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; firstname.lastname@example.org.
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.
1. Roberts SF, Fischhoff MA, Sakowski SA, Feldman EL. Perspective: Transforming science into medicine: How clinician–scientists can build bridges across research’s “valley of death.” Acad Med. 2012;87:266–270
2. Woolf SH. The meaning of translational research and why it matters. JAMA. 2008;299:211–213
3. Brass LF, Akabas MH, Burnley LD, Engman DM, Wiley CA, Andersen OS. Are MD–PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD–PhD programs. Acad Med. 2010;85:692–701
4. Brass LF professor. Department of Medicine, and associate dean and director, Combined Degree and Physician Scholars Program. University of Pennsylvania Perelman School of Medicine. 2011 Philadelphia, Pennsylvania Personal communication, April
5. Nagasako EM. Aligning academic medicine with the needs of the health care system by creating a cohort of physician–researchers in the social sciences. Acad Med. 2011;86:1346
6. Miller J. Career intentions of MD/PhD program graduates. JAMA. 2009;301:597