Our next sketch focuses on Mika Guzman Karlsson, MS4, a world-traveling neuroscientist. Mika was born in Sweden and moved with his family to Bolivia soon after he was born to be with his dad’s family. He lived in Bolivia until he was 13 where his dad worked for the US embassy. To ensure Mika got a good education and to take advantage of the opportunities provided in the US, they moved to the Los Angeles suburbs. Mika then attended high school in LA, went to UCLA for college, and worked for a couple of years as a lab technician before ending up in UAB’s MSTP. Read on for highlights from our interview:
Paige: You have a unique background story. What was it like growing up in Bolivia?
Mika: I cherish my childhood in Bolivia. Although Bolivia is troubled by the same factors that afflict other developing countries, it is the loving people, vibrant culture, and breath-taking landscape that has left a lasting impression on me.
Paige: Continuing that thought, how was the transition to the US?
Mika: It was certainly a difficult transition moving to a new environment for high school, let alone in a completely different country! Fortunately, because my father worked at the US embassy, I was able to attend an American school, so I had some exposure to American culture. I also spoke English and Spanish, so there thankfully wasn’t a language barrier.
Paige: What about your transition from LA to Birmingham?
Mika: Definitely easier than the transition from Bolivia to LA! Honestly, I’ve been pleasantly surprised how much I’ve liked Birmingham. Even though California is a mixture of cultures and lifestyles, I was excited about experiencing southern culture with its unique customs, cuisine, and food. I really enjoy the slower pace of Birmingham living and the ease of getting around the city, but I do miss the diversity in people and landscape that Southern California offered.
Paige: When did you decide to apply for an MD/PhD program?
Mika: I was initially set on the MD-only track and like other pre-med students, I became involved in research to fulfill an application requirement. However, once in the lab I surprised myself by how much I enjoyed it. Going to my first big scientific conference towards the end of college is what sealed the deal for me. I saw science as a process so much larger than the individual experiments I was running in lab. It was no longer a practice performed in isolation but instead a vibrant and engaging community with a shared sense of purpose. After this experience, I became intrigued by the MD/PhD track and took a couple of years off to explore further the idea of becoming a physician-scientist.
Paige: Retrospectively, do you think taking time off was a good choice for you?
Mika: Absolutely. An MSTP is a long, challenging, competitive training program. My time off allowed me to develop additional research experience, foster healthy life balance practices and most importantly solidify my decision to pursue an MD/PhD. I think my parents were afraid that I wouldn’t want to go back to school but taking time off to actively think about what was important to me and what my options were positioned me to be in a better place. I think we all have to do this at some point. Otherwise you run the risk of being at the end of the path and finding yourself in something that might not be exactly right for you. It’s a lot easier to achieve something when you know your end goal and the best way to accomplish it. The more foresight and insight you have, the better off you are. I also figured out during this time what people I needed to talk to, (broadly) what I wanted to study for my PhD, and as a result I was more motivated to push forward. During my time off I realized I wanted to build on my experience with behavioral neuroscience, incorporating molecular biology and biochemical approaches to study the processes underlying learning and memory.
Paige: That’s great advice for anyone considering applying for one of these programs. What made you choose UAB?
Mika: The program’s stewardship and students were, and continue to be, fantastic, so it was a no-brainer. Plus Birmingham is a very comfortable city in which to live. There is an active neuroscience community with diverse research programs, allowing me to readily identify PIs [principal investigators] to work with, including Dave Sweatt who ended up being my thesis mentor. Interestingly, joining Dave’s lab is another example of how my time off prepared me to take advantage of serendipitous opportunities. During that time I had read Dave’s Mechanisms of Memory textbook and familiarized myself with his research. When I interviewed at UAB, I was pleasantly surprised to find that he had, in fact, moved his lab to UAB from Baylor.
Paige: What was your thesis project in the Sweatt lab?
Mika: I used next-generation sequencing and bioinformatics to characterize transcriptional and DNA methylation changes in a mouse model of Alzheimer’s disease. By integrating our results with data from other transgenic mouse models, we identified a conserved profile of dysregulated pathways including extracellular matrix remodeling, immune function, neuronal plasticity and chromatin binding. Our analysis also revealed that each model had overlapping but distinct patterns of dysregulation suggesting that certain models may be depicting unique parts or phases of the overall disease pathogenesis. Building from our results, we also showed that ASO (antisense oligonucleotide)-based therapeutics targeting epigenetic enzymes could rescue AD-related cognitive impairment.
Paige: Did you think getting that experience in bioinformatics will be useful for you as you progress in your career?
Mika: Definitely. I think it’s a useful skill to have and there is an increasing demand across several disciplines/specialties for using genomic or other –omic approaches to answer research and clinical questions. From a scientific perspective, these tools allow us to capture a more accurate, complete picture of normal biology and pathophysiology. Clinically, these approaches help us infer new clinical associations, make novel diagnoses, redefine existing diagnostic criteria, tailor individual treatments, and track treatment effectiveness.
Paige: What was the hardest part of the PhD phase for you?
Mika: I would say gaining the skills to be able to identify when a project is moving forward and when to change the direction of a project. Navigating that learning process requires time as well as repeated trial and error. I spent too much time trying to make things work that, for whatever reason, weren’t working—whether that was the tools I was using, my understanding of the underlying physiology, the availability of necessary resources, etc. Looking back, I should have changed projects much earlier than I did. Even though the transition to a new project was challenging, I learned how to be flexible. Interestingly, some of my initial ideas and hypotheses did find their way into my final dissertation.
Paige: Speaking of transitions, how was it for you going back to medical school after you finished the PhD?
Mika: I feel very fortunate to be part of a program like ours that has the built-in infrastructure like MSTP 795 and retreat workshops to facilitate the transition process. To expand on this information, I made sure to talk to other students who had transitioned before me, picking their brains for specific practical details like which faculty to work with, what services to request, what study resources to use, etc. With those two resources, I was surprised how smoothly the transition went. Looking back, I think that having a smooth transition is less about the depth of your medical knowledge and more about your practical skill set as it relates to gathering data relevant to your patient, interacting with your patient and your team, and presenting to your team on rounds. Your proficiency at these skills is evaluated on a daily basis making them much more important. In one sense MD/PhD students may be at an advantage entering the clerkships as they have spent their PhD years developing these same skills. That being said, I most definitely had to get in the habit of reading daily to relearn much of the medical information that I had forgotten from the first two years of medical school.
Paige: Which month did you go back to clinics?
Mika: I went back at the end of July. All of the third year medical students are still pretty new to the clerkships then so it was a perfect time to start.
Paige: Which rotation did you start on?
Mika: I started on psychiatry because I was interested in that at the time, and felt I was more prepared from a knowledge-base standpoint given my graduate training. Compared to other clerkships, psych is less time-demanding, which provided more opportunities to study and regain my medical knowledge, adapt to the nature of the hospital schedule, and learn the EMR [electronic medical record]. The latter was particularly important as my sun card for access to the EMR didn’t work the first day! Although it took a while to get that fixed, I could still be a useful member of the team. Doing so would have proved more difficult on the other clerkships. By the time I rotated on to my medicine clerkship, I felt more oriented and prepared.
Paige: Now that you’re in your final year of medical school, what is your plan for residency?
Mika: I’m applying for child neurology and neurodevelopmental disabilities residencies, which are 5 and 6 years, respectively. Both have 2 years of general pediatrics, 1 year of adult neurology, and then 2-3 years of child neurology/developmental disabilities.
Paige: When did you decide on that residency track and how have you been prepping for it?
Mika: Towards the end of my third year. Although I made sure to take the time to reflect on my experience with each rotation, including what I liked or didn’t like, what I thought I did well, and where I could improve. Talking to faculty for guidance throughout the rotations, asking what they do and why was also helpful. Most faculty have an inherent desire to give people advice and, when the setting is appropriate, you can gain a lot of information from them. Starting on psych actually allowed me to rule that out early on, after which I deliberated between adult and child neurology. I found myself drawn to the world of pediatrics—a happy and lively place where I could be goofy and joke around, all while wearing a Pikachu name badge. I also enjoyed working with family members to promote the care and development of their children. Ultimately, it was my AI [acting internship] in child neurology that solidified my choice. It was the perfect combination of neurology, pediatrics, medical genetics, development, and psychiatry.
I decided on my specialty early enough that I had time to make all of the necessary connections for applying, which was another reason that transitioning back to clinic in July was a good choice. Being done with clerkships in early May, I had time to do my medicine AI, an inpatient child neurology AI, and an outpatient child neurology elective to spend more time with the attendings and get letters of recommendation; my letters are all from child neurology faculty. It would have been harder to do that if I had gone back in October. I didn’t do any away rotations and wasn’t required to submit my Step 2 scores before turning in my residency application, so that also freed up more time for me, but you have to be cognizant of those things when you’re applying and making your schedule.
Paige: Where all are you applying?
Mika: I’m applying broadly. I’m not tied to any specific part of the country and based on the fact that I enjoyed Birmingham so much, I would probably be happy living anywhere. I know I do want to end up at a large academic center that supports the development of physician-scientists.
Paige: What is most exciting to you about starting residency?
Mika: Right now I feel similar to how most graduate students feel at the end of their PhD training—you have this 6 month sweet spot where you know precisely which experiments to run, you can get data and trust it, and then make the appropriate logical conclusion from that data and design a subsequent experiment. You feel on top of the world, and you have the skills and knowledge to get things done. I’m looking forward to transitioning from being a student to the actual caretaker of the patient, though. I look forward to that responsibility. It’s liberating in a sense because you’re no longer behind the protective wall of your residents or attendings. I’m also excited to be able to focus on the patient population and the type of medicine I’m interested in doing for the rest of my career.
Paige: What are your larger career goals during/after residency?
Mika: I wish to enter a residency program that will provide a rigorous and broad-based clinical education with a diverse patient population. Given my long-term goals of remaining in academic neuroscience, I’m searching for a program that encourages individualized mentorship and facilitates research opportunities, ideally through a formal mechanism. After residency, I plan to devote my time to clinical practice, research, education, and mentorship. At the moment, I think I would enjoy the prototypical 80/20 split with 80% research, 20% clinical duties. The research component being basic science and some translational or clinical research.
Paige: And, most importantly, what do you do for fun when you’re not taking care of patients or studying neurons?
Mika: I like music—playing music, listening to music, and going to concerts. I’ve played the drums since middle school band, and I’ve gotten back into it since I moved to Birmingham. We had a band the first 2-3 years of grad school composed of myself, my friend Jarrod Meadows [UAB MSTP alumni], two medical students, and a graduate student. We played at some of the local bars and music venues. It was an excellent way to relax and do non-school related activities. It’s important to have other things you enjoy, especially during graduate school. The first two years [MS 1-2] are very social, and you feel supported because you’re around your peers all the time. Grad school can be very isolating. I was fortunate because the Sweatt lab was large and I got along with everyone, which made managing the typical scientific struggles easier. On clerkships [MS 3-4], everyone is on different rotations, and you may have 1-2 students you know on your team, but it can also be kind of isolating. Having good outlets is essential. I also like food, beer, soccer, and working out.