Monthly Archives: June 2022

Before trading their white coats for black gowns and receiving their degrees at Convocation Hall,several members of the Temerty Faculty of Medicine's Class of 2022 recently looked back on their time in med school and shared advice for future students.

Five of those students MD graduates Happy Inibhunu, Justin Lim and Jordi Klein,as well as MD/PhD gradsAlainna Jamal and Siraj Zahrdescribe the rollercoaster of emotions they felt during their education atthe University of Toronto, from delivering their first baby to losing their first patient.

Here is a snapshot of their reflections:

Graduating from: MD ProgramUp next: Residency in neurosurgery, Western University

Time goes by really fast, as sometimes I often rewind back to orientation and am amazed of the incredible friends I have made these last four years. Some highlights of my medical school journey are my first-ever triathlon, receiving an honorable mention by the Canadian Society of Palliative Care for my written piece, "10:30,providing care to patients throughout the COVID-19 pandemic through virtual and in-person means, and, undoubtedly, achieving my dream of becoming a neurosurgery resident.

These last four years in Toronto helped define the physician I aspire to be by building interdisciplinary and multidisciplinary networks in a harmonious manner, creating positive, empatheticand trustworthy rapport with patients, and having the extraordinary opportunity of striving diligently to provide care to neurosurgical patients as a life-long vocation.

Being part of the Class of 2022, which didmore than half of medical school during the pandemic, andnavigating clerkship within the pandemic was certainly a hard obstacle to overcome. Striving to build rapport and guidance with patients through the distance created with the application of Personal Protective Equipment (PPE) while balancing the uncertainty of the pandemic placed another layer of complexity to our learning. However, a defining characteristic that resonated through the pandemic is the ability to recognize, acknowledgeand strengthen virtues of humanity. For instance, sharing a laugh, providing extra time within visits, supporting one anotherand always remembering the person is separate from the disease. With this mindset, more unique aspects of clerkship and the pandemic shone through while building a harmonious community throughout my rotations among physicians, residents, allied health-care professionals, patients and caregivers.

I have been aspiring to this moment for a long time. To be one of the incoming PGY1 neurosurgery residents at Western University is a humbling honour. I am excited to continue on this path towards providing optimal care for patients, similar to my mentors, paving the way for me to soon become a well-rounded, skillfully trained neurosurgeon.

Advice for incoming students:It is often common to feel out-of-place in new situations, especially in medical school. You might hear of the phrase "imposter syndrome" in your first few weeks of orientation and throughout your career. Try not to be intimated by this phrase. Instead use it as a template to branch from. To get to where you are, it takes sacrifice, passionand excitement to dedicate your life to the betterment of others.

Graduating from: MD ProgramUp next: Residency in ObGyn, University of Toronto

I don't think I truly knew what I was getting myself into when I decided I wanted to become a physician.I just knew I wanted to contribute to my community in a meaningful way. Through the growing pains of medical school, I learned that there is something incredibly special about how our profession affords us the opportunity to be with people at some of their most vulnerable moments. The highs are high and the lows are low, but ultimately caring for others is central to what continues to draw me in to this profession.

Without a doubt, the most remarkable highlight of medical school has been watching my friends and classmates grow as people, as a communityand as future physicians and growing alongside them. It was so wonderful watching everyone comfortably settle into their future specialties this last stretch of medical school, and be truly excited about going into our respective clinical spaces.

Medical school has been filled with many firsts,which is what makes these four years so fulfilling and exciting, but so darn challenging at the same time. Navigating these firstskept me on my toes as I quickly learned that we all have things were good at (and things we're not so good at). It's funny remembering how nervous I was to take my first patient history. Now, that list of new experiences has grown exponentially all the way from delivering my first babyto experiencing my first patient death. Learning how to sit with these experiences will be something I will be working on for years to come.

I am extremely excited and nervous for the many upcoming milestones that come along with an ObGyn residency, and am really looking forward learning how to do things with my hands. I remember learning how to throw my first knot a few years ago, and it still hasn't hit me that soon enough I'll be learning how to operate.

Advice for incoming students:you will constantly feel like you dont have enough hours in a day.I remember feeling like I just did not ever have enough time. But I promise you that you do have time, and you will finish medical school excellent and competent.

The truth is, your to-do list will never end and the demands of medical school will feel overwhelming at times, but give yourself permission to do the things you need to do for you.

Jordi Klein

Graduating from: MD ProgramUp next: Residency in emergency medicine, University of Toronto

I became interested in medicine because of my own experiences as a patient, which led to an academic interest in co-design for health-care systems and institutions. Ive had some opportunities to use a co-design approach in creating lectures and resources for the MD program, and am excited to continue this work in residency. My experiences as a patient also cemented the importance of medicine as advocacy, and Im motivated to continue my advocacy work supporting the health-care needs of marginalized and under-represented communities.

Its true what they say:the days are long but the years are short.Med school was a collection of so many highlights. From de-stressing in the med lounge after an anatomy bellringer to delivering a baby for the first time, its amazing how much you grow in such a short amount of time. Among my greatest highlights were getting to know so many bright, hardworking, passionate future colleagues, who inspire me to be a better doctor and a better person.

I struggled a lot with imposter syndrome in medical school. I felt like I wasnt cut out to be a doctor, that I didnt belong here. It got worse in clerkship, as I would agonize over every little mistake, fearing it was evidence that all my worst fears were true and I actually wasnt good enough after all. Over the course of clerkship, my mentors helped me feel more grounded and learn to adopt a growth mindset. The imposter syndrome is still a work-in-progress but its become easier to see mistakes as opportunities to grow. Learn by failing!

Ive been incredibly lucky to have so many supportive mentors and colleagues throughout my training, and Im looking forward to having the opportunity to pay it forward by teaching, supportingand mentoring other learners here at U of T. My training would not have been the same without the residents who taught me procedures, got me coffee on night shifts, cried with me after patient deaths, coached me through tough daysand so much more. I hope to be that resident for future medical students.

Advice for incoming students:Each of you has something special to bring to this work. Dont be afraid to bring your full self into medical training. Let your strengths be your strengths, and find the people and places that help you feel like the best, most authentic version of yourself.

Graduating from: MD/PhD ProgramUp next: Residency in internal medicine, University of Toronto

I started my first research project as a bachelor of science student in 2010 under the skillful mentorship of Dr. S. Joseph Kim(an associate professor at the Institute of Health Policy, Management and Evaluation in the Dalla Lana School of Public Health)and Dr. Shahid Husain (a clinician investigator in the department of medicine in the Temerty Faculty of Medicine)in the multi-organ transplant program at Toronto General Hospital. They were the first to show me the physician-scientist career path, and I was fascinated.I saw research and clinical medicine as inextricably linked.I wanted to treat individual patients, while leading a research program that improves patient care and health-care systems.I am most interested in infectious diseases and epidemiology, particularly antibiotic resistance.

My research focuses on understanding transmission of antibiotic resistant bacteria in hospitals and communities, using epidemiological and genomic methods. These data allow us to make policy recommendations for infection prevention and control programs in Ontario.

The greatest highlight of my experience in the MD/PhD program was the opportunity tobe rigorously research-trained by my PhD supervisor, Dr. Allison McGeer [a professor in the Temerty Faculty of Medicine and Dalla Lana School of Public Health and clinician scientist at the Lunenfeld-Tanenbaum Research Institute at Sinai Health) as our team worked on new and evolving public health challenges (antibiotic resistance, and toward the end of my PhD, COVID-19). She is an authority in her field who also takes mentorship seriously.She gave me independence, while always offering constructive criticism and generous support.

I'm looking forward to honing my clinical skills and gaining independence as a physician, serving as a teacher and mentor to my junior peers, and answering the next question on my research agenda.

Advice for incoming students: Open doors for junior peers. Approach everything with a diversity, equityand inclusivity mindset.

Graduating from: MD/PhD ProgramUp next: Residency in anesthesiology, University of Toronto

Looking ahead, anesthesiology offers many avenues for scientific investigation as it encompasses the entire spectrum of medicine and surgery. Im interested in mechanisms of action of certain anesthetics on brain activity, as well as chronic pain mechanisms and treatment. The interplay between what we categorize as psychiatric/mental versus physical in chronic pain disordersand therapeutic modalities that target both is a particularly exciting area to me.

My main doctoral research under the supervision of Dr. Freda Miller [in the department of physiology] and Dr. David Kaplan [in the department of molecular genetics] revolved around how neurons are generated from neural stem cells to build the mammalian cortex. The cortex underlies our perception of sensory information, performance of motor activitiesand higher-order cognition, so you can imagine that aberrations in this process can lead to a whole host of disorders.

Honestly, my biggest highlight [of med school] would have to be meeting my wife, Tina Marvasti, who I couples matched with. Other highlights are the friendships Ive made and inspiring mentors I have met who have made me feel at home in Toronto.

I have faced many challenges, both academically and personally. Not to bore you with the details, but some useful things I have learned are that challenges are inevitable and necessary for growth, and that it is OK to lean on others for advice and guidance when youre stuck.

As I embark on the next phase of training, I look forward to developing focused clinical expertise and independence in managing patients of varying complexity and acuity. Im also looking forward tolearning from the fantastic clinical and scientific mentors in anesthesiology.

There is a proverb of unclear origin that goes: "The person who asks is a fool for five minutes, but the person who does not ask remains a fool forever. In medicine and science, you are faced with many unknowns or unfamiliar territory that naturally evoke fear. Ive noticed that there is sometimes a hidden pressure that even the most junior and inexperienced trainees need to always appear more certain and knowledgeable than is the case. So, in addition to the natural fears one has, there is an added pressure to behave with false certainty despite lack of experience. I think this really stunts learning and understanding, and is ultimately bad for patient care.

Advice for incoming students:Be humble, stay curious, maintain a growth mindset, and ask genuine questions if you dont understand something. Essentially, be willing to be a fool for a bit.

Follow this link:
Medical school grads reflect on their time at U of T and share tips for future students - University of Toronto

A tortoise from a Galpagos species long believed extinct has been found alive and now confirmed to be a living member of the species. The tortoise, named Fernanda after her Fernandina Island home, is the first of her species identified in more than a century.

The Fernandina Island Galpagos giant tortoise (Chelonoidis phantasticus, or fantastic giant tortoise) was known only from a single specimen, collected in 1906. The discovery in 2019 of a female tortoise living on Fernandina Island provided the opportunity to determine if the species lives on. By sequencing the genomes of both the living individual and the museum specimen, and comparing them to the other 13 species of Galpagos giant tortoises, Princetons Stephen Gaughran showed that the two known Fernandina tortoises are members of the same species, genetically distinct from all others. He is co-first author on a paper in the current issue of Communications Biology confirming her species' continued existence.

For many years it was thought that the original specimen collected in 1906 had been transplanted to the island, as it was the only one of its kind, said Peter Grant, Princetons Class of 1877 Professor of Zoology, Emeritus and an emeritus professor of ecology and evolutionary biology who has spent more than 40 years studying evolution in the Galpagos islands. It now seems to be one of a very few that were alive a century ago.

When Fernanda was discovered, many ecologists doubted that she was actually a native phantasticus tortoise. She lacks the striking saddleback flaring of the male historical specimen, though scientists speculated that her obviously stunted growth may have distorted her features. Tortoises cant swim from one island to another, but they do float, and they can be carried from one Galpagos island to another during hurricanes or other major storms. There are also historical records of seafarers moving the tortoises between islands.

Like many people, my initial suspicion was that this was not a native tortoise of Fernandina Island, said Gaughran, a postdoctoral research fellow in ecology and evolutionary biology at Princeton.

To determine Fernandas species definitively, Gaughran sequenced her complete genome and compared it to the genome he was able to recover from the specimen collected in 1906. He also compared those two genomes to samples from the other 13 species of Galpagos tortoises three individuals from each of the 12 living species, and one individual of the extinct C. abingdonii.

We saw honestly, to my surprise that Fernanda was very similar to the one that they found on that island more than 100 years ago, and both of those were very different from all of the other islands tortoises, said Gaughran, who conducted the analyses after arriving at the University in February 2021.

In 2019, he was in the lab of Adalgisa Caccone at Yale University, who is the senior author on the paper.The finding of one alive specimen gives hope and also opens up new questions, as many mysteries still remain, said Caccone. Are there more tortoises on Fernandina that can be brought back into captivity to start a breeding program? How did tortoises colonize Fernandina, and what is their evolutionary relationship to the other giant Galpagos tortoises? This also shows the importance of using museum collections to understand the past.

Museum specimens are a challenge to analyze genetically, but Gaugran has been focused on it for years, developing a tool to compare DNA from ancient specimens to modern samples. His tool is flexible enough to work on many species. The software doesnt care if its a seal or a tortoise or human or Neanderthal, he said. Genetics is genetics, for the most part. Its in the interpretation where it matters what kind of creature the DNA comes from.

At Princeton, Gaughran is working with ecologistsAndrea Graham and Bridgett vonHoldtto unravel pinniped (seal and walrus) evolution.

"Stephen solves conservation mysteries, in species ranging from tortoises to pinnipeds, with the deft and careful application of genetic and bioinformatic tools," said Graham, a professor of ecology and evolutionary biology.

"He has such a curiosity for discovering the messages and codes tucked away in ancient remains," said vonHoldt, an associate professor of ecology and evolutionary biology. "Stephen has been collecting specimens from several hundred years old to a few thousand, and these really hold the keys for understanding the history of when and how genomes changed over time. It is not surprising to me that he also led the effort to unravel the mystery of Fernanda, the fantastic ghost tortoise that has been rediscovered through molecular research. What a cool discovery!"

Since 1906, scant but compelling evidence has hinted that giant tortoises might still live on Fernandina Island, an active volcano on the western edge of the Galpagos Archipelago that is reputed to be the largest pristine island on Earth.

A single specimen of C. phantasticus the fantastic giant tortoise was collected by explorer Rollo Beck during a 1906 expedition. The fantastic nature refers the extraordinary shape of the males shells, which have extreme flaring along the outer edge and conspicuous saddlebacking at the front. Saddlebacking is unique to Galpagos tortoises, and the phantasticus tortoise shows it more prominently than the other species.

Since its 1906 discovery, the survival of the Fernandina tortoise has remained an open question for biologists. In 1964, 18 scats attributable to tortoises were reported on the western slopes of the island. Scats and a possible visual observation from an aircraft were reported during the early 2000s, and another possible tortoise scat was seen in 2014.

The island has remained largely unexplored, due to extensive lava fields blocking access to the islands interior.

Fernandina is the highest of the Galpagos islands, geologically young, and is mainly a huge pile of jagged blocks of brown lava; Rosemary and I once climbed to the top, said Grant, referring to his wife and research partner Rosemary Grant, an emeritus senior research biologist at Princeton. At lower elevations, the vegetation occurs in island-like clumps in a sea of recently congealed lava. Fernanda was found in one of these, and there is evidence that a few relatives may exist in others.

Scientists estimate that Fernanda is well over 50 years old, but she is small, possibly because the limited vegetation stunted her growth. Encouragingly, recent tracks and scat of at least 2 or 3 other tortoises were found during other recent expeditions on the island.

For more than a century, the Fernandina IslandGalpagosgiant tortoise (Chelonoidis phantasticus, or 'fantastic giant tortoise') was known only from this single specimen, collected in 1906.

Photo courtesy of the California Academy of Sciences

Two or three million years ago, a storm carried one or more giant tortoises from the South American mainland westwards. Because they dont swim, the tortoises bred only with others on their own islands, resulting in rapid evolution following the pattern of the better-known Galpagos finches. Today, there are 14 different species of giant Galpagos tortoises, all descended from a single ancestor.

(Some scientists debate whether these should be considered species or subspecies, but the Princeton-Yale team concluded that they are different enough, with thousands of distinctive genetic markers, to be considered separate species.)

Diversification of Galpagos tortoises reveals a continuum of shell shapes, with the easternmost islands' animals showing rounder, domed shells, and the westernmost island Fernandina home to tortoises with the most dramatic saddlebacking. The domed tortoises live in more humid, higher elevation ecosystems, while their saddlebacked cousins inhabit drier, lower elevation environments. All 14 are listed on the IUCN Red List as either vulnerable, endangered, critically endangered or extinct.

The tortoise populations were decimated by European seafarers who hunted them for food, having discovered that they could keep tortoises alive on their ships with minimal effort, as the reptiles could survive with little food or water. They were a great source of fresh meat for the sailors, but it meant that many of the species were severely overhunted, said Gaughran.

The genetic work provides intriguing hints of a mixing of genes with members of another population, said Grant. It would be fascinating if confirmed by future detective work on the genome. Another thought-provoking finding is the nearest relatives are not on the nearest very large island (Isabela) but on another (Espaola) far away on the other side of Isabela. The question of how the ancestors reached Fernandina is left hanging.

Fernanda is now at the Galpagos National Park Tortoise Center, a rescue and breeding facility, where experts are seeing what they can do to keep her species alive.

The discovery informs us aboutrare species that may persist in isolated places for a long time, said Grant. This information is important for conservation. It spurs biologists to search harder for the last few individuals of a population to bring them back from the brink of extinction.

The Galpagos giant tortoise Chelonoidis phantasticus is not extinct, by Evelyn L. Jensen*, Stephen J. Gaughran*, Nicole A. Fusco, Nikos Poulakakis, Washington Tapia, Christian Sevilla, Jeffreys Mlaga, Carol Mariani, James P. Gibbs and Adalgisa Caccone, appears in the June 9 issue of Communications Biology, a Nature family journal (DOI: 10.1038/s42003-022-03483-w). (*These authors contributed equally to the work.) The research was supported by the Galpagos National Park Directorate, the Galpagos Conservancy (GR112688), the Mohamed bin Zayed Species Conservation Fund (GR110489), Re:Wild (5248-0000), Island Conservation, the Ecuadorian Ministry of the Environment, the United States Fish and Wildlife Service, the California Academy of Sciences, and the Yale Center for Research Computing.

Read more here:
'Fantastic giant tortoise,' believed extinct, confirmed alive in the Galpagos - Princeton University