Pritzker's 1-4-3 MSTP track

[StilgarMD]

So, recently I learned Pritzker has an interesting path for the students, where they do one year of med school, go off to the PhD, then return and finish med school. Any thoughts on this? It seems like a great way to avoid the problems commonly associated with the transition back into the clinic for MS3/4.

Also, if anyone would like to share the impressions they have of the program, (program strengths, weaknesses, success of graduates, etc.) That would be great. few people on this forum seem to mention it.

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[gutonc]

It's not unique but I don't particularly care for it. The "problems with transition to the clinic" are overblown for MD/PhDs. Nobody knows their head from their ass on the first day of M3.

But UChicago's a pretty sweet gig if you can get it.

 

[mTORC]

I personally prefer the way Wisconsin, Penn and Yale do it; you gain clinical exposure prior to your PhD years and maintain clinical exposure throughout grad school. I like this because I believe that enables you to start forming an idea of what the clinic is like and what your own clinical interests are. I also believe that starting grad school with some embryonic form of a physician's perspective would enrich your training as a physician-scientist during your grad school years. Doing one non-clinical year before your PhD to me would make it feel like just a long PhD followed by medical school. Of course I'm only an applicant, so this is just my limited perspective.

 

[gutonc]

The only thing I don't like about the 3+X+1 plan is that, arguably the most important grade you'll get in your entire clinical training is your SubI grade which you should be taking as one of your first 2 rotations in 4th year. Which, if you're coming back from your PhD means your first rotation may be the one that causes your app to get screened out of some places. Since after your SubI +/- away rotations, 4th year is otherwise a job interview/vacation/waste of time this is a better idea in my mind than the 1+X+3.

 

[mercaptovizadeh]

It also reeks of being insurance against dropping the PhD fast, i.e. they invest only 1 preclinical year of tuition and stipend rather than 2 before you go into PhD (which you may potentially drop).

I really don't see any strengths to the 1+PhD+3 system. The 3+PhD+1 system obviously has the strength that you have a better idea of what you want to do clinically and that'll help orient the PhD. Again, drawback is the SubI (one of my Md/PhD classmates did his IM clerkship prior to PhD, then went into his SubI post-PhD and was very rusty because of that.

 

[Maebea]

We have had students do the PhD after one year of med school. The biggest challenge from the student's perspective is having to go back to the classroom with a bunch of 23-year-olds after earning a PhD. They feel they do not quite fit in, have little patience for their new classmate's drama, and miss the find themselves questioning everything that is being taught.

 

[StilgarMD]

Gutonc - Well, I guess thats new data. I've never heard of the SubI, so In my book thats a point in favor of the 1 + 3. Also, Pritzker doesn't mandate 1 + 3, it just seems to be the way many students are going now.

mTORC - that path does seem to have its advantages as well, though with the SubI thing it clearly has its cons. Isn't that also what Duke does? I heard some of students there are really suffering. Are the programs you mentioned 3 + X + 1, with students going to a PhD only after 3 full years? that would allow more time for rotations, which may be nice.

Maebea - I can see how thats tough, but I guess you pick your poison. interestingly this discussion gives me more perspective on why 2 + X + 2 was the original track. It seems like 1 + x + 3 may be tough because you end up back in the claseroom after being an independent thinker, but a full length 3 + 1 leaves you in trouble at the SubI and if its condensed, you'll have difficulty with rotations.

 

[NigelVermooth]

As far as I understand, the schools which mTORC mentioned do not quite follow a 3 + X + 1 model.
In the case of UPenn the curriculum is condensed such that during the second year one starts their clerkships, but only for a half of a year and then moves into the PhD phase. After the PhD, in this model, one still does quite a bit of time in the clinics prior to when the SubIs are typically done, so I do not believe the whole "rustyness" is quite as much of a concern.
Yale is more of a 2.5 + X + 1.5 which again gives one clinical time prior to SubIs. (with the new curriculum Yale's model will be more like that of Penn and Baylor in the future it seems)
I am not as familiar with UWisc.
Duke in turn is essentially a 1 + X + 2 model with an even more condensed preclinical period.
The only institution I know of that actively pushes a real 3 + X + 1 is UT-Houston.

 

[mTORC]

Just for future reference, since Wisconsin seems to be a lesser-known medical program (with a top 5 graduate program)... Their curriculum is 2 years more traditional, but their summer before the PhD, the MSTP students start taking ward clerkships that are continued with longitudinal clerkships. Also NigelVermooth is correct in what I meant about the Penn and Yale curricula. Btw Nigel, I think we had an interview together, but I'm not certain!

 

[uniqenam]

My program has not been mentioned yet (UTSW), but also has a 1+PhD+3 option, although it's not pushed by the PD; probably one student out of each class will take this option. As my PD has said previously, the beauty of being able to do a PhD after your first year is that it allows you to keep on a hot project; for instance, say you're joining a big lab with lots of post-docs and grad students, and during your summer rotation between 1st and 2nd year you happen upon a really hot project. In the year off that you'll have while doing 2nd year of med school, the PI probably will not want to sit on the data, so it'll be given to another post-doc or grad student. So, taking the 1-year option can allow you to protect both your slot in a lab and also your progress on a big project.

 

[StilgarMD]

for instance, say you're joining a big lab with lots of post-docs and grad students

I was under the impression this isn't the kind of lab a grad student should be looking to join. Am I wrong in thinking this?

 

[Fencer]

Every MD/PhD student has different needs. A very large lab (>50 people) can be the best match for some students, but the worst for many others. Having met you, I think that you might thrive in a lab with 6-12 people and probably do better than in a lab of 20+. At some point in your career (post-doc), however, you might need to be in a very large lab because it allows you to have the expertise and resources to dream for any project in your area.

 

[StilgarMD]

Every MD/PhD student has different needs. A very large lab (>50 people) can be the best match for some students, but the worst for many others. Having met you, I think that you might thrive in a lab with 6-12 people and probably do better than in a lab of 20+. At some point in your career (post-doc), however, you might need to be in a very large lab because it allows you to have the expertise and resources to dream for any project in your area.

Interesting, thanks for the insight. I'll keep that in mind as I look at labs.

 

[seaso]

One thing worth mentioning: Sub-I grade is not critical for those not going into IM. Many students push the medicine Sub-I into late M4 if they are going into other fields e.g. psych, surgery, derm etc. A rotation in their field of interest early in M4 is more important.

 

[gutonc]

One thing worth mentioning: Sub-I grade is not critical for those not going into IM. Many students push the medicine Sub-I into late M4 if they are going into other fields e.g. psych, surgery, derm etc. A rotation in their field of interest early in M4 is more important.

Actually, Gen Surg, Peds and FM all have Sub-Is. But what you're describing, an advanced subspecialty rotation is basically a SubI.

My point was simply that you don't want your first clinical rotation in 4 or 5 years to be the one that can make or break your residency app.

 

[mercaptovizadeh]

One thing worth mentioning: Sub-I grade is not critical for those not going into IM. Many students push the medicine Sub-I into late M4 if they are going into other fields e.g. psych, surgery, derm etc. A rotation in their field of interest early in M4 is more important.

Actually, Gen Surg, Peds and FM all have Sub-Is. But what you're describing, an advanced subspecialty rotation is basically a SubI.

My point was simply that you don't want your first clinical rotation in 4 or 5 years to be the one that can make or break your residency app.

I have no idea what seaso was trying to say, but the subI grade in IM is actually VERY important when you apply to IM. Probably the single most important clinical grade after the IM clerkship, definitely more important than an elective. Doing a subI early and performing well is seen as a strength in the application.

 

[gutonc]

I have no idea what seaso was trying to say, but the subI grade in IM is actually VERY important when you apply to IM. Probably the single most important clinical grade after the IM clerkship, definitely more important than an elective. Doing a subI early and performing well is seen as a strength in the application.

No, he was saying that if you're not going into IM your SubI grade isn't that important, which is mostly true. But there's an analogous rotation for every specialty.

 

[Neuronix]

It's not unique but I don't particularly care for it. The "problems with transition to the clinic" are overblown for MD/PhDs. Nobody knows their head from their ass on the first day of M3.

We came back to MS3 6-9 months into everyone else's third year. I looked like a total idiot for the first several months compared to my peers. It was traumatic for me. I don't consider these problems overblown at all. I pretty much vowed then to never take another long period of time out of the clinic.

 

[snobored18]

We came back to MS3 6-9 months into everyone else's third year. I looked like a total idiot for the first several months compared to my peers. It was traumatic for me. I don't consider these problems overblown at all. I pretty much vowed then to never take another long period of time out of the clinic.

I completely agree...even if you come back close to on-cycle (e.g. your peers have done 1 or 2 rotations) you are still at a huge disadvantage on the wards due to the time off. Even after a fairly successful M3 year I still feel like my clinical knowledge/skills are playing "catch up" as a result of the common 2 + X + 2 MSTP structure. The downside to 1 + X + 3 is more social/administrative than academic in my eyes. As the match gets increasingly competitive and just having PhD is no longer enough to land interviews at top programs in all specialties (yes even IM, Peds, and Path are getting there) MSTP programs are going to need to do something to alleviate the disadvantages that are now associated with a 4+ year break between M2 and M3 (board score creep, mediocre clinical grades, etc.). Glad to see some programs are willing to break the mold and try something different.

 

[mercaptovizadeh]

I completely agree...even if you come back close to on-cycle (e.g. your peers have done 1 or 2 rotations) you are still at a huge disadvantage on the wards due to the time off. Even after a fairly successful M3 year I still feel like my clinical knowledge/skills are playing "catch up" as a result of the common 2 + X + 2 MSTP structure. The downside to 1 + X + 3 is more social/administrative than academic in my eyes. As the match gets increasingly competitive and just having PhD is no longer enough to land interviews at top programs in all specialties (yes even IM, Peds, and Path are getting there) MSTP programs are going to need to do something to alleviate the disadvantages that are now associated with a 4+ year break between M2 and M3 (board score creep, mediocre clinical grades, etc.). Glad to see some programs are willing to break the mold and try something different.

Board score creep is becoming a serious issue. More serious still is the fact that programs are now seeing the PhD as "just another EC" where it's almost valued no more than volunteering at a free clinic or taking 1 year off to do clinical research. Perhaps I exaggerate, but this is somewhat true. Even in peds. Even in IM. Even in path. IM has shot up in competitiveness over the past 5 years, it's pretty crazy actually. One other thing is that some programs put MD-PhDs at a disadvantage for AOA selection (my school hasn't had any MD-PhD's selected in 2-3 years, not because of poor grades, but because it's basically a posh popularity contest and if you are unknown to the junior AOAs (who vote for the senior AOAs - conflict of interest!), you are SOL. They have that damn wiggle room to pick any 16% out of the 25%, so you could have been the top in your class, MD-PhD, and if the jealous jerks who are your new classmates don't know you well enough, or don't like you, you are not getting AOA. And that hurts for a lot of top residency programs.

 

[StilgarMD]

I never thought AOA functioned through student voting. That's a drag. I guess that would be an advantage of 1 + x + 3.

 

[snobored18]

Board score creep is becoming a serious issue. More serious still is the fact that programs are now seeing the PhD as "just another EC" where it's almost valued no more than volunteering at a free clinic or taking 1 year off to do clinical research. Perhaps I exaggerate, but this is somewhat true. Even in peds. Even in IM. Even in path. IM has shot up in competitiveness over the past 5 years, it's pretty crazy actually.

Disheartening as it is, I think it is true that the PhD degree is definitely seen as an "another EC" valued just slightly higher than the plethora of one year MPH/MS/whatever masters degree is currently in vogue you see on the interview trail. From what I've seen, you really only reap the rewards of a PhD in the match process these days if your CV reflects 4 years of extremely productive research (e.g. multiple publications in glossy journals, tons of published abstracts, patents, NIH/foundation fellowships, awards with crazy names, etc.). That said, a loaded CV can be easily overlooked in the match process if your app never crosses a program directors desk because they are screening on clinical metrics alone (clerkship grades + step 1 score + AOA). This is why I think the MSTPs need to be really aggressive in their attempts to level the clinical playing field. 3 + SubI + X + 1 (would be awesome, but attrition rates would be ridiculous) or 1 + X + 3 (might be the easiest solution, probably less pre-PhD attrition) are just a few of the potential solutions.

 

[mercaptovizadeh]

Disheartening as it is, I think it is true that the PhD degree is definitely seen as an "another EC" valued just slightly higher than the plethora of one year MPH/MS/whatever masters degree is currently in vogue you see on the interview trail. From what I've seen, you really only reap the rewards of a PhD in the match process these days if your CV reflects 4 years of extremely productive research (e.g. multiple publications in glossy journals, tons of published abstracts, patents, NIH/foundation fellowships, awards with crazy names, etc.). That said, a loaded CV can be easily overlooked in the match process if your app never crosses a program directors desk because they are screening on clinical metrics alone (clerkship grades + step 1 score + AOA). This is why I think the MSTPs need to be really aggressive in their attempts to level the clinical playing field. 3 + SubI + X + 1 (would be awesome, but attrition rates would be ridiculous) or 1 + X + 3 (might be the easiest solution, probably less pre-PhD attrition) are just a few of the potential solutions.

Agreed. I suspect a ton of apps are thrown in the recycling bin based on some combo of H in specialty of interest, H in other clerkships (especially X, Y, Z), step 1, and AOA. And this is done by secretaries/coordinators/residents(?) who are reading the apps. Oftentimes we find that trashed apps are suddenly interesting when people make calls/send emails to PDs and suggest a re-review of the application. It's very depressing. Now people will have to up the ante and join monstro labs that regularly churn out Nature/Science/Cell papers, even if the personal dynamics with the lab/mentor are not the best and even if the lab environment is not optimal for training (MD/)PhD students.

 

[gutonc]

We came back to MS3 6-9 months into everyone else's third year. I looked like a total idiot for the first several months compared to my peers. It was traumatic for me. I don't consider these problems overblown at all. I pretty much vowed then to never take another long period of time out of the clinic.

Well that wasn't what I was talking about. I was talking about coming back on-cycle. My program used to let MD/PhDs come back pretty much whenever they wanted but, after a series of disasters like what happened to you, they changed to rule to "July 1 or don't bother".

 

[StilgarMD]

Agreed. I suspect a ton of apps are thrown in the recycling bin based on some combo of H in specialty of interest, H in other clerkships (especially X, Y, Z), step 1, and AOA. And this is done by secretaries/coordinators/residents(?) who are reading the apps. Oftentimes we find that trashed apps are suddenly interesting when people make calls/send emails to PDs and suggest a re-review of the application. It's very depressing. Now people will have to up the ante and join monstro labs that regularly churn out Nature/Science/Cell papers, even if the personal dynamics with the lab/mentor are not the best and even if the lab environment is not optimal for training (MD/)PhD students.

 

[Neuronix]

Well that wasn't what I was talking about. I was talking about coming back on-cycle. My program used to let MD/PhDs come back pretty much whenever they wanted but, after a series of disasters like what happened to you, they changed to rule to "July 1 or don't bother".

There's no real way to come back on cycle where I went. We did 6 months of clinic before the PhD and 6 months after. So you really couldn't come back with the fresh MS3s. I think there were some benefits with that system, but what I experienced was the drawback.

 

[StilgarMD]

There's no real way to come back on cycle where I went. We did 6 months of clinic before the PhD and 6 months after. So you really couldn't come back with the fresh MS3s. I think there were some benefits with that system, but what I experienced was the drawback.

So the "1.5 + clerkship" structure may backfire by ensuring no matter when one finishes their PhD, they come back with "in the middle of MS3", essentially?

 

[Neuronix]

Backfire is too strong of a word. No matter how you structure an MD/PhD program, there will be advantages and drawbacks. The drawback of the 1.5 or 2.5 year pre-PhD structure is coming back off cycle with your MS3 colleagues. Rarely, some still come back on cycle by coming back very early or coming back very late (may be possible for a limited number of scenarios or specialties like pathology). But that's not feasible for most students where I went.

 

[ratherbefishing]

We came back to MS3 6-9 months into everyone else's third year. I looked like a total idiot for the first several months compared to my peers. It was traumatic for me. I don't consider these problems overblown at all. I pretty much vowed then to never take another long period of time out of the clinic.

I am currently living through this. It is comforting to hear other people have felt the same way. At my school we do the 2+X+2 and I came back on cycle but I was/am behind my peers. I started with surgery which was a huge mistake on a number of levels. I am actually a bit surprised that the transition back to med school is handled by just throwing us back into things. I am concerned for the reasons mentioned on this thread like board creep, AOA selection, disadvantage on clerkships/shelfs, "degree creep" on the PhD (MPH, MBA, MS, HHMI, etc). Since MD/PhD programs are often run by people who went through the process decades ago, the rules that applied to them don't apply to the current generation. I'm not sure that "just having a PhD and you're golden" is true anymore. It is frustrating to be spending as much/more time than my peers on studying just to catch up. I know there are MD/PhDs who come back and are rockstars on the wards, for which I am impressed...

 

[mercaptovizadeh]

I am currently living through this. It is comforting to hear other people have felt the same way. At my school we do the 2+X+2 and I came back on cycle but I was/am behind my peers. I started with surgery which was a huge mistake on a number of levels. I am actually a bit surprised that the transition back to med school is handled by just throwing us back into things. I am concerned for the reasons mentioned on this thread like board creep, AOA selection, disadvantage on clerkships/shelfs, "degree creep" on the PhD (MPH, MBA, MS, HHMI, etc). Since MD/PhD programs are often run by people who went through the process decades ago, the rules that applied to them don't apply to the current generation. I'm not sure that "just having a PhD and you're golden" is true anymore. It is frustrating to be spending as much/more time than my peers on studying just to catch up. I know there are MD/PhDs who come back and are rockstars on the wards, for which I am impressed...

Agreed. A lot of things have changed. Last year a classmate of mine applied with a great board score, honors in IM, his own F30, PhD, excellent publications (including 1st author in PNAS), and he didn't so much as get an invite to interview for UCSF's or MGH's IM residency programs. That's just one example.

I think most MD/PhD programs will need some fresh blood (or at least extensive exit interviews/debriefing with graduating students) to keep up with the changing landscape of the residency application and match. Specialties that didn't "need" an away rotation, may now need an away rotation (e.g. if you want to match peds at CHOP, you may want to do an away there). MD/PhD's may no longer be able to rely just on the PhD and their clinical excellence, they may need other extracurriculars/volunteering/leadership to sway PDs their way.

Residency app is going the way of med school and college apps. There are too many people with a strong PhD, numerous publications, multiple clinical honors, and a step 1 of 250+ to distinguish between them any more on this basis. It's coming down to ECs/leadership/LORs that differentiate applicants.

 

[OddNath]

Actually, Gen Surg, Peds and FM all have Sub-Is. But what you're describing, an advanced subspecialty rotation is basically a SubI.

My point was simply that you don't want your first clinical rotation in 4 or 5 years to be the one that can make or break your residency app.

I did a 3-PhD-1 program, and rocking the sub-I was not a problem for my cohort, for the following reasons:
1: We had the opportunity to do clinic time in our specialties of choice during the PhD years, so we could keep reading and presenting patients and going to Grand Rounds, which helps build relationships with your letter writers, and
2. Most of us started with a "warm-up" rotation in July of MS4, then did Sub-I's in August/September, and there was enough time for those letters to get in before interviews.