Mentorship can be defined as the guidance provided by an experienced person in an educational institution or organization. And if you ask any successful medical student to deconstruct the key components that make their educational experience whole, mentorship will surely be at the top of their list.
Fourth-year University of Michigan medical student Jonathon McBride knows firsthand how important a good mentor can be when conducting scientific research. To examine clinically undetectable heart sounds in hospitalized patients, he teamed up with Karandeep Singh, M.D., M.M.Sc., an assistant professor of learning health sciences and internal medicine at Michigan Medicine, and Nancy Jariwala, a U-M undergraduate student enrolled in the Undergraduate Research Opportunity Program.
Together, they conducted a study in which they observed the presence of heart sounds during cardiac auscultation, or the process of listening to the heart with a stethoscope on the surface of the chest, in patients undergoing echocardiography. Their findings were recently published in JAMA Internal Medicine.
McBride spoke to Michigan Health Lab about this project, as well as the resounding impact of mentorship on his work. Here's what he had to say:
Tell us about your research project.
McBride: When people think of a doctor, the first thing they often envision is a stethoscope. It's almost instinctive at this point. Our work looked at how health care providers use the stethoscope to listen to the heart. Essentially, we aimed to study a concept that already exists – the fact that sometimes the heart is difficult to hear with a stethoscope.
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We used a digital stethoscope and recorded the heart sounds – or lack thereof – for patients that fell into various demographic groups. We would see if we could or couldn't hear cardiac auscultation and then we examined the demographics of everyone involved in our study.
The project was created in 2018 by Seth Klapman, who graduated from U-M Medical School. I worked in tandem with Karandeep and Nancy to continue and eventually finish the study.
Our biggest discovery revolved around how often heart sounds were heard. This was in a hospitalized patient population, and we found that it was difficult to hear the heart sounds in many of our participants.
Our data suggested that clinically undetectable heart sounds may play a role in the low sensitivity of auscultation for detecting valvular heart disease, or VHD. Though it'd be great to know if this applies to everyone, we studied patients undergoing echocardiography, which is an ultrasound of the heart.
Our findings also revealed that this issue was most pronounced when it came to mitral valve regurgitation, a condition in which the heart's mitral valve doesn't close tightly enough, thus preventing detectable mitral sounds via a stethoscope.
Did mentorship play an integral role in your work?
McBride: Yes, it certainly did. I started working with Karandeep nearly four years ago.
Karandeep is a great mentor and advisor who truly provided guidance while allowing this project to remain a student-led initiative. And I really appreciated that approach.
When we drafted our manuscript, he assisted us throughout the drafting and revision process, as well. However, one of his strengths was that he recognized (early on) just how driven we were as students to complete this research project and therefore allowed us to lead the project from the beginning. Of course, he also gave us some crucial advice along the way, which we found extremely helpful.
Our team was unique in that I got to work closely with Nancy, my undergraduate counterpart, as well. This study was essentially her baby, and I'd be remiss not to mention that she was an integral part of this project and its eventual completion.
What were your key takeaways from this experience?
McBride: Sometimes in medicine, there's a well-known concept that isn't necessarily examined further. Writing 'distant heart sounds' as an exam finding is one thing but examining it in depth is another thing.
What stands out to me the most about this study is that it was extremely simple, but it deconstructed something that happens every single day.
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When it comes to our study outcomes, I think it's important for us as researchers to further explore the usefulness of the data in certain populations. For example, how do things like body mass index, sex and other identifying factors play into everything, and when is it necessary to use something other than a stethoscope when treating patients?
Our work really sets the foundation for some future building blocks, and I'm proud to have been a part of this project.
Overall, it was incredibly rewarding to work with both Karandeep and Nancy. It was great to see how Nancy approached the study and how much we both learned from it, especially at our different levels of education.
When I look to the future, I'll always remember our work as an example of when it's important to dig deeper. I really enjoyed examining a well-known concept and looking at it from a critical lens. I want to continue doing this as I move closer towards becoming a physician. And one day, I'd love to be a mentor to someone, just as Karandeep was to me.
Paper cited: "Clinically Undetectable Heart Sounds in Hospitalized Patients Undergoing Echocardiography," JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2021.6594