Growing up in Shanxi province, in northern China, Jiani Chai knew from an early age that she wanted to study medicine and investigate diseases. After earning her medical degree at the Zhongshan School of Medicine at Sun Yat-Sen University, in Guangzhou, China, followed by a PhD in immunology at Washington University School of Medicine in St. Louis, MO, and a postdoctoral fellowship, Dr. Chai is doing just that. Today, she is a chief pathology resident in her third year of residency training at Montefiore Einstein.
When she’s not busy diagnosing clinical cases, planning resident schedules or teaching pathology to medical students, Dr. Chai is working with faculty on several research projects, studying diseases with immune dysregulation, and investigating biomarkers and genetic mutations in hematopoietic malignancies. She was recently awarded two intradepartmental research grants to study complement systems in Stevens-Johnson Syndrome, under the guidance of Joseph Mulvey, MD, PhD, an assistant professor of pathology. This unique funding opportunity is offered to Montefiore pathology residents and fellows for research projects lasting up to two years.
A published researcher with several first author papers, Dr. Chai has been invited to present her findings at over a dozen conferences from New York to Tokyo, including the recent 64th American Society of Hematology (ASH) Annual Meeting and the United States and Canadian Academy of Pathology (USCAP) Annual Meeting, both in New Orleans.
We spoke with Dr. Chai about what sparked her interest in pathology, her current research projects, career goals, and how emerging diagnostic technology is helping to morph the field of pathology into an exciting medical career for future pathologists.
What inspired you to pursue a career in medicine and immunology?
I was influenced by my mom who was a pediatrician in a community hospital in Shanxi. On the days she couldn’t find a nanny for me she would bring me to work, and I would do my homework at the hospital. I got to know her colleagues and liked to say hello to her patients. My mom was always happy when she was helping people in the community. I could see it was a very rewarding career and I knew I wanted to go to medical school. I went to high school in China and eventually, during medical school, I realized there are so many questions we cannot address. So that's how I decided to do a PhD in the United States.
Why did you choose Pathology?
What I love most about pathology is that you can always find the answers to help patients, not 100%, but most times. We work closely with clinicians to make sure the patients get the right diagnosis and appropriate treatment. I enjoy the logical process of finding answers. Another aspect of pathology that I enjoy is it can fulfill my research interests. It's a specialty that has so many resources and opportunities, and there is time to do research. Often, pathologists realize something unknown from their daily practice, form their ideas, and quickly carry out the projects with available resources. I also like the visual aspect of pathology; what we see under the microscope is so beautiful.
Can you tell us about your residency research grant and other research projects you’re working on?
I received a Montefiore Pathology Resident Research Grant to investigate the mechanistic origins of complement systems in Stevens-Johnson Syndrome. I’m working under the guidance of Joseph Mulvey, MD, PhD. This project is initiated by Dr. Mulvey in collaboration with Cynthia Magro, MD, a dermatopathologist from Weill Cornell. It’s a great fit as I’m particularly interested in the role of immune dysregulation in diseases. I’m also working closely with Xuejun Tian, MD, PhD, an associate professor of pathology, to study PD-L1 expression in myeloid neoplasms with certain molecular abnormalities/mutations. PD-L1 is mostly being used as a treatment target in solid organ cancers, like lung cancer and gastric cancer. For hematologic malignancies, like AML, there is some basic research showing PD-L1 is involved but the clinical trial has shown some controversial results. We’re using a method to quantify PD-L1 expression so hopefully we can see a subset of patients that express high level PDL that can be targeted. We were invited to present our research at the ASH Annual Meeting in December, in New Orleans.
![PGY3 residents from L to R: Denise Dailey, Hania Shakeri, Jiani Chai, Radhika Sekhri]()
PGY3 residents from L to R: Denise Dailey, Hania Shakeri, Jiani Chai, Radhika Sekhri
Another research interest is to study biomarkers and genetic mutations in hematopoietic malignancies. I’m working with Dr. Tian to research a histone methyltransferase called EZH2 as a potential therapeutic target to treat related hematopoietic malignancies. And I have been working with Yanhua Wang, MD, PhD, a professor of pathology, to study p53 mutations in myeloid neoplasms as well as genetic mutations in other hematologic diseases. We recently reported a novel splice site mutation found in a patient with congenital CD59 deficiency.
What sets the Montefiore Pathology residency apart from other Pathology residency programs?
![Pathology residents at a team building event at a painting gallery in Yonkers. Clockwise L to R: Drs. Fahad Sheikh, Daniel Casa, Jiani Chai, Anita Arackal, Denise Dailey, and technologist Kimberly Brannon]()
Pathology residents at a team building event at a painting gallery in Yonkers. Clockwise L to R: Drs. Fahad Sheikh, Daniel Casa, Jiani Chai, Anita Arackal, Denise Dailey, and technologist Kimberly Brannon
The diverse population here in the Bronx is a great resource for residents to learn from. We see cancer patients presenting at advanced stages and patients with uncommon infectious diseases, malaria, for example, that are pretty rare to see in other parts of the country. Our program has an excellent balance between education and work. I hear that some residency programs are so busy that the residents don’t have time to study. Here we do enough that we can learn but don't feel overwhelmed. And the work environment here is collegial and supportive. In the last two years, five residents, including myself, became parents. We recently had a fun team-building outing at a painting gallery in Yonkers. This event is sponsored by our program director Tiffany Hebert, MD. She gives a generous donation for residents’ wellness activities every year and makes the efforts to address any concerns or challenges that we may face during residency. Dr. Hebert also facilitates a supportive environment in the program. She works closely with every resident in terms of scheduling and designing curriculum to fit everyone’s personal interest. For example, from attending academic conferences to arranging selective rotations, she makes sure that residents get the most opportunities.
Can you describe your experience as a pathology resident during the height of the COVID-19 pandemic?
I experienced the transition from traditional in-person sign-outs to more virtual sign-outs, tumor board meetings, and conferences. I also performed several COVID-19 autopsies and got to see the severity of organ damage caused by COVID-19. Most striking was how the virus can damage the lungs.
Why should medical students consider choosing pathology as their specialty and what can medical schools do better to attract more students to the field?
Pathologists play a very important role in patient care. It’s such a broad specialty, from anatomic pathology to clinical pathology, medical students can find a subspecialty of interest. But in general, pathology is not a focus in medical school and that's why many medical students are not familiar with this specialty. There are some histology courses and teaching sessions, but students don’t spend much time doing clinical rotation in pathology as compared to other specialties like internal medicine. So, if a student isn’t interested or familiar with pathology, they graduate without knowing much about the specialty. Pathology is also a fast-growing specialty, with many new tools being developed as a gold standard to make the diagnosis for many diseases.
Which new diagnostic tools are you are most excited about?
The use of molecular diagnostic tools, including genetic sequencing and tumor sequencing to find new mutations that we can target, or mutations that help with diagnosis is a very, very exciting field. This is getting used more often in the field of hematopathology, neuropathology, bone, and soft tissue. Before, the diagnosis was based on morphology, but now some of these diseases are diagnosed based on the molecular findings of certain mutations or translocations. Digital pathology is also a fast-growing field that is being used in daily sign-outs, tumor board, and case conferences. One promising application of digital pathology is to combine it with AI technology to facilitate pathologists.
![Out to dinner. L to R: Pathology residents Drs. Jiani Chai, Kenji Ikemura, Carlos Castrodad-Rodriguez, Daniel Casa, Raquel Yokoda, Radhika Sekhri]()
Out to dinner. L to R: Pathology residents Drs. Jiani Chai, Kenji Ikemura, Carlos Castrodad-Rodriguez, Daniel Casa, Raquel Yokoda, Radhika Sekhri
You’ll be leaving Montefiore after residency. What’s the next step in your training and what are your ultimate career goals?
I’ll be going to Weill Cornell for a fellowship in hematopathology, with a focus on diagnosing leukemia and lymphoma. I’m interested in pursuing a career in an academic setting where I can perform clinical translational research and get involved in medical education, in addition to clinical pathology duties.
When you’re not at work, what do you like to do?
Swimming, travelling, hiking, and spending time with friends and family. I enjoy being a new parent to my 4-month-old daughter Elodie.
Posted on: Friday, December 09, 2022
