We sat down with Megan Lander, MD, a third year GYN/OB resident at Hopkins who is conducting research as part of the Coleman Research Group to learn more about her work and recent milestones.
SS: Thanks for taking the time to chat, Megan! Can you start by telling me a little bit about where your interest specifically in reproductive health come from?
ML: It was a little bit of a torturous path (laughs). When I entered medical school, I was interested in neurosurgery and women's health wasn't quite on my mind. In undergrad, I was a neuroscience major, so I was very focused on that in medical school too. I started getting interested in women’s health during my preclinical years of medical school – it's a very loaded topic, both politically and medically. And then, my first clerkship of third year was OB/GYN, and I just fell in love with it. I was on Labor and Delivery and realized how much joy I felt taking care of women and how exciting it was to be a part of their experience during labor and delivery of their children. My next couple weeks were on Gyn Oncology, so I was seeing women at a completely different stage of life. I loved caring for this patient population, and it made me realize how strongly I felt about taking care of women for my career. I’m applying to fellowships in Gyn Oncology currently.
SS: What drew you to Gyn Oncology?
ML: I knew that I liked surgery a lot. And I was partially drawn to OB/GYN because it's very procedural in nature – it involves so much surgery as well as bedside procedures – so, I knew that I’d like it from that perspective. But when I did an actual rotation in it, I really fell in love with the patient population. They are the kindest patients, and they're so grateful for the care you give them. These cancers can be terrible, but overall survival can be years, so you get a lot of continuity with your patients. You also get to see a full spectrum of patients – you see some patients for their initial diagnosis and to talk through treatment plans and surgery, and then other patients who are five years out from their operation or treatment and doing really amazing.
For me, the opportunity to see patients through potentially the hardest time of their lives and have a positive impact on them is the most rewarding aspect of the field.
SS: That's awesome. And tell me about where your interest in research came from?
ML: Neurosurgery is a very research-heavy field, and as a neuroscience major, I was pretty involved in research. In undergrad, I stayed on campus for a summer to work on a research project and got a small student research grant to do it. And, I think when you want to go into medicine, research just seems to be part of it, no matter if you want it to be a small part of what you do or a large part. I was really excited to keep going with that. What I think is great about research is that even as an undergrad or a medical student, research allows you to still have an opportunity to significantly impact patients in a way that you can't really do from a clinical standpoint when you don’t yet have medical training.
As only one person in a clinical setting, you can really only help and see a set number of patients in one day, but from a research standpoint, you can have a much broader reach in terms of how many patients' lives you can impact, even if it’s not face to face.
SS: Awesome. So, I know a little bit about your residency research project, but can you tell me more?
ML: The project is a sub-study within the Postpartum HPV Vaccine study (learn more about the parent study here: https://www.jcolemanresearch.com/research). I got a grant through the ASCCP to look at levels of sex steroid hormones, and how those levels affect how patients respond to HPV vaccination. We have obtained patient blood samples from before their first vaccination and before their second vaccination, and we’ll see if there are correlations between sex steroid levels (progesterone, estrogen, testosterone) and patient response to the vaccine. In the postpartum period, sex hormone levels are especially elevated, so it’ll be helpful to learn if the postpartum period is an optimal time for them to be getting the vaccine or not. This would also be relevant to getting the HPV vaccine at certain times during your menstrual/hormone cycles.
SS: What made you interested in this project?
ML: Cervical cancer in general has been something that I have been interested in for a while. I did a quality improvement study when I was a med student on pap smears and how different types of lubricant used affect cytology results. And there’s been so much advancement in the field of cervical cancer in regards to prevention: improved screening guidelines and HPV vaccination, that at this point, it truly is a preventable disease and HPV vaccination is a huge part of that. So, when I heard that they were doing this Postpartum HPV Vaccination Study, I very much wanted to get on board. There is already some existing research on sex steroid hormones and immune response to vaccination, and it seemed a natural extension to this study would be to look at sex steroid hormone effect on this population’s response to HPV vaccination.
SS: Can you tell me a little bit about the rotation you’re on right now?
ML: Right now, I'm on my family planning rotation. It’s a bit different from our typical rotations – there’s a lot more clinic experience; most of our other rotations involve being on labor and delivery or in the OR predominantly. The family planning rotation happens in a number of different places. On Monday, we go to Planned Parenthood. On Tuesdays, we see patients for their pre-op appointments for surgical terminations. Wednesdays are our OR days. On Thursdays, we have complex contraception and medical abortion clinic at JHOC. Complex contraception clinic can entail a lot of different things – for example, if a patient had an unsuccessful attempt at removal of their IUD or Nexplanon, or sometimes, we see more medically complex patients who need a bit more counseling on what contraceptive options are available to them, based on their medical comorbidities. On Fridays, we have medical termination clinic at Bayview.
SS: Have you had any favorite rotations so far during your 3rd year?
ML: My first rotation as a 3rd year resident was the Weinberg nights rotation, where I was the sole resident on-service overnight. I took care of our GYN and GYN oncology inpatients and saw any of the ED consults that came in. As it was my first rotation as a 3rd year and one of the first times in residency we are on our own and not on a team, I think it played a big role in graduating me to a “chief” level resident. We of course always run our plans by our fellows and attendings, but as the only in-house physician overnight, it gave me a sense of autonomy that I think is critical to our progression as residents.
SS: What have you learned about patient care or research so far as a resident or even as a medical student that stands out to you?
ML: Something that has stood out to me especially on my family planning rotation is how important it is to be a patient advocate.
Patients need to feel that you really want what's best for them and that you’re there to listen to whatever it is that they’re going through - whether it’s pregnancy or their decision to terminate or their cancer diagnosis.
I think sometimes when patients don't get the best care, it can be due to a rift in understanding between the patient and the doctor, and the patient kind of shuts down. If they can’t give you the information you need, that’s clearly a barrier to them getting the care they need. I try to establish a good rapport with my patients and make it clear that I’m not just there to spew answers at them, but rather to understand what it is they're going through.
If the patient trusts that you hold their best interest at heart and that you're trying to understand things from their perspective as well, the collaborative relationship that is the patient-physician relationship just works better.
SS: It might be hard to give “best tips or practices,” but are there certain things you do when it comes to being an ally? Any advice for other physicians or residents?
ML: When I approach a patient, I don't want to go in and try to convince them that I'm an all-knowing doctor, or make them feel like there is a hierarchy in our roles. I go in as a fellow human being first and foremost and try to form relationships with them. It’s not perfect – you don’t bond with every patient that you have, but that is always my intent.
SS: Awesome. And are there things from talking to patients and hearing their stories and difficulties of navigating the healthcare system that make you wish that you could change something on more of an institutional level?
ML: There are a lot of things that I don’t think I realized until I was on the provider side of things, as opposed to being a med student. It’s small things, like trying to figure out where a patient can get their labs done and be covered by insurance. On my current rotation, I’m at Bayview a lot, and Bayview serves a large Spanish-speaking population. It can be really hard to communicate with patients who don’t speak English because, not speaking Spanish myself, I have to rely on the interpreter, and I don't know for certain how what I'm saying is being conveyed. It’s with these patients where you see how certain things can fall through the cracks and miscommunications can occur much easier than someone who is super health literate, speaks English, has great insurance, and whatnot. But, I think we do a great job at Bayview really trying to take care of these patients because we see firsthand how many barriers to healthcare they face.
SS: Thank you so much for sharing your insights!
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