Everything you wanted to know about MD-PhD Programs but were afraid to ask Jim Gorham, MD PhD Director, The MD-PhD Program at the Geisel School of Medicine at Dartmouth Dartmouth College May 14, 2012

1.Physician-Scientist Career Paths 2.Preparing your application to MD-PhD Programs 3.Evaluating MD-PhD Programs

Part 1: Physician- Scientist Career Paths MD versus PhD versus MD-PhD

Preclinical Phase Clinical Phase Graduation Post-Graduate Internships/Residencies Fellowships (Specialize) MD Course of Training

PhD Course of Training First Year Graduate Coursework Lab Rotations, Choose Thesis Lab Second Year Complete Graduate Coursework Qualifying Examination Years 2-5 Full-Time Bench Research Thesis Committee Meetings Teaching Assistantships Write Papers and Thesis Thesis Defense

Mission: Provide integrated education and training of individuals to become physician-scientists prepared to bridge the gap between laboratory research and clinical medicine. RESEARCH: Basic Research Disease-Oriented Research Patient-Oriented Research Population-Oriented Research TEACHING: Basic Science Clinical Disciplines CLINICAL MEDICINE: Generalist >Specialist MD-PhD Training WHAT IS THE MD-PhD OPTION?

College Student Physician- Scientist MD-PhD MD PhD Pathways to become a Physician-Scientist or Clinical Investigator Clinical Research

MD-PhD vs MD:Structured research training What is special about MD-PhD education and training? MD-PhD Training MD-PhD vs PhD:Understanding of human biology ( how normal and abnormal function result from complex interactions at many levels of specialization )

Clinicians’ perception of MD-PhD students? They all become basic scientists… MD-PhD Training Basic scientists’ perception of MD-PhD students? They all become clinicians… Conclusion? We must be doing something right… Differing perceptions of MD-PhD training and training outcomes

RESEARCH CLINICAL MEDICINE ADMINISTRATION Student MD-PhD Training Basic Translational Clinical Epidemiological Industrial R&D Academic Industry Public Policy MD-PhD Training

ADVANTAGES: DISADVANTAGES: FULL FINANCIAL SUPPORT: MD-PhD Training Broad education in human biology Broad range of career choices Very long education and training Difficult-to-manage conflicting pressures from laboratory, clinical responsibilities, and family Enables careers in academic medicine (but this is not a free lunch)

Preclinical Coursework Explore Research Opportunities Laboratory Rotations Choice of Thesis Advisor National Board Exam Clinical Clerkships Preclinical Phase – Years 1-2

Graduate Coursework Bench Research and Publication Explore Clinical Interests (medical specialties) -/+ Clinical Experience (limited) Research Phase – Years 3-6

Clinical Clerkships Residency Application Graduation Clinical Phase – Years 7-8

Medicine Surgery (including subspecialties) Ob/Gyn Pediatrics Neurology Psychiatry Primary Care Medicine Subinternship Senior Electives MonthsTotal time M3 Year M4 Year Clinical Phase – Years 7-8

MD-PhD vs MSTP What is a Medical Scientist Training Program? 109 MD-PhD Programs (42 MSTPs, 67 non-MSTP) NIH funded MSTP Training Grant

Part 2: Preparing your application. Making sure you are the applicant that programs will take a second look at

What MD-PhD Programs Seek Strong academics (of course) MCAT’s Plus Passion for Science Research Experience Clinical Experience Leadership Commitment to Serving Others

The To Do List Coursework Research Clinical Exposure Community Service Extras Recommendations

Research - Academic Year Summer Opportunities Post-undergraduate

Posters, Oral Presentations & Publications

The MD-PhD Application How to get the coveted offer of acceptance…

MD-PhD Application APPLY EARLY, APPLY EARLY, APPLY EARLY, APPLY EARLY, APPLY EARLY!! Universal MD-PhD application available on AMCAS. Personal Statements Letters of recommendation GPA and MCAT Publications help Secondary forms

Personal Statements Personal Statement – Individual characteristics, experiences and motivations for choosing a career as an MD/PhD. Discuss unique life experiences or skills Why I Want to be an MD/PhD – Explain rationale for wanting to become an MD/PhD. Discuss generally how you envision using the combined degree in the future (specifics not necessary). Research Experience - Describe any and all research experiences you have had. Provide clear timelines for each experience Discuss your role(s) in the research project.

The Interview During the MD/PhD interview: Try to talk with as many as possible research faculty in your area of interest Ask lots of questions to the students in the program –  they are the best indicator of whether a program has any major issues Be prepared to discuss your research in-depth  You should know the big picture as well as the experimental details Be prepared to discuss your rationale for choosing the MD/PhD track Be personable  engage both the faculty and students in one-on-one conversation about science and extracurricular activities

AAMC - Admissions Data About 2K MD/PhD applicants nationally Of these, about one-half (1K) are offered an interview with at least one MD-PhD Program. Of these, about 2/3 rd are offered admission to at least one MD-PhD Program.

AAMC – National Statistics Nationally, there are about: 4,500 MD-PhD students, of which:  ~12% are underrepresented minority  ~40% are female

Part 3: Evaluating an MD-PhD Program In which program will you not only survive but thrive

Location Geography –  Close to family  Housing availability, proximity, affordability  Variety of extracurricular activities  Proximity to things that matter to you

School - Academics Curriculum -  Preclinical coursework  Clinical requirements (Clerkships/Electives) Patient populations and clinical facilities Flexibility Graduate Programs –  Coursework requirements  # of required lab rotations Residency Placement of Alumni

Faculty Are there sufficient faculty who share your interests? Is there a strong research community? Collaboration Training record (time to degree)

Strengths of MD-PhD Program Program Director’s commitment to program Administrative support Support from Dean/Administration Supplemental program opportunities - seminars, lectures, programs, socials

Gut Feeling In the end, you will almost certainly make your decision based on a gut feeling, and then find rational arguments to support it. And that is the way it should be.

Questions…Concerns? The Complete Guide to the MD/PhD Degree Ben Rosner MD, PhD Jayakar Nayak MD/PhD J&S Publishing