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Preparing for a Career in Clinical Research: A Student Perspective on M.D. Ph.D. Programs


Most college-educated students who go on to pursue graduate school in fields such as business or law have a clearly delineated path in front of them. However, in medicine, there is a small subset of students who choose to pursue a career path that is less well defined. These students aim to combine a degree in medicine with a degree in the sciences and, ultimately, to pursue a career as a physician-scientist.

A physician-scientist is a clinician, an investigator, and an educator. Physician-scientists bridge medicine and research and provide a channel of communication that is a basic yet critical component in any disease-oriented or clinical research endeavor.

One can become a physician-scientist either by completing an M.D./Ph.D. program, such as those offered by most U.S. medical schools, or by completing medical school and then deciding--during residency or fellowship training--to pursue a career in research. For three primary reasons, the first of these two paths, which is the focus of this essay, is a daunting journey indeed.

First, it involves a long training period. The typical M.D./Ph.D. student graduates just a few years shy of a decade of postgraduate schooling. Second, physician-scientists face uncertainty in obtaining a suitable position and adequate funding to pursue research when they are done. And third, the financial debt that accrues throughout the years can be substantial.

Many schools offer a government-funded Medical Scientist Training Program that provides full medical and graduate tuition coverage and a stipend during the graduate years. Other schools are able to offer financial assistance by covering graduate tuition and stipend, yet provide only partial medical tuition reimbursement. In both cases, the M.D./Ph.D. student often must take out loans to cover living expenses.

Despite the drawbacks, these programs open the doors to a vast array of well-funded, cutting-edge, postgraduate possibilities in clinics and in basic, disease-oriented, and clinical research. They also provide the background that can eventually lead to top-level positions within academic institutions. It has been said that the success of an M.D./Ph.D. program is contingent upon the number of deans and department heads that it graduates.

How It Works

For those who choose to go this route, there is a standard program framework. The traditional medical school curriculum requires 2 years of academic study, followed by 2 years of general clinical exposure, which can range from emergency medicine to psychiatry. Ph.D. programs start students with core class requirements, followed by experimental work leading to a thesis dissertation. An M.D./Ph.D. program combines these two entities into one unified program: The student completes the first 2 years of medical school, then switches gears to pursue graduate research. Upon completion of all graduate requirements and a successful thesis defense, the student then returns to medical school for the final 2 clinical years.

Medical school exposes students to the vast amount of knowledge concerning the human body and the physiologic processes that govern its functioning. This training also gives students the tools they'll need to cull relevant information from the burgeoning avalanche of medical information that continues to grow larger every day. Students learn how to listen to, understand, and communicate with patients in a manner that not only protects the patient's rights but also provides the highest possible level of care. Graduate school provides students with a didactic framework of knowledge upon which they can build a vastly more detailed but more narrowly focused range of interests.

Perhaps more importantly, the graduate program portion of an M.D./Ph.D. also aims to allow students to bridge concepts and ideas and to proceed from one experimental step to the next in a fashion that is efficient, rational, and--of course--ethical. A graduate, upon completion of the program, should possess the clinical skills of a medical doctor, the analytical skills of a Ph.D., and a high probability of future success in clinical research.

It is the goal of M.D./Ph.D. programs, and a tenet in which I believe, that those investigators who are clinically trained will approach their research in a different manner than that of those without clinical exposure. Patient contact provides a tangible sense of urgency to laboratory work and also fresh insight into disease processes and their ultimate solutions. Just as the alchemists of old attempted to combine different elements to produce something valuable, the physician-scientist of today attempts to combine medicine and basic research to produce something that has clinical utility.

Currently, I am enrolled in the M.D./Ph.D. program at Brown University. I have already completed the first 2 years of medical education and have begun my first year of graduate school. I have joined a lab that is utilizing natural immunity as a paradigm for isolating novel candidate antigens for a malaria vaccine. Malaria is one of the most important protozoan diseases and is responsible for an estimated 2 million to 3 million deaths per year, particularly of malnourished African children.

Some individuals living in holoendemic areas exposed to malaria for a number of years seem to have acquired natural immunity to the disease. The principal investigator that I am training under has hypothesized that there must be something unique in the immune responses of these individuals that confers protection. Our work focuses on identifying unique immune factors that could potentially confer resistance to susceptible groups. If successful, this work will be incorporated into a larger field study in western Kenya.

The question still remains as to whether all of this training will someday help uncover that proverbial gold: something as spectacular as a disease cure or as mundane as the minor modification of an existing clinical procedure. Despite all of the exciting potential, the number of physician-scientists within the United States has been steadily declining over the last 2 decades, mainly reflecting a drop in the number of physicians who after medical school decide to pursue research careers.

I encourage young researchers and clinicians to keep this career path alive. For any undergraduate students who are thinking about following this track, I can give only one piece of advice: If you are prepared to do the calisthenics, the rewards are truly limitless.