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Niharika Neela, M.D.

Foster Fellow, 2024

What stood out about your research experience at UT Southwestern, and how did it shape your career?

One of my first patient encounters at Parkland Memorial Hospital was with a young woman with heart failure. Through our conversations, I learned that she had lost her child during pregnancy due to acute renal failure and neonatal abnormalities, likely linked to her use of lisinopril, which has teratogenic effects. I was devastated hearing about her experience, but I was also concerned to find out that she was unaware of the teratogenic nature of many of her GDMT medications. It was clear that we were making a concerted effort to up-titrate GDMT, which would improve patient mortality. However, national data indicates that our very patient population experiences significantly fragmented prenatal and ongoing care during pregnancy. Therefore, I believed that preconception counseling and the teratogenic use of GDMT might require more attention and standardization.

Training at UT Southwestern marked my first experience in creating a research project, formulating my own question, and pursuing data to identify and address care gaps. Early in my intern year, I met with Dr. Sandeep Das, knowing his expertise in quality of care aligned with my interests. I arrived at our meeting with several ideas, and we discussed each one in-depth, focusing on 1) Has this question been addressed previously? 2) Is this a compelling topic worth pursuing? 3) Are there flaws in the idea or the overall approach to the project? This exercise was incredibly helpful in shaping my eventual project, which focused on contraception counseling, contraception use, and teratogenic GDMT prescription for reproductive-age women with heart failure. For the first time in the research arena, I felt empowered, largely due to the remarkable mentorship from Dr. Das, Dr. Nicholas Hendren, and Dr. Maryjane Farr, all of whom actively encourage independent thinking while continuously critically evaluating our projects. Having experienced individuals to bounce ideas off of and ask all my questions to (and I have many) has been a powerful way to hone and conduct my research. Although my particular areas of interest are not often pursued by my mentors, their enthusiasm, support, and guidance have been truly inspiring.

Another fundamentally unique aspect of training at UT Southwestern is the presence of two major hospitals with significantly different patient populations. This research would not have been possible if I wasn't working with patients at Parkland daily. At Parkland, you encounter many physicians who are deeply passionate about advocating for our patients, identifying gaps, and continually improving care. Patient experiences from both Parkland and Clements University Hospital have kept me thinking about how I can integrate their care with a focus on improving care delivery. Research does not occur in a vacuum, and this exposure has greatly shaped my sense of purpose.

How did participating in the Seldin Symposium impact your research path?

After presenting my research during the symposium, I was quickly connected with multiple departments in medicine that share the goal of improving contraception counseling for young, high-risk female patients. We were able to exchange our various approaches to research and quality improvement. Through collaborations fostered by the Seldin Symposium, we could collect our efforts to make a real difference in patient care delivery for an underserved population. In my future research, I am keen to continue collaborating across departments to enhance care delivery and drive change at an institutional level.

What are your current research interests and goals?

After working on our heart transplant service at Clements, I spoke with our attending physician, Dr. Maryjane Farr, about my research at Parkland. We discussed our mutual interest in contraception and safe access to pregnancy, and she noted that there was currently no standardized preconception counseling for young female patients undergoing heart transplant or LVAD evaluation, which is a high-risk pregnancy population. We examined the data and recognized that the absence of standardized counseling for patients requiring advanced therapies represents a significant area for improvement. We are now working on implementing preconception counseling embedded within the EMR to automate this part of the committee evaluation process.

My research interests stem from constant exposure to our society and its changes. I have always been drawn to policy, politics, ethics, and law. I find the intersection of these fields with medicine fascinating and critical to how we provide care. My goal is to improve resource allocation equitably by continuing outcomes-related research, as this process can often be highly subjective. I believe this approach would help inform care strategies from a population standpoint and individual patient care.

What advice would you offer current Internal Medicine trainees about pursuing research?

Keep thinking about ideas. I have a notes tab on my phone, and as I go through clinical training, I quickly jot down areas that interest me or gaps in care that I notice but don’t have answers for. This simple exercise keeps my curiosity alive. Clinical care informs my research, and what I learn from my research can, in turn, enhance how I approach clinical scenarios.

Don’t hesitate to share your ideas with faculty because, more often than not, they are interested or can help connect you with the right people. One of my most important takeaways from working in research from college to now is that if you find good mentors, don’t let them go. Even if they aren’t directly in our field, we don’t know what we don’t know, and this exposure and guidance are crucial for our ongoing learning. Lastly, don’t be afraid to send a few follow-up emails if you're having trouble reaching an attending. Everyone is busy (including you!), and faculty notice and appreciate your efforts to keep things moving.

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"Through collaborations fostered by the Seldin Symposium, we could collect our efforts to make a real difference in patient care delivery for an underserved population."

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