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The Integration of Clinical and Research Training

How and Why MD–PhD Programs Work

Ng, Enoch, MD, PhD; Jones, Andrea A.; Sivapragasam, Milani; Nath, Siddharth; Mak, Lauren E., MSc; Rosenblum, Norman D., MD, FRCPC

doi: 10.1097/ACM.0000000000002467

For over 60 years, MD–PhD programs have provided integrated clinical and research training to produce graduates primed for physician–scientist careers. Yet the nature of this integrated training is poorly characterized, with no program theory of MD–PhD training to guide program development or evaluation. The authors address this gap by proposing a program theory of integrated MD–PhD training applying constructs from cognitive psychology and medical education. The authors argue that integrated physician–scientist training requires development of at least three elements in trainees: cognitive synergy, sense of self, and professional capacity. First, integrated programs need to foster the cognitive ability to synergize and transfer knowledge between the clinical and research realms. Second, integrated programs need to facilitate development of a unique and emergent identity as a physician–scientist that is more than the sum of the individual roles of physician and scientist. Third, integrated programs should develop core competencies unique to physician–scientists in addition to those required of each independently. The authors describe how programs can promote development of these elements in trainees, summarized in a logic model. Activities and process measures are provided to assist institutions in enhancing integration. Specifically, programs can enact the proposed theory by providing tailored MD–PhD curricula, personal development planning, and a supportive community of practice. It is high time to establish a theory behind integrated MD–PhD training as the basis for designing interventions and evaluations to develop the foundations of physician–scientist expertise.

E. Ng is an MD–PhD graduate, Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID:

A.A. Jones is an MD–PhD candidate, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

M. Sivapragasam is an MD–MSc candidate, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

S. Nath is an MD–PhD candidate, Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.

L.E. Mak is an MD–PhD candidate, School of Medicine, Queen’s University, Kingston, Ontario, Canada.

N.D. Rosenblum is professor, Departments of Pediatrics, Physiology, Laboratory Medicine, and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

The authors have informed the journal that they agree that Enoch Ng, Andrea A. Jones, and Milani Sivapragasam have completed the intellectual and other work typical of the first author.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Enoch Ng, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, Ontario, Canada, M5S 1A8; e-mail:

© 2019 by the Association of American Medical Colleges