Research Internship for Junior Investigators

The CREST Network has two opportunities for junior investigators: one in Sacramento, discussed here, and one in Oakland, down below.

The unpaid internship in Sacramento provides an opportunity for a med-school-bound, upper-division undergraduate (or recent graduate) to gain valuable knowledge and skills by hands-on experience in clinical research with the CREST Network. 

College credit may be available at your university. To date, we have secured credit from UC Berkeley, UC Davis, CSU Sacramento, and UN Reno. 

The program began in the Sacramento/Roseville region in the summer of 2004. Our Oakland opportunity for a hired research assistant was begun in the summer of 2010. For more on the Bay Area program, see the bottom of the page.

Sacramento and Roseville
 
Aims of the Program
 
We have several goals for our junior investigators:

 

1. To grasp what clinical research is all about. Toward this end, we will read and discuss a user-friendly introduction to research method. We’re currently using Stephen B. Hulley, et al. Designing Clinical Research, fourth edition (Philadelphia: Lippincott, Williams & Wilkins, 2013). In the past we have read Richard K. Riegelman, Studying a Study and Testing a Test: How to Read the Medical Evidence, Sixth Edition (Philadelphia: Lippincott Williams & Wilkins, 2012).  Interns will also familiarize themselves with Human Subjects Protection by taking an online tutorial by the National Institutes of Health and will get acquainted with Health Information Privacy by reviewing a brief training slideshow.  

Guided readings on clinical topics of interest are also available. Current book studies with junior investigators include ECG and CT interpretation.

2. To develop a working understanding of the medical topic at hand. Fields of study have included the cardioversion of atrial fibrillation, deep vein thrombosis diagnosis and management, the safety of procedural sedation in emergency medicine, emergency reduction of long-bone fractures and dislocations, and the safety of central venous catheterization.

3. To participate substantively in the data collection, data analysis, and manuscript composition. Interns serve as co-authors on publications arising from their projects. On occasion, junior investigators have presented their results at national meetings.

4. To shadow an emergency physician during several shifts in the department in order to experience the "real world" of emergency medicine in a community hospital.

5. To fuel a passion for medicine. It's an exciting, challenging, and meaningful profession. Cf. Sachin H. Jain, A Letter To Premedical Students: Stay The Course. Forbes. Jan 23, 2016.

 
Location and Length of the Program
 
The internship is based out of one of our medical centers in Roseville and Sacramento, California.
 
The duration of the internship varies with the project and the intern. In the past we have run internships over one summer, over two summers, and over one year. Summer internships involve 20-30 hours/week. Year-long internships for pre-med students require about 10-15 hours/week while in college.  
 
 
Our Junior Investigators and their Projects

Disha Bahl completed her first two years of undergraduate work at De Anza Community College in Cupertino, CA, before transferring to the University of California, Davis. She is currently a junior, pursuing a degree in genetics and genomics. Her clinical research work focuses on acute pulmonary embolism patients who present with syncope. Disha and Darcy, below, are exploring the association of clot size with syncope and their correlation with adverse outcomes. Disha will be taking the MCAT later this year. 

Darcy Engelhart is a senior at the University of California, San Diego. She will be staying on at UCSD in the fall of 2017 for a master's program in biology. She is working with Disha on a study of pulmonary embolism patients who present with syncope. 

Daphne D. Le is a junior at the University of California, Berkeley. She began her internship in January 2017 while earning 4 units of college credit for this pass/fail research elective. In addition to the above reading assignments, she is tackling the interpretation of ECGs, which will be critical to her research agenda. Her first project is an exploration of the management of stable wide-complex tachycardia in the prehospital setting. She will also be writing a case report on ibutilide-induced torsades de pointes. Daphne's project for the summer will evaluate screening for thyroid disorders in ED patients with symptomatic atrial fibrillation and flutter.  

Le DD, Abraham SA, Ballard DB, Vinson DR. Prehospital treatment of stable monomorphic wide-complex tachycardia in the U.S.: a comparison of protocols with the American Heart Association guidelines. Began Jan 2017. Will soon be submitting abstract to ACEP and manuscript for peer-review.

Ashley S. Abraham is a senior at the University of the Pacific in Stockton, pursuing a major in bioengineering and a minor in global health. She will be taking her MCAT in late 2017. She hit the ground running in July 2016, taking on a case report in her first few months. During this spring semester she is working on two cardiology projects: one on ventricular tachycardia management and the other on diagnosing heart attacks in patient's with ventricular pacemakers. Ashley's project for summer 2017 is a retrospective analysis of intermediate-risk pulmonary embolism across 21 emergency departments. 

Abraham SA, Liu MY, Vinson DR. Image diagnosis: Iliopsoas abscess from Crohn disease. Perm J. 2017;21:16-150. Full-text pending

Le DD, Abraham SA, Ballard DB, Vinson DR. Prehospital treatment of stable monomorphic wide-complex tachycardia in the U.S.: a comparison of protocols with the American Heart Association guidelines. Will soon be submitting abstract to ACEP and manuscript for peer-review.

Abraham SA, Vinson DR, Levis JT. ECG Diagnosis: Myocardial infarction in a ventricular-paced heart. In design for spring 2017.

Farrah Nasrollahi is a CAL grad and a third-year medical student at California Northstate University College of Medicine. She joined us in the summer of 2016. Her primary project will focus on the delayed diagnosis of pulmonary embolism, though her first CREST publication is a letter to the editor on antiemetic efficacy in the ED. 

Vinson DR, Nagam MR, Lugovskaya N, Nasrollahi F, Egerton-Warburton D, Furyk JS, Meek RA. Oligoantiemesis: a premature neologism for an intervention insufficiently substantiated? J Emerg Med. 2016 Oct 6 [Epub ahead of print].


Alisha Othieno is a CAL grad and currently a second-year medical student at UC Davis. She is doing a summer research elective with us on patients with sub-massive pulmonary emboli. 

Manvi Reddy Nagam completed her medical school training and first year of post-graduate work in India. She started an academic research sabbatical with us in early 2016. In addition to extensive reading, she will be helping with projects on atrial fibrillation and pulmonary embolism in order to get hands-on experience with the major steps of clinical research, from study design through IRB approval and on to data collection, analysis, and manuscript composition.

Nagam MR, Vinson DR, Levis JT. ECG Diagnosis: Right ventricular myocardial infarction. Perm J. 2016 Oct 5 [Epub ahead of print]. Full-text

Vinson DR, Nagam MR, Lugovskaya N, Nasrollahi F, Egerton-Warburton D, Furyk JS, Meek RA. Oligoantiemesis: a premature neologism for an intervention insufficiently substantiated? J Emerg Med2016 Oct 6 [Epub ahead of print].

Lugovskaya L, Warton EW, Nagam MR, Reed ME, Ballard DW, Rome AR, Stevenson MD, Vinson DR, for the KP CREST Network. Effectiveness and safety of procainamide in the cardioversion of atrial fibrillation and flutter in the community ED setting: a Pharm CAFÉ study. Ann Emerg Med. 2016;68(4S):S40 [abstract 100].

 
Nelya Lugovskaya was our 2015/2016 pre-med intern. She did her undergraduate work at American River College, then transferred to UC Davis. She designed the data collection tools, helped with data collection, and is contributing to our abstracts and manuscripts of our large Pharm CAFE Study (defined above). Nelya trained our other junior investigators, from medical students to physicians, on methods of data collection. She started medical school in 2016 at UC Davis, and will continue as a part-time CREST investigator. Her first publication, a case report, hit the press in early 2016, followed by three abstracts, two of which she presented at national meetings. 

Lugovskaya N, Vinson DR. Paroxysmal atrial fibrillation and brain freeze: a case of recurrent co-incident precipitation from a frozen beverage. Am J Case Rep. 2016;17:23-26. Full-text

Lugovskaya N, et al. Predictors of ibutilide’s effectiveness in the cardioversion of atrial fibrillation and flutter in the community emergency department setting. Acad Emerg Med. 2016;23(S1):176-177 [abstract 412]. Available here

Presented at the annual meeting of the Society for Academic Emergency Medicine, New Orleans, LA, May 2016.

Rome AM,
Lugovskaya N, et al. Ibutilide-induced ventricular tachycardia in the community emergency department setting: incidence and risk factors. Acad Emerg Med. 2016;23(S1):175-176 [abstract 405]. Available here

Vinson DR, Nagam MR, Lugovskaya NNasrollahi F, Egerton-Warburton D, Furyk JS, Meek RA. Oligoantiemesis: a premature neologism for an intervention insufficiently substantiated? J Emerg Med2016 Oct 6 [Epub ahead of print].

Lugovskaya N
, Warton EM, Nagam MR, Reed ME, Ballard DW, Rome AM, Stevenson MD, Vinson DR, for the KP CREST Network. Effectiveness and safety of procainamide in the cardioversion of atrial fibrillation and flutter in the community ED setting: a Pharm CAFÉ Study. Ann Emerg Med. 2016;68(4S):S40 [abstract 100].

        Presented at the Research Forum of the American College of Emergency Physicians, Las Vegas, NV, October 2016.

Luke Hance
 did his undergraduate studies at Sac City College, Sierra College, then California State University, Sacramento. It was during his stint at Sac State that he did his research internship. After graduating, Luke worked as a scribe in an ED in Folsom, California, and started medical school in 2016 at the University of Kansas. He is very interested in primary care.

Vinson DR, Ballard DW, Hance LG, Stevenson MD, Clague VA, Rauchwerger AS, Reed ME, Mark DG, for the Kaiser Permanente CREST Network Investigators. Pneumothorax is a rare complication of thoracic central venous catheterization in community emergency departments. Amer J Emerg Med. 2015;33(1):60-66. Abstract  

Discussed here: Vinson DR, Ballard DW, Gould MK. Mechanical ventilation and central venous catheterization [letter]. N Engl J Med. 2016;374(15):1489-1492. Full text

Vinson DR, Ballard DW, Hance LG, Hung YY, Rauchwerger AS, Reed ME, Kene MV, Chettipally UK, Elms AR, Mark DG, for the Kaiser Permanente CREST Network Investigators. Bleeding complications of central venous catheterization in septic patients with abnormal hemostasis. Amer J Emerg Med. 2014;32(7):737-742. Abstract  

        Presented at the Research Forum, American College of Emergency Physicians, Seattle, WA, October 2013.

Matt Stevenson had finished two years of undergrad work at Sierra College before transferring to the University of Nevada, Reno. During his UNR time he did a one-year internship with me. He returned to work with me during his fourth year of medical school for a 6-week cardiology research elective. He contributed to both the central venous catheterization studies and the Pharm CAFE study. After graduating from medical school at Loma Linda University in 2016, Matt began his emergency medicine residency training at the KP Santa Clara/Stanford program.

Lugovskaya N, Warton EM, Nagam MR, Reed ME, Ballard DW, Rome AM, Stevenson MD, Vinson DR, for the KP CREST Network. Effectiveness and safety of procainamide in the cardioversion of atrial fibrillation and flutter in the community ED setting: a Pharm CAFÉ Study. Ann Emerg Med. 2016;68(4S):S40 [abstract 100].

Vinson DR, Ballard DW, Hance LG, Stevenson MD, Clague VA, Rauchwerger AS, Reed ME, Mark DG, for the Kaiser Permanente CREST Network Investigators. Pneumothorax is a rare complication of thoracic central venous catheterization in community emergency departments. Amer J Emerg Med. 2015;33(1):60-66. Abstract  

Vinson DR, Ballard DW, Stevenson MD, et al. Predictors of unattempted central venous catheterization in septic patients eligible for early goal-directed therapy. West J Emerg Med. 2014;15(1):67-75. Full text

Casey Hoehn completed his undergraduate studies at La Sierra University, Riverside, CA, and medical school at Loma Linda University. During his summer internship, he led the data collection of our study of the safety of procedural sedation. Casey is now an emergency medicine resident at the Western Michigan program in Kalamazoo.

Vinson DR, Hoehn C. Sedation-assisted reduction of common orthopedic injuries in Emergency Medicine:  The safety and success of a One Physician/One Nurse Model. West J Emerg Med. 2013;14(1);47-554. Full text

Jason Patel completed his undergraduate studies at Washington University, St Louis, MO, and his medical training at the University of Arizona, Tucson. He is now a family physician in Tucson. During his college summer internship he did the yeoman's share of chart reviews for one of our DVT studies.

Vinson DR, Patel JP, Irving CS. Pretest probability estimation in the evaluation of patients with possible deep vein thrombosis. Amer J Emerg Med. 2011;29:594-600. Abstract

Dom Hickey at the time was an undergraduate at UC Irvine. He went on to pursue an additional year of research at the National Institute of Health. He finished medical school at Case Western Reserve, Cleveland, OH, and stayed on for residency training in neurology. He finished an epilepsy fellowship in 2016 and is now a practicing neurologist. He worked on one of our early DVT studies.  

Vinson DR, Berman DA, Patel PB, Hickey DO. Outpatient management of deep venous thrombosis: Two models of integrated care. Amer J Manag Care. 2006;12:405-410. Full text

 
Qualifications of a Successful Intern
 
Our interns to date have possessed the following attributes, and have set the expectations high. They have all been quick learners; curious about medicine; personable, easy to work with; diligent, responsible, trustworthy; and attentive to detail (we can’t have sloppy or inaccurate data abstraction). 
 
An undergraduate GPA of 3.6 or higher is required, as is an MCAT score of 500 or above. 
 
Application Process
 
Applicants will need to submit to me a resume, a letter of interest, and the names and contact information of three references. Eligible candidates will then go on to a conversational interview at Starbucks (or Peet's). Current or prior research interns are available as references on our end as well if applicants would like to get an insider's viewpoint on the program. 
 
The 2017 position has been filled. Those interested in a 2018 position should contact me in August 2017 for an update. 
 
More Information
 
For more on our Sacramento department's research division, link here. For more on the director of the Sacramento/Roseville internship, link here 
 
Contact David R. Vinson, MD, for more information. Future projects have not yet been defined.
 
 
Bay Area
 

The Bay Area program began in 2010 and is designed for research assistants employed by the KP CREST Network. 

Its director is emergency physician, clinical researcher, author, and hiker Dustin Ballard, MD, MBE, who practices at the Kaiser Permanente Medical Center, San Rafael, CA. Dr Ballard is also the medical director of the Marin County EMS system. 

The books he is using are Stephen B. Hulley, et al. Designing Clinical Research, fourth edition (Philadelphia: Lippincott, Williams & Wilkins, 2013) and Dustin Ballard, The Bullet's Yaw: Reflections on violence, healing and an unforgettable stranger (Bloomington, IN: iUniverse, 2007).

Recent Junior Investigators

Michelle Y Liu graduated from UC Berkeley in 2016 before beginning her stint as CREST research assistant in Oakland. She is leading our study of the treatment of patients who develop acute pulmonary embolism despite anticoagulation.  

Abraham SA, Liu MYVinson DR. Iliopsoas abscess from Crohn's disease. Perm J. 2017 in press

Liu MY, Ballard DW, Vinson DR. Acute pulmonary embolism in ED patients despite adequate anticoagulation: prevalence, anticoagulation management, and 30-day outcomes. In progress.

Ridhima Vemula also graduated from CAL before beginning her one-year stint as CREST research assistant in Oakland.  She played a critical role on several projects, mostly notably the MAPLE study (Management of Acute PuLmonary Embolism). She started medical school in 2016 at the University of Cincinnati.

Vinson DR, Ballard DW, Mark DG, Huang J, Reed ME, Rauchwerger AS, Wang DH, Lin DS, Kene MV, Pleshakov TS, Sax DK, Sax JM, McLachlan DI, Yamin CK, Swap CJ, Iskin HR, Vemula R, Fleming BS, Elms AR, Aujesky D; for the MAPLE Investigators of the KP CREST Network. Predicting 30-day mortality of emergency department patients with acute pulmonary embolism: does the simplified Pulmonary Embolism Severity Index perform as well as the original? Thromb Res. 2016 Sept 24 [Epub ahead of print].

Hilary R. Iskin, upon graduating from UC Berkeley, stepped into a full-time two-year position as research assistant with the CREST Network. In additional to her indispensable administrative work, she was a valuable contributor to several of our research projects, particularly our stroke and pulmonary embolism (PE) studies. Hilary was the lead interviewer conducting patient follow-up for our large MAPLE study. She began medical school at the University of Michigan in 2015. 

1. Ballard DW, Kim AS, Huang J, Park DK, Kene MV, Chettipally UK, Iskin HR, Hsu J, Vinson DR, Mark DG, Reed ME. Implementation of an inpatient electronic health record with computerized physician order entry is associated with improved outcomes for patients admitted with ischemic stroke. Ann Emerg Med. 2015;66(6):601-10.  Abstract

2. Kene MV, Ballard DW, Vinson DR, Rauchwerger AS, Iskin HR, Kim AS. Emergency physician attitudes, preferences, and risk tolerance for stroke as a potential cause of dizziness symptoms. West J Emerg Med. 2015;16(5):768-776.  Full-text

3. Iskin HR, Reed ME, Huang J, Kim AS, Park DK, Kene MV, Ballard DW. In-person neurology consultation before the administration of tPA for stroke is not associated with improved outcomes compared to phone consultation. Acad Emerg Med. 2015;22(S1):S54-5 [abstract 108].

4. Vinson DR, Mark DG, Huang J, Iskin HR, Rauchwerger AS, Reed ME, Pleshakov T, Wang DH, Ballard DW. The characteristics and outcomes of ED patients with acute pulmonary embolism discharged home within 24 hours. Acad Emerg Med. 2015;22(S1):S93-4 [abstract 201].

5. Vinson DR, Ballard DW, Mark DG, Huang J, Reed ME, Rauchwerger AS, Wang DH, Lin DS, Kene MV, Pleshakov TS, Sax DK, Sax JM, McLachlan DI, Yamin CK, Swap CJ, Iskin HR, Vemula R, Fleming BS, Elms AR, Aujesky D; for the MAPLE Investigators of the KP CREST Network. Predicting 30-day mortality of emergency department patients with acute pulmonary embolism: does the simplified Pulmonary Embolism Severity Index perform as well as the original? Thromb Res. 2016 Sept 24 [Epub ahead of print].

6. Vinson DR, Iskin HR, Rauchwerger AS, Ballard DW, and the KP CREST Network Investigators.  Describing patient satisfaction, site-of-care preferences, and health-related quality-of-life among ED patients with low-risk pulmonary embolism. Analysis underway. 

7. Vinson DR, Iskin HR, et al. Recent-onset atrial fibrillation and flutter: variations of definitions across specialties. Data collection underway.

Nimmie Singh did her undergraduate studies at UCLA. After her internship she was hired by the CREST Network as a research assistant for two years. She gave the first abstract as a Lightening Oral Presentation at the 2013 annual meeting of the Society for Academic Emergency Medicine, Atlanta, GA. Nimmie is currently in her third year of medical school at Touro University, Vallejo, CA.

1. Singh N, Ballard DW, Rauchwerger AS, Reed ME, Chettipally UK, Mark DG, Offerman SR, Vinson DR. Adaptation of a disease-specific research instrument for Quality of Life assessments in Emergency Department patients with atrial fibrillation/flutter. Acad Emerg Med. 2013;20(5) Suppl:S138 [abstract 332]. 

2. Ballard DW, Reed ME, Singh N, Rauchwerger AS, Hamity CA, Warton EM, Chettipally UK, Mark DG, Vinson DR. Emergency department management of atrial fibrillation/flutter and patient quality of life at one-month postvisit. Ann Emerg Med. 2015;66(6):646-654.e2. Abstract

3. Vinson DR, Warton EM, Ballard DW, Mark DG, Reed ME, Rauchwerger AS, Offerman SR, Chettipally UK, Ramos PR, Glaser D, Singh N, Go AS, for the TAFFY investigators of the KP CREST Network. Thromboprophylaxis of high-risk atrial fibrillation and flutter within 30 days of Emergency Department care. Analysis underway.

Contact Dr. Ballard for more information on the Bay Area internship.