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In this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., sits down with Lynn Cornell, M.D., professor of laboratory medicine and pathology and anatomic pathologist at Mayo Clinic to discuss her journey as a lifelong learner.
A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(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.
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Lab Medicine Rounds
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And until our next rounds together,
we encourage you to continue
to connect lab medicine
and the clinical practice
through insightful conversations.