Path of Excellence capstone projects can take all forms. They range from research projects to publications, from dual degrees to starting a company. There are really no limits to how these projects are designed. Path of Excellence capstone projects generally begin during the third year and are completed by graduation, however the groundwork for these projects can be laid well before the Branches begin.
Each Path of Excellence capstone project must produce one of the following outcomes:
- Written summary of the goals, background, methods, results and dissemination plans;
- Paper submission for scholarly dissemination;
- Arts submission (poem, artwork, short story), professional presentation or significant contribution on a committee or grand rounds;
- Completion of a degree-granting program (MBA, MPH, PhD) and a specific activity or project related to their Path. This can be an assignment or thesis in the dual degree program, or completed during medical school.
Above all, the Path of Excellence capstone project should reflect the student’s interest in the field of study.
Global Health & Disparities was the inaugural Path of Excellence, with the first students graduating in 2015. Subsequent Paths will continue to expand our Capstone portfolio as the first groups of students graduate over the next few years.
Here's a sampling of capstone projects completed so far:
Analyzing medical student ethics in patient care
Student: Lauren Franzblau
Type of capstone: Research
Mentor(s): Dr. Lauren Smith, Dr. Raymond DeVries
“Medical students enter medical school with goals of providing ideal, ethical care for their patients. Prior studies have shown that many medical students feel pressured to act unethically during their training. Less is known about how students process situations that challenge their ideals.
“I worked with Rebecca Grossman-Kahn, another Ethics Path of Excellence student, to qualitatively analyze M3 essays about ethical dilemmas to understand how students respond to ethical challenges. We considered how students responded to these dilemmas and how their views were influenced by the actions of faculty and residents.
“The student essays provided a snapshot of evolving ethical standards and behavior. Many students undergo a shift in their ethical framework from identifying most strongly with patient values to prioritizing efficiency of the health care team. Our analysis suggests students do not necessarily lose sight of ethical ideals or lose empathy, but become more complacent in the face of ethical dilemmas. We presented our findings at a national ethics conference.
“I got interested in this project because of the stories I had heard about unethical/unprofessional things that can happen in the hospital, and how some medical students lose empathy. I thought there may be a connection between how students respond to individual ethical challenges and how their broader ethical values develop and change.
“I found the capstone process to be flexible, self-directed, interesting and meaningful. It allowed me to explore a non-clinical area of interest, develop my qualitative research skills, gain experience presenting at a conference, and further my interest in being involved in medical education.
“A Path of Excellence is a great opportunity to do research in a non-clinical or adjacent field that you are interested in. I also was able to build off my ethics capstone project to create a Branches IMPACT project that I am also excited about.”
Exploring the ethics of anatomical donation
Student: Megan Lane
Type of capstone: Research
Mentor(s): Dr. Andrew Baronsky
“My interest in the topic of ethics of anatomical donation began in the anatomy lab during my first semester of medical school. Unlike some of my peers, I did not excitedly look forward to my first anatomy lab as a transformative experience in which I would suddenly be initiated into the world of ‘The Physician.’ To be frank, I viewed the experience as something I needed to tough through as a way to learn anatomy.
“This changed after an emotionally charged experience in my anatomy lab on the reproductive system. It led me to meet with my Ethics Path of Excellence advisor and begin to read the literature surrounding the ethics of cadaver use. I began with the only book dedicated entirely to the ethics of cadaver use, Speaking for the Dead: Cadavers in Biology and Medicine, and I continued to read about the history, philosophy, and sociology of the topic.
“During my time in medical school, I chose to approach the ethics of anatomical donation from multiple angles: the narrative, the historical, and the philosophical. Before beginning this project, I was unsure of what type of research I wanted to pursue long term, but I now know I would like to continue pursuing a career that incorporates bioethics and clinical medicine.
“Throughout this project, I experienced failure and self-doubt at times, but also success and the confidence of becoming a specialist in a particular research area, which ultimately made me a better medical student. I would like to continue to explore this area if possible while in residency.
“My work as part of the Ethics Path of Excellence has also led to me getting a student guest editorship this year in an issue entitled ‘Ethical Considerations in Plastic and Reconstructive Surgery,’ which is scheduled to be published in April 2018.”
Improving communication about advance care planning
Student: Kunal Bailoor
Type of capstone: Policy
Mentor(s): Ms. Leslie Kamil, Dr. Andrew Shuman, Dr. Christian Vercler
“I am interested in end of life ethics and ethics of advance care planning. Advance care planning allows patients to reflect upon and articulate their preferences for medical treatment, lifestyle, and surrogate decision makers in order to anticipate and mitigate their potential loss of decision making capacity. Ideally, advance care planning is a dynamic process in which patients analyze their preferences regarding medical interventions, goals of care, and quality of life and communicate these preferences to their health care providers. The use of patient and health care provider conversations is vital as an advance care planning tool.
“Michigan Medicine’s advance directive policy had not been updated for many years, and was failing to reflect how clinicians and patients planned their care. We reviewed current national and state laws with regards to written advance directives and dissected how documentation of these verbal interactions can help patients faced with legal barriers. We discussed specific changes our institution could make as a potential model to illustrate challenges related to implementation, and then explored the ethical issues surrounding the increased usage and recognition of clinician-patient conversations in advanced care planning.
“This project arose organically from a pre-existing need mentioned at an ethics committee meeting. It was very useful to have the Path of Excellence to plug me into the committee meetings and give me mentors that I could go to for guidance on completing the project. As a result, I helped revise the policy, presented it to the ethics committee, and publicized the changes at a Bioethics Grand Rounds.
“The Ethics Path of Excellence was an invaluable part of my medical education that helped me expand the breadth of my education beyond simply clinical training. I hope to incorporate clinical ethics into my future career, both in terms of being a clinical ethics consultant and sitting on an ethics committee in a large academic hospital. Many cases involve advance care planning and decision making at the end of life; it was useful for me to familiarize myself with the changes in national and state law, and clinical practice around advance care planning.
Watch Kunal’s presentation about the updated advance directive policy changes at Michigan Medicine.
Global Health & Disparities
Studying the effects of iron therapy in Ugandan children with severe malaria
Student: Meredith Hickson
Type of capstone: Research
Mentor(s): Dr. Joe Kolars, Dr. Cheryl Moyer, Dr. Betsy Lozoff, Dr. Alicia Cohen
“I spent one year in rural Uganda as an NIH Fogarty Scholar studying how malaria exposure early in life impacts children's development.
“I chose to study the intersection of child development with infectious disease because communicable diseases present a global threat to children's rights. Illnesses like malaria limit children's educational and social potential, with lifelong consequences.
“The conclusion of my study suggests that delayed iron therapy does not appear to be protective against the behavioral consequences of ID in children with severe malaria. However, measures of iron status fluctuate with malaria infection. More study is needed to see which measures may help unravel the complex relationships between malaria infection, iron deficiency and neurodevelopment.
“I'm going into pediatrics, so my work in Uganda focused on children's development fits in with this goal. I plan to continue working in global health, and my capstone project was a way to gain both research and clinical experience in a low-income country, allowing me to strengthen my clinical research skills longitudinally.
“The entire process is very flexible and student-driven. It started out as a summer research project after my first year of medical school that then evolved into a year-long fellowship after my third year.”
Uncovering barriers to health care
Student: Carolyn Levin
Type of capstone: Research
Mentor(s): Teammates Brian Desmond, Molly Laux, Jiajia Huang and Dr. Brent Williams, plus the whole U-M Student-Run Free Clinic team!
“My leadership team at U-M Student-Run Free Clinic was interested in doing research that directly benefited our patient population, which happened to coincide with the Affordable Care Act roll-out. A small group of us set out to investigate causes of lack of insurance and interventions to promote insurance application over our M1-M2 summer. I did not know it would be my capstone as I started it, but realized along the way it would work perfectly!
“I am interested in primary care, and particularly care for underserved populations and the interplay between the need, the care and the systems currently in place to deliver quality care. The capstone gave me a great opportunity to explore something I am passionate about in a new way. I had not done much research, but I knew that I was interested in care for uninsured populations. This allowed me to view my interests from a new perspective that could then be applied more broadly and with applicable end-results.
“I think it is vital to find a good mentor. My team and I did not have much research experience, so having Dr. Williams as a leader and a mentor was invaluable. There were quite a few false starts, but having a good team with good communication and someone knowledgeable in the area of interest allowed for progress.
"I think that POEs and capstone projects are an excellent way to develop and refine your existing interests. I had an intellectual interest and some hands-on experience in global health and disparities, but though my capstone and the path I was able to take that interest and develop my own toolkit for ethical and practical research in and application of that interest."
Creating a healthy curriculum for high school students
Student: Kate Meixner
Type of capstone: Health program
Mentor(s): Dr. Maggie Riley, Dr. Liz Shih
“I worked in educational leadership, health science curriculum development, and pipeline programs for diversifying the healthcare workforce for seven years in Chicago prior to medical school. This is where I became passionate about preventive health, adolescent issues, and primary care.
“The mission of our organization is to reduce health disparities facing the diverse, under-resourced adolescent population of Ypsilanti, Michigan through delivery of high-impact health education. Recognizing the prevalence of health risk behaviors in the adolescent population and the reported inconsistency of high school health education, we designed MiHealth. This program aims to reduce adolescent risk behaviors while developing community-oriented physicians. Through a series of six interactive sessions, medical students teach health lessons in a high school classroom.
“Topics were selected and supported by feedback gathered from students, staff, and local adolescent health care providers. In our first year we had 16 preclinical medical students engaging with 52 adolescents on topics such as healthy relationships, sexual health, mental health, tobacco and e-cigarettes, nutrition, and physical fitness. We saw significant positive gains in knowledge and intentions toward risk reduction behavior persisting after six weeks. These lessons featured near-peer strategies, small group dialogue to promote identification of knowledge gaps, training on concrete strategies for health promotion, and dissemination of community resources.
“Six weeks after program completion, results showed promising improvements in long-term knowledge retention and attitude changes in adolescents. MiHealth also allowed medical students to develop their teaching skills, too.
“In our second iteration of the program, we would like to add lessons on gender identity and opioid abuse, two critical areas identified through our data analysis, supported by the broader literature, and confirmed from experiences shared by adolescents and experts in the community. We plan to expand our networking with experts in the fields of our topical focus areas through all stages of our planning, revising, and outcome evaluation. We also hope to create a stronger identity as a student group through branding, organizational promotion and leadership development, and greater presence in medical school community dialogue.
“The main benefit of the capstone for me was creating a home for a project that I wanted to do anyway. As long as you don't think of your capstone as an extra thing to do, but rather a vehicle for the work that you're already passionate about anyway, or a chance to explore something you think you may want to continue, then it's not just an extra thing.
“In the capstone project process there is plenty of behind-the-scenes work, of course, but the real work is in the connections you make. The most important habit is to find those who do work you are interested or who are enthusiastic mentors and keep those relationships strong. Luckily at Michigan, this is often easy. When beginning my capstone project, I tried to make a long list of contacts I could reach out to for advice, and I continue to add to the list! Talking about a project with a diverse set of people can help in unexpected ways. I've found so many unexpected connections, resources, experiences or advice that helped my project evolve and improve.”
Checking the impact of electronic health tools
Student: Bill Mallett
Type of capstone: Research
Mentor(s): Dr. Jason Bell, Dr. Michelle Heisler and Dr. Brent Williams
“Medicine seems to be quickly changing from paper records to electronic databases of information. However, we cannot nonchalantly switch to electronic alternatives without following up and reviewing the impact and/or challenges of this change. Hence, re-evaluation of the effectiveness of health tools (apps) when ‘the rubber meets the road’ is crucial so that we can adjust/re-calibrate and assess the viability of these tools.
“We worked in primary care centers in Brazil to examine the experiences of community health workers and their use of an electronic mobile application as a means of gathering health data/statistics.
“As much as this project helped me get more involved with research, the greatest benefit was getting connected to several great mentors. They have been incredibly helpful as voices of counsel and support as I've been preparing to enter my final year of medical school.
“I would describe the capstone project as similar to a 5k fun-run. It's not a treacherous run, but it still requires sustained effort. Although I spent what seemed like most of my time slowly progressing, there came a point where I could look back and see where the small steps had added up and brought me near the completion of my capstone project. With a little bit of extra effort, everything came together, and I was privileged to write and to reflect some on my GHD experience.
“Once in a while, I got caught up worrying about how things would come together instead of focusing on just learning. Mentors are there to make sure that you are on the right path to completing everything you need to, so just relax and enjoy the experience. Trust the process. As I did this, my capstone experience became a fun-filled, low-stress environment to learn and discuss some of the most important topics in medicine today.”
Measuring depression levels in cancer patients
Student: Stephen Lichtenstein
Type of capstone: Research
“Previous studies have shown that rates of depression among cancer patients are higher than in the general population. In Latin America, social support and social undermining are important, though understudied, factors in a patient’s mental health status. For my capstone project, I worked as part of an established research team that assessed depression levels in a population of patients at a cancer hospital in Quito, Ecuador. We examined the association between depression, social support and social undermining over a two-month period through a computerized screening process.
“We found that high depression scores were associated with low levels of social support and high levels of social undermining. Higher depression scores were associated with female gender, low education status and unemployment. The result is that social support and social undermining are important factors in a cancer patient’s depression status and that computer-tablet based screening is a cost-effective, rapid, and efficient method to identify patients with major depression who should be targeted for therapy.
“In addition to writing a paper and adding a publication to my residency application, I was able to practice my Spanish in a health care setting.”
Designing healthier communities
Student: Regina Royan
Type of capstone: Research
Mentor(s): Eden Wells, Stuart Batterman
“I am interested in the design of healthier communities and the impact that physicians can have on this process.
“The demolition of vacant homes can spread dust to nearby surfaces such as sidewalks, lawns, streets, or exterior surfaces of homes. When lead dust is deposited onto publically-accessible areas, it can be unknowingly tracked into homes where it has greater opportunity to be ingested or inhaled by children.
“The area of research for my capstone project focused on the study of lead dust generated from housing demolitions in Detroit, Michigan.”
Understanding the patient mindset
Student: Brian Desmond
Type of capstone: Quality Improvement
Mentor(s): Dr. Brent Williams, teammates Carolyn Levin, Molly Laux and Jiaxin Huang, the whole U-M Student-Run Free Clinic leadership board (past and present) and, most of all, our patients!
“Our team surveyed uninsured patients at the University of Michigan Student-Run Free Clinic (UMSRFC) about reasons that they remained uninsured following implementation of the Affordable Care Act in Michigan.
“As a leadership member of UMSRFC, we saw many of our patients obtain health insurance following the creation of insurance marketplaces and expansion of Medicaid under the ACA. However, we still had many patients who continued to rely on us for care. Our study sought to a) help us know what health insurance options our patients were eligible for and b) help us understand their reasons for remaining uninsured; both of these knowledge points allowed us to better serve our patients by connecting them to appropriate resources.
“I learned a ton about the ins and outs of completing research like this: IRB approval, data analysis, the publishing process, etc. Also, I got the chance to become informed about the topic of health insurance, and to be a part of the national conversation surrounding health care. We were even exposed to some media coverage in the Detroit Free Press, and got to learn a little about translating research for media/ public consumption.
“I plan to eventually practice primary care, and continue to focus on issues of health equity and social justice through both my clinical practice and through policy work, advocacy and research. I think this project helped me to step into this arena as a medical student, and build my knowledge around important, current health policy issues.
"A path of excellence is your opportunity to really follow your passion outside of the basic science and clinical setting of medicine. Many of us have career aspirations with impacts outside of the walls of the clinic, the wards, or the OR -- this is the chance to begin to build and explore those eventual paths."
Innovation & Entrepreneurship
Fostering connections to strengthen communities
Student: Elliott Brannon
Type of capstone: Organization
Mentor(s): Dr. Julia Lee; Ryan Gourley from TechArb
“I began working on smallworld as an M1 when I realized that few medical students attend lecture (most students watch lectures online). smallworld uses a simple algorithm to connect community members: smallworld randomly pairs community members and informs each member of their partner. The pairs then meet for coffee or lunch to get to know one another. This process is then repeated at a regular interval such as every two weeks.
“I initially thought smallworld would address the issue of personal connections and friendship. However, after discussing smallworld with psychologists and sociologists, it became clear that smallworld uniquely addressed the issues of silos and cliques within communities. During customer discovery, I talked with students, faculty, health care workers, police officers, government officials, members of faith communities, etc. and every community seemed to be struggle with silos and relationships between community members. smallworld offers a simple solution to this problem.
“Through the first pilot at UMMS, smallworld distributed more than 600 connections, and 109 first year medical students participated. Students reported that smallworld connected them with classmates they would not have otherwise met.
“Promoting healthy community relates to my background and interest in public health and relationship building and social dynamics relate to my interest in psychiatry.
“smallworld is currently operating in 10 to 15 different communities, including health clinics, faith communities, academic communities and businesses. We are also developing a platform for researchers to study the science of connection. We've distributed over 2,000 connections and continue to expand and support communities in Michigan and around the nation.
“The benefits that I'm most excited about are the relationships I've developed with faculty and students through the University, businesses throughout Ann Arbor, and the smallworld team. I'm smallworld's number one user and have met at least 50 people through the platform.
“Next year, smallworld will be integrated into the M-Home and will help connect students and faculty vertically across all four years.”
Breathing made easier for infants around the world
Student: Stephen John
Type of capstone: Invention
Mentor(s): Dr. Gary Weiner, Dr. Sunil John
“Every year, more than one million babies die of respiratory illness — 99% of these deaths occur in low-middle income countries. This is something I saw firsthand growing up in Nepal. To address this issue, I began working on a low-cost, low-tech ventilation for infants in respiratory distress around the world. Our team has since grown to include University of Michigan students from the medical, engineering and business schools. For my capstone, I was able to utilize many more U-M resources to move our project forward.
“Now a patent-pending, award-winning device, NeoVent costs less than 1/100th the price of existing ventilators, is easy to use and requires no electrical power. It's already approved for clinical testing with plans to implement the device around the world to save millions of infant lives.
"During this time, we were also able to form a startup company called AIM Tech, which seeks to improve health care options for underserved groups on a global scale through the development of safe, user-friendly, low power, and affordable equipment.
“As a student, you can tap into the University’s great resources, whether at the medical, engineering or business schools. In our case, this included competitions, funding, education, networking and mentorship.
“The Path capstone appealed to me because I was able to work on a project that interests me. Along the way, we learned a lot, whether from educational sessions, discussions with mentors or "on the job.” We got to meet folks interested in similar projects, too.
“We've been blessed with great advisors and mentors. It has been great to collaborate with students from other schools.
“Long term I hope to continue working to design and implement healthcare innovations for resource limited settings.”
Reducing waste through invention
Student: Owen Brown
Type of capstone: Invention
“Routine blood draws are a universal aspect of clinical care. However, this process requires providers to navigate highly complex workflow and communication pathways, leaving ample opportunity for clinical error as well as imposing an inherent inefficiency of care.
“Our team is working on a point-of-care product to be used in routine blood testing which will save time for the medical providers, reduce extraneous cost and waste, and ultimately allow for patient care to be better informed by real-time laboratory values. Our product utilizes a pre-existing vascular access point to nearly instantaneously measure certain laboratory values and communicates directly with the EMR. While there are point-of-care tests on the market, we have not found any product that leverages pre-existing vascular access.
“My sister always told me I should have been an industrial engineer because I had an eye for process improvement. I see this project as another thread in that theme; I envision my medical career will focus not on discovering scientific advancements but rather innovating current practices to optimize both efficacy and efficiency.
“Much of what you learn in the capstone process is self-directed, which I mention as an absolute benefit. You'd be amazed at how much you learn by ‘throwing yourself into the fire.’ While most of medical school is laid out in front of you, it is a breath of fresh air to direct your own learning.”