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From Subsistence to Sustenance in Physician–Scientist Training

Patel, Chirag B., MD, PhD, MSE

doi: 10.1097/ACM.0000000000002139
Trainee-Authored Letters to the Editor
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Neuro-oncology fellow, Department of Neurology and Neurological Sciences, and postdoctoral scholar, Department of Radiology, Stanford University School of Medicine, Stanford, California; cbpatel@stanford.edu.

Disclosures: None reported.

To the Editor: For physician–scientists, transitions between one training phase and the next evoke a sense of déjà vu as a result of the jarring cyclical descents from proficiency to inexperience. Whether transitioning from the successful PhD defense to the bewilderment of the first clinical clerkship, or from the completion of a clinical fellowship/postdoc to the steep learning curve of running a nascent lab, physician–scientists-in-training acquiesce in their existence as perpetual novices. The cyclical descents between transition points theoretically become shallower and less frequent over the course of training, until the idealized physician–scientist who can seamlessly shift between both worlds multiple times throughout the day finally emerges. This nostalgic portrait of the physician–scientist is itself in transition, evolving into today’s reality of weekly compartmentalization (e.g., two clinical half-days) and increasing regulatory compliance demands in patient care and research.1

Subsisting as a physician–scientist trainee is inadequate and unsatisfying. More support is required to decrease the 10% attrition rate2 that renders the training pipeline leaky, and to reduce the almost 25% of MD/PhD trainees who have “ever seriously considered leaving” their training program.3 MD/PhD trainees report that in addition to the inherent challenges of physician–scientist training, many other obstacles (e.g., balancing family/work and clinical/research/education responsibilities) and individual obligations (e.g., raising children, taking care of elderly parents, providing financial support to others) influence their ultimate career choice.4 An increased recognition of such personal challenges and, more importantly, programmatic improvements that buffer against them would provide one form of practical assistance to physician–scientist trainees.5 At each transition point, physician–scientist training programs should coevolve with the rapidly transforming health care delivery and translational research landscapes to best prepare trainees to fulfill the missions of providing excellent patient care and conducting quality translational and/or clinical research.

Chirag B. Patel, MD, PhD, MSE

Neuro-oncology fellow, Department of Neurology and Neurological Sciences, and postdoctoral scholar, Department of Radiology, Stanford University School of Medicine, Stanford, California; cbpatel@stanford.edu.

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References

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2. 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.
3. Ahn J, Watt CD, Man LX, Greeley SA, Shea JA. Educating future leaders of medical research: Analysis of student opinions and goals from the MD–PhD SAGE (Students’ Attitudes, Goals, and Education) survey. Acad Med. 2007;82:633–645.
4. Kwan JM, Daye D, Schmidt ML, et al. Exploring intentions of physician–scientist trainees: Factors influencing MD and MD/PhD interest in research careers. BMC Med Educ. 2017;17:115.
5. Daye D, Patel CB, Ahn J, Nguyen FT. Challenges and opportunities for reinvigorating the physician–scientist pipeline. J Clin Invest. 2015;125:883–887.
© 2018 by the Association of American Medical Colleges