Abstract
Physician-scientists have epitomized the blending of deep, rigorous impactful curiosity with broad attention to human health for centuries. While we aspire to prepare all physicians with an appreciation for these skills, those who apply them to push the understanding of the boundaries of human physiology and disease, to advance treatments, and to increase our knowledge base in the arena of human health can fulfill an essential space for our society, economies, and overall well-being. Working arm in arm with basic and translational scientists as well as expert clinicians, as peers in both groups, this career additionally serves as a bridge to facilitate the pace and direction of research that ultimately impacts health. Globally, there are remarkable similarities in challenges in this career path, and in the approaches employed to overcome them. Herein, we review how different countries train physician-scientists and suggest strategies to further bolster this career path.
| Original language | English |
|---|---|
| Article number | e79738 |
| Journal | eLife |
| Volume | 11 |
| DOIs | |
| State | Published - 2022 |
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A global view of the aspiring physician-scientist. / Williams, Christopher S.; Rathmell, W. Kimryn; Carethers, John M. et al.
In: eLife, Vol. 11, e79738, 2022.Research output: Contribution to journal › Review article › peer-review
TY - JOUR
T1 - A global view of the aspiring physician-scientist
AU - Williams, Christopher S.
AU - Rathmell, W. Kimryn
AU - Carethers, John M.
AU - Harper, Diane M.
AU - Lo, YM Dennis
AU - Ratcliffe, Peter J.
AU - Zaidi, Mone
N1 - Funding Information: All clinical specialties have, and should continue to benefit from, rigorous scientific inquiry led by well-trained physician-scientists, thus improving overall patient health through discovery. Clinical training opportunities in specific disciplines are mandated by the appropriate licensing board and divisional and departmental leadership. Trainees should be able to readily identify those programs that are resourced, structured, committed, and with faculty and mentors to maximize the chances of the trainee successfully launching and maturing their own research programs. To this end, in the context of the US, the Association of American Medical Colleges (AAMC) Training Opportunities for Physician-Scientist (TOPS) Committee was created in 2019 to ‘Provide information and resources to trainees and MD/PhD Directors on postgraduate physician-scientist training activities, programs, and resources.’ The TOPS Committee developed a physician-scientist training program (PSTP) webspace containing discipline-specific content, informational webinars, and program listings providing valuable information to trainees and program directors. Our trainees should be able to use this information to identify those programs that best match their training needs and expectations and maximize their chances for continued success in this career path. Additionally, several US programs at the divisional and departmental levels have obtained competitive National Institutes of Health (NIH) T32 Training Grants that allow small groups of aspiring postdoctoral specialists to have research-protected time to develop investigative skills during their Accreditation Council for Graduate Medical Education (ACGME)-governed training. The overall goal of this NIH-funded training is to move to a Career Development Award (CDA), and subsequent independent competitive grant funding as the physician-scientist evolves. Funding Information: We appreciate the many helpful conversations with collegues serving on the AAIM Research Committee, AAMC TOPS Committee, ASCI Physician-Scientist Development Committee, and for Directors and staff leading MD/PhD and PSTP training pathways with special recognition for several informative discussions with Dr. Diann Eley at the University of Queensland, Australia, Prof. Chak-sing Lau and Prof. Gilberto Leung at the University of Hong Kong, Dr. Patrick Hu at Vanderbilt University, and Dr. Nicola Jones at the University of Toronto. These conversations have helped shape and develop ideas presented herein. Merit Review Grant 1I01BX001426 Christopher S Williams Vanderbilt University Stimulating Access to Research in Residency (V-StARR) NIH R38 HL143619 Christopher S Williams National Institutes of Health T32 GM007347 Medical Scientist Training Program Christopher S Williams Vanderbilt University Vanderbilt Integrated Molecular Oncology Training Program T32 CA217834 W Kimryn Rathmell Vanderbilt University Vanderbilt Clinical Oncology Research Career Development Program K12 CA090625 W Kimryn Rathmell. Funding Information: Mechanisms for training physician-scientists vary widely from country to country. In the US, combined MD/PhD programs have been in existence since the mid-1950s, with formal Medical Scientist Training Programs (MSTP) beginning in 1964. In 2021, these dual degree programs matriculated 750 students, had an enrollment totaling 5,913 trainees in 98 medical schools, and graduated over 660 trainees (AAMC, 2021). Roughly half of the programs are supported by the NIH through a T32 mechanism from the National Institute of General Medical Sciences (NIGMS); this provides financial support and consistency in training activities across the nation. These programs integrate clinical and graduate training and interweave additional career development activities over the training course. Trainees typically spend two initial years in biomedical science training, enter graduate school for doctoral studies, secure their PhD, and thereafter return for two final years of clinical training. A few programs, notably Duke University School of Medicine and Vanderbilt University School of Medicine, have 3-year clinical curricula, thus reducing time to degree. While these programs have created a widely recognized pathway for training, the success of combined degree programs can deter medical students and MD trainees from pursuing research opportunities. Over the past several years, many medical schools are evaluating and revamping clinical training curricula, with a goal to create additional opportunities for innovation and further avenues of physician-scientist training. However, it is important to note that faced with an increasingly complex medical curriculum, many schools have transitioned to flipped-classroom, case-based, and professional-skill-focused course design, raising among other concerns, the deficit of core biomedical science training thus rendering traditional MD students ill-equipped to pivot into a research direction. Funding Information: The levels of formalized support for training physician-scientists also vary from country to country. The Canadian physician-scientist training model, previously funded by the Canadian Institutes of Health Research (CHIH), closely approximates the US MSTP (Twa et al., 2015; Lewinson et al., 2015; Strong et al., 2018). In 2015, the CHIH eliminated this program, leaving an entire generation of trainees with unclear training paths while individual institutions cobbled together support to attempt to maintain programs, in essence, profoundly jeopardizing the physician-scientist pipeline in Canada (Twa et al., 2015). Australia lacks a nationally sponsored physician-scientist training strategy (Eley and Benham, 2016); however, a review of student perspectives revealed an intense interest in pursuing research among Australian medical students (Eley et al., 2017). A survey of trainees indicated that perceived barriers included the absence of a clear, consistent pathway, formal funding mechanisms, time away from the clinic, and purposeful mentorship (Eley et al., 2017). Despite the lack of a formal physician-scientist track, most medical schools facilitate combined MD/PhD training in an intercalated curriculum (Eley, 2018), similar to the US structure. However, the time spent in the graduate training phase is completed in 2–3 years, bringing the total training time to between 6 and 7 years—which is 1–2 years shorter than the US training equivalent. Typically, trainees in these programs are one-offs, with most not having formal pathways or structured training (Eley et al., 2017). Germany and France offer integrated MD/PhD training often between the second and fourth years of primary medical training; in France, there is also an option to pursue a master’s degree during medical school and PhD training during residency (Noble et al., 2020). In Germany, compensation is provided during this time; however, at a reduced rate in comparison to postdoctoral fellow salaries. Nonetheless, in the German system in general, there is limited medical school debt (Bossé et al., 2011), which is in stark contrast to 2021 U.S. Medical School graduates, who accumulate an average of $215,900 in Medical School debt (Hanson, 2021). Publisher Copyright: © Williams et al.
PY - 2022
Y1 - 2022
N2 - Physician-scientists have epitomized the blending of deep, rigorous impactful curiosity with broad attention to human health for centuries. While we aspire to prepare all physicians with an appreciation for these skills, those who apply them to push the understanding of the boundaries of human physiology and disease, to advance treatments, and to increase our knowledge base in the arena of human health can fulfill an essential space for our society, economies, and overall well-being. Working arm in arm with basic and translational scientists as well as expert clinicians, as peers in both groups, this career additionally serves as a bridge to facilitate the pace and direction of research that ultimately impacts health. Globally, there are remarkable similarities in challenges in this career path, and in the approaches employed to overcome them. Herein, we review how different countries train physician-scientists and suggest strategies to further bolster this career path.
AB - Physician-scientists have epitomized the blending of deep, rigorous impactful curiosity with broad attention to human health for centuries. While we aspire to prepare all physicians with an appreciation for these skills, those who apply them to push the understanding of the boundaries of human physiology and disease, to advance treatments, and to increase our knowledge base in the arena of human health can fulfill an essential space for our society, economies, and overall well-being. Working arm in arm with basic and translational scientists as well as expert clinicians, as peers in both groups, this career additionally serves as a bridge to facilitate the pace and direction of research that ultimately impacts health. Globally, there are remarkable similarities in challenges in this career path, and in the approaches employed to overcome them. Herein, we review how different countries train physician-scientists and suggest strategies to further bolster this career path.
UR - http://www.scopus.com/inward/record.url?scp=85138445414&partnerID=8YFLogxK
U2 - 10.7554/ELIFE.79738
DO - 10.7554/ELIFE.79738
M3 - Review article
C2 - 36098684
AN - SCOPUS:85138445414
VL - 11
JO - eLife
JF - eLife
SN - 2050-084X
M1 - e79738
ER -