Carving out more research time for surgeons
When Vaughn Starnes was named chairman of the Department of Surgery at the Keck School of Medicine of USC nearly five years ago, his top priority was to expand his department’s long-recognized excellence in the operating room to include leadership in the research lab.
The latest step toward his ambitious goal is a partnership with the Southern California Clinical and Translational Science Institute (SC CTSI). The Department of Surgery will fund one of its faculty’s participation in the institute’s clinical researcher education curriculum. Known by its National Institutes of Health designation, KL2 programs provide coursework, mentorship and other services to help researchers succeed in careers as clinical and translational investigators.
“I want the Department of Surgery at USC to be known as one of the best departments in the country, but you can’t do that just by being great clinicians; you have to have an academic profile as well,” said Starnes, a cardiothoracic surgeon. “Our vision is to tackle an obvious clinical problem, take it to the bench and work on the science to solve it, and bring it to the clinical areas.”
Every year the institute funds the continued education of early career faculty and fellows from departments throughout USC in the three-year KL2 program. But it can only support up to four scholars a year. Its partnership with the Department of Surgery will boost the number of researchers who can benefit from KL2 programs.
“We have been looking for creative ways to expand the program’s reach beyond the small number of trainees that we support directly,” said Thomas Buchanan, director of the institute. “The decision by Dr. Starnes to protect time for one of his junior faculty members to participate in the program is a great model that we hope other departments and schools will use in the future.
Starnes is eager to make the partnership work because he has recruited several surgical faculty members with strong research backgrounds and goals.
The first researcher to be supported is Julie Lang, associate professor of surgery at the Keck School. To attract her and other research-oriented faculty, Starnes had to guarantee that they could devote 65 percent to 75 percent of their time to research, an unusually high percentage in academic surgery.
“Traditionally, there wasn’t enough money within the department to support clinical investigation,” Starnes said. “Surgeons had to see enough patients to support their salary and their work, and that didn’t leave much time for extensive research projects.”
Lang is also principal investigator of the Breast Surgical Oncology Translational Research Laboratory at the USC Norris Comprehensive Cancer Center, which also helps support her work. Her research includes the study of gene expression in circulating breast cancer cells, which are shed by tumors and travel through the bloodstream. Her lab collects the cells from research participants and uses RNA-sequencing techniques to determine what they can reveal about tumors.
One of Lang’s projects seeks to determine if capturing circulating tumor cells in the blood of stage 4 patients — those whose cancer has metastasized throughout the body — can replace surgical biopsies when a tumor’s location is inaccessible.
“The investigations are studying whether tumor cell DNA can be predictive of therapy,” Lang said. “The hope is to use circulating tumor-cell biology to assess a patient’s response to therapy in real time.”
Other USC surgeons have already entered or completed the KL2 program under the sponsorship of the SC CTSI. Among them are researchers Alex Wong, also of the Department of Surgery, and Gabriel Zada and William Mack, both of the Department of Neurological Surgery.
“Reconstructive surgery is obviously a full-time job, but my division and department both saw I had the desire and the skills to pursue research, and the [institute] made it possible to carve out the time I needed,” said Wong, a plastic surgeon studying lymphedema, the chronic swelling of the arms that often troubles patients who have had breast cancer surgery. He is investigating a molecule called 9-cis-retanoic acid, a newly discovered therapy designed to regenerate lymphatic vessels following surgery.
“The KL2 program provided a formal structure and dedicated time that I could never have created on my own. It has allowed me to connect with remarkable mentors and learn about study design, biostatistics and other areas that have made me much more capable as a researcher,” he said.
Zada, also an assistant professor, is in his second year of KL2 scholarship. His research focuses on pituitary adenomas, a tumor of the pituitary gland, and on the genetic factors that determine tumor invasiveness.
The neurosurgeon sees research as a way to answer questions that first arise in the operating room.
“As surgeons, we interact with the body in a unique way and have the opportunity to see disease, such as tumors, in the body and to develop a grasp of the clinical barriers and issues,” he said.
Starnes urges other scientific and clinical departments to consider partnering with SC CTSI as part of their overall research strategy.
“By sponsoring a KL2 scholar, we may be an exception now, but I don’t think we should be,” he said. “Not to take the fullest advantage of the incredible resource of the [institute] would be a lost opportunity.”
SC CTSI is part of the Clinical and Translational Science Awards network funded through the National Center for Advancing Translational Sciences at the National Institutes of Health (grant number UL1TR000130).