Shaping the MD-PhD curriculum

[aag]

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Dear all

I am a neuropathologist and an MD-PhD. For the past 5 years I have served as the Program Director of the MD-PhD program at the University of Zurich, Switzerland.

I have a few questions that I wish to poll opinions on. My intent is to help identifying the best possible career track for MD-PhD students. For one thing, we are quite concerned that MD-PhD students may be taking too much time to finish their studies.

We believe that a course of 9 years (6 medical school + 3 lab work) should be the absolute maximum. We would wish that the intellectually very best students apply to our program, but I have a hunch that much longer curricula may scare off our best students. After all, a PhD isn't strictly required to do science (unlike an MD license being required for practising medicine), so the sharpest people may opt for "collateral pathways" if the MD-PhD is linked to unreasonable hardship.

Currently, there is one specific issue I would like to discuss. We are having a quite hot discussion related to enrolling students who have done 3 years of med school, stop studying medicine in order to do lab work, and then wish to re-enter medical school when they are done with their PhD. Personally, I don’t like this curriculum. I feel that it engenders the distinct risk of ending up with neither degree if something goes wrong. I prefer that students first finish their med school (and do additional classes to get ready for the program) and then enroll as PhD students.

However, I understand that in the US most student interrupt their MD in order to do their PhD. I wonder what thoughts you have on this. Is it good? Are you comfortable with this arrangement? Do you see any advantages to the Swiss curriculum?

I would be glad to kick-start a discussion in order to learn more about these topics. Your suggestions, if you can make a well-documented case, may influence the future structure of the Swiss curricula and may lead to stronger harmonization and enhanced geographic compatibility between programs.

Best regards

 

[drcushing]

I'm a current MD/PhD student in the US. You may be aware of this editorial:

Whitcomb ME.
The need to restructure MD-PhD training.
Acad Med. 2007 Jul;82(7):623-4. No abstract available.

Personally, I think that doing PhD or advanced research training after completion of MD is better than the traditional format -- 1/2 years of med school, PhD work followed by 2/3 more years of med school.

 

[gbwillner]

Dear all

I am a neuropathologist and an MD-PhD. For the past 5 years I have served as the Program Director of the MD-PhD program at the University of Zurich, Switzerland.

I have a few questions that I wish to poll opinions on. My intent is to help identifying the best possible career track for MD-PhD students. For one thing, we are quite concerned that MD-PhD students may be taking too much time to finish their studies.

We believe that a course of 9 years (6 medical school + 3 lab work) should be the absolute maximum. We would wish that the intellectually very best students apply to our program, but I have a hunch that much longer curricula may scare off our best students. After all, a PhD isn't strictly required to do science (unlike an MD license being required for practising medicine), so the sharpest people may opt for "collateral pathways" if the MD-PhD is linked to unreasonable hardship.

Currently, there is one specific issue I would like to discuss. We are having a quite hot discussion related to enrolling students who have done 3 years of med school, stop studying medicine in order to do lab work, and then wish to re-enter medical school when they are done with their PhD. Personally, I don’t like this curriculum. I feel that it engenders the distinct risk of ending up with neither degree if something goes wrong. I prefer that students first finish their med school (and do additional classes to get ready for the program) and then enroll as PhD students.

However, I understand that in the US most student interrupt their MD in order to do their PhD. I wonder what thoughts you have on this. Is it good? Are you comfortable with this arrangement? Do you see any advantages to the Swiss curriculum?

I would be glad to kick-start a discussion in order to learn more about these topics. Your suggestions, if you can make a well-documented case, may influence the future structure of the Swiss curricula and may lead to stronger harmonization and enhanced geographic compatibility between programs.

Best regards

If I'm not mistaken, the EU systems don't have a "college" component, so that the nine years you speak of are already shorter that the current US system. If you would like to emulate the US system that produces many MD/PhDs/year, then you are NOT being restrictive with your time format, where the US system is 4 years college (-2 years for starting earlier) +4 med school, + 4 PhD= 10 years on average. And let me stress average, as I've MSTPs that have taken more than 6 years to finish their PhDs.

Regarding your second point about the best and brightest... You will never win on that front. "best and brightest" implies some sort of bias. Do you want students who are more likely to finish the program or just ones that score better on exams? It will be easier to recruit the former. You are better off (IMHO) recruiting students who are dedicated and would not be put off by a 6 year PhD than you would be with someone who just wants to finish quickly. The latter are more likely to just go into a competitve specialty afterwards and never again do science. This may just be my biased opinion but I have seen it over and over in my 8 years here. I would stress quality of training over shortness of training for long term science prospects.

Finally, I would address your point about not needing the PhD. This seems like a horrible attitude to take for someone directing and MD/PhD program. I don't know anyone who has dropped out and stopped both careers- most just end up pursuing only medicine because it pays a lot better than science. If this happens to your students, then your institution has essentially failed. Yes, it is true that you don't need the PhD to do science, but who are we kidding? That's fine if you are planning on doing case reports and clinical research the rest of your life. Having the PhD fast-tracks you to grants, experience, and recognition at every institution.

Perhaps there is no good way to shorten things in general. But that's what we get for choosing two careers and trying to fit them into one.

 

[aag]

Thanks. Whitcomb's editorial raises very good points. He is probably right in noting that the 6+3 year model might decrease the number of MD-PhD applicants due to the "financial incentives to enter practice".

But I don't think this should deter us. The program should target physicians genuinely interested in doing curiosity-driven biomedical research of the highest academic standard. These individuals are unlikely to ever make up >5% of the student collective.

Of course, our laureates will hopefully compete successfully in the job market and eventually land well-paid jobs. But if the latter were the overriding consideration, I would say that there are easier ways to get there - and they don't require a PhD... 🙂

 

[aag]

Finally, I would address your point about not needing the PhD. This seems like a horrible attitude to take for someone directing and MD/PhD program. I don't know anyone who has dropped out and stopped both careers- most just end up pursuing only medicine because it pays a lot better than science. If this happens to your students, then your institution has essentially failed. Yes, it is true that you don't need the PhD to do science, but who are we kidding? That's fine if you are planning on doing case reports and clinical research the rest of your life. Having the PhD fast-tracks you to grants, experience, and recognition at every institution.

Dear gbwillner

Sure, but don't misunderstand me! I subscribe to everything you write - and that's why I am passionate about my graduate school! And yet in these years I have realized that the reality is far more nuanced, and not at all black-and-white.

I may have expressed myself somewhat ambiguously. I meant (and I stand by that assertion) that the title "Ph.D." is not crucial to great science. Instead, what matters is the (hopefully great) education that goes along with the title - an education that can be accrued otherwise, as exemplified by the many physician-scientists of the past (one of them works one floor above me and has earned a Nobel prize in immunology). That's why I am motivated to optimize the added-value conferred by an additional doctorate in science to a medical doctorate.

 

[gbwillner]

Dear gbwillner

Sure, but don't misunderstand me! I subscribe to everything you write - and that's why I am passionate about my graduate school! And yet in these years I have realized that the reality is far more nuanced, and not at all black-and-white.

I may have expressed myself somewhat ambiguously. I meant (and I stand by that assertion) that the title "Ph.D." is not crucial to great science. Instead, what matters is the (hopefully great) education that goes along with the title - an education that can be accrued otherwise, as exemplified by the many physician-scientists of the past (one of them works one floor above me and has earned a Nobel prize in immunology). That's why I am motivated to optimize the added-value conferred by an additional doctorate in science to a medical doctorate.

While I agree that the title is not itself a requirement, times are now different than in days past when MDs had essentially no outlet for their interest in science and had to essentially create their own path. I believe Northwestern was the first MSTP program in the US, and that was less than 50 years ago. Now these programs are everywhere. Is it possible to be a great scientist without the PhD? sure, but now you have superior competition with the combined degree. Furthermore, I wonder how many of those great Nobel laureates of years past would have completed the MD/PhD program had it been available to them?

From your original post, you mention losing students to both science AND medicine- something that rarely (if ever) happens in the US. Perhaps this is a function of your students deciding on a long career path while still essentially children than it is about length of training.

 

[aag]

OK, gbwillner, you got me! Now I will have to admit that of the ca. 20 PhD and MD-PhD students that I have supervised in the past 15 years, only very few managed to complete their PhD within exactly 3 years! The average is more around 3.5 yrs, with a few going 4 yrs and one single person who took 6 yrs.

In fact, in my lab both the most and the least successful students tend to run the shortest PhDs. Once you have published several top-tier papers, there's no reason to delay your defense. Similarly, if nothing at all has worked, you (and I) wouldn't want to prolong the agony. It's the looming, unfulfilled promises of success that tend to lure PIs and students into extensions.

The problem with running long is that, yes, you learn more, but you also lose opportunities while growing older. At some point you are expected to become independent and run your lab. But at the Swiss Federal Institute of Technology (a prime research institution, formerly home to Albert Einstein), hardly any assistant professors are recruited if they are over 37. In fact the cutoff is said to be 35.

Sure, in the USA you have anti-age-discrimination, but when I met Elias Zerhouni at NIH a few years ago, he complained about the ever increasing age of first-time R01 recipients - suggesting to me that this problem is not only felt this side of the Ocean...

So, maybe there is some middle ground between "children" and 40ish that may be worth exploring!

 

[DeadCactus]

I'm only a pre-med (so my opinion is more or less worthless), but it always seemed to me that a better system would have been to attach some sort of loan forgiveness to a residency or fellowship.

It seems like it would be easier to take fully qualified physicians and offer them loan forgiveness and a decent stipend/salary to convince them to spend 4 extra years working on a PhD with some clinical duties on the side (to generate some income to offset the cost of training and stipend).

It seems like this system would be more likely to produce physician-scientists who will actualy become physician-scientists...

 

[aag]

Dear LivingCactus, your point is crucially important, and we have been thinking a lot abou it. We provide yearly 50K SFr (roughly 50K US$ nowadays) to our MD-Phd students. See: http://www.snf.ch/e/funding/individuals/md-phd/seiten/default.aspx


You can't get rich on 50K/yr but you can live with dignity in Zurich or Geneva. Hence I would contend that none of our students willl have to take a loan.

 

[gbwillner]

However, I understand that in the US most student interrupt their MD in order to do their PhD. I wonder what thoughts you have on this. Is it good? Are you comfortable with this arrangement? Do you see any advantages to the Swiss curriculum?

I would be glad to kick-start a discussion in order to learn more about these topics. Your suggestions, if you can make a well-documented case, may influence the future structure of the Swiss curricula and may lead to stronger harmonization and enhanced geographic compatibility between programs.

Best regards

I thought I'd get back to the original point of your thread. I think there are SOME advantages to the system you have. However, the US (split training) system is set up the way it is primarily for one reason, and it is exactly the reason you are trying to discover- to keep graduates from withdrawing from the PhD training.

The reason for splitting up the MD is simple- if you allow students to finish their MD before embarking on science, the incentive to drop out is too great. And since most programs pay tuition AND a stipend to recruit these top students, they would essentially be flushing their NIH money down the academic toilet. Not only that, but you run the risk of recruiting students whose sole motivation is to be admitted to an MD/PhD program just to get a free ride through med school, and as soon as their MD training is over they would leave and con the school out of $180-300K. The school's insurance against this kind of behavior is to make sure the students do PhD training before completing the MD. If the student quits during the PhD, the school can simply stop paying for their medical education, and eat a smaller loss or (rarely) force students to repay their stipends (MSTPs are less likely to do this).
As I went through my training (that will be completed in May), the most difficult time I had was when my original med school class graduated. Not only was it because my friends were leaving, but because they were moving on to residency and then a job while I was "stuck" doing a PhD. It was my experience that it was during this second year of PhD training (that correlates with the first in the EU system), that students are most prone to dropping out and returning to med school. Once you passed this hurdle you were more likely to finish.

No matter what progrms do, there will always be some percentage of students who will drop out. I've seen an average of 15-20% on these forums but in reality it is often much higher than this. I believe the #1 reason for this is the realization that all the extra efforts you make during graduate school will only yield you a negative earning potential later in life. We live in a capitalistic society and it is only reasonable to expect people to behave this way- only the few dedicated souls who reject this way of thinking will continue, or those that are too knuckleheaded to bail out before it's too late.

 

[Neuronix]

Hello aag and welcome to the forum,

My personal opinion is that the PhD is best placed towards the end of medical school, as the student at this point should have a relatively firm idea of what type of physician they would like to be. This way the student is able persue a PhD in a topic that interests them, they know will be relevant to their future career, and will best prepare them to be a physician-scientist in their field.

As such I would recommend the PhD placement before the last year of medical school. That way the student can complete their core rotations in the clinics before obtaining the PhD. The student may still return and complete the last year of medical school, setting them up for their future clinical work. If something does go wrong with the PhD there is still only one year of medical school to complete, which does not pose a great risk. In my opinion the problem with putting the PhD at the very end of the program is that the student will go off to become a resident ("junior doctor" in the UK) directly after 3 years of research and be expected to perform at a high level when they have not done medicine in several years.

gbwillner is correct in that the primary reason we do not have this system is because it is feared that too many students would use it to gain free medical school and not complete a PhD if this were the case. After looking at your website it seems that the $50K SF/year is only for the PhD portion. In the American system medical school typically costs the student around $200k USD, however by completing a MD/PhD program they do not have to pay this money and obtain a stipend through medical school and the PhD (~25k USD depending on the school). This creates a tremendous incentive for students to avoid this medical school debt. I imagine that the medical school in Switzerland is free or very cheap and I also imagine that completing the PhD does not give you money towards living during medical school (the USA is the only country in the world I'm aware of that does this) and as such there should not be such financial issues with putting the PhD at the end.

With regards to age and length of training, at our program the more recent average for PhD time is 4.5 years, leading to 8 years of the MD/P. This is different than Europe as we complete a 4 year "undergraduate" (starting at around age 18) education before medical school. I am about the average age for an American MD/PhD at my level and when I am finished with my residency and fellowship I will be 37 years old! It is a difficult issue for me and for everyone I think.

 

[gbwillner]

Hello aag and welcome to the forum,

My personal opinion is that the PhD is best placed towards the end of medical school, as the student at this point should have a relatively firm idea of what type of physician they would like to be. This way the student is able persue a PhD in a topic that interests them, they know will be relevant to their future career, and will best prepare them to be a physician-scientist in their field.

I just want to point out that lots of people have differing opinions about this. While I agree it is better to do some core rotations before the PhD, I approached my training in the opposite light as Neuronix- I am pursuing a medical career that is congruent with my research interests, not vice-versa. Thus, I did not pick a specialty until the end of my PhD. I don't think either viewpoint is more valid than the other.

 

[Neuronix]

I think it's far easier to have a sense of your research interests before doing your thesis. It's also easy to switch early on in your research rotations. It's very difficult, IMO, to have a good sense of your clinical interests without being in the clinics on core rotations.

The nice thing about the pathway I proposed is at least in the American system you can still come back after your thesis is complete and pick your medical specialty. Hence, you have the experience and flexibility to pick either way.

 

[JoeMudPhud]

Our institution recently adopted a different track. Students start in the graduate program taking required courses and rotating through several labs in the first year. The next 1-2 years is spent in a lab until a proposal for the PhD work is completed, preferably 1st manuscript is submitted for peer review. PI's are encouraged to place grad students on a "low risk" project at first. Then, students complete 2 years of medical school, and take USMLE step 1. The next 2-3 years are split into 3 or 6 month blocks of research time and required clerkships with the caveat the PhD requirements must be finished prior to entering 2nd quarter of senior year of medical school. In a nutshell, student will not be eligible to match into a program without PhD in hand.

Pros: students are more invested in the PhD prior to medical course work and thus may be more motivated to finish the degree. Fellow medical students are not as "far ahead" in their career paths (1-2 years ahead instead of 3-4 years ahead). "Switching" from the medical world back to the "science" world can provide experience for future medical scientists who may wish be in both.

Cons: Difficult to match research with eventual medical career as many students do not know until clerkship years. Project may get "scooped" during 2 years of medical course work if on hot topic. Switching back and forth from "science" to "medicine" is not easy, and there is some "catching up" to do with each switch. Of course, you can get scooped while you're on your medical rotation on q4 while the grad student in the regular PhD program is in the lab 80+ hours a week.

Personally, I was on the older 2 med/4 Phd/2med track, but I've heard good things about this track from my juniors. Probably many more cons as no system is perfect, but some students seem to really like this track.

Joe

 

[aag]

JoeMud, you know what I believe is a huge problem with your institution's new curriculum? I believe that the greatest advantage of an MD-PhD over a pure PhD is that we MDs know a huge deal of things that most pure PhD's never hear of. Anatomy, physiology, pharmacology, endocrinology, etc. etc. In fact, medical researchers have been practicing "systems biology" long before non-medical biologist coined the term 🙂

All of this knowledge is incredibly useful to devising an original, successful scientific plan. But if you start the PhD portion of your MD-PhD so early, you will not have heard much of the above... or maybe you already do. I see that I need to familiarize myself better with the US system...

 

[aag]

I imagine that the medical school in Switzerland is free or very cheap and I also imagine that completing the PhD does not give you money towards living during medical school (the USA is the only country in the world I'm aware of that does this) and as such there should not be such financial issues with putting the PhD at the end.

Thanks for this viewpoint. Yep, your conjecture regarding the fees in Switzerland is exactly right. Tuition in CH is subsidized by the taxpayer, and students pay only ca. 500$ yearly.

Personally I like this system. I believe that it helps avoiding situations in which student selection is biased by parental income (which is arguably not the best predictor of academic success). On the other hand, I was for 5 years on the board of trustees of ETH (I resigned last December), and from the discussion there I can tell you that the general sentiment favors a swing towards a USA-like system of loans and tuition fees.

It had never occurred to me that the MD-PhD curriculum saves the candidates from bearing the tuition fees. I understand that US institutions would want to take steps to prevent some from taking undue advantage - but it is somewhat disheartening that this may result in a suboptimal curriculum for all...

 

[greg12345]

The current US model is terribly flawed in that a huge amount of resources is invested in training people who never become PIs (~50%, and you can hardly blame them). I believe breaking up the training between M2 and M3 and then waiting for many years to resume basic science is detrimental to both clinical skills/knowledge and science "skills".

My 2 cents: Everyone should do straight MD-Residency-Fellowship. The extensive research training would then come during your latter fellowship years, where those who are interested in becoming physician scientists should be able to pursue a formal PhD. Most academic medicine fellowships have ~2years of predominantly research time anyways, what's the big deal in tacking on another 1-2? I believe that there should be some sort of incentive to do this (i.e. debt forgiveness) so that people aren't penalized for choosing to train to be a researcher.

 

[dl2dp2]

The current US model is terribly flawed in that a huge amount of resources is invested in training people who never become PIs (~50%, and you can hardly blame them). I believe breaking up the training between M2 and M3 and then waiting for many years to resume basic science is detrimental to both clinical skills/knowledge and science "skills".

So I don't think it's actually NIH's original intention for MD/PhD graduates to become R01 funded PIs strictly. To a certain extent the existence of MD/PhD was to remedy the fact that very few students go into academic MEDICINE in the first place, and to that end, MD/PhD programs have been very successful. Most of the MSTP graduate do in the end go into academia and do some kind of research.

There is a general contempt for anyone who doesn't in the end get a tenure track position and do basic science. I would personally do science if I won't have to worry about all the competition and so forth. But then again when you actually look at the science that's being done, sometimes you are like, omg this is funded by tax dollars? I'm not sure what is a bigger waste of money: training MD/PhDs who end up in "sell-out" careers, or funding useless science.

 

[drcushing]

I agree with what greg12345 said and the points raised in Whitcomb's editorial. As a current MD/PhD student, I think that the present MD/PhD program structure is flawed. It simply doesn't make sense to spend 3-6 years of PhD work in the middle of med school. By the time residency is over, one would be away from science for another 5-7 years. Adding that the current funding climate is incredibly competitive, often takes several years before a first grant can be obtained (even for a full time PhD scientist).
Therefore, in my opinion, other great ways to invest in the training of physician scientists who will do research as their primary professional activity and other translational medical researchers are:
1. more flexible MD/MS training programs, less burnout rate and less disruption in clinical training
2. train more PhD graduate students in basic medical/clinical courses (first 2 years of med school)

 

[Ziggy08]

Well, one rationale I've heard supporting the US system is simply the matter of age. When we're in our early twenties we're more likely to do an MD/PhD because we're not thinking about starting up families. After residency and/or fellowship, we would be in our late twenties. One interviewer told me anecdotes on how some med students in his lab wanted to do MD, then residency, then PhD, but by the time they finished their residencies, they didn't want to get a PhD anymore. So, no matter how much they love research, I think fewer people would elect to do a PhD when they already have a MD, can make $$$, and are more likely to be thinking of their personal, family lives.

 

[aag]

To a certain extent the existence of MD/PhD was to remedy the fact that very few students go into academic MEDICINE in the first place, and to that end, MD/PhD programs have been very successful. Most of the MSTP graduate do in the end go into academia and do some kind of research.

I couldn’t agree more!
The primary intention of our program is to advance science within medicine, rather than diverting MD’s from clinics to wet labs. Much would be gained if, say, 50% of all Chairs of clinical departments at Swiss University Hospitals would have a profound understanding of scientific thinking. By virtue of their knowledge, they would be able to recognize the most promising medical scientists among their residents, and promote them appropriately. They would do many things, and they would eventually foster a rigorous scientific culture in their departments. Conversely, this culture would accelerate the progress of medicine, which – as we probably all agree – is best conducted in academic departments.

Of course it is perfectly legitimate that some MD-PhD graduates go on to become great basic scientists, e.g. crystallographers, developmental biologists, bioinformaticians, etc. etc. I have no issues with that. But that’s not the primary raison d’etre of the program. And some (but certainly not all) of those who opt for a career of pure science may have been better off by studying molecular biology rather than medicine upfront.

Of the MD-PhD students that I have supervised, most have gone back to clinics. The latest one has gone to neurosurgery, which is remarkable in that interventional disciplines are notoriously difficult to combine with science. He seems to be doing well thus far, though (I keep fingers crossed!).

There is a general contempt for anyone who doesn't in the end get a tenure track position and do basic science.

Sorry, but here I do not agree at all. I have the highest respect for physicians who tend to patients and do high-quality clinical research. Occupying yourself with one molecule is not intrinsically nobler than studying a disease.

The problem is that 80% of what is called "translational research" is actually rubbish (at least based on my experience), but that doesn't mean that you can't do great clinical research if you want to!

 

[dl2dp2]

The problem is that 80% of what is called "translational research" is actually rubbish (at least based on my experience), but that doesn't mean that you can't do great clinical research if you want to!

Well, >90% of what is called "basic science research" is worse than rubbish. And that is considering that NIH already filter out 90% of the grants. I don't see how the fact that 80% of "translational research" being crap is a real problem, since a lot of that isn't even funded by NIH.

 

[gbwillner]

Well, >90% of what is called "basic science research" is worse than rubbish. And that is considering that NIH already filter out 90% of the grants. I don't see how the fact that 80% of "translational research" being crap is a real problem, since a lot of that isn't even funded by NIH.

???? Care to elaborate on that ridiculous comment?

 

[aag]

So, I seem to understand that at least greg12345 and drcushing believe that the Swiss program is on the right track. Too bad you guys did not apply to our program... 🙂

Right now we have an applicant from a renowned East Coast medical school who wants to do his MD-PhD in Zurich. However, our PhD programs require an MSc to start with, and a medical license + 35 ECTS (European credit transfer system) credits are considered equivalent to an MSc.

But our applicant does not qualify, since he is in the US MSTP system and therefore is only half way through med school at his alma mater. This situation is giving me headaches and it actually was the trigger for initiating this thread.

But I can already tell you that this particular story will have a happy end because, if the candidate is outstanding, we will simply bend all rules and "pressurize" the Dean of Admissions to go along with it (see "the Godfather" for the methods that I am thinking of using...).

 

[Coclean]

Alright, I feel I have to put my two cents in despite my admitted lack of expertise. I have worked in science in Europe (Berlin and Zurich) and understand how incredibly different the system of education is by comparison to the US. I will admit point blank that I think the US system is better, and that had I been in Europe I would never have been able to achieve what I have in the US (family background, very very rural childhood, migration). That said, I was in Europe to work on some excellent research with truly excellent people.

1. The statement that the average time to completion of an MD/PhD in the US is 10 years is, I believe, patently wrong. Average times to complete the MD/PhD portion is 7 or 8 years depending on the school. All students before entering medical school, masters programs, PhDs, or MD/PhDs must complete a Bachelors degree which is on average 4 years. This adds to on average 11 or 12 years for the degrees. After this, if someone wants to practice Medicine in the US they must complete a residency, the shortest being 2 years the longest 10+. Then there are generally fellowships or other training. But it is safe to say that to start applying to assistant professor positions with clinical work following an MD/PhD path requires a commitment at a minimum of 13 years after finishing "highschool" in the US, and often much more. I predict that my path will require 17 years (and in Europe I would be way out of range to be considered for an assistant professorship by age, what a silly criteria!) See: http://sciencecareers.sciencemag.or...es/articles/2660/an_faq_for_md_phd_applicants for a simplistic overview.

Therefore, I tend to believe that 9 years after "A-levels" or secondary school is almost too little time. I am very concerned with the modern need to rush through things. 26/27 is extremeley young to have an MD/PhD in my opinion (and I am a woman...so family planning lays more heavily on my shoulders that those of an opposing sex).

2. When did having 9, 10, 11, 12 years to learn become "unreasonable hardship"? It might do to consider paying MD/PhD students a stipend as is done in the US (though they are meager in some places, my sister has managed to buy a condo and get married in Boston on her PhD stipend, mostly as the result of being very well trained on frugal living in childhood). This would allow more European students to go to school at the best school for them, rather than the one close to home....which many more European than US students do. Location and early life pathways (poverty, poor early grades due to learning a language, uneducated parents) may be more deterents to the intellectually best students than time spent to obtain a degree. A multi-level entry system is severly lacking in every European system I have been able to study.

3. I personally believe that there are many advantages to completing medical curriculum before doing a PhD. Many MD/PhD students do not well integrate their medical directives with their research ones and this might help to mollify the difficulty.....But only if students were expected to pick a medical speciality following their medical years AND could continue patient contact during their PhD years, IN their chosen speciality.

The US system is the way it is for two reasons 1. to encourage students not to leave with "only" an MD, but perhaps more importantly 2. So that students do not have a large break at the bench after completing their MD and then go back to patient care as a full fledged "doctor".

It should definately be considered the quality of care that would be provided by a doctor who had spent the last 3-4 years at the bench entirely. And also the comfort of the doctor. I would not personally wish to take a break from clinicals for that long and then be thrown back as a full doctor to do a residency or in Europe (some countries) to be a General Practitioner. I think a system in which students take the course work for medical school/PhD and do a "crash" rotation in the hospital touching many specialities before completing research would be best, keeping the major rotations for after or interspersed during the PhD years. In this way students could perhaps narrow their speciality fields or plan for research integration, and also have sufficient patient contact after the PhD to deserve the MD title before they switch to practice or residency.

4. If there are concerns with a student ending up with neither degree if something went wrong, then those concerns may find a solution in being more understanding of the LIFE of a student....more lenient with age restrictions (how about abolish them in recognition of the fact that an organism living well over 80 has a lot to contribute in the 40 years after their 40th birthday), understanding of female students who need to take maternity leave, readmitting students after an illness or life changing event.

In the end it might do to consider why we are producing MD/PhDs in the first place....If it is to better be able to improve understanding and the improvement of human and other life, then we need to consider looking at the education as a process with should improve understanding and the life of the student and future professor (even if the professor gets his/her title at 47 and has a life of good work before the title to show for it).

I'm sure radical changes won't be made any time soon......but maybe at least we can think about them, and in turn what all this is for, really. It also makes me pause as to why we talk more and more about long educational burdens when people are simultaneously living longer and healthier in general. German habilitants and docents in the 1900s were older than our average post-docs of today by and large. Good Luck developing the best program for your students.

P.S. There are ways to integrate research into your residency years. Also, some residencies actually require years of bench research as part of the residency/fellowship for the speciality. So I think it is easier to keep your hand in research (even if you are just diligently reading the literature and writing mock grant proposals for the future) than it is to keep your hand in patient care/clinical while you are scrounging to get your PhD in basic science

 

[drcushing]

People often say the average for MD/PhD completion is about 7-8 years. But in reality it's probably more like 8-9 years. In the US, a biomedical PhD is typically at least 5 years and often 6 or even 7 years. This is much longer compare to the European PhDs. Friend of mine got his PhD in Cambridge University in less than 3 years, that is almost certainly impossible in the US.

I have to say that MD/PhD graduates often specialize in fields other than peds and family medicine. So your calculation of 13 years is stretching it way low. The more realistic math is 4 yrs of college (nowadays average age starting med school is approaching 24 years old, people often take a year or two between college and med school) + 8 yrs MD/PhD + 4 yrs residency then 2-4 yrs fellowship + trying to get a grant ? yrs
So it's more like 20 years + after high school to get to become a starting physician scientist in the US..

 

[aag]

the above collection of opinions is extremely useful and actually fascinating. I am grateful to all discussants for their input.

At this stage, it would be very useful to hold a 60' viva voce discussion, in order to explore aspects that are diffucult to adress in a forum, and to get more immediate feedback.

Please find a few tentative slots at this address:
http://doodle.ch/arsv3zn4k7kbwrfy . You are welcome to post your availability. Please note that the time is Middle European with daylight savings. This means that 5pm in the calender will be 11am Eastern, 10am Central, 9am Mountain, and 8am Pacific.

My office will get the logistics in place. We will use Adobe Connect, for which you only need a microphone and speaker on your computer, and a reasonable broadband connection.

 

[gbwillner]

the above collection of opinions is extremely useful and actually fascinating. I am grateful to all discussants for their input.

At this stage, it would be very useful to hold a 60' viva voce discussion, in order to explore aspects that are diffucult to adress in a forum, and to get more immediate feedback.

Please find a few tentative slots at this address:
http://doodle.ch/arsv3zn4k7kbwrfy . You are welcome to post your availability. Please note that the time is Middle European with daylight savings. This means that 5pm in the calender will be 11am Eastern, 10am Central, 9am Mountain, and 8am Pacific.

My office will get the logistics in place. We will use Adobe Connect, for which you only need a microphone and speaker on your computer, and a reasonable broadband connection.

Do you pay participants for their time? I have always wanted a Swiss bank account....

 

[aag]

Gb, you shouldn't overstimate the reach of my financial means! Swiss bank vaults may be opulent, but we scientists are financially pretty much in the same boat as you guys over there 🙁.

OTOH, come to think of it, at some point in the future it might be interesting to host a transcontinental retreat of MD-PhD students/alumni. The Swiss MD-PhD students meet yearly in a nice place in the northern pre-alps (with ample opportunities for biking/hiking). It shouldn't be too difficult to appropriate some sponsoring for a few travel fellowships.

If anybody's interested and is fluent in German, you may be interested in some blah-blah on MSTPs that I have generated a few years ago, which can be found here. Sorry - no English translation (you may try babelfish, but I doubt that it will result in anything understandable...). A French version is available though.

 

[Neuronix]

Gb, you shouldn't overstimate the reach of my financial means!

You can't get rich on 50K/yr but you can live with dignity in Zurich or Geneva.

Your students do get 50k/year! I wonder how much dignity I'm living with...