Lifelong Learning

(lively music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, the Bow Tie Bandit of Blood, a transfusion medicine pathologist here at Mayo Clinic. And today we're rounding with Dr. Lynn Cornell, professor of laboratory medicine pathology, an anatomic pathologist here at Mayo Clinic to have a discussion around lifelong learning. So thanks for joining us today, Dr. Cornell. - Thank you so much.

I enjoy listening to your podcast normally and I'm thrilled to be on the podcast.

- Now you're flipping into a new role. And so exciting this idea where I think a lot of us in medicine are talking constantly about lifelong learning. We're always going to conferences and getting new training and such. Recently I was talking with you before, we had another committee meeting that was starting, and you were mentioning that you had a collaboration with a group of philosophers (chuckles) and it just really struck me as kind of amazing.

And I was wondering if you could kind of share how'd you get started having a collaboration with a group of philosophers as a pathologist? - Right. It sounds kind of like a funny thing. But I just wanna take a step back and tell you I guess how I started getting involved in some things that seem like they may be outside or not traditionally related to pathology. Over 10 years ago now, I was on staff at Mayo Clinic of course, and I was on call one night.

I was waiting for a rush transplant, kidney transplant biopsy, that was supposed to come in that night. And while I was waiting for the biopsy, the tissue to be processed and everything, and so I could look at the slides, I was looking through the clinical history, of course, as we do on kidney biopsies. And it was someone who had lost his job and consequently lost his insurance and then couldn't afford to take the immunosuppressive drugs to help prevent rejection of his kidney transplant.

So I was expecting the transplant biopsy to show rejection, and indeed it did. But as I was looking through this history, it really made me annoyed and angry that we have a system where we can do something so sophisticated as taking a kidney from one person and putting it into another person, and that kidney can last for many years.

And why might it not survive, because of something as silly as, oh, someone gets insurance coverage through their work and if they lose their job, then they can't afford to take their immunosuppressive medications, and therefore don't take them regularly. So as I was waiting for this kidney biopsy to come in, an email came through in my inbox, from the Minnesota Medical Association and it said, "Volunteer for a committee". And I thought, well, maybe I could volunteer for a committee.

So it turned out there was a committee that I volunteered for. It was called at that time, Healthcare Access, Financing, and Delivery. So I signed up for that and I started learning a little more about this really complicated field of healthcare policy. And there are real experts, I mean, of course these are physicians that are on committees, but, you know, generally not pathologists who are on these committees. So people who really have expertise in this complicated field of healthcare policy.

I thought if there's anything I can do to try to help this issue including coverage for prescription drugs in transplant patients, I was going to do whatever I could do for that. So I ended up getting involved in the Minnesota Medical Association that way. And I eventually also signed up for another interesting committee, which was the Public Health committee. And there we cover many different aspects of public health, vaccinations and all different kinds of things.

And there are some of the, I'll just add, as a pathologist, I'd encourage other people who are in pathology or lab medicine to get involved in these kinds of committees, even if it's not the thought to be the usual thing that pathologists do, because we really can give a different kind of perspective on things. For example, we were evaluating a proposal that had to do with a human breast milk bank. And I looked into it.

The way that it was kind of described was kind of like there, these specimen, these were specimens, kind of like a blood bank sample, you know. But then when I looked into it, it turned out it's actually regulated more like a food and it's not subject to testing like HIV. And their response was, "Oh, well we've never had an issue with HIV." Well, as you'll know in the blood bank, there was never a problem with HIV transmission through the blood until we started testing for it.

So those kinds of things, you know, may seem totally acceptable for a clinician to say, "Oh yeah, this is a great idea." But then the pathologist can go in and say, "Well, wait, maybe we should look at some of the other issues that might arise with this." So that's kind of how I got involved with some of these different committees. And I'm currently on the Minnesota Medical Association Board of Trustees. So we end up looking at all interesting kinds of policy proposals.

And also just to put a plug in for pathologists involvement in their state medical associations, our Minnesota Medical Association, other states are often accepting policy proposals. So I encourage people to get involved, volunteer, especially pathologists, because we can offer a unique perspective sometimes. And generally pathologists don't volunteer for those things. So now moving on to the newer project.

So I mentioned before I was interested in kidney transplants and transplant immunology, and rejection of kidney transplants, and also coverage of immunosuppressive drugs for kidney transplants. So I've been involved in the American Society of Transplantation. The American Society of Transplantation has different kinds of committees and groups called communities of practice. And I have been involved in one community of practice called the Transplant Regenerative Medicine Community of Practice.

Another renal pathologist from Edmonton, Kim Solez is his name, he had encouraged me to run for the executive committee for this Transplant Regenerative Medicine Community of Practice. I said I would do it as long as another friend of mine would run also. (laughing) So it turned out we both were elected and we were on this.

Well, I don't really have much to do with regenerative medicine (laughing) in my practice, which is just renal pathology, although I am interested in the topic and new topics in transplantation. So as you recall, about one year ago, in New York, some surgeons and scientists, researchers, they had a project and they had, I mean, of course it's been a longterm goal of some researchers and some surgeons to engage in xenotransplantation.

So that is when we take an animal organ and put it into a human. So about one year ago in New York, some researchers put a kidney transplant into a human brain dead recipient. And those kidneys lasted for a brief period of time, but this experiment showed that that actually could be done. And then as everyone, or because it was big news, in January of this year, some researchers in Maryland actually took a heart from a pig and put that into a human.

And that was actually meant to be a functioning heart in the human. And that heart actually functioned for about two months and then the patient died probably because of a pig virus infection that was in that heart that caused the heart to fail. Anyway, I'd been interested in this topic even back in college. Many years ago, I did a little bit of research in the field of xenotransplant immunology. And so I've kind of been following the field on the immunology side of it for many years.

But when I saw, you know, I read about this in the news and I also read about, I read interviews just in the lay press of the surgeons and the scientists that were working on this, it seemed to me the ethics side of it wasn't really considered. And they weren't really, seemed to me, weren't really able to express their arguments in favor of xenotransplantation when it has really huge ethical implications.

So I started reading all of this myself, and around that time earlier this year, I proposed to the American Society of Transplantation that we start a work group on ethics of xenotransplantation. So after that long story that I've just told you, (laughing) the AST, American Society of Transplantation did approve this work group and I started inviting people to join.

This was between our Transplant Regenerative Medicine Community of Practice and there's another community of practice or committee that has to do with psychosocial and ethics issues. So both of our committees or communities of practice are contributing to this work group. - Wow, I really like that story you told us. You know, it's highlighting for our listeners

the idea of to not discount our perspective that we're bringing to things. It's also encouraging us to become more involved in our broader healthcare community as a result to share our perspectives. (chuckles) And then you're really a, I guess in movie terms, a strong character and that you're really now able and in positions to really affect change, right?

Like you proposed this work group that would not have existed otherwise presumably, and are really pulling together people to kind of flush out this topic of xenotransplantation for the next steps forward. - Right. And you know, of course a lot of people are interested in this now but the American Society of Transplantation really has had very little to do with xenotransplantation and especially ethics of xenotransplantation.

So there are, we've gathered together really a broad range of people for this work group, people who have, philosophy professors and bioethicists, and a variety of other people, psychiatrists, and all kinds of people to examine all these issues of ethics in xenotransplantation. And as I got into it, I realized like it is much more broad than (chuckles) I ever imagined.

So now I'm going back, I'm trying to study, like I mentioned before, I was looking at how are these researchers and transplant surgeons, who don't generally have a background in ethics or philosophy, how are they, what's their argument for xenotransplantation?

So I have been reading about what's a valid argument and what are logical conclusions from premises and these kinds of things I've been trying to read about as well as ethics of animal experimentation, which is also really interesting, and I've learned so much that I didn't know before, but I never would've even gotten into this topic if it hadn't been for the American Society of Transplantation and then these working groups and committees. - Yeah, I'm really fascinated

about this concept of self-learning, right? So a lot of times when we think about learning traditionally in schools and in training programs, there's some mentor or somebody that's giving you direction and feedback on here's the assignment, this is what you need to do next. You know, you're at a point where you're really self-assigning and exploring this.

And so I'm kind of curious, could you kind of elaborate a little bit for our listeners about how do you go about being a lifelong learner, really choosing your own curriculum, like for example, identifying that you're going to read about arguments and logic and logical fallacies and such? - Well, that also, it just, you know, it was really just based on a hunch of mine.

I just thought, you know, and what I read, for people who are so sophisticated in terms of their clinical practice or in terms of their scientific knowledge, their ethics arguments just didn't seem to be at the level of their scientific knowledge.

And if we evaluate a paper for peer review that someone submits and we're a peer reviewer, we look through this paper and we try to see, well do the conclusions in the paper, are those justified based on their experimental results and what was the design of the study? And we have to evaluate that.

But it seemed to me that these, at least as they were quoted in the lay press and in interviews and things, it seemed to me that they weren't really using their physicians skills, let's say, or their peer review skills when they're using those arguments. You know, they said things like, "Oh, well we humans consume pigs, you know, they eat pigs so there's no ethical issue with using pig organs for transplantation."

It's really much more complicated than that. (laughing) That's only one small part of the ethical implications of xenotransplantation. But it seemed to me that they really were not able to justify a lot of these experiments, especially given some surveys of the public. The public, general public is very uncomfortable with, xenotransplantation and uncomfortable taking a pig organ and putting it into a human for a variety of different reasons.

- You know, one of the things I'm hearing from you is it sounds like you have a really developed sense of where your expertise lies. That I think I've heard that physicians in particularly are prey because we may be expert in one thing, that we just kind of mistakenly broaden what we think we're expert in, and as a result we probably make poor financial decisions.

(both laughing) But it sounds like you have developed a strong sense of this is where my area of expertise is, this is what I'm interested in, and so in order to approach that, I need to do some work and development. Is that fair to say? And if so, how have you developed this honesty about where you are? - Maybe my honesty is that I realize how much I don't know. (laughing) You know, maybe also it's being in a really subspecialized field.

I'm a medical kidney pathologist, so I realize that there is so much in pathology that I don't know about and so much in medicine, and then also consequently so much outside of medicine (chuckles) that I don't know when you are really specialized in one field. So I'm trying to learn about those other things. I think in people who go into medicine are really interested in learning and there's always something new to learn within your field.

Now if I go to a kidney meeting or a transplant meeting or I'm watching some meeting online, at this point in my career when I hear people talk about something, you know, it's always interesting, but when it's actually in my field that I practice every day, there isn't that much that's new in my actual practice. So you learn so much more when you try to learn something that you don't know anything about.

So if you go to a kidney meeting and you go, just, I don't know, something that's still related to the kidney but completely outside of your narrow field, you learn so much more than if you go to the lectures that are just about what you already know about. So that's one thing I wanted to say. - So are there- - It's fun to learn new things like that. - Yeah, and so are there a couple of things that are,

what are a couple of the interests that you have developed kind of in your practice and life? - I'd like to move to something a little bit outside of medicine. And another thing I've been working on for the past year and a half or so is that we formed a local environmental group here in Rochester, Minnesota.

About a year and a half ago, some neighbors had realized that there was a proposed housing development on a site of about 130 acres of mature forest that included a great blue heron nesting site, also known as a rookery. So you may know people who follow me on Instagram or something and may know that I'm a fan of birds and I'm very amateur bird watcher but I do like watching birds. So of course this had to do with a great blue heron nesting site.

And it was at that time really the only one known in our county that supported the entire great blue heron population in our area. So we ended up, there was a grassroots, really truly grassroots development of this what's now called Save the Rookery. We ended up incorporating as a non-profit, and I serve as the board president for the non-profit Save the Rookery. But we work to promote awareness of this threatened great blue heron rookery, and we're working to try to preserve it.

I learned a lot about the local government processes, how local government works, what's the land development, you know, development process for different, for land use, the different steps that are involved. It's a very complicated process that goes between both the town where this is happening and the county level.

- [Justin] Wow. - So we, with this project, we ended up consulting with experts, identifying experts from around the state to submit testimony about the importance of this site, both for the great blue herons as well as other reasons that this is one of the few remaining contiguous forests in the area and there are reasons to preserve that. We also, we called ourselves the Rookies because we really didn't know what we were doing

and we were just learning it. (laughing) And then there was actually a few high school youth groups that got involved and they called themselves the Youth Rookies. And it's been really encouraging to work with these young people in high school. It's been really refreshing to work with them. And it's been a real bright point in this project to realize how engaged young people are in the future and in environmental causes like this. - Wow, that's awesome.

This really thread of a efficacy I really hear in your stories that you're sharing and how your experiences as a pathologist has set you up to kind of look at things in perhaps a slightly different way. And how not only can we kind of make effects in our communities and in our professional environments, but also this concept of mentorship, right, of the younger group of what is it like to learn up, you know, how are things done in local government? How can we affect changes in our communities?

This is really fascinating. I'm curious, so this has been a lot of really big projects you've been sharing with us. What's your next project, Dr. Cornell? - To be honest, my next project is finishing up all the previous projects that I've started. (both laughing) It's so easy to be excited about the next new thing that you want to work on, but it's really important to finish your previous projects.

And here at Mayo, we have a renal pathology fellowship program and we have residents who are doing projects in renal pathology. So of course we have all these projects with the trainees and especially important for them I think to follow up on those projects. So I'm working on finishing up those projects with the trainees. - (chuckles) Brilliant. We've been rounding with Dr. Cornell.

Thank you for taking the time to talk about lifelong learning with us, not just sharing with us your enthusiasm and experience, identifying how we can all be better lifelong learners, but also the importance of being finishers in these projects as well.

- Thank you so much. (lively music) - And to all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email. Please direct any suggestions to mcleducation@mayo.edu and reference this podcast. If you've enjoyed Lab Medicine Rounds podcast, please subscribe. And until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations.