Double Feature: Kristen Noble – Alumna (Ph.D. ’12) and Associate College Advisor (Sutherland)
by Ayesha Muhammad (G1)
Dr. Kristen Noble is a 2nd year neonatology fellow, currently serving as an Associate Advisor for Sutherland College. She is also an alumna of the Vanderbilt Meharry Alliance MSTP, receiving her PhD from Susan Wente’s lab in 2012, where she studied proteins that regulate mRNA export, and MD from Meharry Medical College in 2014. She completed residency at UT Memphis, before returning to Vanderbilt for fellowship. She graciously shared her story in the physician-scientist pipeline and her advice for new trainees with our team through a conversation with G1 Ayesha Muhammad.
How did you decide on neonatology for your speciality?
I was specifically looking for a subspeciality that would afford me the opportunity for research, which already narrows your choices. I knew I was interested in clinical practice, with plenty of opportunities for research. When I did my NICU rotation, I loved it! From a research perspective, neonatology allows a unique opportunity to explore a question and not be limited by an organ system. I also realized I have never enjoyed clinic very much (in medical school or residency), because of the pace.
NICU also allows you certain unique experiences clinically: I love going into deliveries. I do feel like I am stealing the intimate moment from the family, but to be a part of a new life coming into this world is an amazing experience. Even if it is a preterm baby and is really sick, there is something so special about that new life coming in the world that you can’t get anywhere else! I also appreciate clinically being able to have an impact on the rest of somebody’s life. This is something we think about a lot in the NICU, obviously there are things we have to do to help patients survive, but decision making is driven by how what we do now can certainly have long term impacts.
Have your research interested changed since the PhD?
My research background is in basic cell biology, so I am used to thinking broadly in terms of research questions. However, when I first came, I thought I was going to do research on NEC (necrotizing enterocolitis). The one thing I did know what that I did not want to do clinical research – I dabbled into that during residency and did not like it very much.
Just being [at Vanderbilt], [NEC] was not a good option especially for a fellowship, since one of the faculty members working on NEC relocated, and the other transitioned to clinical research. Fellowship is also unique because when you go into the lab, you have limited time. You want to focus on something you can get a product from that you can translate into a K award of some kind. Then I started looking for something that was tangentially related and would allow me to eventually transition to NEC or sepsis. I ended up looking at as many labs as I could. As a resident, I came to the Research Day in the Pediatrics department and I found, through talking to people, a lab that studies chorioamnionitis and Group B Streptococcus in a GBS-ascending mouse model. It is really exciting because I still get to think about neonatal immunology which is really where my passion is. We are currently looking at macrophage function in the fetal membranes in response to GBS-ascending chorioamnionitis. We know something of how they function in placentation and even parturition but not a lot about how they transition to pro-inflammatory roles in infection. I think I have narrowed it down to neonatal immunology and left myself with options to redirect to sepsis, NEC, lungs, etc. which I like in this stage of my career, but I think I am focused enough to be able to get funding.
How did you choose to come back to Vanderbilt after your residency?
When deciding where to go, I needed a place that gave me good research opportunities. There were other places that would have given me equivalent research opportunities, but family definitely pushed me in one direction. [During residency], my husband, who teaches undergraduates here at Vanderbilt, was commuting to Nashville three times a week. And the NICU program was also amazing, so this was my top choice for all those reasons.
When did you realize you wanted to be a physician-scientist?
So during undergrad, I actually tried to join a lab really thinking about either medicine or science but not both, as it wasn’t really a concept that was familiar to me at all. Unfortunately the PI of the lab I was going to join passed away in September of that year, not affording me much opportunity to do research, but after that I worked in a neuroscience lab at Case [Western Reserve University] for two years studying neuronal plasticity.
There was an MSTP in my lab at Case so I had started to think about combining those things, but I applied to medical school still not thinking that it was possible to have a dual career. When I came to [Meharry] medical school, during my first year I went to the head of the graduate school asking how I could do research. She recommended that at the time Vandy MSTP had spots on their grant for two Meharry students at a time, so I applied to Vandy MSTP, and started my PhD in Susan Wente’s lab. The best thing that could have happened to me was finding her as my mentor. The project you do in grad school should be interesting enough to keep you productive, but it is not as important as having a good mentor, that is the thing that will make or break you. She did a really great job of giving us freedom to explore, giving us independence, and networking. She has been a champion for me to this day.
Where do you see yourself in the future?
Absolutely in a level 3 NICU or higher, and ideally I would have a lab but I see myself in a very traditional 80-20 split between research and medical practice. So I think my future is in academia. Furthermore, my husband is the Assistant Dean of Students, Head of the Black Cultural House and a faculty head of residential house at Vanderbilt. So we live in a freshman dorm with my 6-year-old daughter and my 2.5-year-old son and it has been fabulous! Yes, we don’t have a swing-set in the backyard, but there are so many benefits. For instance, my husband has to organize a snack break for the students once a week, and last year one of days fell on my daughter’s birthday. And the students organized a whole birthday party for her. Just being in an environment of academia has been wonderful for us and our kids.
What unique perspective do you bring to the physician-scientist training?
One thing I am interested in that I don’t hear a lot about, is how basic science impacts health disparities. I think that coming out of Meharry, there is a lot of focus on health disparities, and doing residency in Memphis just emphasized that more. That [interest] attracted me to the lab I am in. There are independent risk factors for chorioamnionitis, such as SES, being African American, being from a “third-world” country, which cannot necessarily be explained by social determinants of health. I would like to think about how things on the basic science level can be impactful in reducing health disparities. Dr. Aronoff and Dr. Gady who are my co-mentors have traveled to Africa and done work thinking about this as well.
There are many obstacles in the physician-scientist pipeline. In this stage of your career, what are the major obstacles that you are focusing on?
The thing that scares me the most is the transition from a training mindset to a faculty mindset. We have been in some sort of training environment for over half of our lives. There are a lot of protections afforded to us and a lot of fail-safes to prevent you from failing. Up through fellowship, it is hard to not do okay if you put in the effort. There are always extenuating circumstances, but generally if you want to do it and you work hard for it, you can usually get there. Now, I am learning about this transition, and it is one of the reasons I am so excited about the PSTP because you get a lot of mentoring and networking to help you navigate that process so you can have the best chance of being successful. It will be important for me to think about a department that will be supportive of me as a junior faculty member. But this transition is so different from what I have been doing so far. Hopefully, I have set myself up on how to do that successfully. It is just the next biggest unknown.
What advice do you have on how to find a good mentor?
After doing my first rotation, I fell in love with T-cell biology and decided that was what I wanted to do. However, I got some advice from Terry Dermody, who was the MSTP Director at that time — who is also somebody who has been instrumental in helping me get to where I am today — and he suggested that I think broadly about what would be interesting to me and suggested I rotate in Susan’s lab. You should definitely talk to other graduate students in the lab and the department, because they will be honest with you about their experiences and how successful the mentor has been at mentoring MD/PhD students because we are a unique breed and we have other responsibilities. I was also at Meharry and had commitments off campus, so finding someone who would support me through that was important. I recommend you meet your potential mentors, and make sure you get along as people.
What would you recommend to watch out for for the next steps of our training, residency/fellowship?
I tried to dabble in research projects in residency, which is hard. I personally did not want to limit my patient care experience, so I did not fast track into research. So my research ventures during residency were very limited especially based on the type of research I did in grad school. Fellowship however, is a time when you should do a lot of research, because this is your transition back into research and this is the time when you should be focused on just your mentor but what you want to do. What questions can you get from this project and this lab, because that will be what you write your independent funding on. It is not the same as graduate school that you can do whatever you want and do something completely different for the rest of your career.