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Meet Stahlman-Thomas Associate College Advisor Debra Dixon, MD, MS

Posted by on Wednesday, December 19, 2018 in MSTP Workshop News .

by Ayesha Muhammad (G1)

Dr. Debra Dixon, the newest PSTP advisor for Stahlman-Thomas, obtained her medical degree and a masters in Clinical Research from Lerner College of Medicine of Case Western Reserve University, before joining the Harrison Society in 2016. Currently a fellow in Cardiology, her research focuses on prevention of heart failure with preserved ejection fraction, and her passion lies in the realm of clinical research. Earlier this semester, she generously shared her trajectory with our team.

Tell me a little bit more about your training:
The Lerner College of a Medicine is a partnership between Cleveland Clinic and Case Western Reserve University. It is a 5-year MD-only program designed to train physician-scientists. During my medical education, I also got a masters in Clinic Research so primarily I do clinical research. Then, I did medicine residency and now my fellowship here [at Vanderbilt].

The Harrison Society mostly consists of MD/PhD trainees. How has your experience been as one of the rarer MD-only candidates?
So far, we have only been doing clinical training so it has not been very different from what everyone else is doing. That being said, Vanderbilt is very strong in clinical research, so I have discovered tons of infrastructure and I think that I am getting plenty of support that I would need.

Tell us a little bit about your research background:
My research has been all over the place (laughs). I am interested in heart failure with preserved ejection fraction (HFpEF). During my year off in medical school, I did something called phenomapping: HFpEF is a very heterogenous clinical syndrome. Unlike heart failure with reduced ejection fraction (HFrEF), we now know that beta blockers and ACE inhibitors don’t work. We think one reason for that is because the patient population is really mixed. During medical school, I worked with my mentor who had characterized HFpEF patients into three different classes to see how different classes of patients progressed over time..

Here at Vanderbilt, I am planning to continue on HFpEF and I am looking at the social determinants of health for incident heart failure for example in a large database called the Southern Community Cohort. In the future, I plan to add on imaging and specifically echocardiograms into my analyses.

Do you see yourself moving into research related to treatment of HFpEF?
I am more interested in preventing heart failure. Clinically as well, I think I would focus on [prevention] rather than advanced heart failure and transplants. Research wise, if there are clinical trials that can identify [effective] treatments, I would love to be involved, but currently I am interested in using different data points like echos and clinical history to further understand the pathophysiology. I guess it will depend on where my interests take me.

When did you decide on clinical versus bench research?
During my undergraduate training, I decided that I liked research. I had a professor who talked about how we don’t have answers to a lot of problems. We think that doctors have all they answers about how to live longer and better but we realized that they really don’t. I did bench research in college and medical school, and it was interesting but I didn’t think that it was for me. As part of medical school, we do both a basic science summer and a clinical research summer and that’s when I realized, [Clinical research is] great! I then also applied for the Masters in Clinical Research. Ideally, I would like to be the clinical research person in an interdisciplinary team. I know I am not a basic scientist, but I would hopefully like to work closely with them!

What attracted you to Vanderbilt?
A lot of PSTP programs are designed for MD/PhDs, and there is a small number that are clinical research focused; Vanderbilt was one of them. I thought it was a great training environment in terms of culture. Everyone is very nice and supportive! Also the clinical research infrastructure here is unparalleled and there is extensive support for physician-scientists, from the chair of medicine down.

When did you decide you were interested in cardiology?
I have always been interested in cardiology. When I was deciding what I wanted to do with my biology degree, I shadowed a cardiologist because I was initially not that excited about going to medical school <laughs>. Eventually, I decided maybe medical school wouldn’t be so bad. Then in the summer before senior year of college, I did bench research with an excellent mentor in vascular biology. Between shadowing and the cardiovascular research, I was pretty sure that cardiology would be the way to go in terms of the questions that interested me. I still went to medical school with an open mind, but the process of elimination brought me back to internal medicine and cardiology.

Where do you see yourself in the future?
Definitely want to be a physician-researcher/investigator at an academic center. I see myself in the traditional 70 to 80% research model, since that’s what seems to work for most people. I also am interested in an imaging fellowship and I would like to continue working on heart failure.

What do you think are the biggest obstacles in the the next stage of your career, i.e. establishing a research group and starting your own clinical trials?
I think that all of it centers around coming up with a good idea. You need to come up with something to be able to submit a grant, that will get funded. So right now, I think my focus is on delving more into the literature and to gain more skills, and putting it together into a good idea that can translate into a K award. What am I interested in? What is *my* good idea?

What do you do in your free time?
Honestly? Sleep.

But in all seriousness, I just had a little baby, 4 months old now, and that takes up a lot of my time. Apart from that, I love movies and board games.

What advice do you have for people looking for mentors, especially early on in the program?
Mentors are very important! Don’t be afraid to point blank ask somebody, “Will you be my mentor?” If they say yes, great! If they say no, don’t be offended. It means they will probably not have time, which means they will not be able to be a good mentor to you. Another thing to remember is that you don’t need one mentor, you need mentorS (plural) or a team of mentors. There will be mentors that do different things for you. There are 40 thousand foot mentors that will watch you and help guide you in certain parts of your career, and then there are your day to day mentors who are writing your letters and seeing you in the lab. You also need a breadth of mentors that can help you through different stages of the process. Don’t be afraid to contact them and let them know that you need help. If they have agreed to mentor you, you are not being annoying to them. They are not necessarily going to think of you out of the sky everyday when they have 50 other things going on. So being able to take initiative and contact them is important.

You also want someone who seems engaged and interested. Not everybody knows how to be a good mentor. What is a good project for your level? Find someone who has a track record of training and be sure to talk to other mentees and ask them how their experience was. You should have goals about what you want to get out from that relationship and make sure that their goals for you are aligned with your goals for you. One of you might need to tweak their goals — you don’t know everything, so you might need to change your goals but if your goals are completely different, then that mentoring relationship might not be that beneficial. Finally, it is important to not put all your eggs in one basket. And don’t feel bad about taking, because right now your job is to be a good mentee, so take all that they can give you because you will give back one day!

What advice do you have for people applying for residency and thinking of fellowship?
I would say find a nice support and study group, people whom you can talk to, who are not going to stress you out. There are enough stresses in the world to actually sit next to one.

Some things will feel like the end of the world but they really aren’t, which is why perspective is very important, especially when thinking of boards and applications etc. What I tell people is that you went to medical school to become a doctor, so once you have graduated with a degree, the next step is to get a job. Obviously, it is nice to get a job at your number one spot, but at the end of the day you need a job. You definitely  want to look at your next step and keep in mind where you want to end up. If you want to go to residency knowing you want to go to fellowship, make sure you want to go residency at a place that sends people to the fellowship you want to go to. If you want to go into primary care, go somewhere that trains primary care physicians. Keeping the next step in mind can set yourself up to be successful. It is a very long road and you want to go to residency somewhere that will allow you to do what you want to do.

I appreciate that you emphasize perspective! Our worlds can feel so skewed – what tips do you have to keep perspective?
Have friends outside of med school and outside of residency; outside of the city even. You need to get out of your bubble, because when you are inside your bubble, you forget that you are in one. You need something outside that grounds you in a different reality.

 What tips do you have about work/life and clinical/research training balance during residency?
With residency, the work-life balance is just difficult. In fact I should probably call it work-work balance. Make sure that you take the time to do something that you enjoy outside of research and medicine, that can rejuvenate you. You can do it once in a while, but do it regularly.

One thing about residency specifically is this: to some extent medical school and PhD life can be spent with the mindset of “I have to get through this.” Residency marks the beginning of your life. You can’t just get through it, you have to enjoy it. I mean, you can just get through it if you want to, but that will be miserable. You also similarly have to ask yourself “what are my goals for my life”? What am I willing and not willing to accept for my quality of life? Yes, you can go to a top 5 program but are you going to be miserable there? For example, would you rather be near your family? There are more important things than just the name and prestige. You need to be successful as a whole person, not just as a doctor. It is important not only to just think about these priorities but also to not feel bad about weighing those things more than others. It is okay to choose your happiness. People worry about making those types of decisions but at the end of the day, you will look back and say “what was I miserable for?”