December 18th, 2014

Should dual degree training exist?

By Andrew M. Harrison

By Andrew M. Harrison

No, I will not be writing about the illustrious EdD-JD. However, please note these are both largely regarded as “professional” doctoral degrees in the US. Although still less relevant in the US, you should know the difference, as most of the rest of the world draws a clear distinction between a research doctorate and a “first professional degree”.

As data interferes with effecting social changes (for better or worse), and blogs are by nature not designed to be lengthy, let’s get this part out of the way first and fast. More Commentaries on the subject of MD-PhD training have been published in the academic literature than I care to discuss. The most comprehensive report to date is presumably the 143-page 2014 NIH Physician-Scientist Workforce Working Group Report. Stated to be inspired by the 156-page 2012 NIH Biomedical Research Workforce Working Group Report and amazingly no reference to the fact 2014 also happens to mark the 50th anniversary of the NIH Medical Scientist Training Program. To date, I am aware of no formal, comprehensive NIH history of the MSTP…

To the anecdotes: effectors of social change. My interest in this subject began in the summer of 2010, literally one week after I began MSTP training, with the publication of an economist-centric article in Pacific Standard (then Miller-McCune) magazine, documenting postdoctoral fellows as essentially the most overqualified, underpaid workforce in the US. As an already committed “molecular biologist”—undergraduate honors thesis and multiple summer undergraduate research experiences, including at Mayo Clinic—I was intrigued. However, the real eye-opener came when I was “volunteered” with my classmate, Bennett G. Childs, to co-host the Mayo Clinic MD-PhD Program’s Annual Bench to Bedside Lecture (lecture by Dr. Olaf S. Andersen at this link, on Mayo Clinic intranet only). Buried in the MD-PhD training literature I summarily dismissed above, I discovered Dr. Andersen had co-authored a publication in April 2010 in Academic Medicine, the official journal of the Association of American Medical Colleges, entitled “Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs.” Accurate or not, my interpretation at that time: almost all MD-PhD graduates become physicians, but very few become “scientists”.

Today, my opinions are skewed by many factors: current Year 5 MSTP student*, participant in the National MD-PhD Student Conference, member of the Executive Council of the American Physician Scientists Association (the “other” MD-PhD student conference), and countless interactions with dual degree trainees, graduates, and directors across the US. As for the content of this skewed opinion: I dismiss current, anecdotal arguments that dual degree training, partially funded by the NIH MSTP at many institutions, should be replaced by individual National Research Service Awards, such as the NIH F30. Instead, my own anecdotal argument: the heyday of classic “molecular biology” as the model for dual degree trainees is over. As best as I can divine, with limited formal historical documentation from 1964, MSTP was designed to be “molecular biology, by molecular biologists, for molecular biologists”.

As a failed essayist in the Lasker Foundation’s first-ever 2014 Essay Contest ("innovative ways to build support and ensure funding for medical research"), it would seem the “scientific” community is interested in vagaries such as tax credits for pharmaceutical companies and “innovative” molecular biologists. However, my approach is radically different. In my simple mind, “science” (the hypothesis driven discovery of new knowledge) and “engineering” (the problem-solving driven exploitation of existing knowledge) both fall under the larger umbrella of “research”. This umbrella, which encompasses much more than molecular biology, must be radically expanded to include far more dual degree training in “low level” (math, physics, computer science) and “high level” (sociology, political science, economics) areas of “research”. In my view (lengthy rationale for another time and probably place), progress in these areas of research represents the true rate-limiting factor to improving “medical research” and, more importantly, the health of our society in general. Also for another time and place: dual degree training would make so much more sense if trainees completed the PhD after the MD and medical residency/fellowship training*.

What is ResearchA simple-minded schematic I first created for a presentation for high school students (summer 2013).

I will conclude with two final anecdotes. Both are directly related to diversity. First, I have edited, but not written (here and here), two blog posts on the subject of AI/AN (“Native American”) diversity in education, after attending Annual Meetings of the Association of American Indian Physicians. At both meetings, as well as Spirit of EAGLES 2013, I interacted with many students interested in pursuing dual degree training, but unable to easily do so, largely due to research interest in subjects such as public heath, public policy, and even philosophy. Do these students and their research interests have any place in dual degree training? Second, I refer you to Harvard University’s pioneering dual degree program in Social Sciences-Humanities (“SSH”). Some of the earliest graduates of the “medical anthropology” arm of this program include contemporary leaders in both medicine and global health, such as Dr. Paul Farmer and Dr. Jim Kim. Although dual degree training programs in SSH currently appear to exist at multiple institutions, my understanding is most are underfunded, inactive, or largely defunct…

Andrew M. Harrison is one of the co-managers of Mayo Clinic’s Diversity in Education Blog and a student in the Medical Scientist Training Program at Mayo Clinic.

*Acknowledgement: Although they did not directly contribute to this post, my research doctorate mentors (Drs. Herasevich, Gajic, and Pickering), who I have known since the first year of my professional doctorate training, have expanded my thoughts on this subject in a way I can only hope to experience again.

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Joined: Oct 01, 2014
Posted by @tandatdu, Dec 19, 2014

Mr. Harrison, I commend your attempt to tackle this subject, but you’re missing the big picture.

I’ll assume that “your” answer to your own over-arching question is yes, dual-degree training should exist. And I agree with you. Although on a more informal plane, dual-degree training has existed for hundreds of years, and a decent physician or scientist worth his salt such as Vesalius, Galen or Louis Pasteur were all trained in multiple disciples, most of which were self-directed. Our very own William Worrall Mayo was trained as a pharmacist and then as a physician. They only studied subjects that interested them, and were not suffocated by a barrage of endless courses and standardized tests. These men were not tethered by one particular institution or by time. But, then again, this was a highly selected group of people. And they selected themselves…

Times have changed, and MSTP programs would like to think that the multi-disciplinary path is for anyone interested in science or medicine. It’s not. And that’s the reason why most MSTP graduates “become physicians, but very few become scientists”. Worst yet, I can’t imagine that every shine-eyed 21-year old applying to MSTP programs know what they’re getting into. I’ve interviewed at both small and large MSTP programs. The largest ones were giant social frat clubs of privilege, and in the smaller programs the students seemed generally depressed. However, in the end most of these students will still end up exclusively practicing medicine regardless of the nature of the program. This tells me that it’s hard to select a Galen, Vesalius or Pasteur based on some essays, MCAT scores, GPA, community service and summer lab experiences at the age of 21 or 22 in modern times. In fact, there is no formula.

Perhaps, the only way to find them (Galen, Vesalius or Pasteur) is to make the process as self-directed as possible, and place failure and success ultimately in their hands.

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