New Chapter

In a world of Mayo alumni overachievers, Andrew Landstrom, M.D., Ph.D. (MDPH ’12, MPET ’12), is an overachiever’s overachiever. He simultaneously completed postdoctoral clinical and research fellowships at Baylor College of Medicine in Houston, Texas, in pediatric cardiology and molecular physiology/biophysics, respectively, and then trained in electrophysiology and started a basic science research lab at Texas Children’s Hospital, focusing on determining the genetic and molecular causes of arrhythmias, cardiomyopathies and heart failure in children. He received a mentored clinical scientist development award (K08) from the National Institutes of Health. As of August 2018, he has moved across the country and is on staff at Duke University School of Medicine.

Why did you leave Texas for North Carolina?

It was a chance to go home. I went to high school in Raleigh, North Carolina, and college at the University of North Carolina in Chapel Hill. I met my wife while in college. She is from Asheville and spent her entire life in North Carolina. Duke also offered a unique environment where my research could cut across disciplines. When the opportunity to go to Duke presented itself, even though it was with my alma mater’s basketball archrival, it was an amazing opportunity.

What’s your focus area at Duke?

My clinical practice and research will be integrated. I focus on a very specialized area of pediatric cardiology – arrhythmic disease that can cause sudden cardiac death in children and adults. These arrhythmias often are genetic and often cause molecular defects in the heart, which can be challenging to detect and diagnose. I see children who have diseases or there is concern about these diseases due to an unexplained death in the family.

At the same time, I’m starting a translational basic science research lab to study the causes of these arrhythmias and other forms of heart muscle disease that can cause sudden cardiac death in children.

Duke is a regional referral center and a huge academic university that is adjacent to the hospital, which gives me opportunities to collaborate with many specialties I wouldn’t normally have. Scientific disciplines such as computation sciences, biomedical engineering, molecular modeling and medicinal chemistry offer the chance to rethink how I approach my own research and to try to achieve new insights by bringing together groups that normally do not talk to each other.

What’s life like after training?

Life is easier after training, but I have new challenges in the clinic and in research.

On the clinical side, life is easier logistically, and I get more sleep at night. It is easier to take care of oneself without an intense call schedule. But the job can be just as stressful in different ways. For the first time in my life, I’m the final decision-maker. I started at Mayo Clinic School of Medicine in 2004, and for the past 14 years an experienced clinician looked over my shoulder for every decision I made. Now that person is me. People ask my opinion, and I feel some added weight of responsibility when that happens. For me, going from trainee to faculty has subtly changed my view of medicine. When I was in training, comfort and familiarity slowly crept in over time. Now, without that experienced clinician looking over my shoulder, I find myself thinking more and more about worst-case scenarios, and that comfort and familiarity take a back seat.

If I miss something, it’s my responsibility. On the other hand, I have the opportunity to practice medicine how I have been taught and to interact with families in the way I have been inspired by in my training at Mayo Clinic and Texas Children’s. While there is more responsibility, I can always fall back on the experience of others.

Scientifically, I’ve gone from being a member of the team to running the team, which is another major transition. Issues of grant sustainability, lab finances, who to hire, when to let go, when to make major resource commitments are aspects that are new to my job. But I still enjoy trouble-shooting failed experiments and the feeling when a challenging experiment yields beautiful results. While I spend most of my time managing the team, I still love the hands-on experimental side of the lab.

What does Mayo Clinic mean in your career?

Mayo has a unique environment to provide medical education. It’s a massive hospital with a relatively small medical school and small class size. This means there are a large number of professors, large clinical volume and diversity of clinically relevant research compared to a relatively small number of learners. Bringing all of those resources to bear for medical training presents an incredible opportunity to learn.

You never really leave Mayo, and Mayo’s training never really leaves you. It laid the foundation for how I approach difficult situations and challenging encounters with families. I use these lessons every day in my interactions with patients and families.

Michael Ackerman, M.D., Ph.D. (MDPD ’95, PHAR ’95, PD, ’98, PDC ’00), was my research mentor at Mayo, and we keep in touch. He really inspired me to make research part of my career and helped my passion in genetics and biology come alive during my M.D./Ph.D. training.

As an overachiever, do you think about burnout?

I think about it a lot, especially when there’s a push and pull between academic life and my family and extended periods of training. It is a real problem and can have real consequences for the physician and for the patients.

I have been very fortunate in that I feel energized by what I do. My job never seems like a job, which prevents burnout in my life. Caring for very sick — even dying — children and seeing them do well is incredibly energizing. Being able to discover the unknown in the lab, particularly when it is challenging to do so, is energizing.

Tell us about your NIH K08 grant.

It’s a very competitive research grant and a big deal to me that I was fortunate enough to get it. I’m in the second of five years of the grant. The main goal at the end of that time is to establish more funding to continue my research long-term. In the next year or two, my singular focus will be to build research funding to build a case of why I can pursue large R01 grants. I want to pursue difficult scientific questions that will be impactful to pediatric cardiology and change how we see these diseases and treat our patients.

Ultimately, I want to prevent these diseases before they occur. Parents trust me to care for their children, so I want to push the field forward scientifically.

What about pediatric cardiology appeals to you?

In pediatric cardiology you have the opportunity to do a lot of good. Along with colleagues in an array of specialties that work closely with cardiology, you can intervene with kids who otherwise will die and save their lives. The diseases I’m interested in are genetic diseases that present when children are young, and there’s the chance to do a lot of good if one can identify and treat children at risk for sudden death-predisposing diseases.

What do you do outside of work?

I spend most of my free time with my sons, ages 11 and 7, who have grown up during my training. They keep me on my toes. With my wife, who has supported me throughout my time in training, we are really taking advantage of being near our alma mater. Carolina basketball is a family affair.

Do you have any advice for trainees?

We have a tendency to look down the road and think, “Life will be so much better when I graduate or when I finish my residency, etc.” Enjoy your training journey, and you’ll get more out of it. Being mindful that your actions can positively impact others, particularly when you are in training, can help to maintain the passion for medicine that’s needed to stave off burnout and to not lose sight of why you wanted to train in medicine in the first place.

See past New Chapter stories here.