A Pathway to Discovery

By Lynn McCain | November 2 2023

Physician-scientists are a rare breed of individuals who pursue a combined career in both research and medicine. This committed group of scientists spend years going through medical school, a PhD graduate program, medical residency, fellowship(s), and postdoctoral research training to eventually enter a career where they can engage in both research and the practice of their medical specialty. At the University of Michigan Medical School Department of Pathology, a special training program is offered to residents interested in pursuing this type of career. The program, the Physician Scientist Training Pathway, is a customizable program tailored to the career aspirations of its trainees. Dr. Aaron Udager, Associate Professor and Associate Director of the PSTP, pursued this training pathway, before it became a formalized training program.

Udager, Aaron in lab sq 500.jpgUdager came to Michigan from Minnesota – after a brief undergraduate stint in Boston – as a medical student in 2004 and was a fellow in the Medical Scientist Training Program (MSTP). He was simultaneously pursuing his medical degree and doctoral degree in Cell & Developmental Biology. His graduate research focused on embryonic development of the GI tract. As he completed his graduate studies, he returned to medical school planning to become a pediatric geneticist. Based on the advice of mentors in the MSTP, he took a pathology rotation during his last year of medical school. “About 3 days into the rotation, I realized that pathology was what I wanted to do,” Udager explained. “I loved the diagnostic work, looking at slides with a microscope, translating that into what is going on with the patient, and writing the reports. I also had the opportunity to work with an outstanding group of GI pathologists. People like Drs. Henry Appelman, Joel Greenson, Scott Owens, and Barbara McKenna. They loved what they did, and they are phenomenal pathologists.”

During this time, Udager met his wife in medical school, and they wanted to remain at Michigan, so Udager applied for a residency program in Anatomic Pathology and was matched to Michigan. As he was going through his residency, Udager remained uncertain as to what his career path would look like. He knew he wanted to do pathology but was not sure about his specific specialty nor his research direction. As he passed through rotations, he discovered an interest in Genitourinary (GU) Pathology and met a group of GU pathologists who were also conducting research, including Drs. Rohit Mehra, Scott Tomlins, Angela Wu, and Priya Kunju. Upon completing his residency, Udager pursued a GU fellowship, followed by a Surgical Pathology fellowship to ensure he was well-rounded.

Udager’s wife was now on staff at Michigan Medicine as a radiologist, and Udager was fortunate to obtain a faculty position within Pathology. “I started in a hybrid position, half research and half clinical care. My research mentor at the time was Scott Tomlins, who has since moved on to industry. He introduced me to Next Generation Sequencing (NGS). In my lab, I am now utilizing NGS to study the molecular and spatial heterogeneity of prostate cancer.” Udager explained how tumors continue to gain additional mutations as they progress and that those mutations can manifest differently in different regions of the tumor. He has also done work with head and neck cancers.

Dr. Aaron Udager with a Next Generation Sequencer in his research laboratoryThe most impactful discovery he has made, relates to his research in head and neck cancers. He discovered, using NGS techniques, that almost all sinonasal papillomas have an EGFR mutation. These papillomas often progress to cancer but retain this EGFR mutation. “This is important because that one gene, EGFR, can be targeted with specific anti-EGFR drugs that can potentially kill the tumor cells or prevent growth of the tumor cells,” he explained. “So, some of the work my lab is now doing is developing and validating therapeutics for sinonasal cancers that have that EGFR mutation.” His lab is testing a variety of FDA-approved drugs on these tumors to find which ones are most effective at killing the tumor cells. He is hopeful that there will soon be therapeutic interventions for these sinonasal papillomas and cancers as the alternative of surgical interventions result in severe disfigurement for patients.

Udager continues to provide clinical services in the Department of Pathology in head and neck cancer, GU cancer, and general surgical pathology, although, he now spends most of his time conducting research. He has found balance in his life with his wife and three daughters. He has an 8-year-old and identical twin 4.5-year-old girls who “are a handful, but amazing!”

“I’m super happy here at Michigan. I love what I do – both clinically and in research -- but at the end of the day I try to prioritize spending time with my family.” He also loves to play hockey, which he does 2 or 3 nights per week. “My daughters are beginning to play as well. Whether they continue in hockey or not, what is most important is for them to grow up and become strong, independent women.”

To learn more about the Physician-Scientist Training Program, feel free to reach out to Dr. Asma Nusrat, PSTP Director or Dr. Aaron Udager.