Introduction

Written by Owen Chen, Sarah Maritan, and Joan Miguel Romero

Sarah Maritan is a first-year student in McGill University’s MD-PhD program. She received her Bachelor of Science degree in Life Sciences, and her Master of Science degree in Pathology and Molecular Medicine, both from Queen’s University in Kingston, Ontario. Her research focuses on the cellular signaling mechanisms regulating cancer progression, particularly the pathways underlying tumor cell movement and metastatic growth.

Joan Miguel Romero is a first-year MD-PhD student at McGill University. He completed his Honors Bachelor of Science degree in Pathobiology and Immunology and his Master of Science degree in Laboratory Medicine and Pathobiology at the University of Toronto. His research is aimed at understanding the antitumor immune mechanisms involved in pancreatic cancer.

Owen Chen is a first-year MD-PhD student at McGill University. Prior to medical school, he completed both his Bachelor and Master of Science degrees in Biochemistry at McGill. He is currently pursuing his research at McGill’s Goodman Cancer Research Centre, where he studies cell cycle dysregulation in cancer.

This book aims to provide an overview of the process of becoming a physician scientist. In particular, it focuses on MD-PhD programs, which integrate components of research and medical doctorate training into a single program. As this book is intended for readers at all stages of training, we have divided this book into sections: (I) Applying for MD-PhD Training, (II) Early Days in Medical School, (III) The Transition to Graduate School, (IV) Transitioning Back to Medical School, and (V) Residency, Fellowship, and Your First Job. The book concludes with section (VI) Physician-Scientist Wellness, with chapters applicable throughout all aspects of training. Within each section are chapters related to that phase of the MD-PhD training pathway, including information on specific milestones, first-hand accounts of experiences in the phase, and suggestions to help you during your training.

As an MD-PhD training pathway can be complex, this section of the book will serve as a brief outline of the important steps. Below is a diagram representing the typical MD-PhD training pathway, particularly as it pertains to combined programs, with the aforementioned sections numbered in the figure. This schematic is followed by an explanation of the pathway, with references to specific book chapters in parentheses that you can use to guide your reading.

Prior to applying to an MD-PhD program, it is important to determine the suitability of this training pathway (Chap. 1), and consider which programs are best suited for the prospective applicant based on their goals and circumstances (Chap. 2). The MD-PhD pathway starts very similarly to the path of a pre-med student seeking admission to medical school; MD-PhD applicants have completed or are in the process of completing an undergraduate program, they may have completed a post-undergraduate program (a master’s degree for example), or they may be currently working. One distinction between an MD-PhD applicant and an applicant to a regular medical program is that the MD-PhD applicant should have substantial research experience prior to applying to medical school. This experience is paramount to a strong application (Chap. 3), demonstrating interest in both medicine and research. Aside from this, MD-PhD applicants then go through the same application process as applicants for the regular MD program. This involves keeping up with extracurricular activities and research, taking the Medical College Admission Test (MCAT, Chap. 4) and the Computer-Based Assessment for Sampling Personal Characteristics (CASPer, Chap. 5) (if applicable), completing online applications, and if invited, attending interviews (Chap. 7). MD-PhD applicants will often have to complete supplemental applications, obtain letters of reference specific to their research experiences (Chap. 6), and attend separate PhD interviews in addition to interviews required for the MD portion (Chap. 7).

Once matriculated, most MD-PhD students begin an approximately eight-year journey, completing both undergraduate medical education and graduate studies. The layout of MD-PhD programs varies between medical schools. Many MD-PhD students follow a modified timeline that integrates their medical education with their research (Chap. 8). The typical format of an MD-PhD program is as follows: pre-clerkship, graduate studies, and clerkship. Most MD-PhD students start their programs as medical students learning the basic science of medicine in the classroom—these are the pre-clerkship years, which last around two years, or roughly the first half of medical school. For American and Canadian students who want to pursue residency and/or fellowship in the United States, this is the time to prepare for the United States Medical Licensing Examination (USMLE) Step 1 (Chap. 21), which is usually taken at the end of the second year. After pre-clerkship, MD-PhD students at most schools transition into their PhD programs for approximately three to four years, which can be preceded by a research rotation in some institutions (Chap. 9) to help select a supervisor (Chap. 10).

Early in their graduate studies or possibly before formally beginning their PhD, students may begin discussing different thesis project ideas with their supervisors (Chap. 11). In addition to their research, students take graduate level courses and complete any required qualifying exams. An important component of graduate studies involves demonstrating strong research productivity (Chap. 12), typically in the form of attending conferences, presenting research findings, and in particular, publishing research papers (Chap. 13). As an MD-PhD student, it is also important to maintain clinical knowledge and find ways to integrate and maintain what was learned in the first phase of medical school during PhD training (Chap. 14). The final component of the PhD degree involves the completion of the experimental work of the project (Chap. 15) and the writing (Chap. 16) and defense of the thesis. Other skills relevant to your development as a researcher and a physician, such as the ability to successfully network (Chap. 17), are also cultivated during your PhD training.

After completion of the PhD, students return to the MD stream for about two years. There are steps they can take to help prepare for the transition back into medical school (Chap. 18). During this last phase of training, students select rotations and electives (Chap. 19) in different medical and surgical specialties during clerkship, where they learn the clinical skills necessary to become residents. MD-PhD students are typically integrated with a new cohort for the remainder of their training, and with this comes the excitement of new knowledge and new colleagues (Chap. 20). During this stage of medical training, American medical students take Step 2 of the USMLE (Chap. 21). During the final year, students apply to residency programs and prepare for their interviews (Chap. 22). Students then match into a residency program, and graduation follows. Canadian students typically take the Medical Council of Canada Qualifying Examination (MCCQE) Part I after the fourth year of medical school (Chap. 21).

Depending on the program, postgraduate medical training ranges from two to seven years, or even longer. This is a time of intense clinical training as residents are developing skills to become independent practicing physicians. The first year, intern year, can be particularly intimidating, but provides an important foundation for your continued training (Chap. 23). During this transition, it is important to consider how to combine research with postgraduate medical training (Chap. 24). MD-PhD graduates may find themselves pursuing a residency program that has a significant portion of time dedicated to research, or in many cases, when protected research time is limited, they may choose to pursue research on their own time. Residents in the United States complete Step 3 of the USMLE during residency, whereas trainees in Canada take the MCCQE Part II (Chap. 21). MD-PhD graduates may pursue additional clinical training by completing fellowships and/or research training in postdoctoral programs (Chap. 25). These options entail an additional one to two years depending on the program and number of fellowships one wants to complete. Coming out of their residency or fellowship, MD-PhD graduates are well prepared to start an independent career as a physician-scientist (Chap. 26), with rewarding and diverse career options ahead of them (Chap. 27).

Several aspects of a physician-scientist training career path involve moments of stress and moments of elation, and it is important to acknowledge these times as one progresses through this unique career. There are many opportunities that do not fit exactly into the framework of the training pathway, but deserve to be addressed. Because of the long nature of this training pathway, some may encounter personal challenges and it is worth considering how to balance this with one’s career (Chaps. 28 and 29). Hopeful and current students should be aware of how physician-scientists can best impact society (Chap. 30). Finally, the book acknowledges the need for a more diverse physician-scientist workforce and presents strategies for success in the face of systemic challenges for MD-PhD students from underrepresented populations (Chap. 31).

In this section, we have provided a brief overview of the MD-PhD pathway. By summarizing the sections and referencing the respective chapters, we hope this will facilitate the reading of this book. The journey to completing medical school and a PhD requires careful planning, patience, persistence, and hard work. You will come across many hurdles along the way, but this education and career pathway is a rewarding one.