The Integration of Clinical and Research Training: How and Why MD-PhD Programs Work

New training, new attitudes: non-clinical components in Ukrainian medical PHDs training (regarding critical thinking, academic integrity and artificial intelligence use)

OBJECTIVE

Aim: The paper studies the attitude to critical thinking, academic integrity and the Artificial Intelligence use of the Ukrainian medical PhD students.

PATIENTS AND METHODS

Materials and Methods: In 2023, 56 medical PhD students from the Bogomolets National Medical University, Kyiv, Ukraine, underwent the survey. The participation was voluntary, upon the oral consent. The data included in the survey questions include various aspects related to critical thinking, analysis skills, and attitudes towards plagiarism.

RESULTS

Results: A significant majority of the medical PhD students (75%) place high importance on critical thinking. While a majority (89.29%) apply analysis and critical thinking skills in their English studies, there's a notable percentage (7.14%) that is uncertain. Although most are aware of the unacceptability of cheating and plagiarism (75%), a small proportion admit to having plagiarized (12.5%). Only 30.4% of the respondents reported using GPT Chat for study. Responses to witnessing peers plagiarize or using Artificial Intelligence show a varied attitude, with many expressing unwillingness to report such incidents (30.36%).

CONCLUSION

Conclusions: The survey highlights the recognized importance of critical thinking in academic study among medical PhD students, while also points to areas where attitudes and practices regarding these skills could be improved. The study shows a vast area for improvement regarding academic integrity, as almost one-third of respondents need more defined standards. This definitely puts some questions before the present medical postgraduate education, and requires change of the educational paradigm, clear rules of academic conduct, and a system of control.

Diversity in medical PhD curricula: a call for harmonisation

BACKGROUND

Globalisation has increased human movements around the world, spurring greater connectiveness and opportunities to collaborate. In an increasingly connected world, quality assurance among professionals is paramount, particularly in medical research where PhD (Doctor of Philosophy) degree holders are expected to be at the peak of their field and play advanced-level research, education and leadership roles. While some regional efforts have been made to ensure comparability in the standards of advanced degree training, no previous study has compared these standards for a PhD in medicine across the globe.

AIMS

To explore the structural diversity of medical PhD degrees and identify which aspects benefit from greater harmonisation.

METHODS

In 2021, the 10 best-ranked universities from each of the top five Western countries, and the top Asian country, were identified based on Quacquarelli Symonds World University Ranking. Data were collected for each university based on individual website information regarding the level of degree required to gain entry into a PhD programme in medicine and requirements for completion of coursework, journal publication and oral defence.

RESULTS

Significant variations exist in the requirements for medical PhDs across the world in terms of prerequisite degree and inclusion of coursework. Oral defence is near universal, but a mandatory requirement for publication is largely absent.

CONCLUSIONS

Harmonisation of medical PhD degrees through international standards should be considered to encourage quality improvement and benchmarking between institutions, as well as to facilitate greater ease of movement within the medical research community, improving international collaboration and individual career opportunities accordingly.

Motivaciones y limitaciones de los médicos especialistas para hacer investigación clínica en un hospital de alta complejidad en Colombia

Introducción: los médicos clínicos investigadores son necesarios para el desarrollo de la literatura médica sobre la cual se soporta el ejercicio clínico, y así contribuyen a la calidad del acto médico y del sistema de salud. Se requiere mayor investigación de sus motivaciones y barreras para hacerlo. Objetivo: describir las motivaciones y limitaciones que los médicos especialistas enfrentan para poder convertirse en investigadores en un hospital privado de alta complejidad en Colombia. Materiales y métodos: se realizó un estudio hermenéutico con técnicas de la teoría fundamentada, con 30 entrevistas semiestructuradas realizadas a 20 médicos especialistas del Hospital Pablo Tobón Uribe. El análisis utilizó codificación abierta y se agruparon los códigos en categorías descriptivas, al identificar propiedades y dimensiones de la teoría fundamentada. La codificación axial permitió describir las tensiones entre las motivaciones y las limitaciones para investigar. Resultados: se identificaron como motivaciones para investigar el reconocimiento y el prestigio profesional e institucional gracias al respaldo del Hospital, además de la remuneración económica adicional, tanto por estudios de la industria farmacéutica como propios. Como barrera se destacó la precaria formación en investigación, que se suma al ambiente competitivo entre colegas y a las tareas administrativas y protocolizadas de los estudios, lo cual que genera desinterés. Conclusiones: a pesar de facilitar y respaldar el desarrollo de la investigación en esta institución, en el contexto del país aún no hay una fuerte cultura investigativa que promueva e incentive a los profesionales de la salud a desarrollar investigación de manera independiente o institucional, pues con frecuencia las limitaciones sobrepasan las motivaciones para hacerlo.

Research Buddy partnership in a MD-PhD program: lessons learned

BACKGROUND AND AIMS

There is increasing recognition of the importance of patient involvement in research. In recent years, there has also been growing interest in patient partnerships with doctoral studies students. However, it can be difficult to know where to start and how to go about such involvement activities. The purpose of this perspective piece was to share experiential insight of the experience of a patient involvement program such that others can learn from this experience. BODY: This is a co-authored perspective piece centred on the experience of MGH, a patient who has had hip replacement surgery, and DG, a medical student completing a PhD, participating in a Research Buddy partnership over the course of over 3 years. The context in which this partnership took place was also described to facilitate comparison with readers' own circumstances and contexts. DG and MGH met regularly to discuss, and work together on, various aspects of DG's PhD research project. Reflexive thematic analysis was conducted on reflections from DG and MGH regarding their experience in the Research Buddy program to synthesise nine lessons which were then corroborated with reference to published literature on patient involvement in research. These lessons were: learn from experience; tailor the program; get involved early; embrace uniqueness; meet regularly; build rapport; ensure mutual benefit; broad involvement; regularly reflect and review.

CONCLUSIONS

In this perspective piece, a patient and a medical student completing a PhD reflected upon their experience co-designing a Research Buddy partnership within a patient involvement program. A series of nine lessons was identified and presented to inform readers seeking to develop or enhance their own patient involvement programs. Researcher-patient rapport is foundational to all other aspects of the patient's involvement.

Predictors of academic career progression among early career physician-scientists via an intensive research training program abroad: a case study

BACKGROUND

Despite extensive efforts to revitalize the physician-scientist pipeline, attrition has been observed along the physician-scientist developmental pathway. Research exposure during clinical training is considered an important factor favoring the decision to pursue an academic career pathway.

METHODS

The authors sought to identify factors associated with academic career progression among junior physician-scientists following the completion of an intensive research training program, using the framework of the Social Cognitive Career Theory (SCCT), to benefit the design of efforts to revitalize the physician-scientist career pipeline. We conducted a retrospective study of 108 physicians who completed a long-term research training program abroad during residency, or within a few years post-residency completion, between 2010 and 2017. With potential predictors of academic career progression prioritized by SCCT, multivariable logistic regression was used to identify predictors of sustained research involvement, high productivity and high research competency after training, respectively. The SCCT was used to illuminate our findings.

RESULTS

Co-publications with training supervisors abroad and medical oncology/pediatric oncology as a clinical specialty were positively associated with sustained research involvement and high productivity. Joining the training program after the age of 36 was negatively associated with high research competency. All of the predictors shared a common feature of high correlation with both self-efficacy and environmental elements, the reciprocal interactions of which may affect the career progression of physician-scientists.

CONCLUSIONS

Insights gained through this analysis provide policy recommendations for the designing of efforts to revitalize the physician-scientist career pipeline. Priorities should be given to institutional oversight to ensure strengthened self-efficacy at the beginning of one's academic career, by providing long-term research training opportunities to young residents and promoting co-publications with their training supervisors during the training. In order to avoid the negative impact to self-efficacy caused by patient-related burnout or academic isolation, academic medical centers should take measures to guarantee protected research time, and to develop a positive culture encouraging mentoring relationships between junior and experienced physician-scientists in medical departments.

Assessment of clinical continuity strategies offered by dual-degree training programs in the USA

Background

Integration of clinical skills during graduate training in dual-degree programs remains a challenge. The present study investigated the availability and self-perceived efficacy of clinical continuity strategies for dual-degree trainees preparing for clinical training.

Methods

Survey participants were MD/DO-PhD students enrolled in dual-degree-granting institutions in the USA. The response rate was 95% of 73 unique institutions surveyed, representing 56% of the 124 MD-PhD and 7 DO-PhD recognized training programs. Respondents were asked to indicate the availability and self-perceived efficacy of each strategy.

Results

Reported available clinical continuity strategies included clinical volunteering (95.6%), medical grand rounds (86.9%), mentored clinical experiences (84.2%), standardized patients/ practice Objective Structured Clinical Examinations (OSCEs) (70.3%), clinical case reviews (45.9%), clinical journal clubs (38.3%), and preclinical courses/review sessions (37.2%). Trainees rated standardized patients (µ = 6.98 ± 0.356), mentored clinical experiences (µ = 6.94 ± 0.301), clinical skills review sessions (µ = 6.89 ± 0.384), preclinical courses/review sessions (µ = 6.74 ± 0.482), and clinical volunteering (µ = 6.60 ± 0.369), significantly (p < 0.050) higher than clinical case review (µ = 5.34 ± 0.412), clinical journal club (µ = 4.75 ± 0.498), and medicine grand rounds (µ = 4.45 ± 0.377). Further, 84.4% of respondents stated they would be willing to devote at least 0.5-1 hour per week to clinical continuity opportunities during graduate training.

Conclusion

Less than half of the institutions surveyed offered strategies perceived as the most efficacious in preparing trainees for clinical reentry, such as clinical skills review sessions. Broader implementation of these strategies could help better prepare dual-degree students for their return to clinical training.

The Molecular Medicine Investigation Unit: Linking Patient Care and Scientific Inquiry in Physician-Scientist Training

BACKGROUND

Medical innovation depends on translation, the process of applying clinical insights to solve biological problems, and vice versa, yet existing training programs provide few opportunities for physician-scientists to integrate their clinical and research training.

OBJECTIVE

We developed and determined the feasibility and acceptability of a rotation on the Molecular Medicine Investigation Unit (MMIU), a novel program that engages trainees in the deliberate linkage of patient care and scientific inquiry to cultivate their interest and skills in translation.

METHODS

Between July 2017 and January 2019, fourth-year medical students and internal medicine residents were offered a 4-week elective rotation on the MMIU. Supervised by 2 part-time faculty, trainees evaluated patients with unusual and perplexing presentations with the goal of generating hypotheses and a research plan to elucidate the underlying mechanisms of disease. We tracked the development of research hypotheses and resulting projects and surveyed participants about their satisfaction with the program.

RESULTS

Over 18 months, 21 trainees (11 medical students and 10 residents) participated in the program and evaluated a total of 70 patients. Trainees generated a mechanistic hypothesis in 45 (64%) cases, and this resulted in a patient-centered research project in 38 (54%) cases. Trainees unanimously agreed that the program gave them an opportunity to integrate their clinical and research training, and many expressed that it reinforced their interests in translational research.

CONCLUSIONS

With modest funding support, it was feasible to deliver authentic experiences of translational inquiry for medical students and internal medical residents, and these experiences were valued by trainees.