Gap Year at the National Institutes of Health

NIH Main Campus

I am nearing the end of my post-baccalaureate research fellowship at the National Institutes of Health in Bethesda, MD. I had such a great year working with my lab, meeting other post-bacs and NIH employees, and getting involved in programs and activities that kept me active and engaged in the larger community.

I live in an apartment in a beautiful Bethesda neighborhood with three roommates, one of whom is also a post-bac research fellow at the NIH. Bethesda is one of the most educated places in the US (this is primarily due to the presence of the National Institutes of Health of this suburban town, which attracts workers and researchers from all across the globe). "83% of residents over 25 have a bachelor’s degree — that’s 50% more than the national average of around 30% — and over half of residents also have a master’s degree."

I decided to spend my gap year before medical school as a student researcher at the NIH. I am very glad I made this decision (and was accepted! This program is highly competitive). A gap year is a great time to step back, explore your personal interests, determine if Medicine is the right career choice for you, and perhaps also strengthen your application. Research, teaching, traveling, and completing a post-bac program to boost one's science GPA are just a few examples of what people decide to do during their time off.

I am an IRTA (Intramural Research Training Award) fellow, and I work in the Section on Neural Coding and Computation in the National Institute of Mental Health.
What better way to appreciate the tremendous contributions of scientific research to health and medicine than to have an immersive experience at the largest research agency in the world? I am enjoying the work that I'm doing here; it's a privilege to be part of the ground-breaking research of my lab.

NIH Post-bac Poster Day 2016

A few weeks ago, I presented my research at Post-bac Poster Day with 621 other post-bacs.

My project involves creating a 3-D model of the orbital pre-frontal cortex (OFC) and the amygdala in the rhesus monkey brain. Our lab studies other brain areas that are implicated in motivational learning, emotional processing, and decision making, but my research focuses just on the OFC and amygdala. The goal is to understand how we can improve the methods we are currently using to induce cellular expression in these regions. Cellular expression is induced upon injection of a virus-that we develop- into the brain areas.

So, I am analyzing the shape, size, and 'coverage' of what we call "expression sites". ('Coverage' just means how much of the amygdala and OFC we are seeing expressing cells). This analysis will help us understand the necessary adjustments we need to make in certain parameters to reach more desirable results (which is to see more cellular expression throughout these brain regions). The parameters we'd like to improve include the amount (volume) of the virus and the way in which we're injecting the virus into the monkey's brain during surgery.

Anyway, I won't go into all the details, but I'll answer the question 'Why do we care about all of this?' Well, let's think about it more broadly. My project will get us a little closer to understanding how we can effectively control and modulate neuronal activity in certain brain regions. This is essential for human gene therapy applications, especially in the brain.

A few other wonderful experiences this year:

• My lab paid for the Human Neuroscience course that I took through the NIH Foundation for Advanced Education in the Sciences (FAES) Graduate School last fall semester. It was incredible, overwhelming a little, but I was excited to learn the material, including basic neuroanatomy of major structures (i.e. the four lobes, cerebellum, brain stem, and spinal cord), the 12 cranial nerves (the most reoccurring topic throughout the course; I can now recite each nerve and its function), and the neurophysiology of the sensory (somatic and autonomic), motor, association, extrapyramidal, and limbic systems.
  
  
  I took another FAES course this spring. It was free for post-bacs who are applying to med school or have already been accepted. We learned the basics of taking a patient history and performing a physical examination. We have our final case presentations tomorrow. Each week, we learned how to perform physical examinations of each system (i.e. neurologic, gastrointestinal, pulmonary, etc) from specialists within these fields who work at the NIH. My favorite was the one given by the neurologist. I'm sure you can guess why. This was a short course but the information we learned was invaluable. Here are a couple of important common themes that came up again and again throughout the class:

Much of what you need to know to make a diagnosis is in the patient's history. Listen to your patient and his or her family. They are all the true 'experts' on the patient's illness. William Osler, the Founder of Modern Medicine, once said, "Listen to your patient, he is telling you the diagnosis." The percentage of misdiagnoses and delayed diagnoses in the U.S. has risen over the years, due to many factors, partly to cursory physical examinations and patient histories. That's not a big surprise; today's physicians are burdened, overwhelmed, and overworked. It's no wonder medical errors are one of the leading causes of death in our country.


It is important to learn to triage a patient's concerns. Danielle Ofri, a general internist at Bellevue Public Hospital in NY and an author of several books, explains this well in her third book, Medicine in Translation: Journeys with My Patients. She describes a frustrating encounter with one of her patients. The patient comes in every so often with a litany of complaints, most of which Dr. Ofri deems trivial. These complaints include back pain, abdominal pain, headache, nausea, chest pain, heartburn, and it continues. It's not possible to address all of these complaints in one short appointment with the patient. More importantly, how can you determine which pain is more "real" than the others when the patient insists that all of her pain is of the same magnitude? This is a perfect case to explain this point. The differential diagnoses for a headache, for example, are innumerable. They can range from the 'minor', such as lack of sleep, stress, and poor eating habits, to the more serious, such as a brain aneurysm, tumor, dehydration, and encephalitis. Ascertaining the patient's graver symptoms will depend on the physician's ability to triage the chief complaints.

• Another wonderful experience I had this year was joining a Christian Book Club at the beginning of my research fellowship. It was founded by another post-bac a couple of years ago. We've been reading books written by Christian authors as well as a few books in the Bible. In the past, the group read Blue Like Jazz by Donald Miller, Every Good Endeavor by Timothy Keller, Love Does by Bob Goff, and In the Company of the Poor by Father Gutierrez and Paul Farmer. Currently, we are reading The Language of God written by Dr. Francis Collins, the Director of the NIH. He is a Christian scientist and one of the world's leading geneticists who argues that "a modern understanding of science can be harmonized with a belief in God." It's a fascinating read so far, and it has certainly produced provocative discussions during our morning meetings.

• To make a little extra money on the side, I picked up a job as a substitute ESL Instructor at the International Language Institute (ILI) in Gaithersburg, MD, the most diverse city in the U.S. (There is another ILI branch in DC). I fill in for a teacher when he/she cannot make it to a session. I started a couple of weeks ago and I love it. Back in college I was an ESL volunteer teacher for 4 years with the migrant Latino farmworker community in upstate NY. Working at ILI reminds me of this past experience, which I thoroughly enjoyed.

The basic level students I've been teaching on Saturdays are from a few different countries: El Salvador, Nicaragua, China, and Russia. So far we have touched upon the basics of the English language, including the verb "to be" (I am, you are, he/she is, etc), the verb "to have", nouns, adjectives, prepositions...All of those things. However, I feel as though I am learning more from the students than they are from me. It's a privilege to have the shared responsibility (with the other teachers) to arm these wonderful individuals with the language skills they need to have a voice in a foreign country.

I've gotten involved in other community activities this year ---

• As a volunteer at Mary's Center, a clinic in Washington, DC that serves the uninsured population
• Promoting the work of Partners in Health (a non-profit organization co-founded by Paul Farmer and Jim Kim [President of the World Bank] that is dedicated to serving disadvantaged populations all across the globe)
• And just hanging out and having fun with other post-bacs, my sister, and college friends who live in the area

In mid-July, I will be making the 12 hour drive to Chicago from Bethesda, a distance I've never driven before. I'm excited to wrap up the year and begin the next chapter of my life as a medical student.

Thanks for reading! :)