A Bridge Between Engineering and Medicine

Duke University Medical Center is a quick hop, skip and jump away from Duke’s Department of Biomedical Engineering––but most people prefer to walk. The proximity fosters a plethora of collaborative research and programs between Duke’s medical school and Duke BME, including the Duke Medical Scientist Training Program (MSTP).

Founded in 1966, Duke’s MSTP was among the very first MD-PhD programs in the country established by the National Institutes of Health to train physician-scientists. In similar programs, medical students complete two years of coursework followed by two years of clinical rotations; the Duke curriculum concentrates all coursework in the first year followed by a year in the clinic and a third year devoted to independent research. For MSTP students, that year extends to several as they earn a PhD. After completing their doctorate, medical students spend a final year in the clinic before they graduate.

For students who opt to pursue their PhD in biomedical engineering—such as recent MD-PhD graduates Drs. Veronica Rotemberg and Christina Behrend—the program creates opportunities to pursue research that they can eventually move out of the lab and into the clinic.

Rotemberg (PhD’14), a dermatologist at the Memorial Sloan Kettering Cancer Center (MSK), completed her PhD in BME Professor Kathy Nightingale’s lab, where she used ultrasound imaging to study how changing pressure affects the stiffness of liver tissue. Today, patients with advanced liver disease often need a liver biopsy so physicians can better understand their degree of liver cirrhosis. By correlating liver stiffness estimates with portal venous pressure, Rotemberg explored whether ultrasound imaging-based methods may be used in the future to determine pressure gradient noninvasively.

“When I was looking for a lab I knew I wanted to work with someone who was doing translational research that had the potential to really impact patients that still had a quantitative and technical focus,” says Rotemberg. “I met with Kathy Nightingale and Mark Palmeri, who was an MD-PhD student in her lab. They were working with real patients and the work required a lot of technical development and a thorough understanding of the mechanics of human tissue. It was a perfect combination for me.”

Now director of the Imaging Informatics Program at MSK, Rotemberg has focused her imaging research on skin disease. Building on her PhD research, she’s developing high-resolution approaches to measure skin elasticity to aid in the diagnosis and tracking of skin lesions. She’s also working on tools for automated diagnosis that might allow physicians to determine whether a lesion is benign or malignant from a clinical photo.

“One of the main reasons I went to Duke for graduate school was the BME program, and there were structural aspects of the BME department that are uniquely suited to an MD-PhD student,” says Rotemberg. “One of my roles was to go to the clinic and actually image patients in the hepatology clinic. As compared to other research projects for MSTP students, the opportunity to participate in research that directly involved patients helped me to continue to develop as a physician and scientist at the same time.”

“Kathy was also a really wonderful mentor for me, and I’ve benefited so much from that over the years,” says Rotemberg. “Now that I’m in the position of mentoring others I’m realizing just how impactful her guidance was for me as a scientist, as a professional, and as someone committed to mentoring students––especially women––in biomedical engineering.”

Behrend (PhD’17) is currently a first-year resident in neurology at the Hospital of the University of Pennsylvania. As a student in BME professor Warren Grill’s lab, Behrend carried out research on the basic physiology of Parkinson’s Disease, a neurodegenerative disorder that affects movement and causes tremors, to guide the design of deep brain stimulation devices that can alleviate disease symptoms.

“By understanding more precisely which pathological neural signatures are important to target with electrical stimulation, we can design efficient stimulation therapies that deliver less energy to the brain tissue overall,” says Behrend. “That maximizes the battery life of the implanted devices, which means patients need fewer replacement surgeries. It’s a great example of how basic research can have a clear clinical impact.”

As she progresses through her residency program, Behrend hopes to get involved in clinical research to study disease processes and examine how new and improved technologies can help treat neurological disorders like Parkinson’s. “Duke BME was a highly collaborative environment and it has incredibly strong ties to the medical school, which is evident through the MSTP,” she says. “Half of my MD-PhD class did their PhDs in engineering, and they all had opportunities to interact with physicians and patients. This collaboration was not only easy but welcomed, especially because Duke BME students bring so many skills to the table.”