T H E   N I H    C A T A L Y S T     M A Y  –  J U N E   2008

C O M M E N T A R Y

 

NEEDED: A STRUCTURED TOP-NOTCH PROGRAM AT NIH
FOR THE ASPIRING PHYSICIAN-SCIENTIST

Bolanle Famakin

Training options for the physician aspiring to become an independent bench scientist is a topic that needs to be addressed for clinical fellows who are physicians pursuing basic science research at NIH. (For the record, “clinical fellows” fall into two categories: those enrolled in an ACGME-accredited clinical fellowship with some time allotted to research in the second and third years and those who have completed such a fellowship elsewhere and have come to NIH specifically to obtain training in basic science research.)

Currently, physicians who want to perform patient-oriented research can obtain a Masters in Clinical Research. However, there is a surprising dearth of options for the physician who has not gone the traditional M.D.-Ph.D. route and wants to pursue basic science research after a medical residency and fellowship.

 

Right now, the quality and relevance of training for clinical fellows who have come to NIH to gain experience in basic research depends largely on the mentor’s investment in the fellow’s objectives.

 

With no time-defined structured program that flexibly accommodates the physician’s research objectives, there is no guarantee he or she will acquire the desired research expertise or the tools to creatively ask and answer complex questions.

 

Physicians interested in pursuing a Ph.D. at this stage should be able to do so without having to take the same classes as a traditional Ph.D. student fresh out of undergrad, that is, participating in the Graduate Partnerships Program (GPP). And should a physician choose to pursue a Ph.D. through the GPP—a highly structured, full-time program—there is no provision for seeing patients on a limited basis in conjunction with coursework and basic research training.

 

NIH, with interested degree-granting institutions on board, can provide a program that enables the physician to pursue focused medical specialty–research—a program with targeted relevant coursework, some structured mentoring, time to see patients, and a Ph.D. offered at the end of a defined period of time.

 

Physicians who have completed their medical training can bring much more to basic science research, especially translational research, if given the opportunity to pursue Ph.D.-like basic research training at the end of their formal medical training. A physician at this point in training has defined scientific interests centered on a chosen subspecialty.  This situation contrasts with the traditional M.D.-Ph.D. route:  A student completes dissertation research without having chosen a medical specialty and therefore is not poised to formulate research questions relevant to a given medical field or disease process from the perspective of a health provider.

 

It is also more efficient to have physicians pursue basic science research training after they have completed all formal medical training and before they have secured a tenure-track position. During this transitional period, physicians can also still see patients on a limited basis and hence have the opportunity to pursue basic research questions bidirectionally—from bench to bedside and from bedside to bench. This route may also be more attractive to physicians interested in bench science than is the typical M.D.-Ph.D. pathway, which entails a lengthy period of up to nine years of consecutive training.

 

As things now stand, physicians interested in basic science research pursue this training largely on an ad hoc basis, diminishing their potential to contribute effectively to the translational research mission of NIH. They are also less able to compete with Ph.D. postdocs, who have up to nine years of bench training—four during their graduate training and up to five as postdocs—and who tend to receive most of the translational awards, for instance, the new K99/R00 awards.

 

This is an enormous loss that defies adequate assessment because these physicians tend to go quietly into the world of patient care—and as a result the field of translational medicine to bridge the gap between bench and bedside continues to advance at a snail’s pace.

Bolanle (Bola) Famakin

Clinical Fellow

Stroke Branch, NINDS

 

 

Ed.response: Ten years ago, NICHD physician–scientist Tracey Rouault worked with a group of NIH scientists to propose a program to bring physician–scientists into NIH labs.  Some ICs have begun to do that, but there is not an NIH-wide program.  She wrote at that time:  “Much has been written about the shortage of MD researchers. We argue that the NIH intramural program is uniquely qualified to address this critical issue.  The NIH intramural program was critical in providing MD researchers to medical centers in the 1950s–1980s, and we can play that role again if we design a modern research fellowship program.”  The time has come to craft such a program.

—Michael Gottesman

Deputy Director for Intramural Research

 


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