best in the world.”

Not everyone is so lucky. Across the United States, following the end of the National Institutes of Health clinical research center support program in 2016, dedicated clinical research resources have been disappearing. Many researchers, including Dr. Vella, are sad to see them go. “I wrote an editorial in Diabetes with Dr. Nair and Dr. Jensen four years ago saying ‘clinical trial units … we’ll miss them when they’re gone,’” says Dr. Vella.

Fortunately, the Clinical Research and Trials Unit at Mayo
Clinic is still going strong thanks to robust institutional support. “Mayo is
committed to its Clinical Research and Trials Unit and understands the enormous
contributions it brings to medical science,” says Dr. Vella.

Growing the Clinical Research and Trials Unit

Clinical research nurse views a CT scan of a research volunteer's spine. In the background, a research volunteer lays on their back under the scanner with their upper body slightly twisted to one side.
A research volunteer undergoes a CT scan in the Clinical Research and Trials Unit.

Dr. Vella has set his sights on developing and expanding the Clinical Research and Trials Unit.

Historically, many of Mayo’s most important medical
discoveries have depended on detailed human study. And the clinicians and
scientists who made those discoveries have depended on Mayo’s rich clinical
research infrastructure to advance their discoveries into practice.

The work that led to multiple daily injections of insulin was done here in the 1920s by Dr. Wilder and his colleagues,” says Dr. Vella. “The discovery of the compound called cortisone came out of Dr. Hensch and Dr. Kendall’s clinical studies involving pregnant women with rheumatoid arthritis. And more recently, the discovery that obesity has metabolic consequences only if it’s in the upper body vs. the lower body — that research was done here at Mayo in the Clinical Research and Trials Unit by Dr. Jensen. A lot of that research in humans would have been impossible without Mayo’s clinical research infrastructure.”

Dr. Vella doesn’t think the need for these resources is
likely to go away.

Over the next few years, Dr. Vella’s biggest goal for the Clinical
Research and Trials Unit is to develop its client base to make it more
self-sustaining.

“I want to increase the scope of the studies we support and the number of investigators using the Clinical Research and Trials Unit,” he says. “A year from now, I plan to have increased the number of studies, both industry- and federally-funded, by 10%.”

Dr. Vella also wants to help other academic medical centers find ways to hold on to their existing clinical research units and transition to new funding models less dependent on federal dollars. “Other institutions have seen the success we’ve had here at Mayo and want to learn from that,” says Dr. Vella. “I tell them, it’s cheaper to keep a resource like this going than to rebuild later from scratch.”

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