After earning her Ph.D. in 2018, Nikesha Gilmore left a tumor immunology laboratory that used frogs and tadpoles as animal models to become a Grasshopper.
She joined the Cancer Control Research Training Program at Wilmot Cancer Institute, where each trainee — like the young student in the 1970s TV classic Kung Fu — is affectionately given that moniker. Her goal is to improve the lives of people with cancer by addressing the acute and long-term side effects of treatment.
“I’d like to be more of a translational/clinical scientist, to take what I learned in basic science and merge it with the clinical world and find my own niche,” Gilmore says.
Her challenge is doing that in a fast-paced, constantly changing field where the stakes are high and the goals are ambitious.
As part of an academic medical center, Wilmot has a responsibility to develop the next generation of physicians and researchers and to help shape the ever-evolving landscape of science and medicine. With education and training as key components of its mission, Wilmot offers residencies in surgery and radiation oncology, fellowships in hematology/oncology and different types of surgery, as well as post-doctoral training in a wide variety of sciences. Every year, these programs bring dozens of new physicians and scientists to Rochester, and many of them choose to stay after they finish. Those who move to other parts of the country take with them lessons in teamwork, collaboration and leadership.
Keeping pace with change
Wilmot’s programs address more than how to treat cancer or run an experiment in the lab. They emphasize meeting a patient’s needs now and anticipating what they’ll face in the future. They encourage different perspectives in pursuit of new knowledge and practical applications that will change cancer care and prevention.
In an era of rapid advances, especially in technology, these programs also aim to nurture a thirst for knowledge and a drive for problem-solving.
“The challenges with medical education have been basically trying to keep up with the technology,” says Rabih Salloum, M.D., who leads the residency program in General Surgery. “It is a continuous race, but the idea is no longer to try to train the residents on all this. The idea is to try to have the residents acquire the skill set that will allow them to continue learning on their own when they graduate.”
For scientific trainees, the challenges are similar.
“Advances in technology make our lives easier, but they also mean the bar is set higher,” says Edith Lord, Ph.D., Wilmot’s Associate Director for Career Development and Mentoring.
Becoming an independent investigator is an increasingly competitive endeavor as the cost of research — driven by technology — has grown, while funding for science has not. And advances in information are coming faster than any one person can keep up.
“We can’t know enough ourselves to do the work as it’s done now,” Lord says. “You need teams.”
Bridging the laboratory and clinic
In the laboratory and the clinic, collaboration has become crucial, and Wilmot’s programs instill the importance of teamwork within and across disciplines.
For example, Lord, a tumor immunologist, is working with David Linehan, M.D., the chair of Surgery at UR Medicine, to develop a training program that would bring post-doctoral fellows into the clinical arena and surgical residents into the laboratory.
“We’d like both sides to see how the other side does things because that’s always been a true gap in our culture,” says Lord, who served as the Senior Associate Dean for Graduate Education and Postdoctoral Affairs at the University of Rochester’s School of Medicine and Dentistry for a decade.
This arrangement will help the young scientists understand the challenges their clinical counterparts face with patients and the clinicians to get a better grasp of the possibilities in the lab.
The connections with Linehan’s team have been invaluable, Lord says.
“They’ve provided us with a clinical connection that we’ve never had before,” she says. “And it brings perspective on how things are done in the clinic and influences how we do mouse experiments.”
Even after a team has findings from their study, collaboration is essential.
“Every study that you do, no matter how impressive the results, you need to validate those findings, you need to make sure that they're generalizable, you need to make sure that they're going to be applicable to the wide scope of patients you see,” says Carla Casulo, M.D., Wilmot’s assistant director for Career Development and Mentoring. “Unless you collaborate with others, there's really no way to do that.”
These lessons in multidisciplinary teamwork often begin with the mentors that trainees find at Wilmot.
Radiation Oncology resident Sara Hardy, M.D., came to Wilmot after completing another residency in neurology at Johns Hopkins. She was drawn in part by the department’s focus on survivorship and addressing the late and long-term effects of cancer treatment.
In addition to her clinical training, Hardy has protected time for research through a competitive American Board of Radiology Holman Pathway Award she developed with her mentors, which supports trainees with strong clinical skills and an interest in a research career. With this time, she is planning a clinical trial that will evaluate cognitive changes after partial brain radiation and how that relates to dosing and brain connectivity.
“I have mentors in three different departments, and they routinely meet with me in one room,” Hardy says. Her team of mentors includes Radiation Oncology residency director Michael Milano, M.D., Ph.D., scientist Michelle Janelsins, Ph.D., MPH, from Wilmot’s Cancer Control and Supportive Care Research program and Giovanni Schifitto, M.D., M.S., a professor of Neurology and Imaging Sciences.
“Rochester is one of the few places where you can find this unique combination of mentors,” she says.
Providing a variety of mentors is intentional, Janelsins explains.
“We’re very multidisciplinary,” says Janelsins, who co-leads the University of Rochester’s Cancer Control Research Training Program, which is funded by an R25 grant from the National Cancer Institute. “Any trainee who comes through the program doesn’t have just one mentor. They have a whole mentoring team, and we are helping them to conceive and execute their own pilot study so they learn to develop something that’s their own that they can take and develop their career.”
Like Hardy, Gilmore has a set of mentors from diverse backgrounds whose interests align with hers. She is studying the impact of an anti-inflammatory dietary supplement called EGCG on chemotherapy-associated frailty. Her mentors include Janelsins, as well as Supriya Mohile, M.D., M.S., an expert in geriatric oncology, and Luke Peppone, Ph.D., whose research focuses on nutraceuticals.
“They’re helping you, but not spoon-feeding you,” Gilmore explains. “You really are learning how to be able to stand on your own two feet as a researcher.”
Gilmore also finds support from her peers, who come into the program from very different backgrounds. The program typically has four trainees at a time, and they’re a mix of M.D.s and Ph.D.s. who have a common interest in cancer control and survivorship.
That diversity of perspective is a key feature of the program. It not only helps teach how to work in a collaborative and multidisciplinary environment, it also helps generate new ideas.
And those new ideas are the point, says Karen Mustian, Ph.D., MPH, one of the core mentors in the Cancer Control Research Training Program.
“When you get a bachelor’s degree or master’s degree, you learn how to digest current knowledge and how to use it,” Mustian says. “What you don’t really learn in any of those degrees is how to create new knowledge. It’s one of the most challenging things that our trainees have to learn when they come here.”
Focusing on the practical
At Wilmot, trainees must also learn how to put that new knowledge into practice.
“It’s a huge leap between a theoretical community where you can banter around ideas and one where you actually have to put some rubber on the road and say, ‘This may be helpful,’” says Gary Morrow, Ph.D., M.S., who began training grasshoppers over 30 years ago. He received funding from NCI 15 years ago to start the Cancer Control Research Training Program, which now internationally known and which he co-leads with Janelsins.
In order to do that, Wilmot’s team and trainees have to understand not only the impact of cancer and its treatment on patients and families, but also what matters to them.
Since the 1970s, the University of Rochester has emphasized the biopsychosocial approach in medical education. This model, developed by two researchers at the university, looks at the impact of biology, psychology, and social and environmental factors on an individual’s health. In particular, it emphasizes the importance of relationships in providing health care and understanding a patient’s history in the context of their life circumstances.
The School of Medicine &Dentistry is also credited with developing the Double Helix curriculum, which, in the tradition of the biopsychosocial approach, weaves in behavioral and social sciences with traditional medical education. The goal is to prepare physician leaders who can practice in a dynamic and changing health care environment and meet the needs of diverse patients.
These values also permeate the post-graduate training programs. At Wilmot, they are reflected in the emphasis on survivorship and the late effects of treatment, as well as in the support for training in research.
“Learning about cancer and the treatments is very different than understanding all the issues related to surviving that cancer with the best possible quality of life,” says Louis “Sandy” Constine, M.D., who served as the Radiation Oncology Residency director for 15 years and was named Educator of the Year in 2018 by the Association of Residents in Radiation Oncology. “In order to do that, you have to figure out and address the patient’s needs and what threatens them in the future. Mostly, we want our residents to be empathetic, dedicated, curious, and to learn how to learn.”
To address this need, the residents and the Hematology/Oncology fellows take a course focused on survivorship care, led by Michelle Shayne, M.D., co-director with Constine of Wilmot’s Judy DiMarzo Cancer Survivorship Program.
“We’re one of the few programs in the country to give exposure on this,” explains Michael Milano, M.D., the residency program director. “It’s important because you do what you can to reduce risks and also help patients understand what the risks are.”
Teaching the intangible
Effective communication and leadership are hallmarks of Rochester’s approach to care and research. While these topics are covered in coursework, some of the best lessons come through experience.
“Not everything is taught in courses,” Constine says. “There are always ways in which one can instill hope in a patient appropriately, and that’s hard to teach. But it’s something that can be shown by example.”
Wilmot’s programs include one-on-one communication training that allows them to practice the art of communicating tough news. The residents and fellows also get to see the attending physicians and their teams using those techniques in the clinic.
“It’s watching what they do, seeing their interactions with patients and getting to learn from that,” says Jason Zittel, M.D., who recently finished his Hematology/Oncology fellowship and joined Wilmot’s faculty, practicing at both at Wilmot Cancer Center and the Ann and Carl Myers Cancer Center at Noyes Memorial Hospital in Dansville.
“You’re not just a note-writer,” Zittel says. “You go in to see the patients first, and many times, you go back in with them, and you watch how they go through a similar conversation as you just had, seeing what worked, what didn’t work for you, and then you get to see how they do it.”
General Surgery residents have a similar opportunity to learn communication and leadership.
“A lot is watching in the operating room — how to interact with scrub techs, how to interact with nurses,” says Zhaomin (Tim) Xu, who is in his sixth year of residency and plans to pursue fellowship training in colorectal surgery. “It’s not always a natural thing to take leadership in a situation.”
The residency program supplements those lessons with an annual retreat that focuses on leadership skills, teamwork and how to inspire others to excel. In addition to talks and discussion sessions, the retreat features activities like passing a hula hoop along a rope from one person to the next while navigating different obstacles.
“It helps us practice effective communication, so it’s not just yelling,” Xu says, which is essential in a pressure-filled environment like the OR.
Finding family among peers
Post-graduate training in medicine and science can be very stressful, and in recent years, accrediting agencies — particularly for medical training programs where work hours and lack of sleep have come under scrutiny — have pushed for more attention on wellness for trainees.
On top of the pressures of training, the practice of oncology can be emotionally draining. Coursework can provide a formal outlet, but Wilmot’s programs also provide extracurricular support — everything from throwing baby showers and giving care packages to hosting baseball games and family picnics.
Wilmot also offers a training environment unlike those portrayed on TV that are dominated by cutthroat competition.
“I trained at a small community hospital for residency,” says Bahar Moftakar, a first-year Hematology/Oncology fellow. “So I was nervous coming to Rochester to see if there was going to be that kind of competitiveness, but I’ve seen the exact opposite. All the fellows are incredibly helpful.”
In Surgery, there’s a certain degree of competition, says Xu, “especially when you get so many Type A people together. But in general, it’s very collegial. I consider my co-residents to be family because Surgery is a hard residency to go through.”
For Gilmore, joining the Cancer Control Research Training Program was also like gaining a new family.
“You get this all-around type of support system, not just as scientists, but as human beings, because we have so many other things going on,” she says. “We don’t just work on our grants and on papers. You know, we have kids and we have to go to different things, and you really learn about how to manage that work-life balance.”
And that support continues even when trainees have moved on.
“Once you’re a Grasshopper, you’re a Grasshopper for life,” Gilmore says of the support from the Cancer Control Research Training Program. “It’s not like you come here and they keep you for two or three years and then they send you out. You have this for life.”