Clinician-scientist Training Research Articles

Professional Identity Formation and the Clinician-Scientist: A Paradigm for a Clinical Career Combining Two Distinct Disciplines.

The clinician-scientist role is critical to the future of health care, and in 2010, the Carnegie Report on Educating Physicians focused attention on the professional identity of practicing clinicians. Although limited in number, published studies on the topic suggest that professional identity is likely a critical factor that determines career sustainability. In contrast to clinicians with a singular focus on clinical practice, clinician-scientists combine two major disciplines, clinical medicine and scientific research, to bridge discovery and clinical care. Despite its importance to advancing medical practice, the clinician-scientist career faced a variety of threats, which have been identified recently by the 2014 National Institutes of Health Physician Scientist Workforce. Yet, professional identity development in this career pathway is poorly understood. This Perspective focuses on the challenges to the clinician-scientist's professional identity and its development. First, the authors identify the particular challenges that arise from the different cultures of clinical care and science and the implications for clinician-scientist professional identity formation. Next, the authors synthesize insights about professional identity development within a dual-discipline career and apply their analysis to a discussion about the implications for clinician-scientist identity formation. Although not purposely developed to address identity formation, the authors highlight those elements within clinician-scientist training and career development programs that may implicitly support identity development. Finally, the authors highlight a need to identify empirically the elements that compose and determine clinician-scientist professional identity and the processes that shape its formation and sustainability.

MD/PhD Training in Canada: Results from a national trainee and program director review.

There has been limited examination of clinician scientist training in Canada, particularly regarding training integration and funding. This study assessed program structure, funding, tuition and mentorship structures available at Canadian MD/PhD programs. Clinician Investigator Trainee Association of Canada administered an anonymous survey to current trainees and program directors that captured program structure, trainee funding, tuition and mentorship opportunities and needs across institutions. In June 2015, 101/228 (44%) trainees and 9/13 (69%) program directors completed the online survey. In all programs, students completed the PhD degree prior to clerkship training. Seven programs offered research training upon completion of pre-clerkship, four offered concurrent clinical and research training, and three offered alternative structures. Nine held seminars exposing students to clinical and research integration and two offered clinician scientist skills courses. Stipend funding and tuition varied, especially during clinical training years. Regarding mentorship, all programs held regular meetings, though eight programs do not have formal mentorship opportunities. Both trainees and program directors identified the need for further career planning and development support as a student priority. MD/PhD programs varied by program structure, funding, tuition and mentorship opportunities. Mechanisms to share and spread program innovations should be instated. Students may benefit from concurrent research and clinical training as well as courses specific to clinician scientist skill development. Decreasing debt burden may attract and retain trainees in this demanding path. To ensure mentorship programs align with trainee priorities, program directors should directly collaborate with students in their development and evaluation.

Training of clinician-scientists

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

Personalized medical education: Reappraising clinician-scientist training.

Revitalizing the Oslerian ideal of the clinician-scientist-teacher may help in the training of the next generation of translational researchers.

The Canadian clinician-scientist training program must be reinstated.

Clinical investigators within the Canadian and international communities were shocked when the Canadian Institutes of Health Research (CIHR) announced that their funding for the MD/PhD program would be terminated after the 2015-2016 academic year. The program has trained Canadian clinician-scientists for more than two decades. The cancellation of the program is at odds with the CIHR's mandate, which stresses the translation of new knowledge into improved health for Canadians, as well as with a series of internal reports that have recommended expanding the program. Although substantial evidence supports the analogous Medical Scientist Training Program in the United States, no parallel analysis of the MD/PhD program has been performed in Canada. Here, we highlight the long-term consequences of the program's cancellation in the context of increased emphasis on translational research. We argue that alternative funding sources cannot ensure continuous support for students in clinician-scientist training programs and that platform funding of the MD/PhD program is necessary to ensure leadership in translational research.

Retaining clinician-scientists: nature versus nurture.

In their IOVS article "Rejuvenating Clinician-Scientist Training" (published March 28, 2014), Balamurali Ambati and Judd Cahoon rightly point out the dearth of new clinician-scientists in ophthalmology. Within the context of their suggestions for increasing the number of successful clinician-scientists, they claim that the traditional MD-PhD training programs and K awards have failed to produce individuals who will carry on the important work of clinically relevant research that will improve patients' lives and sight. In this response we present data, including information on the career paths of graduates of the Washington University ophthalmology residency, that call into question the presumed failure of MD-PhD and K award programs and show that, in fact, graduates of these programs are more likely to succeed as clinician-scientists than are their peers who have not trained in such scientifically rigorous environments. We propose that, rather than a failure of early training programs, it may be obstacles that arise later in training and among junior faculty that prevent promising careers from reaching maturity. Funding, one rather large obstacle, takes the form of imbalanced start-up monies, less National Institutes of Health (NIH) funding awarded to young investigators, and study section composition that may work against those with clinically driven questions. We also explore the challenges faced in the culture surrounding residency and fellowship training. We agree with Ambati and Cahoon that there needs to be more innovation in the way training programs are structured, but we believe that the evidence supports supplementing the current model rather than scrapping it and starting over with unproven initiatives. The data on training programs supports the contention that those who have already made substantial investment and commitment to the clinician-scientist pathway through participation in MSTP or K training programs are the most likely to succeed on this career trajectory. To muffle the siren song of private practice and retain those best prepared for the clinician-scientist pathway requires additional investment as their careers mature through protected research time, mentorship, and advocacy.

Research-track programs for residents in psychiatry: a review of literature and a report of 3 Canadian experiences.

Clinician-scientists occupy an interesting position at the interface between science and care, and have a role to play in bridging the 2 valleys between fundamental and clinical research, and between clinical research and clinical practice. However, research training during medical residency for future clinician scientists is an important but challenging process. Our article, written by residents and directors of research-track (RT) programs, aimed at reviewing literature on RT programs for residents, and describing the organization of RT programs at 3 Canadian universities (the University of British Columbia, the University of Toronto, and McGill University). A systematic MEDLINE search was conducted for the review section. Psychiatry program directors in Canada were also contacted to provide information about potential RT programs. Twenty articles were related to resident RT programs in medicine, including 6 in psychiatry. Moreover, 5 out of 16 Canadian programs were found to offer a formal RT program, of which 3 are described here. Most reviewed articles described the program organization, while only one provided an outcome assessment with evidence of increased scholarly activity following RT implementation. Our article sheds light on postgraduate programs aiming at facilitating the dual training of future clinician-scientists, and developed during the last 10 years. It also highlights the lack of outcome assessment, and the paucity of guidelines to organize these programs in relation to the national requirements.

Rejuvenating Clinician-Scientist Training

Clinician-scientists are becoming increasingly rare in medicine as a whole, but especially in ophthalmology. There is a structural gap between MD-PhD training and K-series awards where interested candidates go through residency and fellowship without any structured research exposure or involvement. Furthermore, the success rate of the MD-PhD and K awards leaves much to be desired. The authors propose a redeployment of training resources to reconfigure residency and fellowship training programs for interested candidates with sufficient additional time for a credible research project, augmented salary, and sound mentoring. Opportunities for research training in nontraditional pathways to diversify skill sets and build interdisciplinary teams also would be a prime objective of this novel "Learn-and-Earn" approach.

Doctoral training in Uganda: evaluation of mentoring best practices at Makerere university college of health sciences

BackgroundGood mentoring is a key variable for determining success in completing a doctoral program. We identified prevailing mentoring practices among doctoral students and their mentors, identified common challenges facing doctoral training, and proposed some solutions to enhance the quality of the doctoral training experience for both candidates and mentors at Makerere University College of Health Sciences (MakCHS).MethodsThis cross-sectional qualitative evaluation was part of the monitoring and evaluation program for doctoral training. All doctoral students and their mentors were invited for a half-day workshop through the MakCHS mailing list. Prevailing doctoral supervision and mentoring guidelines were summarised in a one-hour presentation. Participants were split into two homogenous students’ (mentees’) and mentors’ groups to discuss specific issues using a focus group discussion (FGD) guide, that highlighted four main themes in regard to the doctoral training experience; what was going well, what was not going well, proposed solutions to current challenges and perceived high priority areas for improvement. The two groups came together again and the note-takers from each group presented their data and discussions were recorded by a note-taker.ResultsTwelve out of 36 invited mentors (33%) and 22 out of 40 invited mentees (55%) attended the workshop. Mentors and mentees noted increasing numbers of doctoral students and mentors, which provided opportunities for peer mentorship. Delays in procurement and research regulatory processes subsequently delayed students’ projects. Similarly, mentees mentioned challenges of limited; 1) infrastructure and mentors to support basic science research projects, 2) physical office space for doctoral students and their mentors, 3) skills in budgeting and finance management and 4) communication skills including conflict resolution. As solutions, the team proposed skills’ training, induction courses for doctoral students-mentor teams, and a Frequently Asked Questions’ document, to better inform mentors’, mentees’ expectations and experiences.ConclusionSystemic and infrastructural limitations affect the quality of the doctoral training experience at MaKCHS. Clinical and biomedical research infrastructure, in addition to training in research regulatory processes, procurement and finance management, communication skills and information technology, were highlighted as high priority areas for strategic interventions to improve mentoring within doctoral training of clinician scientists.

Additional Perspectives on Transforming Science Into Medicine

To the Editor: We read with interest Roberts and colleagues’ recent article1 on how a growing disconnection between clinical and research activities impedes effective translational research. We agree with the authors’ promotion of dual-degree (i.e., MD–PhD) training in clinical and basic sciences to address this problem. However, we wish to call attention to an equally important consideration the authors did not address: dual-degree training of clinicians in population health. Translational research consists of at least two distinct processes: the transfer of basic science findings into understanding about disease, diagnosis, and intervention; and the transfer of this understanding into clinical practice and decision making. The latter process requires tools and techniques of population-health-oriented disciplines.2 Why is training in both clinical medicine and population health necessary? The transformation of “biomedical research discoveries into tangible clinical treatments and technologies,” as envisioned by Roberts and colleagues,1 requires that we ask which treatments and technologies work best—as well as what “best” means—and how they can be adopted. These questions require a realistic understanding of clinical practice in addition to the methods of population health. We are not alone in recognizing the importance of dual-degree training in population health. Data collected in 2007–2008 from 24 medical scientist training programs funded by the National Institutes of Health show that the number of institutions graduating MD–PhD students in epidemiology has more than doubled since the 1990s.3,4 Moreover, there continue to be calls for increased clinician–scientist training in epidemiology and other population-health-oriented disciplines, including health economics and health policy.5,6 We suggest that efforts toward improving translational research that do not include training of clinician–scientists in population health may miss the mark. Only by training clinician–scientists across the spectrum of translational research can we fully address the disconnect between clinical and research activities and foster both clinically relevant research and evidence-based clinical practice. Matthew A. Rysavy, BS MD–PhD candidate in epidemiology, Medical Scientist Training Program, Department of Epidemiology, Carver College of Medicine and College of Public Health, University of Iowa, Iowa City, Iowa; [email protected] Paul J. Christine, MPH MD–PhD candidate in epidemiology, Medical Scientist Training Program, University of Michigan Medical School and School of Public Health, University of Michigan, Ann Arbor, Michigan. Naman K. Shah, BSPH MD–PhD candidate in epidemiology, Medical Scientist Training Program, University of North Carolina School of Medicine and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

Increasing Complexity of Clinical Research in Gastroenterology: Implications for the Training of Clinician-Scientists

Significant advances have been made in clinical and epidemiologic research methods over the past 30 years. We sought to demonstrate the impact of these advances on published gastroenterology research from 1980 to 2010. Twenty original clinical articles were randomly selected from each of three journals from 1980, 1990, 2000, and 2010. Each article was assessed for topic, whether the outcome was clinical or physiologic, study design, sample size, number of authors and centers collaborating, reporting of various statistical methods, and external funding. From 1980 to 2010, there was a significant increase in analytic studies, clinical outcomes, number of authors per article, multicenter collaboration, sample size, and external funding. There was increased reporting of P values, confidence intervals, and power calculations, and increased use of large multicenter databases, multivariate analyses, and bioinformatics. The complexity of clinical gastroenterology and hepatology research has increased dramatically, highlighting the need for advanced training of clinical investigators.

Clinician-Scientist Trainee: A German Perspective

Clinician-scientists are particularly well positioned to bring basic science findings to the patient's bedside; the ultimate objective of basic research in the health sciences. Concerns have recently been raised about the decreasing workforce of clinician-scientists in both the United States of America and in Canada; however, little is known about clinician-scientists elsewhere around the globe. The purpose of this article is two-fold: 1) to feature clinician-scientist training in Germany; and 2) to provide a comparison with the Canadian system. In a question/answer interview, Rory E. Morty, director of a leading clinician-scientist training program in Germany, and Katrin Milger, a physician and graduate from that program, draw a picture of clinician-scientist training and career opportunities in Germany, outlining the place of clinician-scientists in the German medical system, the advantages and drawbacks of this training, and government initiatives to promote training and career development of clinician-scientists. The interview is followed by a discussion comparing the German and Canadian clinician-scientist development programs, focusing on barriers to trainee recruitment and career progress, and efforts to eliminate the barriers encountered along this very demanding but also very rewarding career path.

Clinician‐scientist training: A perspective from across the pond

Clinician‐scientist training: A perspective from across the pond

Neurologie zwischen Klinik und Forschung

There is currently a lot of discussion about the organisation of cutting-edge medicine in Switzerland. Academic medicine has traditionally been at the forefront of medical advances and given the remarkable progress and opportunities in clinical neuroscience, the field of neurology has exploded in recent years. Clinician-scientists play a unique role in medical research. Notable examples of accomplishments by clinician-scientists in neurology are listed. The author focuses especially on progress that has been made in his special area of expertise, neuroimmunology. Building on the historical contributions of such prominent clinicians as Adolf Kussmaul and Robert Bing, the astonishing advances that have been made in the diagnosis of neuroinflammatory conditions, such as Guillain-Barre syndrome, other immune-mediated neuropathies and multiple sclerosis, are reviewed. Other areas of remarkable innovation in diagnosis and treatment, such as cerebrovascular disorders, are discussed. The ever increasing bureaucracy in medical practice has put the clinician-scientist in a difficult situation. Neurology has the added problem that increasing demands from postgraduate clinical education, with required extended rotations in clinical neurophysiology, have put the career pathway of clinician-scientist in jeopardy. The challenge is to find new ways to support clinician-scientist training programme in neurology in Switzerland.

The cardiopulmonary system: research and training opportunities

The new biology has the potential to provide mechanistic insights into the causes and progression of complex cardiopulmonary diseases such as congenital heart disease and bronchopulmonary dysplasia. Such research requires collaborative investigation supported by sophisticated infrastructures and core facilities. Translating basic observations to clinical outcomes will require networks for collaborative translational research. The research initiatives require excellently trained and motivated clinician-scientists, but there are numerous barriers to the training and support of clinician-scientists in cardiology and neonatology.

Clinician–Scientist Training Opportunities Available through the National Institute of Health

Clinician–Scientist Training Opportunities Available through the National Institute of Health

A graduate student's, graduate program director's, and chairman's perspective of the Dentist Scientist Award program

The Dentist Scientist Award (DSA) program was introduced as an innovative mechanism of support and structure to meet the critical demand for the training of expert clinician scientists. This article presents an overview of the University of North Carolina's DSA program as it relates to the Department of Prosthodontics and the graduate program in prosthodontics. Recruitment of DSA candidates for the program and for faculty positions is described.