Alumni Profile: J. Joshua Smith, M.D. Ph.D.
J. Joshua Smith, M.D., Ph.D.
Assistant Member and Attending Surgeon | Colorectal Service, Department of Surgery
Memorial Sloan Kettering Cancer Center | New York, NY, USA
Assistant Professor | Department of Surgery
Weill Cornell Medical College | New York, NY, USA
My development as a scientist began in Dan Beauchamp's laboratory, where we used comparative functional genomics and basic biological models to investigate the mechanisms by which colorectal cancer cells become metastatic. My pursuit of a Ph.D. in Cell and Developmental Biology at Vanderbilt was made possible through the Clinical Investigator Track, championed by Dr. Nancy Brown, Dr. Jeff Balser and Dr. Terry Dermody, and was supported by Vanderbilt’s Clinical and Translational Science Award (CTSA).
I joined the Medical Scientist Training Program (MSTP) as a late bloomer, after my second year of general surgery residency, and spent four years (2006-2010) in the Beauchamp laboratory. The title of my Ph.D. thesis was Biological Models of Colorectal Cancer Metastasis and Tumor Suppression Provide Mechanistic Insights To Guide Personalized Care of the Colorectal Cancer Patient. Upon completion of my surgical training, I pursued a fellowship in Complex Surgical Oncology at Memorial Sloan Kettering Cancer Center (MSK), with a major emphasis in colon and rectal cancer.
I served as the Chief Administrative Fellow for the Department of Surgery at MSK in 2014-15 and joined the faculty in 2015 as a colorectal surgical oncologist and physician-scientist embedded in the laboratory of Dr. Charles Sawyers. In my first year, I obtained three society-funded grants, and I am currently applying for early-career NIH funding under the guidance of Dr. Julio Garcia-Aguilar (Chief of the Colorectal Service and my clinical mentor) and Dr. Sawyers (Chairman of the Human Oncology and Pathogenesis Program and my research mentor).
Could you describe your day-to-day schedule?
Minor administrative work, writing, lab work and Colorectal Service meetings
Sawyers laboratory meeting, writing and lab time
Teaching and clinic
Lab time and writing
Operating room and clinical time
Catching up, reading and writing
Family time, personal reading and reading one new article identified during the week (one strong recommendation is a provocative recent article co-authored by the surgeon and physician-scientist Dr. Steven Rosenberg, who is the Chief of the Surgery Branch at the National Cancer Institute: https://www.ncbi.nlm.nih.gov/pubmed/27959684)
As a practicing surgical oncologist trained as a physician-scientist, how do you split your time between these two professions? What benefits and challenges do you encounter in your work?
My time is split between clinical work (20-30%) and establishing my laboratory, designing and executing experiments and writing (70-80%). My clinical practice matches my research interests one-to-one. For a physician-scientist, this close interrelationship is critical, as it allows clinical expertise to guide research activity at the bench and to focus the research agenda in such a way that the potential to benefit patient care is maximized. For example, I take specimens from the operating room directly to the lab and test our hypotheses on chemoresistance and modeling of human rectal tumors in a 3D environment.
Taking care of patients is an honor and a privilege, but it also competes with lab and writing time. To be successful and to excel in both arenas, one must carefully guard the time allocated to laboratory work and avoid distractions. Being a colorectal surgical oncologist satisfies the instant-gratification part of my brain (e.g., I can diagnose a problem and fix it right away) and gives me the joy of helping patients. At the same time, being a physician-scientist stimulates the “detective” part of my brain, as research problems are solved at a much slower and methodical pace. It is important to remember that scientific discoveries that effect improvements in treatment require incremental steps, tremendous discipline and steely resolve.
Reflecting on your journey thus far as a physician-scientist, what has been the most impactful training experience that helped to establish your career?
As mentioned earlier, the door was opened for me via the MSTP and the Clinical Investigator Track, pioneered by Drs. Brown, Balser and Dermody in collaboration with Dr. Beauchamp and the Section of Surgical Sciences, as I pursued my Ph.D. in the Cell and Developmental Biology. CTSA funding was critical to this opportunity, as was Dr. Beauchamp’s and Dr. Tarpley’s unwavering support. The four years of rigorous training I received at Vanderbilt under the watchful guidance of Dan Beauchamp, Steve Hanks (committee chair), Bob Coffey, Marc de Caestecker, Jim Goldenring and Ethan Lee was the most impactful training experience I’ve had to date. My general surgery training was also excellent, and by the time I left Vanderbilt I felt fully ready to take the next steps toward becoming a successful physician-scientist and surgeon at MSK. My fellowship training in Complex Surgical Oncology at MSK further sharpened my clinical skills and my ability to ask relevant research questions.
Mentorship is a crucial component of both medical and scientific training. What advice would you give to MSTP trainees about selecting the best mentor?
Interview a good number of potential mentors (I interviewed six before deciding to work with Dan). You should come prepared to ask well-researched questions about their laboratory and the disease process they study. You can then map out their responses, while also taking into account your gut feeling during those meetings, to decide whose work and lab setting interest you the most. Ask yourself how their personality may fit with yours. Pay attention to the way in which they speak about prior and current students and their work. Talk to individuals they have mentored.
Dan Beauchamp was my primary mentor. Dan’s eyes lit up when he talked about potential projects, and his enthusiasm for science was infectious. I show a picture of Dan in each talk I give. As he is knowingly gazing over his OR mask, his eyes reflect his amazing qualities as a teacher, mentor, father figure, scientist, master surgeon and friend. I am fortunate to have been trained by him. I am also fortunate to have had several excellent co-mentors—Jim Goldenring, Marc de Caestecker, Ethan Lee and Bob Coffey—each of whom played a key role in my development as a scientist and as a physician. They had an open door policy and never turned me away when I needed to wrestle through an experiment. Your selection of a clinical mentor will come about organically as you find the disease process that interests you. Your interest in their expertise and their interest in watching you grow will then mutually reinforce one another.
What factors must an MSTP student consider in choosing a field of scientific research and clinical training for residency?
Pick a disease process that fascinates you and choose a medical discipline that plays a significant role in the treatment of that disease process. Pick a research field that excites you in terms of its potential to benefit patient care. Pick something that keeps you wondering—something that you will think of in the shower and while you eat breakfast. Once you’ve identified a field that keeps you engaged and always asking questions, you can decide which mentor can lead you in that field.
What are some challenges you faced in your training and what lessons did you learn from them?
There were people who doubted my ability to be successful, and some questioned my decision to pursue a Ph.D. in the middle of a surgical residency. Fortunately, I had a core group of supporters who never wavered. Do not be deterred by uninformed critics and doubters. Once you have made up your mind about your mentor, your area of research and your plan to successfully complete the MSTP, go at it with everything you have, without looking back. Be persistent, be stubborn, remain focused and show the doubters that you have what it takes to excel as a physician-scientist.
What does it mean to be an effective scientist? What does it mean to be a skilled physician?
An effective scientist asks compelling questions, investigates focused hypotheses to address those questions and challenges dogma. A skilled physician goes beyond the basics of understanding the disease process and views care of the whole patient as their chief goal. It is important to sit down on the edge of your patient’s bed, look them in the eye, hold their hand and take time to listen to their concerns, questions and observations. An effective physician-scientist completely understands the disease process and therefore knows what questions to ask and how to optimally address those questions.
Please feel free to add any other advice, thoughts, or commentary you may have!
As physician-scientists, we are uniquely positioned to find answers to the hard questions facing our patients. I am clearly biased, but I think this is the best job one could imagine. The satisfaction of constantly solving difficult problems and the thrill of helping patients recover from life-threatening illness far outweigh the challenges along the way.