Incubating the research independence of a medical scientist training program graduate: a case study

Abstract

Problem: Physician-scientists play a critical role in discovering new biological knowledge and translating findings into medical practices that can improve clinical outcomes. Collectively, the National Institutes of Health (NIH) and its affiliated Medical Scientist Training Programs (MSTPs) invest upwards of $500,000 to fully train each of the 900+ MD/PhD students enrolled in these programs. Nevertheless, graduates face the challenges of navigating fragmented intervals of clinical training and research engagement, reinitiating research upon completing their residencies, managing financial pressures, and competing for funding following what is typically four or more years of research inactivity. Together, these barriers contribute to the high attrition rate of MSTP graduates from research careers.

Approach: The authors designed and implemented (2009-2014), for a single trainee, an alternative postgraduate training model characterized by early research engagement, strategic mentoring, unyoked clinical and research milestones, and dedicated financial support.

Outcomes: The pilot training experiment was so successful that the trainee secured an NIH project grant and completed his transition to research independence 3.5 years after starting the experimental training schedule-nearly 9 years earlier (based on age) than is typical for MD/PhDs transitioning from mentored to independent research. This success has demonstrated that unyoking research engagement from conventional calendar-based clinical training milestones is a feasible, effective means of incubating research independence in MSTP graduates.

Next steps: The authors encourage the design and application of similar unconventional approaches that interweave residency training with ongoing research activity for appropriate candidates, especially in subspecialties with increased MSTP graduate enrollment.

Figure 1

Standard clinical training schedule for Medical Scientist Training Program (MSTP) trainees. The training schedule is characterized by a sequence of 2 years of medical school training, 3 to 6 years of PhD training, and then the 2 final years of medical school. MSTP trainees then engage in post-graduate clinical training, which consists of 3 to 7 years (depending on the specialty) of immersive clinical training. There are limited opportunities for research engagement during the early stages of clinical training; more opportunities exist during later stages. Trainees interested in receiving advanced clinical training and furthering their research development then, post residency, engage in fellowship for an additional 1 to 4 years. At the conclusion of this 13- to 20-year training process, research-minded trainees have established their independent research laboratories.

Figure 2

A comparison of an experimental and conventional post-graduate training schedule for Medical Scientist Training Program (MSTP) participants. The experimental training model, outlined on the left, hastened research independence for one MSTP graduate. The program allowed for 100% research effort during the first post-graduate year. During the next three years, the clinical schedule allowed the trainee to engage in research at one-third effort and to complete the clinical requirements established for the first two years of typical post-graduate residency training in psychiatry. For the final two years of clinical training, leading to eligibility for board certification, the schedule afforded the trainee the time to engage in research and advanced clinical training concurrently (at 50% effort each). A standard training schedule, shown to the right, is characterized by 4 years of clinical training, with increased opportunities for research engagement during the later stages of residency training. Trainees interested in receiving advanced clinical training and furthering their research development then engage in fellowship for an additional 2 years.