Teamwork: The “Heart” of Medical Research

A Q&A with Dr. Stephen O’Connor and MS4 Pranavi Pallinti

Article written by Laura Edinger

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Medical research is often seen as an essential, but nebulous, part of the journey through medical school; for some students, it's a passion and for others, it can be a box to check. Both are valid approaches, however, getting involved can feel like a daunting task; questions around finding an interesting project, getting involved with a Principal Investigator (otherwise known as a PI), and balancing all the responsibilities of medical education abound. In this installment of our research spotlight series, we speak to two members of one cardiology-focused medical research team to provide insight into the workings of medical research, from the process of getting started to the pitfalls of working as a team, and all the things learned along the way.

The first individual we profiled for this piece is Dr. Stephen O’Connor, a second year internal medicine resident who has closely collaborated with our second interviewee, Pranavi Pallinti and their PI Dr. Michael Ayers, on Cardiology focused research. He attended the Indiana University School of Medicine, and has hopes to complete a Cardiology fellowship. He took time out of his hectic schedule to meet with us over the phone, sharing personal details of his story, and the things he has come to learn along his journey.

Q: Briefly explain your journey to medical school and residency.

Dr. O’Connor had an early interest in medicine- raised by an ER physician in Indiana- he learned early what the lifestyle meant and all the valuable things being a physician could do for a community. He wanted to carry on the family legacy, stating:

“I wanted to be like my dad and my dad was the coolest person I know. And so I was like, I gotta be a doctor…I saw his impact in the community to the point where we would be in the McDonald's drive-thru and the lady in the drive-thru would be like, your dad saved my mom's life."

These interactions, plus shadowing starting in high school, were really impactful and shaped the course of his future. He attended Butler University, studying Biology and Chemistry with a Spanish minor before attending Indiana University School of Medicine. He was able to follow his dreams all the way to residency at UVA- a place where he found community in a way he did not find elsewhere- on the interview trail, he heard an “offhand comment” between co-residents who said:

“I'm at my friend's house and not I'm at my co-resident's house.” 

This showed him the type of place UVA was- a place where community is created. Stephen’s life has been shaped by small but powerful moments that have led him to where he is today.

Q: Was there any particular moment in medical school that you can remember that confirmed your desire to do cardiology and confirmed your desire to do internal medicine or was it really just confirmation of this long-known desire to be a cardiologist?

When it came time to decide a specialty, Stephen also cites knowing “since he was a little kid” that he wanted to do Cardiology.

The heart, he says, is “simple, yet so incredibly complex” and diseases of the heart “affect so many people in the world” that its a relatable thing.

Despite that, however, he almost matched Med-Peds. It was a last minute switch into Internal Medicine after a traumatic Pediatric ICU rotation that made him reconsider.

“I realized, man, I don't know that I can do a career like pediatric cardiology where I'm gonna have to rotate and watch all these young children potentially pass away. But I still loved the cardiology aspect so decided to choose internal medicine after that fact”.

That, coupled with all the interesting subspecialties in Cardiology, from Interventional to Electrophysiology (EP), confirmed for him that he was making the correct choice. He didn’t need to choose between thinking and doing- he could have both- and could see the positive impact of his medical care in real time.

Q: Do you know what area of Cardiology you want to specialize in during fellowship?

When asked to narrow down his choice, he immediately cited EP, valuing the logic of the specialty, and the ability to

“pair a rhythm that you're seeing on an EKG with the anatomical location and get predictable changes is really cool”.

Despite his interest however, he is still keeping an open mind.

Q: Please briefly explain the project or projects you're currently working on.

For the last year, Stephen has been collaborating with Dr. Michael Ayers and MS4s Pranavi Pallinti and Jacob Frenchman on a project to increase the utilization and accessibility of the long-acting PCSK9 inhibitor, Incliseran. The goal is to identify patients who are post-cardiac events, yet who are not at their goal LDL, and reach out to their providers via “nudges” to encourage utilization, given the drugs excellent safety profile and efficacy. As a secondary project, the team was able to generate a protocol for dosing and monitoring lab work on patients prescribed Incliseran. It seems to be working-

“early preliminary data showed that of the approximately 300 patients that had met our inclusion criteria, not a one of them had been prescribed Inclisiran prior, however, after our study, we have already shown a statistically significant impact in the number of people who have been prescribed."

The goal is to continue following this data, and evaluate the number of patients who reach their goal LDL.

Q: Please briefly explain how you get involved in this research, and what about this project really drew your interest?

Interest in this project is both personal and professional- he was approached by his chief resident and met with Dr. Ayers who signed him on for the project. He is willing to admit that in some ways, it came out of necessity.

“It's important for specifically the competitive internal medicine specialties like GI and cardiology to get on research early in that specific career field."

But he was also willing to be vulnerable and share his personal connection to this subject matter.

“I had a specific interest just in the setting of having a history of familial hypercholesterolemia and also having high cholesterol myself…And then ultimately, I had a traumatic event happen in the middle of my intern year…my dad passed away from a heart attack…so I was able to connect to this research on a different level."

He was able to use his experience to connect with and fully engage with the research, in a way that became more meaningful to him.

Q: Please describe to me who is currently the team and how do you fall into that structure?

As with all things in medicine, there is a hierarchy with regards to roles and expertise. As with all things in medicine as well, however, there is also a level of teamwork and collaboration required across all education levels. This particular team is led by Dr. Michael Ayers, who acts as the Principal Investigator, and includes Pranavi Pallinti and Jacob Frenchman as medical student collaborators. Stephen and Pranavi have been there from the start- brainstorming the project and developing the research protocol. Stephen readily gives credit to Pranavi, citing her efforts to spearhead obtaining IRB approval and becoming proficient in Epic’s Slicer/Dicer tool to pull data. Jacob joined a few months ago, leading the team in sending “nudges” and developing the RedCap database to track patient data. Everyone works to play their own role- sharing the load and developing their own expertise across the project. When this works as a well oiled machine, the results can be impactful, as the initial data shows.

Q: Please talk about the hours you invest in this, specific tasks you work on, and how it all comes together.

Because this article seeks to discuss teamwork, collaboration, and the true cost of research, we asked Stephen about the time required- with the hopes of reassuring students that it was feasible, despite the workload of medical school AND residency.

“Some weeks there is minimal to no time invested. And then some weeks, there's several hours a week…I would say on average, maybe one to three hours a week, depending on where we're at."

Oftentimes, this work is coordinated among the research team, requiring lots of communication and interaction- email chains and text group chats become essential. There is often an element of waiting in research, this isn’t always freely discussed.

“There are weeks where you don't do anything because you're waiting on either IRB to come back or you're waiting on someone to get back to you and that's taking a while…Oftentimes you are sending an email to your principal investigator and waiting some time to get an email back and then completing the next step."

All this coordination and work can pay off though.

“Our specific project had a lot of time up front, but has started to get into an autonomous phase where we are just doing a lot more of the data collecting…And a lot of it is stuff that you can do while at work."

There is a core thread in all of this: patience and teamwork.

Q: What qualities do you appreciate in your research team members, both student collaborators and PIs?

As with all things in medicine, a few tenets ring true when it comes to working as a research team. Responsibility, communication, problem solving, and willingness to learn, while seemingly simple, are essential values and the keys to success. The ability to complete tasks on time and have faith your teammates will follow through means limited delays and forward progress. Getting feedback in a timely manner means course correcting without too much wasted effort. Learning to “perform research”, even with limited experience, means being able to collaborate and overcome hurdles.

“A lot of success is going to rely on team responsiveness and their ability to have the bandwidth to help you out when you need it. But you also are going to have to have a lot of responsibility on your own without their guidance and without constant oversight, which I think can be kind of scary at times for a med student. But, at the end of the day…it's a learning experience and not everything is going to go right and you're going to make mistakes and you're going to learn. But that's part of how research improves is that we learn from our mistakes”.

Research is made or broken on the backs of the team- who can show up, who can overcome, and who can follow through.

Q: What tips do you have for students who want to get involved?

Stephen, wanting to attend a competitive fellowship, had a unique perspective and lots of useful advice when it comes to getting involved.

“Don't be afraid to get involved early…don't be afraid to ask…the key is just putting yourself out there."

Dr. O’Connor wishes he was able to follow his own advice early on.

“Something that I regret not doing more as a med student was finding something that interested me and throwing my name out there."

But it's all about balance- medical school is busy, and students should always be cognizant of filling their time with things that hold value to them.

“You don't have to say yes to every opportunity…if your heart's not in it, it's going to feel like a chore."

This can feel like a difficult line to walk, but at the end of the day, research is about resilience and taking a leap of faith- something that often starts before data is collected.

Q: What would you say has been the biggest challenge or the thing you've had to work on the most when it comes to conducting research?

Research is not all sunshine and roses- it can reveal shortcomings and challenges that must be overcome.

For Stephen, that hurdle is statistics, which makes it “really challenging to do research because all of your research is ultimately dependent on the statistics at the end."

What matters though is how you overcome, sometimes in unique ways. Whether that be YouTube videos, or expert statisticians (both tools Stephen has employed). Even if you don’t have all the answers, success is attainable.

Q: What have you learned about yourself or about medicine from conducting research?

Despite the clinical nature and data-driven content, research can still lend itself to generating personal growth. Sometimes you learn that research is NOT what you want to do with the rest of your life. Those who do dedicate their life to research, however, can watch the future of medicine be discovered in real time. Research requires a level of dedication and passion many people don’t see; without research, medicine wouldn’t advance. Sometimes the lesson is in stepping back, and reminding yourself of the teamwork medicine requires on the large scale- and gaining respect for those with passions who don’t align with your own. This rings true for Dr. O’Connor. 

“Research is not something that I ultimately want to do for the rest of my life… the thing I've learned the most is how much I respect and value dedicated researchers who are putting out really life-changing data...these are people who are willing to do a lot of work and look at a lot of ideas that probably don't pan out."

Even if the face of failure, each small success adds up.

Q: Any big developments in this research project recently?

It's always a blessing when tangible results can be seen- this team sure has big things coming up!

“We just submitted an abstract to the American Heart Association!” 

Big congrats to this team.

Q: Any final thoughts you would like to share with our students?

“Research doesn't have to be this big, scary thing. I think I placed a lot of pressure on myself too. You've got to do this research that's going to be life-changing to get noticed. I've come to realize that you can still make an impact and produce meaningful research that's valuable and that other people are going to read and appreciate”.

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Our second interviewee is Pranavi Pallinti, a fourth year medical student at UVA. She originally hails from Northern Virginia, and attended Johns Hopkins University to obtain a degree in Biomedical Engineering. At UVA, she has continued her dedication to quality improvement and academic research, among other valuable extracurriculars. She has hopes to match into Internal Medicine and specialize in Cardiology. She was able to speak on the unique perspective of research from the medical student perspective- how you can use your developing clinical knowledge to make a strong contribution, and the value of taking a leap of faith.

Q: Can you briefly explain your journey to medical school?

In contrast to Stephen, Pranavi did not know from a young age she wanted to be a doctor; in fact, her love of math and science influenced her to major in Biomedical Engineering at Johns Hopkins University. She loves solving puzzles and learning how things work. But during her coursework, she realized that the human body could present just the kind of puzzle she was looking for. 

“I majored in biomedical engineering in college and for a lot of courses  we would do shadowing in the hospital…And I realized I really liked being in the hospital and I really liked interacting with patients even more than I necessarily liked the engineering part of it."

The patients gave her a tangible object to attach her puzzle too, so she pivoted after graduation and applied for medical school.

Q: What specialty are you planning to apply for in the upcoming residency match and what drew you to that specialty? Pranavi hopes to match Internal Medicine, and complete a fellowship in Cardiology! Why, you ask?

“I really like being able to think about patients longitudinally and the reaction to an intervention in real time and I really like the iterative nature of it…I can really kind of fine tune my problem solving and dissect a complex problem into multiple parts."

Cardiology, with its fascinating physiology, is an extension of this process into a more specific organ system, and would allow her to work with her hands in an interventional capacity. She also hopes to carry on research-

“I see it as a way of incorporating kind of my engineering design background into my future practice."

Q: Briefly tell us about some key projects that you're working on?

Pranavi has her hands in a lot of projects! She is working on projects focused on quality improvement and projects focused on women’s cardiovascular health. One of her quality improvement projects is in conjunction with Dr. Ayers, Dr. Stephen O’Connor, and Jacob Frenchman MS4- the Inclsceran project focused on generating “nudges” to encourage the utilization of the medication for patients not at LDL goal after cardiovascular accident. Her women’s cardiovascular health projects focus on developing and evaluating registries of patients with specific disease processes- Spontaneous Coronary Artery Disease and Cardio-Obstetrics- both under researched areas of research.

Q: How did you end up getting connected with the research initiatives you are part of?

As we saw in our earlier interview, one way of getting involved is hearing about a project second hand and volunteering to fill a need- another way is putting yourself out there and generating rapport with a principal investigator. Pranavi was shadowing Dr. Ayers, who helped her plan and develop the Inclisiran project- and in fact, helped her recruit Stephen! Medical students can be powerful forces in the research world.

Q: What is the commitment required of you as a student researcher? And what is your role in the team hierarchy?

The role of a medical student can be really varied on a research project. One of the most important is assisting with getting IRB approval.

“A lot of the legwork initially was developing a protocol that made sense, making sure we had a safe data monitoring plan, making sure there was an effective way to carry out the project in order to get IRB approval."

In addition, the medical student is often deeply involved with data collection, analysis. But each project can mean something a little different. Time commitment?

“A few hours a week on each project."

Q:  What tips can you offer to fellow students who want to get involved?

Like Stephen, Pranavi reiterated the importance of being present in someone’s mind when a project becomes available, and not being afraid to reach out directly in order to get involved in a project that is of interest to you. 

“I think it's about reaching out to people that you have an interest in doing research with… a lot of the research opportunities that I found more longitudinal and more meaningful have been with people thaI had worked with previously or had some connection to."

At UVA, many PIs have been receptive to med student involvement, and are familiar with the “cold email”, so don’t be afraid to take a chance!

Q: What kind of characteristics do you find really helpful in the research setting?

From personal experience, Pranavi mentioned both initiative and innovation as tools of a good student researcher.

“Oftentimes, research gets stagnated- if you let it stagnant, it stays stagnant. But,finding that initiative to be like, hey, like this angle didn't work out. What other angles can we do? Or, you know, we're waiting on XYZ, but what can we get done in the meantime really helps further research."

Being invested is key to helping a project move further along.

Q: What are some of the pitfalls you have had to navigate in the research setting? And what are some ways you've learned to help navigate those challenges?

Medical students, residents, and attending physicians are no strangers to a busy calendar and a full plate. This is often one of the biggest logistical hurdles to conducting research, and often requires unique work-arounds. For example, one researcher might be on the day shift and one might be on the night shift (something pranavi has personal experience with). The work-around often requires some creativity. Thinking back on her various projects, Pranavi recalled instances of tracking down her PI after he finished teaching a course.

“If I had a break, I would try to go find him at the end of the course to talk through certain issues I had because I knew that would be faster and clearer than emailing back and forth."

In addition, it could also be a means of finding the right person to answer the right question. If everyone is able to be flexible and understanding, many hurdles can be overcome.

Q: What has been the most rewarding or positive part about doing research for you?

“Being able to contribute to the wealth of knowledge out there about certain conditions that disproportionately affect different groups is pretty rewarding”.

Q: What has it been like working as a research team?

Being a medical student often comes with the knowledge that you are the “lowest on the totem pole” in the clinical setting; often the person with the least knowledge who is there to learn and observe rather than do. The research setting, however, can be a bit different.

“I think it's slightly different than a team in a clinical setting…there still is a hierarchy, but you are kind of all working towards a similar goal…even though I'm just a med student, I can contribute a lot more to the project than I could in a clinical setting."

Research can be a chance to take ownership and take on the role of leader, which can be really empowering.

Q: What have you learned about yourself throughout the process of doing medical research?

Research comes with challenges, just like all things in life. It can be a space of growth if you let it. For Pranavi, it taught perseverance.

“A lot of times it's easy to be like, oh, this is too much. I don't want to go forward with this. But I feel like in those times, if I keep going forward, the results can be really great."

Q: Any final words for our students? 

“Research can be really exciting when it's something that you're interested in. So I will definitely encourage people to find projects that they're truly passionate about, that they're truly curious about, because it makes it a lot more rewarding and makes it feel a lot more meaningful versus doing research for the sake of research."

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Medical research takes a village, as the cliché goes. Like raising a child, planning a wedding, or becoming a physician, it takes many hands to see a project go from being an idea to being a published set of findings. Each member of the team fulfills a role with a different skill set, but the common thread of effective research is committing to being a team player. This means communicating, being reliable, and being a problem solver. Resilience to succeed means when faced with a hurdle, it doesn’t seem so insurmountable. And that resilience is at the heart of teamwork, and at the heart of medical research.