A Long Trail


When I was in ninth grade, I took the Advanced Placement Biology course offered at my high school. I remember sitting in class listening to my teacher talk about the Human Genome Project--which back then was still in its beginning stages--and thinking that that was something I would really be interested in being a part of. At the time, no one knew that the whole process would take more than a decade, perhaps two, so with the naïve perspective of a 14-year-old, I assumed it would still be in progress by the time I was ready to enter the workforce. Fifteen years have passed, the human genome has been sequenced, and I am still in the training phase of my career.

Dual-degree programs take a long time. Years pass, new science whizzes by, and here I am, still in the training phase of my career.

But there's always more science to do. The sequencing of the human genome, to continue on with that example, was only the first step. An even more daunting, challenging, and invigorating step comes next: applying that vast archive of information to the exploration of the cellular and molecular workings of the human body and the development of new and more accurate therapies for human diseases. That's exciting stuff.

Because of my interest in biology, I was, at first, prepared to enter a career strictly in research once I finished college and graduate school. However, while majoring in biochemistry at Geneseo State University in New York I quickly realized that my interest lay more in the biomedical application of research. I debated whether medical school or graduate school would be the best route for me, until I first heard about MD/PhD programs during my junior year of college. This seemed to be an ideal fit, the best of both worlds. I began to investigate several MD/PhD programs, and in my research I discovered the phrases "from bench to bedside" and "translational research." This was just what I was looking for.

There was, many argued, a great need for physicians and scientists who would have the knowledge to carry out translational research. The need was great then and was projected to be even greater in the near future. Apparently, few medical students have an interest in pursuing any type of research during their career; I've verified this with my own informal surveys. Issues of medical school loans and looming payments are mentioned by many as reasons to avoid research careers, including those who would otherwise at least have considered a research career.

The financial package offered by most MD/PhD programs helps to solve the financial issue, but there is still the issue of time. The duration of an MD/PhD degree program can vary from between 6 or 7 years to as long as 11 years, depending on the program and who you talk to. Regardless of exactly how many years you spend at it, it can be imposing in the beginning, frustrating in the middle--I recall, especially, the day my original medical school class graduated, just as my PCR was failing to work for the 10th consecutive time--but very rewarding as one nears the end of training and begins to make postgraduate plans, whether they consist of a clinical residency, a postdoctoral research fellowship, or, in some cases both.

One of the challenges in pursuing dual degrees, I have found, is the feeling of being always behind. As you enter graduate school your medical school classmates move on to their clinical rotations, which MD/PhD students won't do until years later, after the research phase has been completed. Years later, you may find yourself in the unique, and sometimes amusing, position of having to answer to residents who were once your classmates.

The challenge of balancing the acquisition of both clinical and basic scientific knowledge is very real. Physician-scientist types find it just as important to keep up to date with Science, Nature Medicine, and scores of other scientific journals as they are the latest clinical data in The New England Journal of Medicine. Fitting in time for regular journal reading is more feasible when one is in the lab full time; carving out time from a clinical schedule can be more difficult, but it's nonetheless rewarding and invigorating--and necessary. MD/PhD students may even feel the occasional minicrisis of identity: Some days you are a medical student, some days a graduate student; hopefully you feel like both on most days and learn to apply both sets of skills. And hopefully you don't experience too many days in which you feel like neither.

One central and valuable theme learned during training is that clinical questions can be answered in the laboratory, and investigations in the laboratory can lead to more useful and effective ways of solving clinical problems. Physician-scientists develop a unique way of thinking that is molded by their experience in both clinical and laboratory settings. They often have firsthand and substantial experience in considering both the basic science of a disease and the manifestation of that disease in a human patient in a clinical setting. During each phase of my training I have been able to draw insight from my experiences in another phase. The basic science portion of the medical school curriculum (years one and two) set the stage for me to approach my PhD research project with the treatment of patients in mind--in my case, developing viral vectors for use in the treatment of oral cancer. My experiences in the clinics during the third and fourth years of medical school, although completely different from my graduate school experience, were enhanced by my strong interest and background in the basic sciences. My research training helped me to know what questions to ask in the clinics and how to go about answering them, as with a thorough review of the latest clinical and basic science literature. Furthermore, observations of clinical problems on the wards have provided enough new perspectives and questions to fuel a lifetime's worth of research projects.

The interaction between these two somewhat separate worlds is not only stimulating; it is also rare. Their dual training allows physician-scientists to fill a valuable niche in the worlds of science and medicine, which have both witnessed exponential increases in the volumes of information these last few decades, with so much more to come. The Human Genome Project has come and gone while I've been in school, and the time I've spent in training was worth every minute; I feel satisfied now that I have armed myself with the knowledge I need to carry its promise to fruition, in both the laboratory and in the clinical setting.

My family, on the other hand, is just happy that I am finally ready to graduate and, eventually, get a job.

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