Wednesday, 05 July 2017 10:21

Honoring ASM members among the ASCP 40 under 40

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The American Society for Clinical Pathology’s “40 Under Forty” is a list of young, successful clinical pathologists among its 130,000 professional members. Several of those honored include young, successful ASM members, and we here at Bugs & Drugs reached out to ask the ASM members included about their research and careers.

4u4 Theel ES headshot 2017Elitza Theel, PhD, D(ABMM).

Elitza Theel, PhD, D(ABMM) is the Director of the Infectious Diseases Serology Laboratory and Co-Director of the Vector-borne Diseases Service Line, as well as an Assistant Professor of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester, Minnesota. 

Theel specializes in serologic testing for antibodies to or antigens released from infectious agents, including serological testing for vector-borne and emerging diseases. 

ASM: When did you know you wanted to work with microbiology/infectious disease?

Elitza Theel: I was a junior in college when I was first exposed to the field of clinical microbiology. A very close friend of mine, originally from India, came down with high fevers followed by severe chills and was admitted to the hospital. It took nearly 3 days for the clinical team to diagnose my friend with relapsed Plasmodium vivax infection. The whole episode left me intrigued by clinical diagnostics – How do they know it is P. vivax? How are infections actually diagnosed? Why does it take so long? How can we make the diagnosis faster?

ASM: How do you see the role of clinical microbiologists changing in the future?

ET: I think clinical microbiologists will be instrumental in guiding and optimizing test utilization, especially as reimbursement for laboratory testing continues to evolve.

ASM: Thus far, what has been your proudest moment of your career?

ET: A great moment in my career was publishing one of the first studies on Zika serologic testing and its performance in a clinical laboratory. Other proud moments have been invitations to speak at national meetings, including ASM/Microbe and previously ICAAC.

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4u4 SchmitzJonathan Schmitz, MD, PhD, M(ASCP)CM, D(ABMM).

Jonathan Schmitz, MD, PhD, M(ASCP)CM, D(ABMM) is a Medical Director of the Molecular Infectious Diseases Laboratory and Assistant Professor in the Department of Pathology, Microbiology, and Immunology (Division of Molecular Pathogenesis) at Vanderbilt University Medical Center in Nashville, Tennessee.

Schmitz specializes in molecular diagnostics for infectious disease and heads a recently-launched research laboratory focusing on emerging opportunistic pathogens. He is passionate about the intersection of diagnosis and pathogenesis, whereby improving our understanding of host-pathogen biology can also improve our diagnostic capabilities.

ASM: How did your path lead to you a career in clinical microbiology? 

Jonathan Schmitz: I am only a few years out now from finishing my training in an MD-PhD program. It was during that time—specifically, during my graduate work in microbiology with Dr. Vincent Fischetti at The Rockefeller University—when I knew I wanted to pursue a career in microbiology/infectious diseases, in the broad sense.

A huge emphasis during MD-PhD training is a developing a career where your research endeavors and patient-care responsibilities synergize with one another. The challenge that every physician-scientist must face is discerning how best to accomplish this in the context of their own academic interests; that is what really drove me to the field of Clinical Microbiology. On theoretical, technical, and logistical levels, the work that is done within Clinical Microbiology laboratories aligns so well with translational research themes in infectious diseases.

As an early career investigator, I am very grateful that my day-to-day efforts to serve patients from the clinical laboratory are not only conducive to the work in my research laboratory and my academic collaborations, but can actually drive them.

ASM: What role do you see for clinical microbiologists and laboratorians in the future of health care? How do you think new technologies will change this role (if you think it will change)?

JS: A traditional distinction is that Anatomic Pathology specialties are interpretation-based while Clinical Pathology specialties (which includes Clinical Microbiology) are result-based. Whereas a Surgical Pathologist receives a tissue specimen and makes an interpretation of the underlying pathophysiologic processes, a Clinical Microbiologist directs a laboratory that provides results according to pre-defined parameters (e.g. positive or negative for growth).

However, with burgeoning technologies and a better understanding of the host-pathogen landscape, this diagnostic paradigm no longer necessarily applies. I believe that Clinical Microbiologists will need to play an increasingly interpretative role, synthesizing complex data in a way that is actionable for clinical colleagues. Reporting an MIC-value for an isolate of E. coli simply can’t be done in the same manner as reporting the composition of a patient’s microbiome, as assessed by next-generation sequencing. Going forward, perhaps one of the biggest challenges will be determining if and how other current paradigms in laboratory medicine (involving service commitments and billing) can adapt to this increased need for expert interpretation. 

ASM: What is your proudest career moment yet? 

JS: In general, I am most proud of the unique professional pathway that I have followed to date. Clinical Microbiology is somewhat distinct in that practitioners include both MDs who complete a Pathology residency followed by a one-year American Board of Pathology fellowship, along with PhDs who complete a two-year CPEP fellowship. After finishing MD-PhD studies, I made the decision to forego a general residency and train directly in the CPEP program at Vanderbilt. I have been told that I am the first individual with this particular sequence of training.

Although making a non-traditional choice was a little scary, my motivation was to focus as directly as possible on my development as both a clinical microbiologist and translational investigator. Admittedly, the majority of this pathway is still in front of me, but I am proud to say that (so far) it seems to be leading me in the right direction.

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4u4 MartinezRaquel Martinez, PhD, D(ABMM).

Raquel Martinez, PhD, D(ABMM) is a System Director of Clinical and Molecular Microbiology at Geisinger Health System in Danville, Pennsylvania.

Martinez studies the impact rapid diagnostics, particularly those for respiratory pathogens, have on patient care and outcome. Her work tests the hypothesis that rapid and accurate diagnostics will improve patient care, and the large healthcare network for which she works aims to continually improve the time-to-result for respiratory pathogen detection (now down to 2 hrs from receive to result; see here).

ASM: When did you know you wanted to work with infectious disease?

Raquel Martinez: As the first female and only the second person in my family to go to college, I didn’t know what I didn’t know. I graduated college with a degree, but no plan. Without good guidance, I decided on my own to pursue my childhood dream of becoming a doctor. Therefore, I enrolled in a few medical school pre-requisites and got a job as a phlebotomist at a local community hospital while waiting for school to start.

I was exposed to the clinical laboratory as a phlebotomist. In addition to phlebotomy, my duties included microbiology specimen processing. When my post-baccalaureate program started in the fall, I was enrolled in an introductory microbiology course. I loved that class! The next semester, I took all upper-division microbiology courses. I was hooked! During my second semester, at the suggestion of my microbial genetics instructor, I decided to try my hand at research. I liked it so much that I decided to get my Master’s degree, and then quickly moved on to finish my Ph.D. 

At the ASM Kadner Institute during my graduate career, I learned about the clinical microbiology career path. Instantly I knew that I wanted to be a clinical microbiologist. From that point on, I learned what it was that I needed to do to make that happen. I like to think of this as coming full circle.

ASM: What role do you see for clinical microbiologists in the future of health care? How will technology change this role?

RM: The industry has recently experienced a multitude of technological advances regarding rapid diagnostics for the detection of infectious diseases, which has quickly revolutionized the field of clinical microbiology. As laboratorians, we are driven to test the analytical characteristics of these assays, but as clinicians, we are lost in the many analytical options. It is increasingly evident that there is insufficient evidence for the clinical utility of these tests. As a profession, we need clinical outcomes data to help guide patient care. Despite the constant plea for data, there continues to be limited studies available. My professional goal is to produce evidence to support clinical practice and demonstrate the laboratory’s value.

Moreover, consultation services are more important than ever. Result interpretation is becoming more important with the advent of molecular techniques. With MALDI-ToF mass spectrometry and 16S rRNA gene sequencing, we are able to identify organisms that were not commonly seen before. Our role is to explain the significance of these organisms. Additionally, emerging pathogens will always occur and these will also keep us relevant. Clinical microbiologists are here to stay.

On the other hand, somethings haven’t changed. We are still laboratory stewards who must educate clinicians about the importance of proper specimen collection. “Garbage in equal garbage out;” “Send the blob not the swab;” “Swabs don’t do the job”: These types of campaigns have been going on forever. Medical schools are evolving, students are teaching themselves, and gone are the days of laboratory hands-on learning. Laboratory staff spend much of their day educating providers on all aspects of the laboratory: pre-analytical, analytical, and post-analytical processes. Until more time is spent educating clinicians upfront, I think we must continue to function as laboratory stewards.

ASM: What is your proudest moment of your career to date?

RM: I have been attending the ASM general meeting (now Microbe) for nearly 15 years. First I attended as a Master’s student, presenting my basic science research on soil microbiology. I presented many basic science research posters (as a Master’s an PhD student). At the 2014 meeting in Boston, one of the sponsors/vendors asked me where I saw myself in 5 years. At the time, I was just out of fellowship and had just received my first job as a laboratory director; I was just starting my career after going to school for what seemed like an eternity. I said that my goal was to present at the meeting as a speaker, not just a poster presenter. 

In 2016, I was invited to speak on my respiratory pathogen detection project. I was honored for the invitation to speak. I had reached my goal in only 2 years (proud moment)! Little did I know that my participation would open doors to more opportunities, such as webinars, interviews, and now 40UnderForty. It feels great to be recognized for all my hard work!

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4u4 GrysHeadThomas Grys, PhD, D(ABMM).

Thomas Grys, PhD, D(ABMM) is the director of microbiology and infectious disease serology at the Mayo Clinic in Phoenix, Arizona, and the block leader for the microbiology course at the Mayo Medical School, Arizona campus.

With collaborators at Arizona State University, Grys is working to develop a new method of antigen detection using mass spectrometry, with initial applications used for detecting Coccidioides, then causative agent of Valley Fever, an endemic fungal infection in the Southwest United States.

ASM: What drew you to the challenges of clinical microbiology? 

Thomas Grys: In high school, I was going to be an engineer until a friend gave me a copy of the Hot Zone. That spurred my interest into the biosciences. After finishing a Biochemistry major, I pursued a graduate program in Microbiology at UW-Madison. At an ASM meeting during grad school, I learned about the clinical microbiology career from Dr. Alice Weissfeld at a career lunch. Her talk and the topic really interested me. My wife is a nurse, and I also wanted to have a direct impact to human health, but never had a desire to be a physician. I had a broad interest in pathogenesis and pathogens, so the idea of learning about many of them and how to diagnose them was really appealing. When I told my wife about the career over dinner that night, she said that it sounded like a great fit for my skills & interests. It is always good to listen to the insights from those who know you best! 

I also have a keen interest in quality and statistics, particularly the area of viral load assays. The reason is that, like the basic sciences, diagnostic laboratories pursue truth, and try to get the right answers every day. The difference is that we get one specimen, and run one test to answer a question. So, we have n=1 to try to be correct on every single specimen, every single day. That is a tough challenge! Viral load assays are tricky because this is where a powerful basic science technique, PCR, meets a complex clinical problem, viral infection. Understanding the variability and performance of the assay is crucial to interpreting the result, and after many years, this is still a challenge that labs are working together to address.

ASM: How do you think new technologies will change the role of clinical microbiologists in the future of health care?

TG: Technology is changing the clinical lab, like many sectors of our economy. As automation and technology increases efficiencies in the lab, laboratorians can use their expertise to help connect the results in the lab to the health care action that should take place. After all, if a lab test result does not impact care, then it should not have been ordered! In the increasingly uncertain healthcare environment, labs must pro-actively identify, track, and communicate their value to the delivery of healthcare. We must push to integrate ourselves and avoid being commoditized. There is no substitute for a reliable clinical lab, and not all results are equal. A majority (around 70%) of a patient’s record is lab data. So, we must make sure the data is correct and actionable, and the value leveraged for the best care of the patient. We cannot wait for administrators or physicians to ask for this, we must continue to find ways to advocate for the value of the labs.

ASM: Thus far, what has been your proudest moment of your career?

TG: It is hard to identify the “proudest” moment. I’d like to think it hasn’t happened yet!

I am proud of several events throughout my career. Earning a PhD, filing patents, writing a single author paper are all milestones I am proud of. Then there are the small successes that build confidence and bring satisfaction, like finding rare Pneumocystis in a specimen, and working with two lab mates to overcome their personal conflict. I put a lot of emphasis on building teamwork in my lab. We get many applicants for open positions, both from outside of Mayo and from internal labs. This is a high compliment when folks want to be part of our team! I also am really happy to have found a great collaborator at ASU and I am proud of our increasing funding levels to support our project.

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4u4 Greninger Alex photoAlex Greninger, MD, PhD, MPhil, MS.

Alex Greninger, MD, PhD, MPhil, MS is a second-year resident in laboratory medicine at the University of Washington in Seattle, Washington, where he has set up a new center for metagenomics and viral whole genomic sequencing.

Greninger’s research specialty of virology has a tech-driven focus. In following his interest of viral discovery in humans, he applies metagenomics and proteomics approaches to viral discovery and characterization.

ASM: What drew you to the field of clinical microbiology?

Alex Greninger: I’ve always been drawn to microbiology. Originally it was the experience of just being a kid and getting upper respiratory infections with viruses or bacteria and wondering what is going on. As I studied them more, I was excited by their large effect sizes in epidemiological studies and their unique evolutionary history that enables targeting microbes with drugs with a potentially wide therapeutic window. With microbiology, there really is an opportunity for eradication or cure.

ASM: How do you think new technologies will change the role of clinical microbiologists in the future of health care?

AG: It all depends on what you mean by future. I oscillate between seeing a limited role as technology automates and decentralizes laboratory testing to a central role seeing healthcare providers functioning as the “long-arm of lab medicine.” In addition to technology, I think flux in payment models is increasingly the driver here. But the emphasis is on flux.

ASM: Thus far, what has been your proudest moment of your career?

AG: Two things: seeing continued discoveries and the development of the next generation of scientists.

The first is an ongoing pride when you see new information about discoveries that you were lucky enough to participate in. Whenever anyone publishes a new paper on salivirus (a new human virus) or the protein ACBD3 (a cellular hub used by picornaviruses), I usually write them just to thank them for their work and chat about what’s new in the field. Those were discovered during punishing screens, so I feel pretty invested in them. The second is seeing your excitement reflected in your trainees.

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4u4 Burnham Carey AnnCarey-Ann Burnham, PhD, D(ABMM).

Carey-Ann Burnham, PhD, D(ABMM) is an associate professor of pathology and immunology, molecular microbiology, and pediatrics at Washington University School of Medicine in St. Louis, Missouri. She also acts as an associate editor for the Journal of Clinical Microbiology.

Burnham’s specialties include antimicrobial resistance, hospital-acquired infections, and development of new diagnostic assays. Her work focuses on Gram-positive pathogens such as Staphylococcus aureus and Clostridium difficile that can be both colonizers and cause disease. She and her collaborators focus on optimization of diagnostic testing, the relationship between colonization and disease, and the movement of these microbes between the hospital and the community setting.

ASM: When did you know you wanted to work with microbiology/infectious disease?

Carey-Ann Burnham: During my undergraduate studies, I always enjoyed the laboratory component of my courses. One day a flyer arrived in my mailbox advertising the Medical Laboratory Science program, and after reading it, I knew that it would be a great fit for me! During my clinical rotations through the various clinical laboratory areas, I developed a love for clinical microbiology. This was nurtured during my undergraduate research project and I was hooked.

I am fascinated by microbes and their role in human health and disease. I am privileged to have a career in clinical microbiology which affords me the opportunity to study a topic that I love, teach, write, and have an impact on patient care.

ASM: What role do you see for clinical microbiologists and laboratorians in the future of health care?

CAB: Clinical microbiologists and laboratorians have an important role to play in the future of health care. Emerging illnesses are having an important impact on public health around the globe, and clinical laboratories are challenged to rapidly respond with diagnostic testing methods for these emerging illnesses.

In addition, the “walls” of the clinical laboratory are coming down. What’s historically been considered a “microbiology test” or a “chemistry test” may now be performed in any area of the clinical laboratory. Collaboration and integration of laboratory medicine professionals is essential, and laboratory medicine professionals must effectively integrate with clinicians, healthcare administration, and policy makers.

The rapid explosion of new technology to diagnose infections will make this even more important--laboratorians have an important role to play in validation and implementation of this new technology so that it can be integrated into clinical care in a way to have the greatest impact on healthcare outcomes. To do so, we will have to be increasingly visible in a variety of forums.

ASM: What is the proudest moment of your career to date?

CAB: One of the greatest privileges of my job is that I get to participate in the training and education of outstanding individuals. The part of my career that I am most proud of is the clinical microbiology fellowship training program that I direct. It is wonderful to see the trainees learn and grow and then go on to excel in the field of clinical microbiology.

For more career advice from these early-career clinical microbiologists, be sure to check out our ASM Careers blog. ASCP members can vote for the top five “40 Under Forty” here.

Last modified on Wednesday, 05 July 2017 11:36

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