The Pathways Elective (2020-2021)

The following is an computer-generated summary of the video transcript.

Oh, everyone, I'm Rebecca and I'm Jacqueline, or to the junior medicine residents here at MGH Today, we're going to tell you about the pathways, which is a special program we have here at Mass. General. Theo Pathways Rotation, formerly known as the Pathways Console service, is a two week rotation where 23 residents take a deep dive into a patient leader. Had an unusual or unexplained presentations or pathology were frequently humbled at the bedside by the political unknowns that come with taking care of patients. Here at MGH, patients who either have an extreme phenotype or an unexplained or unknown diagnosis or management plan are often referred to the pathways console service for further investigation. Based on the selected patient case, we formulate the clinical questions a swell as hypotheses regarding the possible underlying biological mechanisms, which we might think about interrupting things kind of connection. One of the most exciting part about the pathways experience is that we get to be connected to speak with world experts in the field. It's a truly wonderful and unique experience after we gather all these information, we then proposed experimental approaches, oftentimes involving novel technologies, to address our original clinical question. Way Started Pathways is the brainchild of two of our residents, Victor Federov and Lawrence. I tells who really saw how bringing science and an individual patient together could change how we think about doing our clinical care, how we ask questions and really, how we drive scientific inquiry. It's become such a big part now of who we are at Mass General Medicine. How I think about patients, how I attend on the Bigelow, how I actually am constantly asking myself, Do we understand what's going on here? So we ended up focusing on two patients. The first was someone with severe disseminated tuberculosis, and the second was someone with a really unique constellation of symptoms who ended up having a fairly novel immune deficiency. In order to understand these patients, we met with a range of experts at MGH in genetics and genomics, who were able to teach us the basics about how to approach genetic testing in our patients. Um, if you threw a rocket MGH, you could probably hit three people who knew more about genetics and genomics than myself, and they were able to teach me the basics up through understanding how we were able to help each of these patients. So my most memorable pathways moment isn't a single moment, but it's kind of a moment that happens each rotation where, at the end of the rotation, the team will give a presentation kind of describing their investigation and their thoughts. They always ask the questions that were raised questions about the underlying mechanisms of disease that are not well understood. There's a moment when they asked those questions where the audience kind of just perks up and when they answer those questions by kind of laying out their hypotheses and what they're thinking, uh, it really grabs the audience's attention in a way that I don't think people are used to. Um, when they sit through a lot of medical discussions. During my path of his experience, I had the opportunity to really dive deeply into a case of a gentleman with recurrent angina Dema the factory toe all no medications at this time. Residency is not all about writing, notes and writing orders, but actually really dug deeply into what's going on with the patient pathways. Experience allowed me toe really dive deeply into one patient and really focus on the biology, the path of physiology and the mechanism of this one issue, which was Angie oedema on. Basically, actually, the two weeks you can ask me any question about G. I loved pathways, and I'm sure all of you enjoy your time on it as well. Way move forward pathways is not only a rotation that the residents will do, but it's going to become embedded. How we think about medicine across the department. How we asked cross cutting questions about what could be going on with a patient or a disease. We're building an ambulatory practice so that the patients could be followed over time as we're learning that the scientific investigations I just got an amazing story that's going to come out in print, soothe scientific investigations, could take months, if not years, to fully come to fruition toe. Understand the new pathways that are occurring over the course of my residency. You've been working on trying to give you guys a skill as you leave the pathways rotation on. We've come up with the idea of advanced pathways where you get training in a skill, whether it be genomics or proteomics or or otherwise. Training with genomic square, you join the pathways block. You learn about how to think about genomics, how to think about a whole extra sequencing. If you were to order that analyzing variants, thinking about disease variant associations and how toe design a proposed experiments to test those variants that you hypothesize that related to your patients presentation. We do think that, you know, learning genomic system, important skill that every physician should have. Hopefully, we could include this a part of your training.