How Much Does MD/PhD Program Curriculum Structure Matter?

[MoveUp221]

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I'm super thankful to have received a few acceptances. I wanted to ask what people's experiences have been, curriculum-wise. A couple places I've been accepted to have a 3-4-1 and a few are the traditional 2-4-2. To me, it seems to make the most sense to do clinical rotations and take Step 1 & 2 before the PhD, and then do the very part-time clinical connections rotation during a few of the PhD. Just seems better and more cohesive to not do half of med school after the PhD, and presumably having clerkships under your belt helps you be a better researcher. Also it seems like more schools are switching to doing clerkships before the PhD, especially with a P/F step 1 leading many med schools to condense the preclinical to 12-18 months. What have anyone else's experiences / ideas / thoughts and the curriculum structure been? Would you advise having the curriculum structure matter as much in choosing a program, all else being equal?

 

[Fencer]

There are over 30K of MD/PhD graduates that did 2-4-2 and they were just fine... There are also potential negatives for 3-4-1 from when to take Step II score, to transition to internship been rougher (as you just did electives in MS4). There is no perfect system, but as you indicated many of the 2-4-2 schools allow to do some electives and even a clerkship prior to PhD graduate work. No matter what, when you come out of PhD training, you will have some rust on your clinical skills. In the long scheme, it is just another transition in the distant past that wasn't too relevant to your career.

 

[eteshoe]

Honestly, I'm an advocate for the 3-4/5-1 model because having some clinical exposure can help shape your long term clinical interests and how you can use your PhD to hone in on skills / projects that would be of use when you transition to the residency component of your training. As @Fencer said, you will have some rust coming back but I've seen friends of mine at various programs have an idea of their specialty, do their PhD, start their clerkships and have a change of heart and struggle on how to sell this gigantic effort they put 4-5 yrs of their lives into for the interview trail. Of course if you have a really strong / niche clinical interest that's solidified over time, maybe the order won't matter since you won't change your mind but it's a lot more common than people advertise - especially to MD/PhD students just starting this journey.

 

[StIGMA]

I don't think it matters much overall. I advocate for choosing excellent PhD mentors over projects. If having clinicals first would help choose a specialty, and you don't change your mind later, it could be a consideration to focus your PhD within your future specialty area assuming the mentor is excellent.

 

[Mr.Smile12]

My opinion/bias is that the administrators and the departments make the difference. How well the parts work together to help MD/PhD students (or similar) is key to ensure that bumps don't become potholes/mountains. You're marrying into a family for 8-10 years and will know your faculty and deans/administrators much better than your MD peers. You might even get to meet your university leaders. That's part of the hidden training of becoming an academic (in my opinion); I trust most MD/PhD administration and support is top shelf, but we all know how miserable it is to be in a program/department/university that is unsupportive. That's the curriculum that matters.