Meet the New PSTP Associate College Advisor for Edwards-Goodpasture: Brandon Farmer, M.D., Ph.D.
by Ghassan Makhoul (G2)
Medical Scientist Training Program: University of Kentucky College of Medicine
PhD Research: The role of APOE E4 allele in altered metabolic pathways contributing to late-onset Alzheimer’s disease.
Hometown: Lexington, Kentucky
Favorite Spot in Nashville: Yazoo Brewery, lots of room for kids to run around.
Fun Fact: Dr. Farmer sang bass in his college acapella group. While he did not offer an impromptu performance, he can be found singing carols at the Anesthesia holiday party.
Advice to medical scientist trainees: Shadow attendings early and often. Get involved with the American Physician Scientist Association (APSA). “Going to the APSA conferences broadens your view and allows you to see the journey instead of just the days.”
What is an MD-PhD: “It’s an integration of being a compassionate provider and being a curious investigator who wants to advance patient care.”
Dr. Farmer is a CA-2 Anesthesiology resident. He completed his MD and PhD at the University of Kentucky, where he studied astrocyte metabolism, specifically how the APOE E4 allele conferred risk for late-onset Alzheimer’s disease (AD). His research found that astrocytes with the APOE E4 allele were unable to successfully utilize glycolysis and thus heavily relied on lipid metabolism. Overtime, lipid droplet buildup alters astrocyte metabolism, increases neuro-inflammation, and may play a direct role in neurodegenerative pathophysiology. Dr. Farmer completed his PhD in 3 years.
Dr. Farmer has accepted a position in Vanderbilt Anesthesia department to join as faculty and plans to start a lab at Vanderbilt. He is initially interested in studying postoperative cognitive dysfunction in patients with AD. He hopes to find anesthetic alternatives to patients with AD to reduce their risk of postoperative cognitive dysfunction.
Early Experiences
Dr. Farmer grew up in rural Kentucky and attended high school in Lexington. In his sophomore year of high school he made a pivotal decision and applied to attend The Gatton Academy of Mathematics and Science. While at Gatton, he was exposed to college level science and math classes. By the time he was a junior in high school, he was “knock[ing] out over 80 credits of college courses. That’s when I got involved in undergraduate research.” He also had the opportunity to study abroad three times. Dr. Farmer reflects that these early experiences fostered his passion for research. At an early age, he could appreciate the full scientific process, from conception, experimentation, data collection and analysis, through eventual publication. He notes: “that moment of discovery where [you’re] getting the results of your blot on a screen and you’re the first person to have discovered that this protein expression changes as a result of your intervention is thrilling.”
During his freshman year of college, he began considering an MD-PhD. He notes the importance of not just engaging with research early on but also bearing the fruits of this labor. During an internship at the University of Louisville, he was able to publish his work on ouabain’s interaction with the kidney’s sodium-potassium ATP-ase pump.
“I think if I didn’t have the research products out of my work and time, then I could see that being unfulfilling, right? You want to see, some result, some product that is a deliverable.”
MD-PhD
Despite his intended PI moving institutions after their first semester working together, Dr. Farmer completed his PhD in 3 years.
I’d be remiss not to ask you about how you completed your PhD in 3 years. What was your discipline like? Are you the ideal implementation of Atomic Habits? I’m going to guess you read it.
“I listened to the audiobook.”
See, that’s efficient.
“I mean I wouldn’t say I was [in lab all the time]. I’m in this hospital more now.”
Dr. Farmer notes that he was willing to pick up where others in the lab left off. There is often a lot of unused data from previous graduate students. Granted that no one else is actively using this data, these datasets can be a valuable avenue to bolster a project or get some work off the ground. “I think it shows initiative for a graduate student to, repurpose or go back and revive the data that the lab has [collected]… My understanding of scientific ownership is if it’s done in a lab, then the lab members should have access to it. I think shared science gets us further… I think that should be absolutely true within a lab. It will be for my lab.”
MD-PhD trainees often find the transition back to the clinical setting after years in research to be one of the most daunting in their programs. Dr. Farmer reflected that while he also struggled to recover all the material from his pre-clerkship studies, he found that the PhD gave him a unique skillset to use on the wards. However, it can be a bit jarring to transition from becoming a world-class expert in one niche of science back to a junior medical trainee.
What was it like coming back into the PhD?
“It’s a weird transition period, because at the end of your PhD, you feel like an expert in your field. You’ve probably given a talk or two at a national conference. You have manuscripts to show you are kind of a leader, you know. And then you get to your first clerkship as an M3, and you’re back at the bottom of the totem pole. Having taken so much time away from med school, I had forgotten a lot of the minutiae, the microbiology, the pharmacology, all those little details you memorize for step one. None of it.”
How did you cope then?
You [quickly] learn what’s clinically relevant. And you make up for it with soft skills [you’ve gained during your PhD].
As Dr. Farmer revisited this transition back to clerkships, he found that presenting at committee meetings and refining his scientific communication skills was very helpful. After all the conferences and scientific presentations, he practiced out the stage fright and found it easier to formulate presentations for attendings. “It makes you feel confident in presenting a patient and talking at an academic level.”
Residency and Faculty
Why Anesthesia?
For. Dr. Farmer Anesthesia is one of the final frontiers in medicine where the interaction has remained solely the patient and the doctor. “It’s all about the patient – It’s very pure in that way. And you are examining them constantly, you are getting immediate feedback on vital signs and there’s nobody doing the role of the nurse because you are that role. Nobody’s doing the role of the pharmacist because you are the pharmacist. You draw up the dose immediately. You’re also the respiratory therapist.”
Advice for choosing a specialty in general?
“You’re going to spend a relatively short amount of time in your career as a resident. And I think it would be wiser to look at the attendings. That’s the long stretch.”
Why Vanderbilt?
When Dr. Farmer was looking for residency programs, he found that Vanderbilt’s Anesthesiology department had a T32 training grant for its residents. “To me that’s like a stamp of approval from the NIH. Someone reviewed [Vanderbilt’s] proposal, the investigators, and their resources to train career PIs.” He advises future medical scientists to look at residency programs that support your transition into becoming research faculty. He notes that Vanderbilt’s program provides him with structured mentorship, a network of career minded residents, and early career faculty with fellows who are trying to do research and get funded.
How about work life balance?
“I think it’s important. I have a wife; I have a daughter. and it’s important for my happiness to see them. They want to see me just as much as I want to see them.” Dr. Farmer passes on the following advice from his mentors: As much as possible, protect time in your week for you to rest and spend time with your family.