The Impact of Cost Cutting on MD-PhD Programs in Canada: Equity, Diversity, and Inclusion Challenges for Clinician-Scientist Training Programs.

Clinician-scientists are physicians with training in both clinical medicine and research that enables them to occupy a unique niche as specialists in basic and translational biomedical research. While there is widespread acknowledgement of the importance of clinician-scientists in today's landscape of evidence-based medical practice, training of clinician-scientists in Canada has been on the decline, with fewer opportunities to obtain funding. With the increasing length of training and lower financial compensation, fewer medical graduates are choosing to pursue such a career. MD-PhD programs, in which trainees receive both medical and research training, have the potential to be an important tool in training the next generation of clinician-scientists; however, MD-PhD trainees in Canada face barriers that include an increase in medical school tuition and a decrease in the amount of financial support. We examined the available data on MD-PhD training in Canada and identified a lack of oversight, a lack of funding and poor mentorship as barriers experienced by MD-PhD trainees. Specific recommendations are provided to begin the process of addressing these challenges, starting with the establishment of an overseeing national body that would track long-term outcome data for MD-PhD trainees. This national body could then function to implement best practices from individual programs across the country and to provide further mentorship and support for early-career physician-scientists. MD-PhD programs have the potential to address Canada's growing shortage of clinician-scientists, and strengthening MD-PhD programs will help to effect positive change.

Aim/PurposeIn response to widespread efforts to increase the size and diversity of the biomedical-research workforce in the U.S., a large-scale qualitative study was conducted to examine current and former students’ training experiences in MD (Doctor of Medicine), PhD (Doctor of Philosophy), and MD-PhD dual-degree programs. In this paper, we aimed to describe the experiences of a subset of study participants who had dropped out their MD-PhD dual-degree training program, the reasons they entered the MD-PhD program, as well as their reasons for discontinuing their training for the MD-PhD.BackgroundThe U.S. has the longest history of MD-PhD dual-degree training programs and produces the largest number of MD-PhD graduates in the world. In the U.S., dual-degree MD-PhD programs are offered at many medical schools and historically have included three phases—preclinical, PhD-research, and clinical training, all during medical-school training. On average, it takes eight years of training to complete requirements for the MD-PhD dual-degree. MD-PhD students have unique training experiences, different from MD-only or PhD-only students. Not all MD-PhD students complete their training, at a cost to funding agencies, schools, and students themselves.MethodologyWe purposefully sampled from 97 U.S. schools with doctoral programs, posting advertisements for recruitment of participants who were engaged in or had completed PhD, MD, and MD-PhD training. Between 2011-2013, semi-structured, one-on-one phone interviews were conducted with 217 participants. Using a phenomenological approach and inductive, thematic analysis, we examined students’ reasons for entering the MD-PhD dual-degree program, when they decided to leave, and their reasons for leaving MD-PhD training.ContributionStudy findings offer new insights into MD-PhD students’ reasons for leaving the program, beyond what is known about program attrition based on retrospective analysis of existing national data, as little is known about students’ actual reasons for attrition. By more deeply exploring students’ reasons for attrition, programs can find ways to improve MD-PhD students’ training experiences and boost their retention in these dual-degree programs to completion, which will, in turn, foster expansion of the biomedical-research-workforce capacity.FindingsSeven participants in the larger study reported during their interview that they left their MD-PhD programs before finishing, and these were the only participants who reported leaving their doctoral training. At the time of interview, two participants had completed the MD and were academic-medicine faculty, four were completing medical school, and one dropped out of medicine to complete a PhD in Education. Participants reported enrolling in MD-PhD programs to work in both clinical practice and research. Very positive college research experiences, mentorship, and personal reasons also played important roles in participants’ decisions to pursue the dual MD-PhD degree. However, once in the program, positive mentorship and other opportunities that they experienced during or after college, which initially drew candidates to the program was found lacking. Four themes emerged as reasons for leaving the MD-PhD program: 1) declining interest in research, 2) isolation and lack of social integration during the different training phases, 3) suboptimal PhD-advising experiences, and 4) unforeseen obstacles to completing PhD research requirements, such as loss of funding.Recommendations for PractitionersThough limited by a small sample size, findings highlight the need for better integrated institutional and programmatic supports for MD-PhD students, especially during PhD training.Recommendations for ResearchersResearchers should continue to explore if other programmatic aspects of MD-PhD training (other than challenges experienced during PhD training, as discussed in this paper) are particularly problematic and pose challenges to the successful completion of the program.Impact on SocietyThe MD-PhD workforce comprises a small, but highly -trained cadre of physician-scientists with the expertise to conduct clinical and/or basic science research aimed at improving patient care and developing new diagnostic tools and therapies. Although MD-PhD graduates comprise a small proportion of all MD graduates in the U.S. and globally, about half of all MD-trained physician-scientists in the U.S. federally funded biomedical-research workforce are MD-PhD-trained physicians. Training is extensive and rigorous. Improving experiences during the PhD-training phase could help reduce MD-PhD program attrition, as attrition results in substantial financial cost to federal and private funding agencies and to medical schools that fund MD-PhD programs in the U.S. and other countries.Future ResearchFuture research could examine, in greater depth, how communications among students, faculty and administrators in various settings, such as classrooms, research labs, and clinics, might help MD-PhD students become more fully integrated into each new program phase and continue in the program to completion. Future research could also examine experiences of MD-PhD students from groups underrepresented in medicine and the biomedical-research workforce (e.g., first-generation college graduates, women, and racial/ethnic minorities), which might serve to inform interventions to increase the numbers of applicants to MD-PhD programs and help reverse the steady decline in the physician-scientist workforce over the past several decades.

MD-PhD programs provide rigorous, integrated training for physician-scientists, enabling them to frame scientific questions in unique ways and to apply clinical insight to fundamental science. Few would question the influential contributions of MD-PhD physician-scientists in advancing medical science. In this issue of Academic Medicine, Jeffe et al affirm high levels of excellence in educational outcomes from MD-PhD training programs at U.S. MD-granting medical schools, especially programs that receive funding from the NIH Medical Scientist Training Program (MSTP). The author of this commentary observes that, in the face of current economic pressures, comprehensive, longitudinal national outcomes data from MSTP- and non-MSTP-funded MD-PhD programs will help verify the value provided by MD-PhD physician-scientists. She proposes that MD-PhD programs should better prepare the next generation of physician-scientists for future research environments, which will provide new technologies, venues, and modalities. These research environments will be more closely integrated within health care delivery systems, extend into diverse communities and regions, and employ complex technologies. MD-PhD physician-scientists also will train and gain expertise in broadening areas of research, such as health policy, health economics, clinical epidemiology, and medical informatics. Program leaders are ideally situated to foster innovative learning environments and methodologies. By sharing their innovations, they can help ensure production of a diverse MD-PhD physician-scientist workforce, prepared to engage in myriad research opportunities to meet patient and population needs in a new environment.

In Reply: Fifty years ago, the first small MD-PhD programs were established with the goal of expanding the physician–scientist workforce by combining the best parts of medical and graduate education. As MD-PhD programs have grown, so has the tradition of granting students full fellowships that pay for both graduate school and medical school and provide a stipend. Mr. Samarasinghe expresses his concerns about the recent decision by the National Institutes of Neurological Disorders and Stroke (NINDS) to discontinue a program that helps defray medical school costs for MD-PhD students. He also voices his concern about the adverse impact of this and other recent federal funding decisions on the career choices made by students planning to become physician–scientists. As program directors, we share these concerns. Intentionally or not, the NINDS decision raises an important question, which is how best to cover the costs of training the next generation of physician–investigators. There is broad agreement that future physician–scientists should be relieved of as much of their training costs as possible so that large debts incurred during medical school do not push them into private practice. The NIH loan repayment program was established with this in mind, but since it kicks in years after the debts are incurred, it may not have the same impact on career planning as would avoiding debt to begin with. Although not the only way to train physician–scientists, recent data show that most MD-PhD program alumni are engaged in academic medicine and biomedical research.1 MD-PhD training takes about eight years and is expensive.1 Institutional Medical Scientist Training Program (MSTP) grants from the National Institute of General Medical Sciences cover some of the costs and provide a strong incentive to create high-quality, integrated MD-PhD training programs. However, MSTP grants typically cover less than 25% of total program costs. The remainder comes from a combination of university funds, research grants, private foundations, and individual fellowships that students compete for nationally. Each of these has a role, and any future expansion of the physician–scientist workforce will require all of them. In 2005 the National Academy called for a 20% increase in support for physician–scientist training programs.2 Individual fellowships offered by NIH institutes are one way to do this and, when combined with other outreach efforts, can help institutes achieve their goal of attracting promising physician–scientists into research and clinical fields aligned with the institute's mission. Physician–scientists play a vital role across the entire spectrum of biomedical investigation that includes basic, translational, patient-oriented, and effectiveness research. We applaud Mr. Samarasinghe's efforts to bring his important concerns to greater public notice. Lawrence F. Brass, MD, PhD Professor of medicine and director, Medical Scientist Training Program, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; [email protected]. Olaf S. Andersen, MD Professor of physiology and biophysics and director, Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, Weill Cornell Medical College, New York, New York. Myles H. Akabas, MD, PhD Professor of physiology and biophysics and director, Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, New York.

Physician-scientists are needed to continue the great pace of recent biomedical research and translate scientific findings to clinical applications. MD-PhD programs represent one approach to train physician-scientists. MD-PhD training started in the 1950s and expanded greatly with the Medical Scientist Training Program (MSTP), launched in 1964 by the National Institute of General Medical Sciences (NIGMS) at the National Institutes of Health. MD-PhD training has been influenced by substantial changes in medical education, science, and clinical fields since its inception. In 2014, NIGMS held a 50th Anniversary MSTP Symposium highlighting the program and assessing its outcomes. In 2016, there were over 90 active MD-PhD programs in the United States, of which 45 were MSTP supported, with a total of 988 trainee slots. Over 10,000 students have received MSTP support since 1964. The authors present data for the demographic characteristics and outcomes for 9,683 MSTP trainees from 1975-2014. The integration of MD and PhD training has allowed trainees to develop a rigorous foundation in research in concert with clinical training. MSTP graduates have had relative success in obtaining research grants and have become prominent leaders in many biomedical research fields. Many challenges remain, however, including the need to maintain rigorous scientific components in evolving medical curricula, to enhance research-oriented residency and fellowship opportunities in a widening scope of fields targeted by MSTP graduates, to achieve greater racial diversity and gender balance in the physician-scientist workforce, and to sustain subsequent research activities of physician-scientists.

Since 1964, the National Institutes of Health (NIH) has funded the Medical Scientist Training Program (MSTP) MD-PhD program at medical schools across the US to support training physician-scientists. Recent studies have suggested that MSTPs have consistently matriculated more students from racial and ethnic backgrounds historically underrepresented in science than MD-PhD programs without NIH funding; however, the underlying basis for the increased diversity seen in NIH-funded MSTPs is poorly understood. To investigate how administrators and faculty perceive the impact of MSTP status on MD-PhD program matriculant racial and ethnic diversity. This qualitative study used a positive deviance approach to identify 9 high-performing and 3 low-performing MSTPs based on the percentage of students underrepresented in science who matriculated into the program between 2014 and 2018. This study, a subanalysis of a larger study to understand recruitment of students underrepresented in science at MSTPs, focused on in-depth qualitative interviews, conducted from October 26, 2020, to August 31, 2022, of 69 members of MSTP leadership, including program directors, associate and assistant program directors, and program administrators. The association of NIH funding with institutional priorities, programs, and practices related to MD-PhD program matriculant racial and ethnic diversity. The study included 69 participants (mean [SD] age, 53 [10] years; 38 women [55%]; 13 African American or Black participants [19%], 6 Asian participants [9%], 12 Hispanic participants [17%], and 36 non-Hispanic White participants [52%]). A total of 51 participants (74%) were in administrative roles, and 18 (26%) were faculty involved in recruitment. Five themes emerged from the data: (1) by tying MSTP funding to diversity efforts, the NIH created a sense of urgency among MSTP leadership to bolster matriculant diversity; (2) MD-PhD program leadership leveraged the changes to MSTP grant review to secure new institutional investments to promote recruitment of students underrepresented in science; (3) MSTPs increasingly adopted holistic review to evaluate applicants to meet NIH funding requirements; (4) MSTP leadership began to systematically assess the effectiveness of their diversity initiatives and proactively identify opportunities to enhance matriculant diversity; and (5) although all MSTPs were required to respond to NIH criteria, changes made by low-performing programs generally lacked the robustness demonstrated by high-performing programs. This study suggests that NIH funding requirements may be a powerful incentive to promote diversity and positively affect representation of students underrepresented in science in the biomedical scientific workforce.

To describe educational outcomes for a national cohort of students who enrolled in MD-PhD programs at medical school matriculation (MD-PhD matriculants). The authors used multivariate logistic regression to identify factors independently associated with overall MD-PhD program attrition (MD-only graduation or medical school withdrawal/dismissal) compared with MD-PhD program graduation among the 1995-2000 national cohort of MD-PhD matriculants at medical schools with and without Medical Scientist Training Program (MSTP) support. Of 2,582 MD-PhD matriculants, 1,885 (73.0%) were MD-PhD graduates, 597 (23.1%) were MD-only graduates, and 100 (3.9%) withdrew/were dismissed from medical school by July 2011. MD-PhD matriculants at non-MSTP-funded schools (adjusted odds ratio [AOR], 1.96; 95% confidence interval [CI], 1.60-2.41) and who had lower Medical College Admission Test scores (< 31 versus ≥ 36: AOR, 1.60; 95% CI, 1.20-2.14; 31-33 versus ≥ 36: AOR, 1.31; 95% CI, 1.01-1.70) were more likely to leave the MD-PhD program; matriculants who reported greater planned career involvement in research (AOR, 0.65; 95% CI, 0.51-0.84) and matriculated more recently (AOR, 0.90; 95% CI, 0.85-0.96) were less likely to leave the MD-PhD program. Gender, race/ethnicity, and premedical debt were not independently associated with overall MD-PhD program attrition. Most MD-PhD matriculants completed the MD-PhD program; most of those who left were MD-only graduates. Findings regarding variables associated with attrition can inform efforts to recruit and support students through successful completion of MD-PhD program requirements.

The contribution of MD–PhD training to academic orthopaedic faculties

To the Editor: In his July 2007 editorial,1 Dr. Whitcomb questions the value of U.S. MD–PhD training, citing the low percentage of students desiring research as their primary professional activity2 and their low rate of NIH grant applications.1 He laments the current system of training as having too much time away from the lab and advocates a system more conducive to research. He makes a number of assumptions, two of which we challenge here. One, the lower than expected percentage of students desiring research is a function of time away from the lab. This is essentially an academic argument, since we cannot randomize students to different training protocols. Yet, we must still consider how best to improve students’ education. While simply increasing the integration of research into early training appears reasonable, it is not the answer. We believe it is too much to ask students (or residents) to effectively integrate both research and doctoring at the earlier stages of learning. Instead, delving deeply into one discipline at a time as a novice, rather than striving for true coherence via integration, is more likely to develop solid foundations. We want our young physicians and scientists to treat their patients and execute their experiments with expertise and not just acceptable competence. The current system should certainly be modified to fit modern needs, but simply more integration and lab time are not the solution. Two, the need for MD–PhDs to perform more lab research as a part of their profession is a more contentious matter. We must remember that most medical lab research is not performed by MD–PhDs, and the majority of physician scientists are not MD–PhDs. Then what do MD–PhDs do? They are uniquely positioned, by virtue of learning two traditional disciplines, to see complex problems from different perspectives—to be innovators, teachers, integrators, and leaders. It is the duty of dual-degree programs to provide the education to encourage such qualities. To push all MD–PhDs toward the lab or particular subspecialties is shortsighted. All fields of medicine and surgery—and, indeed, pubic health policy and many business disciplines—need those who can integrate the skills of rigorous investigation with an understanding of patient issues. For the National Institute of General Medical Sciences to truly get its money’s worth, MD–PhD programs should provide exceptional multidisciplinary education, not career training. They need to encourage creativity, exploration, vision, and, especially, leadership. Only then will our society realize its full investment potential. Jaimo Ahn, MD, PhD Fellow, Orthopaedic Trauma Service, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York, and member, Board of Directors, American Physician Scientists Association, Urbana, Illinois; ([email protected]). Freddy T. Nguyen MD–PhD candidate, University of Illinois, Urbana-Champaign, Illinois, and chair, Board of Directors, American Physician Scientists Association, Urbana, Illinois. Jason R. Mann, MD, PhD Healthcare consultant, McKinsey & Company, Palo Alto, California, and member, Board of Directors, American Physician Scientists Association, Urbana, Illinois. M. Kerry O’Banion, MD, PhD Director, Medical Scientist Training Program, and associate professor, University of Rochester, Rochester, New York, and member, Board of Directors, American Physician Scientists Association, Urbana, Illinois.

To examine demographic characteristics of matriculants to U.S. MD-PhD programs by sex and race/ethnicity from academic years (AYs) 2009-2018 and explore the relationships between trends in the percentage of female and underrepresented minority (URM) matriculants to programs with and without Medical Scientist Training Program (MSTP) funding. Linear regression and time trend analysis of the absolute percentage of matriculants into all U.S. MD-PhD programs was performed for self-reported sex and race/ethnicity, using Association of American Medical Colleges data for AYs 2009-2018, including an interaction for MSTP funding status (yes/no) and year. Linear regression of the percentage of programs matriculating no female or no URM students between AYs 2009 and 2018 was performed, focusing on programs in the top 3 quartiles by size (i.e., those matriculating 4 or more students per year). Between AYs 2009 and 2018, the percentage of matriculants to all MD-PhD programs who were female (38.0%-46.0%, 1.05%/year, P = .002) or URM (9.8%-16.7%, 0.77%/year, P < .001) increased. The annual percentage gains of URM matriculants were greater at MSTP-funded programs compared with non-MSTP-funded programs (0.50%/year, P = .046). Moreover, among MD-PhD programs in the top 3 quartiles by size, the percentage of programs with no female matriculants decreased by 0.40% per year ( P = .02) from 4.6% in 2009 to 1.6% in 2018, and the percentage of programs with no URM matriculants decreased by 3.41% per year ( P < .001) from 49% in 2009 to 22% in 2018. A consistent and sustained increase in the percentage of female and URM matriculants to MD-PhD programs from AYs 2009-2018 was observed, but the annual increases in the percentages across groups were small, and the demographics of the MD-PhD workforce still do not reflect the diversity of the U.S. general population.

Students who are enrolled in MD-PhD training programs face the same stressors and adverse experiences as medical students and graduate students and, additionally, have challenges unique to the dual-degree curriculum. These future physician-scientists can benefit from tailored training to help them manage these challenges. Thus, students in the Medical Scientist Training Program (MSTP) at Virginia Commonwealth University developed and implemented a student-led, administration-supported Wellness Initiative specifically for these trainees. The initiative has four aims designed to improve students’ wellbeing in all major aspects of their lives and to shift the culture of the MSTP to one with a greater focus on holistic wellness. The aims are achieved with four practical components: monthly wellness programming, a peer mentorship program, annual wellness goals for students, and a wellness resource guide. Together, these components help students build their social support network, facilitate vertical transmission of institutional and local knowledge, offer intentional check-ins that encourage students to seek help whenever needed, and encourage wellness and resiliency education that will aid students throughout their careers. Since its inception in 2019, student involvement in the wellness initiative has steadily increased, with promising annual program data suggesting that it has positively impacted our MSTP students and program culture. The success of the initiative is further reinforced by positive messaging and financial support from MSTP leadership. Student leaders within the initiative continue to innovate, ensuring the initiative remains flexible enough to meet new challenges within the MD-PhD training environment as they arise. The VCU MSTP Wellness Initiative, described herein as a framework for other institutions, is the first published model of a comprehensive wellness program specifically designed to address the unique needs of physician-scientist trainees.

Context: Despite equal enrollment proportions in MD and PhD programs, there are fewer women than men in MD-PhD programs and academic medicine. Factors important in degree program selection, including the perception of gender disparities, among undergraduate students were characterized. Methods: In 2017, women pre-health students at four public North Carolina universities were invited to participate in an online survey regarding career plans, decision factors, and perceptions of gender disparities in MD, PhD and MD-PhD pathways. This study characterizes factors important to program selection, and evaluates the association of intended graduate program with perceived gender disparities using Fisher’s exact tests. Results: Among the n=186 female survey participants, most were white (54 %) and intended MD, PhD, and/or MD-PhD programs (52 %). Sixty percent had heard of MD-PhD programs, over half had no research experience, and half were considering but uncertain about pursuing a research career. The most common factors influencing degree program choice were perceived competitiveness as an applicant, desired future work environment, and desire for patient interaction. Twenty-five percent of students considering MD, PhD, and MD-PhD programs stated that perceived gender disparities during training for those degrees will influence their choice of program, however intended degree was not statistically associated with perceived gender disparities. Discussion: Perceived gender disparities may influence choice of graduate training program but are not among the top factors. Perceived competitiveness as an applicant is an important career consideration among undergraduate women. Strategies to increase awareness of MD-PhD programs, to encourage women to consider all training paths for which they are qualified are needed. What is known: Though men and women are nearly equally represented in MD-only and PhD-only programs, women are underrepresented in MD-PhD programs, which train physician-scientists. Prior studies have shown gender is not associated with rates of attrition from MD-PhD programs or differences in academic preparation, research interest, or research experience, suggesting enrollment differences by gender may be due to fewer women applying to MD-PhD programs. Gender parity in the physician-scientist workforce is critical to equitably serving a diverse patient population. What this study adds: This study is the first to examine the role of gender disparities in the career choices of undergraduate women. Given the moderate familiarity with MD-PhD training and lack of research experience among respondents, increased awareness of MD-PhD programs and expanded research opportunities may help undergraduates make informed career choices. This may increase women MD-PhD applicants, creating a more balanced physician-scientist workforce to address the needs of patients from all backgrounds. Keywords: Education, Graduate, Sexism, Career Choice, Biomedical Research/education, Female

Clinician-scientists are doctors who perform laboratory-based or clinically oriented research and have direct patient contact. Not only do they play a critical role in the research and practice of translational medicine, but also they are the educators of the next generation of clinician-scientists. However, clinician-scientists are vanishing. It is urgent to train new clinician-scientists who can be engaged in clinic work, research, and also education. Thus, in order to correct understand the importance of the work of clinical scientists, from multi angle analysis of clinical scientists training problems that may be encountered in the process, the active improvement of the education system and condition, and sustained and efficient guidance to the outstanding seedlings are advocated. Besides, aspiring candidates are also encouraged to seek ideal guidance and support through their career, arrange their work reasonably, strengthen their cooperation and the management ability, and strive to grow into excellent clinician-scientists. Key words: Clinician-scientists; Translational medicine; Training

The declining number of physician scientists is an alarming issue. A systematic review of all existing programs described in the literature was performed, so as to highlight which programs may serve as the best models for the training of successful physician scientists. Multiple databases were searched, and 1,294 articles related to physician scientist training were identified. Preference was given to studies that looked at number of confirmed publications and/or research grants as primary outcomes. Thirteen programs were identified in nine studies. Eighty-three percent of Medical Scientist Training Program (MSTP) graduates, 77% of Clinician Investigator Training Program (CI) graduates, and only 16% of Medical Fellows Program graduates entered a career in academics. Seventy-eight percent of MSTP graduates succeeded in obtaining National Institute of Health (NIH) grants, while only 15% of Mayo Clinic National Research Service Award-T32 graduates obtained NIH grants. MSTP physician scientists who graduated in 1990 had 13.5 ± 12.5 publications, while MSTP physician scientists who graduated in 1975 had 51.2 ± 38.3 publications. Additionally, graduates from the Mayo Clinic's MD-PhD Program, the CI Program, and the NSRA Program had 18.2 ± 20.1, 26.5 ± 24.5, and 17.9 ± 26.3 publications, respectively. MSTP is a successful model for the training of physician scientists in the United States, but training at the postgraduate level also shows promising outcomes. An increase in the number of positions available for training at the postgraduate level should be considered.

Leadership skills are essential for a successful career as a physician-scientist, yet many MD–PhD training programs do not offer formal training in leadership. The Vanderbilt Medical Scientist Training Program (MSTP) previously established a 2-day leadership workshop that has been held biennially since 2006 for students in the first and second years of the graduate school portion of combined MD and PhD training (G1/G2 students). Workshop attendees have consistently rated this workshop as a highly effective experience. However, opportunities for structured training in leadership competencies during the subsequent 3–5 years of MD–PhD training are limited. Given the success of the G1/G2 leadership workshop and the need for continuity in this model of leadership training, we developed a half-day workshop for MSTP students in the clinical years of medical school (M3/M4 students) to foster continued training in leadership. Our workshop curriculum, based in part on original cases drafted by Vanderbilt MSTP students, provides concrete strategies to manage conflict and navigate leadership transitions in the physician-scientist career path. The curriculum emphasizes both short-term competencies, such as effective participation as a member of a clinical team, and long-term competencies, such as leadership of a research team, division, or department. Our inaugural senior leadership workshop, held in August, 2015, was judged by student participants to be well organized and highly relevant to leadership concepts and skills. It will be offered biennially in our training curriculum for M3 and M4 MSTP students.