Core Curriculum

Pancreatic Cyst and Cancer Early Detection

Under the leadership of GHREST mentors C. Max Schmidt, MD, PhD, this NCI U01-funded National Pancreas Foundation research center (U01CA239522) focuses on clinical trials and translational research directed at discovering novel biomarkers and targeted treatment of disease of patients of pancreatic neoplasia. The current work focuses on identifying and validating protein and metabolite signatures and their longitudinal changes, which can discriminate pancreatic cyst malignant progression and detect early-stage pancreatic ductal adenocarcinoma. Several prior GHREST trainees have had successful research experiences in this lab and have gone on to academic surgeon-scientist careers.

Indiana Center for Liver Research (ICLR)

The ICLR is a nationally recognized center for the study of cholestatic liver diseases, hepatocellular carcinoma, alcohol-induced liver damage, and non-alcoholic liver damage. Led by GHREST mentors Naga Chalasani, MD, Charlie Dong, PhD, and Eric Orman, MD, this NIH-funded center (R01DK121378, R01ES032189, R01DK132390, R01AA028506, R01DK121925, R01DK120689, U01AA021840, U01DK065211, and U01DK061737) conducts extensive studies that are both laboratory-based and patient-focused to understand the mechanical drivers of liver disease and improve patient outcomes.

Cardiovascular biology of intestinal disease

GHREST principal investigator Troy Markel, MD, and mentors Meijing Wang, MD, and Michael Murphy, MD, collaborate to understand how cardiovascular diseases such as mesenteric ischemia, aortic dissections, aortic aneurysms, and other cardiovascular pathologies impact intestinal blood flow (R01DK133418, R01HL171277, R01HL155957). Models of the disease include superior mesenteric occlusion, hind limb ischemia, cecal ligation and puncture, and ex-vivo cardiac perfusion. Combined, these mentors have trained nearly 20 GHREST residents during their tenure. These residents have gone on to successful surgical practices and academic careers.

Advanced Endoscopy and Device Innovation

Under the direction of GHREST mentors Evan Fogle, MD, and John Wo, MD, residents have the opportunity to study the neural and endocrine controls that regulate gastrointestinal motility and design novel devices to help manage these problems in the clinical setting. Further education in advanced endoscopic techniques and the opportunity to design novel endoscopically deployed medical devices with the Department of Bioengineering at Purdue University are offered.

Immunotherapy

Led by GHREST mentors Mark Kaplan, PhD, and David Basile, PhD, this group has focused on T helper cell differentiation and the impact of IL-17 in inflammation, such as seen in sepsis and inflammatory bowel diseases. Over the last 20 years, the group has been studying transcription factors that regulate cytokine responses and Th gene programming. It is currently supported by multiple R01s and an R56. More than 25 postdoctoral trainees have trained with this group.

Indiana Diabetes Research Center

GHREST mentor Carmella Evans-Molina, MD, PhD, MS, leads the NIH P30-funded IDRC (P30DK097512) and serves as the Director of the Islet and Physiology Core. She is also the co-director of the Diabetes and Obesity T32 Training Program (T32DK064466). Trainees have opportunities to learn about pancreatic function and physiology and can also work with mentor Ryan Ellis to learn about outcomes associated with islet cell transplantation.

Drug Discovery and Development Accelerator

The goal of this initiative, led by GHREST mentor Mark Kelley, PhD, is to integrate emerging technologies/equipment and computational tools for new drug discovery and development. The collaboration brings together university researchers, experienced pharmaceutical industry veterans, technology cores, and external research organizations.  

Colorectal Cancer Detection

Under the direction of renowned colorectal cancer screening expert Thomas Imperiale, MD, several trainees have studied risk prediction and risk stratification in colorectal cancer. This work has resulted in developing several colorectal cancer risk prediction tools to increase the uptake and efficiency of colorectal cancer screening. This group has also led much of the seminal work on fecal DNA testing and evaluating various colorectal screening techniques. This group is also running a large national study to assess the test characteristics of a second-generation multi-target stool DNA test, one with markers aimed at improving both sensitivity for advanced, precancerous polyps and specificity for advanced neoplasia. This program has been NIH-funded for >20 years, resulting in several seminal publications in NEJM, JAMA, and others, and numerous trainees subsequently becoming funded physician-scientists.

Quality Measurement

The IICER/SOQIC team is a nationally known leader in the science of quality measurement, which includes measure development, risk-adjustment approaches, composite measure development, and measure testing. The group has performed national measure development and testing for the American Cancer Society, supported by grants from the NCI (Bilimoria), NHLBI (PI: Yang), AHRQ (PI: Mohanty, Merkow), NCCN (PI: Bilimoria, Yang), and American Cancer Society (PIs: Bilimoria, Yang). Trainees acquire advanced skills in hierarchical modeling, reliability, and performance measurement, and they have published dozens of peer-reviewed papers in top journals. They have used this work as the basis for developing a research-focused faculty group.

Using Video and AI to Improve Surgical Technical Skills

A novel platform has been developed to automatically capture operative video automatically and clean and analyze the video with artificial intelligence. A recent seminal publication showed that better technical skills during colon cancer surgery were associated with better adherence to best practices, short-term outcomes, and even long-term survival. This work now focuses on assisting surgeons in improving their technical skills relating to specific steps of a surgery that impact cancer outcomes (e.g., high ligation to ensure adequate clearance and nodal staging). Prior GHREST fellow Cary Jo Schlick, MD, and multiple trainees have been engaged in this work.

Quality Improvement and Implementation Science

Using the health system as a laboratory, the SOQIC team has implemented more than 15 quality improvement initiatives focused on multiple digestive disease processes, using applied implementation and rigorous evaluation methods. For example, Anthony Yang, MD, (GHREST mentor) has an NHLBI grant to examine the implementation of best practices for post-discharge venous thromboembolism (VTE) prophylaxis in postoperative patients, using novel approaches and assessed with an established implementation science framework. Trainees are exposed to formal implementation science methods and have had highly productive research experiences through these initiatives. Support for this work includes NCI, NHLBI, AHRQ, VA, NCCN, and the American Cancer Society.

Gastrointestinal and Hepatobiliary Comparative Effectiveness

The SOQIC team is nationally known for innovative comparative effectiveness studies, mainly using national registries. Studies are particularly focused on topics for which clinical trials are deemed impractical, unethical, or otherwise impossible. The registries offer large sample sizes and allow for the assessment of national, real-world experiences across a diverse group of hospitals. Trainees acquire advanced modeling skills, including using propensity scores and instrumental variables. For example, prior GHREST trainee and current external advisory board member Ryan Merkow, MD, published a study in the Journal of the National Cancer Institute (JNCI) comparing outcomes for early esophageal cancers treated by endomuscosal resection versus surgery, stratified by stage. All prior GHREST HSOR trainees have completed one to two studies in this research domain. Recent GHREST mentee Ryan Ellis, MD, leveraged his retrospective comparative effectiveness study to then help launch a national randomized trial in pancreatic cancer surgery (NCT03269994).

Gastrointestinal and Hepatobiliary Health Policy

The SOQIC team is the national leader in research examining how hospital quality is publicly reported and incentivized by oversight agencies, payers, and third parties. Seminal studies published in JAMA and other high-impact journals have identified issues with the Centers for Medicare and Medicaid Services (CMS) pay-for-performance and public reporting programs and offered potential solutions to improve policies to incentivize high-quality care. Trainees acquire skills related to quality and payment policies, policy evaluation (e.g., difference-indifference approaches), and approaches to influence policy changes based on research.

Illinois Surgical Quality Improvement Collaborative (ISQIC)

ISQIC, a 56-hospital statewide learning collaborative, includes academic medical centers and community, critical access and pediatric hospitals. This cooperative has now transitioned to the Iliana Surgical Quality Improvement Collaborative (ISQIC) with the addition of Indiana hospitals (five have already joined), making it the first two-state quality collaborative in surgery. Prior trainees have leveraged the ISQIC infrastructure to conduct quality improvement and implementation science research, such as large-scale initiatives to improve adherence to treatment guidelines and reduce complications after complex surgeries. ISQIC is supported by substantial funding from AHRQ (R01HS024516-01; PI: Bilimoria) and Blue Cross Blue Shield of Illinois (PI: Bilimoria), and specific project-related funding where faculty are the PIs (e.g., NHLBI K08HL145139, PI: Yang; and NCCN, PI: Yang).

Obesity and Metabolic Derangements

Led by GHREST mentors David Allison, PhD, and Tarik Yuce, MD, this program works to understand many aspects related to energetics, obesity, and aging from basic model organism studies through clinical trials, epidemiology, genetic research, meta-analyses, statistical and research methodology, and policy analysis. Projects have involved studying the relations among body weight, body composition, caloric intake, and changes thereof with longevity in animal models and humans; the genetic and environmental influences on obesity and related traits; statistical methods for epidemiologic and genetic studies; and design, implementation, and analysis of randomized controlled trials.

Global Health

Another unique, remarkable area of opportunity surrounds a long-standing partnership with hospitals in Kenya (Moi Teaching Referral Hospital). Numerous IU School of Medicine faculty have grants that support trainees in conducting their research experiences in global health, and numerous trainees have based their research on this surgical global health area.