Do graduate work after two or three years of medical school?

[Bcblazer]

Which of these options sound more appealing to you? The program in which I'll be enrolling this fall has the PhD work fit in after the customary two years of medical school. I'm thinking about asking them if I could do it after three years instead. The advantages I see are the following:

1) There is a huge correlation between the second and third years of medical school, and it would be helpful to not have three years separating them. Third year grades are significant. This is not to say that fourth year grades are not, but I don't think it would be difficult to schedule an easy or insignificant rotation at the beginning to regain my clinical footing.

2) One of the things I thought would be incredibly difficult about the program was not being able to do clinicals with my classmates. This would solve that problem. Everyone is spread out doing random stuff during fourth year, so I probably won't be with classmates then regardless.

3) After third year, there is a good chance that I will have decided upon a medical specialty, and I believe that would help to give my research a direction.

4) Fourth year is much less busy than third year, and if for some reason I were unable to finish my PhD work in the alloted time, I would have more flexibility in working around my rotations to complete the work.

Are there things I'm missing? Doing the PhD after three years seems to make a lot more sense to me.

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[Neuronix]

I agree. I think the PhD should happen after 3 years of medical school. At this point you have a much better sense of your future clinical specialty and how research and medicine fit together. Fully-funded programs are very unlikely to let you do this, due to their fear that since you are so close to the MD you will either not start the PhD or be more likely to leave the PhD when the going gets tough.

My opinion is that your reasons 1 and 2 are not important. Also you should NOT plan on reason 4. Having things leftover to do from grad school is strongly asking for trouble and a bad idea regardless of the clinical situation leaving your PhD.

 

[way112]

That's a really interesting point..I think it would greatly benefit the student. I agree with Neuronix though, that programs would be afraid of people dropping the PhD.

I've never seen a program that lets you start your PhD after MS3 but let us know if you (somehow) get this to happen. It would be very appealing to me and I'm sure many other students

 

[JHopRevisit]

We have people do it both ways. Usually, people start after 1 or 2 medical rotations, but if they haven't found a lab yet or even a field of interest they stick around in med school for another year and see if something catches their eye.

Honestly, I haven't seen a huge difference in how these students do on the different tracks. Grad school is still grad school, med school is still med school. I think getting in one rotation and the boards before you embark on grad school is good for solidifying your pre-clinical work, but after that each part is just gonna have its own challenges.

Personally, I think I'd feel more comfortable as an intern following two straight years of clinical work, but again, students have done it both ways and at least anecdotally there doesn't seem to be a huge difference in preparedness, confidence, etc.

I will say that I don't think third year will necessarily "give your research a direction." Now, if you're having trouble picking a field or a lab, or finding a balance between basic and translational research, that's one thing, but research goes the way it wants (or the way your PI/funding agency wants), so clinical experience only steers you in the broadest sense, IMHO. And don't worry too much about the transition back, yes, you will struggle, everyone does, but you put it all together after a while and MD/PhD students match just fine (unless you're interested in Rads/Derm/etc., at which point I'm out of my league and have no advice I can really give).

 

[smoke47]

Out of curiosity, what if you did the PhD portion first then did med school as a whole? You could have that continuity and stay with your classmates for all the clinical years. And since most of us come from research-intensive backgrounds, starting in the lab instead of going into med school might make sense. On the other hand, your research probably won't relate to your eventual specialty choice but that happens in the current system anyways.

There might be an issue with completing the PhD course requirements if your school gives you graduate credits for med school classes. Could you complete your PhD research and move on with the assumption that the rest of your credits would come as you move through med school?

Has anyone done this before?

 

[OddNath]

1) There is a huge correlation between the second and third years of medical school, and it would be helpful to not have three years separating them. Third year grades are significant. This is not to say that fourth year grades are not, but I don't think it would be difficult to schedule an easy or insignificant rotation at the beginning to regain my clinical footing.

2) One of the things I thought would be incredibly difficult about the program was not being able to do clinicals with my classmates. This would solve that problem. Everyone is spread out doing random stuff during fourth year, so I probably won't be with classmates then regardless.

3) After third year, there is a good chance that I will have decided upon a medical specialty, and I believe that would help to give my research a direction.

4) Fourth year is much less busy than third year, and if for some reason I were unable to finish my PhD work in the alloted time, I would have more flexibility in working around my rotations to complete the work.

These four issues are *exactly* why my school has us do 3 years of med school before the PhD. I loved my pedi and neuro rotations, know I'll go into pedi neuro, and will start going to that clinic a couple afternoons a month to keep up to date. And, it's nicer to go to clinic *after* 3rd year to brush up (since you already have the skills of H+P's, assessing management, etc), whereas after 2nd year these things are still kind of new to you. Basically, I can get more out of clinic time during my PhD since I've already done 3rd year.

So yeah, ask your school if they'll let you do 3rd year first!

 

[CMVpromoter]

I like smoke47's idea.

Are there any programs that do the entire PhD first and then the MD as a whole afterwards? Are there problems with this arrangement that is maybe why there aren't more programs like this?

 

[StIGMA]

PhD's take 5.5-6+ years. You would get no benefit of integrating the two degrees, and graduation times would be outrageous. I have no idea why you would want to do this. Smokes only benefit of staying with your classmates doesn't quite do it for me. Staying continuous with research from undergrad to grad doesn't matter. If you got a bad itch, you can continue to work summers, breaks, nights, and weekends (and risk bombing your clinical grades).

It seems the real argument is starting grad school after M2 or M3. Is it possible for a school to guarantee starting G1 after M3 before enrolling if this is not typical for the program (and not rescind the offer subsequent to enrolling)? Would I need a written statement?

 

[JHopRevisit]

I like smoke47's idea.

Are there any programs that do the entire PhD first and then the MD as a whole afterwards? Are there problems with this arrangement that is maybe why there aren't more programs like this?

Yea, we had a couple of people do it this way too because they chose to come in before med school started for a summer rotation and it went really well, so they didn't want to leave their project behind. The only reason it works is that they guessed right and really did have a hot research project, so they're wrapping up in 3 yrs. and getting the heck out of there. Otherwise I'd be worried about the PhD taking too long just as the previous commenter mentioned.

 

[smoke47]

Yea, we had a couple of people do it this way too because they chose to come in before med school started for a summer rotation and it went really well, so they didn't want to leave their project behind. The only reason it works is that they guessed right and really did have a hot research project, so they're wrapping up in 3 yrs. and getting the heck out of there. Otherwise I'd be worried about the PhD taking too long just as the previous commenter mentioned.

I see what you’re saying: that if you didn't have a project in the works that fall, then you would be rotating while taking grad classes instead of saving time by rotating while in med school.

The M2 vs M3 argument is similar in that it really depends on the individual. If you don't have a lab after M2 then staying in the clinics makes sense whereas if you have a research project going, then it would be reasonable to start the PhD. I wish the programs that I am considering were more flexible in this respect.