From Clinical Questions to Research Impact: Drs. Irum Khan and Nick Mendez Build New Paths in Perioperative Outcomes Research

For Irum Khan, MBBS, PhD, and Nick Mendez, MD, research often starts with a question they encounter while caring for patients: Why does the use of supraglottic airway devices vary so widely across the United States? How is anesthesia being delivered in MRI suites, where clinicians face challenges substantially different from those in the operating room?

Through the UCSF Department of Anesthesia and Perioperative Care’s Clinical Seed Award and the Multicenter Perioperative Outcomes Group (MPOG) Outcomes Research Fellowship, Khan and Mendez have been able to turn those questions into focused research projects while developing the skills and mentorship needed to grow as clinician-investigators.

Their research interests differ, but their paths share a common theme: using observations from clinical practice to identify unanswered questions and generate evidence that can improve patient care.

Building Research Careers from Clinical Experience

Khan is an academic anesthesiologist and critical care physician whose interests span perioperative outcomes research, medical education, and academic leadership. At UCSF, her research has developed around airway management, particularly the use of supraglottic airway devices (SGAs).

As a clinical anesthesiologist, Khan regularly makes airway management decisions with implications for patient safety, operating room efficiency, and resource utilization. She became interested in understanding why SGA use remains relatively limited and highly variable in the United States despite widespread adoption internationally.

The question became the basis of her Clinical Seed Award project, “Describing the Practice of Supraglottic Airway Device Use and Selection in the United States”. Using the MPOG database, Khan is examining national trends in SGA use and the patient, procedural, provider, and institutional factors associated with airway device selection.

Mendez’s interest in clinical research began during medical school, when he participated in the Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship. In 2020, Mendez came to UCSF for a fellowship in liver transplant anesthesia and subsequently joined the faculty. Working with Drs. Kerstin Kolodzie and Dieter Adelmann, he pursued projects examining clinical outcomes following liver and kidney transplantation.

His Clinical Seed Award project built on those interests by examining whether acute kidney injury in the immediate postoperative period following liver transplantation is associated with the development of chronic kidney disease years later.

For Mendez, the Seed Award marked an important transition toward greater independence as an investigator.

“The Clinical Seed Award provided an important next step by creating a formal pathway for me to develop and lead my own research project, with departmental support, structured mentorship, and funding for coursework in clinical research design,” he said.

Expanding Their Questions Through MPOG

The MPOG Outcomes Research Fellowship offered both faculty members an opportunity to take the next step in their research development.

For Khan, that meant moving from describing national airway management patterns to asking what those choices mean for patients and health care delivery.

“Describing practice patterns was only the first step,” Khan said. “I wanted to answer more clinically meaningful questions about the impact of airway device selection on perioperative efficiency and resource utilization.”

Her MPOG fellowship project compares SGAs with endotracheal tubes for general anesthesia cases. Using a target trial emulation framework and advanced causal inference methods, she is investigating whether SGA use is associated with reductions in anesthesia management time, anesthetic drug utilization, and overall health care resource use.

The project has the potential to inform evidence-based airway management while supporting safer and more efficient perioperative care.

Mendez, meanwhile, is using his MPOG fellowship to explore a new area of interest: anesthesia care in MRI suites.

Providing anesthesia for MRI presents challenges that differ significantly from those encountered in an operating room. Clinicians must work with specialized equipment, navigate physical and logistical constraints, and often maintain greater physical distance from patients. Despite those challenges, national anesthesia practice patterns in MRI environments remain relatively poorly characterized.

Mendez saw an opportunity.

His MPOG project examines variation in how anesthesia for MRI is delivered across institutions. By leveraging MPOG’s multicenter data, he wants to identify meaningful differences in practice and ultimately determine where opportunities exist to improve patient safety and outcomes.

“My hope is that this work will help us better understand what is—and is not—working for patients nationally and provide evidence that can ultimately drive improvements in safety and outcomes,” Mendez said.

Mentorship as a Catalyst

Both Khan and Mendez credit mentorship with accelerating their development as investigators.

Khan worked closely with Drs. Matthieu Legrand and Michael Mathis (MPOG Research Director) who helped her refine clinically relevant research questions, navigate large multicenter datasets, and strengthen her skills in study design, statistical methods, and scientific writing.

Their mentorship also introduced her to MPOG’s collaborative research environment and encouraged her to pursue increasingly rigorous approaches to answering perioperative questions. That support was instrumental in her successful application for the MPOG Outcomes Research Fellowship.

For Mendez, Adelmann (himself a former Clinical Seed Award recipient and MPOG fellow) recommended both programs and helped guide him through the process.

“I have been fortunate to have mentors at different stages of my training and career who have been instrumental not only in helping me navigate the challenges of conducting research, but also in opening doors to opportunities that I otherwise would not have known existed," Mendez said.

Both physicians also emphasize that successful clinical research is collaborative. Khan, for example, has worked closely with UCSF biostatistician David Chen to develop appropriate analytical strategies for complex multicenter data and strengthen the methodological rigor of her work.

Research and Clinical Care, Working Together

For both Khan and Mendez, research is not separate from clinical practice. Each informs the other.

“The work I do with patients—whether during liver transplantation or in environments such as the MRI suite—generates questions and ideas that can then become the basis for research,” Mendez said.

Research has changed how he approaches clinical problems. He has found that greater involvement in research has also increased his appreciation for the complexity and nuances of clinical anesthesiology.

Khan has experienced a similar evolution. Developing expertise in perioperative outcomes and airway management has helped her establish a focused research niche and expand collaborations within UCSF and through MPOG.

Her research experience also strengthens her educational work. As director of the Anesthesia Competency-Based Immersion Experience (COBIE) course and the Residency PREPARE Rotation, Khan mentors medical students, residents, and fellows. Her research background enables her to incorporate study design, data analysis, scientific writing, and clinical investigation into that mentorship. She also serves as Chair of the UCSF School of Medicine Faculty Council and Chair of the Action Group for Evaluation of Anti-Oppression Education, noting,

“My goal is to advance patient care through impactful research, innovative education, and collaborative academic leadership.”

Finding a Sustainable Approach to Research

Combining clinical responsibilities with meaningful research requires both institutional support and a sustainable approach to productivity.

Khan describes her strategy as the “tortoise rather than the hare” approach.

Rather than waiting for large blocks of protected time, she tries to make steady progress, even if that means spending only 15 or 30 minutes on research between other responsibilities or setting aside a few focused sessions each week.

Balancing patient care, teaching, leadership responsibilities, research, and life with her family has taught her that consistency matters more than speed.

“Staying consistent, being patient with the process, and continuing to move forward—even in small increments—has been the key to maintaining research productivity while avoiding burnout," she said.

Mendez also acknowledges the challenge of balancing clinical and academic responsibilities. He credits the department, including Dr. Gropper, with connecting him to the mentorship, resources, and opportunities necessary to continue developing his research career.

Choosing research questions that genuinely interest him and are closely connected to his clinical practice has also made the additional work worthwhile.

Advice for the Next Generation of Clinician-Investigators

For residents and fellows interested in research, Khan recommends starting with the questions that naturally emerge during clinical training.

She encourages trainees to keep a notebook or digital record of moments when they find themselves asking, “Why do we do it this way?” or “Is there a better approach?”

Some of those questions will have established answers. Others may eventually become research projects.

She also emphasizes that trainees do not need to have every methodological skill or an extensive research portfolio before beginning. Khan developed much of her own research career after becoming an attending physician and views collaboration, curiosity, perseverance, and a willingness to learn as essential ingredients for success.

Mendez similarly encourages trainees to pursue questions they genuinely care about and to seek strong mentorship.

“Research can add an entirely new dimension to a clinical career,” he said. “It changes how you think about the work you do, encourages you to ask new questions, and can give additional meaning to everyday clinical experiences.”

For Khan and Mendez, the Clinical Seed Award and MPOG Outcomes Research Fellowship have provided the structure, mentorship, and resources to translate that curiosity into investigation.

By asking questions, studying them rigorously, and collaborating across disciplines and institutions, Khan and Mendez are working to turn clinical experience into evidence that can improve care for patients at UCSF and beyond.