Boston Children’s Hospital - Genevieve Medina

Boston Children’s Hospital

FileView Presentation (PPTX)

This summer I conducted clinical research on tonsil malignancy in pediatric patients. Using a national database, we characterized the types of cancers that present in tonsils, which had not been previously published. In doing so we reviewed the records of about 140 patients who underwent tonsillectomy for diagnostic purposes between 1973-2013 using a national database. On top of this, we conducted an intensive chart review of several patients who underwent diagnostic tonsillectomy at BCH that revealed that they had a tonsillar malignancy in the past three years. On a more granular level, this meant that I read through all the data that was available to clinicians before they underwent the tonsillectomy. This included lab results, and imaging studies such as CT scans, MRIs, and X-rays. I read through clinical notes documenting the size of the child’s nostrils, postoperative notes describing the child’s chemotherapy regimen and the clinical course of his or her disease. Then, I critically drafted and reviewed all sections of the manuscript and prepared it for submission.

My internship this summer is a great example of the experience that PICS hopes to provide to its interns. My research project was consistent with the general goals of both Boston Children’s Hospital and PICS in that it combines social change with a personally fulfilling experience. It challenged me in that each experience of the research process in this medical context was very new to me. I am so thankful that my work this summer will have a positive impact on clinical practice. With the publication and distribution of my research, I am confident that clinicians will be more informed when met with a child with asymmetrical tonsils. Given the results of my research, they may be more suspicious of tonsils that are what we defined as “markedly” asymmetrical, and refer them for tonsillectomy sooner. In turn, this could lead to a better prognosis for the child since their malignancy was caught earlier. Conversely, clinicians may be more comfortable recommending a “wait and see” approach to a child who does not exhibit the symptoms we defined as suspicious and spare a child an unnecessary surgery.

By watching surgeries and Dr. Cunningham’s interactions with patients about once a week, I gained clinical exposure that has invigorated my desire to pursue medicine, especially pediatric medicine. Dr. Cunningham was critical to the enriching experience I enjoyed this summer. He and his colleagues provided me with a promising research proposal, and guided me through this process. His warm and friendly staff prepared everything so that I could start as soon as I arrived. He truly went above and beyond his responsibilities as a research adviser as to be a thoughtful mentor. Despite the significant length and business of his work days, there was rarely a day in which we did not confer to discuss research or simply check in. Dr. Cunningham is an example of the ideal mentor: he is a leader in his field, running a department which conducts groundbreaking research and treats challenging patients. He is attentive to his patients and ensures that the child’s and parents’ questions are resolved, and that the best and most conservative course of treatment is pursued when possible. In these regards, he is inspiring. But he’s a wonderful mentor because he makes himself accessible to his mentee, despite his busy schedule. I will have many fond memories from this summer at BCH, and I have no doubt that it has brought me closer to my goal of becoming a doctor.