Integrating Student Research into the Medical School Curriculum
Posted May 01, 2012
Laboratory experimentation has been included in physician training since at least 1839 when Yale University first incorporated a research thesis into its medical school graduation requirements. While Yale has maintained that curricular requirement ever since, and many other medical schools have incorporated research programs, conducting research is not universally required to earn an MD.
Educators say that undertaking basic research can help medical school students sharpen the analytical, creative, and critical-thinking skills that the practice of medicine demands. And in the contemporary environment of rapidly advancing science, uniting medical education with scientific research is seen as a crucial way to ensure that scientific discoveries are translated to clinical practice as expediently as possible. Exposing medical students to research might also lead some to consider career paths that include investigation—historically a rarity among medical school graduates. The outcome of a student's research project aside, the opportunity for a physician-in-training to develop a relationship with a research mentor is considered by many to be invaluable, with career-long benefits.
For these reasons and others, some argue that immersion in a research experience should be a core component of medical training, whether the student intends to pursue a career as a translational scientist or as a rural primary care physician. Nevertheless, others question the wisdom of mandating a research experience, especially when so much required content is already crammed into the modern medical school curriculum. Before loading another core requirement onto students, there are questions to be answered: Does research experience create a better physician? Does it ultimately lead to improved patient care? Is it misguided to encourage MDs-in-training to consider careers in research when competition for investigator posts is already so intense that many PhDs are forced to find alternative careers?
On February 24, 2012, the Josiah Macy Jr. Foundation, Mount Sinai School of Medicine, and the New York Academy of Sciences presented Integrating Student Research into the Medical School Curriculum, a symposium exploring these questions as well as the logistical challenges of incorporating research into the medical school curriculum. Medical educators representing a cross-section of U.S. institutions described the nuts and bolts of their research programs and explored the pros and cons of mandatory medical student research for diverse types of medical careers. A panel of current medical students and recent graduates described their own research experiences and shared opinions for how research experiences could be improved.
Use the tabs above to find a meeting report and multimedia from this event.
Presentations available from:
Louise Aronson, MD, MFA (University of California, San Francisco)
Laurence C. Baker, PhD (Stanford University School of Medicine)
Liselotte N. Dyrbye, MD, MHPE (Mayo Clinic)
John N. Forrest, Jr., MD (Yale University School of Medicine)
Philip A. Gruppuso, MD (The Warren Alpert Medical School of Brown University)
Allen L. Humphrey, PhD (University of Pittsburgh School of Medicine)
David Muller, MD (Mount Sinai School of Medicine)
Frederick P. Ognibene, MD (National Institutes of Health Clinical Center)
Gordon J. Strewler, MD (Harvard Medical School)
Karen Zier, PhD (Mount Sinai School of Medicine)
To view media from the conference's student panel discussion please visit the The Student Perspective: Integrating Student Research into the Medical School Curriculum eBriefing.
Information on the Yale University School of Medicine thesis requirement.
Yale's Summer to Advance Research Training (START@Yale) program.
Harvard Medical School Scholars in Medicine program.
Mount Sinai School of Medicine's Medical Student Research Office
University of Pittsburgh School of Medicine Scholarly Project.
Stanford University School of Medicine MedScholars Program.
Brown Alpert Medical School Scholarly Concentration Program.
UCSF School of Medicine Research Training Programs.
Howard Hughes Medical Institute Medical Research Fellows Program.
Books & Reports
Schafer A. The Vanishing Physician-Scientist? Ithaca: ILR Press; 2009.
Blumenthal D. Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers. The Commonwealth Fund; 2002.
Scientific Foundations for Future Physicians. American Association of Medical Colleges and Howard Hughes Medical Institute; 2009.
Bierer SB, Chen HC. How to measure success: the impact of scholarly concentrations on students—a literature review. Acad. Med. 2010;85(3):438-452.
Boninger M, Troen P, Green E, et al. Implementation of a longitudinal mentored scholarly project: an approach at two medical schools. Acad. Med. 2010;85(3):429-437.
Cooke M, Irby DM, Sullivan W, et al. American medical education 100 years after the Flexner report. N. Engl. J. Med. 2006;355(13):1339-1344.
Dyrbye LN, Cook D. Does the duration of a scholarly concentration affect medical students' productivity? Acad. Med. 2011;86(1):2-3; author reply 3.
Dyrbye LN, Davidson LW, Cook DA. Publications and presentations resulting from required research by students at Mayo Medical School, 1976 – 2003. Acad. Med. 2008;83(6):604-610.
Laskowitz DT, Drucker RP, Parsonnet J, et al. Engaging students in dedicated research and scholarship during medical school: the long-term experiences at Duke and Stanford. Acad. Med. 2010;85(3):419-428.
Rhyne RL. A scholarly research requirement for medical students: the ultimate problem-based learning experience. Acad. Med. 2000;75(5):523-524.
Schor NF, Troen P, Kanter SL, et al. The Scholarly Project Initiative: introducing scholarship in medicine through a longitudinal, mentored curricular program. Acad. Med. 2005;80(9):824-831.
Siddiqui ZS, Jonas-Dwyer DRD. Twelve tips for supervising research students. Med. Teach. 2012.
Zier K, Coplit LD. Introducing INSPIRE, a scholarly component in undergraduate medical education. Mt. Sinai J. Med. 2009;76(4):387-391.
Erica S. Friedman, MD
Erica Friedman is Professor of Medicine and Medical Education, Associate Dean for Education Assessment and Scholarship and Associate Director for Research and Mentorship of the Institute for Medical Education at Mount Sinai School of Medicine (MSSM) overseeing programmatic assessment, faculty mentorship and scholarship. She is the Medical Director of the Morchand Center for Clinical Competence that uses Standardized Patients (SP) to assess clinical skills. She was co-PI for the AAMC "Enhancing Education about Chronic Illness," and for the New York Community Trust grant on "Assessing Medical Student Communication Skills: Focus on Cultural Competence," Co-Investigator on the Attorney General's Prescriber Education Program Grant, "Data smog and marketing fog: A critical skills curriculum to educate health professionals about rational prescribing," and PI on the Mannix Award from the Medical, Educational and Scientific Foundation of New York entitled "Recognition and communication of medical errors: a three-year curriculum for Internal Medicine Residents." In addition, Friedman is an Internist/Rheumatologist and teaches medical students, Internal Medicine residents, and Rheumatology fellows. Her interests include enhancing physician-patient communication, promoting effective health care teamwork, and educating about osteoporosis and chronic illness management.
David Muller, MD
David Muller received his BA from Johns Hopkins University and his MD from New York University School of Medicine. He completed his Internship and Residency in Internal Medicine at the Mount Sinai Medical Center, where he spent an additional year as Chief Resident. Upon completing his training Muller co-founded and directed the Mount Sinai Visiting Doctors Program. Visiting Doctors is now the largest academic physician home visiting program in the country. In May 2005 Muller was appointed Dean for Medical Education and Chair of the Department of Medical Education. His recent honors include the Jacobi Medallion (2011), Founder's Award, Mount Sinai Visiting Doctors, Departments of Medicine and Geriatrics (2010), the AMA Pride in the Profession Award (2009), Department of Medicine's Ruth Abramson Humanism in Medicine Award (2005) the Alexander Richman Commemorative Award for Humanism in Medicine (2005), induction into the Gold Humanism Honor Society (2004), and the Casita Maria Community Builder Award (2002). Muller is Professor of Medicine and Medical Education and is a Fellow of the New York Academy of Medicine.
Karen Zier, PhD
Karen Zier is Professor of Medicine, Medical Education, and Immunology and the Associate Dean for Medical Student Research at Mount Sinai School of Medicine. She received her PhD in Microbiology and Immunology from the State University of Buffalo, having carried out her thesis research under the mentorship of Fritz Bach at the University of Wisconsin in Madison.
Zier is the author of over 70 publications in cancer immunology and medical education. She has served on numerous NIH study sections and received a gubernational appointment to the New York State Health Research Science Board. She is committed to the development of strongly mentored research programs that provide medical students with opportunities for original scholarship. Zier is Principal Investigator and Program Leader of the Doris Duke Clinical Research Fellowship Program for medical students, Program Director of PORTAL (a 5-year MD/Masters in Clinical Research dual degree program), and co-Director of INSPIRE (a 12-week scholarly program in the 4th year). She also serves as director of the first year Immunology course.
Sonya Dougal, PhD
The New York Academy of Sciences
Monica L. Kerr, PhD
The New York Academy of Sciences
Louise Aronson, MD, MFA
Louise Aronson is an Associate Professor at the University of California, San Francisco, where she directs the Pathways to Discovery Program, UCSF's research and scholarship career development program for students, residents and fellows, the Northern California Geriatric Education Center, and UCSF Medical Humanities. She is a geriatrician who provides primary and palliative care to homebound older adults in underserved San Francisco neighborhoods and a writer whose book, A History of the Present Illness, is forthcoming from Bloomsbury. Her scholarly work includes curricular innovations and medical education research on reflective learning, geriatrics education, scholarly concentrations, and public medical communication. Louise is a co-editor of the JAMA "Care of the Aging Patient" Series and director of Public Medical Communication for the Program for the Aging Century.
Laurence C. Baker, PhD
Laurence Baker is a health economist and Professor of Health Research and Policy at Stanford University. Professor Baker serves as Chief of Health Services Research at the Stanford University School of Medicine and has been appointed Fellow of the Center for Health Policy at Stanford University and Research Associate of the National Bureau of Economic Research in Cambridge, MA. He also holds a courtesy appointment in the Stanford University Department of Economics, and directs the Stanford University School of Medicine's Scholarly Concentrations Program. Professor Baker has been the recipient of the ASHE Medal from the American Society of Health Economists and the Alice S. Hersh Young Investigator Award from AcademyHealth. He serves on the boards of directors of the International Health Economics Association and the American Society of Health Economists. He also serves as Senior Associate Editor for the journal Health Services Research, on the editorial board of Medical Care Research and Review. Professor Baker received his PhD in Economics from Princeton University in 1994. Professor Baker's research applies economic and statistical analysis to challenges facing the health care system and health policy.
Liselotte N. Dyrbye, MD, MHPE
Lotte Dyrbye is an Associate Professor and Consultant in the Division of Primary Care Internal Medicine at Mayo Clinic in Rochester, Minnesota. She is also chair of the Clinical Experiences Committee for the Mayo Medical school, a member of the Mayo Medical School Curriculum and Education Committees, and Associate Director of the Department of Medicine Program on Physician Well-being. Dyrbye is a graduate of the University of Wisconsin Medical School where she was selected AΩA and she subsequently completed an internship and residency in Internal Medicine at the University of Washington. She also has a Masters of Health Profession Education from University of Illinois. She holds numerous national education leadership positions including National Board of Medical Examiners USMLE Step 2 Ambulatory Medicine Test Material Development Committee, Association of American Medical Colleges Research in Medical Education (RIME) Conference Planning Committee, and Alliance of Academic Internal Medicine Governance Task Force. In 2008 she received the Clerkship Directors of Internal Medicine Charles H Griffith Educational research award—awarded to the single Clerkship Directors of Internal Medicine member who has made the greatest impact on medical education over the preceding year. Her research interests are focused on medical student and physician well-being and professionalism.
John N. Forrest, Jr., MD
John Forrest graduated from the University of Pennsylvania School of Medicine and trained in internal medicine and nephrology at Yale under Paul Beeson and Franklin Epstein. He received multiple grants from the NIH and the American Heart Association for studies on lithium and the regulation of ion transport and signal transduction in the kidney and shark rectal gland.
From 1998 to 2009 Forrest served as the Scientific Director of the Mount Desert Island Biological Laboratory in Bar Harbor, Maine. For 25 years he has directed the Office of Student Research at Yale Medical School. Forrest has published over 150 scientific papers in peer reviewed journals and currently is a Professor of Medicine (Nephrology) and Director of the Office of Student Research at Yale Medical School.
Philip A. Gruppuso, MD
Philip A. Gruppuso is a Professor of Pediatrics, Professor of Molecular Biology, Cell Biology and Biochemistry (Research), and Associate Dean for Medical Education at the Alpert Medical School (AMS) of Brown University. He obtained his undergraduate degree, a BA in Fine Arts/Music, at Union College in Schenectady, NY, and his MD from the University of Rochester. Gruppuso went on to residency training in pediatrics and fellowship in pediatric endocrinology at Brown University/Rhode Island Hospital. Following postdoctoral training in biochemistry, also at Brown University, Gruppuso became the first director of the joint Division of Pediatric Endocrinology and Metabolism in the Department of Pediatrics at Brown and the Rhode Island Hospital in 1987. Gruppuso has been a lecturer in medical biochemistry and nutrition since 1989 and continues to be an active teacher in the pre-clinical science curriculum. He has long been involved in graduate education, serving as primary advisor to seven PhD students. Gruppuso's research focuses on basic mechanisms that control somatic growth in the fetus. In his capacity as Associate Dean for Medical Education, a role he assumed in 2005, he has overseen a comprehensive curriculum redesign at AMS.
Allen L. Humphrey, PhD
Allen Humphrey received his PhD from Duke University and is currently Associate Professor of Neurobiology at the University of Pittsburgh School of Medicine. His laboratory research focused on neurophysiological mechanisms of visual information processing in thalamus and cortex. He now serves full time in the Office of the Vice Dean as Assistant Dean for Medical Student Research and co-director of the Scholarly Project. He also directs the Dean's Summer Research Program for medical students and the pre-clinical Neuroscience course, and is involved in interprofessional health care education initiatives across the schools of medicine, pharmacy, nursing, and social work.
David Muller, MD
Frederick P. Ognibene, MD
Frederick P. Ognibene serves as the NIH Clinical Center's Deputy Director for Educational Affairs and Strategic Partnerships. In addition, he has directed the Clinical Center's Office of Clinical Research Training and Medical Education since 2003 and the Clinical Research Training Program (CRTP) since 2000. Ognibene is responsible for the clinical research education programs in the Clinical Center and is engaged in the development of new programs and partnerships with external investigators and collaborators around the world. He has been a leader in training clinical investigators at the NIH, including activities such as the NIH Roadmap Clinical Research Workforce Committee, and the development of the NIH's new Medical Research Scholars Program. He received a BA in Biology magna cum laude from the University of Rochester in 1975 and an MD from Cornell University Medical College in 1979. He was an intern and resident in internal medicine at the New York Hospital/Cornell Medical Center, a fellow in critical care medicine in the Critical Care Medicine Department at the NIH Clinical Center, and a NIH tenured senior investigator since 1987. He is a member of the Society of Critical Care Medicine where he takes an active role in governance.
Gordon J. Strewler, MD
Gordon "Buck" Strewler grew up in northern Minnesota and graduated summa cum laude from Dartmouth College. He graduated cum laude from Harvard Medical School Class of 1971 and then served as an intern and resident at Peter Bent Brigham Hospital, the predecessor of Brigham and Women's Hospital. After clinical and research training in Endocrinology-Metabolism at the National Institutes of Health, he joined the faculty of the University of California, San Francisco in 1979. His scientific work concerns calcium and bone metabolism and his laboratory played a role in the discovery of PTHrP. He was Professor of Medicine and Chief of the Endocrine Unit at the SFVAMC and also directed the UCSF Endocrinology Fellowship Program for many years. Strewler returned to Boston in 1996 to become Chief of Medicine at the West Roxbury VA Medical Center (now part of the VA Boston Healthcare System), Professor of Medicine at Harvard Medical School, and Vice Chairman of the Department of Medicine at Brigham and Women's Hospital. In 2001 he moved to Beth Israel Deaconess, where he is now the Vice Chairman of the Department of Medicine for Education and a member of the Division of Endocrinology. In 2010 he was chosen to lead the new Scholars in Medicine program at Harvard.
Karen Zier, PhD
Adrienne J. Burke
Adrienne Burke is a freelance business and technology journalist based in Easton, CT. She is a regular contributor to Forbes.com, Techonomy Media, and Yahoo Small Business and has written for Technology Review, Seed Magazine, Yale Engineering Magazine, and the Yale Alumni Magazine. She was previously the executive editor of the New York Academy of Sciences Magazine, founding editor of Genome Technology Magazine, editorial director of GenomeWeb. com, and a managing editor at the Walt Disney Company.
Opening remarks: George Thibault, The Josiah Macy Jr. Foundation
Introduction: David Muller, Mount Sinai School of Medicine
- In an era of rapid-fire discoveries in the life sciences, connecting medical education to basic research could help translate new discoveries to the clinic more quickly.
- Medical educators say medical school curricula have become jam-packed. Careful consideration must be made before loading additional requirements onto students.
- Developing a relationship with a mentor during medical training is widely viewed as an invaluable aspect of the research experience.
Does research make the physician?
An understanding of basic science is fundamental to the practice of medicine. Sharp skills in applying the scientific method, analyzing data, and critically interpreting scientific literature are crucial to success for any physician. Conducting basic research is a clear route to acquiring those skills. But should basic research experience be required of physicians-in-training? If yes, then to what extent?
George Thibault, who has, over the course of his career, served as VP of Clinical Affairs at Partners Healthcare System in Boston, Director of the Academy at Harvard Medical School, and Professor of Medicine and Medical Education at Harvard Medical School, is a strong advocate of incorporating basic research into the medical school curriculum. Now, as president of the Josiah Macy Jr. Foundation, he drives an initiative to improve public health by strengthening health professional education. Key to that goal is coordinating medical and clinical education with the world of scientific discovery so that advances in science may more quickly be translated into clinical practice.
Thibault opened the symposium pointing to several reasons that research should be part of the training of all physicians:
- Scientific skills are best acquired by immersion in a specific research project.
- Conducting basic research under the guidance of an experienced investigator creates the opportunity for mentorship that can benefit young physicians throughout their careers.
- Student research occasionally even leads to important new discoveries.
- Exposing more students to research could inspire more physicians to consider careers as investigators.
- Conducting research on a particular topic introduces a student to an area of medicine that he or she might otherwise not have considered practicing.
Acknowledging the difficulty of achieving these benefits, Thibault asked, "A lot of time and resources go into these programs ... how do we know that we've achieved the goals? ... And if we're not achieving our goals, how would we change the program to better ensure the [desired] outcomes—improving the student experience, improving the student-faculty relationship, and ultimately improving practice of medicine and the health of the public?"
In the day's introductory remarks, David Muller, Dean for Medical Education at Mount Sinai School of Medicine, implored his colleagues to take a step back, and to first consider the value of research vis à vis other important aspects of a medical education. "We need to produce doctors who are critical thinkers and lifelong learners, and we want to believe that opportunities to do research with mentors will lead to better medicine and [to] better biomedical research. But are there any data to prove that that's the case?" he asked.
Muller asked his colleagues to consider, "If I'm going to take 3 or 6 or 12 months of a medical student's life and divert it to research or add research to a medical school curriculum, does it have equal value in terms of the time used with other things they might be doing? Wouldn't we love to teach them truly sophisticated clinical skills? Don't they really need to understand healthcare policy and healthcare delivery? Wouldn't they love to do national service for a year or half a year and have their debt burden cut substantially? Those are the questions we need to ask ourselves."
More than one speaker during the day cited the findings of Scientific Foundations for Future Physicians, a 2009 publication of a committee convened by the American Association of Medical Colleges and the Howard Hughes Medical Institute that set out to "examine the natural science competencies that a graduating physician needs to practice science-based medicine effectively with the goal of achieving greater synergy and efficiency in the continuum of premedical and medical education." That committee began from a point of "widespread agreement that it is important to educate future physicians to be inquisitive, [to] help them build a strong scientific foundation for future medical practice, and [to] equip them with the knowledge, skills, and habits of mind to integrate new scientific discovery into their medical practice throughout their professional lives and to share this knowledge with patients and other healthcare professionals."
It would be fair to say that the medical educators gathered for this symposium were also in unanimous agreement with those sentiments. And yet, their presentations made clear that there is no single model for successfully integrating research into the curriculum, and there is, as yet, no universally accepted method for measuring the success or impact of student research programs. A full day of presentations by research program administrators from several institutions offered many models for student research and provoked discussion of funding, program design, evaluation, and impacts.
Laurence Baker, Stanford University School of Medicine
John N. Forrest, Jr., Yale University School of Medicine
- Requiring each student to prepare a research proposal stating his or her hypothesis and describing his or her methodologies can help keep a project on track.
- Obstacles including IRB approvals can be avoided if a student can join a mentor's established research project.
- Customized web-based tools can facilitate tracking student progress, managing mentor-student relationships, and sharing information.
- Programs operate with a variety of funding models. Some award students credit instead of stipends. Some require mentors to fund student research.
Surveying the field of student research programs
Administrators from five medical schools presented details of their student research programs. Among them were what may be the nation's oldest medical research training program—at Yale University School of Medicine—and perhaps the newest program—at Harvard Medical School.
Medical research programs at Mount Sinai School of Medicine, Stanford University School of Medicine, and University of Pittsburgh School of Medicine were also described. These presentations made clear that no two medical school research programs are the same. Differences abound in research project duration, position of research on the curriculum timeline, research topics permitted, and the way the research is funded.
A history of research in the medical school curriculum: Yale and Stanford
With a research thesis first instituted as a graduation requirement in 1839, Yale's School of Medicine claims the longest history of integrating research into the medical school curriculum.
John Forrest, director of the Office of Student Research there, says the school's philosophy is that research does far more than train the next generation of physician scientists. "It relates very much to the faculty mentorship, to a sense that all physicians need to incorporate critical thinking into whatever they do, and [to] many other elements."
Yale students are exposed to research from the first day of medical school and throughout their time at Yale. In year one they hear lectures on developing outstanding lab and clinical research projects, they join faculty mentors for dinner panels, and they take a course in the responsible conduct of research. Online resources include a directory of faculty research interests and previous students' evaluations of their mentors.
All Yale students commence their research projects in the summer between their first and second year, but in 2012 Yale will pilot a new program, START@Yale, to give incoming medical students an opportunity to receive research training during the summer before the first year of study. All students must deliver a bound, approved thesis in March before graduation.
Yale students are encouraged, but not required, to take a fifth year of study, fully funded. Forrest said more than 60% of students do, and most of those use the time to pursue research. Students who take required courses in laboratory/translational and clinical medicine are eligible for a joint MD-MHS (Masters of Health Sciences) degree. A three-person thesis committee reviews the candidate's research.
For both short-term and full-year research projects, faculty members provide space and resources, but do not fund student research. With 90 students per class, total annual support for Yale's research program is $2.5 million. That includes up to $700,000 in short-term stipends and over $1 million one-year fellowship stipends for students who pursue the fifth year of study. Forrest said most funding comes from Yale Medical School, with additional external support routed through the Office of Student Research. Sources of funding for the fifth year of study include NIH awards, foundation and professional society fellowships, and Howard Hughes Medical Institute support.
Forrest showed convincing data demonstrating the impact of the research project on the professional choices of Yale graduates. While the AAMC reports that only 15% of physicians expect their medical career to feature significant or exclusive involvement in research, among Yale graduates the ratio is 46%. Some of this discrepancy may also be explained by the particular interests of the students who choose to attend Yale or by the characteristics Yale selects in its students. In a 1990 survey of members of the class of 1970, half were active in research and 35% were full-time medical school faculty. Respondents cited research during medical school as a critical factor in their career choice.
Student research at Stanford University School of Medicine
Stanford University School of Medicine's tradition of encouraging student research dates back to the school's founding, with research grants available to students since a MedScholars Program was established in 1980. But it was not until 2003 that Stanford introduced a Scholarly Concentration Program as a graduation requirement. Laurence Baker, Director of Medical Student Research, says that the term "scholarly" instead of "research" reflects the school's broad approach: students may undertake studies of education or photojournalism as well as in bioengineering, clinical research, or policy research, among other areas.
The program is three-pronged, composed of a required scholarly concentration, a research project equivalent to one quarter of full-time research, and a combined degree program for those who wish to pursue more in-depth research. Students are asked during year one to define their area of scholarly concentration—choosing from eight foundation (discipline) areas and five application areas—to identify a mentor, and to develop a research project proposal to be submitted by the beginning of their second year. Students pursuing degrees in addition to the MD are exempt from a requirement to complete 12 units of coursework in a combination of foundation and application areas.
Baker said students may elect to take their third year as a "step-out" year to focus on research and may complete the coursework then, but most complete the units alongside the MD curriculum. Under the guidance of a mentor, students can conduct research in the summer, during a research year, or during the academic year with a minimum commitment of one-quarter full-time work. No formal training is provided to mentors, but each must submit a letter to the program directors describing the student project. Baker said this helps keep mentor expectations in alignment with the students' capabilities. Acknowledging that mentor selection is an "imprecise process," Baker said, "we have a class of 86 students and each has their own path toward finding a mentor."
Students may apply for funding to support up to five full-time–equivalent quarters of research from the MedScholars program. Funding can support living expenses of students who are pursuing research over the summer and travel costs for those pursuing research off campus. Most students are funded for at least three quarters (about nine months) of research. Baker says the support comes largely from the school's endowment, with some funding from the Dean's office. Some salary support for faculty mentors and administrators is also provided.
While the Stanford program is too young to have tracked measureable effects on graduates' careers, Baker said incoming students are attracted by it and "our admissions office will say this has a noticeable impact on the applicant pool."
Allen L. Humphrey, University of Pittsburgh School of Medicine
Gordon J. Strewler, Harvard Medical School
Karen Zier, Mount Sinai School of Medicine
- Successful projects at UPSOM are "those where the student matches their interest with an ongoing or new project by a faculty mentor."
- Mount Sinai students report that conducting research shapes their goals and plans and alters their perspective on the practice of medicine.
- Harvard program directors have deliberately created several ways for students to connect with faculty and ways to introduce faculty to medical student research.
The University of Pittsburgh School of Medicine (UPSOM) is among several institutions that now require all but MD/PhD candidates to conduct hypothesis-driven research during their MD years. Allen Humphrey, a neurobiology professor and Assistant Dean for Medical Student Research, said senior administrators created a scholarly research training requirement in response to what they saw as a decline in the number of physicians trained to conduct research. Launched with the entering class of 2004, the program spans all four years of study and includes a two-year research project. It is designed to enhance students' critical thinking skills and their ability to analyze the scientific literature, to identify deficiencies in medical knowledge, to design and carry out research that would address those deficiencies, and to encourage students to consider careers in research.
Several first-year courses aim to give UPSOM students the tools they need to develop a proposal for a research project they will carry out between their second and fourth years. After initially requiring students merely to state their research goals, Humphrey said, the program has been adjusted to elicit more scientific rigor by requiring a hypothesis-driven proposal stating the research methodologies the students will employ. As a prequel to their two-year research project, 80% of Pitt's 135 non-MD/PhD students in each class receive stipends to participate in an optional summer research project where many of them kick-start their two-year scholarly project.
UPSOM students submit quarterly progress reports throughout the two-year project, which help program directors identify obstacles and assign interim "satisfactory" and "unsatisfactory" grades. Over the two years, students are permitted to break from research for short periods, when other studies, such as a two-month surgery clerkship, make it difficult to focus on research. Longer breaks are discouraged to ensure that students don't fail to re-engage with their research. Moreover, the school offers students the option to take up to 3 months of Scholarly Project research electives during their third and fourth years.
Successful projects are "those where the student matches their interest with an ongoing or new project by a faculty mentor," Humphrey said. This guideline helps the student focus and greatly increases chance that mentor will guide and follow the student. Because ethical approvals can be an obstacle for students and less experienced research mentors, Humphrey encourages students to take on or to join projects that already have IRB approval, to develop one that could be exempt from the approval requirement, or to get an expedited approval. Pitt now has a dedicated person at the IRB helping its students through the review process.
At an institution where as many as 400 students might be actively engaged in research projects at once, keeping 250 mentors and 5 directors in the loop can be a challenge. Humphrey's team has developed several customized web-based systems. One includes pages to help students find mentors and deal with IRB approvals and other challenges. Another site features individual student portfolio pages. Tools permit mentors to interact with students through those pages. A third management site enables directors to search across portfolios for information. Humphrey called the web-based systems "crucial" but said they are "constantly evolving."
UPSOM is about to graduate its fifth class of MDs who have completed required scholarly research projects in a wide range of disciplines, including medicine, healthcare, public health, and epidemiology. While Humphrey says it is too early to draw conclusions about the broad impact of the program, he has measured direct outcomes. Pitt MD students are producing an average of 95 publications per year, with half of those listing the student as first author. Students also annually average 108 meeting presentations and 28 awards.
Humphrey said the Pitt program is achieving its fundamental aims. "We're enhancing their ability to think critically and [to] analyze the literature; we are seeing that they are learning to design and carry out focused research under appropriate mentorship. Is the program piquing students' interest in academic medicine as career path? It's too early to tell," Humphrey said, but "we believe we are preparing them all to practice evidence-based medicine, whether they follow research or not."
Student research at Mount Sinai School of Medicine
Mount Sinai School of Medicine was the youngest medical school to present its program. Associate Dean for Medical Student Research Karen Zier said Mount Sinai offers a portfolio of research programs with the common goal of enabling students to understand the relationship between research and progress in clinical medicine. The portfolio includes the FAME program, which engages year-one students in an interactive research experience, connects them to a mentor, and teaches them about what a scholarly year will entail. During the subsequent Summer Research Scholars Program, students learn to write an abstract, to create and present posters and talks, and to obtain IRB and IACUC approvals.
A scholarly year following the third year of study at Mount Sinai lets students take ownership of a research project, formulating their own hypotheses and designing and carrying out a research plan. Mount Sinai's most advanced research opportunity within the traditional medical school curriculum is its Inspire Program, a 12-week mentored scholarly program. Finally, for students interested in a dual degree, Sinai's Portal Program offers a 5-year MD/MSCR degree to train leaders in clinical/translational research. The program started with the class of 2014 and will admit just 5 students annually.
Zier said the scholarly program has seen an enormous increase in participation over the years, going from 13 participants in 2002 to 36 in 2011. Students report that the program shapes their goals and plans and alters their perspective on the practice of medicine.
In addition, she said, as scholarly opportunities have increased, so has publication of peer-reviewed papers by students. Zier said that despite the success, the school has seen a decrease in financial support for the scholarly year, and new approaches to funding are needed.
Harvard Medical School
Gordon Strewler leads the Scholars in Medicine Program at Harvard Medical School, established only within the past year. While Harvard is still weighing the pros and cons of requiring research in the curriculum, Strewler said the program aims to ensure that every student knows how to pose and answer a scientific question and that each has a mentored experience in scholarship. Although it is scholarship, not research, that is required of all students, Strewler anticipates that most students will perform a minimum of four months of hypothesis-driven research.
Because Harvard Medical School is home to more than 9,000 faculty researchers, some of whom Strewler said have never interacted with medical school students, program directors have deliberately created several ways for students to connect with faculty and ways to introduce faculty to medical student research. Those include student opportunities to interact with 80 faculty members—some who serve as fellows in the students' academic societies and some who sit on advisory committees for study subject areas. Students also participate in interest group meetings, a first-year course in research—Pursuing Inquiry in Medicine—and a tutorial in proposal writing. Additional resources, including a searchable database of mentors' research interests, have been made available to students online through the Harvard Clinical and Translational Science Center website. Another database tracks student progress as they march through the curriculum.
Strewler said that while response from basic science faculty has lagged, the clinical departments have engaged with the program and 600 Harvard faculty responded to the Dean's request for student research ideas. This summer, students will conduct research in a wide variety of subject areas.
The program is financed with $1.2 million in endowment funding for the part-time summer and full-time research, although students who earn academic credits for research cannot be funded. Advisors' costs of several hundred thousand dollars annually are covered by the Dean's office. And an NIH-National Institute of General Medical Sciences grant funds program evaluation, specifically to understand how research influences minority students' intentions and attitudes and to determine whether it changes students' career objectives.
Liselotte N. Dyrbye, The Mayo Clinic
Philip A. Grupposo, The Warren Alpert Medical School of Brown University
Louise Aronson, University of California, San Francisco
Frederick P. Ognibene, NIH Clinical Center
- One study indicates that the number of weeks in the curriculum dedicated to research does not correlate with research productivity later in career.
- Students of MD/PhD "medical science training" programs have a higher rate of matriculation to academia than students who pursue research within the MD curriculum.
- Students exposed to research are more likely to pursue research during their career.
- Although a study indicates that high levels of debt at graduation influence a student against pursuing academic research, students on a panel unanimously agreed that debt did not influence their career choice.
Evaluating research programs at Mayo and Brown
Leaders of four medical research programs participated in a session that asked, "Does the research experience influence a physician's career trajectory and corresponding capabilities?" Following that session, a panel of current medical students and recent graduates shared their opinions about their research experiences during medical school to provide anecdotal answers to that question.
Each presenter approached the question differently and delivered quite different answers regarding career trajectory. The physicians-in-training on the panel addressed the subject of how the research experience has contributed to their capabilities. For a report on and media from the student panel discussion, please visit the The Student Perspective: Integrating Student Research into the Medical School Curriculum eBriefing.
Liselotte Dyrbye, reported that she and her colleague David Cook undertook a retrospective cohort study of Mayo Clinic College of Medicine alumni who graduated between 1976 and 2003 to determine the value of the 12-week block of research currently required of the school's students during their third year. The required length of a Mayo student's research dropped from 21 weeks to 12 weeks between 1972 and 2009.
Dyrbye conducted a Medline search to find Mayo graduates who had published research reports, abstracts, or extramural presentations during their career after graduation. She used those data to evaluate research productivity by duration of the research experience and to analyze required research's influence on career trajectory. She considered only full-length, peer-reviewed, original research or reviews in subject areas corresponding to the medical specialty or to the title of the research project that had been done to satisfy the curriculum requirement.
Dyrbye found no substantial difference in research productivity based on the length of the block of research, with one exception: Mayo graduates who had completed a 21-week research program were more likely to have been a first author on a paper. And she found that students who had published a full-length report within three years of graduating were more likely to have another publication within three years.
Dyrbye also sought current student opinions on the advantages of doing research. Most reported that they were satisfied with their experience and that they had gained confidence through the training. Many reported that they had been motivated to pursue a career in research and that the experience had helped them to win a competitive residency post. Almost all said research should remain a required part of the curriculum. Students also reported that they learned concepts through research that they would otherwise have missed.
Yet, students did have complaints about the program. Time constraints forced many to use vacation time or to skip lectures to complete research projects, and 30% reported that they did not complete their research.
In an evaluation comparing students who pursue a scholarly concentration verses those who do not, Philip Grupposo, of Brown University's Warren Alpert Medical School was able to show that scholarly concentration tracks do influence student outcomes. Brown features an elective four-year scholarly concentration program commencing with a summer immersion experience especially for students interested in research outside of the traditional biomedical research experience. Grupposo said he would have guessed that the concentrator program would not appeal to students looking to apply to the most competitive residency programs. But his data show that many more scholarly concentration students than traditional students pursue careers in family medicine and pediatrics—among the most competitive residencies. Among 24 concentrator students, 15 coauthored papers and 12 were first author. That's compared to only 6 coauthors and 6 first authors among 47 students who did not pursue the scholarly concentration.
Implications of research programs to later career choice
Louise Aronson of the University of California, San Francisco, undertook a review of academic literature dating back to 1960 in order to assess the influence of research experience on medical students' commitment to careers in academic medicine. Aronson found 21 articles on the topic of medical student research and 6 on the subject of academic career choice. The literature indicated that combined MD/PhD programs—and in particular medical scientist training programs (MSTPs)—yield higher numbers of physicians who pursue careers in academia and who conduct research, and relatively fewer physicians who go into medical practice.
Harvard's Health Science & Technology program, which preselects for interest in biomedical research, had the highest matriculation of MD's to academia at 94%. But Aronson noted that this fact highlights a challenge of trying to study the topic: people interested in going into academia select programs that train them for research, making it difficult to parse out the influence of the programs.
The literature showed that yearlong research programs such as HHMI-Cloister had the effect of increasing participants' interest in pursuing careers in research. The number of graduates of these programs who entered academia was higher than average, but not as high as those who had graduated from MSTPs.
Aronson also found that while MD/PhD programs produce more researchers, those programs cost more to the institution and take longer for students to complete. Although it is unknown why women and underrepresented populations are more likely to pursue a year of research instead of the MD/PhD, Aaronson suggested that the time commitment and delayed career start might be a reason. In fact, Aronson found evidence that, even after controlling for MSTP debt, students with debt at graduation, and especially debt greater than $100,000, were less likely to pursue a career in academia or research. Perceptions about academic bureaucracies and the lack of autonomy, flexibility, and salary for professionals there also negatively influence a student’s choice to pursue a career in academia.
Tracking the NIH's clinical research training program
Frederick Ognibene presented data from the NIH's Clinical Research Training Program (CRTP), one of several yearlong mentored research programs, including Sarnoff, Doris Duke, and HHMI, that invite medical students to take time away from their primary institution to conduct research. Collectively, these and other programs graduate about 500 students per year, he said.
The NIH CRTP involves all NIH institutes and centers in a public private-partnership partially supported by an educational grant from Pfizer Inc to the Foundation for the NIH. Annually, the program accepts 30 rising fourth year medical and dental students to study with an advisor and a clinical or translational research project mentor for an entire academic year.
Since its inception, 340 students from 84 medical and 3 dental schools have completed the program, and 19 alumni have returned to NIH for post doctoral fellowships. More than half of the 95 alumni who have now completed all of their professional training (the rest remain in medical school, residencies, fellowships, etc.) now have careers in academia, and the majority of those who became internal medicine and pediatric physicians conduct research as part of their career.
As George Thibault summed up the lessons of the day: "We heard from an incredible array of programs that are very different, even within schools." Thibault stressed the need for more metrics that could identify the differences and compare the benefits of, for example, eight weeks of exposure to research and a full year focused on research, or the differences in outcomes between students who undertake a hypothesis-driven research project verses those who pursue humanities scholarly research. For now, developing an assessment tool to measure the quality, standards, and outcomes of the medical school research experience is complicated by the very disparate set of programs. Thibault implored his colleagues to "think about how to do a better job categorizing so we can take meaningful measurements."
Does research experience better qualify a physician to practice medicine?
What are the goals of student research?
Should all educational institutions have the same goals?
Should creating future academics be a primary goal of research programs?
What is the benefit to patients of required medical school scholarly research?
What is the most effective and acceptable method of funding medical school research?
Should student researchers be awarded stipends or funding during their research terms?
What's the optimal dose/type/timing of research to produce an academic researcher?
What are effective ways of evaluating research experiences?
What is the ideal length of a research program for medical students?
Are there any proven programs for training or coaching mentors for medical school research projects?
How does student loan debt influence students' decisions about extending their studies to conduct research?
Is student research a more valuable addition to the curriculum than clinical practice, health policy education, or public service training?
Are there components of the current medical school curriculum that could be sacrificed in order to add research to the curriculum?
How can students be supported to stay focused on a research project when there are so many curricular requirements demanding their attention?
If students are not paid for completing other required components of the curriculum, such as their surgery clerkships, does it send the wrong message to pay students or offer stipends for conducting research?