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January 6, 1999

Bridging the Worlds of Medicine and Science: An Interview With Bert I. Shapiro, MD

Author Affiliations

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JAMA. 1999;281(1):98-99. doi:10.1001/jama.281.1.98-JPU2-3-1

Q. How has the Medical Scientist Training Program (MSTP) changed over time in its goals, strategies, research focus, and applicant pool in response to the changing health care climate?

A. The basic MSTP goals have not changed, although our program announcement has recently been updated to emphasize "nontraditional" fields of doctoral study, such as biomedical engineering and epidemiology, that have always been acceptable for combined-degree training. Other fields, such as medical economics and bioethics, are relevant to medicine but fall outside the area of biomedical research. In the increasingly complex world of health care delivery, we believe that students in these fields can provide an important contribution to society.

The applicant pool for the MSTP has always been strong, and my impression is that it is becoming stronger yet. We are seeing a significant number of trainees entering the MST programs with backgrounds in the physical sciences and engineering. This has resulted in an increase in the number of students entering graduate programs in biomedical engineering, biophysics, and neuroscience. A significant number of MSTP students with PhDs in some area of engineering are choosing residencies in radiology.

Q. Sutton and Killian1 recently reported that the proportion of MSTP graduates doing laboratory research vs clinical research resembles that of graduates with PhDs only. How does this relate to the MSTP's primary goals of training physician-scientists?

A. The recent study considers all laboratory research to be equivalent and provides a rather strict definition of "clinical" research as that which focuses on patient care. Someone looking at tumor vascularization or Salmonella toxin secretion is considered a "laboratory researcher" according to this characterization. However, I would argue that a researcher on either of the above problems, who is board certified in medicine, sees patients (as do over half the MSTP graduates), has an appointment in a clinical department, teaches medical students and perhaps even some residents, and collaborates with medical colleagues, is indeed a physician-scientist.

MSTP students can, and do, select their doctoral area from a wide array of graduate programs available at the grantee institutions, but most students select topics that are medically or disease related. We hope that MSTP graduates are more than physicians plus scientists, but rather researchers who can bring together the unique perspectives of medicine and basic research. There are many bench-to-bed and bed-to-bench transfers that require a combination of medical and research understanding that MSTPs can provide.

Current MSTP training provides students with many opportunities to ask questions about the clinical potential of basic discoveries, as well as the basic questions raised by clinical observations. Most programs have incorporated these issues into regular seminars, retreats, and workshops where speakers and discussants provide numerous and diverse examples of successful translational efforts. MSTP graduates are also entering highly selective residencies, often with arrangements to integrate research with their clinical training. I believe that these residencies, and the subsequent clinical fellowships chosen by 70% of the MSTP graduates, are outstanding opportunities for the appropriate training.

We recently compared the career outcomes of MSTP graduates with a matched group of PhD graduates who had received their degrees from the same programs or departments as the MSTP graduates and were also supported by National Institutes of Health National Research Service Award Act funds. The MSTP graduates were about 3 times more likely to have published in clinical (eg, Journal of Nephrology) and mixed (eg, JAMA, Pediatrics) journals. I judge that the program has trained and continues to train physician-scientists who play a crucial role in bridging the two worlds of science and medicine.

Dr Shapiro is the director of the MSTP at the National Institute of General Medical Sciences. This is an excerpt; full text of the interview is available at the MSJAMA Web site.
Sutton  JKillian  CD The MD-PhD reseachers: what species of investigator?  Acad Med. 1996;71454- 459Article