1. Who has influenced your choice of research field the most? And how?

My patients in underserviced and under-represented areas have mostly influenced my decision to further pursue a research career. When I moved back to Saskatchewan a decade ago to work in my hometown of Regina with a large surrounding rural catchment area, I realized that many complex questions surrounding health disparities and poorer outcomes arose that I could not find answers to in our traditional textbooks or literature. An example is – how do we characterize and address common comorbid skin conditions in rural, remote and underserviced areas where solutions are complex and require an interdisciplinary and translational approach? Experiencing many patient cases that were poorly documented, such as the strikingly common presentations of secondarily infected pediatric atopic dermatitis in rural and remote communities linked to determinants of health and barriers to healthcare access left me deeply concerned (Asiniwasis et al., 2021; Asiniwasis & Chu, 2022; Asiniwasis, 2023; Asiniwasis et al., 2024).  One of the fundamental goals of research is to better contribute to documenting and advancing knowledge that can be used ultimately to advocate for closing gaps in health disparities. Years after becoming a dermatologist, I went back to school during the pandemic to complete a Master’s of Science in Health Sciences (MSHS) in Clinical and Translational Research based out of Washington, DC. Throughout my courses, I used a dermatology focus whenever possible.

I am also forever grateful for the ongoing mentorship provided by dermatologists Drs. P. Hull, J. Rao, N. Shear, M. Joseph, Y. Miller-Monthrope, S. Walsh, M. Wiseman, C. Jack and allergist-immunologist Dr. D. Chu who I always will hold in the highest regard. Even though they are based in larger cities and other provinces, these colleagues have been huge supporters who have provided ongoing encouragement of my research and clinical journey which has often been a struggle being in what I call a more ‘academically isolated’ underserviced area.

2. What are the greatest challenges you have faced or are facing in your research area?

I currently live and work in southern Saskatchewan, which is considered an underserviced area that heavily prioritizes clinical work as a fundamental need. In our province, there is no subsidized space for academic or hospital-based dermatologists. As a result, all of our dermatologists in-province run their practices from the community, including research projects. One of my greatest challenges is trying to efficiently conduct research while trying to balance and run a busy community practice. My goal is to ultimately develop an independently sustainable clinical and research practice through multidisciplinary engagement in a way that I can appropriately delegate teamwork as a Principal Investigator to make time most efficient and impactful. However, these challenges have also provided opportunities: due to this lack of infrastructure experienced over an extended period of time, I recently engaged in leading my own research as a PI through, “Visions Clinical and Translational Health Research Inc.” based at First Nations University of Canada in Regina. One mission is to bridge the need for interdisciplinary, multistakeholder engagement for complex health disparities inclusive of all levels of the translational research spectrum and all peoples suffering from skin diseases.

3. What do you think can be done to grow the impact of skin research in Canada?

I have observed that much of our academic discussion refers to international primary data in which we try to ‘extrapolate’ to the Canadian context. In our specialty, a need has been identified to generate our own primary national data, which is especially important when considering how diverse the population is. I am very excited to follow the development of SKIN Canada, an organization aiming to address some of these gaps. Additionally, in my 15 years of experience in dermatology, I have observed that our conferences and academic discussions are often focused on basic science and earlier-phase clinical trials conducted out of larger urban centers which are not always reflective of real-world situations. Although these data sources are greatly needed and important, I believe there is room to encourage approaches inclusive of latter stages of the translational spectrum such as those of the socioecological model, determinants of health, Phase IV (real-world) studies, health services, clinical outcomes, access, public policy, and community-based participatory action frameworks in order to address issues and close gaps in real-life health disparities. Ultimately, these approaches require interdisciplinary and multistakeholder engagement with special considerations of local and regional contexts.

4. If you have worked with patients as part of the research team, what did you learn? If you have not yet, what are you looking forward to learning from patient research partners?

I have had experience with engaging patients as a part of our research team, with some publications pending. I have learned that trust takes time to develop, especially for historically underrepresented peoples and communities. I have learned by taking time to provide informed consent, be truthful and transparent, listen to the patient and address their questions and concerns, and uphold ethical principles that we can really engage our patients and build trust. I prefer to refer to them as research ‘participants’ as compared to ‘subjects.’ They are equally as important as any other research team member.

5. What are the key factors that attract trainees and early career investigators to choose skin research as their field of study?

The field of skin research, on all levels, is an explosive and exciting field right now. My general advice would be find your areas of passion, keep in touch with your mentors and those who share your research interests, stay active in conferences, and connect with SKIN Canada and other support organizations who can shed light on further needs. Also, as someone who ‘discovered research later in my career’, it is never too late to become involved. We need all levels of interest and backgrounds to engage to bring the best level of diverse representation to our specialty and advances in our field. Additionally, finding a trusted and compatible colleague to work on a daily basis with can be life-changing.

References:

Asiniwasis & Chu (2022). Atopic dermatitis and Canadian Indigenous Peoples: Burdens, Barriers, and Potential for Solutions. Canadian Dermatology Today.

Asiniwasis R (2023). Bacterial Skin Infection Burdens in Northern and Rural Canadian Indigenous Communities: A Review of National and Regional Data, and Evidence-Based Solutions. Canadian Dermatology Today.

Asiniwasis, R., Merati, N., Roesler, J., Simpson, E. L., Aubry, R., McMullen, E., Fraess, L., Choi, U. Y., Hinther, K., Chu, D. K., & Jack, C. (2024). The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations. The journal of allergy and clinical immunology. In practice, 12(2), 290–299. https://doi.org/10.1016/j.jaip.2023.11.034

Asiniwasis, R. N., Heck, E., Amir Ali, A., Ogunyemi, B., & Hardin, J. (2021). Atopic dermatitis and skin infections are a poorly documented crisis in Canada’s Indigenous pediatric population: It’s time to start the conversation. Pediatric dermatology, 38 Suppl 2, 188–189. https://doi.org/10.1111/pde.14759