Re-Engineering Breast Cancer Surgery: A Device to Improve the Accuracy of Breast Cancer Surgery

The February Eichler seminar was an exemplary glimpse into the interdisciplinary partnership between surgical oncologist Richard J. Barth Jr., MD and biomedical engineer Venkat Krishnaswamy, PhD to improve the efficiency of breast cancer removal surgery. 

The seminar kicked off with a reminder by Dr. Manish Mishra, “why does this all matter?”: As a physician, you can use your voice where it matters by advocating for a patient. For Drs. Barth and Krishnaswamy, it was responding to the fear following a breast cancer diagnosis. 

Dr. Barth took the seminar attendees through a brief introduction to the beginnings of Cairn Surgical, the joint venture that Drs. Barth and Krishnaswamy created to proliferate their innovation: The Breast Cancer Locator. In his work, Dr. Barth noticed the inefficiencies in breast cancer tumor removal surgeries. The goal of breast-conserving surgery is to remove the cancerous mass with negative margins while minimizing the loss of healthy breast tissue. However, 20-25% of the time, in trying to balance removal of the tumor with conserving health tissue, a positive margin results. This means that Dr. Barth has to call the patient to return to surgery to remove the additional tumor margin. This got him thinking, what are ways we can improve this surgery to increase the precision of breast-conserving surgery?

Enter Dr. Krishnaswamy. Dr. Krishnaswamy had been studying to receive his PhD as a biomedical engineer at Dartmouth on a completely different project. But he was intrigued by this issue posed by Dr. Barth, and he was uniquely positioned to see this clinical problem from an engineering lens. Dr. Krishnaswamy quickly became engrossed with this project, finding an “innate satisfaction” in working in healthcare. In his partnership with Dr. Barth, the Breast Cancer Locator (BCL) device was created. The BCL is a 3D printed cast that fits over the breast that assists surgeons in projecting the area of breast cancer mass removal. 

The success of this project highlighted two overarching themes: a “stick-to-it-ness” and an open-mindedness, as Dr. Mishra described it. The identification of a problem to the creation of a solution is no easy task and requires time and dedication through the ups and downs of innovation to succeed. In addition, this collaboration was only possible through the open-mindedness of both parties not just to the unique perspectives of other disciplines, but also a willingness to be humble and recognize the limitations of their own specialties alone. From there, they could see the synergistic impact on improving care for these breast cancer patients that this interdisciplinary approach could have. 

These skills of “stick-to-it-ness” and open-mindedness are things we can all practice in our day-to-day lives. Whether it be through the ups and downs of an organic chemistry course or the willingness to ask for help when we need it, we will all be stronger future healthcare providers for doing so.

#DartmouthFoundations

#FellowsFriday: Matthew Fam ’21

The Eric Eichler ’57 Fellowship for Health Care Leaders is a one-year fellowship that includes one-on-one mentorship with senior faculty and researchers at The Dartmouth Institute to guide your exploration of research, policy or health outcomes improvement work.

#FellowsFriday individually features each of the twelve Eichler Fellows and the projects they are working on with their mentors.

Matthew Fam,
Eichler Fellow

Matthew Fam is a Dartmouth ’21 from Staten Island, NY. He is a neuroscience and English major with a concentration in creative writing. After completing his undergraduate degree, he plans to pursue a medical degree on his path to becoming a physician focused on patient care. However, Matthew hopes to carve his own unique path. While he hopes to make a difference as a practicing physician, he is considering the possibility of completing an MPH or MBA (perhaps even an MFA) as a way of having a larger impact on #healthcare while merging his many interests.

Having grown up in New York City as a first-generation Egyptian-American, Matthew is interested in the effects of language, culture, and background on treatment—how the conscious, subconscious, and environment informs actions and reactions to health. This relationship between people’s subjective and objective realities, seen through #data, is something he hopes to explore through the lens of #healthcare. He looks forward to gaining more insight about the field and how he can move it forward

Jessica Poludin, Program Director of HARP and mentor to Eichler Fellow, Matthew Fam

As part of the fellowship, Matthew is involved in a project with Jessica Poludin, the director of the Hartford Autism Regional Program (HARP). At HARP, he works with a specific group of students on the autism spectrum throughout the academic year. He helps with an intervention strategy called Applied Behavioral Analysis (ABA),  performing functional assessments and supporting the creation of new intervention plans.

#DartmouthFoundations

The Art of Narrative: Communicating in the ER

The January series of the Eric Eichler ‘57 Foundations in Medicine and Humanities Seminar Series kicked 2020 off with a fresh start. This seminar was a discussion-style talk between Dr. Manish Mishra, Dr. Matthew Babineau, and Ricardo ‘Liniers’ Siri, with fresh insight by Professor Elizabeth Carpenter-Song. In the span of an hour, we covered Dr. Babineau and Liniers’ life paths, explored the cross-over between storytelling and medicine, and ended with student thoughts and questions.

Friends and Colleagues (Left to Right): Ricardo, Babineau, Mishra

Dr. Matthew Babineau, with Dartmouth roots himself, began by sharing with us his passion for trees and forest ecology as well as being a pre-medical student. Following his graduation from Dartmouth, he followed his passion for medicine to Zimbabwe where he worked to develop sustainable microenterprises that worked for both the people inhabiting the land and the ecology surrounding them. On this trip, he realized that the local people knew more than he ever could about their land; but what he did see was an opportunity to do something about the AIDS epidemic that impacted so many people he worked with. This ultimately drove his path back to medicine, and he is now an Emergency Room physician at DHMC. 

Ricardo ‘Liniers’ Siri grew up with his father as a lawyer who was “super happy” when Liniers took the decision of becoming a full-time cartoonist. While @siriliniers was aware that this was a risky decision, by age 22/23 he was certain he “could not not do it”. He started off just drawing and creating as many comic strips as possible. As Siri puts it, “I was going to draw so much that one of them had to be good – statistics!” This method did in fact work, as by November 2014, @siriliniers was a New Yorker cover artist. 

Interested in seeing Liniers in action?
(Check out @linierscartoon on insta for even more action!)

Through the collective experiences of @MKM and Elizabeth, Dr. Babineau, and Liniers, the power of interdisciplinary perspective in health care was evident. To listen and understand a patient’s story and then to communicate to other healthcare professionals the key treatment-related takeaways highlights two different skills. In this seminar, @mkm asked the Eichler ‘57 Fellows who were present to write down a word that came up in this group discussion: receptive. It is not only important for physicians to be properly trained in the skills of medicine, but also to be able to listen to stories, understand the context, and deliver a concise medical suggestion. These skills are what @siriliniers practices every day as he draws upon social context and humor to create a story within a single panel. 

#DartmouthFoundations Check out all seminar photos here!

#FellowsFriday: Ameena Razzaque ’21

The Eric Eichler ’57 Fellowship for Health Care Leaders is a one-year fellowship that includes one-on-one mentorship with senior faculty and researchers at The Dartmouth Institute to guide your exploration of research, policy or health outcomes improvement work.

#FellowsFriday individually features each of the ten Eichler Fellows and the projects they are working on with their mentors.

Ameena Razzaque,
Eichler Fellow

My name is Ameena Razzaque, I am a ’21 (junior) from San Antonio, TX. My special major is titled “Women’s Health in the MENASA (Middle East North Africa South Asia) Region” and I am minoring in Middle Eastern Studies. I don’t know what my future holds, but I do know that I want my career to be flexible. I want to have a balance between global/public health and clinical work and I want to serve international communities. I want to aid Muslim women in the regions I have chosen to focus my major on, and work closely with non-profits, NGOs, and Doctors Without Borders.

I loved attending the Foundations session with musician doctors and learning about how they balanced both of their passions and how important improvisation and spontaneity is in healthcare. I also loved seeing a close-knit community come together to enjoy the last closing picnic and felt like I belonged with this group of amazing individuals.

Carol Stamatakis, Executive Director of Senior Solutions and mentor to Eichler Fellow, Ameena Razzaque

My project is in partnership with Senior Solutions and Carol Stamatakis. Senior Solutions is a non-profit community organization that “provides social services to Vermonters 60 years and older, their caregivers, and their families.” As my project evolves, it will most likely be about aiding non-citizen female survivors and other survivors of domestic and sexual violence, thus working closely with WISE as well. WISE aims to “end gender-based violence through survivor-centered advocacy, prevention, education and mobilization for social change.”

Foundations Alumna Spotlight: Eryka Molino

Eryka Molino, Foundations ’19

The Dartmouth Health Care Foundations was a once in a lifetime experience that I will carry near and dear to my heart. Of the many moments of inspirational truth touched on throughout the week, I believe the most powerful is the idea that health care is not a political issue, but a human one. The program has shown me the different ways to think of health care as more than a clinical practice, but as a human opportunity to better others. The reimagining of health care as a person to person effort was the ultimate goal of the interdisciplinary approach.

My favorite part of the week was meeting with Dr. Agnes Binagwaho, the Vice Chancellor of the University of Global Health Equity. Learning the ways in which she improved Rwandan healthcare after a genocide was so moving and captivating. It truly lit a fire within me to push for a better healthcare system. Her speech brought to a head how we need to push for the agenda of the vulnerable.

As an aspiring doctor, I have always believed in One love, and the interdisciplinary approaches Dr. Manish K. Mishra and Dr. Elizabeth Carpenter-Song took towards healthcare has changed my views of the system forever.

#FellowsFriday: Jessica Kobsa ’20

The Eric Eichler ’57 Fellowship for Health Care Leaders is a one-year fellowship that includes one-on-one mentorship with senior faculty and researchers at The Dartmouth Institute to guide your exploration of research, policy or health outcomes improvement work.

#FellowsFriday individually features each of the ten Eichler Fellows and the projects they are working on with their mentors.

Jessica Kobsa, Eichler Fellow

My name is Jessica Kobsa, and I am a ’20 from Wilton, Connecticut. I am a Psychology major and Biology minor. I am also a Senior Fellow conducting research on an intervention to reduce problematic eating behaviors in adolescents. I tend to be drawn to issues that I feel are too often overlooked, such as care for the elderly, end-of-life decisions, women’s health, and the intersection of mental health with physical health. I feel very passionately that I want to be a clinician applying the knowledge and tools of medicine to positively impact people’s lives.

                  Clinically, I am especially interested in difficult yet hugely important conversations involving decisions about end-of-life care and palliative care. As a psychology major, I am also interested in how the mind affects our physical health and vice versa. I would argue that principles of psychology can be used to improve just about every human experience there is, including the experience of being a patient and the experience of being a doctor in today’s burnout-breeding environment. My goals pertaining to healthcare are to first understand the needs and perspectives of as many stakeholders as I can and then to use that knowledge to help make structural changes in today’s healthcare system that improve people’s experiences.

Dr. Robert Santulli, geriatric psychiatrist and mentor to Eichler Fellow, Jessica Kobsa

I am working with Dr. Robert Santulli, geriatric psychiatrist, on the Dartmouth Dementia Directive Video Project. In this project, we promote the Dartmouth Dementia Directive, an advance directive that allows people to describe their wishes for their medical care specifically at three different stages of dementia. Additionally, we provide interested individuals an opportunity to video record their directive, as evidence suggests that video advance directives are more likely to be followed and are valuable to family members and physicians involved in an individual’s care.

Foundations instilled in me incredible passion to make a difference and ignited my curiosity to learn as much as I can about the needs of the players in today’s healthcare system. I believe that with the right mindset, the willingness to compromise, creativity, and resilience, we can solve some of these problems. I am incredibly grateful for the opportunity to be an Eichler Fellow, and I look forward immensely to this step in my journey.

“Imprecision Medicine: Health Without History” with Dr. Rick W.A. Smith

November Seminar with Dr. Rick W.A. Smith, MA, MS, PhD

Dr. Rick Smith speaking with the Eichler fellows and greater Dartmouth community.

This talk titled “Imprecision Medicine: Health without History” given by Dr. Rick W.A. Smith of the Dartmouth Anthropology department targeted the intersection of Anthropology and genomic advancements. The Eichler fellows were joined by their classmates and colleagues as @rickwasmith shared his insights on his research interspersed with the information he would’ve wanted to hear as a pre-medical student. 

We are all familiar with the recent boom in genetic tests commercialized to uncover our family lineage and ancestry; these consumerized genetic test kits are what Dr. Smith refers to as “the unfulfilled promise of precision medicine”. Following the advancements in genetic medicine, we were promised a revolution in health, but what we got were take-home ancestry kits. In this talk, we were encouraged to think about all the greater possibilities and untapped potential in genetic testing. 

Dr. Smith’s research focuses on the ways that social and political power structures shape human biology in both ancient and contemporary societies. Not only does colonialism leave marks on the physical locations of civilization, but also on the bodies of the native civilians. Violence and trauma can be traced through genetic and epigenetic data. However, it has been only scientists deciding that “pure” blood qualifies a person as indigenous; genetic scientists have been studying indigenous populations without acknowledging the social experiences, trauma, and sexual violence that these populations have experienced. This manner of genetic data collection erases the history of white violence on indigenous bodies that indigenous women have faced.

How are scientists, removed from a historical and cultural context of what they are studying, the ones making decisions regarding indigenous people? Not only has this resulted in the erasure of alterations in genetic variation of indigenous people following colonialism, but also raises an ethical problem of how scientific literature determines both who is getting studied and what the implications mean without a full understanding of the social context.

This seminar topic and the work of Dr. Smith are a robust examples of interdisciplinary study. Dr. Smith’s multidisciplinary approach to his work is one that the Dartmouth Health Care Foundations program hopes to continue inspiring in pre-medical students. We must not only examine the most pressing issues in medicine as a biomedical problem – but additionally, how to approach these issues from a sociological/anthropological, psychological, social perspective. In doing so, we – as future medical leaders – will be able to better represent the people and phenomena we are studying. 

#dartmouthfoundations See photos here.

For more information on the Dartmouth Health Care Foundations program, visit the site here.