Letters to the Editor
We thank the authors for their insightful comments and suggestions for further inquiry regarding the predictive validity of our findings relating to career plans of MD–PhD students in U.S. medical schools. We agree that other institution-specific factors, beyond a particular medical school's status regarding Medical Scientist Training Program (MSTP) funding, may well contribute to the gender and racial/ethnic diversity of any single school's MD–PhD cohort. However, school-level data provided to us were limited to protect the identities of individual students and medical schools. Since we lacked institutional identifiers, we could not investigate the extent to which greater diversity among MD–PhD students in MSTP-funded schools was due to MSTP funding or to other school characteristics, but this question merits exploration. We obtained information about whether a medical school was in the top 40 institutions funded by the National Institutes of Health (NIH) during the matriculation years of our study population, but this variable was highly associated with MSTP-funding status: 94% of long-standing MSTP-funded, 42% of recent MSTP-funded, and 9% of non-MSTP-funded institutions were in the top 40 NIH-funded research institutions. Thus, we did not include the top 40 designation in our models to avoid overfitting the data.
We agree that the institutional environment likely plays an integral role in the development of physician–scientists. Institutional factors other than financial support of MD–PhD students (e.g., mentoring, research resources, other social and environmental characteristics of the institution) may well be influential in promoting students' development as physician–scientists. But the extent to which this may be true is an empirical question requiring further study.
Finally, in an earlier multiinstitutional study of six midwestern medical schools' graduates,1 we reported the predictive validity of the career-intention item of the Association of American Medical Colleges (AAMC) Graduation Questionnaire on the outcome of full-time-faculty appointment using AAMC Faculty Roster data. The predictive validity of this career-intention item nationally among MD–PhD graduates, specifically, is the subject of ongoing research. Inclusion of career-intention information from the AAMC Matriculating Student Questionnaire could further our understanding of the role of the medical school environment in the evolution of the career paths of MD–PhD program enrollees.
Donna B. Jeffe, PhD
Research associate professor of medicine, Washington University School of Medicine, and director, Health Behavior, Communication, and Outreach Core, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri; email@example.com.
Dorothy A. Andriole, MD
Assistant dean for medical education and associate professor of surgery, Washington University School of Medicine, St. Louis, Missouri.
1. Andriole DA, Jeffe DB, Hageman H, et al.. Variables associated with full-time faculty appointment among contemporary U.S. medical graduates: Implications for academic medicine workforce diversity. Acad Med. 2010;85:1250–1257.