Integrating Student Research into the Medical School Curriculum

Resources

Websites

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.

NIH Clinical Research Training Program.

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.

Journal Articles

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.

Sponsors

Presented by

This meeting is part of our Translational Medicine Initiative, sponsored by the Josiah Macy Jr. Foundation and The Mushett Family Foundation.

Speakers:
Opening remarks: George Thibault, The Josiah Macy Jr. Foundation
Introduction: David Muller, Mount Sinai School of Medicine

Highlights

• 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?

A brief history of medical school research programs (Image courtesy of Louise Aronson)

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."

The goals of requiring research from medical students are common among schools. (Image courtesy of John Forrest)

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.

Speakers:
Laurence Baker, Stanford University School of Medicine
John N. Forrest, Jr., Yale University School of Medicine

Highlights

• 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.

Sources of funding for Yale Medical School student research (Image courtesy of John Forrest, Jr.)

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."

Student research funding awarded by Stanford MedScholars program (Image courtesy of Laurence Baker)

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."

Speakers:
Allen L. Humphrey, University of Pittsburgh School of Medicine
Gordon J. Strewler, Harvard Medical School
Karen Zier, Mount Sinai School of Medicine

Highlights

• 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.

Pittsburgh's program

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.

Impact of the UPSOM Scholarly Research Training Requirement (Image courtesy of Allen Humphrey)

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.

Mount Sinai students agree that exposure to research increases their interest in its relationship to medicine. (Image courtesy of Karen Zier)

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.

Speakers:
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

Highlights

• 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.

The relationship between duration of the research experience and research productivity during a physician's career appears to be insignificant. (Image courtesy of Liselotte Dyrbye)

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.

MD/PhD programs yield high numbers of academic research physicians. (Image courtesy of Louise Aronson)

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?