integration of MD and PhD curriculum

[Adcadet]

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Hey all -
I'm starting to wonder how MD/PhD programs (MSTP and non-MSTP) integrate MD stuff and PhD stuff. Among the MD/PhD community there seems to be much talk about training physician-scientists, individuals trained to see the overlap between clinical medicine and (usually basic) research, and that these individuals aren't simply medical students who also happen to do a PhD. Can somebody explain to me how an MD/PhD program (a distinct program, MSTP or otherwise) differs from a medical student taking a leave of absence after his/her second year of med school to complete a PhD and then returning to finish up medical school?

A few methods I've heard of which try to bridge the gap between the MD and PhD worlds:
1. rotations during medical school
2. "molecular grand rounds" and research seminars that MD/PhD students attend during the first two years of medical school
3. Fast-track programs in which you do a clinical experience one day/week during the grad school years and then shorten your last two years of medical school to a single year. I think I've heard Yale mentioned as offering this.


Is there other ways in which program fuse the MD and PhD portion of the training to form a coherent program that is something other than a discrete MD and a discrete PhD?

Thanks

 

[DarkChild]

here's what goes on at columbia - it seems like a pretty cool idea:
The Clinical Competence course works based on the assumption that the students will spend four years in the lab, though it is flexible enough to accommodate the needs of each student.

The first year in the lab, each student meets with one other student and a faculty member (Dr. Elizabeth Mayer or Dr. Nell Eisenberg) in the hospital. They practice history and physical exam skills with the cooperation of one of the patients in the hospital, and discuss the patient's illness in detail. The first year students also meet once a month in small groups with Dr. Steven Mackey, reviewing the pathophysiology of some common diseases and presentations.

During their second and third years in the lab, the students pick fields that interest them and are assigned preceptors who work in that field. They meet with that attending twice a month. Students have accompanied their mentor during office hours, on hospital rounds, in the operating room, at clinical conferences, and at clinical research meetings, thus allowing them to see what the attending's daily schedule is like as well as providing continuing exposure to patients.

Their activities during their last year in the lab are the same as in the first year, except that more emphasis is placed on write-ups and presentations when they meet with Drs. Eisenberg and Mayer. Through these activities, the Clinical Competence course aims to fulfill three main goals:

By providing continuing exposure to patients, it helps students maintain their clinical skills and fund of knowledge while they are in the lab. The course is structured to make sure they review the most common diseases and complaints, but also gives them the chance to see a wide range of diseases in the hospital and with their preceptors.

By giving them experience in different fields of medicine and surgery, it allows them to return to medical school with some idea of which specialty interests them most. They are thus able to plan their third and fourth years of medical school and their residency applications more efficiently.

Finally, by introducing them to faculty who maintain successful academic careers, the course exposes them to a variety of career paths available to physician scientists. They may meet attendings who run labs, who do clinical research, or who spend a significant part of their time teaching. Thus, they have the opportunity to ask questions about, for example, whether to short track through residency or whether it is possible to run a lab and to have a career as a physician without working 24 hours a day.

 

[Adcadet]

wow, that program at Columbia definitely seems like a cool idea.

 

[pathdr2b]

Originally posted by Adcadet
wow, that program at Columbia definitely seems like a cool idea.

I'll second that!

Integration or lack thereof at many MD/PhD programs is the main reason I'm not interested in completing the combined degree simultaneously. The idea of leaving th MD "training" for 2-4 years while I get a PhD has never made a lot of sense to me.

The program at Columbia sounds pretty good though. Seems like everytime I've think I've decided on which schools to apply to, I learn some interesting fact about another school.

 

[bailey39]

Most, if not all, schools I visited tended to have this sort of longitudinal clinical training. Definitely Penn, Cornell, UCSF, Vandy, WashU Pitt and Harvard. Pitt even gives you "credit" for the clinical time during your PhD which lets you have less required rotations (by one month I think) during year(s) 3/4.
Definitely make inquiries through the MD/PhD offices if you want to know more. The only reason I cannot elaborate more on any one program is that they all seemed to realize how important it is to maintain clinical activity during the PhD. Some schools so not require it, but all seemed to have ample programs in place.
If you want more than 1/2 day per week, it'll be another story altogether. That was the max that I heard of. Oh, and the MSTP I who supervised me as an undergrad worked in a clinic at Yale-New Haven Hospital every Wednesday night for 4 hours. It may have not been a MSTP-specific program, but it gave her great clinical exposure to all sort of disciplines.

 

[surge]

Originally posted by bailey39
Pitt even gives you "credit" for the clinical time during your PhD which lets you have less required rotations (by one month I think) during year(s) 3/4.

Oh, and the MSTP I who supervised me as an undergrad worked in a clinic at Yale-New Haven Hospital every Wednesday night for 4 hours. It may have not been a MSTP-specific program, but it gave her great clinical exposure to all sort of disciplines.

It's not MD/PhD specific, but MD/PhDs can get credit for it at Yale. Also, you can get credit for ambulatory care clerkship while in the lab. There are also other opportunities available.
I think this integration is definitely one of Yale's strengths (I felt it was better organized than at WashU). Generally speaking, it's something that's very important to me.

 

[Neuronix]

Like Bailey said, every strong MD/PhD has some kind of integration where you still get clinical skills during your research years. Sometimes they are required and sometimes they are optional, but they are always available. It just depends which one best fits your style.

At Baylor for example, rotations start before you enter the lab (you get in 3 in the last few months of second year) and you get credit for your research. This adds up to no M4 year. Somehow they still manage to average just under 8 years total though. I do think getting in rotations before you begin (Duke, Penn, and Baylor do this) your PhD is a nifty idea.

I think everywhere I visited had some kind of at least semi-weekly MSTP seminar. There's also molecular grand rounds. At Northwestern for example, a PhD student will present the science aspect of a case and cite the related papers, then a MD student will present the clinical side.

That's what is cool about MSTP. With most of them, you can't go wrong. Sorry I couldn't come up with anything new for you though Adcadet 🙂

 

[surge]

Originally posted by Neuronix
At Baylor for example, rotations start before you enter the lab (you get in 3 in the last few months of second year) and you get credit for your research. This adds up to no M4 year. Somehow they still manage to average just under 8 years total though. I do think getting in rotations before you begin (Duke, Penn, and Baylor do this) your PhD is a nifty idea.

Ah, it's too early.... I forgot....

You also do (or have an option to) this at Yale. Actually, it's required (6 months) if you want to take advantage of the longitudinal rotations.
They also have different Grand Rounds almost every day of the week (my favorite: Department of Surgery at 8am on Saturday mornings).